World Bank Open Forum focuses on open development, global unemployment, and MDGs

On October 7-8, the World Bank is hosting an online open forum in conjuction with live video coverage from the World Bank/IMF annual meetings and panel discussions with subject matter experts.  Similar to the USAID’s Global Pulse event held earlier this year, this 24-hour interactive chat session will be focusing on three key areas: open development, the global unemployment crisis and strategies for creating jobs, and the effect that the MDGs will have on development.
Open Development Solutions
Jumpstarting Jobs
Development Changes Now

The World Bank’s own “Inside the Web” blog entry on this event can be found here.
Follow the World Bank’s Twitter list.

More cell phones than toilets: Mobile technology emerges as the new lifeline for the world’s poor

A report on inadequate sanitation, released by the UN University, made waves earlier this year when it reported that while 45% of India’s population owned cell phone, only 31% of them had access to improved sanitation in 2008.1  Headlines proclaiming “India has more cell phones than toilets” found their way into several of my e-mail news digests.  “It is a tragic irony to think that in India, a country now wealthy enough that roughly half of the people own phones, about half cannot afford the basic necessity and dignity of a toilet,” said Zafar Adeel, Director of United Nations University’s Institute for Water, Environment and Health (IWEH), and chair of UN-Water.  With the focus on the Millennium Development Goals growing more acute as the deadline approaches, people were understandably astonished.  

It is shocking to think that so many of the world’s poor cannot access appropriate sanitation.  However, the widespread use of cell phones should not be juxtaposed against the conditions of poverty, but should rather be seen as a way to empower the poor to improve their conditions.  The cell phone market has seen explosive growth in the last decade: 90% of the world’s population will soon be within the coverage of wireless networks,2 and there are already an estimated five billion cell phones used globally.3  Villages without running water or electricity often have at least one mobile phone, and people can switch out their own SIM cards for access.  They are being adopted faster than basic services such as routine medical care and schools.2  When a basic toilet costs 15 times more than a basic cell phone ($3001 compared to $203), it becomes easier to understand the discrepancy between access to sanitation vs. mobile technology.  If mobile penetration is so widespread, then, should it not be viewed as a tool and an opportunity for innovation?  

A man holds a cell phone in front of a woman with four children.
Photo taken from mHealth Alliance Executive Director David Aylward's blog entry in the Global Health Magazine.

Some governments and organizations have already caught on.  In Rwanda, for example, the government provides free cell phones to rural health workers to register expectant mothers, get answers to their questions from a health expert, and send monthly status reports to doctors.2  Other programs send reminders to HIV-positive pregnant women to take ARVs and work to reduce stock-outs of drugs in rural clinics.  Pharmaceutical companies are also working with application developers to fight drug counterfeiting: customers will be able to submit a numeric code on drug packaging via SMS and get a reply that states whether the drug is “NO” or “OK,” along with the drug’s name, expiration date, and other information.4  And I have already featured Tostan’s Jokko Initiative, which applies their literacy lessons to cell phone usage and includes a lesson on the health-related utility of SMS.  Other applications include facilitating electronic banking and providing information on crop disease and weather to farmers.2  

Progress on the MDGs should not be overlooked, and the importance of access to sanitation is should certainly not be downplayed at all.  With an expected return between $3-34 for every dollar spent on sanitation, it is absolutely worthwhile to stress the importance improving people’s access to this need.  Now, if only we could develop an app to improve sanitation – that would be perfect.

Plasmodium goes viral as the global health community observes World Malaria Day

If you think you’re too small to accomplish something big, picture yourself locked in a room with a mosquito. –African proverb  

An African woman lies under a light-blue bed net.
Mali 2010 @ Barbara Sigge/MSF

Yesterday, World Malaria Day was observed by organizations and communities all over the world with all the resolve appropriate for one of the world’s deadliest diseases.  According to the WHO, approximately half of the world is at risk for the disease.  Though most of the cases and deaths occur in sub-Saharan Africa, malaria was present in 108 countries and territories in 2008, causing approximately 247 million cases and nearly one million deaths.1  Most deaths are in children under 5.  The international day of observation was recognized by high-profile celebrities, NGOs, and small communities in a variety of ways.  But the newest – and potentially the most effective – way to raise both money and awareness is by going viral with the protozoan parasite.  

Malaria first went viral when Ashton Kutcher celebrated his beating CNN to one million followers on Twitter by donating $100,000 to Malaria No More to purchase 10,000 mosquito nets.2  Through his donation, 89,724 insecticide-treated bed nets were sent to villages in Senegal.  By using the RT2Give Twitpay service, any Twitter user can retweet a message from their malaria-related non-profit of choice and donate $10 to Malaria No More.  Internet Explorer and Firefox users can also download and use the Nothing But Nets browser toolbar, which raises money every time it’s used to search and shop online.  

