Global Health Ideas

Finding global health solutions through innovation and technology

Archive for December 2006

HIV/AIDS Awareness and Prevention Through Animation-Based Curriculum

Interactive Teaching Aids, Learning ScaffoldingPiya Sorcar, of the Learning, Design and Technology Program at Stanford University is leading Interactive Teaching AIDS (ITA), an initiative to develop “an animation-based curriculum to teach HIV/AIDS awareness and prevention strategies.” There are currently two versions of the application in development, one for India and one “general Asian version”.

I had the opportunity to speak with Piya about her work:

Why cartoon animations?

When I started this project last year, as part of my research I interviewed dozens of people on this subject. I couldn’t understand why so much misinformation was out there about a virus which many organizations have tried to combat through strong dedication and millions of dollars. After many interviews and running an IRB-approved study in India, I realized that people averse to discussing HIV/AIDS because of the stigma associated with its connection to discussing sexual practices. The educational materials are actually quite simple, it is getting the education to the people that is hard. Fighting stigma is not easy and we know this because people are so embarrassed and frightened of asking simple questions that in the long run might save their lives. I wanted to use cartoons to make the subject less embarrassing, to enhance learner comfort. When I originally ran the IRB-approved study in India, I gauged the comfort of students in learning HIV/AIDS material with various illustrations. People were most comfortable with simple graphics and actually, the simple graphics seem to get the points across just fine. It was important to me that individuals learn about this subject while feeling comfortable. I felt that cartoons accomplished this mission.

Why emphasize the biology of HIV/AIDS?

HIV/AIDS is a difficult subject to talk about. There are schools that won’t teach the prevention strategies because of its close ties to sexual practices. What we often forget is that HIV is just a virus, and we study viruses in biology classes all the time. By bringing the subject back to the basics, we can discuss it more openly and clearly. In order to prevent the spread of the virus, it’s important to build a coherent conception of where it lives, how it works and how it is transferred. In order to fully understand this, it’s important not to merely memorize a list of safe actions but to understand why a virus spreads.

What is the underlying pedagogy of this initiative?

There are many pedagogical principles utilized, but I would say the most important is based on the cognitive theory that it is important to create a coherent conception in the mind of the individual learning the material. Since in many countries there are few, if any, requirements for students to learn about HIV/AIDS in educational institutions, they tend to learn about it from mass media campaigns through television, billboards and radio. Although there are strong efforts to disseminate HIV/AIDS information in India (among other countries), because of the nature of the aforementioned education strategies, individuals must make sense of short, out-of-context pieces of information on their own. This often leads to misunderstanding as well as the memorization of random fragmented data, which doesn’t build a clear conceptual map. Interactive Teaching AIDS provides calculated learning steps to provide scaffolding for learners, allowing them to develop a coherent conception of basic biology, bodily fluids, transfer of bodily fluids into the human body, and their application to various actions or scenarios. In addition to building on a cognitive approach, we relied on other learning techniques including the use of mnemonic devices as well as Vygotsky’s scaffolding techniques. [See also: ITA Learning Theory & Rationale]

What is the current status of the projects in India and Korea? What makes those initiatives different from one another?

The Asian version of Interactive Teaching AIDS was fully funded by the Medical Research Information Center in Korea, which is funded by the South Korean government. The storyboard, which was developed at Stanford University, was animated by a professional development team and now needs to be translated into several different languages. We plan to test the production version of the project early next year. The prototype for the Indian version is complete and we have just received funding from a couple donors to create a more industry-ready version. Once that is complete we plan to test it throughout India. We hope the testing will provide us with useful data so we can iterate and make the project more effective. Finally we hope to give it away for free to various AIDS control societies, schools and eventually port to mobile devices so the information can truly be viewed in the privacy of one’s home. We are hoping also to partner with various organizations who are interested in the same goal as us – to promote awareness and prevention methods to people all over the world.

What is the overall assessment plan?

As I mentioned earlier, we hope to test this project with many students in Asia in order to inform our design and create a more effective learning tool. We hope to compare and contrast our work to other AIDS and general health education materials.

What are the key challenges ahead? (development, deployment, adoption, behavior change)

I would love to see the educational content available on all mobile devices across Asia. Perhaps governments and mobile service providers would be interested in partnering with us in order to either make this content freely available to download online or better yet, be preinstalled on the buyers cell phone or PDA. In terms of development the challenge is, of course, to develop something that is fairly short yet still gets the message across using limited screen real-estate. Once we have tested this project widely, hopefully we will have a better idea of what works and what doesn’t work and this will inform us in designing a mobile version of the project. Secondly, since there is no universal platform for cell phones, it will be challenging (not to mention expensive) to develop the animation using various scripts. When I ran the study in India, I was appalled that so many college-educated students were misinformed. The number one question was whether there was a cure for AIDS. My goal right now is to inform masses about the virus and prevention strategies. I think we have a huge problem if the population of the country with the greatest number of HIV/AIDS cases in the world doesn’t have a general understanding of how the virus spreads. Once the goal of educating people has been met, this will hopefully lead to behavior change.

