The specter of segregation haunts global health


In Ghana, a louder approach to a silent killer: Hypertension

By Richard Ofori-Asenso, ComHIP Technical Advisor, FHI 360, Ghana Country Office, and Irina Ofei, District Health Director, Lower Manya Krobo District, Ghana

Hypertension is a serious public health issue, with nearly one billion people across the world currently hypertensive. And the numbers are increasing every day. In Ghana, where we are based, the number of reported new cases in outpatient public health facilities increased more than tenfold between 1988 and 2007. A recent estimate of the prevalence of hypertension in Ghana was 27.3 percent.

If hypertension is identified early, it can be treated and managed to prevent life-threatening diseases such as stroke and heart failure.

A Ghana Health Service nurse screens a patient for hypertension during an outreach activity. Photo: Olivia Edem Dotse

A Ghana Health Service nurse screens a patient for hypertension during an outreach activity. Photo: Olivia Edem Dotse

In the Lower Manya Krobo, a district in the eastern region of Ghana with a population of nearly 100,000, there is a growing recognition of the increasing burden of hypertension. Unpublished 2014 data from the Lower Manya Krobo District ranked the disease as the eighth leading cause of mortality in the district, accounting for 3.8 percent of all deaths. This figure underestimates the overall impact of hypertension because it has a role as a risk factor for other, potentially fatal diseases, such as cardiac diseases, congestive heart failure and cerebrovascular disease. When combined, these conditions would rank as the leading cause of death (25.4 percent) in the district.

Raising awareness

The World Health Organization has called hypertension a silent killer, because it seldom causes symptoms. For this reason, prevention hinges on raising awareness and detecting it early.

FHI 360’s work has called attention to the prevalence of hypertension and its associated risk factors within the Lower Manya Krobo District. (more…)

In support of those affected by Nepal disaster

By Patrick Fine, Chief Executive Officer

On behalf of my colleagues at FHI 360, I extend my heartfelt condolences to those affected by Saturday’s catastrophic earthquake outside Kathmandu. Our thoughts and prayers are with those suffering from this tragedy. I am deeply relieved that all of FHI 360’s Bangladesh, India and Nepal staff are accounted for and safe.

Our organization has deep roots in Nepal. We are privileged to work alongside talented, inspiring Nepali and international partners. We stand with them now, offering all the support we possibly can, and will continue to do so as this crisis unfolds.

The full human impact of the earthquake remains unknown, but FHI 360 will work closely with our partners to understand how we can best support the relief effort.

Thanks to each of you who have reached out to express your concern for our team.

Malaria elimination and the role of partnerships

A Q&A with Halima Mwenesi, Director, Infectious Diseases, FHI 360

Roll Back MalariaQ: We’re working toward malaria eradication. How close are we?
A: Malaria eradication as a shared vision can mobilize stakeholders and much-needed financial resources. The World Health Organization estimates that 584,000 people died from malaria in 2013. So, while that big goal of eradication is important, malaria elimination, which means the end of endemic transmission, is what many countries are aspiring to in the meantime. As noted in the President’s Malaria Initiative’s World Malaria Day report for 2015, the community continues to work toward a vaccine, and we’ve had some impressive successes in reducing mortality and increasing the uptake of prevention measures. But, there is much more to be done in order to defeat malaria.

Q: Who are FHI 360’s key partners in this fight?
A: The Roll Back Malaria Partnership is the global framework that was established to create a common vision of how and where we want to go as a global community. It consists of more than 500 partners, including the governments of malaria-endemic countries, bilateral and multilateral donors, the private sector, foundations, and research and academic institutions. The World Health Organization’s Global Malaria Programme sets policies and guidelines for fighting malaria, and the Roll Back Malaria Partnership works with individual countries to implement them.

On April 25th, in recognition of World Malaria Day, we will be participating in a discussion, Partnerships for Malaria Elimination — Lessons and Opportunities, co-hosted by GBCHealth, the Corporate Alliance on Malaria in Africa and Harvard University’s Defeating Malaria Initiative. The focus will be the role of public–private partnerships. You can follow the conversation on Twitter at #PPP4malaria.

Q. Can you provide an example of an FHI 360 partnership to address malaria?
A: I think FHI 360’s work in Nigeria, the Malaria Action Program for States (MAPS), funded by the U.S. Agency for International Development, provides a useful example of a partnership at work. We’ve supported Nigeria’s national malaria elimination program, increased awareness of malaria as a killer disease, particularly for those ages 5 and under, and worked with the country’s Ministry of Health on mass distribution campaigns of insecticidal nets to schools and health facilities. We’ve supported capacity strengthening for health workers in the nine project states, built ministry demand for and capacity in monitoring and evaluation and collection of data for decision making, and teamed with community health workers to reach remote and underserved areas.

