Guest Blog: Research, Data and the Risk of Inaction

Guest Blogger: Amanda Hirsch


Research and data are a necessity to execute public health agendas – to identify populations in need, pinpoint existing gaps in healthcare systems, and to track and monitor progress. Data collection exists to ensure these necessary details are documented and not forgotten as every person, health affliction, and need is logged as a number, a figure, a statistic.

Data collection, although crucial, can also become highly counter-productive as this, a vast collection of numerated people and needs, can cause these people and needs to become just that – numbers.

Dr. Binagwaho highlighted the experience of West Africa during the recent Ebola epidemic, one in which the identities of thousands of individuals were lost to the tool most necessary for successful public health interventions.

When the faces and stories of West Africa became blended together through numbers and statistics, the potency of the cause and the intervention became lost. Data can allow people to disappear as their identities take-on a range of figures that highlight their poverty, poor health outcomes, and perceived failures therefore undermining their humanity, discouraging action and perhaps encouraging inaction by those that cannot see the direction nor the importance of the aid that is necessary.

Inaction, when these figures display what appears to be a hopeless and trodden population, is lethal to the real-life humans that the numbers account for.

The Rwandan Experience

In honor of David E. Barmes, renowned public health dentist and epidemiologist, the National Institute of Health (NIH) in Bethesda, Maryland hosted the annual Barmes Global Health lecture featuring Rwandan Minister of Health Dr. Agnes Binagwaho on “Medical Research and Capacity Building: The Experience of Rwanda.”

As the sole presenter, Dr. Binagwaho spoke upon her experience as a physician, researcher, and government health official in her native Rwanda and the country’s substantial improvements in public health following the Rwandan genocide of 1994 that took the lives of over 500,000 citizens.

In need of rapid and effective reconstruction efforts after the end of the civil war, the country was pushed to reinvent its public health systems and infrastructure to make Rwanda a stronger and healthier country than it had ever been before.

Since the genocide, Rwanda, a country smaller than most American states with a population of slightly over ten million, has achieved health outcomes for its people that far surpass those of many developed nations. After reconstructive efforts, the under-five mortality in Rwanda decreased by three-quarters, life expectancy nearly doubled, vaccination rates skyrocketed to 90% for vaccines such as HPV for both young boys and girls, and over 90% of Rwandans acquired health insurance coverage.

“Rwanda is a clear example of what is now possible in sub-Saharan Africa”- Dr. Agnes Binagwaho

How were such great achievements accomplished? An emphasis on resilience- a concept that requires not only a strengthening of health systems, but a focus on strengthening the backbone of those health systems as well- the people.

Research and data collection were key to Rwanda’s reconstruction efforts. In Rwanda, Binagwaho explained that public health workers used this research and data to the population’s advantage, maintaining a scientific and moral responsibility to the people, leaving no one behind and holding research to a new standard: an impact- focused standard that would not allow for inactivity.

The people maintain culture, infrastructure, morale, and economic wellbeing. When the people are healthy and stable, the benefits to the country are immense. According to Dr. Binagwaho Rwanda recognized this connection, encouraging  vast vaccination campaigns, emphasis on maternal and child health, and a reach for universal health coverage to protect the country’s most valuable asset. In turn, Rwanda experienced substantial economic growth, social rest, and improved population health- a feat that would not have been accomplished had the needs of the people not been put first.

You can hear Dr. Agnes Binagwaho’s presentation at the NIH here.


twitter photoAmanda Hirsch is a summer Global Health intern for APHA. She is starting her final undergraduate year at the GWU Milken Institute School of Public Health. Her passion for global health began in rural Honduras, and she is particularly interested in disparities in healthcare systems that affect the Latino community. She intends to pursue an MPH degree with a dual concentration in Community-Oriented Primary Care and Global Health. You can follow her on Twitter at @amandahirsch12.

Global Health News Last Week

The 13th Triennial World Congress on Public Health, to be hosted by the Ethiopian Public Health Association and held from April 21-29, 2012 in Addis Ababa, will bring together leaders in health from across the globe. The conference, “Towards Global Health Equity: Opportunities and Threats,” is currently accepting abstracts; the deadline is Friday, October 21, at 12 a.m. PT (3 a.m. ET). More information can be found here.

International Women’s Day was March 8.

