The Disruptive Women in Health Care blog continually aims to encourage discussion and debate among readers about emerging issues and topics in the health care world. Historically, one of the ways that we have done that is through our weekly round-ups – that is, posts containing summaries and links to some of the big stories in health care news for the given week, with some original commentary and content sprinkled in as well. The way we see it, there is just too much happening in this burgeoning industry; it’s hard to keep up, especially when you’re busy disrupting and making headlines in the health care world yourselves. We know the weekly round-ups have been on hiatus for a while, but are happy to report that they’re finally making a comeback. Each week, we’ll be gathering some of the biggest health care news you can use from at home and abroad for posting on Wednesdays. Feel free to comment on what’s included and send us some links to articles to be considered for next week!

Has your week been too disruptive for you to keep up with the news?  Disruptive Women are on the case!  Here is this week’s round up of some of the most pressing issues here in America and around the world.

Here at Home:

Thanks to a provision of the Affordable Care Act (ACA), women are now able to receive free birth control, but only if it’s prescribed.  The New York Times explains how Catholic Colleges are using this loophole to combat contraception.

And, speaking of the Catholic Church and the ACA, USA Today says that Obama’s decision on Friday not to expand the conscience exemption to include religious institutions has been met with outrage from Church leaders and parishioners.

Remember that moment of panic you had when the swine flu epidemic came to the United States?  CBS News reports that swine flu numbers are rising again in Mexico. Will the US be next?

Susan G. Komen for the Cure, the nation’s leading breast cancer charity, announced Tuesday that it is halting its partnership with Planned Parenthood (per NPR) – a controversial decision that ignited a backlash from some of its supporters.

Here’s one perspective on Komen’s decision. What do you think? Will this impact your decision in giving donating to Komen, or another breast cancer non-profit in the future?

Sick? Took a sick day?  Is that enough of a reason for you to wind up unemployed?  HuffPo explains how an issue as simple as recovery from the flu has reached the Supreme Court.

With nearly two million women lacking health insurance and a quarter of a million unplanned pregnancies per year, Florida has a lot of challenges in terms of women’s healthcare.  Here’s what the state is doing to try and move ahead.

Around the World:

Brazil is calling for a registration of all pregnant women.  What does this mean for a woman’s right to choose within Brazil?

Japan’s population is shrinking. As more women choose a career over family, Japan faces declining birth rates. Could the United States be next?  ABC News takes a look.

Check back each week for the latest health care news!

A man who contracted polio walks on crutches in the village of Kosi, 113 miles from Patna, India. Photo by Altaf Qadri / AP.

By Lois Privor-Dumm. This is a moment we have been cautiously optimistic about. Would Friday the 13^th finally be the day? Rather than being an unlucky day this year, it is the day that India has gone one year without a single new case of poliovirus!  Every time I look out the window as I’m driving around India, I witness the all-too-common sight of someone suffering the debilitating effects of the disease.  That image is a reminder about how horrible this disease is and that polio’s impact is not just on the individual, but a whole nation.

The efforts to stop this disease in India have been dramatic and it has been a roller coaster with significant ups and downs.  After 741 new cases in 2009, there were only 42 in 2010 – the country was almost there. And then in 2011, there was just a single new case in 18-month old named Rukhsar from West Bengal. It was a heartbreaking occurrence, but efforts persevered.

I am struck by the level of effort committed to this goal: government, civil society and international organizations including WHO, the National Polio Surveillance Project (NPSP) based in Delhi, UNICEF, CDC and Rotary are all laser-focused on making sure that kids even in the hardest to reach places were immunized. The Bill & Melinda Gates Foundation is also instrumental in these efforts. It was no easy feat, as we’ve seen in other polio-endemic countries including Nigeria, Pakistan and Afghanistan. India was considered one of the toughest countries to tackle, making this effort all the more impressive.

The infrastructure requires an enormous amount of coordination with stakeholders who were not part of the government or its partners. Civil society, including community and religious leaders, NGOs and others all needed to be engaged. The outcome of polio eradication efforts is not just the achievement of interrupting transmission, but the commitment that is gained by those involved in disease prevention efforts. I don’t work directly on polio, but I recognize the benefits of building an understanding of the value of vaccines, creating a system that can handle the supply chain, monitoring and evaluation and constant communication. On a recent GAVI consultation visit to India, I was very happy to hear that the discussion was about how we can leverage the infrastructure created by the polio efforts.

It is important that we learn the lessons from polio and leverage the best practices, not only in India, but in other large countries like Nigeria, where stopping Polio is also within reach. One of the biggest lessons is that there are a lot of stakeholders that contribute to a successful vaccine program – it takes a village. The government plays a big role, but it is the community, that will directly determine success. 

Building an understanding of what can be achieved, and helping to implement the strategies that can lead to that success, are ways that I am privileged make contributions as a part of my work at IVAC. We are all working towards the goal of improved health for people in countries like India and Nigeria. Today’s milestone inspires others to act in ways that can help not only polio eradication efforts, but disease prevention and control efforts more broadly. One year without a new case of polio in India is an important milestone, but as we continue to make great strides around the world, our best years are ahead of us.

By Olaoluwatomi Lamikanra. Since the introduction of mobile phones in Nigeria, the number of users has increased exponentially and usage is pretty much found in both rural and urban areas.