Q: What is the next set of challenges to address?
A: I’ve been thinking a lot about exactly that question. Reaching out to hyper-remote areas for prevention and treatment will be critical — nobody should be left out. As urbanization accelerates, we need to start disaggregating data so that we capture what’s happening with malaria among the urban poor. Dealing with the increased resistance to antimalarial drugs and insecticides is another key challenge, as is the relatively thin pipeline of new malarial medicines in development. We need to train more community health workers. Malaria in pregnancy is a double whammy. It kills both mothers and infants. We need to strive to increase the uptake of the proven intermittent presumptive therapy for pregnant women to address the problem. And, of course, we need to revamp our efforts on financing going forward — otherwise these challenges will only escalate, and at worse, reverse the gains we have made.

International development’s awkward stage

By Patrick Fine, Chief Executive Officer, FHI 360 and Kristin M. Lord, President and CEO, IREX

A version of this post originally appeared here on Foreign Policy. Reposted with permission.

We all know that children are the future. We have seen the commercials picturing heartbreaking photos of children in need or adorable youngsters with the brightest of dreams, and asking for donations to support them. Such attention has made a difference. Children globally are healthier and better educated than at any time in human history. According to a 2014 U.N. report on the Millennium Development Goals, the enrollment rate in primary education in developing regions increased from 83 percent to 90 percent over just the last decade. In addition, the child mortality rate has almost halved since 1990, with 6 million fewer children dying in 2012 than in 1990. These are achievements that development organizations — and the taxpayers who support them — should be proud of, having plowed billions into primary education, vaccinations, and other efforts that have helped young boys and girls around the world.

But here is the problem: Even as development organizations have prioritized children, they have consistently overlooked youth and young adults. There have been countless earnest speeches pledging that youth will be placed at the center of the development agenda. But groups tend to lose focus at the exact time of life that determines whether people will become healthy and productive adults or not. Adolescence, it turns out, is not just an awkward and vulnerable stage. It is a difficult phase for development organizations to deal with, despite ongoing concerns about the world’s demographic youth bulge. The result of this awkwardness is a policy failure with broad social, political, and economic consequences. (more…)

Taking a student-based approach to youth development

By Elizabeth Buckner, Research Associate, Education Policy and Data Center

How do we best meet the needs of adolescents, recognizing that the world they are entering is rapidly changing?

Youth programming should focus on the successful transition from adolescence to adulthood, rather than on the reduction of behavioral problems, a past trend. Such programming ensures adolescents’ mental and physical health, as well as provides opportunities to develop positive social values, human and social capital, a sense of well-being and an ability to make sound choices.

Unfortunately, donor-funded discourse on secondary education reform is still dominated by a dialogue on expanding access and improving quality in education. Youth development and large-scale secondary school reform usually operate on parallel tracks, with youth development approached through afterschool, extracurricular or nonformal programming.

If our goal is positive youth development at scale, we must work in — and with — schools, where youth spend the majority of their time.

Promoting adolescent development in Senegal’s middle schools
There are only a few good models for promoting youth development in middle schools in resource-constrained countries. FHI 360’s Education de Base (EDB) project, which improved the quality and governance of the middle school system in Senegal from 2008 to 2013, is one of them. (more…)

Research points to the power of educational equity in reducing civil conflict

By Carina Omoeva, Director, FHI 360 Education Policy and Data Center

Photo: Leanne Gray/FHI 360

Unequal educational opportunity often lies at the heart of deep inequities in economic productivity, social well-being and participation in democratic institutions. Key livelihood statistics show that across the globe, individuals with lower levels of education are more likely to earn less, have poorer health outcomes and are less likely to enter leadership positions. For this reason, efforts to improve equity must start with education.

A soon-to-be released study, completed by the FHI 360 Education Policy and Data Center (EPDC) and commissioned by the United Nations Children’s Fund (UNICEF) Peacebuilding, Education and Advocacy Programme, indicates that ensuring equitable access to educational resources may be more than just a moral right: It may also contribute to reducing the likelihood of civil conflict.

Using an innovative methodology that captures disparities in educational attainment among ethnic and religious groups, as well as among subnational regions within countries, we found that violent civil conflict is more likely in countries with high levels of disparity among groups. Preliminary results showed that the difference in the odds of conflict between highly unequal and more equal countries was large in magnitude and held true even after accounting for the countries’ differences in economic development, political systems, populations and income inequalities. (more…)

The specter of segregation haunts global health

By Patrick Fine, Chief Executive Officer, FHI 360 and Leith Greenslade, Vice Chair, Office of the U.N. Special Envoy for Financing the Health Millennium Development Goals and Co-chair of Child Health at the MDG Health Alliance

A version of this post originally appeared here on Devex. Reposted with permission.