The battle against malaria continues to rage on many fronts, and much progress has been made.  A variety of rapid diagnostic tests are available to facilitate accurate diagnosis and prompt treatment, requiring only a drop of blood and giving results in 15 minutes.  Artemisinin-based combination therapy acts quickly with few side effects and has proven extremely effective at treating malaria cases.3  Malaria vaccine candidates, though they only confer partial protection, have shown great promise and are currently in Phase III testing.4  However, there is still much work to be done: insecticide-treated bed nets must be made more widely available, reliable testing and treatment need to be implemented on a much wider scale, and care and treatment must be made more affordable and accessible.   

When UN Secretary General Ban Ki-moon announced the first World Malaria Day in 2008, he made the bold proposal of ending malaria deaths by the end of 2010 by ensuring universal coverage in Africa.  In an op-ed piece in the Guardian, he cautioned that while we may not be able to wipe out malaria right away, we can combat it effectively if we act together.  “We have the resources and the know-how. But we have less than 1,000 days before the end of 2010. So let’s get to work.”5 

~~~traduction française~~~ Continue reading “Plasmodium goes viral as the global health community observes World Malaria Day”

Despite successes in reducing global maternal mortality, Yemen still struggles to provide adequate maternal care

The Lancet grabbed the attention of global health advocates this week when it published a study recording a significant drop in maternal mortality between 1980 and 2008.  The global maternal mortality rate has declined approximately 1.3% per year, due to a combination of lower pregnancy rates, higher income, more education for women, and higher availability of skilled birth attendants.1  Though progress toward the fifth Millennium Development Goal varied significantly by country, the news is encouraging, particularly in a field where there has been a perception of no progress.

Woman a black hijab cleans a newborn baby.
An Oxfam-trained midwife cleans up a newborn at Sayoun General Hospital, Yemen. Photo courtesy of Abby Trayler-Smith/Oxfam.

However, this positive finding also brings a new sense of urgency to countries where maternal mortality remains high.  Yemen in particular has a depressing maternal and child health record.  According to UNICEF, each Yemeni woman has 5.2 children on average, and the adjusted maternal mortality ratio was 430 per 100,000 live births.  Only 47% of women were attended by skilled health personnel even once during pregnancy from 2003-2008 (only 11% were attended four times or more), and a mere 36% gave birth with a skilled attendant present.2  In 2005, 1 in 39 women died from childbirth or related complications.  And yet maternal care is only one area where women suffer in Yemen: the country, which has attracted recent media attention for “child brides,”3,4,5 is ranked last in the World Economic Forum’s global gender gap index.3

In the face of such dismal statistics, one intervention, supported by the Extending Service Delivery project at Ibn Khaldoun Hospital in Lahej, is working to reduce maternal mortality.  This intervention has greatly improved care given to mothers and newborns over the past year by implementing eight best obstetric practices:

  • family planning counseling for women immediately after delivery
  • Vitamin A provision to mothers after labor
  • infection prevention controls
  • kangaroo mother care for premature babies
  • exclusive and immediate breastfeeding
  • active management of the third stage of labor
  • tetanus and polio vaccines for newborns
  • newborn resuscitation

Through a partnering program, progressive religious leaders preach the merits of family planning in mosques and midwives meet with women’s groups to discuss contraceptive choices.  Prior exposure to these issues then increases couples’ acceptance of the best practices when they arrive at the hospital.  Dr. Jamila Raebi, Yemen’s deputy minister of health, is championing the program and has developed a plan to scale-up the practices to health facilities throughout the country.

The global-scale progress in maternal health currently being made highlights the need for progress in countries struggling with MDG5.  Though these interventions have demonstrated promising results, all Yemeni women desperately need improvements to their country’s maternal health capabilities.

Water and Public Health

IMG_2301

The theme of APHA’s annual meeting is Water and Public Health. During the opening general session Dr. Mirta Roses Periago, Director of the Pan American Health Organization (PAHO) underlined the effects of climate change on human health, the new challenges faced by global health and the importance of access to safe water. Dr. Periago reinforced that combining water, sanitation and hygiene interventions can reduce up to 80% of the preventable water borne and related disease. The Millennium Development Goal target for 7c is to reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation. Dr. Periago stated that a one dollar investment in water and sanitation provides a $46 savings in social and development cost. The ideal would be to have water, climate change and equity addressed in a combined sustainable approach.

Celine Cousteau reinforced the importance of the connection between people and the environment. Ms. Cousteau is a story teller whose passion preserving our natural resources is equaled by her passion to bring health care to the indigenous people of the Vale do Javari reserve in Brazil. The film Amazon Promise is a celebration of one organization’s goal to bring health care to those in need…. the same passion found in so many of our public health workers around the globe.