Written by Jaspal

December 26, 2006 at 10:58 am

Computer-based ARV Dispensing

Pharmacies, as specialized services with specialized staff, are often the limiting factor for the delivery of health care in low-resource settings. I work with a small clinic in South Africa that has more than 1,300 patients on ARV treatment. We’ve worked with an NGO Cell Life to bring in a computer-based ARV dispensing system, iDART, to speed dispensing and decrease clerical work. Simple solutions to help pharmacies such as pre-packaging drugs, dispensing two months supply to stable patients, and easy to use registers can make a big difference, however as clinics grow, there comes a point when a computer system will keep the clinic ahead of the crush.

Here are a couple of systems that we’ve come across for dispensing at the clinic level with some key attributes. We’re not exactly clear which will work the best and would love input if you have used these, or know of others.

* Cell Life, iDart – Built for ARV dispensing, iDART incorporates the ARV start date, treatment supporter contact info, and defaulter tracing. Reports cover the necessary requirements for government (stock dispensed, etc.), and will soon allow for easy PEPFAR reporting. Bottle labels print with a click of a button speeding the consultation. The system can be used for dispensing directly to the patient or to keep track of drugs that have been packaged for individual patients at a central pharmacy and then distributed at local clinics. The system is Open Source, but no outside developer base exists as far as I know.  It is downloadable at their site.

* ProPharm – Built for retail dispensing ProPharm has a large customer base and fast and easy customer support (a key need when computer skills are lacking). The system is more complicated than iDART but can be modified to include ARV specific dispensing information. An NGO manages thousands of patients on numerous studies with this, and, as far as I know, likes the system. I don’t think, however, that they are using it at the clinic level. The learning curve is steeper given greater complexity and features that are not used in public sector dispensing. It’s a proprietary system.

Written by Justin

December 21, 2006 at 4:16 am

Posted in HIV/AIDS, ICT, Innovation

Can microfinance improve health services to the poor?

The question was raised on the Pienso blog [Dec 18 "Link Drop"] in reference to a Harvard Business School newsletter Q&A [Dec 13, "Improving public health for the poor"] with Michael Chu, Harvard Business School lecturer and one-time micro-financier. Chu developed Project Antares [course description at bottom of HBS link] with colleagues at Harvard School of Public Health to explore means of delivering public goods and services via the private sector.

Microfinance may offer a window on new methods for widening access to healthcare for the poor, says Harvard Business School’s Michael Chu… Bringing together public healthcare and market forces “could have huge impact,” he says.

I have two problems with the interview and some praise for taking on issues outside the standard purview of business schools.

First criticism: The language in the Q&A comes off at times as naive -

Martha Lagace: What is missing by defining health, as we do today, as a public good?

Michael Chu: …right off the bat you need scale and permanence. Both private and public philanthropy, when they work well, play a key role in fostering the birth of new concepts and ideas. But neither philanthropy nor development agencies are structured for scale or permanence. Some really powerful instruments of philanthropy, like the Bill & Melinda Gates Foundation, are putting hundreds of millions of dollars towards the eradication of a disease. Huge as that is, it’s not an effort that can be permanent.

There are numerous examples of public sector health programs in the past 200 years that have operated at scale and achieved lasting impact. Two immediate examples contradict his odd statement on disease control: global eradication of smallpox led by public sector agencies and the history of the March of Dimes, an innovative charity that financed the research for and distribution of the polio vaccine [Amazon link: Patenting the Sun: Polio and the Salk Vaccine].

Second criticism: This interview indicates a partial understanding of what is involved in protecting the public’s health. “Public health” consists of activities across several domains: research, education, service delivery, and disease surveillance. The ratio of social and private returns varies across those domains and in only one do health care services, both public and private, figure prominently.

However, the idea of incentivizing the health care for the poor via the private sector is an applaudible effort. It’s well known that the poor in low-incomee countries, when they seek care at all, disproportionately use private sector services.

In the majority of the sub-Saharan African countries for which DHS [Demographic and Health Surveys] data were available, of those children seen by a medical practitioner, the use of public services by the rich was not significantly different from that by the poor. On average, of those children seen by a medical practitioner, most of those from the poorest quintile sought care from private providers for both diarrhoeal disease and ARI [Prata et, al. 2005 "Private sector, human resources and health franchising in Africa" WHO Bulletin].

Chu’s work does underscore the need for greater investment in innovative schemes to bring scaled health services to the poor and lessons from microfinance would certainly apply. Identification of the appropriate services is key as is targeting the right service to the truly poor patient.

Q: What are your next steps for Project Antares?

A: We want to refine the matrix that will allow us to propose what the high-impact interventions are and develop commercial delivery systems for them. Next term, we’re looking towards establishing teams of HBS and School of Public Health students who will work on independent field study projects in the development of commercial approaches.

THDblog recommends the Disease Control Priorities Project with its exhaustive chapters of cost-effective interventions across the full range of human illness.

