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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One Simple Pill: Deworming the World

- Katie Pace, MAP International Public Content Specialist

Katie Pace, MAP International Public Content Specialist

Helminthes.  It sounds like a character out of a poorly written book that wants you to struggle with the pronunciation.

Worms, now we all know what that means.  Or do we?

It’s not extremely common in the United States to hear that a child has worms, our pets, yes frequently – but not our children.  You might think that a worm isn’t a big deal, but in the developing world it can take a severe toll on a child’s most formative years.

Soil-transmitted helminthes, or the parasite so commonly called worms is one of the most common infections in developing countries.  It can cause children to suffer from internal bleeding, causing anemia, it inhibits the absorption of vital nutrients, causes diarrhea, severe stomach pain, loss of appetite and itchy scaly rashes caused by secretions and waste that the worms release into the body. Children with worms often suffer from nutritional impairments and pain that causes them to lose focus at school.  These tiny little worms can negatively impact a child’s growth and development and take away their energy levels.

 

IMG_0210Helminthes are on the WHO’s list of 17 Neglected Tropical Diseases (NTD).  NTD’s are a group of chronic disabling infections that affect more than 1 billion people worldwide, mainly in Africa and people living in remote rural areas, urban slums and conflict zones.

So how do children get worms in the first place?  Poor water and sanitation, which includes feces contaminating the soil and transmitting the eggs right into the feet of children who are barefoot.

There are approximately two billion people worldwide that are infected with soil-transmitted helminthes.

If you’ve never had a parasite inside of you, it’s quite painful.  Even as an American with substantial access to healthcare, worms can be debilitating.  So image this in a child that can’t receive treatment or relief from the pain and diarrhea.

So how do we stop these microscopic enemies?  Albendazole, health education and improvement of water and sanitation.  Albendazole is the miracle drug when it comes to deworming children, and is an on the essential medicines list from the World Health Organization.  It’s simple, beyond cost effective and can be given anywhere.  This broad-spectrum anthelmintic is a single pill that is given twice a year, and doesn’t have to be administered by a physician.  Large deworming campaigns at schools and clinics have seen high impacts.

“Deworming is at the foundation of being able to help the malnourished people recover because unless you rid their bodies of the parasites first, no amount of nutritious food you provide them will help”, said Rad Hazelip, Assistant Executive Director at Love A Child Haiti.  “The worms steal all the nutrients intended for the patient.  Lack of adequate food is only one part of the equation of malnutrition.  Solve the parasite issue then you can truly help them recover with proper nutrition.”

This is why we provide our partners with deworming medicines.  It is critical in keeping children healthy.  MAP provides over 1 million deworming tabs each year, treating 500,000 people.  The price of Albendazole in the US has increased by nearly 4,000% since 2010, causing MAP to purchase in bulk from Europe to keep the cost down to around two cents per 200mg tablet. nrmicro962-f1

“Deworming meds are very inexpensive, making it one of the most cost effective ways to prevent a Neglected Tropical Disease”, said Kipp Branch, MAP’s Director of Medicines.  “Two simple pills a year can improve the quality of life for a child in the developing world.”

Ezekiel 3 DewormingThis is Ezekiel, he lives in Cote d’Ivoire and just turned eleven.  For years Ezekiel has had regular stomach pain, bloating, nausea and itching and it has caused him to have trouble focusing in primary school.  “I felt tired all the time,” says Ezekiel.  “All these troubles made it hard for me to follow carefully in classes.  Today I feel better.”  This year, Ezekiel was giving deworming medication from MAP International.  “Since then, these troubles have totally disappeared.”  Ezekiel says, “Today, thanks to this deworming I feel better.”

Ezekiel is now attentive in class and his marks have greatly improved in school.  Now he can enjoy school and playing with his friends and lead a happy healthy life.

We are currently preparing a shipment of 2 million Albendazole tabs destined for the West African country of Cote d’Ivoire where Ezekiel receives deworming medicines from MAP.

