Improving Health Data to Improve Health Outcomes in Low- and Middle-Income Countries

By Cho-Yau Ling

Cho-Yau Ling, senior program officer at the CDC Foundation

Cho-Yau Ling, senior program officer at the CDC Foundation

Each year, more than 50 million people die around the globe and for many, the actual cause of death is never recorded. That fact alone is quite troubling, but a critical carry-on issue is that not knowing the cause of death presents a major obstacle in developing data-driven policies that can improve public health outcomes in low- and middle-income countries.

Last month, Bloomberg Philanthropies and the Australian government announced a new Data for Health initiative that will assist 20 low- and middle-income countries across Latin America, Asia and Africa in strengthening their public health data systems and use of data for critical policy-making decisions. This innovative $100 million effort is aimed at solving the world’s most pressing public health problems using technology and data to help fill major gaps in global health. Bloomberg Philanthropies describes the initiative as seeking to provide governments, aid organizations, and public health leaders with tools and systems to better collect data—and use it to prioritize health challenges, develop policies, deploy resources, and measure success.

The CDC Foundation is honored to partner with Bloomberg Philanthropies in one aspect of the initiative. In this work, the CDC Foundation, in partnership with the U.S. Centers for Disease Control and Prevention (CDC), will support dedicated government staff in-country to strengthen birth and death registration systems and improve information on cause of death. In addition, this partnership will support and convene experts to create the best-in-class mobile phone risk factor surveys for noncommunicable diseases. Finally, the partnership will help in-country, CDC-supported Field Epidemiology Training Program (FETP) residents and National Public Health Institute staff improve capacity in Ministries of Health to use health data to inform policy development.

We are grateful to Bloomberg Philanthropies, in partnership with the Australian government, for funding this initiative that will gather vital health data, target resources and save lives. More than 1.2 billion people will be impacted by this project, living in countries with improved capacity to use data to inform critical public health decisions.

Ling is a senior program officer with the CDC Foundation

New Data for Health initiative will assist low- and middle-income countries in strengthening data collection for addressing public health challenges.

New Data for Health initiative will assist low- and middle-income countries in strengthening data collection for addressing public health challenges.

 

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Idyllic? Maybe. Resilient? Definitely. From the Front Lines of Cyclone Pam

By Tom Perry, CARE.

Tom Perry works in emergency communications for aid organization CARE

Tom Perry works in emergency communications for aid organization CARE

When people talk about the South Pacific and countries like Vanuatu, they often use words like ‘idyllic’, ‘relaxed’ or ‘peaceful’. And yes, there are plenty of parts of the South Pacific that fit those descriptions.  Yet Cyclone Pam, the worst natural disaster to hit the region in recorded history last month, has, for at least a little while, changed the world’s image of the country. Images of lush green islands and cozy lagoons, usually in the newspaper’s Travel section, have been replaced by photos of homes that have been flattened.

But for those who know the Pacific, it’s far more complex than the postcards would suggest. Getting from one part of a country like Vanuatu to another can take weeks. Boats are completely unreliable and dangerous. Gas – the lifeblood of travel in the Pacific – is extraordinarily expensive, and plane flights are reserved for the lucky few that can afford them. This makes getting to everyday essentials – clean water, markets to buy and sell food, schools or medical clinics – a huge task.

Yet people of Vanuatu are adaptable, tough and fiercely proud of their way of life. They’ve used the knowledge of their ancestors to grow, cultivate and market international-quality crops and livestock in some of the toughest terrains on the planet. They’ve pushed phone companies to expand into areas that are unlikely to be commercially viable because they know, better than most, how important a simple cyclone or tsunami warning SMS can be for communities that are a 10 hour boat ride from others.

CARE Scene of the storm’s impact in Vanuatu.

Scene of the storm’s impact in Vanuatu. Credit: CARE

 

This toughness, this resilience, is one of the most remarkable stories of Cyclone Pam. Within days of the cyclone hitting, people were out in the street, many on empty stomachs and with little water, lifting destroyed iron sheets into piles and chopping away at timber.

I arrived in the Vanuatu capital Port Vila on Sunday 15 March, and with Cyclone Pam’s winds and rains still lingering in the south of the country, there was a darkness, both literally and emotionally, that was hard to miss. The airport was still officially closed; it looked like it’d been bombed. Yet within 24 hours, the roads were full of people lining up for gas and chopping at trees strewn across their path.

The energy to get on with recovery and rebuilding was everywhere, and it was infectious. When I was passing through Port Vila’s Freshwota area four days after the storm, I stopped to see a family pulling apart a huge structure made of iron and timber. Robert, the elderly man who was leading the charge, told me that it was the entire roof of the nearby government building that had blown 100 miles through the air, and that sitting underneath it was the flattened shell of his former home.

Shocked, I put my arm on Robert’s shoulder and asked if he was ok.

“Well,” Robert told me with a half-smile. “It’s not too bad. Now I have some great new materials for my new home.”

And this remarkable positivity – this resilience – is reflected across the country.