Microfinance also has unique targeting properties that may hold some lessons for targeting of services to low-income patients. Micro-finance brings limited but critical credit to customers. The customers self-select in the applicant pool for screening. Better-off individuals do not apply. One example where this happens now is in the hugely successful Indian NGO, Aravind (Aravind Eye Care System). Aravind provides a no-frills eye care services including cataract surgery at little cost for low-income patients. The same medical procedures are sold to high-income patients but additional customer service amenities are added to enhance the experience and justify the expense. And Dr. Chu’s program will certainly add new insights in the entrepreneurial approach to public health.

ADDENDUM Dec 20th:

There’s a great discussion started last August at NextBillion.net about the new found consumer potential at the bottom of the pyramid. Should the poor be empowered as consumers or producers? Perhaps simplistic to group low-income earners as “either-or” but interesting discussion.

And Laurie Garrett writes in the Jan/Feb 2007 issue of Foreign Affairs ["The Challenge of Global Health"] on the importance of local private sector investment in health if increases in healthcare provision and innovation are to be sustained beyond limited donor horizons in low-income countries.

…it is curious that even the most ardent capitalist nations funnel few if any resources toward local industries and profit centers related to health. Ministries of health in poor countries face increasing competition from NGOs and relief agencies but almost none from their local private sectors. This should be troubling, because if no locals can profit legitimately from any aspect of health care, it is unlikely that poor countries will ever be able to escape dependency on foreign aid.

Written by Ben

December 19, 2006 at 1:54 pm

Forum 11 in Beijing: Call for Abstracts

Following Forum 10 in Cairo, the Global Forum for Health Research will be holding it’s next annual meeting, Forum 11, in Beijing from 29 October – 2 November 2007. They have announced a call for abstracts with a deadline of 31 January 2007. From the website:

The Global Forum for Health Research invites you to submit an abstract for Forum 11 in any area of health research relevant to the overarching theme of Equitable Access: Research challenges for health in developing countries.  Papers addressing these areas from a national, sub-national or regional perspective are particularly invited. The Global Forum welcomes submissions from all parts of the world and encourages participation from lower income countries.  Submissions of abstracts from students are especially encouraged and the best papers will be specially featured in Forum 11.

The five thematic strands are: access to health, innovation, research resources, decision-making, and communication. The website suggests a particular emphasis on gender equity.

Written by Jaspal

December 18, 2006 at 10:03 am

The Power of Salt: Diseases on the Brink

salt.jpgFascinating story in today’s NY Times about the impressive population wide impact of iodized salt and also the difficulty in implementing this very technologically “simple” intervention: “putting iodine in salt, public health experts say, may be the simplest and most cost-effective health measure in the world. Each ton of salt needs about two ounces of potassium iodate, which costs about $1.15.” The article details what happened when the Soviet Union fell apart and the following public health consequences. For those of you in a rush, the video synopsis by the NY Times of this article is great (see article for “multimedia”).

This article is part of a series that examines diseases that hover on the brink of eradication, and the daunting obstacles that doctors and scientists face to finish the job.

NY Times 12/16/06 In Raising the World’s I.Q., the Secret’s in the Salt
Excerpts:

Studies show that iodine deficiency is the leading preventable cause of mental retardation… Putting iodine in salt, public health experts say, may be the simplest and most cost-effective health measure in the world. But the effort has been faltering lately. When victory was not achieved by 2005, donor interest began to flag as AIDS, avian flu and other threats got more attention.

The cheap part, experts say, is spraying on the iodine. The expense is always for the inevitable public relations battle.In some nations, iodization becomes tarred as a government plot to poison an essential of life — salt experts compare it to the furious opposition by 1950s conservatives to fluoridation of American water. In others, civil libertarians demand a right to choose plain salt, with the result that the iodized kind rarely reaches the poor. Small salt makers who fear extra expenseoften lobby against it. So do makers of iodine pills who fear losing their market.

Rumors inevitably swirl: iodine has been blamed for AIDS, diabetes, seizures, impotence and peevishness. Iodized salt, according to different national rumor mills, will make pickled vegetables explode, ruin caviar or soften hard cheese…Breaking down that resistance takes both money and leadership. “For 5 cents per person per year, you can make the whole population smarter than before.”

FULL STORY

Written by Aman

December 17, 2006 at 8:54 am

Posted in Global Health

The New Global Health Argonauts (Entrepreneurs)

As I like to contend, non-public health people from various disciplines are starting to have dramatic impact on public health, unlike never before … and folks in public health are far behind the curve in many respects. One of which is keeping up with others who are jumping in and changing the face of global health. The following story in today’s Wall St. Journal is a great example of how industry/private sector immigrants in the US are going to eventually make big strides overseas in the health arena. This particular case has been already well documented in the IT services sector and even though not many are talking about it, I do not see why the same will not hold true for the health care sector, to a more limited extent. Professor Anno Lee Saxenian just released a book about succesful immigrants in the high tech/IT arena going back to their home countries to start up ventures. The book, “The New Argonauts”, is well worth checking out. In my opinion, a similar potential exists for the pharmaceutical and medical device sectors. Admittedly, the process will be much harder with pharmaceuticals, but stories like the one below in the WSJ are promising for developing regions. The team over at the Canadian Center for Genomics and Global Health have begun to study this pheonomena in the biosciences, check out their article for a discussion on the potential and limitations faced – Scientific Diasporas.

