The Hindu Business Line, January 2015
Jack Sim, sanitation champion and founder of the World...
Community-level perception of a public health intervention is tantamount to the success or failure of its uptake. Programs generated in the West can often be perceived as irrelevant, culturally removed, or unimportant by the local population. Local buy-in is critical and, as development professionals have learned again and again, without it projects fail.
Community Health Workers (CHWs) and in-country partners are the bridge to the communities that Western organizations and their programs seek to serve. Together they have the power to generate much needed positive perception and buy-in. The Center for Infectious Disease Research in Zambia (CIDRZ), in partnership with the Zambia Ministry of Health (MOH), is one such in-country collaboration partnering with UK-based Absolute Return for Kids (ARK). With a program supported by ARK, CIDRZ is working to reduce childhood deaths due to diarrhea by utilizing a comprehensive approach that incorporates prevention (introduction of a rotavirus vaccine), treatment (training of clinicians and CHWs), and control (community education and awareness-raising) activities. Communities are educated through group sessions at clinics, CHW consultation at the home, and monthly meetings facilitated by CHWs and Community-based Organizations.
Kenneth Mumba, a CHW serving the urban-poor community of Kamonga in Lusaka, told us that mothers don’t often visit the clinic, so it is best to bring health messages right to their doorsteps.
CHWs come from the communities they serve, are respected by the community, and perceived as authorities and resources. Commencing in December 2011, CIDRZ conducted a paid one-month training for CHWs on Better Health Outcomes through Mentoring and Assessments. CHWs then went back to their communities, visiting household-by-household, teaching the importance of using ORS and zinc, hand washing, safe water storage and treatment, etc., and performing demonstrations. They educate on personal sanitation and hygiene and give recommendations on treatment options and where to seek treatment if a child becomes ill. They were instrumental in the rollout of rotavirus vaccination in Lusaka Province, giving education and information about the vaccine, raising the broader communities’ awareness about vaccination and health improvements in general. CHWs generally make 50 home visits per day and are responsible for about 500 households. Trust and relationships are built through these interactions, and information is disseminated and made locally relevant, which generates positive perception and ultimately, greater acceptance and success of CIDRZs’ and ARKs’ initiative.
Josephine Tubalange, CHW, assisting a mother using an infant scale at a Kazimvua Rural Health Center in Lusaka Province.
In the rural village of Chigwilizano, which means “to be united,” a community where CIDRZ is utilizing CHWs, Josephine Tubalange couldn’t contain her pride in being a CHW for her community: “I[t] feel[s] very nice to serve, and the final reward comes from God. There is a lot of reward from those thank you’s I get.” Agnes Mulenga, another CHW in Chigwilizano Village, demonstrated home-visits for us, educating mothers of two children on the importance of sanitation, covering her water tank, chlorinating water, and handwashing hands with soap.
Agnes Mulenga, CHW, demonstrating a home-visit, educating a mother on the importance of diarrhea prevention through sanitation and hygiene practices, including covering her water tank, chlorinating water, washing hands, and using soap.
Every year more than 15,000 children die in Zambia due to diarrhea-related dehydration, and lack of awareness at the community level of prevention and treatment options is a main contributor.Utilizing the CHW interface is smart public health practice, and CHWs’ in-roads and influence in the community are significant. Focused health messaging and community mobilization by CHWs is combating child diarrheal disease. Thanks to them and the education and training they received at CIDRZ, an educated and informed population is in-the-know and willing to adopt interventions that save lives.
Photo credits, top to bottom: PATH/Lisa Anderson (1), PATH/Gareth Bentley (2-4)Read more
Over the past few weeks excitement has been building for the upcoming GAVI Partners Forum that took place in Tanzania. This is the 5th GAVI Partners Forum, a meeting that brings together a range of stakeholders including implementing country officials, technical agencies, donors, the private sector and civil society. The meeting was organized around the central themes of Results, Innovation, Sustainability and Equity and provided an important platform to discuss and strategise about how immunization programs can be expanded even further within developing countries as a critical tool to decrease childhood morbidity and mortality.
Attending the Partners Forum provided me with an opportunity to visit Tanzania for the first time. I was struck by the beauty of the country and from a public health perspective it was inspiring to witness first hand that, despite resource shortages both financial and human, there is a high level of commitment to improving health outcomes, particularly through immunization. I had the chance to participate in a field visit to Sinza Hospital a facility on the outskirts of Dar Es Salaam. It was an impressive facility providing a wide range of services to a catchment area of approximately 500 000 people.
Sinza Hospital has actively worked to increase the coverage and uptake of vaccination services in the community realizing that this is one of the most effective interventions in ensuring increased child health. Mother classes and awareness-raising activities are conducted on the importance of vaccinations for women and caregivers, and outreach vaccination services are delivered directly in the community each week. The awareness-raising activities are clearly having an impact as the waiting room at Sinza Hospital, for example, was filled to capacity with mothers and care givers and their children, each one waiting for their chance to see a health care worker.
