Archive for the ‘Private Sector’ Category
It’s been more than two years since we reported on Seattle as the new Geneva, that is, as the new epicenter of global health activity. An article in this morning Journal-Sentinel (Water-engineering firms see potential, challenge in developing countries) – which includes an exclusive interview with the Acumen Fund’s chief executive Jacqueline Novogratz – suggests that Milwaukee is angling to do the same for water technology:
It’s an issue that almost certainly will preoccupy business leaders in metro Milwaukee in their strategy to brand the region as an international hub of water technology. The metro area is home to scores of water-engineering companies. Gov. Jim Doyle and the University of Wisconsin-Milwaukee this month announced plans to invest millions of dollars for UWM to become a center of freshwater research.
An 2008 article from the same newspaper (Area’s tide could turn on water technology) provides more evidence:
[F]our of the world’s 11 largest water-technology companies have a significant presence in southeastern Wisconsin, according to an analysis of data from a new Goldman Sachs report.
Wall Street has tracked automakers, railroads and retailers almost since there were stocks and bonds. But water remains a novelty. Goldman Sachs Group Inc. didn’t begin to research water treatment as a stand-alone industrial sector until late 2005.
While several large MNCs have shown an active interest in clean water in developing countries (e.g., Procter and Gamble, Vestergaard Frandsen, Dow) open questions remain as to what role large MNCs will play in providing access to safe water for the one billion people who don’t have it.
(Thanks to Dr. Jessica Granderson for sending the link)
“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:
A few days back Aman wrote a post about Google Flu Trends. Thought I’d add a few thoughts here after reading the draft manuscript that the Google-CDC team posted in advance of its publication in Nature.
By the way, here’s what Nature says: Because of the immediate public-health implications of this paper, Nature supports the Google and the CDC decision to release this information to the public in advance of a formal publication date for the research. The paper has been subjected to the usual rigor of peer review and is accepted in principle. Nature feels the public-health consideration here makes it appropriate to relax our embargo rule
Ginsberg J, Mohebbi MH, Patel RS, Brammer L, Smolinski MS, Brilliant L. Detecting influenza epidemics using search engine query data. Draft manuscript for Nature. Retrieved 14 Nov 2008.
Assuming that few folks will read the manuscript or the article, here’s some highlights. I should say I appreciated that the article was clearly written. If you need more context, check out Google Flu Trends How does this work?…
- Targets health-seeking behavior of Internet users, particularly Google users [not sure those are different anymore], in the United States for ILI (influenza-like illness)
- Compared to previous work attempting to link online activity to disease prevalence, benefits from volume: hundreds of billions of searches over 5 years
- Key result – reduced reporting lag to one day compared to CDC’s surveillance system of 1-2 weeks
- Spatial resolution based on IP address goes to nearest big city [for example my current IP maps to Oakland, California right now], but the system is right now only looking to the level of states – this is more detailed CDC’s reporting, which is based on 9 U.S. regions
- CDC data was used for model-building (linear logistic regression) as well as comparison [for stats nerds - the comparison was made with held-out data]
- Not all states publish ILI data, but they were still able to achieve a correlation of 0.85 in Utah without training the model on that state’s data
- There have attempted to look at disease outbreaks of enterics and arboviruses, but without success.
- For those familiar with GPHIN and Healthmap, two other online , the major difference is in the data being examined – Flu Trends looks at search terms while the other systems rely on news sources, website, official alerts, and the such
- There is a possibility that this will not model a flu pandemic well since the search behavior used for modeling is based on non-pandemic variety of flu
- The modeling effort was immense – “450 million different models to test each of the candidate queries”
So what does this mean for developing world applications?
Here’s what the authors say: “Though it may be possible for this approach to be applied to any country with a large population of web search users, we cannot currently provide accurate estimates for large parts of the developing world. Even within the developed world, small countries and less common languages may be challenging to accurately survey.”
The key is whether there are detectable changes in search in response to disease outbreaks. This is dependent on Internet volume, health-seeking search behavior, and language. And if there is no baseline data, like with CDC surveillance data, then what is the best strategy for model-building? How valid will models be from one country to another? That probably depends on the countries. Is it perhaps possible to have a less refined output, something like a multi-level warning system for decision makers to followup with on-the-ground resources? Or should we be focusing on news+ like GPHIN and Healthmap?
