Voice of America, June 2014
At the second anniversary of USAID's Child Survival Call to Action, USAID...
As Co-Chair of the All Party Group for Child Health and Vaccine Preventable Diseases, I have been extremely fortunate to visit a number public health programmes in the developing world. With each visit I have been privileged to meet with some of the committed staff that make these programmes possible and have learned more about how sustainable aid programmes can be delivered on the ground.
In recent years I’ve been to Kenya, Bangladesh and Tanzania to see how UK money is being spent on vaccinating children against pneumonia and diarrhoeal disease, the two leading killers of children under five in the developing world. Despite being largely preventable, these diseases kill 1.1 million and 760,000 children every year respectively. Ensuring that safe, effective vaccines reach the communities that need them is a key priority in international development and it rightly forms the backbone of our global health and development efforts.
Despite all of this positive work, I also witnessed something which shocked and concerned me - the lack of adequate sanitation and hygiene practices in some of the clinics I visited. As a microbiologist I understand only too well that access to water, sanitation and hygiene (WASH) is an essential underpinning to any health system. I was alarmed by the thought that the children I had seen being vaccinated could remain at risk from future infection because they simply didn’t have access to basic WASH facilities.
These experiences lead me to think that we need to be more joined-up in our thinking about public health and development. For me, this means not only better integration of project funding and delivery but also more effective communication between the Governments, NGOs and international institutions involved. With this in mind I have been working with the Earl of Dundee, Chair of the Council of Europe Subcommittee on Public Health, to bring stakeholders together to establish how we achieve our goal of greater integration, in particular organisations like PATH and WaterAid who have a real interest and have shown true leadership in this area. Following a roundtable event at the end of October I am convinced that there is a collective will to work together more effectively to achieve better health outcomes for children around the world.
There is also a growing weight of evidence in favour of greater integration and coordination. Earlier this year UNICEF and the WHO published their Global Action Plan for Pneumonia and Diarrhoea (GAPP-D), which recommended an integrated ‘Prevent, Protect and Treat’ approach to reducing the global burden of these diseases. This integrated approach encompasses vaccines, WASH, nutrition and basic treatments like antibiotics. Similarly, a recent Action for Global Health report highlighted the success of joined-up initiatives and called for greater incentivisation for integrated approaches to child health.
My message is a simple one. We don’t need to completely overhaul international development policy to achieve better results. Vertical integrations, such as vaccines programmes, can be highly effective. We just need to look for ways to better coordinate and complement these existing efforts. We teach our children that working together can reap greater rewards than acting alone. It’s high time that we remembered this lesson when trying to save the lives of vulnerable children around the world.
-- Jim Dobbin MP is Co-Chair of UK's All Party Group for Child Health and Vaccine Preventable Diseases
Photo credit: PATH/Heng Chivoan.Read more
While Zambia launched the rotavirus vaccine nationally today, the vaccine has been in public health clinics across Lusaka Province—the most populated province and home of the nation’s capital—for over a year and a half. The Government was keen to introduce three new vaccines into the national immunisation programme, but it needed to meet the conditions for GAVI Alliance support based on their 2011 request for introduction. In the government’s plan, rotavirus vaccine was third in line behind pneumococcal and the second dose of measles. Hence, Zambia embarked on an innovative approach to accelerate the introduction of rotavirus and new vaccines into the country, and to embark on a collaborative, comprehensive approach to combat diarrhoeal disease.
Dr. Joseph Katema, Minister of Community Development, Mother and Child Health, giving the vaccine against rotavirus to the first child in Zambia.
Annually, there are an estimated 10.5 million cases of diarrhoea, and 63,000 hospitalisations and 15,000 deaths attributed to the disease in children under-5 in Zambia. A myriad of factors contribute to Zambia’s third largest killer of under-5 children, including poor public awareness of appropriate life-saving measures, a high nurse and doctor-to-population ratio, limited vaccine cold chain capacity, erratic access to essential medicines and competing priorities for investments in health.
This was the impetus for the initiative known as the Programme for the Awareness and Elimination of Diarrhoea (PAED), a collaborative effort initiated by the Centre for Infectious Disease Research in Zambia (CIDRZ), Absolute Return for Kids (ARK) and Comic Relief, working in partnership with the Zambian Ministry of Health (MoH) and the Ministry of Community Development, Mother and Child Health. PAED works together with key stakeholders to jump-start and build momentum to control diarrhoea and create awareness of this critically neglected disease. PAED is a pilot whose aims are to reduce under-5 mortality in Lusaka Province through the introduction of a comprehensive diarrhoea control programme that includes rotavirus vaccination, improved clinical care for diarrhoea and dehydration, and community mobilisation and action, as well as to accelerate the country-wide introduction of rotavirus vaccination and other high-priority childhood vaccines into the country.
