Archive for the ‘Access to Health’ Category
Swine flu is in. In the rush to cover this latest possible pandemic, newswires are alive with activity, blogs and social networking sites are buzzing, and the CDC and WHO are back in the limelight. This despite the fact that the number of cases are limited (only 40 confirmed infections have occurred in the US).
The rush of news has been accompanied by a rush to track that news. The WSJ, amongst others, has a tracking website, including a map of infections in North America. Best of all, Google has a map showing how the infection is traveling.
This rush was started by Google Flu Trends, a website that tracks flu-related search queries to estimate influenza levels in different US states. Further studies suggested the same approach might work for other diseases as well.
Analyzing Google Trends
So how has Google Trends, the broader application of the Flu Trends concept, performed in the current scenario? A quick analysis shows that Google search results did in fact increase over the past few days (see chart – source: Google Trends).
A quick analysis shows three items worth mentioning:
- First, while Google Trends does show an increase in search activity on “swine flu,” the first uptick in activity only occurred on April 23. By contrast, the first news stories appeared on April 21 when two cases were confirmed in California.
- Second, Google Trends reports that the majority of search queries were from New Zealand, USA, UK, Canada, and Australia. Only a very small minority were from Mexico. Yet, Mexico is the country supposedly at the heart of the pandemic.
Explaining the Discrepencies
I had used a Google Trends like methodology two years ago to track the evolution of climate change as an issue in news coverage. Having worked on that, I can propose a few general reasons that explain why Google Trends is limited in this case.
First, it appears that Google Trends follows with some time lag, actual infections. This should not be surprising, as people are not likely to search for a disease before having had some exposure to it. This does not mean that it is not a useful tool for tracking diseases over the long term. At the very least, the response time of a system based on GT might be lower.
Second, the current scenario shows that Google Trends is highly susceptible to “noise.” Prior to this outbreak, swine flu was probably not a commonly known disease, and queries on it were extremely rare (if not non-existent). Thus, even the slightest uptick in search activity would show up as a major change. That uptick was provided by the highly charged media coverage of the subject. Given this, one wonders if the search results are more “noise” and less people with a genuine interest in the subject. So, Google Trends is likely to be more accurate where general knowledge of a subject (the baseline) is high, and media coverage (noise) is low.
Finally, and most interestingly, why is it that most of the search results came from the US, while Mexico is more exposed to it? Not surprisingly, this methodology only works where both a large number of the population and media are on the internet.
What Next for Google Trends?
When discussing why most search queries occurred in the US, it is worth noting another fact about the swine flu outbreak – that it has traveled extremely fast. Originating in Mexico, it has been carried to the USA, Spain, and New Zealand. This brings into question the validity of using the geographic source of search queries as a reliable indicator of where the disease actually is.
Still, it may also offer a way to enhance Google Trends. What if Google Trends data was combined with travel data on the number of people traveling from a “hotspot” of an infectious disease. It would be logical to assume that popular destinations, or ones which receive travel groups, would be the most likely next locations for further infections. Thus, a map could potentially be created of not only where the disease is generating interest, but where it might be headed.
Of course, Google does not have access to such data – though at some point it may decide to acquire a travel operator. But the general lesson is simply that to make Google Trends more useful, search query data needs to be looked at together with real-world data (such as travel data or hospital records).
It is still early days for the swine flu outbreak, but some commentators are already suggesting the “social web” has actually created hysteria rather than help track the disease. That may be true, but it is hardly a problem of the “social web.” As a reader on the FP pointed out, “Twitter is only a natural extension of a typical neighborhood.”
So, in this “typical neighborhood,” what the swine flu outbreak has done is illustrate where Google Trends does well – in tracking general interest amongst heavy Internet users. But it also exposes limitations – the methodology is (not surprisingly) susceptibility to “noise” from media coverage and is biased towards countries and issues that are online. This does not mean that the idea itself is flawed. Just that it must be taken with a pinch of salt, and that it needs work – especially interfacing it with real-world data streams – to make it really useful.
Please vote for Ben’s mobile payment for health systems project. Voting closes Friday.
VOTE – NETSQUARED: By introducing a smartphone and web-application system for submitting and reviewing claims, we hope to reduce the delays and errors, increase clinics’ profitability and improve communication. Below is a related post by Melissa Ho who is working with Ben on this project which fills a critical gap. Cross posted from ICTDCHICK:
As I have been pre-occupied with writing lectures for my class, and setting up my research, my collaborating partners at Marie Stopes International Uganda have been busy launching a new phase of the output-based aid voucher program, financing in-hospital delivery of babies, in addition to the in-clinic treatment of sexually-transmitted infections (STIs). The new program, called HealthyBaby is eligible to mothers who qualify under a specific poverty baseline and covers four antenatal visits, the delivery, and a postnatal visit. Last week they just started distributing vouchers, and this past weekend was the delivery of the first baby whose birth was covered by the program.
Like the HealthyLife program, the mother purchases a voucher for 3000 USh (approximately 1.50 USD, the HealthyLife program charges 3000USh for a pair of vouchers treating both sexual partners). The voucher then can be broken into several sticker stubs, one of which is submitted with a claim form on each visit.
The hospital then submits the claim form with the voucher to the funding agency (my collaborating organization), who then pays the hospital for the cost of the visit – labs, any prescriptions given, the consultation fee, etc. You can see in the picture to the right the nurse filling out the paper form and the mother putting her thumbprint on it. Filling out the forms can be tedious and error prone – this particular clinic had almost 18% of their STI claims rejected for errors last October. In the same month another clinics had 38.6% of their claims rejected. I am trying to work on digital systems that can help improve communications between the clinics and the funding agency, and also decrease the cost and burden of claims administration.
The Claim Mobile project actually focuses on the HealthyLife program – the STI treatment program, rather than the HealthyBaby program, but I hope to demonstrate the sustainability and replicability of the system that I’m developing by training the engineers here to retool my system for HealthyBaby – so by the time I leave, I am hoping it will be in place for both programs.
By coincidence, this first birth occurred in one of the two clinics where I’m running the pre-pilot of the Claim Mobile system.