Another thought is that we could mine SMS traffic for detecting disease outbreaks. The problem becomes more complicated, since we’re now looking at data that is much more complex than search queries. And there is often segmentation due to the presence of multiple phone providers in one area. Even if the data were anonymized, this raises huge privacy concerns. Still it could be a way to tap in to areas with low Internet penetration and to provide detection based on very real-time data.
In case you missed this in the NY Times today – fascinating experiment with a new Google tool on the frontiers of diseases surveillance and global health trends. Remains to be seen how useful this will be and lots of validation needs to be done, but this is yet another example of people outside of traditional health/public health communities who are on the leading edge of public health innovation:
“What if Google knew before anyone else that a fast-spreading flu outbreak was putting you at heightened risk of getting sick? And what if it could alert you, your doctor and your local public health officials before the muscle aches and chills kicked in? That, in essence, is the promise of Google Flu Trends.
“Google Flu Trends (www.google.org/flutrends) is the latest indication that the words typed into search engines like Google can be used to track the collective interests and concerns of millions of people, and even to forecast the future.”
We have discussed before how data indexed on the web can used for all sorts of fascinating things. We had a previous posts on global health job trends and also on publications that use the terms global health and private sector. The graphs below show a large increase in both areas, however there are dozens of caveats with this kind of trend analysis and the below graphs have to be taken with a grain of salt:
1. Global Health Job Trends (see for full post)
2. Trends: Development/Global Health in the Business Press (see for full post)
Russell Southwood had a short story (full report at balancingact-africa.com) on Kenyan banks crying foul with the rapid expansion of mobile money credits acting profitably as current account institutions without the same regulatory oversight. From Southwood’s emailed summary:
“Currently, the two leading mobile phone service providers – Zain and Safaricom – are offering money-transfer services in the country under Sokotele and M-Pesa brands respectively… To avert undue competition with the banking fraternity … M-Pesa and Sokotele services have to meet the capitalisation requirement as stipulated in the Banking Act. According to the Act, a deposit taking institution should maintain a minimum capitalisation of Ksh250 million ($3.5 million). This is however expected to double come December next year before hitting Ksh1 billion ($14.2 million) by 2010 after capitalisation requirements were amended in this financial year’s budget.”
How small is too small for regulation? As clear from Kenya, small transactions at scale can leverage significant economic activity and worry the big bank competition.
The question was raised elsewhere this week. The World Affairs Council of Northern California and UC Berkeley are holding a roundtable dinner next Wednesday with space reserved for UCB students if they address, in 150 words, some of the industry challenges as microfinance and m-money mature. So any UCB students reading this post, check out BalancingAct for a few ideas. A few choice subjects:
- When is a bank account a bank account?
- Does the market want mobile phone enabled financial services?
- What’s makes a successful customer business model interface?
The growth of the mobile services in microfinance has been breathtaking and defining the space where traditional banking, microfinance and mobile services intersect will continue to be a challenge as the technology matures and demand continues to grow.
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.
I missed a few links from our previous post on global health and mobile phones, so this is part deux, which will be followed by Part III later this week. As you can see from the frenzy of recent activity – the mobile phone for health revolution is moving ahead rapidly, where it will take us and how useful it will ultimately be will be known in due time. And as mentioned, this is a case where the “Third World is First”, innovation is happening far ahead of what we are seeing in the US. There are a several good links below. For those seeking more documentation beyond news items, see the report from the Bellagio e-health conference which I believe is being organized by the UN Foundation, Vodafone Group Foundation and the Telemedicine society of India.
CellScope: Mobile-phone microscopes, Link
Dan Fletcher, a professor of bioengineering at the University of California, Berkeley (Go Bears!!), has developed a cheap attachment to turn the digital camera on many of today’s mobile phones into a microscope. Called a CellScope, it can show individual white and red blood cells, which means that with the correct stain it can be used to identify the parasite that causes malaria.
