Bringing the Avon Lady Philosophy to Rural Ghana

One of the HealthKeepers sales ladies heading out on her rounds.

In many rural areas of Ghana, a ringing bell is the traditional way that itinerant sales agents announce their arrival in a village. More and more, those bells are announcing the arrival of the entrepreneurial women from the HealthKeepers Network who are promoting health while also making a living, with the motto “prevention is better than cure.” And they are forging a new way of using the private sector to deliver health and hygiene to rural areas often overlooked by traditional global health programs.

Daniel Mensah, head of HealthKeepers

Although different private sector strategies have been tried to promote contraceptive use in Ghana (where the 2008 Demographic and Health Survey  indicated a contraceptive prevalence rate for modern methods was 16.6%), the impact of these strategies has been limited due to the long distances to be traveled to reach relatively small numbers of people with limited purchasing power.

In October 2009, I visited HealthKeepers with two colleagues and Executive Director Daniel Mensah in a village about an hour outside of Accra. We were the first visitors just after HealthKeepers had been registered to continue the work begun by Freedom from Hunger. I immediately thought of Avon, a U.S. company I remember from my youth, and its Avon ladies who have sold cosmetics door-to-door since the 1930s. The HealthKeeper difference is that these sales ladies travel by foot, with their products in a basket perched on the top of their heads.

The merchandise includes a mix of health products — such as contraceptives, insecticide-treated mosquito nets, oral rehydration salts and home water treatment tablets —and other carefully selected personal care products which help ensure that the ladies turn enough of a profit to keep them motivated. In 2009, they were also selling low-cost eyeglasses; they gave one of my colleagues an impromptu eye exam under the mango tree.

Crisis in Horn of Africa is not over; how can we prevent another one in future?

This article was originally published in The Huffington Post on Oct. 4, 2011.
 
The last time the Horn of Africa was hit by a famine as severe as the current one, it was 1985 and I was just finishing two years as a Peace Corps volunteer in West Africa. My wife and I, moved by the horrific images coming out of Ethiopia, volunteered to work at a feeding camp with World Vision. But the U.S. relief organization was besieged with similar offers, and politely turned us down. Michael Jackson and Quincy Jones convinced a plethora of pop stars to record "We Are the World." That humanitarian disaster somehow became firmly entrenched in the hearts and minds of people around the world.

The current drought and famine is worse than the one in 1985 -- some say it is the worst in 60 years and affects more than 12 million people, most of them women and children -- but seems to be attracting a fraction of the world's attention, despite the proliferation of social media and social networks.

By some estimates, 300,000 children are suffering from severe acute malnutrition and are likely to die at a very high rate and very quickly, according to Executive Director Lisa Meadowcroft of AMREF USA, the U.S. affiliate of the African Medical and Relief Foundation (AMREF) based in Nairobi, who just came back from a trip to the Horn of Africa.

Cancer Rises in Africa, A Continent Ill-Prepared to Handle It

This article originally appeared in The Huffington Post on Sept. 20, 2011.

"Thank God I have AIDS and not cancer, because that would be a death sentence," an HIV-positive woman told Ann Kim, a freelance journalist on a fellowship from the International Reporting Project, in a clinic in Botswana earlier this year.

Botswana, a well-off country by African standards, has an adult HIV prevalence of 24 percent, the second highest in the world, and a health system well-prepared for dealing with it, but not cancer.

In Togo, Dr. Kokou Agoudavi, the head of non-communicable diseases at the Ministry of Health, told me that Togolese cancer patients sometimes sell their houses or fields to pay for cancer treatment, which is not available in-country. They have to go to neighboring Ghana, if they can afford it. He said this often happens in the late stages of cancer, when survival rates are low.

New campaign aims to reach Americans to give unvaccinated kids a Shot@Life

NEW YORK — Did you know that in developing countries a child dies every 20 seconds from diseases that are entirely preventable with vaccines? Did you know that the number of children dying every year from these preventable diseases is nearly equivalent to half the children entering kindergarten in the U.S.?