The WHO has decided to focus this World Health Day on hospital infrastructure during times of emergency. The folks over at Global Health Progress have a good round of what some bloggers are saying and include health journalism folks as well as thoughts from the AvianFlu diary. I thought I would go off theme and briefly throw out some thoughts on the bigger picture and encourage you to use this day to think about what is the future of global health? In this context of thinking about the future in 10, 20 or 30 years, the world is in turmoil and we are questioning the fundamental nature of market driven economies, why not use this as an opportunity to do the same for global health in a forward looking way? Think about where we are and whether we are prioritizing the right things and moving in the right directions?
Approximately 10 (only TEN!) years ago there was no Google, Kiva, Gates Foundation or knowledge about the cost differences between generic and brand name drugs (see this great talk on the Future of Global Health by Jim Yong Kim and his discussion of how they reduced the price of treating MDR TB patients by 80-90% in 1999) amongst major care organizations (absolutely stunning). Mobile phone penetration was less than 1% in developing countries and social entrepreneurship wasn’t hot, the vast majority of us probably hadn’t even heard of that term.
Where we were ten years ago is arguably a profoundly different world from where we are today and per the video below “we are living in exponential times“. To give you further inspiration to think differently today definitely watch the below (via 2173):
The acceleration of technology for social change and global health is going to increase, in this decade alone the convergence of movements in philanthropy, entrepreneurship and technology all enabled by the internet and mobile phone revolution have allowed people to collaborate, innovate and communicate on an entirely different level. I don’t know what the future of global health is – but I wonder how open source collaborations will contribute to solutions and whether twittering for global health will be around in five years and for whom and what purpose? Or will we just be doing more of the same. I wonder if we will be doing entire marketing and health education campaigns via mobile phones and how this will evolve. Will there be convergence of people and ideas working on global and domestic health? Will the flow of innovation and products from “South” to “North” become the next hot topic? I wonder if we will have a TED just for Global Health?
We might face a global crisis in 2030 but we will also be better equipped to face that crisis.Today is a day we should be thinking about what all the possibilities are and how we can get there in the fastest way possible. The last idea I will throw out as food for thought is to think about what have been the top 10 biggest developments in global health in the last decade and how will these shape the future?
“In London, Washington and Paris, people talk of bonuses or no bonuses…in parts of Africa, South Asia and Latin America, the struggle is for food or no food…the greatest price for incompetence at the summit will be borne by the poorest people in the world.
Oxfam has calculated that financial firms around the world have already received or been promised $8.4 trillion in bailouts. Just a week’s worth of interest on that sum while it’s waiting to be deployed would be enough to save most of the half-million women who die in childbirth each year in poor countries.”
Nicholas Kristoff, NY Times, At Stake are More than the Banks, April 1, 2009
A different more pro-active spin on the above comes from Lynne Twist:
“This is a time that I think history will look back on and say, ‘These are the people, this is the generation of humankind that went through a transformation that made the future of life possible. These are the people who had the courage to make profound changes in the way they were thinking, as well as in the way that they were behaving, that gave the future to life itself.”
I got a couple of requests to post two informative efforts. Note the Senate hearing tomorrow and the tie made to global food security. Second various agencies are linking up to administer 4 million anti-worm medication, that’s an impressive amount:
GLOBAL HUNGER HEARING
As a reminder, tomorrow, Tuesday, March 24th, the Senate Foreign Relations Committee will hold a hearing entitled “Alleviating Global Hunger: Challenges and Opportunities for U.S. Leadership” at 9:30 a.m. in room 419 of the Dirksen Senate Building (AGENDA). The committee has invited Dan Glickman, former secretary of agriculture, and Catherine Bertini, former executive director of the World Food Program to testify at the hearing, offering their insight as co-chairs of a recent Chicago Council on Global Affairs’ report entitled “Renewing American Leadership in the Fight Against Global Hunger and Poverty: The Chicago Initiative on Global Agricultural Development.”
Congress has recently recognized the importance of this global food security (2009 Foreign Operations Appropriations bill). This legislation mandated that $75 million in Development Assistance funding be spent “to enhance global food security, including for local or regional purchase and distribution of food, in addition to other funds otherwise made available for such purposes and notwithstanding any other provision of law.”
RWANDA’S MOTHER AND CHILD HEALTH WEEK KICKS OFF MARCH 24
The Global Network for Neglected Tropical Diseases’ Control Program Teams with Rwandan Government and International Organizations to Deworm More Than 4 Million Children Nationwide, Covering Nearly Half of the Country’s Population
NTD Prevalence Rates Up to 95% Among Rwandan School-Children
Over the course of the week-long initiative, representatives will administer albendazole to a targeted population of 4 million children under five, school-aged children, and post-partum women, to treat for soil-transmitted helminthes (STHs). Additionally, in the high prevalence areas, praziquantel will be administered to an estimated 100,000 people for schistosomiasis infection. The goal of the campaign is to treat all pre and school-aged children nationwide – covering approximately one-half of Rwanda ’s population. Vitamin A, immunizations, family planning services and health education messages will also be delivered throughout the country during the course of the campaign.
Why: Research has shown that eliminating the burden of NTDs could lift millions out of poverty worldwide by ensuring children stay in school to learn and prosper and improving maternal and child health. NTDs infect over 400 million school-aged children throughout the developing world. Treating their infections is the single most cost-effective way to boost school attendance. Controlling intestinal worms alone will help to avoid 16 million cases of mental retardation and 200 million years of lost primary schooling
When: Tuesday, March 24th – Friday March 27th
I’ll be in New York attending the health portion of the following workshop. Please pass the word and if you are around and want to meet up send us an email (thdblog AT gmail).
“The CATER research group cordially invites you to attend the 2009 workshop on “Technologies for Development” which showcases our ongoing research efforts in the space of appropriate technologies that aid development in under-developed areas around the world.
Cost-Effective Appropriate Technologies for Emerging Regions (CATER) is a new multidisciplinary research initiative at NYU that focuses on developing appropriate, low-cost Information and Communication Technologies (ICT) for addressing pressing problems in developing regions. CATER is a joint initiative comprising faculty from Computer Science, the School of Medicine, the Wagner Graduate School of Public Service, NYU’s Economics Department, and NYU-Polytechnic.