Yet make no mistake, despite this resilience, Cyclone Pam has been a massive disaster for the people of Vanuatu. It has destroyed 15,000 homes, left much of the country without food or clean drinking water, and blown away around 90 per cent of the country’s crops.

This disaster needs, and will continue to need, a massive response from the international community.

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Making the Path Straight to Global Health: Saving Lives Together

By Katie Pace, Public Content Specialist, MAP International

Katie Pace, Public Content Specialist, MAP International

Katie Pace, Public Content Specialist, MAP International

A few short weeks ago we were hand delivering very special cargo, as the plane turned at an extreme angle into Tequcigalpa, Honduras, one of the world’s most dangerous airstrips, I hoped that we would land safely for this momentous occasion.  When the plane safely met land, our group was thrilled, we would be able to deliver our medicines to a clinic in need and reach the $5 billion mark in medicines delivered by MAP International.  We have delivered medicines and medical supplies for 60 years, to over 100 countries, impacting millions of people, but for me, this will be the most memorable shipment.

This team encompassed some of the best Georgia leaders to provide health, hope and a better way of life to people living in remote villages in Honduras.  It’s not every day that we have the opportunity to not only see the lives changed by what we do, but to interact with the missionaries carrying out our life’s work.  This was so much more than delivering our medicines to those in need, this was joining with the Atlanta community to change lives in Honduras through global health.

This week in Honduras was completely out of the norm for our typically journeys, and for that I am eternally grateful because it’s not every day that we get to see the full scope of how medicines change lives and how the leaders of Atlanta make a difference worldwide.

In Tequcigalpa we joined with Honduras Outreach Inc (HOI) based in Atlanta as well as The HAVE Foundation’s Wilderness Team, made up of mostly Atlanta Rotarians to make the 7 hour bus ride to the Agalta Valley.

The remote Agalta Valley has 50,000 inhabitants that HOI and HAVE partner with to improve their lives through education and health care.  At MAP, we see the HOI clinic as the heart of the Agalta Valley community.  We had the honor of bringing enough antibiotics from two Atlanta based pharmaceutical companies to last the clinic an entire year, as well as one of our Johnson & Johnson Medical Mission Packs that is packed with the best donated J&J products to treat a wide range of conditions.    We were also pleased to see medical equipment from MedShare, another Atlanta based NGO in the Agalta Valley clinic.

Each morning, members of the community come mostly by foot or horseback to be seen by the clinics impressive Dr. German Jimenez and his nurses. One mother walked over 30 minutes through a river with her sick infant son to receive medical care, the HOI clinic is the only clinic in the Agalta Valley and it has a vast impact.

Charro, a mother in rural Honduras walked 30 minutes through a river above her knees to bring her child to the clinic.  Photo credit: Katie Pace, MAP International

Charro, a mother in rural Honduras walked 30 minutes through a river above her knees to bring her child to the clinic.  Photo credit: Katie Pace, MAP International

We were privileged to see hundreds of patients that week and each one left healthier than they arrived because of proper medical care.  On day 2, I was standing in front of the clinic staring down the long road that leads each patient there, watching a woman ride slowly towards me on a horse.  It was only after she dismounted that I saw the young child seated behind her.  Mary was 7 and had a difficult time dismounting the horse, she never removed her hood from her head even though it was a very warm morning.  As she walked towards the clinic it was very apparent that she could barely stand, she was very sick.  This sweet little girl had been throwing up for days, more than likely from a parasite and was dehydrated.  The clinic treated her for the parasite and gave her Oral Rehydration Salts from MAP to rehydrate her.

The children at this clinic are much like our own, ear aches, coughs and simple infections that are easily treated with basic medicines.  The problem is that medicines are not readily available in

A sick young girl waits on her mother to tie up their horse before walking into the clinic. Photo credit: Katie Pace, MAP International

A sick young girl waits on her mother to tie up their horse before walking into the clinic. Photo credit: Katie Pace, MAP International

the Agalta Valley, unless you come to the HOI clinic.  This clinic brightens the lives of the children in the community by providing them with medicines, medicines that can create a healthier happier life for a child with worms, a common cold or suffering from days of diarrhea.  These medicines are so important to the world and the people that we serve.

On our final day in Honduras we were honored to have the President of Honduras, Juan Orlando Hernandez join MAP’s CEO, Steve Stirling in the Agalta Valley to receive MAP’s $5 billionth shipment of medicines and supplies delivered to over 100+ countries in 60 years.  “We’ve gone from $4 billion to $5 billion in just 3 short years, so why can’t we go from $5 billion to $10 billion in less time?” says MAP CEO Steve Stirling.  “Working through partners like HOI we can save even more lives.”

MAP CEO Steve Stirling presents MAP’s $5 billionth mark in medicines delivered to Juan Orlando Hernandez, President of Honduras and the First Lady.  Photo credit: Greg Thompson

MAP CEO Steve Stirling presents MAP’s $5 billionth mark in medicines delivered to Juan Orlando Hernandez, President of Honduras and the First Lady.  Photo credit: Greg Thompson

MAP International has provided medical aid to the people of Honduras for over 25 years and last year alone we provided over $36 million in medicines and supplies to Honduras through partners like HOI.  We all need to be inspired and encouraged to continue our work to make Global Health a reality in the far reaches of the world.  Partnering with Atlanta organizations like Honduras Outreach Inc., The HAVE Foundation and the Atlanta Rotary has inspired us to do even more for the people of Honduras.

