Global Health Ideas

Finding global health solutions through innovation and technology

Archive for the ‘Human Resources’ Category

Donation Mapping Tool

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

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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:
mapping_pic

A few other things to note – the PQMD site has various interesting resources. Here are some more notes, and things to check out:

Have comments about the tool, leave them here:

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Rapid HIV CD4 Counter (8 minutes)

With slight modifications I lifted the below from the CIMIT Blog (note Video on their blog), certainly a needed innovation for global health:

Via CIMIT: Microfluidic CD4 Cell Counting for Resource-Limited Settings

“The HIV pandemic has created an unprecedented global health emergency. In response, the price of effective, life-saving HIV drug treatment has been reduced by 99%. More than $10 billion is now invested each year to treat people suffering from HIV and AIDS…BUT Treatment is only half the battle. “

“Of the 33 million people living with HIV worldwide, fewer than 10% have access to CD4 counts, the critical blood test used by clinicians to decide when to start treatment. Fewer than 1% have access to viral load assays, which are used for infant diagnosis and for patient monitoring. Both tests are considered essential to effective treatment. The Use Case for appropriate CD4 and viral load tests appropriate for resource-limited settings is clear”:

  • Tests need to be performed by a minimally skilled health worker,
  • A the true point of care,
  • Reliably and inexpensively, and
  • Wth reasonable accuracy and precision. The HIV pandemic thus represents an unprecedented opportunity to drive technology development in point-of-care diagnostics.

“Based on this Use Case, William Rodriguez’s lab has developed a series of technologies for an integrated CD4 cell count device, with microfluidics as the key platform…Integrating these microfluidic technologies has led to a prototype handheld device that can accurately capture CD4 cells from a 10 microliter fingerstick sample of whole blood, and accurately measure CD4 counts in under 8 minutes.

Written by Aman

August 7, 2008 at 8:38 pm

Stat of the Day: Dabbawala 99% Error Free Rate

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.

Written by Aman

July 21, 2008 at 10:35 pm

Global Health Council 5: We ♥ Margaret Chan

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
Victor Kamanga of the Malawi Network of People Living With HIV/AIDS was supposed to speak at this panel representing the community perspective, but was denied a visa by the United States.  Nils was brave enough to say that it may have been due to Kamanga being HIV-positive.
The session was moderated by Susan Dentzer, Editor-in-Chief of Health Affairs, and her performance – one that was witty, but neither overbearing or spectatorish – made more sense after I learned about her NewsHour and NPR roots.
Administrator Fore spoke of USAID’s accomplishments and left immediately for the White House.  The session was awash in metaphors related to the theme: diagonal (Sepulveda), fractal (Daulaire), circular (Gordon Perkin, in the audience).  Dentzer synthesized the overall position of each of the speakers in a few words (in order that they spoke):
  • Fore: “horizontal aspects to vertical programs”
  • Sepulveda: “integration”
  • Chan: “connect”
  • Nils: “fractal”
The collective message for me from the session was this: health systems are complex, we need to look at integrated solutions, and it will take time.
Sepulveda’s framework for looking at health systems requirements was his effort to “make that black box {of health systems] transparent”.  His four requirements of health systems are:
  1. Stewardship
  2. Financing
  3. Delivery (personal and non-personal services)
  4. Resource Generation (people, information, vaccines, technology)
He referred in his comments to 2 articles:
  1. 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.
  2. 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.)
Both Sepulveda and Daulaire had some interesting things to say, but I want to focus on Margaret Chan.  About 2/3 of the way through the sesssion, I was so taken by Margaret Chan’s honesty and perspective that I wrote “I ♥ Margaret Chan” in my notebook.  I passed my notebook to an NIGH colleague sitting next to me, who then showed me his notebook which had “I [heart] Margaret Chan” written atop his penultimate page of notes.  He didn’t want to draw a heart, he later told me, because he was afraid somebody might see it.  If that wasn’t weird enough, I told the story to another NIGH colleague, who responded that she too had written “I ♥ Margaret Chan” in her notebook.
Some Margaret Chan highlights (keep in mind her emphases in her tenure at the WHO have been Africa, primary healthcare, and women)
  • 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.
I encourage you to watch the session if you can spare the time.  Posted from the Wi-Fi bus between DC and New York.

Global Health Council 2: “Small is beautiful, but big is necessary”

Yesterday’s plenary session The First Mile: Setting the Framework for Effective Community Health Systems was a global health conference experiment.  The session linked the Global Health Council Conference (Washington, D.C.) to the Geneva Health Forum by video conference.  Keep in mind these were sessions attended by hundreds of people on both sides.  Louis Loutan, who modertated from Geneva, a self-professed “technical skeptic”, was so impressed by the technical success of the video conference that he proposed it as a model that we need to consider for future meetings.