This workshop will feature a combination of invited talks from accomplished researchers and short talks by student researchers within
CATER on their ongoing research efforts. The talks will cover four important areas:”
· Technologies for improving access to communications in rural areas
· Technologies for enhancing rural healthcare
· Technologies for enhancing financial and commerce services
· Technologies for enhancing rural education
On March 19th I will be participating in an online conversation about output-based aid hosted by PSP-One. Output-based aid (OBA) financially empowers patients to make choices about where they receive their healthcare and incentivizes providers to deliver high quality services. The management of OBA systems builds institutional capacity to provide cost-effective care to targeted populations. However, OBA is by no means a panacea to what ails health systems in low-income countries. Join in on the discussion to find out more! Once again it is March 19th:
9:30 am Eastern (United States)
1:30 pm (13:30) Greenwich Mean Time
2:30 pm West Africa Time Zone
3:30 pm Central Africa Time Zone
4:30 pm East Africa Time Zone
If you would like to receive details about the chat or would like to suggest questions for discussion, please email the organizers at: email@example.com. You will need to register beforehand on the Network for Africa. Registration takes 30 seconds at the following link: http://www.conferences.icohere.com/vouchers
I feel compelled to throw out some slightly disjointed thoughts about the global economic meltdown, especially since the discussion with respect to global health is just beginning. One of the other voices discussing this is Lucy Bernholz, she has a series of fantastic posts on the impact of this downturn on philanthropy and I link to some of her posts below which is must reading.
Global wealth has been destroyed to the tune of 50%; Microsoft and NPR are laying off people for the first time in a long time; Google, Disney, WSJ and the NY Times are laying off and NYC Mayor Bloomberg is suggesting he might have to cut 20,000 city workers; the nation of Iceland has declared bankruptcy and tens of millions have been laid off in China where they are facing a gargantuan commercial real estate bust in Beijing coupled with dwindling job prospects. And if you think the US is in bad shape, Europe is facing a whole lot more pain. The point is that the economic meltdown is having an impact far beyond the usual suspects; this economic crisis is wide and deep and no one knows how long it will last. There is no question that we are entering a fundamentally different world on many levels – dialogue is needed now on what can be done and how this will reshape giving, accountability, fiscal responsibility, priority setting, and of course what counts at the end of the day – health and poverty. The global health community should have discussions on how we can all be more accountable and how we are using funding. We need to be aware of the coming impact on global health funding and beyond.
Pillars of the Global Health Complex
Capital flows and financial support for global health comes from a spectrum of actors (governments, foundations, NGOs, private donations, and many others – see our previous post here on R&D funding flows). These agents are the threads that provide patchwork netting for funding and capital injections through a range of channels, whether that is via medical donations, immunization campaigns, pilot projects, research, education, training programs or remittances. Make no mistake, all of these channels have been or will be impacted. “CGD fellow David Roodman has shown that after each previous financial crisis in a donor country since 1970, the country’s aid declined…“Aid for health is no exception.” But don’t expect governments to announce cuts in foreign assistance; the contraction will be invisible, with disbursements quietly dragged out and a contracting seeing a slowdown…” (Source: Global Health Magazine). With regards to US based foundations, a March 2009 research report found that “of the largest 100 foundations ranked by total giving, only two with announced intentions to grow their funding in 2009–the Gates Foundation and the MacArthur Foundation…six of the largest 100 foundations have so far announced plans to reduce their giving in 2009.” (Source Foundation Center).
I have blogged previously on the University based global health bubble (?) and I would like to see some hard numbers on global health jobs placement, impact on these new programs, whether the programs are halting building construction and staff hiring (as many universities are). Endowments at top universities in the US have taken a beating, so much so that some are considering selling prized art collections. Even one of the world’s richest business schools, with a $1 billion endowment, is cutting back. What will be the impact on schools of public health or all the newly opened schools of global health? Will all this promised global health funding actually materialize? Will students rethink spending tens of thousands on graduate programs in global and public health? Will there be scholarship funding for international fellowships and the development of new ideas and products for global health populations? The university system is of course just one corner of the global health complex but an important one – one that is a foundation for research into neglected diseases or developing human resource capacity in developing countries through education and exchange programs. Steven Davidoff, a professor at the Univ. of Connecticut, has a must read breakdown of why schools like Harvard are cutting back and are facing a worsening economic picture in 2010 and beyond (NY Times, 3/3/09, Harvard, Private Equity and the Education Bubble). In short, below are five obvious trends to watch, by no means is this a comprehensive list.
Impact on pillars of the global health/development sector:
1. Foundations/Philanthropy – many will suffer due to unprecedented (poor) investment returns and reduced donations.
2. Corporate Sector – reduced giving and less leverage to engage in partnerships or development of new products (drugs, etc).
3. Government Aid – some countries rely on massive amounts of aid for even basic things like immunization programs.
4. Remittances – with global job losses this will continue to erode.
5. Universities – endowments have been drastically reduced, classes cut and hiring freezes implemented.
Reorientation to Infrastructure Spending
This crisis is an opportunity to recognize bigger picture global health issues and perhaps with the relatively recent shift in thinking and the push to reshape the global health agenda to emphasize health system infrastructure and workforce development, there may be more interest in funding long range macro level projects (as with some of items included in the US stimulus package for infrastructure). Even small amounts of money for infrastructure can have large impacts, like building bridges to reduce malaria, for example.
And let’s not forget, that one of the best things Cuba did for population health after its economy collapsed was to invest in its health system. Obama has called for massive infrastructure spending and I am wondering if poor economies will be able to do the same. There is some hope for this because low income nations know they must continue to build roads, bridges, and highways in order to continue “development”. Hopefully this will largely be positive for global health efforts (especially if some of that includes public health and medical infrastructure). Perhaps this economic meltdown will be an opportunity to take stock and shift some funding towards long term capacity building.