With regards to the internet, Nigeria has about 43 million users (total population over 155 million) which far exceeds by more than double the next African country on the list-Egypt.¹

 
There are many projects associated with mobile health in Nigeria and with the exponential growth of mobile and internet users; there is an ever increasing market. Different sectors of the economy which have an impact on the health of the populace also stand to gain a lot from the introduction of mHealth initiatives. Water, Sanitation, Agriculture, Finance and Development are a few of the sectors. In Kenya, the introduction of the mPESA, a mobile phone application where moneys can be sent via mobile phones all around the country has solved the problems of money transfers. No longer do people in rural areas have to wait until someone is visiting from the city before money arrives. They receive the money as soon as it is sent from a PESA center. At a recent WaterHackathon event organised by CCHub in Lagos, one o f the tools suggested for Water development was a mobile system to facilitate the sharing of water resources in hard hit areas.²

Examples of some projects already in place include Mobile Community based Surveillance.mCBS is a mobile platform which is given to Traditional Birth Attendants to report vital maternal and child health indicators in real time using mobile phones. Using texts designed for this purpose the TBA can transmit alerts to nearby health officials who can respond immediately thus reducing delays in reaching appropriate care at a facility.³ Other mHealth projects currently being developed in Nigeria  is being collated by Ime Asangasi (@Imeasangasi- twitter handle) here.

REFERENCES:

1. http://www.internetworldstats.com/stats.htm (accessed 26th December 2011)
2. http://www.cchubnigeria.com/watermeetup (accessed 26th December 2011)
3. http://ehealthnigeria.org/where-we-work/list-of-implementations/mobile-community-based-surveillance-mcbs/

As it turns out, we not only outsource jobs, we outsource problems. A paper in the Journal of Personality and Social Psychology reviews a number of studies about how adults react to complex social policy issues. Though health issues were not included in the research, surely these qualify – they’re complex and involve social policy, as well.

According to the authors, people – including those who are college educated – react to information differently depending on whether the issue is simple or complex.

If an issue is simple, people are willing to learn more, ‘take charge’ and act on what they know. When the issue is complex, however, people avoid learning more. Rather than learning or taking personal actions, they ‘depend on’ and ‘trust in’ government to do it.  They even avoid information suggesting government can’t do it, and only focus on information that government can. 

If the issue was not only complex but also ‘urgent,’ people are even more reluctant to learn about it.

The authors were stunned, saying all things being equal we should have less trust that someone, anyone (including government) can manage a complex issue. Instead, the studies suggest we psychologically ‘outsource’ management of complex issues to someone else.

It happens in health care often, when management of serious disease is outsourced to the clinician or when a person fails to use reasonable self-care measures believing that the health care system will fix whatever eventually ails them. Apparently it also happens in the case of social issues, in which case we outsource to the government. To make matters worse, not wanting to shatter our faith in government, we shun information that suggests the government can’t manage it.

There is good news in the research as well, however. Given simple, straightforward ‘bite sized’ information relevant to them, people are willing to learn more and take actions. Complex issues are risky territory indeed, unless they’re communicated well. 

This squares with something I worry about: that far too many important decisions are made my non-experts when the experts are not in the room. As an expert on some issues, I’ve always worried that those of us who are experts don’t know how best to talk with those of us who are not. As a non-expert on other issues, I’ve been frustrated at how hard the experts make me work to understand what they’re trying to tell me. Can’t they just make it simple?

I thought this came from my cynicism at having watched far too many late-night wranglings, idiotic, posture-for-the-press hearings and zero-sum negotiations. Now, I believe, I was seeing ‘problem outsourcing’ and ‘information avoidance’ all along and that government and other decision-makers were not immune.

In fact, it occurs to me that even government (today’s) outsources to government (tomorrow’s) when it fails to address deficits, challenging demographic trends and economic downturns.

I’m not alone in having urged for decades that public engagement was essential to creating a healthy population and a sustainable health care system. Doing so won’t be easy because both the workings of a person’s bodymind and the workings of our health care system are complex.

This research suggests a pathway forward: that is, those of us in the health policy- and real- worlds should develop a new skill set – one that perfects the art of creating relevant, bite-sized bits of information that help people (including those in Congress) remain engaged and willing to learn instead of outsourcing the problem to someone else.

The following is a guest post by Ms. Nasreen Sulaiman a Senior Instructor at Aga Khan University School of Nursing. She  has worked with palliative patients.

By Nasreen Sulaiman. Palliative care is an urgent humanitarian need for people worldwide with cancer and other chronic fatal diseases as it provide comfort and ease suffering. Nearly 80 % of the cancer patients in Pakistan present late in stages 3 & 4 with terminal disease.  In Pakistan, the concept of palliative care is in its infancy stage and need to be strengthened. In Karachi, one of the mega cities of Pakistan, only two hospices each of 20-25beds provides palliative care services where the health care professionals’ main focus is on providing the physical aspects of care. Pain management, a crucial aspect in the palliative care still remains partially addresses due to lack of narcotic supplies and other medications.  Furthermore, I strongly feel that other than providing pain and symptom relief measures, the social, emotional, and spiritual needs of the patient should also be given prime importance in order to provide holistic care to the patients. Nurses need to learn to utilize various non-pharmacologic measures such as therapeutic communication techniques, use of humor, guided imagery, therapeutic touch, relaxation exercises, religious songs and other diversional activities in order to ease the suffering, emotional distress and provide optimal comfort and support to the patients including their caregivers. Moreover, in palliative care settings, caregivers hold a great importance as they are the ones who are providing the total care and most of the time with the patients. Caregiver role strain is an essential area to be looked at. Caregiver support is another area to be looked upon. We need to establish caregiver self-help groups or other avenues to support the caregivers as they go through lot of emotional pain and need immense help and affection which may assist them to perform their roles effectively with the patient suffering from the disease.

So far we have seen women as victims of gender inequalities, but how about the role that women have as perpetuators of these inequalities? In many developing countries mothers, wives and teachers have a high acceptability of behaviors that maintain disparities between genders. For example, in some countries mothers teach their daughters that they have to cook and clean the house while their sons can keep playing. So when these daughters become mothers they assign their children the same roles, perpetuating this cycle. Mothers in some settings decide to favor her son over her daughter to attend the school and university. In some areas this is also true for health. In rural areas parents may sell their cow to pay the medical treatment of their sick son but they will not do this if their daughter gets sick.

Studies have shown that women with lower socioeconomic status and education are more likely to hold on to traditional ideas that perpetuate gender inequalities, and also more likely to perpetuate such ideas in the younger generation. For all of these reasons, it is important that in future awareness campaigns we place women not only as victims of inequalities (which gives them a passive role), but also as perpetuators of these inequalities.