Honourable Minister of Health Kasonde opens the cold chain warehouse in Lusaka.
This initiative works hand-in-hand with Government, ensuring they are not just aware of PAED activities, but actively involved in the development and guidance of the project. This approach involves greater coordination amongst all partners working within the child health and diarrhoeal disease space, and includes policy-makers, donors and all organisations working within the national immunisation programme, public health clinics and in commodities management, as well as working with community groups supported by Government and at the grass-root level. PAED’s model involves a concerted effort to:
· Coordinate amongst all relevant stakeholders;
· Have complete integration within Government child health activities, ensuring integration of projects into existing programmes;
· Advocate at national and international levels;
· Network amongst other multilateral, bilateral and non-profits for awareness and additional support (technically and monetarily); and finally
· Mobilise resources, with a focus on leveraging off of other initiatives to lessen the burden of support on one organisation.
PAED was successfully integrated into the health system and officially launched by the Minister of Community Development, Mother and Child Health in January 2012. Preparatory work prior to that launch included: introduction and acceptance of PAED in the Inter-agency Coordinating Committee (ICC); development of Zambia’s proposal for introduction of new vaccines to GAVI Alliance; addressing GAVI Alliance conditions, including conducting the World Health Organisation’s tool and training to assess vaccine management in the country (called Effective Vaccine Management), this led to the development of a national cold chain scale-up strategy and included a plan to mobilise resources; development of vaccine orientation materials and adaptation of routine health information tools; lobbying for a vaccine donation from GlaxoSmithKline Biologicals; conducting health worker training and health facility preparations; and finally the launch and step-wise Lusaka Province-wide roll out of the rotavirus vaccine.
The PAED approach has directly and indirectly assisted to leverage over $14 million USD (including the seed funding of $5.6 million) to combat diarrhoeal disease through the support for the immunisation programme and the vaccine cold chain, to conduct research, to address stop-gaps in the supply chain for essential medicines and to extensively evaluate the impact of this programme in order to provide evidence for policy and decision-making in the future.
Through the pilot approach—before national introduction—PAED was able gain insight on practices and barriers to vaccine uptake and diarrhoea prevention and treatment in clinics and communities. PAED gained feedback on difficult areas of vaccine delivery, clinical management and community uptake, and tried to address and strengthen these issues, as well as to look into behavioural implications in communities. All of this insight and information directly feeds-back to the Government to assist in national rollout of vaccines and service delivery for child health interventions within the Ministries technical working groups, which address implementation at every level within the country.
Another important aspect to the PAED pilot is the unique funding partnership. ARK and Comic Relief go beyond typical donors support, who often operate within more rigid terms or funding mechanisms. ARK and Comic Relief are keen to respond to the ever-changing and dynamic environment of public health systems in resource-poor countries. Between new policies and governments, fluctuating donor activities and realising that some information is only found out when you really start implementing, ARK and Comic Relief have provided flexibility to this dynamic environment. This ability to change and adjust based on an evolving situation should be a recommended model for other donors, as it creates strong partnerships.
To date, PAED has fully-immunised over 100,000 children against rotavirus. The pilot has also trained almost 500 community workers on diarrhoea prevention and treatment, and trained over 500 public health workers and strengthened Oral Rehydration Therapy corners in every public health clinic in the province.
As PAED moves forward in its final year of implementation it hopes to be a model of which not only Zambia can learn from, but other countries as well. Dissemination of lessons learnt and sharing PAED’s evaluation results, including vaccine efficacy, cost-effectiveness and overall impact on under-five mortality is equally important. This information will not only assist policy and decision-makers in Zambia, but within the region as we look for better ways to coordinate, impact and reduce child mortality. PAED also serves as a model platform for how to operationalise new initiatives such as GAPPD—the Global Action Plan for the Prevention of Pneumonia and Diarrhoea.
We are excited for Zambia’s national rollout of the rotavirus vaccine and its impact on child mortality, but equally we are excited on how we can learn from this model to have even more impact in the future.
For more information:
-- VIDEO: Zambia's integrated approach to diarrhea serves as a model for other countries.
-- PHOTOS: In Mazabuka, Zambia, students become teachers about safe drinking water, sanitation, and hygiene.
-- PHOTOS: In Mukuyu Village, parents share what they have learned from their community health workers about how to care for their children.
Photo credits: CIDRZRead more
Today, November 19, is World Toilet Day. But unless you only plan on using the toilet once a year, we think it makes sense to celebrate this unsung hero every day.
That’s why today, without further a-doo, we launch our long-awaited 2014 calendar! “Oh, the places we go: Public health’s humble hero” will help you celebrate the toilet every day of the year. Print it out, hang it proudly in your cube (or bathroom), and share with friends!
