Wednesday, December 31, 2014

In Brazil, a charity makes successful transition to social enterprise

A DKT Brazil promoter hands out samples of Prudence condoms in downtown São Paulo, Brazil on World AIDS Day. Photo: David J. Olson
This blog was originally published on Devex Impact on Nov. 28, 2014.
SÃO PAULO, Brazil — In its 24 years of existence, DKT Brazil has transformed itself from a charity entirely dependent on international donors to a social enterprise dependent only on its own business and marketing savvy.
Brazil has become one of the centers of the social enterprise world. In 2012, the Social Enterprise World Forum was held there. I’m reading more articles, like this one in the Guardian, which claims that social enterprise is becoming the norm, “a really valid option proposed for anyone wanting to start or grow a business in Brazil.”

When DKT Brazil was launched in 1990 as a condom social marketing organization, it considered itself a charity and received most of its funding from the U.S. Agency for International Development and other donors. But when it lost its USAID funding in 2003, it was forced to become financially sustainable.
It achieved 100% financial sustainability, and more. All of its Prudence condom products make money, yet many of them are within the contraceptive affordability index, which dictates that the cost of a year of contraception should not be more than 0.25% of a family’s disposable income. In fact, DKT’s cheapest condom is only 0.22%; even its most expensive brand does not reach 0.5%. DKT believes it prevented over 9,000 HIV infections in Brazil in 2013.
DKT Brazil believes it has lessons to offer other social enterprises in Brazil and elsewhere. DKT Brazil Country Manager Dan Marun offers three:

Ebola makes the definitive case for health workers and strong health systems

This blog was originally published by Global Health TV on Nov. 25, 2014.

Since I first wrote about Ebola here at Global Health TV two months ago, the number of Ebola deaths has more than doubled, to 5,459, and the number infected has reached 15,351, according to the World Health Organization. Ebola has caused countless angst and affliction, mostly in West Africa but also in Spain and the U.S.

But there is one good thing that Ebola has done: It has made the case for strengthening health systems and frontline health workers more effectively than we in global health have been able to do. It has shown that weaknesses in health systems in poorer countries can affect people in richer countries. It has made that case not only to the global health community, but to the entire world.

“Weaknesses in West Africa’s health systems do not affect just West Africa – they affect us all,” said Pape Gaye, president and CEO of IntraHealth International, in testimony to the U.S. Senate Appropriations Committee on Nov. 12. “Ebola, HIV and other viruses and infectious diseases do not respect borders. Globally, our countries’ health systems are interconnected, creating one global interdependent health system. Today, that system is woefully precarious.”

Social marketing poised to make major contribution to 2020 family planning goal

A Pakistani couple receives family planning counseling at a health center that is part of DKT Pakistan's Dhanak social franchising network.
This blog was originally published at on Nov. 3, 2014.

Social marketing organizations are providing more contraception than ever before, but its leaders are determined to up their game even more and become major contributors to the international family planning goal of 120 million new women and girls in the next six years that was set by Family Planning 2020 (FP2020).

In 2013, social marketing organizations around the world delivered 70 million couple years of protection (CYPs), an increase of 7% from 2012, according to the 2013 Contraceptive Social Marketing Statistics published recently by DKT International. (A couple year of protection is the amount of contraception needed to protect one couple for one year; see note at end of article). The report provides details on the 93 contraceptive social marketing programs that produced more than 10,000 CYPs in 66 countries.

2013 FP2020 report is released

This week, FP2020 released its annual progress report, announcing that 8.4 million additional women and girls used modern contraception in 2013 as compared to 2012. The report notes that this accomplishment did not meet the goal of 9.4 million additional users in the first year but “is still a significant milestone.”

Thursday, November 13, 2014

General foreign aid and health aid are up but donors still not meeting targets

This blog was originally published by Global Health TV on Oct. 29, 2014.

After two years of declines, overseas development assistance (ODA) rebounded in 2013, but most donors have not met their commitments and are not sending a high enough proportion of their aid to the poorest countries, according to the ONE Campaign’s 2014 DATA Report.

Global health funding hit an all-time high of $31.3 billion in 2013, and funding for maternal, newborn and child health increased by nearly 18% between 2010 and 2011, reported the Institute for Health Metrics and Evaluation at the University of Washington in its annual report on global health financing.

