tag:blogger.com,1999:blog-77822542033528658782024-03-13T07:04:58.691-07:00Blogging4GlobalDevelopmentThis is the blog of David J. Olson, a global development consultant with 20+ years experience on five continents, and covers global development, related policy and communications and non-profit use of social media. I welcome comments, quips and musings.David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.comBlogger154125tag:blogger.com,1999:blog-7782254203352865878.post-81078738119227485592019-07-02T11:34:00.000-07:002019-07-02T11:37:35.242-07:00From Hot Spots to Holy Places: Group sales of health products contribute to women’s empowerment and better health in Mali<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;"><b>Togo Kadiatou Malle, president of Muso Yiriwa Ton in Mali, is now an ardent proponent of condoms and contraceptives.</b></td></tr>
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<span lang="EN-GB"><i>This was originally published on the Knowledge4Health Blog on July 1, 2019.</i></span></div>
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<span lang="EN-GB">The first five times the sales manager of <a href="https://ccp.jhu.edu/projects/keneya-jemu-kan/" target="_blank">Keneya Jemu Kan</a> came looking for Madame Togo Kadiatou Mallé to talk about her women’s association selling condoms and other health products, she ran away and hid, so terrified was she of the prospect of having to work with condoms. <o:p></o:p></span></div>
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<span lang="EN-GB">But the sales manager’s persistence paid off. Eventually, they talked, and Madame Togo has become such an enthusiastic condom promoter, she is known as Mama Condom. She laughs about her fear of condoms. <o:p></o:p></span></div>
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<span lang="EN-GB">Madame Togo is president of Muso Yiriwa Ton (MYT), which means “women-empowering group” in the Bambara language, a women’s association based in the very poor Sabalibougou neighbourhood of Bamako, Mali. Her association – as well as other women’s associations – are a major reason for the success of Keneya Jemu Kan (“Communication Around Health”), or KJK, a project funded by the U.S. Agency for International Development and led by the Johns Hopkins Center for Communication Programs that seeks to reduce maternal, infant, and child mortality in Mali. Palladium leads the social marketing component of KJK.<o:p></o:p></span></div>
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<span lang="EN-GB">MYT has more than 400 members, and roughly half of them sell the KJK’s male and female condoms, as well as <a href="http://www.aquatabs.com/home/" target="_blank">Aquatabs</a> (water purification tablets)<i>, </i>Orasel Zinc (zinc tablets and oral rehydration solution to treat diarrhoea), and CycleBeads (a natural family planning method). MYT members sell an average of 107 cartons of Protector Plus condoms per month. That’s 64,200 condoms. The partnership helps to enhance economic prospects of its members. <o:p></o:p></span></div>
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<span lang="EN-GB">“It has become a source of life for many families,” said Madame Togo. “And it is improving health of the areas where they sell, in Commune 5 and beyond.”</span></div>
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<b><span lang="EN-GB">Overcoming Obstacles<o:p></o:p></span></b></div>
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<span lang="EN-GB">MYT works with local authorities – including imams, priests, and pastors. Many of these religious leaders used to be against condoms, but MYT was able to convince most of them to accept condoms as a health product. MYT members don’t sell inside a mosque or church, but have no problem doing so outside. The older men will ask for a Cube Maggi, a popular ingredient for making food tasty. That’s a secret word for condom, a word most of them would be nervous about saying aloud.<o:p></o:p></span></div>
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<tr><td class="tr-caption" style="text-align: center;"><b>Kadiatou Samake</b></td></tr>
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<span lang="EN-GB">One of MYT’s best condom sellers is Kadiatou Samake, 19 years old. She used to work in MYT’s hair salon. Then she found she could make more money selling condoms. Now she sells five to six cartons per week (there are 600 condoms in each carton), and she earns 2,500 CFA francs on each carton. That’s about USD 4.25.<o:p></o:p></span></div>
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<span lang="EN-GB">Her winning strategy is to visit “hot points,” places where there is a lot of sexual activity, like hotels and night clubs. She asks to see the manager, makes the case for her product, and builds relationships with clients and potential clients. <o:p></o:p></span></div>
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<span lang="EN-GB">Aminita Djiré, 17, is another top condom seller of MYT and mother of a 15-month-old baby. <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
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<tr><td class="tr-caption" style="text-align: center;"><b>Aminita Djiré</b></td></tr>
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Her selling prowess is such that her nickname is Condoms Diatigi (“representative of the condom”). She also sells five to six cartons of Protector Plus condoms per week. Like Kadiatou, she goes to the hot points and nurtures her contacts. “Even if they don’t buy,” she said, “I give them information and take their contact information.” <o:p></o:p></span></div>
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<b><span lang="EN-GB">Improving Community Health<o:p></o:p></span></b></div>
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<span lang="EN-GB">Madame Togo claims that MYT, with the support of KJK, has made a significant impact on behaviour change in the communities where they sell products. For example, she says that Aquatabs has become an indispensable product to ensuring clean drinking water. <o:p></o:p></span></div>
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<span lang="EN-GB">Although MYT’s biggest sellers are male condoms and Aquatabs, the first quarterly report of the project’s last year cited the fact that Protectiv female condom and CycleBeads sales exceeded objectives. The community-based distribution of MYT was identified as one of the reasons for these sales.<o:p></o:p></span></div>
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<span lang="EN-GB">Professor Mamadou Traoré, a gynaecologist and obstetrician, is the chief doctor of Commune 5, where MYT is based. He says it is “comme la brousse” – like the bush, or a rural area. Commune 5 is one of the poorest of the seven communes of Bamako. In terms of amenities, it is more like a village than an urban area. For example, there is no piped water in Commune 5. He says there is also a lot of promiscuity.<o:p></o:p></span></div>
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<span lang="EN-GB">Professor Traoré reports that the contraceptive prevalence rate in Commune 5 increased from 10.5% in 2015 to 14.2% in 2018. That’s an increase of almost 4% in three years. There are surely many reasons for that, but he believes that the work of Muso Yiriwa Ton is one of them.<o:p></o:p></span></div>
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<b><span lang="EN-GB">Women’s Groups Are Having an Impact<o:p></o:p></span></b></div>