Reason for Hope
On the positive side, the Gates Foundation is actually increasing their payout, not decreasing it by $300 million as we first discussed a few months ago. Additionally the new center of gravity for global health (Seattle) is going to be adding 2400 global health jobs over the next few years. The World Bank is going to double their health loans and as of now very few ministries of health are reporting they will cut back on health spending (although I am not sure I believe this entirely). There is also some evidence that giving actually rose through the depression, perhaps because people still give to causes that are part of their core belief sets (as opposed to nixing discretionary spending like holidays or eating out).
I believe the pain is going to be severe (with 2010 being worse) and we are already seeing major cracks in the social fabric in various locations. The velocity and violence of this global economic downturn will have serious widespread impacts. Over the past decade the Gates Foundation along with others have brought unprecedented financial resources that helped fuel a boom in certain sectors and innovation in the development of appropriate technology, social ventures and the growth of areas like microfinance, all of which generated tremendous energy and buzz. We have now entered a new era with a drastically different macroeconomic backdrop, yet we are equipped with these new tools (think Kiva) developed during what might be have been a golden age of global health funding/philanthropy in comparison to what might happen over the next decade. A discussion is needed on how to prepare for the worst, how to fund and spend more wisely, how to allocate resources, and how to spot vulnerabilities (e.g. what areas or diseases are especially sensitive to funding flows). I welcome your thoughts and discussion on this.
1. Some nonprofits can’t touch their money, link
2. Global Financial Crisis, Global Issues
3. How to Get Funding for Your Global Health Activity, Change.GlobalHealth.Org (my new favorite blog)
4. Economic crisis fueling social unrest, link
5. Aid Agency Budgets Go Bye-Bye, Change.org
6. Global Health tv: Global Economic Downturn, video
7. Philanthropy in a Global Economic Crisis, link
8. The Economic Crisis: A Generation of Reproductive Health “Horror Stories”, RH Reality Check
9. Migration in light of the economic crisis, NextBillion
10. Hard Times for Health Charities, link
11. WHO on the crisis, WHO
12. The global financial crisis: an acute threat to health, Lancet
13. No relief: Red Cross hit with tough times, ChemistsWithoutBorders
14. World Bank offers dire forecast for world economy, link
Purely as entertainment I enjoyed Slum Dog Millionaire and because of the Oscar victory people have become more curious about global slums. How do I know this? The hits on this blog have increased in the past two days with people specifically drawn to a previous post we did: Dharavi: Mumbai’s Shadow City. Take the following with a grain of salt, but note the increase in interest:
“Movies have a powerful ability to evoke a sense of the exotica about the locations in which they are filmed. They are widely acknowledged to inspire travel to those destinations….According to Expedia sources, post ‘Slumdog Millionaire’, Mumbai now tops the chart of global tourist destination.” Source Yahoo News
Additionally, OneWorld Health has decided to explicitly use the movie as a avenue to educate people more about global health needs:
The Institute for OneWorld Health, the non-profit pharmaceutical company that develops drugs for people with neglected infectious diseases, announced it is launching a new awareness campaign inspired by the highly acclaimed Oscar-winning film, Slumdog Millionaire…OneWorld Health is running a full-page ad in the New York Times on Monday, Feb. 23. Slumdog Millionaire, an underdog story about poverty, love and hope, won eight Oscars at last night’s Academy Awards ceremony, including Best Picture. For the full story see OWH here.
A by product of Slum Dog is that tens of millions of people who previous had very little knowledge about global poverty got a little glimpse into that world. Picking up on this curiosity, another place to learn more is a fantastic multimedia project by Magnum Photos that is well worth your time (hat tip to TinkuB) :
The above two headlines on global health funding flows and allocation caught my attention. The original study was published in PLoS Medicine. The article has some great figures (some of which I have reproduced below). A few things immediately stick out – the amount concentrated on HIV/AIDS, TB and malaria is astounding. Second the US is providing 70% of the funding and on the surface one could argue that other countries really could be pitching in more. On that note, the Gates Foundation by itself is out funding the European Commission almost 4 to 1 – if that isn’t embarrassing I don’t know what is. Finally, the US Department of Defense is high on the list (surpassing USAID). Interesting stuff:
“HIV/AIDS, tuberculosis and malaria initiatives accounted for about 80% of the $2.5 billion that was spent on research and drug development for developing countries in 2007… However, pneumonia and diarrheal illness, which are two major causes of mortality in developing countries, received less than 6% of funding.”
Guest post by Khizer Husain, Owner of Shifa Consulting (see also previous post on healthcare in the Emirates)
Three Observations in Arab Healthcare Delivery
I attended the 34th annual Arab Health Congress in Dubai last week. This is the largest regional conference on healthcare. The event was massive: it drew more than 50,000 visitors and 2,300 exhibitors which span all facets of healthcare including care delivery, technology, consulting, staffing. According to the medical director in Abu Dhabi’s Sheikh Khalifa Medical City, ‘Our institution looks forward every year to Arab Health as a means of reviewing the latest technology; networking with suppliers and vendors and to update medical knowledge. The increased participation and attendance at Arab Health is of value to all of us in the healthcare field.’ Here are some observations on the delivery of healthcare in this part of the world:
Economic Downturn Putting Projects on Hold
The global financial meltdown has not spared the Middle East and the UAE in particular. There are many sites that are empty pits with cranes standing idle. Hospitals have put on ice new expansion plans. Overall, it is estimated that 8% of the labor force in Dubai has left the country in the last four months due to the worsening economic climate. I heard a couple of people talk about the thousands of cars that were left abandoned at the Dubai airport as people could not pay their loans and thought it best to flee the country. Up until last year, healthcare expenditures in the region were growing 16% per year and exceeding $74B.
The silver lining here is that global steel prices are down 75% and smaller construction projects at well-capitalized institutions can for the first time gain traction. A notable exception to the economic dip is Qatar. According to ArabianBusiness.com, Qatar’s economy (http://www.arabianbusiness.com/541046-qatar-economy-could-grow-by-10-in-2009) could grow 10% in 2009 as it expands exports of liquefied natural gas, making it the world’s fastest growing economy.
