Health

  • Trickle-down health care

    Do investments in private hospitals and clinics catering to the wealthy strengthen primary health care systems in poor countries?

    At a recent roundtable discussion in New York City, a representative of a private equity group presented plans to build private hospitals in emerging markets, such as Kenya, as one of the best ways to strengthen primary health care delivery. For most of us who have worked on strengthening health systems, investing in hospitals that cater to the well-off doesn’t sound like the best way to meet the health needs of the poor.

    Continue reading

  • What does it take to control an epidemic? Learning from Thailand’s experience

    Earlier this summer, the HIV/AIDS effort achieved a notable accomplishment that the rest of the public health community may have overlooked, missing an important learning opportunity. In June, the World Health Organization certified that Thailand achieved what was inconceivable just 20 years ago: elimination of mother-to-child transmission of HIV. Thailand is the first country with a generalized HIV epidemic to achieve this milestone, one that is crucial to epidemic control.

    Two decades ago, the HIV epidemic was expanding in Thailand. Use of antiretroviral drugs to prevent mother-to-child HIV transmission was an expensive, newly discovered intervention that had barely been implemented in areas of the world where resources were limited and the disease burden was greatest.

    Despite these challenges, only 85 children were born with HIV infection in Thailand in 2015, compared to 1,000 children in 2000. This remarkable achievement resulted from a combination of essential factors:

    • Strong national leadership
    • A solid, functional health care system
    • A commitment to extending health care services to all people in the country, including undocumented individuals

    Continue reading

  • Keeping male contraceptive research front and center

    Developing a new male contraceptive might seem like a daunting challenge. But, novel approaches, identification of new genetic targets and more expansive research on acceptability could lead to the development of a game-changing male contraceptive in our lifetime. In recognition of World Contraception Day 2016 (September 26), we are pleased to share this five-part blog series, Keeping Male Contraceptive Research Front and Center. In this series, the Contraceptive Technology Innovation (CTI) Exchange brought together experts in the field to discuss the state of the science. Over the next several months, the CTI Exchange will continue hosting other guest authors who will offer insights on this subject. The CTI Exchange is a knowledge-sharing portal managed by FHI 360 experts.  

    Continue reading

  • The issues we must address to #EndHIV4Her

    Adolescent girls and young women continue to be at unacceptably high risk for HIV infection. UNAIDS estimates that 7,500 girls and young women, 10 to 24 years of age, become infected with HIV every week, with the highest rates in southern and eastern Africa. Girls and young women account for 71 percent of new HIV infections among adolescents in sub-Saharan Africa, highlighting the gender disparity in this age group. Despite active prevention efforts, recent clinical trials in southern Africa have measured new HIV infection rates of 4 to 6 percent per year among young women. It is imperative that we implement aggressive measures to decrease new HIV infections among girls and young women.

    Our current HIV prevention package of HIV testing, behavioral risk reduction, management of sexually transmitted infections and condom use is inadequate because young women often lack the ability to control their risk. The evidence is clear that the source of HIV infection for most girls and young women in southern Africa is older men. For young women, a complex mix of economic dependency, limited educational opportunity, gender inequality, unequal power dynamics and social norms leads to a lack of choice of how and with whom to have sex.

    Continue reading

  • What do AIDS 2016 in Durban and integrated development have in common?

    A version of this post originally appeared on Huffington Post. Reposted with permission.

    As FHI 360 and the global health community prepare to travel the “Road to Durban” to the 21st International AIDS Conference (AIDS 2016), it is poignant to reflect on how far we have come since the AIDS 2000 meeting held in Durban, South Africa. I recommend taking the time to read a recent message from the conference organizers titled, The Return to Durban: A Critical Moment in History.

    After reading the piece, I was reminded of what a critical role the entire development community, including organizations like FHI 360, has played in the global response to HIV. I am inspired every day to witness how the broad global response has rallied around the concept of building on the available evidence and advancing integrated development solutions — which is why we continue to make real and sustainable progress in battling HIV.

    As part of FHI 360’s deliberate approach to advancing integrated development solutions, we will be hosting a summit June 13, 2016, in Washington, DC, titled, Greater than the Sum of its Parts: The Power of Integration. The event will be a space for innovative thinking, learning and dialogue that will focus on the “how” to achieve the Sustainable Development Goals. The discussions will include global development leaders and practitioners, policymakers, donor organizations and other change-makers.

    Continue reading

  • Women and girls deserve better

    How can an adolescent girl succeed in school if she is not protected from sexual violence inside the classroom? How does a child thrive when his mother must choose between buying medication or nutritious food? We know that poverty, lack of access to education, poor health and violence are intimately linked, and how we tackle these problems is a global issue with important implications for the way the United States funds international development programs for women and girls. At the moment, we tend to compartmentalize our efforts in top-down, single-issue solutions, not because that is the most effective way to meet the needs of women and girls, but because it meets the needs of funders and their implementing partners. As we enter the new era of the Sustainable Development Goals (SDGs), we need to do better.

    There is an obvious starting point.

    We need to be a lot more deliberate and get a lot better at integrating efforts to improve the well-being of women and girls. Given the siloed nature of how we organize development work, especially in terms of funding and specialized expertise, we tend to think and act with narrowly predetermined notions of cause and effect. As a result, we miss vital connections and opportunities for action and impact. For example, I recently asked an African Minister of Health what was the biggest obstacle to women’s and girls’ health, and he immediately responded, “access to transport” to get to health facilities and obtain medicines. And yet, how often does transport come up as a priority when funders and development agencies plan health programs?