We couldn’t have done it without the photographers who helped us cause a commode-tion by submitting their photos through social media. Check out all the amazing contest entries on our “Places We Go” Pinterest Board.
Though we loved each contribution, in the end, we could only feature a handful of photos in the calendar. What inspired the winners to celebrate the toilet in the first place? Let’s hear from some of the photographers themselves.
I was inspired to take this photo purely by the fact that someone had taken the care to create such a peaceful, natural & colourful environment in a basic public toilet at a small petrol filling station in the middle of nowhere in the UK. I am pleased that my picture will rub shoulders with other images so diverse as those from far reaching places throughout the world. I am also proud & excited to be part of a wonderful organization bringing sanitation awareness of a global concern to the rest of the world.
- David Ditchfield
After hiking for several hours up a treacherous, rocky trail, with no light but moonlight to guide us, my friends and I arrived at the top of Mount Sinai. We huddled together in the darkness, shivering against the freezing wind, waiting for the sunrise. Slowly, but surely, the sun came up. It was a mediocre display at best. Still, being atop a mountain and surrounded by ancient history felt pretty damn cool. But nothing could compare to the moment when light flooded over everything and there, perched so precariously, perfectly, was a loo!
When you spend your days working to increase sanitation access, and you've spent many a day "in the field" without it, you gain a true appreciation for the glorious, glorious toilet. You learn that it provides dignity to a family, privacy to the vulnerable, all the while protecting health, and the environment as well. It's the shit, really.
What's better than a pretty picture of a toilet? One that's shaped like a toilet seat and you can hang on your wall. Your bathroom wall, of course.
- Genevieve Kelly, PSI
I am an advocate of global sanitation because I have lived through the difficulties of lacking proper sanitation services, and seeing the effects of poor sanitation to community and in the overall countries’ economic development.
The idea behind the pictures with zebra in the back ground occurred as we were on a road trip and came across some wildlife. We thought, “What happens to all the tourists who visit our countries’ wildlife, and especially when they have to answer the call of nature?” Sadly, in those cases open defecation is the solution, or some quickly dug-up hole in the ground. A real solution is needed in addressing this issue to avoid cross-contamination of the species, and that’s why we feel the Banza toilet addresses it very well.
We are very excited as an organization (Banza Ltd) to be featured in this calendar, as we are working towards addressing the global issue of over 2.5 billion people without proper access to sanitation services. Our aim is to provide a new and better option of sanitation service through the Banza toilet.
- Patrick Kiruki, Banza Ltd.
I take pictures of school toilets regularly; I like to think that I have the biggest collection of pictures of toilets in the world (or one of the biggest) since I have been taking pictures of them for over 15 years as part of my job as a school health expert currently with Save the Children and previously at the World Bank. I visit schools to ensure to that school children have access to basic health such as health education and healthy environments. It is quite depressing to see the facilities that children have to use; my picture from Mozambique shows an innovative and sustainable attempt at privacy but inside the straw walls, the lack of regular cleaning makes the use of the toilets hard to imagine. Even worse for a menstruating girl! I’m glad that the need for better sanitation is being highlighted through this calendar and that one of my pictures will be featured – I’ve been wanted to share my “toilet” collection with others for many years so this is a first step.
- Seung Lee, Save the Children
I took the photo during a camping trip with California Overland Jeep Excursions. I wanted to remember this quaint facility for its simplicity and the serenity I found, after a use or two!
I am excited to be chosen because all the photos were great. When the calendar arrives, I may throw a "potty"!
Many people are unaware of health issues that can often easily be eradicated by supporting organizations who work on justice issues. Intentions are good; actions are better!
- Lisa WhiteRead more
The theme for World Pneumonia Day this year is innovation, which has been instrumental in the progress made against childhood pneumonia to date—and is key to enabling future success against this top childhood killer. To mark World Pneumonia Day, global health activists came together to call on leaders to scale up investment and support for existing interventions to defeat pneumonia and new innovations that can accelerate progress toward the finish line. In the spirit of this call, I thought I’d reflect on some ways that stepping off the beaten path has led to accomplishments and opportunities in the fight against this complex and powerful disease.
Perhaps the biggest reason to celebrate is that child deaths from pneumonia are dropping. Indeed, the disease still kills more children less than five years of age than any other disease worldwide (mostly in the developing world), but it is giving ground. Between 2000 and 2012, childhood pneumonia deaths fell by 35 percent—that’s 1.8 million deaths down to 1.1 million, respectively. That’s progress!