Those are a few of the points driven home yesterday at the official launch of Shot@Life, a new United Nations Foundation campaign directed at the U.S. public and Congress, at a luncheon here on the first day of the U.N. High-Level Meeting on Non-Communicable Diseases.  

 Some of these facts were new to me even though I have been working in global health for almost 20 years, and not all of it was bad. For example, I learned that 80% of the world’s children are vaccinated. That was wonderful to hear.

But the flip side is that, in 2011, one in five children does not have access to the immunizations they need, and that translates into 1.7 million children dying from diseases that have all but disappeared in the U.S. The UNICEF representative at the launch called this “The Last Quintile,” and it will undoubtedly be the toughest quintile.

U.S. committed to fighting NCDs, but not financially

Non-communicable diseases (NCDs) are now the leading cause of deaths in the world, killing more than 36 million people in 2008 (63% of the total). Cardiovascular diseases were responsible for 48% of these deaths, cancers 21%, chronic respiratory diseases 12% and diabetes 3%, according to a report published this week by the World Health Organization. 

But NCDs are definitely not “rich country”  diseases anymore: 80% of those deaths took place in low- and middle-income countries. 

And it is getting worse. This week the Washington Post reported: 

“The world is facing a growing avalanche of death from heart attack, stroke, cancer, emphysema and diabetes, with many of the victims working-age people in poor countries. Governments and individuals could intervene to prevent up to half those deaths, but no country is doing all it could.”

The economic impact of all that death and disability is profound. Just take cancer, the second leading cause of NCD deaths. Last year, the American Cancer Society reported that the total economic impact of premature death and disability from cancer worldwide was $895 billion, representing 1.5% of the world’s gross domestic product. That’s enormous, and it’s just one of the four main NCDs.

What to do about the newly-discovered worldwide epidemic in a time of fiscal austerity and, in the U.S., hostility to new social spending, was one of the main issues discussed at an event last week at the Center for Global Development “U.S. Outlook for the Non-Communicable Disease Summit.” 

Social Good Summit aims to put social media to work for development during UN Week

African first ladies tweeting for the first time is only one of many wonders of technology and global development to be highlighted at the upcoming Social Good Summit and its Digital Media Lounge to be held during the U.N. General Assembly next week in New York.

The United Nations Foundation and its high tech partners behind the Summit gave us a sneak peek of coming attractions during a tele-briefing yesterday.

There will be a head of state at the Social Good Summit — President Kikwete will accept an award for his commitment to furthering technology and new media in Tanzania — and the first ladies of Kenya, Nigeria and South Africa will also be on hand to tackle Twitter. In an event entitled “First Ladies, First Tweets,” they will publicly demonstrate their first efforts to harness social media to advance their issues.

Have we learned what we need to know to deliver microbicides?

ROME — The first day of this Sixth IAS Conference I attended a satellite session “From Proof to Delivery: Scaling Up HIV Prevention for Women: The Challenge of Delivering the First Microbicide in Africa.” The promise of microbides and “treatment as prevention” are proving to be the biggest stories of this conference — new prevention tools showing highly positive results.

Demonstrators in the IAS Media Centre in Rome 

demand fast action on a microbicide.

(Photo by David J. Olson)

This is perhaps the most encouraging moment in the long, and often frustrating, history of HIV prevention, and I believe there is not a person here that is not tremendously excited about the potential these technologies hold for its future. Exactly a year ago, at the Vienna International AIDS Conference, we heard the results of the CAPRISA trials in South Africa  and how effective the product had proven to be.

A year later, I am struck by how the conversation has moved far beyond mere effectiveness and now focuses on the delivery, marketing and pricing of the eventual product, and how we will get women to use it correctly. It is amazing that the conversation has moved so dramatically in only 12 months, and wonderful that we are thinking about these issues now, years before we are likely to have a product on the market. This augurs well for thinking this through properly and getting it right.