Both meetings had complementary themes this year: “Community Health” and “Strengthening Health Systems and the Global Health Workforce”, respectively.  This session brought together these themes in the context of community health systems. 

Here’s who was involved from each side:

Geneva:
  • Sigrun Møgedal, HIV/AIDS Ambassador, NORAD, Ministry of Foreign Affairs, Norway
  • Frank K. Nyonator, Director, Policy, Planning, Monitoring, and Evaluation Division, Ghana Health Service, Ghana  
  • Halfdan Mahler, Former Director-General WHO, Switzerland
  • Moderator: Louis Loutan, MD, Head, Service of International and Humanitarian Medicine, Department of Community Medicine of Primary Care, University Hospitals, Geneva, Switzerland
Washington, D.C.:
  • Fazle Hasan Abed, Founder and Chair, Bangladesh Rural Advancement Committee (BRAC)
  • Gretchen Glode Berggren, MD, MScHyg, Consultant, International Health and Nutrition
  • Molly Melching, Founder and Executive Director, Tostan
  • Moderator: Nils Daulaire, MD, MPH, President and CEO, Global Health Council

I’m really happy that I attended this session because of the shift in thinking that it seems to represent.  Key quotes from each of the 6 people on the panels (tried to get quotes verbatim, but will be off by a few words):

  • “Health must not only be seen as a whole internally, but also externally as an integral part of social and economic development.” -Mahler [he had a beautiful metaphor involving kaleidoscopes, but I didn’t capture it – he also quoted Mark Twain and Niels Bohr]
  • “Maybe we can’t do great things, but we can do small things with great love.” -Berggren, quoting Mother Teresa who said this at the Global Health Council Conference in the 1980’s
  • “Doing holistic healthcare was hard, it was messy … it lost its energy” -Møgedal
  • “We need someone nearby, who tells us what’s wrong, what to do, and where to go.” – Nyonator, quoting an opinion leader from a community in Nigeria describing what is needed in terms of healthcare workforce
  • “If 10 people dig, and 10 people fill, we have plenty of dust, but no hole.” -Melching, citing one of her favorite African proverbs
  • “Small is beautiful, but big is necessary.” -Abed, describing BRAC’s village health worker system in Bangladesh

There were five themes throughout the session that stood out to me:

  1. Revisiting Alma-Ata
  2. Collective impatience
  3. Listen to the people
  4. Changing social norms
  5. Community health workers
The issue of food security was a recurrent one throughout.  The overall message was that there needs to be an increased emphasis on holistic primary healthcare using community resources, that understanding social norms was critical to success in improving health, and that this will take time.
Revisiting Alma-Ata
  • Why it came up: the WHO Declaration of Alma-Ata (PDF) is celebrating its 30th anniversary in September, Dr. Mahler directed the creation of the declaration, the WHO has recently recommitted to strengthening primary health care, and the theme of both conferences and this session were very relevant to Alma-Ata
  • There was a “total betrayal of Alma-Ata within months” because structural adjustment programs (e.g. FMI) “sapped energy” from health systems and “made it impossible for developing countries to conduct experiments necessary to test the recommendations achieved by global consensus” -Mahler
  • At the time, one of Mahler’s colleagues told him “It is not doable. We must only do what is doable.”
  • Alma-Ata is about “bottom-up” approaches and “social justice” -Møgedal
  • “It’s not about convincing your adversaries that they’re wrong, but it’s about uniting with your adversaries at a higher level of insight.” -Mahler
Collective impatience
  • “It takes time.” “We suffer from ‘Instant Coffee Syndrome’.” -Berggren
  • Møgedal spoke of an impatience that we have in addressing the problems of global health in the context of a “broad-based global health push”.
Listening to the people
  • “Let’s go back and listen to the people.” “Everyone deserves a home visit.” “We must return to be more in touch with people.” -Berggren
  • We need to think “where people are” and “what makes a difference to people” -Møgedal
Changing social norms
  • “We must change social norms.” -Nyonator
  • Melching spoke of the role of social networks and testimonials (not her words) in effecting behavior change in FGC (female genital cutting) with Tostan in West Africa.  She called this the “organized diffusion approach”.  The goal was “widespread change of social norms.”
  • We need “change agents and fieldworkers.” -Abed
Community health workers
  • “How come we keep talking about community health workers without talking about the support that they need?” “Work at each problem … solution in each context.” -Møgedal
  • “Community-based health workers need extra arms and legs.” “We must work with groups.” -Berggren

Written by Jaspal

May 28, 2008 at 9:54 am