My question to all of you is…Are we (as women who work for women’s rights) working to end the cycle of women as perpetuators of gender inequalities? Should we start by changing our own minds and own approaches towards interventions to decrease these inequalities?

By Saundra Pelletier. Big numbers always make people stop and think. Big birthdays, anniversaries or milestone are moments to reflect on what once was, and what could be.

Over the last few months, media coverage of the population reaching seven billion people has been especially ponderous, causing wonder about what the pressure of so many people will do to our planet. Questions abound. What will the carbon footprint of seven billion plus people be? Will there be enough food to feed everyone?  What can we do about population growth? How many people can the planet manage?

One of the ways we can help our planet is by investing in family planning. Family planning is one of the most cost-effective, high-yield interventions that exists today. Countries that invest in family planning can reap immediate health benefits, investment savings in health and education sectors, and social and environmental benefits that extend well beyond a single generation.

As I wrote in an earlier post, the ability for women here in the U.S. to use birth control to prevent or delay pregnancy gave every woman  the power to decide if and when she wanted to have children, and how many to have. And with the ability to keep families smaller, came the ability to provide for their present and future well-being.

This argument – small-family-equal-prosperous-communities– is not lost in the broader discussion about the seven billionth baby, but while pundits stress the urgent need to reduce the size of the world’s population, nowhere near enough is being done to ensure that the 215 million women who want to use modern contraception have access to do so.

The fact that this amazing milestone has made people stop and think about the people on our planet is a good thing. A good place to start on a road to a healthy, more prosperous planet is to ensure  that the women and girls, who make up just over half of the planet, can make informed choices about if and when to have children, and that they have access to the supplies to allow them to do so. Providing this access will slow the pace to reaching 8 billion.

About WomanCare Global: It is a nonprofit organization working with partners around the world to improve the lives of women by providing access to affordable, quality reproductive health products. The organization believes that every woman, no matter where she lives, should have control over her reproductive health and family planning needs, ultimately improving her ability to care for herself and her family. WomanCare Global closes the access gap by bringing the same quality products available in the developed world to developing countries. WomanCare Global serves both public and private sectors via an established global supply chain reaching countries around the world, with particular focus on under-served markets in Africa, Asia and Latin America.

However, my grandfather was not afraid to die. He desired death instead. At about the age of 90 years (calculated, since there were no records when he was born), many of his age mates – friends and relatives, no longer visited him and he suspected that they had died.  He was always told that they were alive. Nobody was bold enough to tell him the truth. One of his almost daily wishes was to join them, as he could not understand what he was still doing on earth while all his contemporaries were gone.

Many Africans, especially men, loathe leaving the world without leaving behind certain “achievements”. A man is regarded as a failure, if he is unmarried, does not own a house and more importantly, has no male child at the time of death. The absence of a male heir means the tragic end of a lineage as that family name becomes extinct. The pain of death is somewhat lessened by the fact that the deceased left behind male children, to carry on the family name.

A notable feature of the end of life in many African cultures is the belief that most deaths are not natural, but occur through supernatural means. There is always a strong suspicion that someone, usually a close relative, must have been responsible for a death in the family. Sadly, wives are usually accused of killing their husbands, while husbands are rarely accused of ending their wives’ lives. So, who is responsible for women’s death? According to my auntie, women kill their husbands, while women die as a result of their sins.

By Saundra Pelletier. In 1965, Griswold v. Connecticut gave a married woman the right to use birth control to prevent or delay pregnancy as she saw fit. This guarantee of a basic human right led to other reforms that allowed millions more American women to decide the direction of their own reproductive lives.  This summer, we are proud to see another key reform go through: starting next year, the Affordable Care Act will allow even more women in the United States to be in charge of their own health by requiring new health plans to provide free birth control without a co-payment. These are hard-fought wins for women’s health and for women’s rights of which we can all be proud, but sadly the ability of a woman to choose when and whether to become pregnant is far from assured in other parts of the world.

Pause for a moment and imagine you’re not American, but from Sub-Saharan Africa – Ethiopia for example. You are 20 years old and have four children – the first of which you had when you were 15 and newly married. You’re worried about becoming pregnant again. You tried to get birth control once, but arrived at the clinic only to find the shelves bare and no way to access any form of birth control.  The thought of another pregnancy, whether by a husband who won’t take no for an answer, or by a stranger who might force his way upon you while making your way to fetch water for the family is overwhelming. You’re not in great health, and another pregnancy would take its toll on your weakened body. The chances are high that you might not survive pregnancy or labor to be able to take care of your family.

Globally, 215 million women would like to be able to prevent or delay pregnancy, but do not have access to the supplies that would allow them to take control of their lives. As American women, we know from our own experience that the ability to make our own fertility decisions has made an immeasurable impact on our own lives. For women in the developing world, access to reproductive health supplies would save lives and improve health, as well as the economic and social well-being of families and communities.

Consider the staggering number that every single day, 1,000 women die due to pregnancy-related complications. Access to contraceptive supplies would mean that unintended pregnancies would drop by more than 70 percent every year. 150,000 maternal deaths would be avoided every year. And 600,000 children would not lose the love and care of their mothers.

Why is it that a private sector product like a Coca-Cola or a mobile phone can get to ‘customers’ yet much-needed health care information and products are beyond reach? This question has perplexed the global health community for decades.

WomanCare Global was founded in 2009 to address the profound problem of maternal mortality that has challenged the reproductive health field. The path is very clear and one word sums up the problem and the solution – ACCESS.  Our “hybrid” model is trying something new – a way of offering women hope because the emphasis is on access to affordable quality products for the women who need them most.  WomanCare Global recognizes the many challenges facing the distribution of healthcare technologies in underserved markets. All too often, pharmaceutical and device manufacturers decide not to invest in low resource settings, limiting product availability in much of the developing world. Additionally, supply-chain gaps keep products from reaching healthcare facilities, providers, and the women they serve.