Photo by: Getachew / UNICEF Ethiopia / CC BY-NC-ND

There is no question that the greatest health achievements under the Millennium Development Goals have focused on single diseases. Arresting the spread of HIV and AIDS and malaria is perhaps the most significant development success of the new century. And vaccination, especially of measles, is one of the reasons that deaths among older children have fallen faster than deaths among infants or women during pregnancy and childbirth.

In contrast, the lowest-performing areas across all eight MDGs — reducing infant and maternal deaths — are targets that don’t lend themselves to a single disease strategy. Just six countries have met the MDG target for reducing infant deaths, and only 15 countries have achieved the target for reducing maternal deaths.

Could these targets have actually been achieved if we had pursued an integrated approach to advancing the health of women and children? Did our fascination with and confidence in the segregation of single-disease initiatives cost us achievement in other areas requiring more complex solutions?

Read the remainder of the blog here.

The thin blue line: Increasing access to pregnancy tests in family planning programs

By Kate Rademacher, Technical Advisor and John Stanback, Senior Scientist, FHI 360

A version of this post originally appeared here on The Lancet Global Health Blog. Reposted with permission.

Increasing access to pregnancy tests

Photo: Jessica Scranton/FHI 360

What is the true value of a 10-cent (US$) pregnancy test? In many countries, women are routinely denied same-day provision of family planning methods if they arrive at the clinic on a day when they are not menstruating. When it comes to ensuring reliable access to contraception, it turns out that simple, low-cost pregnancy tests can be extremely valuable.

Sonia, a 49-year-old woman in Rwanda, is a long-time user of Depo-Provera, the popular three-month injectable contraceptive. She explains that women who are not menstruating are often turned away for family planning services because health care providers are concerned that these women might be pregnant. Many are told to return during their next menses, leaving them at risk of unintended pregnancy in the meantime. Sonia says, “When you get there, they ask if you are having your period. When it is ‘no,’ they give you another appointment. When it is ‘yes,’ they give you cotton wool and you go somewhere discreet to put some blood [on it] and come back to show it to the provider. It is only then that the provider shows you the methods.” (more…)

A unique partnership develops emerging global health researchers

By Dr. Timothy Mastro, Director, Global Health, Population and Nutrition, FHI 360

At FHI 360, cultivating partnerships and building capacity are high priorities that lead to lasting impact globally. Capacity development in global health has many facets. In the more than 70 countries where we work, many of our global health, population and nutrition programs and research studies include the training of public health workers and scientists. We also value partnerships in the United States that foster the development of the next generation of public health leaders.

This year marks the 10th anniversary of the FHI 360 and University of North Carolina (UNC) Gillings School of Global Public Health Research Fellowship Program. This relationship provides graduate students from the Gillings School with the opportunity to work side by side with leading global health researchers. For the last decade, FHI 360 and UNC have built and sustained a local partnership through which yearly at least two students from the Gillings School work at FHI 360 and are mentored by our global health research experts.

Through this program, FHI 360 has had the privilege of working with some of the brightest young minds in the growing field of global health research. Over the years, 23 fellows have worked on a wide range of topics, generated research protocols, analyzed data, written manuscripts for scientific journals and developed technical skills that are essential to global health research. (more…)

Let’s get real in Addis: The high cost of people-centered development

By Patrick Fine, Chief Executive Officer, FHI 360

A version of this post originally appeared here on Devex. Reposted with permission.

When heads of state, ministers of finance and leaders of the international development community gather in Addis Ababa this July for the Third Conference on Financing for Development, I hope that the discussion will be grounded in the hard realities facing the least-developed countries struggling to provide basic services to their growing populations.

I also hope that conference participants rise above the popular but misleading narrative that the private sector is the panacea.

Looking to the private sector as the primary source of financing for development is particularly seductive for two reasons: Statistical evidence seems to support the argument, and it provides a rationale for reducing official development assistance at a time when donor nations are struggling with debt and budget crises.

However, placing unrealistic expectations on the private sector to meet basic needs in health, education and public administration clouds a critical debate.

Part of the problem is definition. “Private sector financing” is one of those catch-all terms. It encompasses business spending (foreign and domestic direct investment), remittances from migration in a globalized world, user fees to private providers of public services, and large-scale private philanthropy that has exploded out of the technology revolution.

Read the remainder of the blog here.