Cellphones for HIV, Link
mHealth and Mobile Telemedicine – an Overview
Great links below and full news link here
- Sizing the Business Potential (Link)
- Relationship among Economic Development (Link)
- mHealth: A Developing Country Perspective (Link)
Wireless Technology for Social Change: Trends in NGO Mobile Use, Link
Related to above: “Technology plays crucial role in vaccination distribution”, Link
The Pill Phone for US Markets. This kind of application was used long before in developing countries – now it is slowly entering the US market: “In a first-of-its-kind application, Verizon customers in the US can get information and set reminders regarding medication and dosage with “the Pill Phone”. Link
Managing Symptoms By Mobile Phone May Revolutionize Cancer Care For Young People, Link
New wi-fi devices warn doctors of heart attacks, Link
“The Bluetooth wireless technology that allows people to use a hands-free earpiece could soon alert the emergency services when someone has a heart attack…” How they will manage the data flow and response is a big question in my opinion.
- Microtelecom for the Next Billion Mobile Users, Link
- MobileActive08 is the only global gathering that is connecting leaders who are working at the convergence of civil society, mobile technology and social change. Link
As many of you may know, the tiffin delivery/dabbawala system in India has achieved remarkable rates of success in setting up a complex delivery system. Their ability to deliver millions of meals a year without making mistakes makes me think about how this system can be transferred to healthcare and for what purpose… something to think about. As Dr. V took inspiration (WSJ, PDF) from a highly standardized and high volume system, I am wondering the same thing for a system already in place in a low resource setting. Food for thought, well worth checking out:
From The Economist (link):
“Using an elaborate system of colour-coded boxes to convey over 170,000 meals to their destinations each day, the 5,000-strong dabbawala collective has built up an extraordinary reputation for the speed and accuracy of its deliveries. Word of their legendary efficiency and almost flawless logistics is now spreading through the rarefied world of management consulting. Impressed by the dabbawalas’ “six-sigma” certified error rate—reportedly on the order of one mistake per 6m deliveries—management gurus and bosses are queuing up to find out how they do it.” Full story link here.
Hat tip Intangible Economy.
Friday ended with an impressive lineup of global health leaders discussing the disconnect between horizontal and vertical funding in the plenary session titled Meeting Along the Diagonal: Where the First and Last Mile Connect. A webcast of this session, and 2-3 others from the Global Health Council Conference, will be available on kaisernetwork.org starting Tues-3-Jun-2008. It’s nearly 2 hours long, but brings together ideas from the Gates Foundation, WHO, the Global Health Council, and USAID. As much as it was about these organizations and the types of organizations (foundation, multilateral, advocacy, bilateral), it was about the individuals who spoke their minds:
- Jaime Sepulveda, Director, Integrated Health Solutions Development, Bill & Melinda Gates Foundation
- Margaret Chan, Director-General, World Health Organization
- Nils Daulaire, President and CEO, Global Health Council
- Henrietta H. Fore, Administrator, U.S. Agency for International Development, Director, U.S. United States Foreign Assistance
- Fore: “horizontal aspects to vertical programs”
- Sepulveda: “integration”
- Chan: “connect”
- Nils: “fractal”
- Delivery (personal and non-personal services)
- Resource Generation (people, information, vaccines, technology)
- Walsh J A & Warren K S. Selective primary health care: an interim strategy for disease control in developing countries. N. Engl. J. Med. 301.967-74, 1979.
- An “forgotten” article that Sepulveda wrote in the 1980s in the Bulletin of the WHO on the topic of “diagonalism”, but perhaps not in those words. (I wasn’t able to find it, but if you know of the article, please post a link as a comment.)
- Dentzer told her she was “the James Brown of global health”, a reference to her work ethic
- “What works for Hong Kong doesn’t work for Zambia.” This sounds obvious, but there was quite a lot of talk at this conference about exporting successful models from one country to another. I’m not saying you can’t learn from successes, but there is at least some better work we need to do in adapting those models to different situations.
- “Primary healthcare faded from the vocabulary of global health.” She cited Periago’s “crushed” comment from earlier in the day. In fact, she brought in a lot of examples of what other people were saying throughout the day, so it’s clear that she was listening.
- One of the other examples she brought up was a Johns Hopkins professor who in a morning comment advocated for “health impact assessments” like “environmental impact assessments” prior to doing something new. (Sorry, don’t know the name of the JHU professor.)
