The New York Times, July 2015
A new report from WHO/UNICEF warns that while access to clean drinking...
For most people, the new year means a bit of champagne, a reason to celebrate, and resolutions about personal changes. For Bill and Melinda Gates, the new year brings their annual letter and thoughts about global issues, world progress, and changes for billions of people. And this new year included a bet: in their annual letter, the Gates’ bet that “the lives of people in poor countries will improve faster in the next 15 years than at any other time in history. And their lives will improve more than anyone else’s.” Gutsy? You bet.
Their ambitious goal is comprised of four pillars, one of which is cutting the number of children who die before age 5 in half… again. Twenty five years ago, one in ten children failed to reach their fifth birthday. Increased access to vaccines and to commodities like oral rehydration salts, zinc, and antibiotics children cut that rate in half: today, in 2015, about one in 20 children die before their fifth birthday. And here’s where the gutsy prediction starts: the Gates’ are betting that by 2030 – just the next 15 years – that rate will be cut in half again, to one in forty.
Now most people probably ask the simple question – how? The initial halving of the mortality rates took 25 years. How can we make the same progress in just 15? While I won’t claim the answer is simple or easy, I will claim that we have the solutions. Access to vaccines continues to improve with more countries introducing vaccines against rotavirus and pneumococcal to prevent two of the leading infectious killers of children. Oral rehydration salts, zinc, amoxicillin, and litany of other treatment interventions continue to make their way to health clinics, pharmacists, and when appropriate, to community health workers. Importantly, improved sanitation is becoming more accessible to even the most poor and rural communities.
And we can’t forget newborns. The vast majority of improvements in child health will come from reducing newborn deaths. Improved access to newborn commodities, including resuscitation devices and injectable antibiotics, as well as practices such as breastfeeding will continue to drive down the number of children who die within the first 28 days of life.
But here’s the caveat: in order to accomplish the remarkable milestone set forth by the Gates’, we have to reach the last mile. We – government leaders, donors, the collective global health community – have to reach the most rural and remote. We have to make sure the most far-flung health clinic has health commodities available and a trained health provider on staff. We have the solutions, but we have to make them work. To me, this is our true test.
I’ve often hoped that we’re all working ourselves out of a job, collectively doing our individual parts to improve the lives of children. And now, more than ever, I see that materializing. Perhaps we won’t all be out of jobs in 2030, but if the Gates’ bet is right – and something tells me they don’t gamble frivolously – we will all begin to see a world where children are thriving. We certainly have our work cut out for us, but I, for one, can’t wait until we hit this jackpot.Read more
Photo credit: Marco Betti, WaterAid.
See more photos from DefeatDD's 2015 toilet calendar: "Oh, the places we go: Public health's humble hero"
Now that India has the political commitment at the highest level to strive towards an open defecation-free nation, the buzz around sanitation is infectious. Despite the daunting figures – getting 630 million people into ‘aspirational and wonderful toilets every day, preferably without subsidy’ – this could truly be a historic movement in India’s sanitation history.
Significantly, in the plethora of information about building toilets, voices calling for certain types of toilets are also pretty strong. The founder of the World Toilet Organization, Jack Sim, set the tone of the World Toilet Summit held in Delhi in January 2015, advocating that toilets be made the happiest room in any household. More importantly, he advocated the removal of subsidies to encourage communities to aspire for toilets and let that drive is demand. ‘Make toilets a status and fashion statement. Change the toilet experience from a disgusting one to a wonderful one!’
For India, that will be the challenge. There has never been a dearth of funds. The toilets have been built, just not used. Therefore, with the highest level of political commitment and funds pouring in both from Governments and the private sector, the hurdle is how to get people to change a habit. How can India replicate Bangladesh’s progress, which changed attitudes to bring down its open defection from 34 percent to three percent?
It cannot be overemphasized that the enthusiasm of ‘building toilets before temples’ will need rigorous implementation to reach an extremely ambitious goal of 111 million toilets before 2019 – to honor Mahatma Gandhi on his 150th birth anniversary.
At the Summit where businesses, institutions, CSOs and individuals put their might behind one of the most important Millennium Development Goals (MDGs), what was truly inspiring were the endeavors of tweaking already existing systems to leverage water and sanitation initiatives, like building toilets and motivating people to make it a habit to use and maintain them. Where there are more women teachers, building clean, safe toilets on school campus – simple decisions that have been taken by visionary district collectors. That could begin to help check the 23% of girls in India who drop out of school due to lack of clean toilets and begin to bring down the number of schools that do not have functional toilets – currently 400,000.
Almost all the speakers insisted on the need for a new mindset to help communities understand that the cost of treating associated diseases was much higher than building toilets. There is also an urgent need for communities to calculate the economic cost of poor sanitation – a price that the nation as a whole pays.
In scattered and seemingly disconnected bits, India has moved in this direction. Jack Sim wryly recalls not using the Delhi airport toilet years ago, and compliments the toilets in the new terminal. Earlier, no Indian politician would be photographed for a sanitation drive; today it is a done gimmick. Jack Sim’s call to Indians to greet each other by calling out ‘Are you happy?’ to indicate that you have used a clean toilet makes complete sense. What could be better than a healthier and open defecation-free India? After all, the MDG 7C is unlikely to be achieved without India moving ahead.
When I first came to work at Vadu, I was not sure if I could use my knowledge of biotechnology in this setting. Was it worth travelling 25 miles every day to reach my place of work, and what would I be able to achieve? After five years, I know I have taken the right decision. Work at the Vadu Rural Health Program (VRHP) touches every aspect of human life: birth, maternal and child health, nutrition, and much more.