Helping to save these lives have been innovative efforts within the global health community to speed access to lifesaving prevention and treatment tools in populations traditionally left behind. One such success story is the record time with which vaccines against pneumococcus, the most common cause of severe childhood pneumonia, have rolled out in the developing world following their introduction in the industrialized world. This is due, in large part, to the creativity of the GAVI Alliance and other global health donors in finding innovative ways to finance introduction and to work around affordability and supply barriers that traditionally preclude vaccine access in low-resource countries. Today, GAVI is on course to help more than 50 low-income nations introduce lifesaving pneumococcal vaccines by 2015.
In addition to existing interventions, cutting edge science is advancing the development of new vaccines designed specifically to meet the health and cost needs of the developing world over the long term. These include novel vaccines that could provide affordable, broad coverage across all of the many varieties of the pneumococcal bacterium, in contrast to currently licensed vaccines that provide limited coverage. Other vaccines in the development pipeline are combining existing and new technologies to boost affordability and protection.
Beyond scientific advancements, a revolutionary strategy is gearing up to have enormous impacts on child survival by integrating the fights against pneumonia and another leading child killer, diarrhea. Together, these diseases account for roughly one third of all child deaths worldwide. Guiding the strategy is the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea released this year, which calls on national governments and donors to integrate and scale up prevention and treatment interventions to tackle these diseases simultaneously.
What makes this approach so promising is that many of the interventions for both diseases either overlap or complement each other—conserving resources and maximizing efficiencies in even the most resource-poor settings. The suite of interventions includes basic sanitation, safe drinking water, handwashing with soap, good nutrition, antibiotics, exclusive breastfeeding, clean cook stoves, antibiotics, zinc, and oral rehydration solution. If access to these cost-effective interventions continues to improve in the poorest communities around the world, more than two million children can be saved by 2015.
With so many children dying each year due to pneumonia and diarrhea, the immense human toll can take one’s breath away. The good news is that innovative tools and strategies are helping to reduce child mortality, giving increasingly more children a reason to breathe a sigh of relief. Still, the road to finishing the job is long and complex and requires a good deal of creativity. But, just like pneumonia cannot be solved in a vacuum, innovation needs the free flow of information and ideas.
So, if you’re interested in ways to help, one easy way is by spreading the word. Be it in person, through social media, over the phone or email, or some other mode of communication, you can share information about the impacts of these diseases on children and the prevention and treatment strategies that work. Tell people about why integrating pneumonia and diarrhea interventions is so important for child survival in the poorest regions of the world. Encourage investment in the resources needed to fight these diseases. You might just enlighten some minds—a first step in laying the groundwork for innovation to sprout.Read more
Ask your average American about the biggest health challenges for children in poor countries, and you may hear a range of things. Two words you are not likely to hear are “pneumonia” and “diarrhea.” That is because many don’t know that pneumonia and diarrhea are two of the biggest killers of children under the age of five in the developing world. And even more don’t realize that we have many of the solutions we need to end these preventable deaths.
That is why, for the very first time, we at PATH are commemorating World Pneumonia Day (November 12) and World Toilet Day (November 19th) together. While one is a disease and the other a critical tool, in tandem they draw attention to an important point: pneumonia and diarrhea are best tackled together. And, many of the solutions—like certain vaccines, basic sanitation, handwashing with soap, safe drinking water, and adequate nutrition—help defeat both diseases.
On November 18th, PATH and partners will host a “game night” on Capitol Hill to educate Members of Congress and their staff about what it takes to tackle pneumonia and diarrhea in poor countries and specifically the vital contributions of the United States.
Our policy goals are serious, but we’ve found a fun way to focus attention on improving children’s health.
This event will be a celebration of what has been accomplished to drive down child morbidity and mortality over the past 20 years, and an opportunity to learn about needed investments to promote what we know works and where research is needed in a light, fun environment. Participants will play educational games (like “ORS/zinc ball toss” and “I spy health worker”) to figure out answers to scavenger hunt questions. Those who complete the scavenger hunt will receive our exclusive toilet calendar, ”Oh, The Places We Go: Public Health’s Humble Hero.”
By playing, Members of Congress and staff can learn about important investments to deliver lifesaving tools and the need to develop those we don’t yet have. It is our hope, that when budget season comes around, policymakers think back upon what they learned and protect precious programs that have such a critical impact on children and families around the world.
We also hope you’ll raise your voice with us and encourage policymakers to commit to take action to defeat diarrheal disease and pneumonia. Join the conversation on social media at #stateofplay.
-- Erin Fry Sosne, Advocacy and Policy Officer for Child Health, PATH
For more information:
· Earlier this year, WHO and UNICEF launched the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea, the first ever plan to simultaneously tackle the two diseases.
· INFOGRAPHIC: Tackling the Deadliest Diseases for the World’s Poorest Children
Photo credit: PATHRead more