Despite the improvements in vaccine coverage, Tanzania is still struggling with high levels of child morbidity and mortality due to the two leading killers of children under five—pneumonia and diarrheal disease. The GAVI Partners Forum was a momentous occasion in Tanzania because it marked the dual introduction of pneumococcal and rotavirus vaccines which is set to have a significant impact in terms of addressing the two leading causes of under-five mortality in the country.
The vaccines’ launch, the country’s hosting of the GAVI Partners’ Forum, as well as my visit to the local hospital reiterated the importance of vaccines as a critical component in the package of health care interventions needed to protect children. The healthcare workers at the facility are eagerly awaiting the arrival of the new vaccines and have undertaken an extensive amount of work at both the facility and community level to increase awareness and generate demand. The focus on community engagement and empowerment has been an effective vehicle to increase the uptake of health services and vaccines. I left Sinza Hospital with a real sense of hope that 2013 will bring with it further improvements in child survival as the new vaccines are rolled out nationally as of January.Read more
As a pediatrician in Tanzania, my days are spent making individual children healthy and working to save their lives. But today, I am celebrating my contribution to an effort that will save millions of children’s lives – more than I could treat in an entire lifetime!
Today, two new vaccines, pneumococcal and rotavirus vaccines, were launched in Tanzania; they provide children the best protection available against the primary causes of pneumonia and the severest form of diarrhea. These two diseases are among the leading killers of children in Tanzania and around the world, and I am proud to be an advocate for the introduction and use of these life-saving vaccines in my own country, Tanzania, and in other developing countries.
Dr. Namala treats a child with pneumonia.
Diarrhea accounts for nine percent of under five deaths in Tanzania, and more than half those deaths are due to rotavirus, the most common cause of severe and fatal diarrhea in young children worldwide. Rotavirus takes the lives of more than 8,100 Tanzanian children under five each year and is the cause of one-third of hospitalizations for diarrhea of under-fives.
On duty recently at the hospital in Dar-es-Salaam where I work, I took a call from a woman who was in such distress she could barely tell me her name. Her baby was terribly sick -- vomiting and with profuse diarrhea -- and not responding. I told the woman to rush her baby to the hospital, where we found she was so severely dehydrated that her heart was unable to pump enough blood around her body. She needed urgent and intensive care to save her life. The baby survived, but only because her mother reached the hospital in time. Many children across Africa are not lucky enough to have a hospital within easy reach.
Vaccination offers the best hope for preventing severe rotavirus infection and the deadly dehydrating diarrhea it causes.
Our pediatric society in Tanzania has been active in promoting this message and advocating for new vaccine introduction. Thanks to the 2010 International Pediatric Association Immunization & Millennium Development Goal Champion advocacy training workshop organized in Johannesburg, South Africa by the GAVI Alliance, Johns Hopkins University and PATH, our pediatric society learned how to more effectively advocate for immunization, which we have successfully put into practice.
We organized events to raise awareness about pneumonia and diarrhea control, including radio and TV sessions, visits to rural health centers to brief our peers about pneumococcal and rotavirus vaccines, and visits to schools to brief teachers and children about these killer diseases. We convened advocacy meetings, including a Vaccine Symposium at the National hospital where we presented the importance of introducing these new life-saving vaccines to the Ministry of Health and Social Welfare, among others.
Now we can finally see the results of our advocacy efforts with today’s joint introduction of pneumococcal and rotavirus vaccine into our routine immunization program! Our children will now have the best tools to fight the leading causes of pneumonia and severe rotavirus diarrhea, and we will certainly see a dramatic decrease in these diseases. I would like to call upon all my fellow pediatric colleagues to raise their voices and to advocate for the introduction of pneumococcal and rotavirus vaccines in their countries, because advocacy pays off. Because vaccine advocacy saves lives!
Now it’s time for me and my fellow pediatricians to go celebrate… and vaccinate!
-- Dr. Namala P. Mkopi, MD, is Secretary General of the Pediatric Association of Tanzania and a pediatric advocate and immunization champion.
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Photo credit: PATH/Doune Porter.Read more
As I was writing my new book, my granddaughter of 6 asked me what I was up to. I am writing my book, I said. What is it on? She asked. On what grandpa thinks is most important. Do you know what grandpa thinks is most important? That the children may live, she replied with a big smile.
She is so right, and that is also the common goal behind the efforts of the partners working together in the GAVI Alliance: That the children may live.
What would it take to protect a child against five diseases with a single vaccine in a country like Haiti, which is still rebuilding after the devastating 2010 earthquake? Or to bring vaccines against pneumonia and diarrhoea, two of the biggest killers of children in developing countries, to places such as Pakistan and Yemen? Or to target Africa’s meningitis belt by reaching 100 million people less than two years into a mass vaccination campaign?