Our aim in to save lives, but we can only do this with our partners help.  Our partners make the communities where we provide medical aid thrive and they give them a hope for better future.  I was inspired to see members of the Atlanta Rotary, the Atlanta media, Georgia’s own Vince Dooley and even a ER physician at Emory shoveling concrete to make the school in the Agalta Valley a safer place for the children.  “We are trying to make straight the path,” said Georgia great, Vince Dooley.  This entire project in Honduras encompasses all we stand for, Global Health.

UGA’s Vince Dooley shovels concrete at a school in Honduras with Atlanta Rotary and The HAVE Foundation’s Wilderness Team’s Gray Campbell and Clark Dean.  Photo credit: Katie Pace, MAP International

UGA’s Vince Dooley shovels concrete at a school in Honduras with Atlanta Rotary and The HAVE Foundation’s Wilderness Team’s Gray Campbell and Clark Dean.  Photo credit: Katie Pace, MAP International

MAP’s $5 billion shipment did so much more than just originate in the great state of Georgia, it brought the kindness and generosity that is Atlanta to those in need in Honduras.

Learn more about Global Health Day 2015

Learn more about MAP International

Learn more about Honduras Outreach Inc.

Learn more about The HAVE Foundation

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Georgia’s Critical Mass of Global Health Organizations Could Make Up a Statewide Alliance

Mark's Portrait

Mark Rosenberg, MD, MPP President and CEO, The Task Force for Global Health

By Mark Rosenberg, MD, MPP President and CEO, The Task Force for Global Health

Global health pioneer Bill Foege demonstrated in the 1960s and ’70s that eradicating a devastating disease such as smallpox requires collaboration among governments, organizations, and large teams of healthcare workers. These problems are too large, he said, for any one person or organization to solve on its own. Coalitions are absolutely critical.

Although Foege’s experience with smallpox eradication demonstrated that global health had to be a collective effort, the global health community has struggled to understand the principles of effective collaboration and apply them successfully. Last year’s Ebola outbreak was not effectively addressed until the global health community was mobilized to work together on the issue. Africa’s HIV epidemic did not slow in the last decade until donors began working together with affected countries on the issue. Similarly, programs to control and eliminate neglected tropical diseases have only succeeded because of sustained collaborations among endemic countries, global health organizations, pharmaceutical companies, and donors.

An alliance among Georgia’s global health organizations could help connect this community to work collaboratively on large issues. It also could serve as a resource for members and other organizations interested in engaging the sector, and advocate for global health priorities at the state, national, and international levels. An alliance would contribute to the economic development of the state by strengthening Georgia’s global brand and helping to attract new organizations to the state. It would also provide a mechanism for Georgia’s global health organizations to apply their expertise in solving global health problems to public health issues in Georgia.

Through its Global to Local Initiative, the Washington Global Health Alliance (WGHA) partnered with the Tukwila Community Center to provide Somali women in South King County with the opportunity to participate in culturally appropriate, weekly physical activity classes to improve their health. WGHA’s experiences with addressing health disparities in South King County are helping Georgia stakeholders understand the potential contributions that could be made by a Georgia Global Health Alliance.

The Washington Global Health Alliance seeded Global to Local, a non-profit that partners with the Tukwila Community Center to provide Somali women in South King County with the opportunity to participate in culturally appropriate, weekly physical activity classes to improve their health. Global to Local’s experiences with addressing health disparities in South King County are helping Georgia stakeholders understand the potential contributions that could be made by a Georgia Global Health Alliance.

Georgia has a critical mass of organizations that could begin to work together in an alliance. They include academic institutions, nonprofit and nongovernmental organizations, corporations, government agencies, and trade associations that are already engaged in global health work or could contribute in meaningful ways. The Washington Global Health Alliance (WGHA) has been providing guidance about how a Georgia alliance might operate. Since 2007, WGHA has been forging collaboration within its global health sector to improve the health of people around the world including residents of Washington State. WGHA started with six members that each committed initial funding combined with a grant from the Seattle-based Bill & Melinda Gates Foundation. WGHA now has 65 members spanning diverse sectors and a budget of $1.2 million.

One of WGHA’s biggest contributions has been to map the global health sector in Washington to identify existing connections among members and opportunities for new collaborations. Out of this work, WGHA facilitated a partnership between the Seattle Sounders professional soccer team and four global health organizations in the state to propose an innovative program in Tanzania to promote health equity called “Wealth and Health.” The four global health organizations involved in the partnership–PATH, World Vision, the University of Washington, and Washington State University–had all been working in the Tanzanian city of Arusha for years, but never together until WGHA cultivated this collaboration. WGHA has facilitated other partnerships to bridge the non-profit and corporate worlds by exploring how business expertise could address supply and logistical issues encountered by global health organizations in the developing world. In return, the nonprofits have provided their expertise to corporate partners in working in emerging markets. In 2014 alone, WGHA facilitated more than 255 partnerships.