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<span lang="EN-GB">KJK is also working successfully with five other women’s groups in Bamako and the Regions of Kayes, Mopti and Sikasso and finding that women’s groups, particularly those in rural areas, can help “reach the last mile,” meaning those people living in remote or neglected areas that are not served well by public health clinics or private sector retail outlets.<o:p></o:p></span></div>
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<span lang="EN-GB">KJK knows this approach works in different areas of Mali and believe it can also work in different countries of Africa. KJK is building capacity in these women’s organizations so that they can continue supplying products when the current project ends. KJK hopes to eventually link the women with existing commercial distributors so they can continue reaching “the last mile.”<o:p></o:p></span></div>
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<span lang="EN-GB">It is sustainable at the local level because these women who benefit from microcredit funds to commercialize the social marketing products make enough margin to help support their children’s education fees and family health. <o:p></o:p></span></div>
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<i><span lang="EN-GB">The KJK project is implemented by the Johns Hopkins Center for Communication Programs, in collaboration with Palladium and Management Sciences for Health. <o:p></o:p></span></i></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-4569498276129961712019-03-18T06:49:00.000-07:002019-03-18T06:52:15.817-07:00In Brazil, condoms become popular by emphasizing fun, not responsibility<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;"><b>DKT promoted its <i>Prudence</i> brand of condoms in the São Paulo Carnival of 2019, as they do every year.</b></span></td></tr>
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<i>This was originally published by Knowedge4Health Blog on March 11, 2019.</i><br />
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SÃO PAULO, Brazil — In 1991, a non-profit social marketing organization set out to make condoms accessible and affordable in Brazil at a time when condoms were hard to find and expensive and the number of Brazilians infected with HIV was climbing. In the process, <a href="https://www.dktinternational.org/country-programs/brazil/" style="color: #954f72;">DKT Brazil</a> made its brand <i>Prudence </i>the number one condom in the very competitive Brazilian market, and also helped enhance contraceptive security. <o:p></o:p></div>
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The result is that condoms have become normalized in Brazil – more used and less stigmatized – and that has helped limit the spread of HIV.<o:p></o:p></div>
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In 1990, the World Bank estimated that Brazil would have 1.2 million people living with HIV by 2000. However, that never happened: By 2000, there were fewer than 500,000 infections. After peaking in 1996, according to UNAIDS, AIDS-related deaths have remained fairly stable. <a href="http://www.unaids.org/en/regionscountries/countries/brazil" style="color: #954f72;">Brazil</a> is now considered an HIV success story. Condoms – distributed both by the public and private sectors – played an important role in that success.<o:p></o:p></div>
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<i>Prudence</i>has become the most popular condom in Brazil by taking a very different approach to the positioning and marketing. While most commercial condom distributors marketed their products for responsibility and protection, DKT eroticized its condom messaging, celebrated sexuality and used humorous vernacular, with no medical jargon. Its advertising was daring and provocative: The <i>Prudence</i><a href="https://www.youtube.com/user/prudencedkt" style="color: #954f72;">YouTube page</a> demonstrates that.</div>
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“Sexy advertising is a part of our success but we’re not sexy for the sake of being sexy,” said Dan Marun, the managing director of DKT Brazil. “It has to have a proposition behind it. When we have just a girl or just a guy, the campaign is OK but it’s a hard sell. Our most appreciated campaigns feature couples.”<o:p></o:p></div>
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Marun said the main secret of DKT Brazil’s success is consistency – in marketing, messaging, imagery, product development and target groups.<o:p></o:p></div>
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“We look at the 4 Ps of marketing [product, price, promotion and place], and always try to pay attention to the basics – having a well-developed message targeted to the right people,” said Marun. “We always look at the market and know where we want our products positioned. We take care of our distribution channels. We want our retailers to sell our products. It’s not just about pushing products on them.”<o:p></o:p></div>
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When DKT broke into the Brazilian market in 1991, condom sales were anemic. More importantly, the few commercial brands available were largely unaffordable and inaccessible to the poor. At the time, two Brazilian manufacturers dominated the market and their locally manufactured condoms typically sold at retail for 60¢ to more than $1 in local currency. That was much too high for many low-income Brazilians.<o:p></o:p></div>
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So DKT Brazil set out to bring condoms to the market at much lower prices. The Brazilian government was starting to liberalize its economic and trade policies and DKT Brazil took advantage of that liberalization to buy good quality Asian condoms sell them to consumers for about 15¢, which meant a high quality condom affordable for a quarter of the price that commercial companies were charging.<o:p></o:p></div>
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DKT Brazil launched <i>Prudence</i>condoms in 1991. Sales took off and reached 121 million in 2018. The commercial condom market in Brazil also began to grow rapidly. Other companies were now importing condoms and competition was heating up. Commercial sales, including DKT Brazil, grew from 82 million condoms in 1991 to 443 million in 2018. Government free distribution of condoms has also increased greatly.<o:p></o:p></div>
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<i>Prudence</i>’s share of the commercial market grew from a very small fraction in 1991 to becoming the best-selling condom brand in Brazil, with a market share of 27.4 percent in 2018.<o:p></o:p></div>
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It used to be that condoms were found mainly in pharmacies and drug stores. DKT still sells them there but also in a variety of non-traditional outlets such as grocery stores, supermarkets, convenience stores, gas stations, bars and nightclubs. This makes them more available where and when people need them, contributing to contraceptive security.<o:p></o:p></div>
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An important way to achieve profitability without sacrificing affordability is to practice cross-subsidization, which involves having different brands at different price points reach different income segments (this is also done for other contraceptives, like oral contraceptives and injectables). For DKT Brazil, this meant offering more condom variants, all of which turn a profit.<o:p></o:p></div>