 

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Tanzania’s Safe Motherhood Campaign Reaches Half a Million Registrants

By Linda McGehee, Associate Vice President for Programs for the CDC Foundation

By Linda McGehee, Associate Vice President for Programs for the CDC Foundation

By Linda McGehee, Associate Vice President for Programs for the CDC Foundation

Mobile phone technology has proven to be a powerful tool in Tanzania, where the statistics on maternal and infant mortality have improved over the years but still remain high.

To help with this public health problem, the Healthy Pregnancy, Healthy Baby text messaging service (also known as Wazazi Nipendeni), offers Tanzanians free text messages in Swahili for pregnant women, mothers with newborns up to 16 weeks old and supporters of pregnant women and new mothers. The service also offers an enrollment option to those seeking information, providing Tanzanians with a wide range of information concerning healthy pregnancy and early childhood care.

We are so proud to announce that since the launch in 2012, 500,000 men and women received 40 million informative safe motherhood messages and reminders from this campaign.

he Healthy Pregnancy, Healthy Baby text messaging service offers Tanzanians free text messages in Swahili for pregnant women, mothers with newborns up to 16 weeks old and supporters of pregnant women and new mothers. Photo credit: The CDC Foundation mHealth Tanzania Partnership program

The Healthy Pregnancy, Healthy Baby text messaging service offers Tanzanians free text messages in Swahili for pregnant women, mothers with newborns up to 16 weeks old and supporters of pregnant women and new mothers. Photo credit: The CDC Foundation mHealth Tanzania Partnership program

The service is supported by the mHealth Tanzania Public Private Partnership, led by the Ministry of Health and Social Welfare of Tanzania and operates with support from the CDC Foundation, Centers for Disease Control and Prevention (CDC), as well as numerous Tanzanian and international public and private sector partners. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)—through CDC—funded the development of the service and continues to provide financial and technical support for its ongoing development and operation.

Lydia Mwakisambwe registered with Healthy Pregnancy, Healthy Baby the moment she realized she was expecting. Lydia learned about the service while listening to a Wazazi Nipendeni radio announcement. The weekly text messages are providing her with key information about her pregnancy and tips on how to stay safe and healthy.

Find out more about the Wazazi Nipendeni campaign.

Mobile phone technology has proven to be a powerful tool in Tanzania, where the statistics on maternal and infant mortality have improved over the years but still remain high. Photo credit: The CDC Foundation mHealth Tanzania Partnership program

Mobile phone technology has proven to be a powerful tool in Tanzania, where the statistics on maternal and infant mortality have improved over the years but still remain high. Photo credit: The CDC Foundation mHealth Tanzania Partnership program

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Hope for Human Dignity: Haiti Five Years after the Earthquake

Martin Luther King Jr. Day is an appropriate occasion to reflect on the Haitian people’s struggle for human rights and dignity. I thought about Haiti’s remarkable history in the aftermath of the horrendous earthquake, five years ago this month, when I traveled there with CARE’s emergency response team. Even amid vast human suffering, Haitians remained deeply proud of their country’s legacy as a trailblazer for civil rights for people of color. In 1804, after overthrowing its French colonial masters, Haiti became the world’s first independent, black-ruled republic.

By Rick Perera, Researcher for CARE’s Proposal, Stewardship and Information team

By Rick Perera, Researcher for CARE’s Proposal, Stewardship and Information team

The earthquake dealt a profound blow to that proud legacy. I was struck by the sense of paralysis, that the damage suffered by public agencies had left Haiti’s government all but immobilized. Nothing symbolized this more than the sight of Haiti’s National Palace – the official residence of the president, reminiscent of our own White House – lying in ruins.

In the intervening years, despite political turmoil, Haiti’s government has worked closely with the humanitarian community and we have achieved a great deal. Most of the 1.5 million displaced people who were sheltering in spontaneous camps have left them. But the dream of civil rights and opportunity remains elusive. Most Haitians live in poverty and lack adequate public services, while a small minority controls most of the national wealth – an injustice that stands in the way of recovery and future development.

Addressing these challenges is central to CARE’s earthquake response. Initially we focused on meeting critical humanitarian needs such as emergency shelter and water. We quickly transitioned to a longer-term strategy of empowering Haitians to rebuild, advocate for their rights and demand accountability from authorities.