- “Famous soft drink”. She didn’t name it because she didn’t want to advertise for it, but asked “why can’t we get to the same areas of the world?” (a reference to technologies like vaccines and medicines). If we can’t do that, “we fail our people”.
- “It’s easy to blame people when you fail.”
- In referring to her 30+ years of experience: “I look young, but I’m not”.
- “Primary healthcare was alive” in places like Brazil, India, and Argentina, even though it wasn’t in the “official vocabulary”.
- “I’m not going to repeat the WHO definition of health. To me health is a social objective.”
- In indicating that we need to train more mid-level professionals: “For the clinicians in the audience, don’t worry, there’s plenty of work.”
- “We have not listened enough.” ”We underestimate the ingenuity of the community.” “If you say ‘talk is one thing, walk is another’, I rest my case.”
- “We are insular. We only look at the health sector.” We need to look at safe water and sanitation, education, etc.
- “Ministry of Health [alone] cannot handle the complexity of the situation.”
- “Let’s be realistic. Even NGOs are making profits.”
- “Why is it that working with industry is seen as dirty?” “Industry is part of the solution.” We need to work with food and pharmaceutical industries.
- Peer review is “another elephant in the room”- Chan identified most of the elephants. It is a process by which “your friends condone your work”.
And my favorite, because it directly addresses the work I do and that we need to advocate for in the development of new technologies and services:
- “I didn’t realize that the color of bednets makes a difference.”
- “It wasn’t until we brought in the anthropologists that we found out that the color red represented death.”
- They changed the color to yellow and people started to use them.
On Tuesday of the conference, I attended the Social Marketing to Facilitate Behavior Change and Action workshop. I personally found it to be very educational, although I did have one gripe (see #3 below). A few thoughts I had during the workshop:
(1) Creating new products and the lead user. In describing the role of social marketing, the facilitators considered the question “how do we make the choice easier [for adopting healthier behaviors]?”. Their answer was “creating new products” and the example they gave was the LifeStraw. A woman from Vestergaard-Frandsen, the company that makes LifeStraw, was in the audience and shared the story of the conceptual development of the product – it seems this was a case of a lead user. One of the fieldworkers who worked on a national Guinea worm eradication campaign created her/his own life straw with reed and some mesh for local use.
(2) Social marketing and social design ethnography. The reason I went to this workshop was to establish a better understanding of how my work relates to social marketing. My work uses applied ethnography for the purposes of design in global health, not just products, but also services and systems. While there is considerable overlap, the idea of creating new products felt like an awkward fit within the framework of social marketing. I expect it was there because it has no other home (e.g. social product design). The danger in placing it in the context of social marketing is that it may ignore the considerable knowledge we have developed and are developing in the field of human-centered design. There is also a difference in the methods. Ethnographic research seems play a minor role in social marketing, and as in many fields, the label ethnographic seems to be used fairly loosely.
(3) Know your audience. The majority of examples (not all) in the workshop were drawn from the US context (e.g. commercial advertisements, surveys, anecdotes), and further weren’t well-contextualized. Not what I expected at a global health conference, with a very international group, where the focus of the workshop was “know your audience”.
(4) Adapt, don’t adopt. One of global health’s strengths is that it borrows from so many diverse fields. The dangers with this are in simply adopting the idea rather than adapting it to the contexts of global health. In the case of social marketing the ideas that have been borrowed are framework (effect behavior change), process (how to understand your consumer), and theory (behavior change models). The typical dangers of doing this are: (a) what is borrowed can be viewed as gospel (e.g. if Madison Ave. does it this way, it must be right) or (b) the ideas don’t progress as they do in the original field (e.g. is social marketing making use of advances in commercial marketing? is it evolving on its own?). I still don’t know enough about social marketing to argue this, but I’ve seen this pattern with other ideas that have been borrowed across fields.
(5) “We’ve already been doing this”. One of the audience members brought up the fact that people have been doing this for a long time in many places and that it simply hasn’t had the “social marketing” label. Agreed, but in my opinion – and that of the facilitators – the value is in the framework. By creating a formal way of thinking, we can improve the social marketing work that people have been doing by other names, and bring it to people who haven’t been thinking in these terms.