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DKT now offers an amazingly varied portfolio of condoms, including condoms with <a href="http://useprudence.com.br/#produtos" style="color: #954f72;">colors, aromas and tastes</a> (strawberry, chocolate, mint, coffee, grape, tutti-frutti, melon, watermelon, sparkling wine and <a href="https://www.wsj.com/articles/condom-maker-scores-at-brazils-world-cup-1403088314" style="color: #954f72;">caipirinha</a>); condoms lubricated with mild anesthetic to delay ejaculation; extra-large, anatomically shaped condoms; condoms lubricated to create a cool or warm sensation and glow-in-the-dark. Its competitors never introduced such a variety of condoms.<o:p></o:p></div>
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Even though all of the <i>Prudence </i>condom brands make money, some of them are still within the contraceptive affordability index, which dictates that the cost of a year’s supply of condoms should not cost more than 0.25 percent of the Gross Domestic Product per capita. All of the basic <i>Prudence </i>condom brands (i.e., not the premium brands) are well within this index. <o:p></o:p></div>
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In the last 28 years, DKT Brazil social marketing has made significant progress in contributing to Brazil’s contraceptive security.<o:p></o:p></div>
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The total condom market (free government condoms, the commercial sector and social marketing) has increased from 92 million in 1991, when <i>Prudence</i>was launched, to 806 million in 2018. All three sectors have improved their condom distribution dramatically, so condoms are more available to people at all income levels.<o:p></o:p></div>
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Brazil’s Ministry of Health reports that 96% of Brazilians identify condoms as a barrier that can prevent the spread of HIV and sexually-transmitted infections, according to <a href="https://www.avert.org/professionals/hiv-around-world/latin-america/brazil" style="color: #954f72;">this Avert fact sheet on HIV and AIDS in Brazil</a>. However, condom use varies widely with only 25% of the population reporting condom use in all sexual relations and 63% reporting use during sex with a casual partner. Reported data on condom use in key populations is higher than that what is observed in the general population. <o:p></o:p></div>
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And Brazil has one of the highest contraceptive prevalence rates in the world – 80 percent for all methods and 77 percent for modern methods, according to information from DKT. Almost 16 percent of the 77 percent comes from condoms.<o:p></o:p></div>
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DKT Brazil has become self-sustaining. Since 2004, DKT Brazil has been repatriating a portion of its revenues back to DKT headquarters in Washington. Some of these funds have been used to start new DKT programs in Mozambique, Nigeria and Kenya. DKT Brazil has transitioned from being <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807744/pdf/006.pdf" style="color: #954f72;">a charity to a social enterprise</a> that fulfills its social mission but makes most of its decisions on the basis of profits.<o:p></o:p></div>
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In 2016, DKT Brazil started an expansion into other contraceptive products in Brazil, and into other South American countries with IUDs, condoms and lubricants. So DKT Brazil now sells product in Argentina, Bolivia, Chile, Colombia, Ecuador, Paraguay, Peru and Uruguay. The regional expansion will improve contraceptive security throughout the region, by offering IUDs and hormonal contraceptives.<o:p></o:p></div>
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Despite the fact that DKT Brazil has transitioned into a successful social enterprise, Marun believes it is it is still reaching the poor.<o:p></o:p></div>
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“We do serve the poor because our brand is the one you find in the most remote areas of the country. Our distribution in those areas is huge. We track the affordability of all our products to make sure we always have some products under 0.25 percent of per capita GDP.”<o:p></o:p></div>
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In 2018, DKT Brazil launched a new condom called <i>Sutra</i>specifically for the Northeast, one of the poorest regions on the country. Marun says it is the most affordable condom in Brazil.<o:p></o:p></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com1tag:blogger.com,1999:blog-7782254203352865878.post-31340888264035272132018-12-11T06:12:00.001-08:002018-12-11T06:12:51.005-08:00Faith groups do more to promote "healthy timing and spacing of pregnancies"<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;"><b>The Reverend Cannon Kabana and his wife Damalie Kabanda talk to their congregation about the benefits of family planning at St. Mark's Church in Uganda. More religious institutions are promoting the "healthy timing and spacing of pregnancies to their members. Photo: Mona Bormet, Christian Connections for International Health.</b></td></tr>
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<i>This was originally published on Oct. 31, 2018 on Global Health TV.</i></div>
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The role of religious organizations in promoting and advocating for voluntary modern methods of family planning – once met with skepticism or derision — is gradually gaining more acceptance both in the religious and secular worlds. However, the faith-based community still does not get significant funding for family planning (or global development more broadly) despite a growing consensus that faith-based organizations (FBOs) are vital and trusted development partners at the community level. <o:p></o:p></div>
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“<span style="background-color: white;">When family planning is positioned primarily as a major public health contributor to improved maternal, child, and family health, the trend has clearly been for growing support for family planning in most religious communities,” said Ray Martin, who was executive director of Christian Connections for International Health(CCIH</span>), a membership network of faith and secular organizations that promote global health and wholeness from a Christian perspective (full disclosure: I am a board member of CCIH)<span style="background-color: white;">. “When family planning was seen as a tool for old-style versions of population control, it was harder to marshal Christian support.” </span></div>
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It is difficult to gauge the trend in FBO involvement in family planning, said Doug Fountain, interim executive director of CCIH. The Christian church does not speak with one voice on family planning, according to Fountain. Some actively promote it, and some don’t. <o:p></o:p></div>
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“<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #222222;">I’m struck that there are Christians who believe ‘we don’t need family planning; God will give us the number of children we should have’” said Fountain. “It’s the same line of thinking as ‘we can ignore medical care, God will give us the health we need.’ I would not agree with that personally and I don’t think that voice is increasing.”<o:p></o:p></span></div>
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I have the impression that more FBOs are promoting and advocating for family planning. But sometimes they don’t call it “family planning,” because of the political baggage attached to that term but call it <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.ccih.org/ct_resources/family-planning/#section-1" style="color: #954f72;">“healthy timing and spacing of pregnancies.”</a></span><o:p></o:p></div>