And while aid donors are finally showing signs of improvement in meeting transparency commitments on that ODA, the majority – including the United States – is a long way from its commitment to adopt standards set by the Aid Transparency Index 2014.

These were some of the headlines coming out of two reports released this month, but very much overshadowed by the justified focus on Ebola, as well as an earlier report on global health financing released in April.

Tuesday, November 11, 2014

Justified focus on Ebola should not compromise efforts against other diseases that kill more people

This blog originally appeared on Global Health TV on Sept. 23, 2014.

Ebola is a terrible disease that has already infected 5,335 people and killed 2,630 as of Sept. 14, according to the World Health Organization (WHO), and threatens to kill many more thousands before its rampage of destruction is slowed down or stopped. WHO designated it as a global emergency on Aug. 8.

“This Ebola epidemic is the largest and most severe and most complex we have ever seen in the nearly 40-year history of this disease,” said Margaret Chan, director-general of the WHO. “This is a global threat that requires global coordination to get it done. We can and we will bring the Ebola epidemic under control.”

Yet another of its terrible legacies may be that it will distract attention and resources from other diseases that are killing far more people.

Friday, November 7, 2014

Are donors adequately funding faith groups in global health?

This was originally published by Global Health TV on Aug. 26, 2014.

Last November, at an event associated with the International Conference on Family Planning in Addis Ababa, Ethiopia, I was struck by a public comment from a representative of the U.S. Agency for International Development (USAID): “With almost 90% of people globally professing a faith, it doesn’t make sense to do family planning without the faith community.”

I was bowled over by this statement. I checked up on the claim, and found that, according to the Pew Research Center, 84% of the 2010 world population of 6.9 billion is considered “religiously affiliated.”

So the point was valid, and I would go even further: We in global development should be partnering more with the faith community in all areas of global health. After all, if the faith community can work on family planning – fraught with all of its social, cultural and religious baggage – it should also be able to work effectively on less controversial issues like malaria, diarrhea, water and sanitation. Especially in places like Africa where people have a high level of confidence in their religious institutions.

Thursday, August 28, 2014

We will not banish AIDS until we banish stigma

Eugene comes to a drop-in center for men who have sex with men.

This originally appeared on the ONE Campaign Blog on July 23, 2014.

Earlier this year, I met Eugene and Dominique at a drop-in center for men who have sex with men (MSM) outside Nairobi, Kenya.

Eugene, 23, comes to the center regularly to get condoms, lubricants and HIV counseling and testing, and has brought other gay men to the center. So far, he is HIV-negative.

Dominique, 26, also frequents the center. He was treated for a sexually-transmitted infection, and gets tested there every month. He, too, is HIV-negative.

In Kenya, most gay men are very much in the closet, due to the strong stigma against them. Many of these men would not have access to health services if not for the handful of drop-in centers in Nairobi, Kisumu and other urban centers for the simple reasons that most health facilities are not gay-friendly. Quite the contrary. Thus, most MSM have no access to gay-friendly services.

Wednesday, August 27, 2014

New momentum to end preventable child and maternal deaths by 2013

A six-year-old girl in a small village in Nicaragua. Photo: David J. Olson

This originally appeared on Global Health TV on July 22, 2014.

In June 2012, the governments of Ethiopia, India and the U.S., in collaboration with UNICEF, hosted the “Child Survival: Call to Action,” designed to focus the disparate priorities of the global health world into a single, achievable goal of ending preventable child deaths by 2035.

Much progress has been made in the last two decades – the total number of child deaths fell from 12.6 million in 1990 to 6.6 million in 2012. And maternal mortality worldwide dropped by 45% between 1990 and 2013, according to the World Health Organization, from 523,000 deaths in 1990 to 289,000 in 2013.

However, there are still unacceptably high levels of maternal and child mortality, as shown in this terrific infographic, and the status quo will not get us where we need to be — the elimination of preventable child and maternal deaths by 2035.

We are not making particularly good progress towards Millennium Development Goals 4 and 5 on child and maternal health, which expire in 2015. Out of the 24 high-priority countries on which the U.S. Agency for International Development focuses, only six countries have achieved MDG 4 (Bangladesh, Malawi, Nepal, Liberia, Tanzania and Ethiopia) and only two have achieved MDG 5 (Rwanda and Nepal).

Tuesday, August 26, 2014

AIDS-free generation will not be achieved without more investment in harm reduction

Abubakar, an injecting drug user since 1989, receives a safe injecting kit in Nairobi, in a project supported by the International HIV/AIDS Alliance.

