USAID, August 2015
October 31st was a big day for my country, Burkina Faso, because finally introduced vaccines against rotavirus and pneumococcal disease in our routine vaccination program! Thanks to these new vaccines, we will be able to save thousands of children’s lives.
As a pediatrician, not a single day goes by where I do not see children suffering from vaccine-preventable diseases, and specifically from pneumonia or diarrhea. Currently, thousands of children less than five years die each year from pneumonia and diarrhea in Burkina Faso, as well as in most countries in sub-Saharan Africa. In 2010, 21,764 child deaths were caused by pneumonia and 14,648 were caused by diarrhea in Burkina Faso. Today we know that prevention through vaccination is the most effective way to guard against these diseases.
As President of the Burkina Faso Pediatric Society (SO.B.PED), I would like to congratulate my Government on this major advancement that allows us to fight these two diseases, which are the most deadly among our children less than five years, and a true blight in our country. By introducing these vaccines together, Burkina Faso is taking a step forward in promoting the approach of the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD), which advocates for the introduction of both vaccines as part of a comprehensive and integrated strategy to combat these two diseases.
I rejoice that my country has finally introduced these long-awaited vaccines. Burkina Faso has just joined several other countries in the sub region that have already introduced these two vaccines, thanks to the support of the GAVI Alliance. Globally, 17 of the 48 countries that have introduced rotavirus vaccines into their national immunization programs, and 33 of the 72 countries that have introduced pneumococcal vaccines into their national immunization programs have done so with GAVI support. 18 other countries—17 in Africa—have been approved by GAVI for rotavirus vaccines support and another 18 countries—9 in Africa—have been approved for pneumococcal vaccines support. We sincerely hope that donors will continue to support the GAVI Alliance so that we can continue to benefit from their support for the introduction of new vaccines in our country as well as reduce the deaths caused by these vaccine-preventable diseases.
The Burkina Faso Pediatric Society (SO.B.PED) has been waiting for many years for this new victory for our children’s survival. Blowing out its 24th candle this year, the SO.B.PED is one of the oldest academic societies of Burkina Faso. It was founded in 1989 by ten pediatricians and now has over 70 active members scattered in 45 provinces. One of the first objectives mentioned in the statutes of our Society is to support the development of maternal and child health policies at national and regional levels. It is in this frame that we focus our advocacy efforts towards the introduction of new vaccines against the most deadly childhood diseases. When the Haemophilus influenza b vaccine was introduced in the routine immunization program in 2006, SO.B.PED leveraged this opportunity to multiply advocacy efforts towards decision-makers and partners. We did this during World Pneumonia Day in December 2010, and again at the UNAPSA Pan African Pediatric Congress in December 2011 in Ouagadougou. Today, our advocacy efforts are finally paying off!
SO.B.PED gathers for World Pneumonia Day
We must thank not only our leaders but also our numerous partners, donor countries and other donors, and especially the GAVI Alliance and its financial support, without which none of this would have been possible. I would also like to take this opportunity to thank our colleagues at PATH and IVAC/Johns Hopkins University for their assistance and support in our advocacy efforts.
As of October 31, 2013—the “D-Day” of the dual new vaccine launch under the patronage of the First Lady of Burkina Faso—our children will finally be protected against the two biggest killers of children under five: pneumonia and diarrhea. Now, it is up to us to ensure that the introduction and implementation of these vaccines are effective, successful, and sustainable.Read more
Kiersten Israel-Ballard, Technical Officer for the Maternal, Child Health and Nutrition Program from PATH’s Seattle office was in India in September 2013. Kiersten, who loves the outdoors and spends as much time as possible in the mountains around Seattle, speaks about her experiences in India over the past few years. Her work includes the Digital Public Health Project and working on the global milk bank. The human milk banks operates on a sophisticated level: screening donor milk, collecting this excess milk, sending it to the laboratory , pasteurizing and freezing it, and making it available for low-birth-weight babies.
Could you tell us about your work in India?