Ben was there for part of the workshop and may have more thoughts.
The UN Foundation and the Vodafone Foundation released a new report this week – Mobile Technology for Social Change: Trends in NGO Mobile Use. Thanks to Mark over at the UN Dispatch blog for telling me about this in the first place. Credit for the below description goes to an email I recieved (thanks very much Adele!) from folks at the UN Foundation, which is reproduced below:
Case studies exploring use of ‘mobile activism’ for public health projects include:
Mobile health data collection systems ( Kenya and Zambia ): Collecting and tracking essential health data on handheld devices, in countries where statistical information was previously gathered via paper and pencil, if recorded at all.
Monitoring HIV/AIDS care ( South Africa ): Using mobile devices to collect health data and support HIV/AIDS patient monitoring in a country with the world’s highest HIV/AIDS infection rates, and where rural populations often otherwise go unassisted.
Sexual health information for teenagers (US and UK ): Connecting youth to important information on sexual and reproductive health via anonymous text messaging, to empower young people to make informed sexual health decisions.
Continuing medical education for remote health workers ( Uganda ): Providing medical updates and access to vital information via mobile phones for doctors and nurses working in some of the most destitute regions, where continuing medical education services are lacking.
A total of 11 case studies identify emerging trends in ‘mobile activism,’ and investigate both the promise and challenges of innovative use of mobile technology to meet international development goals.
Richard Smith at the BMJ Blog wrote about last week’s Private Sector Health Systems conference [program PDF] in Wilton Park. The full text is at the BMJ, but here’s my summary. In many developing countries, the poor are much more likely to use private providers than public sector, if they use healthcare at all.
People in Bangladesh get 80% of their healthcare from the private sector. Across Sub-Saharan Africa it’s 60%, and the proportion is increasing. The poorer people are the more likely they are to receive private care, and the middle classes consume more publicly funded care than the poor…Much of the private care that the poor receive in developing countries is, of course, of low quality. It is often provided by unqualified practitioners and is undermined by corruption, but there are – a McKinsey study in Africa showed – “islands of excellence.”
As Smith indicates, private healthcare in many low-income countries isn’t the only sector suffering from highly inconsistent quality.
government provided health care is also commonly poor, throughout Africa public health systems are derelict, and governments cannot fund, provide, and regulate care.
Smith’s intended audience of high-income country donors and policymakers may be reluctant to engage with private sector actors. Some caution is understandable but the need for practical solutions to dramatically improve healthcare provision leads to private sector mechanisms (for a good review of competitive contracting, performance-based finance and similar tools check out “Getting Health Reform Right” by Roberts, Hsiao, Berman, and Reich). The interesting thread I don’t hear as often, but have run across in my own work, is the challenge that low-income governments will have regulating the purchase private sector healthcare. Smith didn’t address it at length but the comments that followed focused on government’s regulatory role. The first response from Nigeria Health Watch blogger Chikwe Ihekweazu got to the point.
The major problem in many African countries in addition to the resistance of the concept is ‘management’ and ‘strategic thinking’ in the health sector. In Nigeria, where I am from, there is a proliferation of private health care facilities at all levels with no regulation, no accountability and no governance. …the private sector has a huge role to play…but only if there is the strategic leadership by governments to drive and regulate this.
As has pointed out more and more in the literature, private healthcare deals in volume in many low-income countries, but for these schemes to succeed governments need to lead and donors ought to be willing to invest in building effective public management of broad (diagonally funded?) health systems.
This is an interesting story — GE redesigning an EKG machine (the last one of which they made in 1999) for a place like India. The have also been advertising a lot on TV – I was able to find the ad on YouTube which is pretty cool. Four things immediately struck me:
1) The accomplishment – Cost reduction from $10,000 to $1500 in under 2 years and weight from 15lbs to 3lbs!
2) The original machine took 3.5 years and $5.4 million to develop. Compared to drug development this is minuscule. Making devices is generally orders of magnitude cheaper, far quicker to develop and face far fewer regulatory hurdles (FDA). So why didn’t this happen sooner?
3) This is great for India, but what about for use in the US (especially for community clinics and in rural areas)?