This was originally published on the Huffington Post on July 21, 2014.
NAIROBI, Kenya -- In 2010, the United Nations announced that an AIDS-free generation was achievable if we focused on the most disadvantaged communities.
Almost four years later, three leading harm reduction organizations are telling us we are not paying enough attention to one of those communities -- people who inject drugs (PWID) -- and that "an AIDS-free generation will not be possible" if the rate and pace of investment in harm reduction continues.
Harm reduction is a range of public health policies designed to reduce the harmful consequences associated with, in this case, injecting drug use.
To coincide with the 20th International AIDS Conference in Melbourne, Australia, Harm Reduction International, the International Drug Policy Consortium and the International HIV/AIDS Alliance are publishing a report that says that due to changing donor policies, HIV prevention services for PWID are not being prioritized and this failure to invest will bring an exponential rise in HIV transmission which will impose much higher costs on governments and donors.

Monday, August 25, 2014

What are the keys to family planning success in Africa?

This was originally published on the Global Health TV website on June 24, 2014.
In the last 20 years, Ethiopia has emerged as a family planning powerhouse. In Studies in Family Planning, I reported that, from 1990 to 2011, modern contraceptive use increased ninefold, from 2.9% to 27.3%, and the total fertility rate (the average number of children born to a woman in her lifetime) dropped from 7.0 to 4.8.

Now Ethiopia’s reputation has been further burnished by the results of a report released May 27th by Performance Monitoring and Accountability 2020 (PMA2020) that show an increase in the use of modern contraception from 27.3% in 2011 to 33.3% in 2014 and a drop in the fertility rate from 4.8% to 4.4%.

Four Central Determinants of Success

This prompts the question: What are the factors that lead to family planning success? And what are the factors that stall such progress? Our article in Studies in Family Planning identified four determinants of success in Ethiopia. I suspect that many, if not all of these, ring true elsewhere in sub-Saharan Africa:

Saturday, August 23, 2014

Global health needs more strange bedfellows, unorthodox partnerships

Puppets walking into the audience at the SwitchPoint conference in Saxapahaw, North Carolina.
The was originally published on the Huffington Post on July 14, 2014.
In Tanzania, the non-profit group IntraHealth International works with a cotton gin to provide circumcision services to their male employees and collaborates with local police to bring together 400 motorcycle taxi drivers to learn about road safety and HIV prevention. Both projects are funded by the U.S. Centers for Disease Control and Prevention.
The African Christian Health Associations Platform, based in Kenya, is working with Novo Nordisk and Johnson & Johnson that provide Christian health associations in several countries with technical support, training and drugs to combat diseases like diabetes, HIV and opportunistic infections.
Those are examples of an increasingly common approach to development. It used to be that a donor would sit down with the ministry of health to work out the design and implementation of a new global health initiative, with no significant input or involvement of other stakeholders. Those days, thankfully, are long gone.
Nowadays, it's widely recognized that more stakeholders need to be consulted, both in the design and the execution of an intervention. Does this make the process more messy and complicated? It sure does, but this messiness is essential to take global health to the next level.

Sunday, June 29, 2014

Condom flavors like strawberry and caipirinha key to social marketing success in Brazil

A print ad for DKT's new caipirinha condom brand.
This was originally published on the Huffington Post on June 10, 2014.

SÃO PAULO, Brazil — “DKT do Brasil,” the social marketing juggernaut of South America, started in 1991 with one variant of Prudence condoms (now called Prudence Clássico). Over 23 years, DKT has grown that product line into 40 variants, with its latest offering featuring the flavor and scent of caipirinha, the iconic Brazilian cocktail made from cachaça, lime and sugar.

Over that same time period, its condom sales increased from 30,840 in 1992 to 124 million in 2013. This is considerably more than the combined total sales of every other condom social marketing project in all Latin America — South America, Central America and the Caribbean — according to DKT contraceptive social marketing statistics.

And yet DKT do Brasil does not consider itself a commercial enterprise, but a social enterprise. All of its products make money, and yet all are within the contraceptive affordability index, which dictates that the cost of contraception should be less than 1% of a family’s annual income. In fact, its cheapest condom, Prudence Clássico, is only 0.22% and even its most expensive brand is less than 0.5%.