Globally, PATH has the momentum to scale up human milk banks, an innovative strategy to reduce neonatal morbidity and mortality. We have a Global Technical Advisory Group in place to provide guidance based on the expertise of human milk bank technicians and managers from around the world. From these experts, we have compiled information on best practices of human milk banking processes. More importantly, we are developing an integrated model of human milk banking based on the system in Brazil which has contributed to the reduction of neonatal deaths in that country. India has a significant infant mortality burden and we would like to see how we can help. PATH is working to provide assistance at the policy level and also to develop improved technologies for low-cost and high-quality pasteurization monitoring and bacterial screening to ensure safety of donated breast milk.
Simplified systems could be appropriate for small-scale human milk banks in district centers in India.
What are some of the immediate learnings that India can take from Brazil?
The Brazilian National Network of Human Milk Banks has been successful in the reduction of neonatal deaths in that country, because of their integrated approach to milk banks. The milk bank is situated within hospitals where women seek lactation support among other birth-related facilities. Apart from neonatologists, the centre has nursing students, psychologists, nutritionists, and others addressing every aspect that new moms face. There is huge awareness on this and the primary focus is on promoting breastfeeding.
This awareness is also crucial for the success of milk banks. Even as moms are encouraged to breastfeed, they are also counseled on how to deal with ailing infants, and in case they have extra milk, they are told about the significance of donating, too.
In Brazil, celebrity footballers and media personnel have lent their might to the movement and have endorsed breastfeeding promotion, significantly strengthening the effectiveness of Brazil’s awareness campaigns. The country has achieved a reduction in neonatal deaths since the 1980s.
All these align with the challenges that India is faced with while dealing with under-five mortality.
Would you like to share some experience in India?
This is my fifth visit to India. I find the PATH India staff very warm and welcoming, but also very driven and dedicated and it is a pleasure to be here. My experience from the field says that even in the the most remote areas, such as in mothers’ groups, people are so eager to learn and practice healthy behaviors.
Some learning that you will be taking back?
There is also a lot of learning from the Digital Health Project. PATH has learnt that the most effective projects are those that are community-driven, locally designed, and implemented back within the same local community. This creates sustainability and is an approach can be applied to other PATH projects and expanded globally.
The work that the community advisory board in the villages in Uttar Pradesh does in the DHP project is community-driven targeting maternal health. The videos focus on danger signs during pregnancy, birth prepardedness, emergency transport, newborn care, and family planning. I would say that for every project there needs to be a champion to ensure sustainability.
-- Sushmita Malaviya, Communications Officer, PATH's India office.
PATH’s team tested designs for hand-washing stations with all ages. Photo: PATH/Walter Thorn.
Originally posted on the PATH blog
Think about how you wash your hands. Are you happy with the process?
If you live in a place where scented soap and warm water spurt from sink-side dispensers, your answer is probably fairly rote. Hand-washing? No complaints. If you live where water, soap, and sinks are less common, though, your response may be more thoughtful.
“They would like to be able to wash both hands at the same time,” says PATH’s Jesse Schubert, who lately has been asking people in Tanzanian villages what could make their hand-washing time more satisfying. “They’d like flowing water, and they’d like the hand-washing station to be secured to a wall or a post, so the kids can’t mess with it and break it.”
Today is Global Handwashing Day, and Jesse and his US- and Tanzania-based team are spending it analyzing what they learned from their latest trip to two villages that are serving as a kind of hand-washing research center. The team’s objective is to design a hand-washing station that enables and motivates people to wash their hands. You can see more photos of their trip on our Facebook page.
Washing your hands with soap is a simple and inexpensive way to reduce the risk of contracting many illnesses. Two of the intervention’s biggest targets are diarrhea and respiratory tract infections, such as pneumonia. Together, pneumonia and diarrheal disease kill 2 million children a year; they are the leading causes of death for children from birth to age five. Studies have found that washing hands with soap can cut the chances of getting diarrhea by nearly half and the risk of respiratory infections by almost a quarter.
For the PATH team, developing the concept for a successful hand-washing station is a process. It starts with watching people wash their hands—in Tanzania, Jesse says, that often means scooping water from a bucket or basin to wash one hand followed by the other—then asking how the experience could be better and more effective. The team takes that information and brainstorms concepts, builds prototypes, tests them out in Tanzania, and then asks more questions, in part to find out what’s essential to people and how much they’d be willing to pay to get it.