If you don’t believe the capacity of regions across the world is growing, click on the map below to see biotech clusters around the world. It is a bit strange that they do not highlight Cuba’s well known biotechnology capacity. To be fair, there are challenges, for another take on the limitations of R&D in places like India see this article on Innovators without Borders.

biosecuritymap.jpg

Many thanks to Katie for passing the WSJ article along!

WSJ 12/14/06 Patent Remedy: Indian Scientists Return Home

wsj_indiarx.gifPUNE, India — For more than 20 years, Rashmi Barbhaiya lived a comfortable life in New Jersey…Now, in a move that hints at a big shift in the global pharmaceutical business, Dr. Barbhaiya is back home in India. He’s still trying to discover new drugs, but he’s doing so with an all-Indian-born research team at a company he founded in this center of Indian high technology. Dr. Barbhaiya runs Advinus Therapeutics, a company whose new-drug research would be powered by Indian scientists returning from the U.S. and other countries.

As big drug companies shut down some research facilities in the U.S. and other rich countries, labs in India and China are increasingly picking up the slack…Eli Lilly & Co., Wyeth and GlaxoSmithKline PLC all have outsourced chemistry work to Indian firms…Now Indian companies are increasingly conducting clinical trials, performing contract chemistry work and, as Dr. Barbhaiya’s journey shows, carrying out original research aimed at discovering new drugs.

One of Dr. Barbhaiya’s passions is discovering drugs for diseases that are prominent in poorer countries but rarely get attention from Western drug makers…Dr. Barbhaiya steered Ranbaxy into a pact in 2003 to develop an antimalaria drug with the Geneva-based Medicines for Malaria Venture. The drug is now in midstage clinical trials.

Full story at WSJ.

Written by Aman

December 15, 2006 at 12:33 am

Male circumcision reduces risk of HIV

Yesterday the National Institutes of Health announced the halt of two randomized control trials on male circumcision for HIV prevention. To continue the studies, the investigators believed, would be unethical. From the NIH news release posted on Politics and Policy of HIV/AIDS*:

The trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV acquisition in circumcised men relative to uncircumcised men, while a trial of 4,996 HIV-negative men in Rakai, Uganda, showed that HIV acquisition was reduced by 48 percent in circumcised men.

More from the NIH press release

“Many studies have suggested that male circumcision plays a role in protecting against HIV acquisition,” notes NIAID Director Anthony S. Fauci, M.D. “We now have confirmation—from large, carefully controlled, randomized clinical trials—showing definitively that medically performed circumcision can significantly lower the risk of adult males contracting HIV through heterosexual intercourse. While the initial benefit will be fewer HIV infections in men, ultimately adult male circumcision could lead to fewer infections in women…

Scaling the intervention will be interesting, to say the least. The procedure can be conducted safely on infants, boys and young men in a clean field clinic setting. Risk of minor adverse events is low, though present. It is low cost; one South Africa study estimated the average cost to be $55 per patient and considering that it’s a one-time procedure with an estimated 50-60% reduced rate of infection, it’s likely to be highly cost effective in populations with a high prevalence of HIV.

However, in my own limited time in East Africa, questions about circumcision for HIV prevention raises mixed responses among colleagues. It’s a topic weighted with ethnic and religious identities. Yet, Culture should not be overplayed especially in light of the incredible potential implied by the recent findings. The early response in southern Africa to a similar study finished in Orange Farm last year (see “Swaziland to endorse male circumcision“) suggests that the intervention, given its solid science and policymakers’ strong endorsement, can quickly gain public interest and save lives. A detailed mathmatical model published last July (“Potential impact of male circumcision on HIV in sub-Saharan Africa“) estimates that 1.1 to 3.8 million lives can be saved in the next ten years if male circumcision is scaled quickly across sub-Saharan Africa.

*full disclosure: I help run the Politics and Policy of HIV/AIDS blog and the link and NIH news quote are from a post I made Dec 13th when the MC news was first released.

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Written by Ben

December 14, 2006 at 2:26 pm

Whitehouse Malaria Summit: LIVE

UPDATE: Both the Center for Global Development and Owen Barder have added there thoughts about the Summit.  

I wanted to highlight the LIVE webcast (via KFF) of the Whitehouse Malaria Summit tomorrow.

malaria-bnr.jpg

Written by Aman

December 13, 2006 at 7:07 am

In the News: Diagnostics for Global Health; White House Malaria Summit

Several different news items worthwhile reporting plus one unrelated video I found very interesting:

improveddxggh.jpg1) Improved Diagnostic Technologies for the Developing World

A Great series of articles published in NATURE – Description from SciDev.net: “Improving people’s access to tests for the major diseases of the developing world and making the tests more accurate could save hundreds of thousands of lives, say researchers. Millions of people in developing countries die each year from illnesses that are preventable or treatable because the diagnostic tests are too expensive, complex or inefficient to use. A series of papers published in Nature (7 December) calls on scientists, policymakers, and global health organisations to work towards making these tests appropriate for use in poor countries.”