4) Let’s not forget that the introduction of any “new” technology will have unintended social consequences which are sometimes horrendous, here is another example from GE and their ultrasound machine.
“GE Healthcare engineer Davy Hwang’s marching orders were straightforward. Take a 15-lb. electrocardiograph machine that cost $5.4 million and took three and a half years to develop. Squeeze the same technology into a portable device that weighs less than three pounds and can be held with one hand. Oh, and develop it in 18 months for just 60% of its wholesale cost. ‘He thought I was crazy’…” Crazy or not, Hwang pulled it off…The result: The new MAC 400, GE’s first portable ECG designed in India for the fast-growing local market.”
Full story at Business Week.
This piece is cross-posted from the Uganda output-based aid (OBA) site which just got a major under-the-hood overhaul in its move to a blog format. The Uganda OBA project contracts private clinics to see qualified patients for complaints of suspected sexually transmitted infections (STIs). Patients who buy a subsidized voucher from local drug shops and pharmacies are entitled to seek care for themselves and their partner at any of the contracted clinics. Clinics are reimbursed on a negotiated fee-for-service schedule.
The following report (“VSHD, 2007, Assessment of OBA Clinic Utilization”) is an evaluation of the OBA program’s first year impact on utilization at participating clinics (July 2006 to June 2007). The study, led by Berkeley graduate students Richard Lowe and Ben Bellows, was undertaken June to August 2007 and required an extensive review of thousands of handwritten lab and outpatient entries at OBA facilities. Records were kept differently at many of the clinics and,at several clinics, data were simply not available. However, we have information from 7 of the 16 clinics and they indicate a strong patient uptake and program improvement in the first year of OBA. One of the more dramatic findings is that the total number of patient visits at contracted clinics increased 226% in the first year of OBA compared to the year before OBA.
It does not appear that patients who have attended OBA clinics simply substituted the OBA voucher for their own out-of-pocket spending. Taking all seven clinics together, the number of non-OBA patients seeking STI treatment actually increased in the first year of OBA. One likely reason is that social marketing stimulated greater demand for STI treatment beyond the voucher-using population.
Program adherence also appears to be improving over the first year of OBA as the number of fully paid claims increased from 30% of all submitted claims in July/August 2006 to 70% of all claims in June 2007. Although it should be stressed that claims quality varied significantly between providers.
There is some concern about the quality of lab testing at participating clinics. Lab technicians could benefit from better on-site follow-up and incentives for high quality diagnoses. However, the percent of positive gonorrhea tests more than doubled, indicating increased awareness of this infection in the community and at provider clinics.
The report paints a detailed picture of the participating clinics in their first year of OBA and it is hoped that findings can be used for program improvement as the expansion is planned.
Our many thanks go to both Microcare and MSI who graciously assisted with our many requests for supplemental data and assistance reaching clinic providers. Many thanks as well to the KfW Development Bank and the Bixby Program at UC Berkeley for funding the research.
BBC reports that “a study published in the Public Library of Science journal by researchers from the Harvard School of Public Health suggests the policy has saved Brazil around $1bn between 2001 and 2005.” The article itself is available freely online as a part of the open access policy of PLoS.
From the Harvard School of Public Health press release:
The results showed that, although costs for Brazil’s locally produced generic antiretroviral drugs (ARVs) increased from 2001 to 2005, the country still saved approximately $1 billion in that time period through controversial price negotiations with multinational pharmaceutical companies for patented ARVs. Since 2001, Brazil has been able to obtain lower prices for patented ARVs by threatening to produce AIDS drugs locally. Though these negotiations initially prompted major declines in AIDS drug spending, HAART costs in Brazil more than doubled from 2004 to 2005. The steep increase reflects the fact that more people living with HIV/AIDS began treatment and are living longer. The increase also reflects the challenges associated with providing complex, costly second- and third-line treatments as people develop resistance to first-line drugs, live longer and require more complex treatment regimens.
Figure 6 from the article – Impact of Alternative Price and Quantity Scenarios on Total ARV Costs, 2001–2005 – shows how the increase in spending is primarily related to increases in quantities rather than costs (Figure 6.A). This figure also shows how much would have been spent if there were no price changes (6.B) and the theoretical minimum that could have been spent by buying the lowest-priced generics on the market (6.C).