By identifying innovative reproductive healthcare technologies and utilizing existing distribution channels, WomanCare Global promotes sustainable access to these critical products.

Family planning is one of the most important, cost-effective interventions available in the world today. Every woman, no matter where she lives, deserves access to the lifeline of information and affordable reproductive health products.

Women for a Healthy Future

Non-communicable diseases (NCDs), commonly known as chronic diseases, cause two out of three deaths worldwide, and are the leading cause of death for women around the world.

We have a once-in-a-lifetime opportunity to tackle NCDs, considered to be one of the 21st century’s greatest health and development challenges. In September, world leaders will gather at the United Nations (UN) for a historic summit on NCDs. The decisions they make will impact the lives of millions.

NCDs threaten women’s lives and our children’s future. Yet, we know that 80% of cardiovascular disease and diabetes and 40% of cancers can be prevented by avoiding tobacco, increasing physical activity and eating healthy foods. It’s going to take strong commitments from the world’s leaders and sweeping policy changes to reduce women’s and children’s vulnerability to NCDs.  

As a result, organizations representing global health, women’s health, child rights, and youth perspectives have come together to form the Women for a Healthy Future movement. This movement is aligned with UN Secretary-General Ban Ki Moon’s “Every woman. Every child” initiative and is mobilizing women from around the world to demand action against NCDs.

Raise your voices. Sign the petition. Tell your friends.

If we gather 10,000 women’s signatures, we will take them to the media, to world leaders gathered at the UN, and to business leaders. We need your support to show the world how deeply we care, and to ignite action against NCDs.

“So, how was China?”

We recently returned from China and Vietnam and have been asked this question many times by curious friends, family, and colleagues.  Recognizing that we live in a world of soundbites and that no one really wants to hear every detail about our fourteen day trip, I’ve responded by focusing on the experiences and observations that had a lasting impact on how I think.  There were three: one is personal, one is political, and one is professional.

Personal: While “Made in China” is present on everything from chatchkas to clothing labels to housewares, and although China’s thriving economy is a frequent topic in the business world…I simply wasn’t expecting to see their ultra-modern infrastructure.  I went to China with a visual image that was pre-Mao.  Shame on me.  Instead, I saw 14 story shopping malls, a Shanghai skyline best described as “New York on steroids,” an efficient and clean subway system, and construction cranes on every square block. While analysts predict an economic and building bubble that will deflate soon…there is national confidence that China’s  5 Year Plan (for 2011-2015) will address these risks.  Take a look at the well-defined, measurable goals regarding their economic targets, innovation, the environment, people’s livelihood, social management, and reform.  The Plan is translated into action down to the individual citizen level to assure that they achieve their goals.  We may not agree with socialist/communist ideals, but step back for a moment and imagine how much progress the US would make if we had a unified plan regarding our nation’s advancement.

How was China? A strong world power.   Never again will I refer to China as an “emerging economy.” They have emerged, and there are a few things that the US can learn from them.

Political: In Vietnam, our guide whisked us to Ho Chi Minh’s tomb, and proudly announced, “We are a communist country.”  Well versed in his country’s history, Happy (yes, that was really his name) gave described, in depth, how communism liberated the Vietnamese from the French.  As usual, we peppered him with as many questions as he would tolerate about life in, what we presumed to be, a classless society.   He was understandably cautious in how he represented the government, and his standard response to many questions, such as “How much corruption is there?” was “That is a sensitive question that I cannot answer.”  Recognizing there are pros and cons to any ideology, we looked forward to hearing about their health care system and how it was designed to offer equitable access to care.  We were shocked when he explained that only those who have money can afford health insurance, and only those who have insurance get health care. Everyone else struggles. I was distraught. “What?! How can this be? How can a fundamental need not be provided in a communist country?” His response? “That is a sensitive question that I cannot answer.”

How was Vietnam?  Physically beautiful but politically contradictory.   I have since learned that Vietnam (and China) have a “socialist market economy”–in other words, they have both the political and social disadvantages of communism as well as the economic disadvantages and disparities of capitalism.

Professional: During the annual business planning cycle of US businesses, it is typical for managers to request a budget to hire more staff.  In most cases, the proposed employee increase is trimmed, slashed, or completely eliminated with subsequent grumbling about the “impact on service and innovation.”  Sound familiar?

While we were in China, I paid particular attention to staffing.  In a nation with almost unlimited opportunity to hire due to low labor costs,  I paid special attention to whether more people resulted in better service.  My observations were far from a formal analysis..but, here’s what I saw:

• Staffing levels were 3-4 times higher than in the US. Example: In a casual US restaurant, there is typically 1 host who greets and seats customers. In China, there were 4:
• At the entrance to the restaurant.  Responsibility: open door
• In front of the hostess stand.  Responsibility: ask for number of people in the party
• Behind the hostess stand:  Responsibility: assign the table
• Beside the hostess stand:  Responsibility: lead guests to their table

The service was adequate (but not extraordinary) as long as we had ordinary, predictable requests.  But, when we strayed from the norm—service collapsed.  When we tried to order a plain bowl of rice for Zoe in a restaurant with rice-based dishes, we created a bit of chaos.  The waitress called the supervisor who called the manager.  After fifteen minutes of huddling, they were unable to serve a plain bowl of rice since it wasn’t specifically listed as a menu item. An overflowing chafing dish of plain rice was 20 feet away in the buffet line.  We gave up.

This scene, with different details, was repeated multiple times each day. (No, we were not being difficult Americans.) While our daughter lived in Shanghai,  she was in the bed/mattress section of a department store and asked where she could find bed pillows. The bed salesman had absolutely no idea…and was unable to help figure it out.