2) Whitehouse Malara Summit – LIVE WEBCAST, 12/14 (8:45am EST)

The WSJ (via Brown Global Health Blog) has an interview with Melinda Gates. “She is stepping into the limelight as an outspoken advocate for closing the global health gap. On Thursday, she plans to announce an expanded initiative with President Bush and first lady Laura Bush’s summit on fighting malaria, a mosquito-borne disease that kills one million people a year, mostly children under five.” The White House Summit on Malaria to bring together international experts, corporations and foundations, African civic leaders, and faith-based organizations to raise awareness of the issue of malaria. Kaisernetwork.org will provide a LIVE webcast of the summit.

3) Health Affairs Blogging about Health Insurance – Private Insurance For Developing Countries

4) The Dove Campaign – this is unrelated but I found this short clip fascinating, which I originally saw over at From Tribeca to Tanzania.

Written by Aman

December 12, 2006 at 8:41 pm

Cautionary ICT tale: Laptops not a panacea in Alexandria, Va.

The Washington Post yesterday (“For Some, Laptops Don’t Compute“) reported on an model ICT rollout in a DC area suburban high school system. In the fall of 2004, the Alexandria school system gave every high school student a new laptop leased by the district over four years. The rollout was part of larger effort to modernize the city, probably driven in part at the time by the nascent buzz around municipal wireless clusters. The initiative’s goal was, according to the Post, “to make the machines indispensable, linking them to electronic textbooks, classroom projectors and other academic tools” as well as linking them to the web on new wi-fi networks.

I couldn’t help but think of the One Laptop per Child project with plans to distribute millions of laptops to school children in low-income countries. There are important lessons to be learned from the Alexandria experience and similar places (state wide programs in Michigan and Maine according to the same Post article) if OLPC is to truly be the great leap forward its promoters promise.


Two years into the Alexandria rollout some are now arguing the $1.65 million expense has yet to produce justifiable improvements in student performance. The question about impact is hard to estimate without a strict evaluation strategy beforehand (read the first comment in this OLPC wiki post “Parable 2“, in the same vein as Easterly and others on rigourous eval). And not surprisingly some school officials were quick to defend the program.

Alexandria officials say it is too soon to gauge laptop-driven achievement gains, because T.C. Williams started issuing the machines in fall 2004 to sophomores, juniors and seniors, and the Minnie Howard School, which feeds into T.C., began distributing Dell laptops to ninth-graders in fall 2003.

Others pointed to the significant difference between introducing new technology for its own sake and thoughtful rollout of effective pedagogy reform.

“I think they made the realization that they may have put the cart before the horse,” said G.A. Hagen, a technology resource teacher at T.C. Williams. “It was like, ‘Okay, teacher, here’s the laptop — go with it,’ and [teachers] were like, ‘What do you mean, go with it? Is there a Web site I go to?’ “

Lessons have been learned, if not formally evaluated, and teachers are now trained on software apps and curriculum strategies while students are offered instruction on effective ways to get more from the laptops. One web application now in place at the Alexandria system is Blackboard, an electronic space built for instructor and students to post lectures, provide mentored forums, and backend grade management if needed. Only now, two years into the program are nearly “all T.C. Williams teachers … trained on Blackboard. They will be required to make their courses available on the system by Jan. 8 and to use the program regularly by June.”

I’m surprised I haven’t been able to find much on incorporating appropriate educational tools into the OLPC project yet. A quick check of the OLPC wiki had a paragraph about educational strategies, limited text on documentation and incorporating OLPC into effective pedagogy in low-income settings as well as long laundry list of questions from the interested and curious. You should definitely browse the wiki if you have any interest in the OLPC project. And anticipating criticisms in the Post article, the OLPC wiki does mention teacher training, recognizing that it will be an obviously important element driven by local experts but no greater detail yet.

The OLPC has a admirable goal to take the information age to children who have little chance to be part of it now. Yet to see OLPC as a success five years from now, more thought and effort must be put into user-centered design. There are some entertaining images of village children cranking the machines by night to watch DVDs with their family gathered ’round, but more needs to be done (and shared with an eager world) to indicate how this tool will improve student performance in grossly under-performing educational settings; or in five years’ time we might be reading about the OLPC in the same underwhelmed tone of today’s Washington Post article.

Written by Ben

December 12, 2006 at 1:16 am

Tools for Better Living

The latest issue of Fortune profiles 7 recent devices and ideas that according to them are “remaking our world”. I am not sure if it because I am focusing on this type of thing, but it seems that the mainstream press is paying much more attention to social issues and various private sector focused entities, like Fortune Magazine, are profiling great people and innovations that are helping society. Or it could simply be that as the private sector gets increasingly involved the coverage is also increasing. In my opinion, public health is shamefully far behind in connecting with and realizing the use of the private sector (and technology) in global health efforts. There is a huge chasm between the business world and public health (see Jaspal’s post on the APHA private sector session). Although this may be slowly changing.

fortune_clinton.jpgOn the note of increased coverage, the cover story for Fortune in the summer was about Warren Buffet and from September it was about Bill Clinton’s Foundation. An excerpt from “The Power of Philanthropy” -
Bill Gates has the money. But no one motivates people and moves mountains like Bill Clinton. A look at how the former President has borrowed from the business world to fight HIV/AIDS in Africa and other scourges. “We take a lot of cues from the business world,” says Clinton, who these days can sound more like a CEO than a politician. “We have very entrepreneurial people and a very entrepreneurial process. We identify a problem, we analyze it, and we move. “Much of his staff comes from business, and he says using business practices “allows us to do a lot with relatively small resources.”