CARE encourages local officials, like Dierry Léger, deputy mayor of the hard-hit Carrefour community, to become more responsive to constituents. Dierry is proud of his work addressing a major reason the quake killed so many people: lax building code enforcement. “There has long been a problem with people building houses without respecting building standards,” he told me. “But things have changed.”

At the community level, CARE identifies natural leaders and helps them build organizational skills. I met an inspiring local activist, Emmanuel Beauvoir, when I returned to Haiti recently. A 32-year-old pre-law student, he rallies Carrefour residents around improvement projects with CARE’s support – like building paved stairs and walkways linking rugged, hillside neighborhoods with jobs and schools in the city below.

Engaged and dedicated citizens like Emmanuel are crucial if Haiti is to achieve equality and economic opportunity. Humanitarian groups like CARE can help. But ultimately our goal is to see Haitians acquire the skills and tools they need – and let them lead the way. “Every project we undertake is a drop in the bucket” in view of the country’s enormous needs, says Emmanuel. But these are learning opportunities for volunteer groups like his. “It’s the people of Haiti that are living the reality every day and have a lot to offer.”

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Leprosy, Not Just a Biblical Problem

Katie Pace, MAP International Public Content Specialist

Katie Pace, MAP International Public Content Specialist

As World Leprosy Day approaches on Sunday, January 25, we thought it fitting to bring one of the world’s oldest known diseases to light.

Even though the global elimination of Leprosy was officially announced in 2000 (i.e. a prevalence rate of less than 1 case per 10,000 people at the global level), over 200,000 cases are reported worldwide each year in over 103 countries.  Global elimination doesn’t seem like the best term to communicate that there are as many leprosy cases each year as there are people living in Richmond, Virginia.

1-Untitled Infographic (1)-001

Leprosy and Buruli ulcer are both chronic infectious diseases caused by the Mycobacteriums leprae and ulcerans.  Both diseases mainly affect the skin and nerves, if left untreated they can cause severe deformities and have life threatening consequences.  50% of those infected with Buruli ulcer are under 15 years of age, it is considered a flesh eating bacteria and has the power to sometimes eat through bone.

Leprosy and Buruli ulcer are curable.  Yes, curable.  If caught early, Buruli ulcer can be treated with an 8 week course of antibiotics.   Multidrug therapy (MDT) treatments have been provided worldwide by the WHO free of charge since 1995 and it is a simple yet highly effective cure for all types of Leprosy.

Even though it is curable, many people with Leprosy and Buruli ulcer are stigmatized and shunned from their communities – at times comparable to that of biblical times.

Waiting at the clinic in Kobedi

Waiting at the clinic in Kobedi

“When 55 year old Yaa discovered a small nodule on her right leg last year – she did what most people in her village in Ghana would do, apply herbs.

When that failed, she went to the nearest clinic and was sent away because the nurses didn’t know what was wrong with her.  Months went by and the nodule grew into an ulcer that consumed her leg and she had to be hospitalized for four months.  Yaa’s husband and eleven grown children decided that the only option was to leave her to a spiritualist to deliver her from what they believed to be witchcraft.

Six months after being sent to the local healer, the health team in her village came to find her.  After hearing a radio announcement made in part by MAP, they realized that Yaa was suffering from Buruli ulcer, a debilitating flesh eating bacteria.  MAP provided financial and technical support to the Community Health Workers in Yaa’s area so that they could identify additional cases and stop the spread of the disease.

As Yaa finishes her treatment and the ulcer has almost completely healed, she is delighted to be with her family again “I am very happy that my children have accepted that I am not a witch.  I was neglected by my own children, but now they call and visit me.  I am very grateful to MAP International for the tremendous support, I am blessed.”

MAP International has been engaged in the fight to end Leprosy and Burlui ulcer in West Africa since early 2002.  We are joining with renowned partners like American Leprosy Missions, Effect:Hope and The Leprosy Mission Ireland to eradicate Leprosy and Buruli ulcer.