The employees did not seem are complacent, uncaring, or intentionally inflexible.  Instead, they just couldn’t think or act outside the boundaries of their tiny, narrowly defined scope of responsibility.  I realized, for the first time, that excess labor isn’t necessarily a solution to better service. Rather, it can drive inefficiency and dilute accountability for the entire consumer experience.

How was China? A culture that fosters order and compliance versus risk-taking.  Yes, they can copy couture fashions before they are off the runway, and reproduce the newest Apple device before Steve Jobs is off the stage, but the lack of flexibility and, consequently, little problem solving, translates into a larger national issue for China: lack of innovation.  The government, however, has recognized this risk,  and the 5 Year Plan includes investments in R&D with a goal to  achieve 3.3 patents per 10,000 people. 

What was my overarching takeway, or, should I say takeout? Our trip was analogous to a Chinese feast that offers a disparate array of exotic foods that I never imagined eating. Similarly, our trip offered a disparate array of impressions and observations that disrupted some of my long held beliefs. I am still digesting it…though with a little heart burn.

Originally posted on Archelle on Health on July 20th.

It’s actually not as easy as you might think to test the hypothesis, as Hopkins PhD candidate Kyla Hayford found out.  We did, however, get enough data to say comfortably that the anecdote is true as you will find in our new IVAC report, Improving Access of Essential Medicines through Public-Private Partnerships.

Photo credit: Tielman Nieuwoudt

First, we found an astonishing lack of available data about stock outs, wastage and other measures that indicate whether essential medicines are available.  Our report compared this to measures of availability of consumer packaged goods – things like candy bars and cola and calling cards – which seem to be stocked in abundance throughout the developing world. 

Why are these indicators important?  The simple truth is that no one dies if there aren’t mobile phone cards at the local kiosk, but the stakes are high if an antibiotic is not available to treat a child with a deadly disease.  Why is it, then, that consumer goods companies have many means to effectively track distribution, while there are very few measures in place to track the availability of essential medicines throughout Africa?

We found that injectable ceftriaxone, for example – a life-saving antibiotic for those with severe infections – was available in Kenyan and Tanzanian hospitals less than half the time, while mobile phone cards were available 90% of the time. 

So what can be done?

First, we need to build and maintain better planning and tracking systems.  Recognizing areas where distribution mechanisms are in need of improvement is a first step in making progress to better distribution of essential medicines.  Those managing the supply chain process also need to have the skills necessary to interpret this information, and make modifications accordingly..

Second, we need to share knowledge on distribution practices.  Many for-profit companies have mastered the art of product distribution and have their systems down to a science.  This includes information tracking, training of personnel, network expansion strategies, flexible financing and incentives, and investment in analyses that lead to a reduction in the cost of distribution. 

Infrastructure for distribution is one area to consider leveraging and exploring potential partnerships.  If Coke can deliver to Timbuktu, why couldn’t they bundle some oral rehydration salts into that same load?  The packages are small and don’t add much weight.

This is happening already, but on a small scale. Exxon Mobil distributes malaria-preventing bed nets to pregnant women at gas stations across Ghana and Zambia, for example, and shipping company DHL provides warehouse space and distributes vaccines in remote Kenyan villages.  These efforts are commendable, and should serve as models for what is possible.

The challenge will be matching up programs with beneficiaries and working out kinks. We can think creatively and recognize that the value we bring is not always money.  For companies that have the infrastructure and know-how – let’s figure out how you can share that.  Post your comments.  I welcome your feedback.

Francis S. Collins, MD, PhD is the Director of the National Institutes of Health and because of  his work and leadership is Disruptive Women in Health Care’s June Man of the Month. Dr. Collins wrote the article below which was originally posted in The Huffington Post on June 15th. This article is a perfect example of why he is our Man of the Month for June.

Broadening Our Global Health Vision

Over the past few decades, global health research has primarily focused on the “big three” diseases: AIDS, TB and malaria. And, thanks in large part to biomedical innovation, we today have better ways to treat these dreaded, infectious diseases and lower the risk of transmission — advances that have saved millions of lives and promise to save countless more.

However, the job of biomedical research is far from over. Given the changing nature of the global health landscape, we must act now to broaden our vision even further. First, we need to apply the power of scientific innovation to more health problems. Secondly, we need to recognize that developed nations are not the only source of such innovation.

While infectious diseases remain a significant problem, low-income nations face many other serious health challenges. In fact, the fastest growing causes of death and disability in the developing world are injuries, such as those caused by traffic accidents, and non-communicable diseases, such as cancer, heart disease and diabetes.

It will be no easy task to identify and implement the right tools to tackle this formidable — and potentially very costly — array of problems in resource-poor countries. To succeed, we will need the brightest minds in all parts of the world, including those from both the public and private sectors, to work together in new and highly creative ways.

As an example of such an approach, the National Institutes of Health (NIH) and the Wellcome Trust, a global charity based in London, recently formed a partnership to support population-based studies in Africa of common, chronic disorders, as well as infectious diseases. That effort, called Human Heredity and Health in Africa (H3 Africa) project, will enable African researchers to take advantage of new research approaches to understand both genetic and non-genetic factors that contribute to risk of illness. Not only will this help people living in Africa, but, since Africa is the cradle of humanity, what is learned about genetic variation and disease likely will have an impact on the health of populations around the globe.

The H3 Africa project also illustrates the second way in which we need to broaden our vision of global health. Rather than seeing biomedical innovation as something that flows from developed nations to low-income nations, we need to start viewing innovation as a two-way street from which the entire world stands to benefit. As global health advocate Lord Nigel Crisp so aptly puts it: “Innovation is happening everywhere.”

Recently, some of the most creative — and cost-effective — strategies for medical products and procedures have arisen from research that reflects the needs and ideas of people living in poorer countries. Such innovations include: a quarter-sized microscope that can transmit high-quality images via a mobile phone, lower cost intraocular lenses for cataract surgery, non-surgical methods for treating clubfoot, a high-performance prosthetic knee joint for amputees that costs only $20, a cheaper way to deliver IV fluids to children and an inexpensive, non-electronic device to warm premature babies. While some of these innovations are tailored to the specific needs of developing nations, others may come in handy in the United States — particularly in remote areas or low-resource settings.