Moving onto the current issue of Fortune, one of the chosen 7 brilliant, practical inventions is a self-destructing syringe by UK based Star Syringe (company website). It is good to see that their product is manufactured and marketed in India by Hindustan Syringes & Medical Devices. Full story below:

Fortune Magazine December 2006 – ONE SHOT DEAL

Problem: AIDS and hepatitis are spread by reused needles.
Solution: A syringe that can’t be shared.

Each year 23 million people in the developing world contract hepatitis and 260,000 get HIV from reused syringes, according to the World Health Organization. Twenty-two years ago Briton Marc Koska, 45, saw a solution: a syringe that self-destructs after one use. With seed capital from friends and family, he set about absorbing everything he could about how syringes are used – and misused – around the world.

He reached one important conclusion: “The world didn’t need any more factories,” says Koska. “If I could go to a factory and get them to convert, I could stop them from making bad syringes and help them make the good.” Koska had to design a syringe that could be made with existing equipment and persuade makers to license his design. It was 17 years before his company, Star Syringe, sold its first single-use syringe in 2001.

Today Star Syringe has 16 licensees making and selling 350 million of its K1 devices in 25 developing countries. The K1, says Koska, has helped save more than two million lives. Thanks in part to a nationwide implementation of Star Syringe’s needles, for instance, Uganda has cut AIDS infection rates in half since 2003, dropping from one of Africa’s highest infection rates to among the lowest.”

Written by Aman

December 9, 2006 at 10:57 pm

Ultra run across Sahara

In keeping with the THDblog interest in inspirational personal challenges (see a previous post “Ride for World Health“) an upcoming documentary about an ultra-run across the Sahara also has a public health subtext – bringing clean water to communities across the Sahel and Sahara regions.

Coordinated in part by the ONE campaign, the run has received a good deal of attention on blogs and news outlets. Matt Damon’s production company and the National Geographic are involved in the film.

The charitable aspects of the run are outlined in a Dec 5 Gnet news release.

The money raised by H2O Africa will fund activities of leading charitable organizations and NGO’s that have experience and current programs on the ground in Africa. As the Running the Sahara Expedition crosses Senegal, Mauritania, Mali, Niger, Libya, and Egypt, it will identify key areas of need for clean water programs and H2O Africa will turn to its group of charitable partners to address those areas of need. A key advisor to H2O Africa in the selection of charitable partners is the ONE Campaign. Oversight of H2O Africa programs and initiatives will mainly come through progress-based grant agreements.

It’s a lot of hype with a humanitarian element that will hopefully respond to local need. Stories of overcoming adversity (self-imposed or otherwise) can be powerful narratives that spark a greater or systematic improvement. Witness Michael Fay’s trek (“Megatransect“) across Central Africa in 2004 and the boost to conservation that followed. Or Emmanuel Yeboah’s bike ride across Ghana, despite having only one leg, (“Emmanuel’s Gift“) that changed the way people and institutions treat the disabled.

Written by Ben

December 8, 2006 at 2:39 am

Posted in Global Health, Water

Malaria Atlas Map & Malaria March Madness

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Dec. 5, 2006 Malaria map aims to tackle killer disease

LONDON (Reuters) – Researchers are creating a global malaria map to tackle the killer disease by pinpointing the areas where it strikes most often. The map, the first in 40 years, is designed to spot mosquitoes carrying the malaria parasite and determine where they are likely to infect people so the best control and treatment strategies can be implemented.

The map is based on malaria data from surveys that have been done, population censuses and satellite information. The first version, which will be freely accessible on the Internet, should be available in 12-18 months. You can read the full story via Reuters…

The MAP project has taken a fun approach to knocking out Malaria, they using the US college basketball tournament, March Madness, as a way to energize teams – check it out – malaria march madness. See Pienso for another cool sports/basketball story on tackling Malaria – Sports Illustrated on Malaria Nets.

malariascientist.jpgUPDATE: The cover story of The Scientist this month is – Beating Malaria. Its an okay aritcle with interesting tidbits of information.  The article covers a whole range of issues surrounding the malaria fight – problems with biology, supply chain issues, private market for Coartem, pharamceutical care, provider and patient education, public-private partnerships, poor quality manufacturing, and the role of the private sector. The story is centered around a pioneer in anti-malaria drug reserach and how he shifted the paradigm in malaria treatment to combo therapy which was a breakthrough in the field. This fellow is described as such – “Nosten, who founded SMRU 20 years ago after several years as a young volunteer for Medicine Without Frontiers,  built it into one of the most innovative and productive malaria research outposts in the world.” FULL STORY.