“Every two minutes someone is diagnosed with leprosy,” says American Leprosy Missions President and CEO Bill Simmons. “For more than 100 years, American Leprosy Missions has been working to cure leprosy, care for those damaged by the disease and ultimately bring an end to leprosy. Each year, World Leprosy Day is a time to pause and be thankful for the many people who have been cured of leprosy. But it is also a time to remember the thousands of people who will contract leprosy this year and the millions who suffer from disabilities caused by this terrible disease. We must not forget, that in many parts of the world, leprosy is still a public health problem. So we encourage everyone to join us in observing World Leprosy Day.”

The fight against leprosy and related diseases in West Africa includes strategies that focus on cure, care and ending Leprosy and Buruli ulcer. In addition to teaching awareness, prevention and treatment of these diseases to the local people, we also train healthcare professionals to identify symptoms and begin treatment in the earliest stages of the disease to save lives.  We also provide medicines and medical supplies to over 100 countries each year, including medicines that fight Leprosy and Leprosy like diseases.

“In order to stop the consequences of Leprosy and Buruli ulcer we must properly train healthcare workers in infected regions to stop the diseases in the early stages,” says MAP International Vice-President of Global Programs Dr. Julien Ake.  “We must remove the stigma associated with Leprosy and restore the hope to people suffering from deformities from the diseases.  You can help by supporting MAP International and American Leprosy Missions in the fight to end the ancient disease of leprosy. “

World Leprosy Day, Sunday, January 25, join us in standing with some of the poorest and most marginalized people in the world – those affected by leprosy.

About MAP International

MAP International is a global health organization that partners with people living in conditions of poverty to save lives and develop healthier families and communities.  Learn more about MAP International at www.map.org

About ALM

American Leprosy Missions exists to serve as a channel of Christ’s love to persons affected by leprosy and related diseases, helping them to be healed in body and spirit and restored to lives of dignity and hope.  Learn more about Leprosy from American Leprosy Missions at www.leprosy.org

About effect:hope

effect:hope (The Leprosy Mission Canada) is a Christian development organization, focused on achieving lasting, positive change among people living with the causes and consequences of leprosy and conditions related to leprosy www.efffecthope.org.

About World Leprosy Day

Leprosy is one of the oldest diseases known to humankind. It is also known as Hansen’s disease, named after Norwegian physician, Gerhard Henrik Armauer Hansen, who debunked the prevailing notion of the time that leprosy was a hereditary disease. He showed that the disease had a bacterial cause instead. For thousands of years, people with leprosy have been stigmatized and considered to be at the extreme margins of the society. The aim of World Leprosy Day is to change this attitude and increase public awareness of the fact that leprosy can now be easily prevented and cured.

The date for World Leprosy Day was chosen to coincide with the anniversary of Indian freedom fighter, Mahatma Gandhi’s assassination on January 30, 1948. During his lifetime, Mahatma Gandhi worked tirelessly towards the betterment of people afflicted with leprosy.

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Development of Healthcare Workforce Allocation Tool Demonstrates Real Collaboration Among Atlanta-based Global Health Organizations

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

Tool will help developing countries deploy their healthcare workers in the most optimal manner

Chronic shortages of healthcare workers (HCWs) represent one of the biggest barriers to development and improvements in health outcomes for people living in developing countries. In Mozambique where life expectancy is only 50 years, HCW shortages are particularly pronounced. Fewer than 1,500 doctors serve a population of 25.2 million, with only 89 HCWs per 100,000 people – a ratio significantly below the World Health Organization’s recommendation for the minimum number of HCWs that are needed for a country to adequately meet the health needs of its population.

In another example of Georgia’s impressive global reach and the value of real collaboration, the Centers for Disease Control and Prevention (CDC) and the Public Health Informatics Institute (PHII) at The Task Force for Global Health, in collaboration with researchers and students affiliated with Georgia Tech’s Center for Health and Humanitarian Systems, have developed an innovative tool to help Mozambique improve the allocation of HCWs and ensure more consistent healthcare services for its population. Called the Workforce Allocation Optimization Tool, the Excel-based system considers different indicators and key factors such as budget constraints and provincial-level demand to assign HCWs to locations around the country. Provinces with high levels of disease such as HIV receive priority for HCWs in order to ensure that the health workforce can be scaled up to address health needs in those locations. CDC is currently testing the tool and plans to pilot it in Mozambique during the next allocation period for new HCWs.