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CCIH defines healthy timing and spacing of pregnancies this way: “Enabling couples to determine the number and timing of pregnancies, including the voluntary use of methods for preventing pregnancy — not including abortion — harmonious with their values and religious beliefs.”<o:p></o:p></div>
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CCIH has even identified <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.ccih.org/cpt_resources/scriptural-support-for-family-planning/" style="color: #954f72;">scriptural support for family planning</a></span>— Biblical support on the healthy timing and spacing of pregnancies.<o:p></o:p></div>
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But are such faith-based health programs effective? <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.94.6.1030" style="color: #954f72;">This study</a> </span>published by the American Public Health Association that found that “faith-based programs can improve health outcomes.”<o:p></o:p></div>
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But the study also found something often mentioned about faith-based health programs, even by advocates for greater FBO work in global health: Faith-based programs need to be more rigorously evaluated and the results of these evaluations disseminated more widely. <o:p></o:p></div>
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A <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.ghspjournal.org/content/6/3/500" style="color: #954f72;">2018 study by the Nigerian Urban Reproductive Health Initiative</a> </span>found that “exposure to family planning messages from religious leaders was significantly associated with higher modern contraceptive use” and that “interventions that engage clerics of different faiths as change agents for shaping norms and informing behaviors about family planning and contraceptive use are crucial for increasing contraceptive uptake in Nigeria.”<o:p></o:p></div>
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Even Duncan Green, the strategic adviser for Oxfam GB and a lifelong atheist, seems to be warming to FBOs, especially those that work at the grassroots. In a blog entitled <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://oxfamblogs.org/fp2p/are-grassroots-faith-organizations-better-at-advocacymaking-change-happen/" style="color: #954f72;">“Are grassroots faith organizations better at advocacy/making change happen?”</a> </span>he quoted a Tearfund study that said “church and community mobilization advocacy has proven that churches are regarded with a high level of trust. They are trusted by their congregations, by the communities in which they are located and by local government.” Green called this “powerful and convincing stuff.”<o:p></o:p></div>
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The faith community advocating for family planning is also playing a more prominent role on the international stage. In 2016, 85 representatives of the faith community from 26 countries held a faith pre-summit at the International Conference on Family Planning in Indonesia. They represented Buddhist, Christian, Confucian, Hindu, Jewish and Muslim faiths.<o:p></o:p></div>
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They issued <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.ccih.org/cpt_resources/unprecedented-faith-involvement-in-international-conference-on-family-planning/" style="color: #954f72;">a statement</a> </span>which was read in the conference’s closing ceremony in which they re-affirmed their commitment “to continuing to inform and educate our communities on family planning, especially youth and faith leaders, as is consistent with our faith values as it protects the lives and health of mothers and children and families.”<br /><br /><o:p></o:p></div>
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And the faith community plans a strong presence at the <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://2018.fpconference.org/" style="color: #954f72;">2018 International Conference on Family Planning</a> </span>in Kigali, Rwanda next month, with interfaith prayer, a faith celebration, nine sessions and many poster presentations. <o:p></o:p></div>
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But the amounts going to FBOs for family planning have been modest, said Ray Martin, who was executive director of CCIH from 2000 to 2014.<o:p></o:p></div>
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“<span style="background-color: white;">One of my criticisms of the major donors is that even though they have been discovering that FBOs can make a contribution to progress in achieving ambitious global objectives, e.g. in the Sustainability Development Goals, they are still stuck in a mode of tokenism, not appreciating the sheer magnitude of the importance of religion in the lesser developed countries, and the huge impact that FBOs could have in family planning and other development areas,” said Martin.</span><o:p></o:p></div>
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Martin said three other factors create impediments to greater support for FBOs in family planning: 1) Some fundamentalist Christian groups continue to conflate family planning with abortion, even though they are completely different issues; 2) Continued Catholic opposition to modern contraception; and 3) The timidity of some FBOs who see the maternal and child health value of family planning but prefer to “play it safe” because of perceived uncertainty about support in some quarters.<o:p></o:p></div>
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Last year, there was a lively debate within the Christian community on whether evangelical Christians should support family planning. The Christian Journal for Global Health <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://journal.cjgh.org/index.php/cjgh/article/view/184/469" style="color: #954f72;">published an article</a> </span>which strongly questioned the Christian morality of such support.<o:p></o:p></div>
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Dr. Henry Mosley, professor emeritus in the Department of Population, Family and Reproductive Health at Johns Hopkins Bloomberg School of Public Health, <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://journal.cjgh.org/index.php/cjgh/article/view/205/503" style="color: #954f72;">responded</a> </span>with a strong defense of such support. <o:p></o:p></div>
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Christian public health professionals should show the love of Jesus by modeling His life of service and healing, writes Moseley. “This can be done these days with many powerful, lifesaving technologies, not the least of which is contraception, since this is such a fundamental public health intervention that can have a powerful influence on the health and welfare of couples and their children as well as on the roles and status of women.”<o:p></o:p></div>
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The Islamic world has seen an increase in family planning in the majority of countries, according to Ahmed Ragab, professor of reproductive health at the International Islamic Center for Population Studies and Research at Al-Azhar University in Cairo, Egypt.<o:p></o:p></div>