Foot-activated stations, such as this one, were the most popular with testers. Photo: PATH/Jesse Schubert.
Take water pressure, for example, says team member Walter Thorn. Is it essential?
“To us, a pressurized delivery system makes sense because that’s what we’re used to feeling,” Walter explains. “But to someone in rural Tanzania who’s used to a small basin of water, pressurized water may cause too much splashing.”
Developing a successful concept—and eventually a successful product—takes more than asking people what they want. The team has been meeting with other international health and development organizations that work in water, sanitation, and hygiene as well as Ministry of Health representatives and potential product manufacturers to find out how we might work together.
“Just as with all PATH projects, we know that the technology is only a part of it,” Jesse says. “There’s policy, there’s education, there’s getting the device made, and there’s setting up the distribution channels—who’s going to move it to the places it needs to get so people can buy it?
“We want to do all of that upfront to get people on board,” he continues. “And all of those things could influence the design of a hand-washing station that people will want to use.”Read more
There’s a story that haunts me in child health. It’s the story of the child who successfully fights an episode of malaria one year because she got the right medicine at the right time but the following year, after a severe episode of pneumonia, she dies because she never received antibiotics. Or the story of a baby born HIV-free because her mother took the right medicine at the right time only to grow up to become so malnourished that after several bouts of diarrhea and with no access to oral rehydration salts or zinc she dies at the age of two. What is so alarming about these stories is how common they are and how they are directly related to the way the financing of global health is structured.
It’s not that we don’t have clear goals in child survival. Millennium Development Goal 4set a very specific target – to reduce the child mortality rate by two-thirds from the 1990 level by December 31st 2015. What we are lacking are institutional structures at the global level that are focused on financing child survival and that are accountable for achieving MDG4. Instead we have institutions that are either focused on financing and delivering a specific child survival intervention (e.g. vaccines) or on financing the prevention, diagnosis and treatment of a specific disease (e.g. AIDS, malaria, tuberculosis or polio). These organizations are primarily accountable for increasing vaccine coverage, or bed net ownership, or the distribution of rapid diagnostic tests but not for the number of children’s lives saved, or for their impact on the rate of reduction in child mortality or for their relative contribution to MDG4 achievement.
There’s no question that this degree of focus has delivered results in specific areas. AIDS, malaria and measles deaths among children have fallen dramatically and now represent 7, 2 and 1 percent of all under child deaths respectively. Polio is almost eliminated. In contrast the areas that have not had a well-financed institution driving progress, including newborn health and pneumonia and diarrhea now account for 65 percent of all under 5 deaths and malnutrition is an underlying cause of more than 50 percent of child deaths. At the end of the day the bigger question remains: how much have we really achieved if we provide the bed net that protects one child from malaria one year, only to leave that child malnourished and totally exposed to death from pneumonia or diarrhea the next year?
With about 800 days to the MDG deadline, there are welcome signs that the major institutions that finance child survival are committed to achieving the unprecedented levels of collaboration that are required to fund the gaps in child survival and accelerate achievement of MDG4. The World Bank, the Global Fund, GAVI, UNICEF and the UN Commission on Life-Saving Commodities for Women and Children and their leading donors have the capacity to both finance and deliver more integrated packages of interventions that target the leading causes of child death and “fully protect” children against the leading threats to their survival and there are positive signs that they are moving in this direction.
During UN General Assembly week the leading stakeholders in child survival met to discuss ways to support the efforts of ten countries to ensure that children with diarrhea and pneumonia are actually treated with oral rehydration salts, zinc and antibiotics. One million child deaths could be prevented by 2015 if these ten countries achieved this goal. There was a genuine willingness to find ways to reduce diarrhea and pneumonia deaths by better aligning the delivery of vaccines and the prevention, diagnosis and treatment of pneumonia, diarrhea and malaria. There was recognition that not only could greater integration deliver better health outcomes for children, but that the efficiency savings from more coordinated delivery of interventions could be significant.
We need to turn this good will into action quickly because many children’s lives depend on the global health architecture getting this right. As the President of the World Bank, Jim Kim, has said, it is patients who pay the ultimate price for the current fragmented approach to health delivery. What we need to be aiming for, and what MDG4 achievement actually requires, is integrated, effective health delivery systems that provide value for children. Financing and delivering these integrated packages of interventions for newborn care, pneumonia, diarrhea, malaria and nutrition and targeting them to the greatest concentrations of vulnerable children is now the central challenge of the child survival community in the countdown to 2015.