So, as a nation, let us renew and strengthen our commitment to biomedical research aimed at improving the health of the world’s poorest peoples. It just might improve our own.

By Jane Sarasohn-Kahn.

WHO learned that mHealth is most easily deployed into health applications where voice communication via traditional phone networks has been used. Thus, in important applications like surveillance and decision support, mHealth is less likely to be established because these functions require more advanced capabilities and technology infrastructure.

The survey evaluated mHealth services in 14 categories, as shown in the chart. These include health call centres, emergency toll-free phone services, emergencies and disasters, mobile telemedicine, appointment reminders, community mobilization and health promotion, treatment compliance, mobile patient records, information access, patient monitoring, health surveys and data collection, surveillance, health awareness raising, and decision support.

The most prevalent of these services are toll-free emergency applications, mobile health call centres and emergency services, and mobile telemedicine, all available in over 50% of WHO member states. In addition, mHealth-based appointment reminders are available in a plurality of nations.

The most popularly piloted mHealth programs include patient monitoring, treatment compliance, mobile telemedicine, and patient records.

Health Populi’s Hot Points:  Most of the mHealth deployments around the world tend to be small-scale pilots that deal with single issues. The largest scale mHealth programs are usually supported via public/private partnerships.

The second chart presents the major barriers to mHealth implementation cited by WHO member states. The most significant barrier to adopting mHealth is competing priorities within health systems. Without a strong evidence-base, WHO concludes, nations with limited health resources must allocate them based on expected return on investment — for example, buying vaccines versus investing in a mobile health project.

The second most cited barrier is “knowledge:” in this case, understanding how mHealth can impact public health. Here again, evidence needs to be gathered and disseminated so that potential investors in mobile health applications can identify the right application and success factors for their health citizens – taking into account limited health resources.

Gathering a sound evidence-base is key to mHealth getting its due around the world. Yet the level of evaluation of the projects, both established and piloting, is scant, based on the survey findings.

Public policy, cost-effectiveness, legal issues and operational expenses are also key barriers to adopting mHealth programs. In many countries, the concept of mHealth isn’t part of public policymakers’ mindsets. WHO rightly points out that technology has developed far faster than the public’s understanding of how it can positively impact public health.

One important barrier not mentioned in the survey, but suggested early in the report, is the lack of a standard definition of “mHealth.” WHO defines it as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.”

The important point here is that mobile health goes beyond the mobile phone: that there is a growing array of various mobile platforms that can be used for mHealth. Infrastructure-independent health services are being deployed in countries, both rich and less-so. Because this survey is based on 2009 data, the needle will have moved in 2010 on mHealth. But this survey does prove that mHealth is a moving market, on the upswing, the world over.

Originally posted on Health Populi on June 15th.

Help Wanted? is an apt title for the report from The Organization of Economic Cooperation and Development (OECD), subtitled, “providing and paying for long-term care.” The report details the complex forces exacerbating the LTC carer shortage, focusing on the fact that current policies to address this future are fragmented and piecemeal. Instead, OECD argues, policymakers must smartly weave together a comprehensive approach that addresses the many facets of the problem.

Statistically, in today’s world, 1 in 5 LTC users is under 65 years of age; one-half are over 80. Most of the LTC services paid-for are based in institutions: 62% of total LTC expenditures occur in institutional settings, not at home.

That simple aging demographic is the first aspect to consider: in 1950 under 1% of the global population was over 80. By 2050, that share will increase from 4% in 2010 to 10% in the OECD countries.

Today, it is informal, unpaid caregivers — usually family carers — who bear the brunt of long-term care.

Health Populi’s Hot Points:  The report states, “Family carers are the backbone of any LTC system.” That backbone is breaking in developed countries. More than 10% of adults over 50 living in an OECD country provides help with personal care to people who have limited ability to care for themselves. Without support, OECD says that caregiving is associated with a reduced labor supply for unpaid work, higher risk of poverty, and a 20% greater prevalence of mental health problems.

Supporting family caregivers is key to strengthening the backbone, and financial health, of long-term care infrastructures around the world. OECD’s solution is several-fold:

• First, to design financial support programs for caregivers in the form of allowances and cash benefits that would be paid to care recipients, which would increase the supply of family care.
• Second, to promote better work-life balance through family leave programs. While childcare leave is fairly common in most countries, family care (say, for aging parents) is not. Flexible work arrangements are a core part of this solution for carers working in full-time jobs. Care leave is most prevalent in Denmark, Poland, Finland, the Netherlands, Hungary, Sweden and Belgium.
• Third, support services such as respite care, training and counseling are key to managing eventual carer burnout and loss of personal control.

Still, even with these supports, OECD believes that over-reliance on family carers is not optimal. It’s the formal, labor-intensive LTC sector, that needs addressing. Currently, that sector is marked by high turnover and low retention, largely due to low pay, and lack of professional training and recognition and lack of technology support.

Improving job quality is key for LTC workers. The technology aspect could greatly turbocharge worker productivity and enhance job satisfaction, which better managing costs that are currently eaten up in institutional care. Implementing remote health monitoring, electronic health records, and personal safety response systems would keep older people safer and healthier at home, while enabling care workers to truly care and reduce their paperwork load and administrative hassle. Financing policies that speak to infrastructure-independent health care — not tethered to institutions — would move care back into peoples’ homes, where most would prefer to be to age in place and continue to be part of their local communities. Home care is a lower-cost alternative to institutional care today. As technology evolves to provide more care in home settings, evidence is gathering to prove cost-effectiveness of these approaches for chronic conditions like heart failure, COPD, and cancers. Furthermore, peer-to-peer care via online social networks can help homebound people feel and be connected with both people like them and caregivers.

While home-based LTC may not be clinically appropriate for very sick and/or frail seniors, appropriate utilization of institutional settings could be sorted out using clinical protocols and assessment tools.