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“However, there are still pockets of individuals opposing family planning and advocating against it as a conspiracy against Muslims, like Nigeria,” said Ragab.<o:p></o:p></div>
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Ragab said only a few Islamic FBOs are working in family planning and those that are – such as the Islamic Center for Population Studies at Al-Azhar University in Egypt and Muhammadiyah and Nahdat El-Ulama in Indonesia — are increasing their support.<o:p></o:p></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-17113370300668402662018-12-10T09:24:00.000-08:002018-12-10T09:24:20.433-08:00Breastfeeding becomes controversial again even through breast is still best<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;"><b>A woman breastfeeds her child while waiting for health services outside a health center in Nampula, Mozambique. Copyright 2017 Arturo Sanabria, Courtesty of Photoshare</b></td></tr>
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<i>This was originally published on Sept. 25, 2018 on Global lHealth TV.</i><br />
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Breastfeeding — one of the most documented and proven best practices in global health — has become controversial again.<o:p></o:p></div>
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In the mid-1970s, Swiss-based Nestlé corporation was accused of unethical methods of marketing infant formula over breast milk to poor mothers in developing countries. Legal challenges to these practices by Nestlé and other companies led to a boycott of Nestlé. This led to the 34<sup>th</sup>World Health Assembly adopting an International Code of Marketing of Breast Milk Substitutes in 1981. Three years later, Nestlé agreed to the code, and the boycott ended.<o:p></o:p></div>
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In May, the U.S. delegation to the World Health Assembly shocked other delegates when they tried to water down a resolution to promote breastfeeding and limit misleading marketing of infant formula. When that failed, according to <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html" style="color: #954f72; text-decoration: underline;">The New York Times</a></span>, they threatened Ecuador, the sponsor of the resolution, with trade sanctions and withdrawal of military aid. Russia introduced a similar measure and it was ultimately approved in a slightly altered form that was supported by the U.S. The U.S. ambassador to Ecuador, Todd Chapman, later called reports that the U.S. threatened Ecuador “patently false and inaccurate.” <o:p></o:p></div>
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<span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #14171a; letter-spacing: 0.2pt;">President Donald Trump weighed in on the brouhaha, </span><span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; letter-spacing: 0.2pt;"><a href="https://twitter.com/realDonaldTrump/status/1016367395294908421" style="color: #954f72; text-decoration: underline;">writing on Twitter</a></span></span><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #14171a; letter-spacing: 0.2pt;">: “The U.S. strongly supports breast feeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty.”</span><span><o:p></o:p></span></div>
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The response of the U.S. government over its objections to the breastfeeding resolution came in an email from the Department of Health and Human Services to The New York Times: “The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children. We recognize not all women are able to breastfeed for a variety of reasons. These women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so.”<o:p></o:p></div>
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“The events that unfolded at the World Health Assembly reflect the Trump administration’s deeply troubling disregard for evidence and its impact on an issue that shouldn’t be controversial: promoting what is best for babies,” <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.cgdev.org/blog/when-us-opposes-evidence-based-efforts-promote-breastfeeding-what-comes-next?mkt_tok=eyJpIjoiTm1FNE1tTmxNR0UyWW1GbSIsInQiOiJ1ckxXSkJrdndGTFZQb2ZQZHRhMkZ0YUlzY2Z4cHZjWTh5NUFCaGVhdnNuUEdkYnkrK3JBNFl0cUQxbzhVc2FaeU50V2xiNHhydkd5c1NPYVZObXhqNHlDZWJGZHBaNHF0SVVIUk5xdUxodG10NXVwXC9RQWwwTHFuZXBOWlVsWDMifQ%3D%3D" style="color: #954f72; text-decoration: underline;">wrote Cindy Huang</a></span>, a senior policy fellow at the Center for Global Development, a think tank based in Washington, D.C.<o:p></o:p></div>
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I don’t think that anyone wants to deny formula to women who are unable to breastfeed for whatever reason (and there are certainly women who cannot). But because the benefits of breastfeeding are so compelling and well established, its advocates want to make sure that breastfeeding is promoted better, and that inaccurate and misleading marketing of formula is limited.<o:p></o:p></div>
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There is strong and convincing evidence regarding these benefits. Over 800,000 children’s lives could be saved every year if all children under 24 months were optimally breastfed, according to the <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding" style="color: #954f72; text-decoration: underline;">World Health Organization</a></span>. <o:p></o:p></div>
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<span style="color: #3c4245;">"Breastfeeding gives babies the best possible start in life," said Dr Tedros Adhanom Ghebreyesus, director-general of WHO. "Breast milk works like a baby’s first vaccine, protecting infants from potentially deadly diseases and giving them all the nourishment they need to survive and thrive."</span><span><o:p></o:p></span></div>
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Exclusive breastfeeding for the first six months provides many benefits for the baby and the mother including protection against gastrointestinal infections. It helps prevent diarrhea and pneumonia, two major causes of death in infants. It’s also an important source of energy and nutrients for children 6-23 months.<o:p></o:p></div>
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“Breast is best” even in <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.devex.com/news/breast-is-best-even-in-emergency-situations-humanitarian-orgs-say-93212?access_key=acfa9848ef2dcc140e7e6059bf2da14aabd83062&utm_source=newsletter&utm_medium=email&utm_campaign=newswire&mkt_tok=eyJpIjoiT0RVNU9UVm1PR1l5WlRNNSIsInQiOiJRSjdjVkJCdmMrc3NGcWNtUlJuNmUrRHZSMkRKTDJxczdmeDdPQTVjSDcrSHRWMGgwVXFQQ01KOWM3QUpOb2o3RUVqbCttK1wvbnJCVDRyMFNnNk5oRFZiRlprdXB6bkRZYjIydHd1SWVjODdxT3k2ZmFsSnRTZ2VxY2t5V1RXN1YifQ%3D%3D" style="color: #954f72; text-decoration: underline;">emergency and disaster responses</a></span>. Save the Children began investing in breastfeeding during emergency responses following the Haiti earthquake and now incorporates it into every emergency response plan.<o:p></o:p></div>
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And the benefits of breastfeeding extend well beyond infancy. Breastfeeding improves IQ and school attendance. Adolescents who were breastfed are less likely to be overweight and obese. Breastfeeding is associated with higher income in adult life. And the list goes on.<o:p></o:p></div>
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Few health interventions are as effective — and cost-effective — as breastfeeding.<o:p></o:p></div>