Written by Aman

December 6, 2006 at 7:12 am

Pharmaceuticals for Global Health, 15 Minutes with Victoria Hale

The “News of the Week” from the latest issue of Science (December 1, 2006) has to do with drug research for developing regions and the IP protection system (SEE — DRUG RESEARCH: WHO Panel Weighs Radical Ideas).

globalrxmarketv1.gifAs you can see from the Science figure, the drug market is heavily focused on the US, Japan and Europe (although I think this will change significantly in the next 15-20 years). There is a clear lack of drug development for neglected diseases because there is no market and the current global patent regime prohibits generic knock offs/cheaper alternatives to treat people with diseases such as HIV/AIDS at an affordable price. There is contentious debate over this issue. From the Science article – the Medicines for Malaria Venture president Chris Hentschel says: “If people spent less time thinking about IP and more about other things, we would make more progress.”

So what do you do? Victoria Hale decided to do something. Dr. Hale, who has training in academia, with the FDA and with industry decided to start her own non-profit pharma company, the first in the US. She was interviewed for the most recent issue of Stanford Social Innovation and Review. The interview discusses her mission, how she has brought her first drug to market for visceral leishmaniasis, the cost of drug development ($17 million in this case), drug pricing and some discussion on patent issues. Well worth reading.

Finally I encourage you to check out SSIR, they have some good articles on social innovation and also a several podcasts from leading social entrepreneurs (unfortunately there is no text for the podcasts).

UPDATE: Somewhat related to pharmaceuticals/drug companies, on the technology development front there are two recent news items about vaccine technology. First, the NY Times features a story on pneumonia which the the largest global killer of children, I saw this via the CGD health policy blog. Second, Dr. Buttery discusses the malaria vaccine roadmap, a goal Dr. Buttery has heard about for the past 40 years.

Written by Aman

December 5, 2006 at 9:04 am

Seattle – the new Geneva

This article last Sunday in The Seattle Times (“Seattle moves to forefront in global fight to save lives“) presents a good summary and quick history of the changing centers of power in global health. It is well worth reading.

“Seattle is going to be the epicenter of global health for the 21st century,” said Dr. Paul Ramsey, dean of the University of Washington School of Medicine.Dr. Jim Kim, a Harvard health expert who formerly led the World Health Organization’s AIDS programs, predicts additional donations from Gates will eventually push the foundation’s annual health expenditures to $2.5 billion, rivaling the combined spending of European nations. With such vast sums at play, no other American city can match Seattle’s influence on the world of public health, Kim said. “The presence of the Gates Foundation just blows everybody else out of the water,” Kim said.

[Read full story]

Written by Ben

December 4, 2006 at 9:31 am

Freeware for HIV meds and HIV services management

This past week on the Afro-nets listserve, a consultant in the Netherlands asked about the availability of free software for management of HIV anti-retroviral treatment. The request generated some interesting feedback, as well as gave me pause to consider incentives, development, and leadership.

Tworespondents gave links to freeware options for follow up of patients on HIV anti-retrovirals (ARV). The field epidemiology group, EpiCentre (created by Medecins Sans Frontieres in 1987 – details at Epicentre’s “About us”) has freely available clinical management software called “Fuchia”. The software is updated as of October 2006. The site explains:

The “Follow-Up and Care of HIV Infection and Aids” software, otherwise known as Fuchia, has been designed tofacilitate the clinical, biological and therapeutic monitoring of HIV positive patients.

A software prototype was created at the start of 2000, in partnership with MSF France’s technical department and various medical teams working in the field. Since June 2001, a technical committee – comprising of members from five MSF sections (Belgium, France, Switzerland, the Netherlands and Spain) and the Epicentre – has been involved in the process of developing Fuchia. These five MSF divisions are also responsible for financing the development of this software.

More technically speaking, Fuchia is a database interface operating in a standard Windows environment (95, 98, Millénium, NT4, 2000 et XP), written in Object Pascal (Borland Delphi) and connected to an Access database.

As a footnote, one of EpiCentre’s field offices operates at the same Ugandan university (MUST) where I conduct field work.

The second respondent highlighted the OpenMRS wiki (open medical records). The developers explain:

OpenMRS is an application which enables design of a customized medical records system with no programming knowledge (although medical and systems analysis knowledge is required). It is a common framework upon which medical informatics efforts in developing countries can be built. The system is based on a conceptual table structure which is not dependent on the actual types of medical information required to be collected or on particular data collection forms and so can be customized for different uses. AMRS is based on the principle that information should be stored in a way which makes it easy to summarise and analyse, i.e. minimal use of free text and maximum use of coded information. At its core is a concept dictionary which stores all diagnosis, tests, procedures, drugs and other general questions and potential answers. OpenMRS is a client-server application which means it is designed to work in an environment where many client computers access the same information on a server.

These and related efforts to create functional and cost-effective ARV management databases should take a pointer from the Healthcare IT Blog – agree on a common language and foundational concepts. And AmbulatoryComputing.com has solid recommendations for any local system implementation, though the focus is on US operations.