On March 11, a 9.0 earthquake rocked Japan’s Chiba prefecture, followed by a colossal tsunami that washed entire villages away.


The world, of course, stands ready to help, but it is unlikely that most of the assistance will be needed, as Japan is one of the most disaster-ready countries in the world. Unfortunately, the explosions in several of the country’s nuclear plants means that the threat of radiation poisoning looms heavily.

POLICY

  • A panel of independent experts has released a report harshly criticizing the World Health Organization’s handling of the 2009 epidemic of H1N1 swine flu.
  • UN officials expressed concern that rising food and energy prices could compromise or even reverse progress toward the MDGs in developing nations.
  • UN Secretary-General Ban Ki-moon has instructed senior managers to cut 3%, or US$5.4 billion, from budgets.
  • The Kenyan government has moved to strip HIV/AIDS of its special status and begin treating it as a chronic medical condition. It has begun implementing a disease integration model that will do away with emergency response measures and dismantle parallel administrative structures set up to manage the disease.

RESEARCH

  • HealthMap, a project that aggregates health and surveillance data from sounces such as the WHO, Google News, and Eurosurveillance, was launched recently to “[bring] together disparate data sources to achieve a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health.”
  • According to a study done by Tuberculosis Research Centre in India, alarming numbers of women with TB become homeless after they are diagnosed. Approximately 100,000 women are abandoned by their husbands due to TB every year in India.
  • A group of researchers from EPFL’s Global Health Institute and Inserm (Institut National de la Santé et de la Recherche Médicale, the French government agency for biomedical research) has discovered that a class of chemotherapy drugs also kills the parasite that causes malaria.

PROGRAMS

  • Oxfam recently released a report criticizing the World Bank for its praise of Ghana’s healthcare system. Amanda Glassman of CGDev disagrees, arguing that Oxfam ignored surveys indicating the system’s success in improving health indicators and beneficiaries’ satisfaction with the quality of service.
  • On March 9, Saving Lives At Birth, a global partnership between USAID, the Government of Norway, The Bill and Melinda Gates Foundation, Grand Challenges Canada, and the World Bank, was launched. The partnership “will seek innovative solutions to reduce maternal and newborn mortality in developing countries.”

DISEASES

  • Rwanda is on track to completely eliminate malaria, the first country in its region.

Global Health News Last Week

POLICY

RESEARCH

  • A paper published in Science by a research group at the University of Maryland demonstrates that a fungus, Metarhizium anisopliae, can be used to combat the malarial parasite inside the mosquito. Another promising study suggests that a compound produced by a seaweed in Fiji could be used to combat malaria.
  • A new study has shown that that Internet kiosks providing information on prenatal and postnatal care have helped reduce infant, child, and maternal mortality rates in rural India.
  • A study published by the Harvard School of Public Health last year found that the poorest third of the world’s population account for only 4% of surgeries worldwide, and that over two million people in low-income countries have no access to life-saving surgery.
  • The first phase trials of the HIV vaccine developed in India were completed with no side effects reported. Meanwhile, a three-year research trial on a vaginal anti-HIV gel has been launched in Rwanda.
  • The Trachoma Atlas, an open-access resource on the geographical distribution of trachoma, was launched by a team of collaborators from the London School of Hygiene & Tropical Medicine, the International Trachoma Initiative at The Task Force for Global Health, and the Carter Center. It is funded by a generous donation from (you guessed it!) the Bill & Melinda Gates Foundation.
  • The European Solutions Enterprise for Neglected Diseases (euSEND), a new initiative, based in the Netherlands, was launched to aid in the fight against neglected tropical diseases. The organization’s goal is to “take the role of matchmaker” to facilitate partnerships in research for NTD treatments and vaccines.

PROGRAMS

  • Swaziland has a large-scale circumcision drive in an attempt to lower HIV rates.
  • Cash-transfer programs as a means of assisting the poor are beginning to gain attention and popularity from development and economic professionals. Mexico’s and Brazil’s have captured particular attention and are credited with poverty reduction and GDP growth.
  • The first methadone maintenance program in sub-Saharan Africa recently opened in a hospital in Dar es Salaam, Tanzania. Heroin use is a growing problem in port cities, where the drug passes through en route from Afghanistan to Europe.

DISEASES

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.