But I noticed something missing from this conversation — both in the event I attended here in Rome and more broadly . That is, there was much talk of the need to deliver the product through multiple channels — presumably including the private sector, although that was not explicitly mentioned — and much talk about the need for finding innovative ways of doing that.

Farewell to Deauville: How did global health fare?

DEAUVILLE, France — Nothing of significance for global health came out of the G8 Summit here. We expected little, and the G8 lived up to our expectations.

President Sarkozy briefs the media at the Deauville Summit.
(Photo by David J. Olson)

Overall, the NGO community found the Deauville Declaration, in the words of Sherpa Times,  “vague, confused and lacking any sort of concrete advances on the main issues.” Most NGOs had criticized the Deauville Accountability Report, on global health and food security, as lacking in clarity and honesty.


The Global Health Council, in our official reaction to the Deauville Declaration, was kinder than most. We said the GHC “welcomes the G8 leaders’ reaffirmation of their commitment to global health as expressed in their Deauville G8 Declaration and urges them to live up to the promises of the declaration and to track their implementation in a fully transparent manner.” Frankly, we were vastly relieved that the declaration did address global health, and reaffirmed previous commitments, specifically, the Muskoka Initiative, the Global Fund to Fight AIDS, TB and Malaria, and the GAVI Alliance.

The rise and fall of a global health success story, and how the G8 can bring it back

This article was also published in The Huffington Post on May 23, 2011.

Lancet once called it “potentially the most important medical advance of the 20th century.” But in the 21^st century, oral rehydration therapy (ORT) — a simple, cost-effective treatment given at home using either packets of oral rehydration salts (ORS) or a simple home solution of sugar, salt and water — seems to be on life support. The result is the unnecessary deaths of children under five.

ORT and ORS are indisputable bright spots in global health: Almost a billion episodes of child diarrhea are treated with ORT annually, reducing child deaths from diarrheal disease by more than 50 percent, according to the U.S. Agency for International Development.

Since the 1970s, ORS has saved an estimated 50 million lives, costing less than US $0.30 per sachet, reported the World Health Organization in 2009. Among major causes of child death, it is now tied for second place, at 14%, with pneumonia.

ORT is also highly cost-effective. A 2005 British Medical Journal paper found that ORT was one of the interventions that “would be chosen on purely cost effectiveness grounds for any level of resource availability.” But after the success of ORT, its uptake has slowed and even reversed in some countries.  A 2008 analysis of the change in ORS use in children under 3 between 1992 and 2005 found declines in 23 countries and increases in only 11. Declines in ORT use seemed to occur despite overall improvements in awareness of ORS.

Mali: One of many African malaria success stories

This blog was published on The Huffington Post on April 25, 2011.
 
One night, as a young development worker in Mali 20 years ago, I engaged in high-risk behavior in a village west of Bamako -- I slept without a mosquito net in the middle of the rainy season.

I came to regret my lapse: I was struck down with a severe case of malaria a week later in Morocco, a country where malaria is not endemic, and the doctor I consulted in Casablanca could not diagnose it. Initially, I thought it was some form of flu, but soon realized it was much worse, and that I had carried it with me from Mali.

David as a young development worker in Africa.

Malaria was the most debilitating illness I had ever experienced. Usually when I am sick, I enjoy reading, or at least watching TV. But malaria made me feel more awful, more lethargic than I ever had in my life and I felt like doing nothing except staring at the ceiling.

In those days, mosquito nets were hard to come by for anyone, but especially if you were a poor, rural Malian. And most Malians were poor and rural.

Much has changed. A 2010 Roll Back Malaria report shows that Mali is part of a pan-African malaria success story: In 2000, there were an estimated 22,663 malaria deaths among children 1 to 59 months in Mali. From 2001 to 2010, the global investment in malaria control prevented 65,065 malaria deaths, more than any of the 34 malaria endemic countries in Africa studied in the report.