While working to bring together the global health community, WGHA has also been supporting what Dr. Howard Hiatt, former dean of the Harvard School of Public Health, calls “global health at home.” In Washington State, residents of South King County suffer high rates of poverty and disease, with health outcomes comparable to those experienced by people in Kenya. Through the Global to Local initiative, WGHA is working with its members to identify global health approaches that could help address health disparities in South King County. Swedish Health Services, a large non-profit medical provider in the Seattle area and a WGHA member, has committed $1 million in funding to the initiative. Georgia’s health equity issues are equally as pressing as those in South King County, and a Georgia alliance could help bring to bear solutions that have worked in other parts of the world. For example, community health workers have helped improve health outcomes for people in the developing world with chronic diseases such as HIV. A similar strategy might be employed in Georgia to help promote medication compliance for people with diabetes, HIV, and other chronic health conditions.

Georgia is well positioned to become a global health hub. In addition to its large, diverse group of organizations already working in the space, it has a world-class international airport that provides a gateway to all parts of the globe. Stakeholders from Georgia global health organizations have been learning from WGHA representatives about their experiences in making Washington a global health center. WGHA representatives recently traveled to Atlanta to meet with Georgia stakeholders to discuss elements of the WGHA model of collaboration that may be useful to Georgia. Those discussions will continue in earnest over the coming months and are expected to help a Georgia Global Health Alliance take flight.

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Elimination of Malaria on Hispaniola Targeted with $29.9 Million Grant

By Charles Stokes

By Charles Stokes, president and CEO of the CDC Foundation

By Charles Stokes, president and CEO of the CDC Foundation

Malaria has long been intertwined in world history, with characteristic malaria symptoms noted as far back as 2700 BCE. Unfortunately, malaria today remains a deadly disease, one that also holds back economic activity. The good news is that important progress is helping to better control malaria—even eliminating indigenous cases in some parts of the world.

The CDC Foundation recently announced a new consortium with the goal of ending malaria on the island of Hispaniola. The consortium is being funded through a $29.9 million grant from the Bill & Melinda Gates Foundation and is bringing together partners led by the U.S. Centers for Disease Control and Prevention (CDC) to eliminate indigenous cases of malaria on the island of Hispaniola by 2020.

Hispaniola, which includes the countries of Haiti and the Dominican Republic, is the only remaining island in the Caribbean where malaria is endemic. In Haiti, where the majority of Hispaniola’s malaria cases occur, there were more than 20,000 confirmed cases in 2013.

Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. However, malaria is preventable and treatable.

Haitian health worker Jonel Mompremier pricks the finger of a young child to test his blood for malaria parasites in Ouanaminthe, Haiti. Credit: The Carter Center

Haitian health worker Jonel Mompremier pricks the finger of a young child to test his blood for malaria parasites in Ouanaminthe, Haiti. Credit: The Carter Center

Eliminating malaria will save lives and result in increased productivity and economic gains for the people of Hispaniola as well as attract foreign investment and safeguard existing philanthropic investments. Additionally, eliminating malaria on the island will lessen the burden on Hispaniola’s public health systems, freeing up resources to tackle other pressing health issues.

The Haiti Malaria Elimination Consortium (HaMEC) being formed through this grant will work closely with the international community and partners on Hispaniola to eliminate indigenous cases of malaria in Haiti. HaMEC includes three Atlanta-based organizations—CDC, the CDC Foundation and The Carter Center Center. In addition, HaMEC includes the Haiti Ministry of Public Health and Population, the Dominican Republic Ministry of Public Health, the Pan American Health Organization, the Clinton Health Access Initiative, Tulane University School of Public Health and Tropical Medicine, and the London School of Hygiene & Tropical Medicine.

These organizations will collectively work to assist the countries of Hispaniola in developing, adopting and implementing an evidence-based strategy and operational plan for achieving malaria elimination. The group will also secure the additional financial resources needed to achieve elimination, improve and refine malaria surveillance systems, and reduce malaria transmission through implementation of effective community-based interventions that are tailored to the level of malaria risk in high-prevalence areas. The goal of the group is to eliminate malaria on Hispaniola by 2020.

Learn how you can support the effort to make malaria history in Hispaniola.

Stokes is president and CEO of the CDC Foundation

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Working Behind the Scenes in the Fight Against Ebola

By Carolyn Baer, CARE’s Senior Technical Advisor, Sexual and Reproductive Health for Emergencies

By Carolyn Baer, CARE’s Senior Technical Advisor, Sexual and Reproductive Health for Emergencies

By Carolyn Baer, CARE’s Senior Technical Advisor, Sexual and Reproductive Health for Emergencies

Landing in Monrovia, Liberia, I immediately started taking in the sights and sounds of this small West African country that Ebola has hit so hard. My ultimate task was to provide operational support for colleagues directly addressing the Ebola crisis, but in the short term I was struck by how the health crisis already had influenced culture there.