CDC’s Division of Global HIV/AIDS initially asked PHII to analyze the current state of health workforce business processes in Mozambique as part of CDC’s efforts to scale up HIV services in Mozambique. PHII staff worked with JHPIEGO, a Baltimore-based global health organization, and the Ministry of Health (MOH) in Mozambique to learn from health officials around the country about how they allocated doctors, nurses, laboratory technicians, and other staff. The team’s analysis revealed that the decision-making process was inconsistent and resulted in uneven allocation of HCWs around the country. Out of their analysis emerged the recommendation for a data-driven, evidence-based system that would allocate HCWs in the most optimal manner.

The workforce allocation tool will help ensure that healthcare workers are assigned to facilities in Mozambique that have the greatest needs. Here a nurse tends to a woman in a post-natal care unit at a hospital near Xai-Xai, Mozambique. (Jhpiego/MCHIP/Kate Holt).

The workforce allocation tool will help ensure that healthcare workers are assigned to facilities in Mozambique that have the greatest needs. Here a nurse tends to a woman in a post-natal care unit at a hospital near Xai-Xai, Mozambique. (Jhpiego/MCHIP/Kate Holt).

The PHII team led by Vivian Singletary and Juneka Rembert worked with a Georgia Tech team that included students Emily Gooding, Colleen Goottee, and Monica Villarreal who were advised by Professors Pinar Keskinocak and Julie Swann, to develop the workforce allocation tool. PHII also collaborated with CDC, JHPIEGO, and the MOH to ensure the tool met Mozambique’s requirements and needs. An Excel-based system was ultimately chosen to ensure that the tool could be used effectively even if only basic computer equipment was available. For the Georgia Tech students, developing the tool provided a valuable educational opportunity to apply skills in industrial and systems engineering while addressing a particular global health issue.

To address the significant issue of HCW turnover in Mozambique, the workforce allocation tool takes into consideration HCW preferences for particular location assignments. The aim is to maximize their satisfaction with their assignments, which should help reduce turnover and ultimately ensure more consistency in the delivery of healthcare services, especially in rural areas where health services often are not available.

It is anticipated that better allocation of HCWs should help address gaps in health services across the country and eventually improve health outcomes for the population. HCW shortages will continue to be an issue in the scale-up of HIV services in Mozambique, but there should be fewer gaps in services after the country deploys the workforce allocation tool.

Mozambique’s adoption of the workforce allocation tool demonstrates a commitment to the use of data and objective criteria for allocating HCWs, an approach that more developing countries are recognizing as vital for stronger health systems. Tanzania and Malawi have already expressed interest in using the tool for their own HCW allocation processes. PHII plans to demonstrate the tool to Ministries of Health in these countries later this year.

The collaboration among CDC, PHII, Georgia Tech students and researchers, JHPIEGO, and the Mozambique MOH, that yielded the workforce allocation tool demonstrates the value of collective action in addressing an intractable global health problem. The Atlanta area is rich with innovative organizations that are working together to make critical and worthy contributions to global health. But these collaborations tend to be project-specific and typically end due to discontinuation of funding. For Atlanta and Georgia to become the “Global Health Capital” – a distinction that we can own – we need to build a coalition that harnesses the power of our collective and synergistic actions. Under such a coalition, it will be possible to facilitate and promote more regular and systematic collaborations among Georgia’s global health organizations. In future blogs, we will continue to explore the value of such a coalition and highlight more success stories about real collaborations in global health.

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Africa United in the Fight Against Ebola

By Charles Stokes, President and CEO of the CDC Foundation

By Charles Stokes, President and CEO of the CDC Foundation

The unprecedented Ebola epidemic in West Africa has now taken the lives of more than 6,346 people and infected more than 17,800 people in the region. Ebola is a threat to people, health systems and economies around the globe. But West African communities in particular are being hammered by Ebola as a result of already-strained healthcare systems, mistrust of healthcare workers and fear and stigmatization of those infected. One major aspect to halting the epidemic is to ensure that healthcare workers, patients, and the public receive accurate information that dispels myths, promotes prevention methods and outlines resources for those affected by Ebola.