Thirst for World-class Standard of Healthcare
There is a strong desire in the Gulf to catch up to the healthcare levels of the industrialized world. Until just a few years ago, the only way to bridge the gap between what national populations desired and what was offered in their native countries, was to open the doors (wide open) to medical tourism. The UAE reportedly spent over $2B per year to ship its citizens to foreign countries for medical treatment. Not only were these expenditures unsustainable, but they put these countries at a competitive disadvantage for recruiting highly skilled expatriates. The only way to turn down the medical tourism spigot was to invest locally in building healthcare expertise. Due to poor perceived quality in local healthcare, stymied access to care, and perverse financial incentives to go abroad for care, medical tourism is still a powerful force.
Enter Multinational Healthcare Corporations
The landscape for international healthcare providers with business in the Middle East is becoming increasing crowded with the major players hailing from the US, Europe, and Canada. There seem to a few dominant models:
a. Market Destination Hospital: A number of institutions have outposts in the Middle East that they use to run clinics and make the necessary arrangements to funnel patients to the flagship entities. Mayo, Washington Hospital Center, University of Chicago follow this model. The Great Ormand Street Hospital in London sends in a rotational team of pediatric specialists to run clinics close to the patients.
b. Secure Management Contract: This is where the cash is. Running a tertiary hospital in the UAE can yield $6M per annum. The big players in this sector include Cleveland Clinic—which runs Sheikh Khalifa Medical City and will run the new Cleveland Clinic Abu Dhabi when it finishes in a few years. Johns Hopkins International has three affiliate hospitals in the UAE and a hospital in Beirut. UPMC runs the gamut of managing whole hospitals to managing individual departments like the emergency room. The Methodist has teamed up with property development company Emaar to create an outpatient clinic which they will manage—the Burj Medical Centre. Emaar has aggressive plans to expand clinics and hospitals throughout the Middle East and North Africa.
c. Joint Venture: South African Mediclinic obtained ownership share of Emirates Healthcare in 2007 for $53M. With two hospitals and three clinics in the pipeline, they are the largest private provider of healthcare in Dubai. Mediclinic derives nearly half of its profits from overseas ventures (in the Middle East and beyond).
While it is quite exciting to see all this development in healthcare, everyone agrees that the only way to have real, sustainable progress in region is to build an army of indigenous healthcare workers. Unfortunately, the curse of petrodollars is that it leaves little incentive for nationals to aspire to become nurses and doctors, let alone outstanding clinical managers. In the meantime, India and the Philippines serve as the golden geese.
Want to know what 50 cents can buy? Watch the video in full, read the press release below (announcement to be made today at Davos) and check out http://www.just50cents.org/:
I will link to the full press release when it’s up, in the meantime here is the intro:
Global Network for Neglected Tropical Diseases Receives $34 Million Gates Foundation Investment to Scale up Prevention and Treatment Efforts
New “End the Neglect 2020” Campaign Aims to Greatly Reduce the Burden of NTDs Davos, Switzerland, January 30, 2009 –
“The Global Network for Neglected Tropical Diseases today announced that it has received $34 million through a grant from the Bill & Melinda Gates Foundation to the Sabin Vaccine Institute to step up the global effort to prevent and treat neglected tropical diseases (NTDs). These debilitating and sometimes deadly diseases affect 1.4 billion people worldwide who live on less than $1.25 a day. With the new grant, the Global Network is launching a campaign to catalyze additional funding and will establish a global alliance to scale up NTD treatment and prevention efforts. “
Controlling NTDs is considered a “best buy” in public health because of the availability of extremely low-cost interventions and the resulting high return on investment. For approximately 50 cents per person per year, the seven most common NTDs – which together represent 90% of the global NTD burden – can be effectively treated. ”
Ashoka’s Changemakers along with RWJF is sponsoring a very cool competition – “Nudges” – read below for details and please pass along (thanks to Roberto for sending). The competition was named after Cass Suntein’s book Nudge, Cass has been asked to join the Obama administration. In addition to checking out the competition link below, see the RWJF Pioneer Blog which I follow. The “Nudge” competition is about the little reminders, notifications, and encouragements towards action. With health, behavior change is one of the hardest things to impact and we haven’t been very good about designing or focusing on subtle pushes which are fundamentally critical to health care. While I could name quite a few innovative ideas we have covered on this blog, one that comes instantly to mind is the teachAIDS animation created by Piya Sorcar (it’s got technology, education and behavioral impact components). I am looking forward to seeing what innovations this competition yields.
Designing for Better Health Competition
Ashoka’s Changemakers is collaborating with the Pioneer Portfolio of the Robert Wood Johnson Foundation to launch a global search for “nudges” – innovative little pushes – that help people make better decisions regarding their own health and the health of others.
We are inspired by people and organizations like the Destiny Health Plan that provides “vitality bucks,” an alternative currency that allows people to earn travel and shopping rewards every time they make healthy choices. Another motivating example is CARES, an anti-smoking and savings program in the Philippines that offers smokers the option to invest the money they would normally spend on cigarettes into a savings account. “Designing for Better Health” is investing in the most valuable of all resources – people themselves. Here are the many ways in which you can participate:
Do you know innovators who work to help people make choices that improve their health? By nominating them, you will provide them the opportunity to promote their projects on a global platform and get connected with potential funding.
We are generally focused on solutions and here, but I couldn’t help but post this news story on pharmaceutical “waste” being dumped into the water supply in India and what the subsequent impact might be (drug resistance, unknown clinical damage to those who consume the water, environmental destruction):
PATANCHERU, India –When researchers analyzed vials of treated wastewater taken from a plant where about 90 Indian drug factories dump their residues, they were shocked. Enough of a single, powerful antibiotic was being spewed into one stream each day to treat every person in a city of 90,000.
And it wasn’t just ciprofloxacin being detected. The supposedly cleaned water was a floating medicine cabinet — a soup of 21 different active pharmaceutical ingredients, used in generics for treatment of hypertension, heart disease, chronic liver ailments, depression, gonorrhea, ulcers and other ailments.
