Bitra George, India Country Director at FHI 360, discusses the role of innovation in human development.
The human population surpassed seven billion in October 2011, a milestone noted by many concerned about our planet’s capacity to sustain additional billions in the coming years. Inspired by this milestone, FHI 360 hosted a symposium on “Population, Development, and the Environment: Integrated Solutions for Global Challenges” on February 19, 2012 at the American Association for the Advancement of Science (AAAS) Annual Meeting in Vancouver — one of the world’s largest and most diverse general scientific gatherings. Presented with our colleagues Dr. Gladys Kalema-Zikusoka and Vicky Markham, the symposium follows on a 2010 Policy Forum in the journal Science that addressed the ways in which population growth intersects with other areas of human development, including reproductive health, social and economic development, and environmental sustainability.
First, we highlighted the connection between sustainability and the 215 million women worldwide who have an unmet need for family planning. In particular, we demonstrated how improving women’s access to contraceptive choice positively affects other areas of human development such as maternal and child health, educational attainment, HIV prevention, gender equity, and social and economic development. We underscored the critical role the scientific community has in further examining and addressing these essential connections.
We also shared the preliminary outcomes of a groundbreaking project in Uganda that aims to improve the health of both human communities and mountain gorilla communities, demonstrating that economic development and environmental sustainability can go hand in hand.
Finally, we explained how the United States has an essential role to play as it represents only 1/20 of the planet’s population but consumes one quarter of its natural resources. We looked at the impact of these factors on both the global environment and on women around the world.
The session was very well attended. Our audience included scientists, engineers, development workers, students and technology professionals, all of whom expressed enthusiasm about our message that healthy people and a healthy planet are interdependent.
Connections are at the heart of sustainable development — connections among population growth, reproductive rights, global and public health, food security, livelihoods and environmental preservation. We look forward to continuing our collaboration with champions from diverse fields to achieve truly comprehensive global health and development.
Talking about sexually transmitted diseases (STDs) is no easy matter, especially when speaking to youth. That’s why the Centers for Disease Control and Prevention (CDC) enlisted FHI 360 to assist with a new project to educate young audiences about STDs (also called sexually transmitted infections or STIs).
The mission is to convince youth to get tested and treated. The challenge was to convey the message without sounding parental, preachy or patronizing. FHI 360 met that challenge by helping CDC and its partners MTV, Planned Parenthood of America and the Kaiser Family Foundation develop an interactive video for their joint Get Yourself Tested, or GYT, campaign.
The video lets you scroll, click and listen in on different conversations between people at a house party. After each conversation, icons pop up to link to key information ranging from where to get tested to STD basics and tips on talking about STDs. Check out the video this Valentine’s Day, and beyond.
VOA’s health correspondent Linord Moudou talks to FHI 360’s Dr. Doyin Oluwole about the cholera outbreak in Mali. Dr. Oluwole works as the Director of the Center for Health Policy and Capacity Development at FHI 360.
For more infmoration about cholera, visit the WHO Cholera Topics Page.
On December 4, 2011, I attended the inaugural Climate and Health Summit in Durban, South Africa. The Summit was organized by Health Care Without Harm and other organizations and occurred simultaneously with the Conference of the Parties (COP-17) of the United Nations Framework Convention on Climate Change (UNFCCC). The goal of the Climate and Health Summit was to bring together actors from key health sectors to discuss the impacts of climate change on public health and solutions that promote greater health and economic equity between and within nations.
Climate change has brought about severe and possibly permanent alterations to our planet. The Intergovernmental Panel on Climate Change (IPCC) now contends that “there is new and stronger evidence that most of the global warming observed over the last 50 years is attributable to human activities.” These changes have led to the emergence of large-scale environmental hazards to human health mainly in the following areas:
- Poorer air quality and increased pollution leading to respiratory disease
- Increase in the spread of infectious diseases including diarrheal disease and insect-borne diseases such as malaria and dengue fever
- Reduction in the availability of land for farming due to floods, droughts and other dramatic weather changes, which leads to poverty and malnutrition
- Increase in the number of extreme weather events, such as floods, droughts and heat waves, which leads to substantial morbidity and mortality as well as economic loss
- More forced migration as families move to find food and water and end up living in crowded and under-resourced refugee camps
The impacts of climate change on health are, and will continue to be, overwhelmingly negative. To make the situation worse, the majority of the adverse effects of climate change are experienced by poor and low-income communities around the world, which have much higher levels of vulnerability to these impacts. This was a hot topic in Durban, where it was argued that the more developed countries should pay “climate debt,” that is, compensate the poor for damages suffered as a result of climate change.