We are in the midst of the greatest child survival revolution the world has ever known. In our lifetimes, we have witnessed countries like Ethiopia, Bangladesh, Malawi, Egypt and several more reduce their child mortality rates by 70 percent. But despite this progress, the MDG4 achievement gap remains wide. As UNICEF has told us in the A Promise Renewed Progress Report, the deaths of 3.5 million children must be prevented to achieve MDG4. The current global health architecture can be made to work for MDG4 but it will require leaders to align around one primary mission – child survival; to hold themselves accountable to one fundamental measurement – children’s deaths prevented; and to find creative ways to finance the major gaps in child survival within the framework of the financing structures that we currently have. Because at the end of the day, we all work for children and we have to make the global health architecture work for child survival and MDG4 achievement.
-- Leith Greenslade, Co-Chair, Child Health, MDG Health Alliance
The MDG Health Alliance works in partnership with governments, non-government organizations, academic institutions and corporations to accelerate global progress towards the health related Millennium Development Goals. The Alliance operates in support of Every Woman, Every Child, an unprecedented movement spearheaded by the United Nations Secretary-General to intensify global action to improve the health of women and children.
Photo credit: PATH/Gareth Bentley.Read more
In August I attended the International Congress of Pediatrics, which was hosted in Melbourne, Australia. The Congress is a global meeting place of physicians, researchers, nurses and health care workers in the field of pediatrics and civil society partners. A key thematic area of the conference was addressing pneumonia and diarrhoeal disease – the two leading killers of children under five across the globe. Given the extensive experience of PATH Cambodia in terms of addressing childhood pneumonia and diarrhoea, we felt that engagement in this Congress would be critical.
With the support of the Advocacy and Public Policy (APP) team at PATH we developed a poster for presentation at the Congress. The poster, entitled Tackling Pneumonia and Diarrhoea Through Policy Integration and Community-Level Implementation, highlighted the integrated approach that Cambodia has adopted in terms of preventing and treating pneumonia and diarrhoea.
Since 1998, the Ministry of Health Cambodia (MoH) has integrated both diseases into one National Acute Respiratory Infection and Control of Diarrhoeal Disease Program (ARI/CDD Program) and made it a top priority in terms of addressing childhood morbidity and mortality. In collaboration with the Cambodia MoH, PATH implemented the Enhanced Diarrheal Disease (EDD) Initiative from June 2011 to August 2012. The programme, piloted in one district, consisted of a two-pronged approach to build the political will to strengthen policies related to diarrhoea and pneumonia, and then to implement a new integrated package of services within communities.
The Cambodian MoH was encouraged by the launch of the Global Action Plan for Pneumonia and Diarrhoea (GAPPD) by WHO and UNICEF in April 2013, which provides the global normative guidance supporting the integration of pneumonia and diarrhoea and calls on countries to adopt this approach. Cambodia is integrating the policies and programmes for pneumonia and diarrhoea and the results are being felt – Cambodia is on track to reach Millennium Development Goal 4 on reducing the levels of childhood morbidity and mortality and the efforts to address the leading killers of children under 5 has played a significant role in this success.
Partners at the Conference were highly interested in the integrated approach that has been adopted in Cambodia. Many participants came to ask how this had been rolled out, and what the results have been, and how this is working from an operational level. So many participants wanted to know how this could be replicated in their own countries and what the key lessons learned have been. I feel proud of what we have been able to achieve in Cambodia and excited that we can share the lessons learned and provide a model that could be used in other countries. I believe this model can be replicated and have a major impact of addressing these two diseases; strong political commitment, advocacy to create an enabling environment for policy integration and programme implementation, with a strong focus on community involvement and ownership, are some of the essential ingredients to making this a success!
For more information
- Fact sheet: Combining forces in Cambodia to overcome childhood diarrhea and pneumonia
- Case study: Tackling pneumonia and diarrheal disease through program and policy coordination: A case study of PATH's integrated approach in Cambodia
- Photo gallery: Cambodia 2011