How has DKT do Brasil been able to become the largest social marketing operation in Latin America, and one of the largest condom distributors in Brazil, while remaining true to it mission of “improving lives by encouraging family planning, sexually-transmitted disease prevention, pleasure and well-being; offering products that are accessible, diverse, innovative and high quality in Brazil and South America”?

Kenya quietly takes public health approach with HIV most at-risk groups

Chief Rose Ayere talks to a group of injecting drug users in Nairobi.
This was originally published on Global Health TV on May 27, 2014.

NAIROBI and KISUMU, Kenya — Anti-gay legislation recently signed into law in Uganda and Nigeria has alarmed organizations implementing HIV prevention in Africa, fearing that such laws will further stigmatize and marginalize at-risk populations already hard to reach with health services.

So when I traveled to Kenya this month to interview men who have sex with men (MSM), injecting drug users (IDUs), and people working in programs trying to help them supported by the International HIV/AIDS Alliance, I wondered whether I would encounter “the next Uganda” in gay rights. I did not, but what I did find surprised me.

Social enterprise for health, Brazilian style

With the leaders of Saúde Criança at their headquarters in Rio de Janeiro.
This was originally published on Global Health TV on April 27, 2014.

RIO DE JANEIRO, Brazil — One is poised to become the condom market leader in Brazil, with 40 variants in its Prudence condom line. Its newest offering features the flavor and scent of caipirinha, the iconic Brazilian cocktail made from cachaça, lime and sugar. DKT believes it prevented over 9,000 HIV infections in 2013.

Another rescues the poorest and unhealthiest children from the urban slums of Rio de Janeiro, Sâo Paulo and other cities, and nurses them – and their families – back to health.  Since its creation, an estimated 50,000 people have benefitted from its work.

They are very different global health organizations, with very different operating models, but both call themselves social enterprises, Brazilian style, and both were created in 1991.

Tuberculosis finally catching up to 21st century

This was originally published on Global Health TV on March 24, 2014.
Tuberculosis (TB) treatment, which had been lost in a time warp for a century, seems to be finally joining the 21st century.
Until recently, there were no new TB drugs on the market in half a century, little progress in the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) forms of TB and virtually nothing new on pediatric TB, according to David Greeley, the president and CEO of Accordia Global Health Foundation, who previously worked for the TB Alliance. The current vaccine, developed more than a century ago, is largely ineffective, he said. TB diagnostics were ancient, too, as is TB itself, which has been around since 4,000 B.C. Current treatment was cheap and sometimes effective but took a long time and misses a lot of people  (like children, and MDR and XDR patients).
Which is why the Stop TB Partnership has made those missing people the theme of this year’s World TB Day on March 24: “Reach the 3 Million.” That’s the number of TB patients the World Health Organization (WHO) estimates are “missed” by public health systems out of the 8.6 million who fall ill of TB each year.  Many of those 3 million live in the world’s poorest, most vulnerable communities and include groups such as migrants, miners, drug users and sex workers. Over 95% of TB deaths occur in low- and middle-income countries. India and China are the countries with the most TB patients.

Thursday, May 8, 2014

In 2014, will family planning be able to sustain the euphoria of London and Addis Ababa?

Young Ethiopians partake in traditional coffee ceremony at the International
Conference on Family Planning.
This was originally published on the website of Global Health TV on Feb. 19, 2014.

2012 was a watershed year for international family planning, with the UK government and the Bill & Melinda Gates Foundation holding the high profile London Summit on Family Planning where new commitments of $2.6 billion were secured, enough to provide contraceptives for 120 million more women and girls in 69 very poor countries by 2020.

In 2013, this effort morphed into a global partnership dubbed Family Planning 2020 (FP2020). The process received a further moral and financial boost in November at the 3rd International Conference on Family Planning in Addis Ababa, where five countries made new commitments (Benin, Democratic Republic of Congo, Guinea, Mauritania and Myanmar) and FP2020 released its first progress report on successes realized since the London Summit. Ethiopia was chosen as the conference site because of its status as an emerging family planning success story in Africa.

Movers, shakers, thinkers, doers converge on former N.C. mill town

This was originally published by the Huffington Post on April 9, 2014.

One is a British mobile phone guru who has become a storyteller of "reluctant innovators," propelling some of the most exciting social innovations outside the traditional development system.

Another is an architectural wunderkind from Togo in West Africa who leads a team that recycles old plastic bags into building materials.