Where one normally might shake a person’s hand to greet them, for example, they bumped elbows instead – thus respecting the “no-touch” rule that was commonly upheld by both the foreign aid workers and the Liberians. Having lived and worked in Africa for many years, I didn’t immediately adapt to the new greeting. For the first few days, as I extended my hand to introduce myself, the gesture would usually end with a light scold from one of the aid workers. This was only one of the many behavioral changes that Liberians have made since Ebola arrived and began ravaging their country.

It was a clear measure of how serious our work was.

As a CARE employee with years of experience in both global health development and emergencies, I was asked by the Liberian office of the Centers for Disease Control and Prevention and eHealth Africa, a technology focused nonprofit and CDC partner, to visit Liberia for one month to provide operational and logistical support to the epidemiologists — both local and American — who were responding to the Ebola outbreak there. Many of the locations in which they worked were incredibly remote, with few amenities, and that only compounded the need for operational oversight.

In some cases, for instance, it took two or three days to travel about 375 miles. The roads contained deep trenches where rain collected, leaving drivers unsure of how deep the trenches were — or how safe the passage was. “Bridges” often were mere planks of wood casually thrown across a creek. Food and water were not readily available in some areas, leading the logistics team to recommend that traveling field teams carry with them at least two weeks’ worth of each. Field teams spent weeks at a time in these rural areas, walking between villages and working closely with officials from the Liberian Ministry of Health and Social Welfare in order to support active surveillance, provide guidance on infection prevention and control activities, and determine contacts of known Ebola cases.

During my time there, I helped oversee the field team’s orientation, geographical placement and operational needs. I helped ensure reliable transportation, communication and administrative support so they could focus on their tasks in the field. This was a real-time global health emergency whose rapidly changing landscape was not always easy — but was always necessary — to navigate.

I am grateful to CARE, the CDC and eHealth Africa for the opportunity to have helped chart that course on the ground — and am humbled to have played a small part in the global effort. I deeply appreciate and respect all those who have engaged in the response, especially those on the front lines caring for and comforting others so directly caught in the crisis.

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Health paradigms shifts in the 20th Century

By Dr. José Miguel De Angulo, MAP International Regional Director for Latin America and Luz Stella Losada, MAP International Bolivia Community Health Specialist

Dr. José Miguel De Angulo, MAP International Regional Director for Latin America and Luz Stella Losada, MAP International Bolivia Community Health Specialist

Dr. José Miguel De Angulo, MAP International Regional Director for Latin America and Luz Stella Losada, MAP International Bolivia Community Health Specialist

We are witnessing the emergence of new paradigms that allows for a more comprehensive understanding of the world in general and various phenomena specifically.  New paradigm overcome the limitations of the traditional, fragmented understanding of phenomena and problems based on the mechanistic or Newtonian worldview.  Systems theory and study of complexity allow a more holistic view of what it means to be human.  New paradigms recognize that phenomena are interrelated, and that individual parts cannot be understood by only focusing on the analysis of their individual qualities.  Rather, the individual parts can only be understood in relation to the whole and by being analyzed in the context of their interaction with the whole. A paradigm of complexity opens the door to previously unimagined models of thinking.

Paradigmatic shifts have also affected medicine and an understanding of human health in the modern western world.  There has been a shift from focus on specific biological analysis and pathological diagnostics to complex human interactions with the environment and with sociopolitical and economic processes.  There are complex models of systems in immunology, in neuroscience, and in genetics, as well as complex ways of understanding interactions as in epidemic modeling, in social media technologies, socioeconomic factors, and artificial intelligence.  Paradigms that historically were broader and more inclusive, such as “international health” excluded many critical components essential to a robust understanding. The old “international health” has been replaced by the paradigm of “global health” that exercises more comprehensive claims.   The international health paradigm focused primarily on the control of epidemics across national borders and considered government as the only health actor; this perspective has come to be seen as excessively reductionist.

The first two paradigms share a focus on pathologies and the organism of the individual. The last two paradigms reveal a shift resulting from an understanding that the health-disease process is not merely a biological and organic phenomenon in individuals. It represents an attempt to move away from what is a fragmented focus and attempts to handle reality in a more comprehensive manner. In this paper we describe three paradigms of the health-disease (H-D) process that in some degree correspond to the historical development of modern medicine and healthcare over the previous century.

HOSPITAL-BASED PATHOGENIC BIOMEDICAL PARADIGM.

This paradigm uses the concept of “pathogenic” because it is based on a search for and discovery of the origin of a disease.  Health is viewed as the absence of disease, with disease being defined as a deviation from the normal biological functioning of the body. The paradigm is called “biomedical” because it requires highly qualified scientific personnel, with the doctor playing the main role supported by a team of other professionals such as laboratory technicians, pharmacologists, biochemists, nutritionists, nurses, etc.  The human body is viewed as a complex biological machine, requiring the services of “biological engineers” who understand its complex chemical reactions as well as the possible modifications in its cells and organs.  The model is called “hospital-based” because health care is delivered primarily in this setting.  Biomedicine emphasizes the scientific treatment of the individual.  Such services require sophisticated and expensive instruments and high technology equipment.  Hospitals, by keeping patients together, can make more efficient utilization of both human and technological resources.

