RotaFlash, December 2013
In late November, Zambia expanded a pilot project that originated in Lusaka district...
We can prevent 95% of deaths from diarrhea and 65% of deaths from pneumonia by scaling up cost-effective interventions. How cool is that? That was the bottom line from US AID’s briefing about the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD). Speaking at the event, Samira Aboubaker of the World Health Organization (WHO) invoked US President Obama’s campaign slogan, “yes, we can.”
So, the next challenge is to turn yes, we can into yes, we will.
While the GAPPD from UNICEF and WHO maps out the key steps that are needed, it will be up to national governments to actually take those steps. They will need the help of civil society organizations (CSOs), nongovernmental organizations (NGOs), donors, multilateral institutions, and the private sector. CSOs and NGOs have an important role in keeping attention on the GAPPD and its implementation. Because the effort now shifts to what will change within countries of high burden, PATH partnered with World Vision International to compile an Advocacy Tool Kit for our colleagues and allies working in country.
We hope the toolkit will help CSOs, NGOs, and other advocacy groups or individuals to advocate for the successful implementation of the GAPPD. In addition to concrete tips and tactics, it includes links to useful resources, and templates for creating effective materials tailored to local needs.
When our team first heard rumors that the work was underway on the GAPPD, we were quite excited. You might find that strange and suggest we need a bit more excitement in our lives (and you might be right) but what an opportunity to focus attention on these two leading killers of children under five and the solutions needed to significantly reduce the death and illness they cause. And it turns out, we’re in good company with the over 100 organizations and pediatric societies expressed their enthusiasm by signing the statement of support.
We know from our work in Cambodia and Kenya, among other places, that governments are eager to bring together the right package of solutions to protect children from diarrhea and pneumonia. We are excited that advocates everywhere can use the GAPPD and the Advocacy Toolkit to bring these ideas to the countries and communities most in need.Read more
This week, we celebrate integration. Though it is intrinsically at the heart of what we and our partners do in addressing myriad global health challenges through thoughtful, efficient strategies, today integration is particularly at the fore. For the very first time, there is a global plan to simultaneously take on the two diseases killing more than 2 million young children each year: pneumonia and diarrhea.
The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), released today by the World Health Organization (WHO) and UNICEF, provides the latest strategies and evidence needed to reduce death and illness from the two leading killer diseases among children. Beyond integration across the two diseases, the GAPPD is an opportunity to meld global and local agendas, giving national governments a comprehensive tool to determine the specific plans, investments, and partners needed to address the unique needs of their countries and achieve the greatest health impact for their citizens.
Global prioritization can only make a difference if it spurs complementary urgency among national governments where diarrhea and pneumonia still claim far too many lives. Engagement among national officials, health ministers, civil society, the private sector, donor agencies, multilateral institutions, and vulnerable communities is an ideal reflection of the GAPPD’s integration of prevention and treatment strategies and its combined focus on diarrhea and pneumonia.
Through integration, the GAPPD pairs prevention with treatment, pneumonia with diarrhea, and applies several proven interventions like ORS and zinc to pursue the greatest possible impact for children worldwide.
Clinical workers from Cambodia to Kenya know well that neither diarrhea nor pneumonia occurs in a vacuum. These diseases are often linked in a vicious cycle that exploits weakened immune systems struggling to overcome co-infections and threatened by basic environmental perils. By the same token, the good news is that many of the solutions needed to fight pneumonia and diarrhea are complementary. The GAPPD provides a framework to protect children, prevent disease, and treat those who do become sick using proven interventions that we know work against both diarrhea and pneumonia, like vaccines, proper nutrition, safe water, sanitation, and integrated case management.
PATH is working to integrate our work related to diarrhea and pneumonia across a range of countries and platforms to contribute to this critical global health priority, aligned with the GAPPD framework. Specifically, we will be partnering with governments, international organizations, private-sector entities, and others to maximize utilization of critical interventions proven to reduce illness and deaths from these killers of children – and holding ourselves accountable for achieving clear results.
We will, for example, be building on our work in Cambodia, where about 9,100 children under the age of five die from pneumonia every year, and 2,300 die from diarrhea,integration is already at work.Since 2005, PATH has helped Cambodian officials implement clinical and community interventions that integrate diarrhea and pneumonia control, particularly in rural communities where child deaths are highest. Policy changes at the national level are cascading to provincial, district, and village levels, and empowering volunteers and caregivers to spark change and achieve lasting impact. During a one-year demonstration project, village health volunteers trained through the project hosted more than 450 mother classes, reaching more than 11,000 pregnant women and caregivers with lifesaving messages on pneumonia and diarrhea prevention and treatment. In parallel, Cambodia’s national investment provides a model for the translation of integrated policies into action plans and interventions in other vulnerable communities.
Mothers’ classes in rural Cambodian communities brought messages of diarrhea and pneumonia prevention and treatment directly to families. In a pilot project that is now expanding nationwide, PATH reached more than 11,000 caregivers.