One of VRHP’s first studies in 2005 on child health looked at the relation of hand-washing practices to acute respiratory infection and diarrhea. While the study sought to identify appropriate tools to study hand-washing practices, it also gave insights into hand-washing practices of care givers, indoor air pollution, sanitation, and their impact on children.
We learned that because people in Vadu use biomass fuel and coal for cooking and heating purposes, this leads to exceptionally high levels of indoor air pollution, which is a major risk factor for pneumonia. In reaction to these findings, VRHP began to research pulmonary disease and eventually collaborated with other institutions to test the adoption of improved cook-stoves in rural India after targeted behavior intervention.
One of such studies aims to determine how a targeted behavior engagement strategy affected adoption and adherence to the improved cook stove technology and whether its use improved household air quality and reduced human exposure to air pollution. Recently during a visit to Vadu, Dr. Kirk Smith, professor of Global Environmental Health, University of California, Berkeley lauded the efforts that Vadu is taking in the field of indoor air pollution and health.
Apart from research, VRHP’s presence in this rural area has had another spin off. Individuals from Vadu and nearby villages have had an opportunity to assist in research studies. Nearly 50 percent of these are women. Most of them have gained confidence, independence, and they say that their personality has developed. Many of these field workers can now address a group on various health aspects. One that I especially recall was a home maker who earlier did not have any say in her household decisions. Today, she is a member of the village council and she not only makes decisions for the village, but for her household, too!
I understand today that it is not just health research that is beneficial to the community. The work that VRHP does has helped community in Vadu become more informed and knowledgeable on health aspects too.
-- Rutuja Patil is a biotechnologist who works on ‘research to policy implications’at the Vadu Rural Health Program (VRHP), run by the King Edward MemorialHospital Research Centre in Pune, India.
Photo credit: PATH/Gabe BienczyckiRead more
Several health clinics in Indonesia implemented electronic systems to capture data, but one facility in particular far outperformed the rest in almost every indicator measured. However, this should not have been the case. This facility was more rural, served difficult to access populations, had limited resources and faced challenges related to infrastructure and geography.
Why was this facility so successful? The clinic manager was a true data champion and facility staff used data every day to identify trends and potential issues to act on. For example, health workers noted that there were several children who came to the clinic with diarrhea and that these children happened to come from one village.
Using this data, the clinic was able to get ahead of a potential disease outbreak, sending health workers out to provide proper hand washing lessons, rehydration treatments and interventions like vaccines before it had a chance to spread.
Leveraging data to identify these trends can have a profound effect on the clinic and surrounding population. Although global stakeholders and national governments acknowledge that there are strong challenges related to data quality, few can identify which problems matter most and where.
This is where PATH’s Better Immunization Data (BID) Initiative comes in. The BID Initiative seeks to empower countries to enhance immunization and overall health service delivery through improved data collection, quality, and use. To start, we’re partnering with demonstration countries Tanzania and Zambia to develop interventions addressing some of the most pressing routine immunization service delivery problems through interventions such as electronic immunization registries and adding barcodes to vaccine stock and child health cards.
DefeatDD is creating champions in the fight against diarrheal disease, driving awareness of solutions, such as the vaccine for rotavirus. This enables key stakeholders and government officials to make informed decisions about how to fight this terrible disease. With improved data products, practices and policies, the BID Initiative will help these countries reach every child.
If successful, a true tipping point will occur—one in which countries can access, analyze, and act upon accurate immunization data anytime, anywhere—resulting in improved immunization outcomes and healthier families and communities.Read more
With two college-going children – pardon – adults in the house – it is difficult to recall them reaching their fifth year milestone. I still recall, though, the amazement that often came from friends and family in the larger cities of India (who took their children to hip private doctors) when they heard of the immunization schedule. ‘Your children have been immunized at a primary health center. Did you check to see if the needles were sterilized?’
My husband and I brought up the children in the calm and serene city of Bhopal fully supported by my husband’s family. Vaccinations and routine doctor’s visits were always a point of discussion, since we lived in a village. The Government health worker would stop by to inquire about the children, then vaccinate and update the "mother and child" card that the State Government issued to children once they are registered at a primary health center. For my son, Varun, this document was frantically sought for during his college admissions – to confirm that all his vaccinations were done!
Ipsita and Varun in their treehouse in Bhopal.
From 2007 – having moved away from hard core news production to being part of communications teams that support public health – I sometimes chuckle at my naivete, but am greatly relieved that both the children are doing well. Why? Because in large parts of north India, routine immunization is still not a right for every child. Take for instance Madhya Pradesh. My adopted home state’s record on fully immunized children still hovers around 40 percent. In the state that I supported for the polio eradication program (Uttar Pradesh) – the same – 40 percent.
Walking through high-risk polio endemic regions of Western Uttar Pradesh between 2007 and 2009, I learnt the most difficult lesson as a mother. When mothers were asked why didn’t they limit their families, “I have the number of children I have, because I do not know how many will survive!” Where each day is a struggle and immunization schedules are amongst the last priority on a family’s agenda – I marveled at the Government’s foot soldiers – month after month reminding families to vaccinate their children against polio. Sometimes abused, sometimes taunted, oftentimes ignored - the Government system was trying to reach children – just as they had reached my own, Varun and Ipsita.
It’s not an irony that I moved from working on polio to diarrheal diseases. It was evident in the last mile polio eradication endeavor that safe clean drinking water, sanitation, and nutrition were essential interventions to check that debilitating disease. Today, the challenges in India still remain: safe and clean drinking water, sanitation and nutrition can save 1.35 million children from diarrhea and pneumonia.
That I work with a sharp team of communication experts is a bonus on several fronts–breaking down scientific jargon, precision, accuracy, timeliness, and yes non-stop humor. If you are reading my piece you would have realized that by now!Read more