This paradigm has many strengths, such as more effective methods for diagnosing and treating life-threatening and disabling diseases. It has saved many lives, alleviated pain, and facilitated the recuperation of patients.  It also has several limitations such as high costs for qualified human resources, advanced technology, and extensive infrastructure.  It has low geographical accessibility, low financial accessibility, and low cultural accessibility.  Its high cost is affecting healthcare everywhere.  Low cultural accessibility occurs because of language and worldview differences between patients and service providers affecting how signs, symptoms and feelings are framed. Another problem is the misuse of pharmaceuticals. Furthermore, many doctors and hospitals fail to treat the poor as well as they would treat the wealthy, so that a large sector of the population simply avoids doctors and hospitals completely due to inferior care.

An important limitation of this paradigm has been in the management of disease processes that require intervention in social groups rather than individuals.  Even in developed countries health officials now recognize that a high percentage of pathologies depend on lifestyles that lead to chronic and degenerative disease.  Adoption of a lifestyle has a major social dimension.  Linear causality, a feature of the pathogenic aspect of the paradigm, may be insufficient to explain diseases whose cause and evolution is multifactorial.    An example of this is the failure to deal with mental illness.  A reductionist approach to health care is blamed for making medical practice impersonal and seeing patients as isolated “problems”.

In the developing world this limitation of the paradigm may be amplified since the prevalent diseases need to be viewed in the context of complex social, economic, sanitary, environmental, and political conditions.

Infant diarrhea illustrates this.  The paradigm says that the diarrhea is the result of a virus or parasite being transported by a vector, which in this case is contaminated food or water, to a host, the child.  The “colonization” of these germs in the child produces the disease.  If the many other factors associated with this illness such as lack of potable water, the poor sanitary conditions in which the child lives, lack of time for the mother to care for him due to her excessive work responsibilities are dismissed, this solution begins to be simplistic.  The same mother returns a month later with the same child with the same symptoms. The same diagnosis is given as before, and she leaves with the same recommended treatment.  This mother will return several weeks later with the same problem.   Because of this, hospitals, clinics and health centers have been called disease palaces or patient recycling centers.

This critique has been made by Helfdan Mahler, director general of the World Health organization, (23) and Ivan Illich. Mahler has deplored the tendency to devote increasingly large sums of money to maintaining `disease palaces´.

Perhaps the best summary critique of this paradigm is that of John Germov:  “While the biomedical model represented a significant advance in understanding disease and resulted in beneficial treatments, it has come under significant criticism from both within medicine and from a range of social and behavioral disciplines such as sociology and psychology. The major criticism is that the biomedical model underestimates the complexity of health and illness, particularly by neglecting social and psychological factors”

Community-based health development should not be managed as isolated biological or sanitary conditions as the two previous paradigms did, but should focus on comprehensiveness and the processes generated by the interactions of the different actors. Even though science has been able to identify the specific biological causes of many diseases and the specific medical actions that need to be taken to cure those diseases, the multiple social, cultural, political, religious and economic factors that underlie disease processes cannot be managed in isolation. The traditional western development approach is a problem-driven process.  The approach is an expression of Newtonian science that views the world like a gigantic clock with reality made up of discrete parts, each with its individual structure and function.  It breaks systems and units into their constituent sub-units and analyzes their distinct elements. A problem-solving approach focuses on “rational dimensions” and frequently loses its connection with people’s lives and runs the risk of being unnatural and ineffective. A problem-driven development approach reproduces the old model in which the focus is the problem itself instead of the capacity of people to build healthy and sustainable environments, to maintain healthy behaviors, and to promote policies that foster those environments and behaviors. Problem-driven development takes the effort away from building people’s capacity for self-agency in their lives.

The end of the 20th Century leaves us with an open horizon to address the root causes of many health problems and also the health determinants fostering familial, communal, and societal well-being. At the turn of the century, neuroscience research provided the material for developing a new understanding of how people think, learn, and behave. Though this research was not then considered critical for addressing global health, it paved the way for a shift to a new health paradigm.  This new paradigm focuses on the critical period of life during which human beings establish their brain architecture and lay the foundations of the key determinants for mental and physical health.

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US Measles Outbreak Is Wake Up Call for More Concerted Action to Address This Global Health Threat

By Mark Rosenberg, MD, MPP President and CEO, The Task Force for Global Health

By Mark Rosenberg, MD, MPP
President and CEO, The Task Force for Global Health

The recent U.S measles outbreak that began in California and subsequently spread to 16 states and the District of Columbia shows that the progress that has been made towards measles elimination can easily be lost without continuing vigilance about the disease. The measles outbreak also is a wake up call about the interconnectedness of our world and the importance of taking a global approach to infectious diseases and immunization programs. Georgia’s global health organizations are already playing central roles in both these areas. An alliance among these organizations could help strengthen this work and move us closer to a world in which measles doesn’t exist.