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Yet only about 40% of infants 0-6 months old are exclusively breastfed. No country in the world fully meets recommended standards for breastfeeding, according to a report by <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.who.int/news-room/headlines/01-08-2017-babies-and-mothers-worldwide-failed-by-lack-of-investment-in-breastfeeding" style="color: #954f72; text-decoration: underline;">UNICEF and WHO</a></span>.<o:p></o:p></div>
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Meanwhile, sales of infant formula are soaring, and expected to reach $71 billion next year, according to the Lancet. Reports of violations of the International Code of Marketing of Breastmilk Substitutes <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://adc.bmj.com/content/97/6/529" style="color: #954f72; text-decoration: underline;">are numerous</a></span>.<o:p></o:p></div>
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“Research continues to show that the industry’s aggressive marketing is associated with lower breastfeeding rates, as formula becomes more common around the world,” <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.devex.com/news/opinion-we-must-improve-the-global-state-of-breastfeeding-93260" style="color: #954f72; text-decoration: underline;">wrote Victor Aguayo</a></span>, chief of the UNICEF Global Nutrition Program. “The data tells us that mothers who receive free formula samples when they are discharged from hospital breastfeed less, and that the widespread promotion of formula and other breast milk substitutes leads to misinformation about breastfeeding, influencing families’ feeding decisions in ways that impact children throughout their lives.”<o:p></o:p></div>
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Formula is a particular concern for families that do not have access to clean water.<o:p></o:p></div>
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<span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding" style="color: #954f72; text-decoration: underline;">WHO and UNICEF recommend</a></span>:<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Early initiation of breastfeeding within one hour of birth;<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Exclusive breastfeeding for the first six months of life; and<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Introduction of nutritionally-adequate and safe complementary (solid) foods at six months together with continued breastfeeding up to two year of age or beyond.<o:p></o:p></div>
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It seems that everyone, including the Trump Administration, acknowledges the benefits of breastfeeding so we should all work together to promote breastfeeding more energetically, while also allowing infant formula to be widely available through accurate and responsible marketing.<o:p></o:p></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-73886107542296245992018-09-18T05:52:00.000-07:002018-09-18T05:53:52.959-07:00Stepping up fight against malaria in Asia to protect gains made everywhere<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
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<b>A mother from Myanmar and her child waiting to be seen at the Wang Pha clinic near Mae Sot, Thailand, near the Thai–Myanmar border. Her son has symptoms of malaria. Photo: Mark Tuschman </b></div>
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<i>This was originally published on Global Health TV on August. 31, 2018</i><br />
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The future of malaria in sub-Saharan Africa and everywhere else may depend on whether we can stop drug resistant malaria in five countries of the Greater Mekong subregion of Southeast Asia and whether new vaccines will work against it.<o:p></o:p></div>
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Great progress has been made against malaria on both continents. The incidence rate of malaria has decreased 18% globally between 2010 and 2016, according to the World Health Organization. The WHO South-East Region recorded the largest decline (48%) followed by the African Region (20%). Malaria cases worldwide have fallen from 237 million in 2010 to 216 million in 2016.<o:p></o:p></div>
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Two years ago, <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.searo.who.int/mediacentre/releases/2016/1631/en/" style="color: #954f72;">Sri Lanka</a> </span>became the first country in the region to eradicate malaria. Six more countries (Bhutan, China, Malaysia, Nepal, South Korea, and Timor-Leste) <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://apps.who.int/iris/bitstream/handle/10665/273633/WHO-CDS-GMP-2018.13-eng.pdf?ua=1&TSPD_101_R0=1f9d4665bb238d69b55679cdc91246c9j750000000000000002e0cf386cffff00000000000000000000000000005b7322dc00b7628fe5" style="color: #954f72;">are on track to eradicate it by 2020</a> </span>and the other 15 nations are targeting 2030. But a few of those 15 countries are struggling – malaria cases increased in six of them in 2016. India has the third largest burden of malaria in the world, accounting for 89% of malaria cases in the Southeast Asia Region.<o:p></o:p></div>
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“We’ve made extraordinary progress in the Asia-Pacific Region,” says Dr. Ben Rolfe, CEO of the Asia Pacific Leaders Malaria Alliance based in Singapore. “Malaria has been halved, and then halved again. Even Myanmar has made extraordinary progress in the most difficult of circumstances. The downside is that we have only bitten off the easy fruit. We are now getting down to dealing with remote communities with very little access to health services. It gets exponentially harder to reach those places.”</div>
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And to make matters worse, drug resistant malaria was first reported in 2008 in Cambodia and has since spread to four other countries of the Greater Mekong subregion – Laos, Myanmar, Thailand and Vietnam. If this resistant strain spreads to Africa and India, it could wipe out the gains of the last 20 years. This <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.theguardian.com/global-development/gallery/2018/apr/27/malaria-on-the-march-thai-myanmar-border-in-pictures" style="color: #954f72;">photo essay</a> </span>shows images from a malaria research site on the Thai-Myanmar border.<o:p></o:p></div>
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The only wait to safeguard those gains is to wipe out malaria in the Greater Mekong subregion and the larger region. To that end, global donors led by the Australian government, have made financial commitments to fight malaria in Asia. Domestic financing for malaria has increased by over 40% in the Asia-Pacific between 2015-2017 as compared to 2012-2014 (Nepal, Thailand, Myanmar, Vietnam and Timor-Leste all increased domestic financing by more than 100%). The Global Fund to Fight AIDS, Tuberculosis and Malaria have come up with $243 million. And the Australian government announced <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.sbs.com.au/news/global-effort-to-end-malaria-bishop" style="color: #954f72;">an AUD $300 million package</a> </span>to support efforts to end the disease in the Asia-Pacific region.<o:p></o:p></div>
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The private sector is also playing their role in the region.<o:p></o:p></div>
