Global Health Ideas

Finding global health solutions through innovation and technology

Archive for the ‘Sanitation’ Category

Milwaukee: hub of water technology in global health?

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)

PhotoVoice(+cultural probes) for clean water and sanitation in Mumbai

Last Thursday, I had the opportunity to view a PhotoVoice exhibition at the University of California, Berkeley organized by Haath Mein Sehat (HMS), a group working to improve access to clean water and sanitation in six slums of Hubballi and Mumbai, including Dharavi.

It was exciting to see a group effectively blend the advocacy elements of PhotoVoice with the design elements of cultural probes. The difference between the two approaches is less in the methods and more in the use of the outputs. In this case, they organized the exhibition to raise awareness and break down stereotypes of slum life, and they are using the photographic corpus to guide the design of both programs and technologies related to their core mission.

What I was most interested in from a design perspective were the instructions given to community photographers and how this tied back to the mission of HMS. The results below followed from the simple prompt: “Represent your daily experience with water”.

Written by Jaspal

March 2, 2009 at 1:09 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.

Experts Call for Rethinking AIDS Money

This week’s KaiserNetwork report just hit the two hottest topics for me on HIV right now: male circumcision (Rwanda now has a formal program) and the flattening of vertical HIV funds into primary care, 30 years after the Alma Atta conference had called for a universal primary care package.

“In the two decades since AIDS began sweeping the globe, it has often been labeled as the biggest threat to international health. But with revised numbers downsizing the pandemic — along with an admission that AIDS peaked in the late 1990s — some AIDS experts are now wondering if it might be wise to shift some of the billions of dollars of AIDS money to basic health problems like clean water, family planning or diarrhea.”

“If we look at the data objectively, we are spending too much on AIDS,” said Dr. Malcolm Potts, an AIDS expert at the University of California, Berkeley, who once worked with prostitutes on the front lines of the epidemic in Ghana.

Read the full story at the KFF.

P.S. The CGD blog (Is donor spending on AIDS a “Gross Misallocation of Resources”?) highlights findings from a recent paper on global health funding for HIV, population, infectious disease control, and broad health sector support. Two key points:

  • donor support for AIDS has grown from around 5% of total health commitments in 1992-3 to about 30% in 2003-5, a six-fold increase of AIDS’ share, but
  • funding for general health sector support is the fastest rising category in absolute terms in the years 2003-5

Written by Ben

January 24, 2008 at 11:00 pm

World Toilet Summit 2007

World Toilet Summit 2007 LogoAs BBC reports, the World Toilet Summit 2007, which was scheduled to be inaugurated by former Indian President A.P.J. Abdul Kalam, is being convened in New Delhi from 31-Oct until 3-Nov.  The summit has been organized by NGO Sulabh International Social Service Organisation and is supported by various Indian ministries along with UN Habitat New Delhi.  Fourty countries are reported to be participating in this meeting which in recent years took place in Russia, Northern Ireland, and China .  For reference, UNICEF provides a mid-term assessment regarding the Millennium Development Goal drinking water and sanitation target.

Written by Jaspal

October 31, 2007 at 7:59 am