The entire western hemisphere was declared measles-free early in the 21st century. The United States and other countries had reached this point by ensuring ready access to immunizations and instituting mandatory immunization requirements for students in schools. Large-scale immunization campaigns also have been effective in ensuring children in other countries are protected against a range of infectious diseases. But although measles has been officially eliminated from the western hemisphere, small measles outbreaks have occurred annually in the United States due to importations of the disease from other parts of the world. These events and last year’s Ebola outbreak remind us of the significant challenges in eliminating infectious diseases that easily cross national boundaries.

Despite the significant media attention that the recent U.S. measles outbreak has generated, there have only been 141 cases in the United States and no deaths have been reported. This compares starkly to the 146,000 deaths that occur each year globally from measles, mostly in India and sub-Saharan Africa where many children are still not vaccinated against the disease. Measles is the most contagious and lethal disease known to man. It strikes children with a speed and precision unrivaled by most any other infectious disease. Introduce measles to a classroom of unvaccinated children and more than 80% will become ill one incubation period later. Until a vaccine became available in 1963, at least 3 million people, mostly children, died each year worldwide from measles. The disease was once so feared in parts of Africa that parents would wait to name their children until they had survived the disease. Since the 1960s, immunization programs have reduced measles deaths by more than 90 percent in Africa and nearly 100 percent in the United States.

The prospect for global measles eradication was first suggested in a manuscript published in The Lancet in 1982. Like smallpox, it was believed that the widespread use of an inexpensive, and effective measles vaccine could eliminate measles. Each of the World Health Organization’s (WHO) six regions has since set a goal of eliminating the disease by 2020. While substantial progress has been made, the biology of the disease and other factors including anti-vaccine sentiment in the United States and other countries have posed barriers to the effort.

Success of measles immunization programs has depended on achieving “herd immunity” in which at least 95 percent of the population is protected against the disease. This can only be achieved if a very high proportion of the population receives two doses of measles vaccine. Measles has one of the highest thresholds for “herd immunity” because it is so contagious. Measles has likely gained a foothold again in the United States because “herd immunity” for measles has been breached in some areas. There aren’t enough vaccinated people to protect those who have not have not been vaccinated. While there are many reasons children might not be vaccinated, public health experts believe the anti-vaccine movement play a large role in the loss of “herd immunity.” Global measles elimination, however, will require more than just achieving “herd immunity.” Political will, persistence, and additional funding also are needed to fill the gaps in immunization coverage in the United States and the developing world.

Georgia has a robust community of organizations that could be marshaled to help address the “last mile” of global measles elimination. The Centers for Disease Control and Prevention is actively involved with WHO in implementing measles immunization programs. Other organizations such as The Task Force for Global Health, which played a central role in increasing global immunization coverage for children in the 1980s, has deep experience with immunization programs focusing on other vaccine-preventable diseases including cholera, polio, and influenza, as well as measles and rubella. Several other Georgia global health organizations also are active in the vaccine space; they are working to develop new vaccines for HIV and other infectious diseases, and increase access to vaccines against cancer-causing diseases such as hepatitis B and human papillomavirus.

Georgia’s global health organizations frequently work together, but opportunities exist for more frequent, sustained, and structured collaborations to focus on issues such as immunizations and measles elimination. In Washington State, 63 global health organizations have formed an alliance to mobilize the sector and increase impact. Last year, the Washington Global Health Alliance (WGHA) helped save two important funding sources for life science research and global health programs from state budget cuts. WGHA members also have been speaking out in significant numbers about limiting exemptions for immunizations, which has contributed to the U.S. measles outbreaks. An alliance similar to WGHA among Georgia’s global health organizations would have the firepower to positively affect a broad range of global health issues including the global measles immunization effort. WGHA has demonstrated that working together on important global health issues creates greater efficiency and decreases competition for scarce resources, resulting in outcomes that organizations could not achieve on their own.

Efforts are underway to understand how a Georgia Global Health Alliance (GGHA) could develop and operate. WGHA recently received a grant from the Robert Wood Johnson Foundation to analyze its “global-to-local” formula for creating a regional global health alliance and provide other areas of the country with guidance on how to replicate its model. Several Georgia global health organizations are currently working together to partner with WGHA and learn about its model of collaboration. WGHA’s experiences in leveraging partnerships, raising community awareness, and supporting creative solutions to address local and global health challenges will be relevant to understanding the potential impact of a GGHA on global health issues such as immunizations and measles elimination.

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Combining Government and Private Sector Support to Beat Back Ebola

Pierce Nelson, Vice President for Communications at the CDC Foundation

Pierce Nelson, Vice President for Communications at the CDC Foundation

Pierce Nelson, Vice President for Communications at the CDC Foundation

For 10 days in January, I joined two of my CDC Foundation colleagues on a trip to Guinea, Liberia and Sierra Leone. The purpose was to see first-hand how private-sector funds contributed to the CDC Foundation are being used to make a difference in these countries.

In support of CDC, the CDC Foundation has raised more than $50 million in donations in donations that are being deployed in West Africa. These funds are advancing the U.S. Centers for Disease Control and Prevention’s (CDC) response, one in which CDC is working with local and international partners in each country.

