RotaFlash, April 2016
Schoolchildren in Zambia pair health and hygiene through lessons in sanitation. The country is pursuing an integrated strategy to overcome childhood diarrheal disease with education, proven interventions, and new tools. Photo: PATH/Gareth Bentley.
Dr. Ayo Ajayi is PATH’s vice president of International Development.This post originally appeared on The Guardian‘s Global Development Professionals Network partner zone.
When a child is educated, a community can prosper. On the International Day of the African Child, commemorated on June 16 each year, we celebrate school enrollment and educational improvements. But when a child is not healthy, he cannot attend school. If he is vulnerable to resilient diseases that target poor, rural communities, he may not even reach school age.
Each year, we celebrate the growing number of African children who thrive beyond their first years, young lives spared from preventable diseases. Often, we can credit innovation: new tools that help conquer old threats. The African Rotavirus Symposium, which begins this week, will celebrate rotavirus vaccines’ steady march across the continent—expanding access to an innovative tool to conquer the most common and deadly cause of childhood diarrhea.
Pairing innovations to tackle dangerous diseases
Just as a child’s health and education are inextricably linked, the integration of proven stalwarts with innovative new tools can yield lifesaving symmetry when tackling the most dangerous childhood diseases. Pairing access to new vaccines with established interventions like proper sanitation and oral rehydration therapy gives us the best chance to overcome childhood diarrhea.
Rotavirus vaccines, education on nutrition and hygiene, and the availability of clean water are some of the interventions that have helped slash childhood diarrhea deaths by half since 2000. But more than 1,500 children still lose their lives each day to the life-threatening dehydration that diarrhea can cause.
Diarrheal disease wages war on Africa's children
In the poor, rural communities where diarrhea poses its greatest threat, malnutrition and opportunistic coinfections strip away children’s ability to withstand diarrheal disease or slow down their recovery from it. As a clinician in Nigeria many years ago, I remember often struggling to find veins to administer IV fluids in children who were severely dehydrated and wasting away from malnutrition. Their brothers and sisters waited nearby—uninfected at the moment, but just as malnourished, just as vulnerable—and I knew it would only be a matter of time before their family visited the hospital once again.
Today, it is heartening to travel to large cities throughout Africa and see far fewer children fighting diarrheal disease. But beyond the busy streets and bustling capitals, diarrheal disease still wages its war on Africa’s children.
We have the solutions
Though diarrheal disease is stubborn and often intractable, it is not insurmountable. Even in the world’s poorest places, deaths among children are declining. We have the tools and we know what works. Putting them into action takes a strategic combination of partnership, resources, and political will.
In this collaborative and comprehensive spirit, my organization, PATH, is working with partners worldwide, at local levels, and across our own disciplines to advise national policies; increase access to new interventions; bring clean, safe water to rural communities; research new medicines; and more.
But action also requires awareness. Raising our voices together, we can encourage an integrated approach to diarrheal disease, and a brighter future for Africa’s children.Read more
Dr. Desmond Chavasse, the Senior Vice President of Malaria and Child Survival for PSI’s programs, recently traveled to Bihar, India to gain a deep understanding of PSI’s largest market-based sanitation program, 3SI: Supporting Sustainable Sanitation, funded by the Bill and Melinda Gates Foundation. Below is part one of a three-part travel journal of his experience. Originally posted on PSI's blog.
It is remarkable that while India routinely launches satellites into space, half of its population (600 million) does not have access to a toilet. If the Indian state of Bihar were a country, it would have the 14th highest population in the world and yet only 18 percent of its households have a toilet.
In February, I visited PSI’s market-based sanitation program in India. The project is funded by the Bill & Melinda Gates Foundation and is attempting to develop business solutions to increase access to sanitation in Bihar, where open defecation is common.
This $8.7 million project aims to deliver over 450,000 toilets over the course of five years – but not by simply building them for people. The focus is on combining product innovation with testing different consumer-focused business models in markets that need both badly. The different business models will attempt to link demand-creation for toilets and toilet-consumer financing mechanisms with businesses, while also improving masons’ capacity to deliver toilets that meet the needs, desires, and pockets of Bihar’s residents.
The first two days of my visit involved a field trip to see the communities where PSI is working and to meet business owners, masons, and members of the community. I also met with microfinance providers, government officials, and other stakeholders, including representatives from UNICEF and from the Gates Foundation.
After the field visits, what struck me was the complexity of the project and the large number of moving parts that will need to be coordinated carefully to create a healthy and sustainable sanitation market that delivers the required toilets in the community; toilets that will provide the foundation for ending open defecation in Bihar.
PSI has existing frameworks and tools to help us identify problems and how to prioritize them, such as PSI’s marketing planning and performance improvement processes. In addition, PSI/India has assembled an excellent team of partners including Monitor Deloitte, PATH, and Water for People; by working together we can achieve greater results.
It’s the first time that PSI has been directly involved in using a business approach to increase access to, and use of, sanitation; involving interventions that attempt to fix the existing market rather than replace it. It is also PSI’s largest sanitation project and right in our bulls eye as it seeks to make markets work for the resource-poor, and will contribute to delivering on our core values of relevance, scale, and value.
The existing market is unable to provide toilets for the community in Bihar without investments to overcome fundamental blockages that prevent the toilet market from working effectively. The key to success will be using a new approach to market research, to really understand how the market is currently operating, identify the weak links that require fixing, and to then develop innovative and sustainable business models that lead to more rapid growth in the number of toilets in the community.
Why a market-based approach? Because we don’t expect to be in Bihar forever. What PSI looks to do, as an intervention, is to move markets consisting of consumers and entrepreneurs to a new equilibrium that will be sustainable for the long-term. We’ll be able to measure our impact, using DALYs averted as a bottom line, and long after we’ve gone those entrepreneurs will continue averting DALYs while they are also making a living.