Those Indian factories produce drugs for much of the world, including many Americans. The result: Some of India’s poor are unwittingly consuming an array of chemicals that may be harmful, and could lead to the proliferation of drug-resistant bacteria.
In India, villagers near this treatment plant have a long history of fighting pollution from various industries and allege their air, water and crops have been poisoned for decades by factories making everything from tires to paints and textiles. Some lakes brim with filmy, acrid water that burns the nostrils when inhaled and causes the eyes to tear… “I’m frustrated. We have told them so many times about this problem, but nobody does anything,” said Syed Bashir Ahmed, 80, casting a makeshift fishing pole while crouched in tall grass along the river bank near the bulk drug factories. “The poor are helpless. What can we do?”
DC is going through the post-election post-inaugural blues. Now the real work begins and there is plenty of buzz around all sorts of issues. One that is receiving some attention is a push to influence food policy. The guys over at WhoFarm.org (White House Organic) have been traveling across the country in an organic farm bus to show that you can do this anywhere. Additionally, leading celebrity chefs are pushing the issue as well. Did you know that the White House did have its own garden before? The Victory Garden planted by Eleanor Roosevelt inspired the rest of the country, so don’t doubt the impact this could have if Obama ripped up the White House lawn. Check out the below video and if you are inspired sign the petition below the video:
- San Francisco City Hall already has their own Victory Garden, Link
- American Victory Garden, Past and Present, worth checking out, Link
- A lengthy post over at BlogHer debating the issue, Link
This is a requested post (the info was sent to me to post). For those who are looking for more events during the blockbuster inauguration weekend/week and for those with some serious cash (serious at least for my blood), this certainly will be an interesting event:
HEALTH FOR ALL BALL
WASHINGTON, DC January 9, 2009 – Event Emissary, a DC-based event planning company, and The Vineeta Foundation, a health and human rights organization, announced today that in celebration of Barack Obama’s Inauguration, the Health for All Blue Diamond Ball will be held January 20, 2009 at the Smithsonian Institution’s Natural History Museum, home of the Hope Diamond. American and international health-makers will gather to refocus attention on health as a human right as specified in the 60-year old United Nation’s Universal Declaration of Human Rights.
Today in the United States, 45 million people don’t have medical insurance. Around the world, billions are deprived of the basic human right to health. In December, Moveon.org asked its three-million members “What is the most important issue for the nation?” The survey concluded that Universal healthcare was the number one choice ahead of the war in Iraq and the economy.
The presidency of Barack Obama is a historic opportunity for reforming the health care system in the United States and strengthening support for health worldwide. The Health for All Blue Diamond Ball supports Obama’s vision of change and will secure a prominent place for health on the presidential and legislative agenda by gathering powerful constituencies that passionately believe that health care is a human right.
Songwriter’s Hall of Fame inductee Jackson Browne and GRAMMY-winner Graham Nash—both also members of the Rock and Roll Hall of Fame—will headline the event. In addition to their enduring legacies as two of the most literate and respected singer-songwriters in contemporary music, Browne and Nash are both known for the social, environmental and political activism they have championed for almost four decades. In 1979, they collaborated on organizing an all-star series of concerts for MUSE (Musicians United for Safe Energy); in 2004, they both participated in the Vote For Change tour. With the Health For All Blue Diamond Ball, they continue their tradition of raising their voices in support of people across the United States and around the world.
Radia Daoussi, President of The Vineeta Foundation, explains, “A true transformation of the health care system in the United States has never been such an urgent priority. The presidency of Barack Obama offers an historic opportunity for reforming the health care system in the United States and strengthening support for health worldwide”.
Daoussi continued, “In addition to fabulous entertainment, our program will feature many speakers committed to health for all such as: US Congressman John Conyers, Michel Sidibe Executive Director of UNAIDS, Dr. Anthony Fauci, Director NIAID, NIH; Helene Gayle, President of CARE, Georges Benjamin, Executive Director of the American Public Health Association (APHA), Donna Smith, Community Organizer, California Nurses Association; Dr. Oliver Fein, President, Physicians for a National Health Program, Dean Mike Klag of the Johns Hopkins School of Public Health, and Dr. Renee Jenkins Immediate Past President American Association of Pediatricians will address ballgoers.”
The Health for All Blue Diamond Ball (www.bluediamondinauguralball.com)
Jenna Mack, Event Emissary
As you may have heard by now, Obama might be seriously considering Sanjay Gupta of CNN to be the US Surgeon General. Two good friends had an initially negative reaction to this – “but he is just another TV anchor!”. Well Gupta is much more than that. In addition to his proflic duties as a medical correspondent for CNN where has done in-depth assignments on Iraq and Katrina, he practices surgery on a weekly basis, is the associate chief of neurosurgery at a major university, has traveled the country and the world witnessing first hand major health issues giving him a global sensibility. Also along with his government experience ( as a White House fellow), he knows how to reach mass audiences and will be a media savvy. Clearly he can handle high pressure situations and his celebrity is a huge plus (how many people can remember the name of the last or current surgeon general or know of any significant issues they have tackled?).
For better or worse we are already far down the path of celebrity endorsed causes (what impact this has, I really don’t know, but it certainly commands some attention in a world with lots of noise and information overload). We have Bono, Bill Gates, and Bill Clinton – all rockstars for global health. Even NextBillion is advocating for rockstars in public health, which I do agree with. Sanjay Gupta is extremely smart and talented and can be a celebrity for public health on a national scale. And actually much more than a rockstar, public health in this country and globally needs an ambassador, a champion and an activist. This pick is good for both domestic and global health, and the two have never been so intertwined (not just with the migration of infectious diseases across borders but also with the explosion in chronic disease (and see here Jan 2009) in developing countries and issues like brain drain). You would have someone who has appeal beyond the experts and policy wonks, he has strong credibility with the American public. As such, this is a great media strategy by the Obama team – they have found someone who is well known, a media professional (and as some criticize – a propaganda machine), and can deliver complex health policy messages.