It takes partnership, and the belief that by working together those of us who are passionate about saving lives and improving health can accomplish much more than we could on our own. Since 2000, GAVI has been able to save more than 5 million lives and will work to save an additional 4 million by 2015. This is possible by working as an alliance whose partners include UNICEF, WHO, the World Bank, the Bill & Melinda Gates Foundation, governments and pharmaceutical companies in the developed and developing worlds, research institutes, and civil society and advocacy organisations such as ONE and many others.
Next week, more than 600 global health leaders will come together in Dar es Salaam for the GAVI Alliance Partners’ Forum. The United Republic of Tanzania is the perfect place for this three-day event, which will include a dual introduction of pneumococcal and rotavirus vaccines and discussions aimed at advancing access to vaccines and immunisation. In 2010 pneumonia accounted for 15% of child mortality in Tanzania, according to the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health. And yet, according to 2011 estimates from WHO and UNICEF, Tanzania’s vaccine coverage rate against key causes of child pneumonia meet or exceed targets that if adopted worldwide could prevent two-thirds of child pneumonia deaths.
GAVI’s mission underscores the themes of the Partners’ Forum, which are Results, Innovation, Sustainability and Equity (RISE). Those who are unable to join us in Tanzania can follow the conversation on the GAVI website, where we’ll be streaming some of the sessions, and on Twitter at #GAVIpartners.
The results of our work lie not only in the number of lives saved or lives we hope to save but in the fact that an additional 370 million children in the world’s poorest countries now have an opportunity to grow up healthy and contribute to their communities. Innovation is at the heart of what makes vaccines one of the most cost-effective ways to save lives. GAVI uses several funding mechanisms to raise funds in international capital markets and stimulate the development and supply of vaccines to make them affordable for developing countries. By using these tools to shape vaccine markets and lower costs, countries are able to sustain their commitment to providing immunisation after they graduate from GAVI support. Even the world’s poorest countries take pride in contributing to the cost of their vaccines. This reinforces their role as equal partners in this effort. Equity drives a central goal of our work to dramatically reduce the amount of time it takes for vaccines to reach poorer countries after they’re introduced in wealthier countries. Just 20 years ago, this would not have seemed possible.
I’m excited to journey to Tanzania for several days of discussion and be further inspired by what can be achieved when we come together in partnership.
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I would like to take this opportunity to welcome World Toilet Day, an annual event which takes place on the 19th of November to highlight the fact that many people in the developing world lack access to a clean and safe toilet. This situation is so concerning that one in three women risks shame, disease, harassment and even attack because they do not have a safe place to go to the toilet.
As Co-Chair of the All Party Group for Child Health and Vaccine Preventable Diseases I have spent many years working to raise awareness of the burden of preventable diseases in the developing world. Speaking as a former microbiologist one of the issues which concerns me most is access to clean water and proper sanitation facilities. I know very well the effect that improved water, sanitation and hygiene (WASH) can have in reducing child mortality in the developing world.
Despite the progress which has seen diarrhoea-related child deaths decline from 12 million to 7 million in the past two decades, diarrhoeal disease remains the second largest killer of children worldwide and is the most common cause of all diseases. Today around 760,000 children die from diarrhoeal disease every year making it a significant obstacle to achieving Millennium Development Goal 4.
Aside from child deaths, diarrhoeal disease can have even more long-lasting effects. It can cause malnutrition which can be a huge contributing factor to stunted growth and can impact negatively on future cognitive development. These effects are intergenerational as they can prevent affected children from attending education and being economically active and can further limit their chances of raising healthy and productive families.
I have seen for myself the effects of diarrhoeal disease when I participated in UK parliamentary delegations to Kenya and Bangladesh. In spite of the excellent efforts of wonderful and committed medical staff, hygiene remains a significant problem. In conjunction with improving access to appropriate vaccines and medication, more must be done to support initiatives aimed at promoting hygienic practices like regular hand washing and exclusive breastfeeding. We should also ensure that where diarrhoeal disease does occur, it can be effectively treated with oral rehydration therapy (ORT), oral rehydration solution (ORS), zinc and other micronutrients alongside regular feeding.
The UK has always been a leader in international development policy and I want to make sure that we continue to provide investment, expertise and leadership on the issue of access to clean water and sanitation. Whilst great strides have been made in creating effective tools to combat diarrhoeal disease there is a real need for greater action and to build on our progress.
I welcome the commitment made by the Government in April 2012 to double the number of people that will be reached by WASH by 2015 and I call on the Government to work further with international partners such as PATH, WaterAid and Tearfund to prioritise these vital issues and to roll out the tools that have been developed.
Preventing and controlling diarrhoeal disease and improving access to clean, safe toilets can significantly transform the lives of many people across the world and help them to build healthy, prosperous communities to raise their children.
Photo: PATH/Gareth BentleyRead more