With support secured from the world’s leading health authorities, the call now shifts to national governments to translate this global framework into reality in the clinics and communities that battle childhood diarrhea and pneumonia every day. The GAPPD offers guidance on tapping into the strengths of national programs that already combine diarrhea and pneumonia interventions; on clarifying roles, responsibilities, and accountability across ministries, sectors and partners; and on dedicating resources to reduce health inequality and reach those in greatest need.
In addition to our commitment to working at country level to ensure access to life-saving diarrhea and pneumonia interventions, we also are helping to turn the action plan into health impact. For example, PATH and World Vision International developed an advocacy toolkit for in-country NGOs and CSOs. GAPPD messages, advocacy actions, and template materials (press release, brief, letter) can be tailored for each country context.
Today’s launch of the GAPPD with its complementary resources is a reminder of the crucial value of collaboration and integrated efforts: Global and local officials must work together. Stakeholders such as civil society and the private sector must work together. Governments must engage health workers who must in turn work with their communities, so that diarrhea and pneumonia can be overcome… together.
-- Steve Davis, President and CEO, PATH
Photo 1: PATH/Hope Randall
Photos 2 and 3: PATH/Heng Chivoan
Steve Davis headshot: Auston James
This past Friday was World Water Day and an opportunity to celebrate the excellent work being doing to promote water, sanitation and hygiene (WASH) in the developing world. The UK has played a leading role in making WASH a priority for international development funding and the Government’s commitment to doubling the number of people reached by WASH by 2015 sets an ambitious target for us, and other developed nations, to follow.
While much progress is undoubtedly being made, great inequality of access still remains with too many communities reliant on unclean water and inadequate sanitation facilities, whilst simultaneously employing poor hygiene practices. One of the biggest concerns about this inequality is the prevalence of diarrhoeal disease. This is of particular concern in Africa and Asia, where eighty percent of diarrhoea related child deaths occur. Staggeringly, around 80 children die every hour from diarrhoeal disease, making it the second largest killer of children under five worldwide, after pneumonia, and the most common cause of childhood illness. It is worth reflecting that in Britain we consider the condition little more than inconvenient.
Effective methods to both prevent and treat diarrhoeal disease exist and are being rolled out across the developing world. Improving access to WASH is a vital stage in this process. However we must also utilise all available tools to prevent and treat the condition, including vaccines, antibiotics, oral rehydration therapy (ORT), exclusive breastfeeding and zinc and other micronutrients. UNICEF estimates that combining all of these into one single package of care would cut deaths due to diarrhoea by around 60 percent.
This strategy of integrating care is gaining significant momentum in the development community, particularly in light of constrained public finances. In the vaccines sector, we are already seeing the benefits of integration in vaccine effectiveness and delivery. Vaccines are far less effective in environments where WASH access is poor and infrastructure development is becoming a key part of vaccine roll-out. Without adequate cold chain storage facilities and serviceable roads, it is extremely difficult to ensure that effective vaccines against a number of preventable diseases reach children in rural areas.
As Co-chair of the All Party Group for Child Health and Vaccine Preventable Diseases, I have met with a number of the leading organisations in the WASH sector to establish how integrated packages of care can work on the ground. The theme for this year’s World Water Day is Water Cooperation and we continue to support our partners at WaterAid, Tearfund and PATH in calling on the Government to make cooperation and integration key priorities for future development policy. By working together and joining up our efforts, we can significantly reduce diarrhoeal disease, and other preventable conditions, and make substantial progress on attaining our Millennium Development Goal targets for improving child and maternal health.
-- Lord Avebury, Co-Chair of the UK's All Party Parliamentary Group for Child Health and Vaccine Preventable Diseases
Photo credit: Gareth Bentley/PATH.Read more
What if we lost 32 school buses full of children today? That’s 2,195 children—the number who die daily of diarrhea around the world. That’s more than die from AIDS, malaria, and measles combined.
As World Water Day approaches on March 22, we should consider water’s role in those deaths—and what we can do to prevent them. About 88% of diarrhea-associated deaths are attributable to unsafe water, inadequate sanitation, and insufficient hygiene. Yet most diarrheal deaths are preventable using simple, low-cost interventions.
Diarrhea: common illness, global killer
Diarrheal diseases account for 1 in 9 child deaths worldwide, making diarrhea the second leading cause of death among children under the age of 5. For children with HIV, diarrhea is even more deadly; the death rate for these children is 11 times higher than the rate for children without HIV.
Despite these sobering statistics, strides made over the last 20 years have shown that, in addition to rotavirus vaccination and breastfeeding, diarrhea prevention focused on safe water and improved hygiene and sanitation is not only possible, but cost effective: every $1 invested yields an average return of $25.50.
We know what works
A young girl drinks water from a safe storage vessel in her home.