As with any candidate there are drawbacks and deficiencies, with Gupta, these will all come out in due time. I understand that some in public health circles and others will consider this pick to be more style than substance, but my main point is that is time for us to think creatively beyond our traditional notions and perhaps take a risk with someone who doesn’t have a strong public health background, but who has the potential to have a major positive impact. Gupta is someone who can link both local and global health causes together and that is rare and signficant skill. The envirionmental movement over the last decade has made tremendous strides in melting the division and lines between local and global into something that can be grasped at all levels and into something where people understand the connection. Granted health is a very different animal, but as a community and movement we are light years behind the environmental folks – perhaps Gupta helps to push this in another way.
- Krugman on the Trouble with Sanjay Gupta, link
- See Abel and Jake over at Science Blogs on their differing views
- WSJ health blog on Gupta, link
- Read the comments over at Daily Kos, link
- Huff Post on Gupta, link
- Questions about Gupta at KevinMD, link
I was recently contacted by a non-profit organization based in Washington D.C called International Action (IA) to help them raise awareness about the problems they are tackling in Haiti. IA installs water treatment systems in Port-au-Prince, Haiti using chlorinators. Chlorniators, according to IA, are very cheap, simple, easy to install and maintain. It would be interesting to see how this method stacks up against other water sanitation efforts in terms of costs & financing, logistics, sustainability, adoption/use and impact.
Haiti Innovation recently profiled IA: “At the end of five years, IA aims to have installed 500 chlorinators covering most of the Port-au-Prince metropolitan area, giving clean water for the first time to 2.5 million people.” You can view some of the locations IA is working in with their nifty Google maps mashup:
Below is a guest post from Amelie over at IA:
Guest Post by International Action
Among 147 countries Haiti scores last on the water poverty index scale according to the World Water Council (WWC). This means that Haiti is the country with the worst access to clean water in the world.
In fact, most water sources in Haiti are contaminated with human waste and disease. The result is a tragedy. Haiti has the highest infant mortality rate in the Western Hemisphere and this is due to preventable waterborne diseases such as chronic diarrhea, typhoid and hepatitis.
International Action, a Washington D.C based non-profit installs water treatment systems called chlorinators on top of local public water tanks. They now protect more than 450,000 Haitians with clean, safe drinking water in 23 of the poorest neighborhoods in Port-au-Prince.
International Action’s special tablet chlorinators are easy to install, use and maintain, they do not require electricity and therefore they are ideal for the developing world. The system is simple: 10% of the water runs through the device, dilutes the chlorine tablets and mixes it with the rest of the water in the tank. The chlorine levels are safe, pre-set and regularly tested. A chlorinator can provide clean water for up to 10,000 people for the smaller model LF1500 and 50,000 for the larger one LF2000.
The biggest installation in Jalousie supplies a community of 50,000. The local hospital has instantly noticed a reduction in the cases of waterborne diseases which they must treat. Analyses of the water have shown that germs of typhoid, cholera and hepatitis are no longer present in Jalousie’s water; waterborne diseases have virtually disappeared in the communities which have the chlorinators installed.
During the month of December, International Action has installed 6 new chlorinators in the neighborhood of Delmas 30. The population is thrilled because although they receive water from CAMEP — Independent Metropolitan Water Company — four days a week, they do not drink it because it is contaminated. In early December, CAMEP called International Action for help. 50,000 more Haitians are now protected with clean, safe drinking water provided by International Action.
For more information visit our website at www.haitiwater.org
“The Partnership for Quality Medical Donations (PQMD) Mapping Tool, provides unprecedented access to information about the medical product donations being made…to the world’s most vulnerable populations. [Anyone] can easily determine where PQMD member donations are sent, find information on how the donations are being used by the communities who receive them and access a library of medical donation resources…” Source: Google Map Technology Enhances First Global Medical Donations Map
I was alerted to the newly launched donation mapping tool by Jessica over at GHP (Global Health Progress). Thanks to her I got to sit in on a presentation of the tool which I found fascinating (but not sure anyone else did based on the lack of questions in the audience). The tool is a mashup of Google maps and donation metrics globally (location, type of donation, organizations involved, what type of supplies, volume, staffing on the ground to name some). The goal is to help collaboration, answer questions and facilitate the process of identifying who is working where and what are they doing? Second they wanted to bring to life the impact of donations (places, faces and outcomes). Other things I took away from the presentation:
- Massive unmet need for medical supplies. Poor infrastructure & distribution are key challenges
- Donations are meeting up to 40% of health needs in some areas
- PQMD has 27 members total (non cash EX US dollar volume was $4 Billion dollars, including non PQMD members)
- Private sector + NGO + Academia combo mix: The tool was incubated at Loma Linda School of Public health and is a joint effort with PQMD and industry.
They have put a lot of work into this and I think they have lots of neat information. The data comes from primary and secondary data sources. For example they use actual donor member shipping records and augment that with onsite data collection, interviews and site visits on ground with facility staff (location, staffing, needs). The public view is different from the private view so as not to compromise security of the facilities. There is a lot more I could write about this, but I’ll stop here and let you play around with the tool yourself:
A few other things to note – the PQMD site has various interesting resources. Here are some more notes, and things to check out:
- PQMD case studies
- PQMD fellowships
- PQMD educational resources on proper documentation, storage, distribution, see their basic primer on health care logistics
Have comments about the tool, leave them here:
I have been hearing ancedotally (based on very few data points) that charitable giving is not going to be that impacted by the current economic crisis. I don’t agree with this view, but apparently there is some evidence for this line of thought when looking at past recessions (according Philanthrophy2173). This time things are very different and there could be a fairly substantial impact on giving in general and on global health charities. There were two stories in the WSJ this week about the impact of the global economic meltdown on philanthropic giving. The first article states that even the Gates Foundation will be reducing donations by approximately 10% (they provide about $3 billion in funding per year which is how I came up with the $300 million figure).
The impact of this economic crisis will be widespread and will impact health in developing countries in the short run (we have already seen massive inflation in food prices and staples such as rice). Decreased funding flows will not only come from reduced giving, but from governments being forced to cut budgets (France is already cutting funding to NGOs), and also from worldwide layoffs of migrant workers who send hundreds of billions of dollars in remittances back home to support their families (on forecasts and drops in remittances see more here, here, here and here).