Support from international governments, including the United States, has been critical to the response. And working in a supportive role, funding from private sector donors—including individuals, philanthropies and corporations—is providing flexibility to address many of the real-time needs that arise as well as longer-term solutions to public health challenges in the region.

In recent months, tremendous progress has been made in the fight against Ebola in West Africa. Efforts on the ground in this region are impressive, but much work remains to push Ebola cases to zero.

 

Monrovia, Liberia - Contact Tracer Dorissa Bestman records the temperature of a contact she is tracing in the New Cru Town section of Monrovia. She was trained by CDCF partner agency EHealth Africa and uses a tablet provided by the CDC Foundation to record her results, part of a pilot program.

January 18, 2015, Monrovia, Liberia – Contact Tracer Dorissa Bestman records the temperature of a contact she is tracing in the New Cru Town section of Monrovia. She was trained by CDCF partner agency EHealth Africa and uses a tablet provided by the CDC Foundation to record her results, part of a pilot program.

While in West Africa, we heard heart-breaking stories, including one from Liberia about 30 people living in one home who contracted Ebola—29 ultimately died. But we heard stories of hope as well. After being closed for six months, for instance, schools in Liberia were preparing to reopen, and subsequently did reopen last week, as weekly cases there dropped to single digits.

We also saw CDC Foundation donor funding in action. Examples include the purchase of 206 vehicles for transporting lab samples, supplies, patients and bodies of the deceased; vital lab equipment for speeding Ebola tests; and communications to help change practices around social traditions that contribute to the spread of the virus.

To share insights about the response in West Africa, CDC Foundation staff have posted a number of blogs with photos. Stories of the courage of public health workers are featured in one blog. Another conveys how private-sector funding is being used, such as at CDC’s lab in Bo, Sierra Leone, which has run more than 10,000 Ebola tests since opening last fall. Others highlight how donor funding is supporting technology used by contact tracers in Liberia to follow up on those potentially infected with Ebola, social mobilization campaigns in Sierra Leone, and progress in turning back Ebola in Guinea. For more posts, go to the CDC Foundation’s web site.

At the CDC Foundation, we are honored to help advance CDC’s life-saving work in West Africa. We look forward to the day when Ebola is defeated and no longer a threat to the people of this region or the citizens of the world.

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Ivory Coast: Stopping Ebola at the Borders

By Balla Sidibe, CARE Ivory Coast Country Director

Balla Sidibe, CARE

Balla Sidibe, CARE

That leftover Valentine chocolate you’re still nibbling on? It probably originated from cocoa beans grown in the West African country, Ivory Coast.

Cocoa farming is big business here. Ivory Coast is the world’s top producer of cocoa beans, and with the Ebola outbreak ravaging our neighbors in Liberia and Guinea, fears that Ebola would cross the borders placed CARE Ivory Coast staff on high alert.

We knew that an Ebola outbreak would be nothing short of disastrous for this country, which is still reeling from two civil wars. The economic impact, alone, would be far reaching. If farmers couldn’t produce their top crop — the cocoa bean — livelihoods would be lost. The economic impact would be felt for months, even years, to come.

CARE has a vital presence in the cocoa farming communities. One of our poverty-fighting projects, dubbed “Cocoa Life,” empowers farmers to grow their businesses and develop opportunities for their communities.  When news of the nearby outbreak hit, we leveraged our relationships with farmers in support of the government’s key prevention plans. We integrated Ebola prevention training, for example, into regular training events where we educated community leaders on ways to prevent infection, such as not eating bush meat and regular hand washing.

We worked with people like Adjoua Martine Konan, who at first didn’t think the outbreak was real.  “I thought it was just a rumor,” she said, “created by Westerners to stop us from eating bush meat.”

Her community, like many here, has long depended on bush meat, including small rodents, as a source of vital protein and for businesses. So it was hard to accept what health experts were saying: that the handling and consumption of Ebola-infected bush meat can spread the disease among humans.  But after seeing media images of those who had fallen ill from the virus, “I realized that Ebola is very real,” said Konan. Her thinking changed more substantially after attending Ebola prevention training.

More importantly, she started influencing a change in how others in her community viewed the Ebola threat. A single mother of five boys and one girl, Konan serves as vice president of the Community Development Committee in Brokoua, a village of 1 000 people in the central west of Ivory Coast. Armed with posters and storyboards designed by the Ministry of Health, the committee spreads messages about how to stop Ebola in its tracks. “I now know more about Ebola,” Konan said, “what it is and how to prevent it from entering into my village.”

Konan returned home and started holding meetings with neighbors. Families are now eating more fish, pork and beef instead of bush meat, she said.  Konan also has coached her neighbors in regular hand washing and advised them to avoid shaking hands and other greetings that involve touching. She crosses her arms over her chest to demonstrate.  “It is hard for us to change our habits,” she said, “but we know we need to in order to stop transmission.”

I’m proud of the work CARE has done in partnership with the government to prevent Ebola from crossing our borders. Still, I know that the threat is far from over.

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