One thing is certain: Climate change IS happening. It also impacts human health. Governments, societies and individuals need not only to adapt to the changes that have occurred but also to take steps to mitigate any further damage to our planet. There is no Planet B!
Janet Robinson is the Director of Research, Asia Pacific Region, and the Global Director of Laboratory Sciences for FHI 360 based in Bangkok, Thailand.
Watch videos and join the conversation at our LIVE coverage of the Climate and Health Summit here.
A version of this post originally appeared on K4 Health Blog. Reposted with permission.
She stood there, in beautiful red robes, with a small, serene baby bound firmly to her back. “This document is our bible,” the woman said as she cradled the green volume, in a way that was both matter-of-fact and full of awe. The book she was referring to is the vastly popular collaboration between WHO, USAID, and Johns Hopkins Bloomberg School of Public of Health: Family Planning: a Global Handbook for Providers. “The Handbook,” as it is known around the world, was first published in 2007 and has been updated with new content this year. More than 500,000 paper copies have been distributed, with tens of thousands of electronic copies downloaded and distributed on CDs and flash drives. The Handbook has also been translated into nine languages.
Here in Dakar, at the 2011 International Conference on Family Planning, the Knowledge for Health (K4Health) Project, led by Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU•CCP), has distributed thousands of updated Handbooks in French and English, and taken orders for tens of thousands more. But this Conference has also provided us the opportunity to broaden the reach of this critical content, by launching a portfolio of technology-based versions of the manual.
During the Conference, the K4Health Project launched the English and French versions of the Handbook in EPUB and Kindle formats, allowing the handbook to be read on a variety of platforms including iPads, iPhones, Kindles, and other eReaders. Perhaps the most exciting product release was the first version of K4Health’s Android App for Contraceptive Eligibility (ACE), based on the Contraceptive Eligibility Criteria from the Handbook. ACE allows a healthcare provider to quickly and simply identify the most appropriate contraceptive methods depending on a woman’s health conditions. Alternately, it can also be used by a provider to learn more about any of the contraceptive methods in the manual, their effectiveness, and their side effects. “This is incredible,” said a young man from Ghana who supervises a cadre of community health workers. “This means that we can carry the handbook in our pockets, even when there is no Internet or mobile connection.”
At K4Health, we strive to combine appropriate information technology with knowledge management best practices to ensure that the right information is made available to the right people at the right time in the right format. We believe that by making this seminal text available through a variety of formats, we can contribute to expanding access for service providers and health workers at all levels of the health system. This will improve knowledge and best practices about Family Planning and Reproductive Health, thereby expanding awareness about choices that women have to make informed decisions about their lives, their families, and their futures.
The Knowledge for Health (K4Health) project is a leader in health information dissemination using traditional and new media mechanisms and in facilitating information use through dynamic learning and exchange programs. K4Health is implemented by the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs in partnership with FHI 360 and Management Sciences for Health. Find more information about K4Health here.
The MAM program – led by FHI 360, GSMF, LSHTM and Health Partners Ghana, and funded by Pfizer – was established in 2007 to help close critical gaps in malaria prevention, treatment and education. Malaria is endemic in all parts of Ghana, with all 24.2 million people at risk. It accounts for over three million outpatient visits annually in the country and 30% of all deaths in children under five. Pregnant women are particularly susceptible to malaria, increasing the risk of severe anemia and death, as well as premature delivery, stillbirth and low birth weight in newborns.
The MAM program educates Licensed Chemical Sellers (LCSs) – the local health authority and main suppliers of medicines across communities in Ghana – on malaria symptom recognition and treatment approaches. The program also involves community mobilization to educate patients, particularly the high-risk population of pregnant women and children under five, and strengthen their demand for quality care. Over 25% of malaria in Ghana is resistant to widely-available monotherapies. Combination therapies that address resistance issues were also cost-prohibitive for most of the population prior to the program.
In addition to the barriers of cost and availability, there were also many common misconceptions held by community members and even LCSs. These included:
- The belief that malaria is a common disease, is not dangerous and does not kill
- The lack of knowledge that malaria is spread by mosquitoes
- The impression that malaria is caused by heat, house flies, dirt, hard work or eating fatty/oily foods or unripe mangoes
To address these issues in a comprehensive way, the MAM program includes health, education and even economic improvement aspects.