Below are a several articles you should check out if you care about this issue and about what the funding environment might look like over the next 12-18 months:
1. Gates Foundation Feels Pinch From Market Turmoil, Wall St. Journal 11/24/08, Link
2. Big Players Scale Back Charitable Donations, Wall St. Journal 11/25/08, Link
3. John Holmes – Impact of the Financial Crisis on Humanitarian Funding, Link
4. Comment on the MIT Course blog: Health in a Global Crisis, Link
*5. For a special review see a great post by Lucy Bernholz, Link
Cat Laine over at AIDG alerted me to Maternova…After a little bit of effort I think I finally figured out what they are up to, and the potential is exciting. From what I can tell, Maternova is acting as a clearinghouse and agent to spur the production of low cost life changing technologies in the area of maternal and child health. They are building a portfolio of innovative projects and products. What they are doing is critical for many reasons, one is that they are filling a major gap by coordinating and organizing in one particular area. There are many individuals and groups working globally on similar issues, however attempting to bring some of these ideas together under one umbrella is much more powerful than those projects standing alone.
Here is an introduction to 2 of their several products:
“Embrace is a $25 incubator designed to save premature and low birth weight babies. The product’s mission is to help the 20 million vulnerable babies born every year around the world, who can’t access traditional incubators that cost up to $20,000. It is not yet on the market.”
“Study findings show the use of a neoprene suit can save the lives of women suffering from obstetrical hemorrhaging due to childbirth. Hemorrhaging accounts for about 30 percent of the more than 500,000 maternal deaths worldwide each year due to childbirth…”
I read on the Maternova website that they are thinking about linking up with mothers in the US as one funding stream. This seems like a great idea, especially if it is to get high volume low cost donations (e.g. <$10-$20). Part of the sales pitch could include an appeal to our global community – today we truly live in a global community and are inextricably linked to one another. Our fates are intertwined like never before. I could see making a pitch like this to appeal to new grandparents, parents, uncles and aunts to make donations in the name of their newborns. I’ll follow up with more information on Maternova…
The Global Health Council has released the theme for their 2009 conference to be held in Washington, DC: “New Technologies + Proven Strategies = Healthy Communities”. I’ve been helping them with development of their CFP over the summer months – the focus is largely on ICT, but there is consideration given to other technologies also. This is an applied conference with significant international representation. In terms of a broad global health meeting, this is the best I’ve attended.
1. Microsoft is funding research in Argentina and India into low-cost electrocardiogram (ECG) machines. The devices, which can cost less than $100, use cell phones to transmit data to a computer, where it can be analyzed and then conveyed to a doctor.
2. Using Rubinsky’s gear, a doctor could use a cell-phone screen to view a cross section of tissue. In this image, a doctor uses a cell phone to magnify a patient’s breast tissue and examine it for a tumor.
SOURCE: Business Week
This is our third post on mobile phones and international/global health (post 1, post 2). This post is largely imcomplete, but I wanted to get it up. The above pics and quotes below are based on a feature in Business Week:
“It’s not easy to lug an ultrasound machine into a remote village’s health clinic—much less keep it running. But a cell phone? No problem…”
“According to the World Health Organization, about half of the imaging equipment sent to developing countries goes unused because local technicians aren’t trained to operate it or lack the necessary spare parts. So researchers are stepping up efforts to employ wireless technologies to deliver crucial medical services, particularly in underserved areas…Scientists from the University of California, Berkeley, have just developed a prototype technology that uses cell phones to deliver imaging information to doctors.”
“The University of California professor says that by reducing a complex electromagnetic imaging machine to a portable electromagnetic scanner that can work in tandem with a regular cell phone and a computer, he has essentially replicated a $10,000 piece of equipment for just hundreds of dollars.”
Another source – Imaging technology could be useful in poor countries:
Some types of medical imaging could become cheaper and more accessible to millions of people in the developing world if an innovative concept developed by an engineer at the Hebrew University of Jerusalem fulfils its promise. The device uses cellular phone technology to transmit magnetic resonance images, computed tomograms, and ultrasound scans (PLoS One 2008;3:e2075; doi: 10.1371/journal.pone.0002075)
One other recent article in this area, from PC World -
Mobile Phones and the Digital Divide: Whether you’re building an application for the 3G iPhone in the United States or trying to figure out how to deliver health information via SMS (Short Message Service) to a rural community in Botswana, the mobile space is diverse and exciting in equal measure.
Also be sure to check out:
- Why people seek out health information, link
By Sept 1 Please vote for AIDG (Appropriate Infrastructure Development Group) to help them get $500K, only 9 days left! I have great respect for the folks over there and what they are doing. Click on the image below for more information. Here is the AIDG blog and here is a short description of their project is below. Your vote can help push them to the next round:
“Half the world lives on less than $2 a day, but there are few products made for them other than by charity NGOs and universities. Look around yourself. Much of what you will see was made and marketed by a major corporation. I want to bring together experts in development engineering to help corporations create products that will alleviate poverty for people in developing countries. The right products can bring clean water, save weeks of labor, and help the poor lift themselves out of poverty.”
We previously mentioned the malaria ad sponsored by ExxonMobil during the Olympics. I have seen this several times now during coverage and said in the original post:
“with regard to ExxonMobil’s commercial on Malaria during prime time, when over 1 Billion people were watching, this might have been the largest audience ever for a global health ad.”
I realized after I said this that I probably made a major miscalculation. The NBC channel broadcast I have been watching is only produced for an American audience. The top estimates I have seen for viewership at a given time hit 66 million people. So while Exxon may have had their ad broadcast across countries and major national networks, it is likely that somewhere between tens and hundreds of millions of people saw their commercial – which is still an impressive number. Thanks to Responsible China I found the youtube version of this ad, which is below. In addition I have also seen GE’s portable re-designed low cost EKG machine advertised several times as well. Despite what you may think about these companies it is better than nothing to see MNC’s promoting social causes. We blogged about the EKG machine previously and the commercial is the first one below, followed by the malaria ad. For another check, definitely check out ResponsibleChina.