And a third is a San Francisco Bay Area global health tech innovator who is building a web platform to help African countries make better decisions about HIV drug procurements. He speaks English, Punjabi, Spanish and Mongolian.

The three are very different but have at least two things in common: First, they are hellbent on changing the world. Second, they are converging on the tiny former mill town of Saxapahaw, North Carolina later this month to share their distinctive world views with hundreds of other global thinkers and doers.

Wednesday, January 8, 2014

In Ethiopia, the beat goes on, in music and health

Global youth dance at the beat making session at the International Conference on Family Planning in Addis Ababa. Credit: Laura Hoemeke/IntraHealth

This was originally published in the Huffington Post on Dec. 11, 2013.
ADDIS ABABA, Ethiopia -- In November, in a chilly outdoor amphitheater at the African Union headquarters here, Stephen Levitin, aka Apple Juice Kid, asked an audience of mostly young Africans and North and South Americans to suggest the best type of beat.
"Afro beat," one young African called out.
"Slow and sexy Afro beat?" Levitin asked. "Or fast and danceable?"
The consensus was fast and danceable. Then a percussive sound was chosen, and several of the young people -- each in his or her mother tongue -- recorded brief health messages of personal relevance to them.
And when they combined it all, the result was an original song. The group jumped to its feet and danced away the chill. Not a PowerPoint slide was to be seen anywhere.

Tuesday, January 7, 2014

Ethiopia: An emerging family planning success story

Delegates at the International Conference on Family Planning pose for a photo in front of DKT Ethiopia's coffee ceremony tent.

This was co-written with Andrew Piller and originally published on Impatient Optimists on Dec. 10, 2013.
When global family planning practitioners gathered in November for the Third International Conference on Family Planning, there was a timely relevance for meeting in Ethiopia. Over the last two decades, Ethiopia has become a family planning success story, one of only a handful of countries in Africa to achieve that status.
 Positioning of population and family planning at the center of development is critical.In 2000, Ethiopia’s contraceptive prevalence rate for modern methods was only 6.3 percent, which, at that time, was lower than any other country in Eastern and Southern Africa except Eritrea. By 2011, the rate had increased to 27.3 percent. Over the same period, the total fertility rate (the average number of children born to a woman in her lifetime) had decreased from 5.5 to 4.8.

Monday, January 6, 2014

Young people should lead efforts to improve sexual health

Members of a youth group in Addis Ababa meet regularly to debate sexual and reproductive health issues. Photo: Sheikh Rajibul Islam/duckrabbit

This was originally published on Impatient Optimists on Nov. 19, 2013.

ADDIS ABABA, Ethiopia -- A young Ethiopian woman went to a health clinic and found out she was pregnant. She was asked to take an HIV test and found out she was HIV positive. She told her husband she was pregnant but not about being HIV positive, and she suggested they be tested together. He refused, and said he would leave her if she got tested. She decided to have an abortion and went to a health professional who advised her against it. At that point, she decided to have her baby despite the fact that she had no support from her husband. 

That story was acted out in a session at the International Conference on Family Planning held here from November 12-15, but is based on a true story. It is one of many such storylines being played out in real life by the five million young people aged 15-24 living with HIV, especially by young women living with HIV, young sex workers, young men who have sex with men, young transgender people and young people who use drugs. This is true because they are the people least able to access sexual and reproductive health services, including family planning. They also face stigma and discrimination based on age, gender, HIV status and sexual orientation.

Thursday, January 2, 2014

Reaching most vulnerable young people with family planning, HIV services

More than half of Ethiopia's population are young people under the age of 24. Credit: Sheikh Rajibul Islam/duckrabbit

This article was originally published on The Huffington Post on Nov. 11, 2013.
Ethiopia -- where international advocates will open their biennial International Conference on Family Planning on Nov. 12 -- has succeeded in bringing down the unmet need for family planning from 36.6 percent of currently married women 15-49 in 2000 to 26.3 percent in 2011. But the unmet need is greatest among those aged 15 to 19. In that age range, almost one-third want contraception and cannot get it.
The great need of young people for integrated family planning, sexual and reproductive health (SRH) and HIV prevention services is not limited to Ethiopia, and is one of the great challenges facing conference participants. This is particularly true of youth from marginalized groups such as people living with HIV, sex workers, men who have sex with men, transgender people and people who inject drugs, who may be particularly vulnerable to sexually-transmitted infections, including HIV, and other reproductive health issues.