See Part II or Part III of this series or learn more about PSI’s sanitation program in Bihar.Read more
Our new video “Defeat diarrheal disease? Together, we’ve got it covered” shows how an integrated approach to tackling diarrheal disease can save thousands of children’s lives each year. In this guest post, Geno de Hostos, who directs PATH's research and preclinical development work for antidiarrheal drugs, comments on some of the video’s themes and offers his insight on what it will take to defeat diarrhea.
The uneasy reality
When you walk into a diarrheal disease health clinic in a place like Bangladesh, the reality of the disease strikes you immediately. It’s the rows of bright orange bed covers drying in the sun, long lines of women with children waiting to be seen, and the patients—most of them too young and vulnerable to be already fighting for their lives.
The onslaught of diarrhea is sudden and loss of fluids is copious. Mere inconvenience quickly turns to a daily struggle for life as you fight off dehydration that diarrhea causes. A child is rushed to a hospital where lifesaving oral rehydration solution (ORS) is administered, usually by a mother or a care provider. Spoon by spoon, lost fluids are slowly restored, though weakness can persist for several weeks, and repeated bouts of diarrhea are common.
The reality is that despite rapid progress in reducing child deaths from diarrhea over the last decade—a decrease by more than 50 percent, from almost 1.3 million in 2000 to approximately 600,000 in 2012—there is a lot more to be done. And as long as diarrhea continues to take the lives of more than 1,600 children every day before they can grow to see their fifth birthday, there is no time we can allow ourselves to waste.
Power of an integrated approach
Another reality is that it doesn’t have to be this way. Effective, proven solutions for tackling diarrhea— safe drinking water and improved sanitation, adequate nutrition, rotavirus vaccines, ORS, and supplemental zinc, combined with continued feeding—are already in our hands. We need to work harder to scale them up and find new methods to deliver them to those who need them. Research and development efforts focused on new drugs and vaccines hold tremendous potential, and we need to sustain appropriate funding and efforts on that front to continue with our progress forward. Together, these critical solutions form a network of approaches to diarrheal disease that reinforce one another and form a solid foundation for a healthy life.
That’s why at PATH, we work to address diarrhea on multiple fronts. Our drug development team isdeveloping new treatments to shorten the severity and duration of diarrhea before it becomes fatal, while also working to improve the effectiveness of proven diarrhea therapies like ORS. PATH is also working to develop new vaccines against the leading causes of diarrheal disease, partnering with countries to increase access to existing vaccines for rotavirus, developing and delivering safe water treatment and storage products, advancing health devices, and strengthening behaviors like breastfeeding education.
Let’s keep going!
Having worked in nonprofit drug development for nearly seven years, I am more heartened than ever before by the impressive gains being made in research and development of innovative health technologies to fight the leading causes of child death like diarrhea. I am also reminded of the critical value of sustained commitment to our children and the need to accelerate progress. A multipronged approach can help us get there— among other factors, development of innovative health technologies, opening access to needed vaccines, drugs, clean water and sanitation, adequate nutrition, and education will continue to push us forward.
It’s time we change the reality of diarrheal disease.
Photo credits: Jonathan Torgovnik ©Read more
May 28th is Menstrual Hygiene Day! Though my excitement has occasionally been met with raised eyebrows and puzzled expressions, I couldn’t be more thrilled for the global attention to this crucial yet neglected issue.
You see, like diarrhea, menstruation is a taboo topic: a fact which works against the awareness needed to address their associated health risks. We make significant sacrifices for the sake of polite conversation.
But the similarities don’t end there. During my time at PATH, my passion for the rights of women and girls has led me to proactively seek out its seemingly unlikely connections to diarrheal disease advocacy. I’ve learned that while diarrhea indiscriminately kills boys and girls alike, girls stand far more to gain from access to hygiene and sanitation. The water, sanitation, and hygiene (WASH) interventions that protect children from diarrheal disease also help to ensure that girls can stay in school during their menstrual cycles.
AfriCare’s WASH in schools program provides just one example of the basic tools that should be available everywhere. Until then, you can do your part to raise awareness by joining the conversation at #MenstruationMatters and #MHDay.
Photo credit: PATH.Read more
If you move in global health circles, you may have had the good fortune to meet soccer star (and ONE Campaign Global Health Policy Director) Erin Hohlfelder. In her recent blog, she reflects on how access to lifesaving immunizations gave her the opportunity to be happy and healthy in the game of life, which still eludes too many children. The GAVI Alliance exists to help level the global playing field, and this week, ONE Campaign launched the game plan for donors in the new World Cup-themed report, Going for Goal: Immunisation and the Case for GAVI.
All these sports analogies make me reflect on my own athletic career… as an unwilling participant in my grade school physical education class. That is, until hockey flipped the switch in me. I became a maniac, relentlessly chasing the ever-moving puck, blind to the confusion of my teammates and to irrelevant distinctions like “offense” and “defense.” I was a zealot on a mission, and I had no time for strategy. Good intentions notwithstanding, it wasn’t the best use of my newfound passionate energy.
It turns out what’s true in the hockey (or soccer) field is true in the global health field, too. Each player contributes unique strengths to build a winning team. It’s why we constantly talk about an integrated approach to diarrheal disease: prevention efforts (water and sanitation, vaccination, breastfeeding, and nutrition) must team up with treatment efforts (ORS/zinc, and eventually new drugs). We would inevitably suffer losses if everyone focused on a singular approach, forgetting that each player – each intervention – is necessary in the game.
Saving 5 million children with vaccines is an ambitious but achievable goal. If we can dream even bigger with a combined approach, why wouldn’t we?
Photo credit: Susan Sola.Read more