Originally posted on Health Populi on May 31st.

One of the best and prudent ways to invest though, is in future generations.  In the US, we provide all of our children the best chance at life, with fewer worries about preventable, devastating disease.  Imagine what that kind of security could do for a family in Africa.  Healthier children in Africa would be able to stay in school.  Families would worry less about the all too common diseases of pneumonia and diarrhea, and their devastating costs.  Rather than accepting the fate that their children may fall ill, they would be thankful that new vaccines are being made available.  Throughout the years, as healthcare improves because of our investment, so would income and productivity. Our investment would return to us through a country’s improved stability, better governance, and more – and all directly relate to our own security. 

The introduction of a new vaccine is not something taken for granted in the developing world.  Up-to-date immunization cards of young children are among a family’s prize possessions.  Throughout Africa, pneumococcal vaccines, once deemed far from the reality of any African village are now being introduced and are offering hope.  Rotavirus vaccines, helping prevent one of the most deadly forms of diarrhea in young children, may soon also be a reality across Africa -  all for a relatively small fraction of the US budget.  How often do we have a chance to save so many lives with such an effective and minimal financial commitment?  Four million lives over a five-year period is a pretty good return on investment!

Let’s make wise investments

Next month, the GAVI Alliance will be holding their pledging conference to encourage donor countries like ours to contribute to providing the most basic and effective prevention.  Please tell President Obama and your local leaders that you care.  Sign the ONE petition, and tell your friends and family to do so. The more they hear from you, the more they know this is an investment we as Americans care about.  Do it for their future – and ours.

Photo credit: Adrian Brooks, Imagewis

VSI is a California-based nonprofit organization committed to improving women’s health in developing countries by creating access to life-saving and affordable health solutions for all. Their largest safe motherhood program brings life-saving generic tablets to rural women for management of excessive bleeding after childbirth, or postpartum hemorrhage. VSI has assisted 17 developing countries in the integration of life-saving maternal health solutions, trained over 18,000 health care providers on safer childbirth, and educated over 130,000 women and their families on safer childbirth.

Here is one mother’s story…There are many faces of motherhood.  Mariye from Ethiopia is both a mother to her own seven children as well as a mother to the countless women she helps through labor and childbirth.  She confidently fulfills her role as a traditional birth attendant (TBA) in a world that often overlooks the importance of these essential community health workers.  Mariye is a vital resource to the women in her community, providing care and compassion to women who deliver at home, who would otherwise be alone. Her strength and her wisdom are derived from her own experiences in childbirth and her own inspirational story.  Mariye’s first child was delivered stillborn.  As time passed she grew weak and began to realize that her afterbirth still had not come.  In order to save her own life, she found the strength to pull out the placenta herself, thereby saving her own life. Mariye sees her story as a gift. Without strong and supportive women like Mariye, VSI’s work to reach women at the margins would be left unaccomplished.

Maternal Mortality Facts:

• Each year, over 340,000 women die of causes related to pregnancy and childbirth; 99 percent of these deaths occur in developing countries.
• This means that every 90 seconds, a woman dies in pregnancy or childbirth. This is unacceptable and preventable.
• In many developing countries, large numbers of women deliver at home, sometimes alone and many without the aid of a skilled attendant.
• Because women are social and economic providers, saving women’s lives and improving their health strengthens their communities and gives their children greater security.
• In Ethiopia, 94% of women give birth at home.  And only 6% of births are attended by a skilled provider.
• In the communities that VSI serves, becoming pregnant is one of the most dangerous things a woman can do.

For more information on VSI including how to become involved in their efforts visit: http://www.vsinnovations.org/.

The key priority of the UN Summit on Non-Communicable Diseases (NCDs) is to ensure it lives up to its promise of being a genuinely transformative moment in world health.

The good news is that momentum is building. Until just a few months ago, the very word NCDs was unknown. Now thanks to the UN Summit, the foundational work of the WHO and of the NCD Alliance and the Global Health Council, NGOs, academic centers, individuals in key corporations, and civil society, an NCD community is beginning to gel. We are debating the definition of NCDs, issuing Declarations articulating the “asks” from the UN Summit, attending conferences and meetings to discuss how we can address NCDs the world over, and encouragingly, we are mostly agreeing with one another. The Summit has already energized the entire NCD community.

So what must happen for the Summit to be considered transformative? It should serve as a pivotal point to rally the whole world, touching not just the UN, policy elites, and the NCD community, but families everywhere. It must make NCDs resonate with the man on the street, so that everyone the world over is clear on the issues, what their governments and communities are doing to address them and what they themselves can do to prevent them.

The Summit should ignite action. It should lead everyone to ask themselves the question – How can I use my platform and my sphere of influence to help reduce the crippling public health impact of NCDs? It should lead to the global health community embracing NCDs fully and to donors investing in them substantially. Heads of State should attend the UN Summit, and make public commitments to address NCDs in their own countries and globally. The Summit provides a wonderful opportunity for industry to show sincere engagement in improving the lives of people in the communities where they live and work. And for NGOs to show how they can do better.

The Summit should deliver some long-term political wins. It should address how NCDs will get included in the next iteration of MDGs and also how the world will pay for NCDs. It should identify some way the world will monitor progress post-summit. And it should foster true collaboration between multiple sectors globally and in-country, because a multi-sectoral approach is the best solution for these complex diseases. The UN could issue a “how-to” guide for countries – spelling out for example how countries can move from a disease-specific to a people-centered approach as the WHO recommends, or change from vertical to diagonal health delivery, or even how health systems could be strengthened.

I don’t think we can declare the Summit “transformative” until people feel a sense of personal responsibility and make healthy lifestyle choices to prevent disease, until leaders step up and “own” the crisis, until governments roll out national NCD plans, until we figure out how to measure results, and until health and non-health, state and non-state players work together to deliver sustainable solutions. This wont all happen before September, but the work should begin now.