Poor air quality after California fires safer than indoor air from biomass-burning in low-income countries
A Berkeley school of public health prof recently posted to the SPH listserv a great NASA link to high altitude photos of the southern California fires. You can click through several days worth of pics and see what conditions were like prior to the fires as well as tell when the winds kicked up as they carried dust plumes in areas unaffected by fire (for instance Oct 22nd).
The point the prof made was that as bad as the air is there, the particulate matter density of 200-300 micrograms per cubic meter (10x greater than average figures for US cities) is still less than the levels typically seen in biomass-burning homes in the developing world.
More efficient, hotter burning charcoal stoves are one immediate solution to indoor particulate matter (i.e. soot) in low-income homes. In Uganda for instance, Kampala residents use a huge amount of charcoal (my own estimate…) every day. The city’s air, not to mention the air in individual homes, has a great deal of suspended soot – you can easily smell it across the city during the peak cooking hours. Venture Strategies for Health and Development in Berkeley, together with an innovative Kampala for-profit stove manufacturer, are marketing the hotter burning stoves through targeted subsidies financed in part with carbon credits.
Perhaps one silver lining to the devastation in southern California will be greater awareness of the importance of high air quality.
Its great to see a generally conservative business magazine discussing positive, successful global health efforts in Africa. Forbes has 3 very recent pieces that are worth skimming. Again, this is yet another indication of increasing convergence of the social and business sectors that we had previously profiled (trends in global health coverage by the business press).
The Rwanda Cure: Success Stories
Forbes Oct 29.2007, link
Western do-gooders are pouring billions of dollars into ontrolling malaria, AIDS and other killers ravaging the world’s poorest continent. Now comes the hard part…Some of what sub-Saharan Africa needs is new technology, like a malaria vaccine. But what’s needed most, particularly in Africa, is better logistics.
“The hardest truth for people to come to terms with is that the practical solutions are already out there, but they are not being applied…Donors always want to do something new. The simple things aren’t so glamorous.” Full story
In Pictures: Seven Ways To Fix Health Care In Africa
Follow this link
HealthStore to expand to Rwanda, link
How do you get basic care to the remotest villages in Africa? One clever idea is to borrow tactics from retail chains like McDonald’s and Subway–operate an easy-to-replicate, owner-operated franchise system focusing on health care.With a budget of under $1 million a year, HealthStore Foundation subsidizes nurses in rural areas to run 65 for-profit retail clinics in Kenya that provide basic treatments for malaria, respiratory infections and worms.
Nurses pay about $300 to buy a clinic, and sell medicines for a modest profit at a retail price of $1. The 65 clinics run under the name CFW Shops and treated 400,000 patients last year. Many are run by retired nurses lured back to work by the prospect of owning their own business.
Full story here.
Here is a new site by MTV – think.mtv.com. They have various videos and links that of course feature artists and also non-artist involvement. MTV can clearly be a powerful motivator, their engagement is interesting and a testament to the hipness of being involved in social causes or at least giving that perception. Let’s hope this does well and gets a younger generation mobilized, screen shots and description below (along with a Jay Z video of him at the UN, click on the picture):
“NEW YORK (Reuters) – Viacom Inc’s MTV will launch a new Internet social network sponsored by foundations operated by the founders of Microsoft and AOL to encourage youth activism….It will let users create pages, as on other online social networks Facebook and MySpace, and upload photos and videos, some of which may be aired on MTV’s online or cable network.” Full story here: MTV to launch activism social network
The think.mtv.com web site:
Wired magazine has a fascinating piece from last month on the “ultimate medical diagnostic device” which is being developed in collaboration with the private sector. It is by Thomas Goetz who runs his own blog: Epidemix. Excerpts below:
“Our inability to diagnose and track infectious disease quickly and accurately remains a serious problem…The problem with cultures is that they take a long time — three weeks or more — to produce a definitive result. In those three weeks, antibiotics may be fortifying the bacteria’s resistance rather than curing the patient. In those three weeks, a TB patient goes back into the population and spreads disease. In those three weeks, the bacteria have enough time to escape our grasp. What’s needed, then, is a new way to diagnose the disease: one at least as fast as the sputum microscopy test, as accurate as the culture, and refined enough to differentiate between garden-variety bacteria and drug-resistant strains. What’s needed is nothing less than a new gold standard…Those tests might finally be at hand. There is a crop of diagnostic tools on the horizon… Dozens of companies are investing hundreds of millions of dollars to develop these new tools.”