At the core of the program is reducing malaria-related morbidity and mortality in Ghana’s Ashanti region by improving malaria symptom recognition, treatment and referral. The program contributed to the advocacy that resulted in a declassification of combination anti-malarial drugs by the Ministry of Health. Subsequently, LCSs are now permitted to stock and dispense these drugs, bringing effective treatment into the communities. The program has reduced the time needed to obtain effective treatment by 40%. Through community mobilization, household knowledge of early signs of malaria has increased. Combination therapies are also now the most widely used treatment for malaria, increasing cure rates. The program established links so that community-level data is now being collected, analyzed and fed into the health system, helping to inform decision making at all levels and strengthening the connectivity between LCSs and the District and Regional Health Office.
Robust education programs trained 1700 LCSs in Ghana to recognize the symptoms of malaria, refer complicated cases directly to health centers, and provide proper treatment and dosage for those who do not need a referral. As a result of the trainings, participating LCSs were elevated in the community for their expertise in malaria and are now recognized as part of the health system and a source of community-level data on malaria.
There were economic benefits to both the program beneficiaries and the LCSs. Following training and education, participating LCSs became area experts on malaria, which increased traffic and built customer trust, often driving business growth. The increased business helps to reinforce the value of MAM training and better customer service, making the program more sustainable. Community members also benefited from the program: the MAM program and its partners worked with the National Malaria Control Program (NMCP) to apply for the Affordable Medicines Facility for malaria (AMFm) from the Global Fund for AIDS, Tuberculosis and Malaria. This approach resulted in a price reduction for combination therapy, thus making it affordable for lower-income members of the community. As a direct result, caregivers and mothers are spending less time at home caring for sick family members and more time at work or in income-generating activities.
Programs like MAM improve lives by addressing more than health. Through the MAM project, LSC program participants have gained powerful expertise and improved their businesses in the process. And program beneficiaries have gained better knowledge of the signs of the disease, while gaining improved access to and lower costs for treatment. Although MAM is a health-centered program, it would not be as successful without a more comprehensive approach.
Contraceptive technology has come a long way, but there is still much more work that needs to be done to increase women’s access to safe and effective contraceptive choices.
Since Margaret Sanger overturned anti-contraceptive legislation in 1936, making it legal for doctors to provide diaphragms and spermicides to women, researchers have been working to develop improved contraceptive methods. Oral contraceptives were introduced to the public in the 1960s and paved the way for future innovation. Today, contraceptive hormones are delivered in a variety of ways, including through implants, long-acting injections, patches and vaginal rings.
Yet there is still a gap in contraceptive technology that FHI 360 is working to fill – an effective, safe, easy-to-use, and low-cost vaginal contraceptive.
FHI 360 has developed a new vaginal insert, made of soft, non-woven textile materials that can contain different types of vaginal gels. What makes this insert innovative is that it virtually eliminates leakage of the vaginal gel, a critical issue for both effectiveness and acceptability. The insert is packaged as a single-use, ready-to-use product, pre-moistened with medicated gel. Depending upon the type of gel, the device could be used to prevent pregnancy or HIV or to treat vaginal infections.
Currently, the only over-the-counter vaginal contraceptives that are available are detergent-based spermicides containing nonoxynol-9 or similar agents. Detergent-based spermicides are irritating to vaginal tissues and with frequent use can cause ulcerations that could increase the risk of HIV infection.
The insert could be used with new non-irritating spermicides such as BufferGel® (developed by researchers at Johns Hopkins University) or with a ferrous gluconate formulation (developed by researchers at Cornell University). So far, the Hopkins and Cornell researchers have used other delivery methods, including diaphragms and vaginal rings, for their formulations. The FHI 360 insert could also be used to deliver microbicide gels, considered to be one of the most promising interventions to emerge over the past decade to prevent HIV infection in women.
Results of a pivotal study, presented on September 17 at the Reproductive Health 2011 conference, showed that the combination of BufferGel and the new SILCS® diaphragm—a one-size-fits-all device—was as effective as a diaphragm with nonoxynol-9 gel. This is a double dose of innovation—a new, non-irritating spermicidal gel and a new one-size-fits-all diaphragm—and it’s great news for women.
In 2009, we conducted a Phase I study to assess the acceptability of the FHI 360 insert among women and their male partners in Durban, South Africa, using the device saturated with 10 mL of an FDA-approved vaginal lubricant. We recruited 40 women, who first inserted and removed the device at the clinic and then at home. For home use, we asked women to discuss the product with their male partner and—if their partner agreed—to wear it during intercourse.