UPDATE DEC 13th:

An additional firm, South African Health Information Systems Programme is worth checking out.  A short summary of their work:

The Health Information Systems Programme (HISP) has since 1994 expanded from a pilot project in three Cape Town health districts to a global South-South-North network active in around 15 countries/states with over 200 million people in Africa and Asia. The network comprise universities, Ministries of Health, NGOs, and companies. All our ICT solutions, materials, and experiences are shared based on “Free and Open Source Software” principles. The primary focus for HISP is developing and implementing integrated Health Management Information Systems for routine data, semi-permanent data, and survey data. Databases using our District Health Information Software (DHIS) contain data representing over one billion patient visits. The DHIS is designed to support health workers and managers at all administrative levels through a balance between flexibility and standardization, and with a strong emphasis on USING INFORMATION FOR LOCAL ACTION. The DHIS has been translated into Portuguese, Swahili, Spanish, Telugu, Russian, Mongolian, and Chinese – Vietnamese and French are under way. Around 70% of overall HISP effort goes into training, with an estimated 7-8,000 health workers and managers trained in South Africa alone. The HISP network, while having university partners in Norway and Sweden, is predominantly run BY professionals from the south and FOR countries in the south.

Written by Ben

December 3, 2006 at 1:05 pm

Ride for World Health 2007

ride4health.jpg
Are you searching for an opportunity to get involved with international health?  Are you interested in biking cross-country?  Now is the time to act…In April 2006, the first Ride for World Health departed from San Francisco, CA on a 3,700 mile journey ending in Washington, D.C. in May 2006.  Along the way, the riders hosted over 40 lectures at major medical centers and community health clinics.

With vigorous fundraising efforts, Ride for World Health grossed over $130,000 for its 2006 beneficiary, Partners in Health.  This year, the money raised will benefit The Pendulum Project and Global Health Access Program.  The Pendulum Project provides funding to grass-roots community groups in sub-Saharan Africa to support children with AIDS.  Global Health Access Program is run solely by professionals who volunteer their time to provide health services and basic resources.

1. We are still searching for motivated individuals who are interested in participating in the 2007 Ride as a riders.  Please apply today at www.rideforworldhealth.org/apply.

2.  Plan to attend a lecture, or better yet, attend a lecture and help us promote The Ride for World Health Coast-to-Coast lecture series as we come through your area.

Written by Aman

December 2, 2006 at 8:48 am

Microbicides, Cheaper ARV Drugs and Global Media AIDS Initiative

Today is World AIDS Day and there are three pieces of good news to report.

vivagel.jpg

1) UCSF study will test new vaginal microbicide for herpes and HIV
Two days ago, UCSF reported that they will start the phase I clinical trials of microbicides in the US. For those of you unfamiliar with microbicides, I do not think that it is a stretch to say the potential of this drug is revolutionary. As the the Global Campaign for Microbocides states – “Microbicides would be the most important innovation in reproductive health since the Pill.” I first read about this new trial over at medGadget. The entire microbicide story is a fascinating example on many levels – women’s empowerment, innovation in drug design, potential low cost supply of raw materials, and a massive public-private partnership undertaking. I am sure we will have many future stories about this technology.

2) Clinton’s Foundation Brokers AIDS Deal
The NY Times reported yesterday that a major and timely breakthrough that may not have been possible in a few years due to changing global IP (TRIPS) regulations, the Clinton Foundation negotiated an over 50% cut for 19 different ant-retroviral (ARV) drugs for kids.

3) Global Media AIDS Initiative now being run by South Africa ABC Network
“Today at the United Nations MTV Networks International (MTVNI) is handing over the Chair of the Global Media AIDS Initiative (GMAI) Leadership Committee to Dali Mpofu, CEO of the South African Broadcasting Corporation (SABC). Kofi Annan, commented: “Since the launch of the Global Media AIDS Initiative in 2004, there has been overwhelmingly broad participation…has mobilized media companies around the world to make unprecedented commitments to HIV prevention through innovative campaigns and programming. “There has never been a greater effort by media to fight this epidemic,”

Written by Aman

December 1, 2006 at 7:08 pm

Reproducing Inequities (in Haiti)

Last week in Berkeley, I had the chance to hear Catherine Maternowska speak about her new book, Reproducing Inequities. In the book, she reflects on 12 years of fieldwork in Cité Soleil, Haiti, developing a political economy framework to explain the causes of inequities in reproductive health services in an urban slum of Port-au-Prince. In part, what makes it interesting is that she worked in a very dangerous part of Haiti during tumultuous times. Just last week, two Jordanian UN Peacekeepers were shot dead in Cité Soleil (BBC News).

Related to the concerns of technology, health, and development were her observations regarding clinical studies. At one time in Cité Soleil, 22 simultaneous studies were being conducted, including one for Norplant, a subdermal contraceptive. Here is some info from a Population Research International report on the Norplant study:

USAID has carried out Norplant testing in Cite Soleil, one of the poorest communities in Haiti. Norplant insertions were done without the informed consent of the women concerned. Norplant removals were denied or delayed, even to women who suffered extremely severe side effects such as bleeding extensive enough to cause anemia or paralyzing headaches.

Needless to say that the realities of informed consent on-the-ground were very different than the policy of the foreign managing organizations.

Written by Jaspal

December 1, 2006 at 1:46 pm

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