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Last month the pharmaceutical company GSK and the Medicines for Malaria Venture (MMV) announced that Tafenonqine, a new drug specifically for the recurring (or relapsing) form of malaria (which accounts for a half of the Asia-Pacific’s malaria burden) <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.bbc.co.uk/news/health-44801139?mkt_tok=eyJpIjoiWXpFME5qUm1PRFUyTXpObCIsInQiOiJtT2o1NWdrRE9HNVE5SjFnZkxLeHVydjRQTVlsMlFWWjl3UTJBSk1OUnBrbWg1SUtCY0pJQW5yMmpGR1ZXU3dYZ1JSeVpVQ0V4NWNyWmhpV2JaalhpQStJenVtMGRrY0M3Y2VXamE3S0hOYWxoV2ZFcDFMcm1ySFdwSWUrMGlEZyJ9#share-tools" style="color: #954f72;">has been approved by the U.S. Food and Drug Administration</a></span>. Rolfe says Tafenonquine will be “a real game changer in this region particularly when you’ve got the parasite hiding in people’s livers.”<o:p></o:p></div>
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<a href="https://www.blogger.com/blogger.g?blogID=7782254203352865878" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a>Novartis, another pharma company, is now testing two drugs – known as KAF156 and KAE609 – specifically against drug-resistant malaria in Africa, Thailand and Vietnam. If they prove effective, they would be a huge step forward in making malaria treatment simpler and safer.<o:p></o:p></div>
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“We are very excited about those two antimalarials because they are distinctly different from current antimalarial therapies available and have the ability to combat the resistance that we now see emerging in the Mekong sub-region, specifically in Cambodia,” says Dr. Lutz Hegemann, global development head, Established Medicines and Anti-Infectives at Novartis. “Those two molecules are not only distinct from what is out there, but they are also distinct from each other. They are potentially useful beyond just the treatment of uncomplicated malaria.” This means that they could potentially help prevent malaria, as well as treating it.”<o:p></o:p></div>
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Both drugs are in clinical phase 2 (which is followed by Phase 3 and then FDA review). Lutz estimates that, if development goes quickly, he would expect to see them on the market in 5+ years. So far, he says, the data is very encouraging.<o:p></o:p></div>
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Lutz said that Novartis is deeply committed to moving forward with KAF156 and KAE609 and has invested $100 million in those two compounds plus related activities to help bring those products to market in close partnership with MMV.<o:p></o:p></div>
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Rolfe frames the malaria fight as an extraordinary mission. “It’s not like global warming that has no clear end date,” he says. “We are making huge traction. Look at the Philippines and Sri Lanka. There are some incredibly dedicated people working quietly every day. People who would normally be wearing suits are out in Land Rovers and small boats with their sleeves rolled up making sure they finish the job. That kind of commitment is an extraordinary thing to be a small part of.” <o:p></o:p></div>
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But Rolfe said we have to defeat malaria in the Greater Mekong sub-region to safeguard those gains. “Donors have invested billions of public money in making historic gains fighting malaria in sub-Saharan Africa. If ACT (artemisinin-based combination therapy) resistant malaria spreads to Africa, just as resistance to chloroquine, just as resistance to sulfadoxine-pyrimethamine did, we’re going to see what we saw the last time – a massive increase in child mortality solely due to malaria.”<o:p></o:p></div>
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Australia has stepped up its regional leadership in the malaria fight, announcing an AUD $300 million, five-year package called the Health Security Initiative for the Indo-Pacific, a five-year program focusing on the avoidance and containment of infectious diseases. Since launching in October 2017, the initiative has committed AUD $68.5 million for malaria activities.<o:p></o:p></div>
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“I can assure you that Australia is deeply committed to this goal of the elimination of malaria but the key is to work in partnership,” <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.sbs.com.au/news/global-effort-to-end-malaria-bishop" style="color: #954f72;">Australian Foreign Minister Julie Bishop, who resigned last week, told the Malaria World Congress</a> </span>in Melbourne in July. “No one country, no one agency, no one foundation can do it alone.” As we have seen with polio eradication, we can eliminate malaria in our lifetime. We know that some countries will achieve it by 2020, others later, but if we work collectively and collaboratively this goal is within our grasp.”<o:p></o:p></div>
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<i>If you want to take a deeper dive into drug resistant malaria in southeast Asia, check out <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.nature.com/immersive/d41586-018-05772-z/index.html" style="color: #954f72;">Amy Maxmen’s excellent article</a> </span>in the July 26th issue of Nature. <o:p></o:p></i></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-47647404783628579712018-09-17T06:10:00.001-07:002018-09-17T06:12:56.808-07:00New book "Factfulness" asserts that world is much better than most believe<div dir="ltr" style="text-align: left;" trbidi="on">
<i style="font-family: Calibri, sans-serif;">This was originally published on Global Health TV on August 6, 2018.</i><br />
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I first saw Hans Rosling deliver a presentation on <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.youtube.com/watch?v=1FVzHLXbgew" style="color: #954f72;">facts and fiction on global health</a> </span>in New York in 2010. Like many of his fans, I was swept away by his stunning visual presentations of data, his charming Nordic folksiness and his ability to shed light on some glaring misconceptions of global health and development that he has been working to rectify the last two decades.<o:p></o:p></div>
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He was shocked to discover that people get basic facts on population, health and development wrong, and not just the general public but also highly educated people, even at the World Economic Forum in Davos and Nobel laureates. So this Swedish professor of global health set out to educate people, primarily through his TED talks, which have been viewed more than 35 million times (check out <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.ted.com/talks/hans_rosling_at_state#t-154771" style="color: #954f72;">“Let my dataset change your mindset”</a> </span>and <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.youtube.com/watch?v=Sm5xF-UYgdg" style="color: #954f72;">“How not be ignorant about the world”</a></span>), to such an extent that he became a nerdy global health rock star.<o:p></o:p></div>
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In September 2015, Hans and his son Ola Rosling and daughter-in-law Anna Rosling Rönnlund decided to write a book to explain why people do not see the world as it really is, and why we get so many basic facts so wrong. Five months later, he received a diagnosis of incurable pancreatic cancer, and was told he had two or three months to live. He threw himself into finishing this book to such an extent that he was going over printed copies of the latest draft from his hospital bed in the days before he died in February 2017.<br />