    Continue reading

  • Zika infection during pregnancy: Why we need gender and social norms changes for girls and young women

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

    The link between Zika virus infection during pregnancy and birth defects poses yet another threat for girls and women of reproductive age in the Americas as they struggle to chart a positive course through life transitions.

    Unfortunately for girls and young women, the choice of whether or when to become pregnant is often not their own. Age and power dynamics heighten the impact of traditional gender and social norms for girls and young women and can inhibit informed decision making and positive sexual and reproductive health behaviors. Lack of empowerment leaves them more vulnerable to gender-based violence, increasing the risk of unintended pregnancy, while fear of discrimination from health providers or condemnation from family and community means girls and young women delay seeking and receiving contraception or antenatal care.

    The Zika virus is another threat for girls and women as they chart a positive course through life. Click To Tweet

    A public health response to the Zika virus must include addressing some of these root causes that preclude girls and young women from realizing their sexual and reproductive health choices — and social norms that inhibit contraceptive use for girls and young women need to be addressed in programming.

    Note: The authors would like to thank their colleagues from the Passages project team. FHI 360 is part of a team of global health organizations implementing this new reproductive health initiative in Asia and Africa, which aims to improve the healthy timing and spacing of pregnancies by youth and first-time parents in developing countries.

    Read the entire blog here.

  • Creating healthier Nigerian communities through laboratory strengthening

    Laboratory strengthening is a component of Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS), a five-year project to build local capacity for the delivery of sustainable, high-quality and comprehensive HIV/AIDS prevention, treatment, care and support services. FHI 360 implements SIDHAS in 13 states in Nigeria.

    What is laboratory strengthening and how is SIDHAS meeting this need?

    Lab strengthening is a form of support to improve the capacity of a lab for quality service delivery, helping to achieve optimal performance, increase productivity and efficiency, deliver accurate and replicable diagnostics services, achieve customer satisfaction and promote safety. Lab strengthening also provides infrastructural development, equipment maintenance and quality control services to allow timely delivery and accurate results.

    FHI 360 has supported the improvement of labs through training and mentoring to facilitate good quality management systems and record keeping. This work in lab improvement aligns with the World Health Organization Africa Regional Office (WHO-AFRO) initiative known as Strengthening Laboratory Management Towards Accreditation (SLMTA). Working within SLMTA parameters with our Nigerian government counterparts provides regular collaboration and deepens the leadership, stewardship and sustainability of the country’s labs.

    Continue reading

  • Keeping up the momentum to control TB

    Dr. Timothy Mastro

    Dr. Timothy Mastro
    Photo: Leanne Gray/FHI 360

    World TB Day 2016 comes at a watershed time in the history of the tuberculosis (TB) epidemic and the broader global response to health and development. In recent years, we have expanded access to more sensitive TB diagnostic services, increased awareness about the important role of infection control within health care settings and have new treatment options for individuals with multidrug-resistant (MDR) TB. But, there is much work still to be done.

    TB now rivals HIV as the top global infectious disease, yet we have not applied the same vigor to controlling TB as we have to controlling the HIV epidemic. That time is no longer. We have the opportunity to mirror the advances gained toward ending the HIV epidemic, largely based on evidence, driven by ambitious targets and linked to well-designed guidance.

    In many parts of the world, HIV poses a particular challenge to TB control, which we cannot ignore. We have developed HIV prevention and treatment tools that will allow us to end the HIV epidemic, and we must add urgency to align these with TB control efforts. Doing so will assure successful outcomes in the fight against HIV and TB coinfection. The urgency comes from World Health Organization reporting that indicates mortality from TB eclipses mortality from HIV. The tremendous research and program advances from unprecedented investments in the HIV response must be leveraged to take control of TB morbidity and mortality.

    Dr. Carol Dukes Hamilton

    Dr. Carol Dukes Hamilton
    Photo: Leanne Gray/FHI 360

    This moment in time is particularly important as we transition to the Sustainable Development Goals (SDGs) that will guide policy and funding over the next 15 years and are linked to a pledge to end poverty, everywhere, permanently. While health is now only one of 17 goals, the shift in focus may bode well for control of TB, which is a disease of poverty exacerbated by malnutrition, overcrowding and poor hygiene.

    FHI 360’s TB initiatives strategically align with the SDGs. Our projects provide technical assistance to governments to yield evidence-based solutions to their local TB situations. We assist governments with improved disease surveillance so they can invest in ways that will yield the greatest impact by providing curative treatment and limiting new infections. We promote an approach that focuses on those most vulnerable in society because TB concentrates in the most marginalized populations of any given society. A human rights-based approach that engages affected communities is the basis for a sound, effective response.

    Continue reading

  • Social marketing for public health systems change

    Can social marketing efforts to promote individual behavior change inhibit progress instead of advancing it? On one topic at least, the answer appears to be yes.

    A couple months ago I had the pleasure of attending the Robert Wood Johnson Foundation’s Childhood Obesity Program Leaders’ Advance, which brings together leaders in the fight against childhood obesity to discuss strategies and approaches for reversing the increases we’ve seen in the past 30 years. The meeting was held in Oakland, California, and included a visit with the Alameda County Public Health Department to learn about their efforts. An official from the department posed a question to the group, “What do we think is the biggest barrier to the success of community efforts to reduce obesity?” What he didn’t say was: funding, poverty, racism, education, or the food and beverage industries. His answer might surprise you — individualism.

    Individual-focused messaging has led Americans to believe obesity is caused by personal choices. Click To Tweet

    Continue reading