Participants found the insert easy to place in the vagina and easy to remove with minimal to non-existent leakage. Most men (34) agreed to have intercourse with the device in place. Participants reported that the insert was comfortable during intercourse. Most women said they would be willing to use the insert for contraception or preventing sexually transmitted infections, including HIV, and most men said they would approve of their female partners using it if it became commercially available.
Once again, we have the potential to advance women’s health in the U.S. and around the world. This is what innovation is all about – improving lives.
Next week, global leaders will meet at the United Nations to take on some of the world’s greatest killers: cancer, diabetes, chronic respiratory disease, heart disease, and stroke. The UN High-Level Meeting on the Prevention and Control of Non-Communicable Diseases on September 19–20, has the potential to finally address these leading causes of death and disability, which until now have been largely ignored.
Yet when we wake up on Sept. 21, how much will have changed? Will there be a new Global Fund to fight noncommunicable diseases (NCDs)? Will key stakeholders, such as those involved in urban planning, agriculture, trade and current global health priorities be as engaged as they need to be to realize ambitious goals of measurably reducing disease? Will the public even know what an NCD is — even though more than 60 percent of deaths worldwide are from noncommunicable diseases, the majority from cardiovascular disease?
The answer to all of these questions is: not yet. September 21 will be the start of the real work. The problems of NCDs are complex, but we have many opportunities to alter the course of what has become a global crisis.
There are a number of concrete steps that countries and health systems can take immediately to strengthen their commitment to reducing noncommunicable diseases. They can ratify and implement the Framework Convention on Tobacco Control, the world’s first public health treaty. Many countries already have the makings of NCD plans in existing cancer plans, tobacco control programs and strategies for diabetes and cardiovascular disease. They may also have specific programs to address respiratory disease, mental health and other issues. Health systems can make essential drugs, such as aspirin and statins, available immediately and at a low cost because many are off patent.
As leading researchers and public health officials said in an April 2011 Lancet article, “An effective response to NCDs requires government leadership and coordination of all relevant sectors and stakeholders, reinforced through international cooperation.”
In the end, we will need to make compromises and learn to share resources with people and institutions with whom we are not accustomed to collaborating. We will need to delay gratification and risk unpopularity in some of our choices. And we will likely not see the payoff in our lifetimes. But with time, effort and investment, we will see results.
In Kenya, where more than half of young people are unemployed, 22-year-old Boniface Kirang’a has watched many friends in Flax, his hometown near the Rift Valley town of Eldoret, get involved in petty crime, partying and drinking alcohol.
But Kirang’a escaped the traps of crime and substance abuse. He went through a two-year automotive mechanic training through APHIAplus (AIDS, Population, and Health Integrated Assistance), a USAID-funded FHI 360 program to improve health in 16 Rift counties. Today, Kirang’a is a self-employed car repairman.
As part of its comprehensive commitment to health, APHIAplus prevents and treats communicable illnesses such as HIV, AIDS or tuberculosis; assists families affected by HIV; runs programs to reduce hunger; and develops economic opportunities for the region’s residents.
Like many Kenyan youth, Kirang’a had struggled to stay in school. His father was diagnosed with HIV, and when his condition worsened, the family lost vital income.
“My father started being sickly in 1999,” when Kirang’a was 10 years old. “He had two butcheries, but he shut them down because of his illness. He died in 2003. After my father died, we returned to our original home in Nyahururu [in central Kenya]. We lived in my grandmother’s home. Life was hard because we were many in the family,” he said in Kiswahili.
When the family returned to Eldoret, Kirang’a stayed with a relative until he finished primary school in 2004. The uncle “could not educate me after that. He had seven children of his own. I started keeping chickens, which I sold to buy food and clothes. I also worked as shamba boy,” tending crops in cleared forestland.
But Kirang’a’s uncle got him a scholarship from the Mission Sisters of Mary Immaculate, a community-based organization that partners with APHIAplus. With the bursary, he was able to go to the polytechnical institute, said Kirang’a.
Since graduating from the institute, Kirang’a joined a group of mechanics in the fast-growing town of Eldoret. He’s doing his share to make sure that young people have chances to learn and develop skills. With his knowhow and earnings, he is saving to build his mother a house and pay for his younger brother’s school fees. In the future, he plans to hire three apprentices from the mechanics institute.