NCDs are our generation’s problem to fix. And fix it we must. The UN Summit is our first step.

Originially posted on the Center for Strategic International Studies on April 6th. Nalini Saligram was the winner of the CSIS Blog Contest on NCDs.

“Women Bloggers Deliver” will award two female bloggers with a trip to Kenya to learn about clean water and women in development

6 April 2011, New York – Women Deliver, in partnership with Vestergaard Frandsen, announced today the launch of “Women Bloggers Deliver,” a competition that will send two female bloggers on a trip to Kakamega, Kenya to observe a unique public health campaign with a climate change component that will provide millions of girls and women with access to safe and clean drinking water. The winning bloggers will accompany community workers as they distribute LifeStraw® Family water filters to almost a million households, and watch as families and communities are transformed by this important public health intervention.

In April and May of 2011, LifeStraw® Family water filters will be distributed to approximately 90% of all households in the Western Province of Kenya in a groundbreaking program that links access to safe drinking water with low carbon development. The program, called “Carbon for Water,” will provide more than four million residents with quick access to safe drinking water at home. The program is led and solely funded by Vestergaard Frandsen (VF), a global company that specializes in complex emergency response and disease control textiles, including LifeStraw® Family. It is self-funded by VF and will be reimbursed by carbon financing.

“This competition will provide a unique opportunity for leading bloggers to travel to Kenya and observe the most important project yet to combine the power of climate change mitigation with public health,” said Mikkel Vestergaard Frandsen, CEO of the Group, Vestergaard Frandsen. “I’m sure the winning bloggers will have the experience of a lifetime and will share their knowledge and insights with a very wide and influential audience.”

For one week in May, from May 14 to May 22, the bloggers will travel through Kenya’s Western Province, all expenses paid, to research and write about the campaign and the women whose lives are being affected. In sub-Saharan Africa, many girls and women spend hours a day collecting water, often walking miles in extreme conditions and on dangerous roads to fetch water and wood for fuel. This is time that could be better spent in school, as one in three girls in sub-Saharan Africa does not attend primary school and misses out on the opportunity to build a better future for herself and her family.

“The huge challenges in sub-Saharan Africa—poverty, access to safe and clean drinking water, access to family planning, maternal mortality—can only be tackled if women are central to the conversation,” said Jill Sheffield, president of Women Deliver. “We hope that this competition will harness women bloggers’ energy and passion to showcase women as not only part of the problem, but part of the solution.”

To honor the bloggers’ work and the work of Women Deliver in raising the profile of women from this community, the Emusanda Health Center in Kakamega will receive a long sought-after maternity ward donated by Vestergaard Frandsen with contributions from the blogosphere.

To learn more and apply for the competition, visit this link: http://www.vestergaard-frandsen.com/women-bloggers-deliver/

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About Vestergaard Frandsen:

Vestergaard Frandsen is a European company specializing in complex emergency response and disease control products. The company operates under a unique Humanitarian Entrepreneurship business model. This “profit for a purpose” approach has turned humanitarian responsibility into its core business. Vestergaard Frandsen was founded in 1957 and has evolved into a multinational leader focused on helping to achieve the UN’s Millennium Development Goals. For more information please visit www.vestergaard-frandsen.com

About Women Deliver:

Women Deliver is a global advocacy organization that brings together voices from around the world to call for action for improved health and well-being for girls and women. Launched in 2007, Women Deliver works globally to generate political commitment and financial investment for fulfilling Millennium Development Goal #5 — to reduce maternal mortality and achieve universal access to reproductive health. Building from the groundbreaking conferences Women Deliver convened in 2007 and 2010, the initiative harnesses commitments, partnerships, and networks to help prevent the approximately 350,000 deaths of girls and women from pregnancy-related causes that occur every year. Women Deliver’s message is that maternal health is both a human right and a practical necessity for sustainable development. Invest in women—it pays. Visit www.womendeliver.org

Children in developing countries though faced a different picture over the past decade. Pneumococcus in the developing world not only causes severe meningitis, but is a leading cause of pneumonia.  Without access to PCV, 3 month-old Dominic Mwangi, found himself in the district hospital undergoing antibiotic treatment for life-threatening pneumonia.  His mother was away from home and family for 3 days.  Dominic was lucky and recovered; An astonishing 1.5 million children, mainly in Africa and Asia, are not so lucky.  Almost half of all severe pneumonias and meningitis deaths are thought to be caused by bacteria that can be prevented by the use of vaccine. Much more disease could be prevented with better nutrition and access to care.   Dominic, because he was born in Kenya, was 112 times more likely to die of pneumonia than an American child.  In Afghanistan, that number is 400. 

2011 paints a more promising picture.   A new generation of vaccines from Pfizer and GSK providing the broader protection needed to fight pneumonia and meningitis in developing countries has been made available in Nicaragua, Yemen and now Kenya within a year of launching in the industrialized world.  By 2015 more than 40 countries will do the same. 

What changed?  It was a convergence of factors – pharmaceutical companies, seeing a greater likelihood of demand with secured financing, were willing to offer low prices to those most in need, supplying at prices of less than 90% of those in industrialized countries.  Low-income countries wanted the vaccine because they saw the potential impact and a plan again for financing.  Financing was needed – and eventually made possible by Italy, UK, Canada, Russia, Norway and the Bill and Melinda Gates Foundation who donated $1.5B to the Pneumococcal AMC, an innovative financing mechanism and the GAVI Alliance who is making up the price differentials that low-income countries cannot manage as yet.   

It took a lot of effort to see these pieces fall into place, but one that can’t stop with just this example.   In a time where all of us are paying attention to how to do more with less, efforts like this one provide an important lesson of what is possible. Investing in health, individual countries have made dramatic economic progress and this will help all of us.  Take a look at this Hans Rosling video and you’ll see why investments in health are, well, a good investment.   Children of all nations deserve a solid foundation to become healthy adults. We have more to do, we need to keep going.