“TruDiagnosis: It combines advances in microfluidics (miniaturized pumps and channels), microarrays (micron-sized sensors affixed to a chip), and engineering into what could be the ultimate medical gadget: a handheld device that, using a small sample of blood or spit, reveals in mere minutes every pathogen inside the body.”
Here is another story on the growth of medical technology consumption and production in emerging regions. A few days ago we had a related post (Trends in Global Pharmaceutical Manufacturing). According to the McKinsey report, the rural health services sector will provide significant growth in the demand for pharmaceuticals.
India’s fast-growing economy, expansion in health care insurance and infrastructure, to grow national drug sales to triple by 2015. The report said India will undergo a “significant transformation” to become one of the top 10 pharmaceutical markets in the next decade.
In addition, improvements in medical infrastructure – like rural hospitals and clinics – would contribute to 20 percent of the projected growth, while the strengthening of health insurance within the country would contribute to 15 percent of the growth, the report said. Full news release at CNN Money.
Pharma boom: Drug market to hit $20 bn by 2015, The Economic Times
Table: Global Insight, Link
KPMG Pharmaceutical Practice Report: The Indian Pharmaceutical Industry, (PDF)
India: The Next Pharma Superpower?, IPA Convention 2007, Trade Group
Pharma & Biotech in India Presentation, (PDF)
Over the past several months I have noticed what seems to be consistent coverage of development and/or global health issues by the business press. Almost every time I open up Fortune Magazine, Business Week, Forbes, or some other mainstream business publication there seems to be some coverage of the issues we care about (water, clean tech, etc.). You might ask – so what? For those in the public health world, yes “business” is a four letter word, but this is an important development (good and bad) because the private sector unlike never before is having an increasing impact on development and global health issues. Even the financial news channel, CNBC TV, has had consistent coverage of issues such as the global water crisis (probably largely due to one main proponent). To give you an idea of frequency and content covered, below the graph is a sample of articles I have seen in the major business news publications in just the past couple of months.
In addition I decided to do a very quick and dirty check of the number of publications listed on Google Scholar over the past decade to see if there has also been an increase in attention in the academic press. I searched using the following two terms:
“Global Health” and “Private Sector”
“Global Health” and “Business”
You can see the results in the below graph which again is a back of the envelope analysis that has flaws, but gives us a rough idea of changing content being published. In 1996, the use of those words “Global Health or Private Sector” and “Business” was almost non-existent and a decade later we see a tremendous increase that is 12-23 times greater (some of which can be attributed to SARS).
Back to changes by the business press, there seems to be no question that there is much greater interest in development and social issues compared to a decade ago. However, the majority of these articles seem to be clear that their interest is largely driven by profit, as the Smart Money July 2007 issue states: “It’s not a social or moral debate, it’s all economic…”
Business & Development Examples
1. Jeffery Sachs: “How I’d fix the World Bank”, link
Fortune Magazine 6.9.2007
4. BusinessWeek on BOP – A False Dichotomy? via NextBillion
Business Week 8.1.2007
6. MTV Searches for Hope & Profit in Africa, link
8. Money Magazine August 2007 page 61: Full page color ad for VillageBanking.org (sorry no link to the ad)
9. “Reap profits & save the planet…Corporate America is responding to climate change considerably faster than the US.” Smart Money, June 2007 (sorry no link to article available, see print edition)
On a related note, definitely read this-
Environmentalism for Billionaires: “How businesses are looking to cash in on global warming with green-washed plans that aren’t as eco-friendly as they seem.”
Clean tech becomes big business (8/2/2007), link
While I am not aware of blogs that are mostly devoted to covering development or global health issues from a business perspective here are some blogs that have related content. If you know of any others please let me know:
The Heart of Business
Lunch over IP
Silicon Valley Microfinance Network
The Discomfort Zone