Global Health Ideas

Finding global health solutions through innovation and technology

Archive for the ‘Water’ 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)

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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

Pharmaceutical Waste Dumped at Record Levels

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):

rx_waste
World’s highest drug levels entering India stream
AP News, Jan 25 (see full story here or here)

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?”

Written by Aman

January 25, 2009 at 9:43 pm

International Action: Clean Water Solutions in Haiti

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:

ia_locations_haiti

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.

ia_water_haiti

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

Written by Aman

January 2, 2009 at 1:56 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 1: Social Marketing

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.

Update from Aman – here are some other great resources in the area of social marketing:
http://socialmarketing.blogs.com/
http://pulseandsignal.com/
http://www.social-marketing.com/blog/

Written by Jaspal

May 28, 2008 at 8:35 am

Clean Water, Sanitation and Electricity Fundraiser

AIDG is a wonderful organization and they are having an event tomorrow in NYC. Please pass this onto your networks:

“The Appropriate Infrastructure Development Group (AIDG) helps individuals and communities get affordable and environmentally sound access to electricity, sanitation and clean water.  Through a combination of business incubation, education, and outreach, we help people get technology that will better their health and improve their lives.”
aidgbenefit_11082007_fr.jpg

Written by Aman

November 7, 2007 at 6:59 am