To aid in that effort, a new health communications campaign, Africa United was launched earlier this month by the CDC Foundation, well-known actor Idris Elba, a global team of African soccer stars and international health organizations.

The CDC Foundation, actor Idris Elba and a global team of African soccer stars, international health and aid organizations recently announced the launch of Africa United, a global health communications campaign aimed at preventing the spread of Ebola in West Africa.

The CDC Foundation, actor Idris Elba and a global team of African soccer stars, international health and aid organizations recently announced the launch of Africa United, a global health communications campaign aimed at preventing the spread of Ebola in West Africa.

For Africa United, Elba and a team of professional soccer stars, who have ties to West Africa, appear in new public service announcements (PSAs). The first PSA, titled “We’ve Got Your Back,” is aimed at engendering solidarity for healthcare workers who are on the front lines working to protect the public from Ebola. In another campaign video titled “West Africa vs. Ebola,” Elba stars as a soccer coach giving a rousing and educational team talk to West Africa in preparation for its “life or death” game against Ebola. Elba explains the symptoms of Ebola and tactics for how to beat the virus, which includes spreading the word and working as a team.

I am very proud of the CDC Foundation’s backing of this important effort, and I appreciate the support of the many organizations who have come together and donated their time, voice, creativity and skills to make this communications campaign possible. This collaborative effort is an example of why public-private partnerships are crucial in uniting organizations to work together to address public health challenges—including the spread of Ebola.

To learn more about Africa United and to view the educational materials, visit www.WeAreAfricaUnited.org.

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From fear, to preparation

CARE Philippines staff Rona Casil shares her experience with typhoon Hagupit

CARE Philippines staff Rona Casil shares her experience with typhoon Hagupit

“Not another Haiyan,” was my first thought when I learned about a potential super typhoon hitting our region again and including our dear Tacloban in its path.

The Haiyan nightmare is something I couldn’t imagine my family, the people in Tacloban or the rest of the Philippines experiencing again, only a year after one of the strongest storms on record devastated us.

Even its name – Hagupit (a Filipino term which means ‘lash’)- evoked fear in us.

It didn’t help that initially there were a lot of reports that Hagupit would be stronger than Haiyan.  It brought back painful memories of the trauma of Haiyan.

We decided to be prepared. Two days before its expected landfall, our small family of four (with one 11- year-old kid) worked like a team.

My mother meticulously packed our things and clothes in plastic bags. We anticipated electricity being cut off, so my brother prepared emergency light by preparing a bulb which he would connect to a car battery.

And then there were the essential and practical things. Last year, our supply of rice was swept away by the floods. Then, we just placed our staple in plastic bags. This time, we put rice in bottles for better protection. In time of possible disaster – and characteristically Filipino – our family can’t survive without rice so we made sure to secure supplies of it!

Then we stocked up on food items and other supplies.

During Haiyan, clean and safe water became scarce. So this time we put water in bottles and placed them inside the bathroom – the safest place in the house they say in time of disasters- and locked the room so in case of floods, our drinking water would be safe.

We tied our roofs. We secured our important documents. We made sure to stay in the house during the storm. We did both small and big adjustments this time all to be better prepared for Hagupit.

Then Hagupit came. We felt it from Saturday night to Sunday early morning. The winds were strong but not comparable to the ferocity of Haiyan. There were rains but not anywhere near as heavy as last year’s biggest storm. There were some small floods in Tacloban, but to our greatest relief, as correctly advised by concerned government agencies, there were no storm surges.

As predicted, power shut down. But our emergency light worked, and gave us a good measure of ease. Tacloban appeared like a deserted city days before, during and right after Hagupit. There were hardly any people on the streets. Most establishments were closed. Families preferred to stay home or in evacuation centers.

Tacloban was prepared. I am so happy and proud of my hometown. I was supposed to be on leave on the first work week after Hagupit, but I decided to report for work to contribute to our efforts to monitor, collect information and respond to the most affected areas in our neighboring region in Samar.

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