I have learned through my work on the etiology, control, and prevention of enteric diseases in the developing world that most water sources in these countries are contaminated. If we were to test water sources where families draw their water for drinking and cooking, we would find many colonies of bacteria, such as E.coli, which is a sign of fecal contamination. And where there are feces, there’s the potential for disease, because that’s one way germs spread from one person to another. Yet, despite the enormity of the problem, there are proven ways to tackle diarrhea. They include:
· Vaccinate for rotavirus
· Provide safe water and adequate sanitation and human waste disposal
· Promote handwashing with soap and breastfeeding to reduce exposure to contaminated water
· Treat diarrhea appropriately with oral rehydration therapy and antibiotics
· Train health care providers and community health workers on diarrhea treatment
· Educate mothers and caretakers about caring for ill children and when to seek medical assistance
· Build laboratory diagnostic capability and identify the causes of diarrhea
Partnerships for action
To prevent diarrhea around the world, we must work together at all levels, using effective interventions and proven treatments. One example is the Safe Water System, which addresses household water treatment and safe water storage. It is a simple technology, but, setting up effective safe water programs in developing countries can be complex. We rely heavily on our partners at home and in the field. We work with local partners to determine appropriate packaging for the system, translate educational materials, and develop plans for distribution and use of the product.
Rob Quick (CDC) and Greg Allgood (Director, Children’s Safe Drinking Water Program, Proctor & Gamble) in Kisumu, Kenya. From blog: With a Little Help from My Friends: CARE, CDC, and SWAP Kenya.
Resources must be available to produce the locally branded diluted bleach solution and safe water storage containers, and, once the project is underway, we also must have the capacity to work with local partners to conduct research on usage rates of the system and its effectiveness in preventing disease and death.
From government investments in safe water infrastructure to individuals treating their household water and promoting handwashing in their communities, we can all do our part to prevent diarrhea and save lives.
-- Robert E. Quick MD, MPH, Medical Epidemiologist with the Waterborne Disease Prevention Branch, US Centers for Disease Control and Prevention, in Atlanta, Georgia.
Photo credits: 1 to 3 – CDC; 4 – Proctor & GambleRead more
While I waited to board my plane en route to Kenya in September 2012, I was reading the newspaper, hoping for good news about the teacher strikes in Kenyan schools. Instead, I found myself comparing the similarities between the strikes in Kenya to those occurring in Chicago at the same time. Teachers in both Kenya and Chicago were protesting similar plights: insufficient budgets, too few teachers to meet the needs of a large student body, and inadequate pay. But there was one big difference: In addition to budget struggles, the majority of Kenyan schools also lack access to safe water, a basic human need. Without safe water, it is difficult to live let alone learn.
Students from Ebulala Primary School fetch water
from a nearby borehole for drinking, cooking, and washing.
By the time the teacher strikes ended, I was already in Kakamega, Kenya, ready to pilot a water treatment and education program in three primary schools. The program aimed to improve drinking water quality and improve education about water, sanitation, and hygiene (WASH), since these improvements are more powerful together than they are alone. To treat water, the schools used the Smart Electrochlorinator 200 (SE200). The SE200, co-developed by Cascade Designs, Inc., and PATH, generates chlorine on-demand from salt, water, and a battery.
In Kenya, I worked closely with some talented and dedicated people: Alfred Ochola and Rael Odengo from PATH, Paul Ogutu from World Vision and others within the AIDS, Population, Health Integrated Assistance plus western Kenya (APHIAplus) program, a five-year USAID-funded program being implemented by PATH. I learned about the importance of government involvement from my Kenyan team. They introduced me to the district officers from the ministry of public health and sanitation and ministry of education who became my field companions and were the glue that made the project stick after I left.
Every morning before heading to the field with the district public health officer or the district education officer, I would check in with Ochola at his office. One morning, Ochola asked me, "Jenna, what do you think, are things going as planned?" I paused for a minute then stated, "Well not really according to plan..." Ochola's face contorted in response before I could add, "but things are going much better than I could have ever planned." And a big smile spread over his face.
We achieved our intended goals, measuring improvements in drinking water quality and students' knowledge. There were other improvements too, like changes in attitude, which are not so easily measured but are equally meaningful. Several students, inspired by the program, declared their intent to study hard in school to become scientists, engineers and doctors because they saw the importance of keeping water clean and keeping people healthy.
PATH and Cascade Designs, Inc. began working together to address community water needs in Kenya in 2008, developing their first prototype electrochlorination technology called the Smart Electrochlorinator 20 (SE20) funded by the Laird Norton Family Foundation. With funding from the Lemelson Foundation, PATH and Cascade Designs, Inc. developed the next generation technology called the SE200. In 2012, Jenna Forsyth assisted PATH as a graduate student intern to pilot use of the SE200 in three schools in Kenya through an award from the Reed Elsevier Environmental Challenge and programmatic funding from USAID’s APHIAplus Western Kenya project. The pilot included training on the technology and interactive WASH educational materials. Building on this successful pilot, PATH is expanding to more schools in 2013 with additional support from the Laird Norton Family Foundation and APHIAplus Western Kenya.
Experience the challenge and rewards of Jenna’s work with PATH in Kenya through an insightful video by Reed Elsevier
Photos: Jenna ForsythRead more