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“This book is my very last battle in my lifelong mission to fight devastating global ignorance,” he writes in “Factfulness: Ten Reasons We’re Wrong About the World – and Why Things Are Better Than You Think.” In my previous battles, I armed myself with huge data sets, eye-opening software, an energetic lecturing style, and a Swedish bayonet. It wasn’t enough. But I hope that this book will be.”<o:p></o:p></div>
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The resulting book is a must-read for anyone interested in global health and development. Indeed, I hope it is read far beyond those small groups of people. The entire world needs to realize that things most things are<u>not</u>getting worse, as most people think. Indeed global health and development indicators are improving in much of the world.<o:p></o:p></div>
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Hans co-wrote the book in close collaboration with Ola and Anna, and they explain <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.youtube.com/watch?time_continue=84&v=8-kbZiCX7h4" style="color: #954f72;">here</a> </span>why they wrote Factfulness.<o:p></o:p></div>
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The book starts out with a global health and development pop quiz. It consists of 13 basic questions. Take the test <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://forms.gapminder.org/s3/test-2018" style="color: #954f72;">here</a> </span>before you read the rest of this blog (where I reveal two of the answers). If you did badly, you are in very good company. Full disclosure: I got only seven correct and I have been working in global health and development for over 30 years. <o:p></o:p></div>
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Hans writes that in 2017, he and his team asked nearly 12,000 people in 14 countries to answer these questions. They scored, on average, just two correct answers out of the first 12. No one got a perfect score, and just one person (in Sweden) got 11 out of 12. A stunning 15 percent scored zero.<o:p></o:p></div>
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“I have tested audiences from all around the world and from all walks of life: medical students, teachers, university lecturers, eminent scientists, investment bankers, executives in multinational companies, journalists, activists, and even senior political decision makers,” writes Hans. “But most of them – a stunning <i>majority</i>of them – get most answers wrong. Some of these groups even score <i>worse</i>than the general public; some of the most appalling results came from a group of Nobel laureates and medical researchers. It is not a question of intelligence. Everyone seems to get the world devastatingly wrong.”<o:p></o:p></div>
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One of the 13 questions is on how the proportion of the world population living in extreme poverty has changed over the last 20 years: Did it double, stay the same or almost halve?<o:p></o:p></div>
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The correct answer is that it almost halved. “This is absolutely revolutionary,” writes Hans. “I consider it to be the most important change that has happened in the world in my lifetime. But people do not know it. On average, only 7 percent get it right.”<o:p></o:p></div>
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Another question is about the percentage of one-year-old children who have been vaccinated against some disease. Is it 20, 50 or 80 percent? The correct answer is 80 percent but only 13 percent of people surveyed got this right.<o:p></o:p></div>
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Eighty-five percent of 71 global finance managers at the headquarters of one of the world’s largest banks got that answer “extremely wrong,” and believed that only a minority of the world’s children have been vaccinated.<o:p></o:p></div>
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“The fact that 88 percent are vaccinated but major financial investors believe it is only 20 percent indicates that there is a big chance that they are failing at their jobs by missing out on huge investment opportunities (probably the most profitable ones in the fastest-growing parts of the world),” writes Hans.<o:p></o:p></div>
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Why do so many people get the world wrong? “It seems like people are suffering from an overdramatic worldview. They think the world is in much worse shape than it actually is, and this leads to terrible decisions and tons of unnecessary stress,” said Ola. <o:p></o:p></div>
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The authors found clear patterns behind the misconceptions and identified 10 “dramatic instincts” that make people misinterpret the world and lead to an “overdramatic worldview.” And they give us rules of thumb and “new, relaxing thinking habits which we call factfulness.”<o:p></o:p></div>
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An example of those dramatic instincts is “The Straight Line Instinct,” the tendency to imagine that a line will continue at the same angle into the future. That can manifest itself in the chart showing the world population forecast. If you look at the line showing population growth between 1950 and 2000, it seems to be going up at a 45 percent angle. If you follow your Straight Line Instinct, you might imagine that this will continue to skyrocket to 15 billion or so by the end of the century. In reality, though, UN experts expect the line to flatten out over the next few decades and land at somewhere between 10 and 12 billion people by 2100. <o:p></o:p></div>
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Please read this book and share it widely with friends, family and colleagues. The authors say it will soon be available in 24 languages.<o:p></o:p></div>
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<i>Here is Hans at his best – though more serious than usual – in <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.youtube.com/watch?time_continue=5&v=WjVHvC9EeB4" style="color: #954f72;">an appearance on Fareed Zakaria GPS on CNN</a> </span>in 2010 – on how the rest of the world caught up with the U.S. You can view other related videos on the Gapminder website <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.gapminder.org/videos/" style="color: #954f72;">here</a></span>.<o:p></o:p></i></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-79166971926684495482018-09-13T06:30:00.000-07:002018-09-13T06:31:37.339-07:00Trump's expansion of Global Gag Rule sows chaos in global health<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: "calibri" , sans-serif;">One of Donald Trump’s first acts as U.S. president was the re-imposition of the Global Gag Rule (GGR), also called the Mexico City Policy, a policy that denies healthy options to women and girls, not just safe abortion and contraception but potentially all areas of global health. </span><br />
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Trump changed its name to “Protecting Life in Global Health Assistance,” but most global health advocates call it the Global Gag Rule because it silences health providers from providing comprehensive reproductive health options to women and girls.<o:p></o:p></div>
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<span style="font-family: "calibri" , sans-serif;">The global gag rule is a failed, outdated and deadly policy,” writes Serra Sippel, the president of the Center for Health and Gender Equity (CHANGE), in the comprehensive new report <span class="MsoHyperlink" style="color: blue; text-decoration: underline;"><a href="http://www.genderhealth.org/files/uploads/change/publications/Prescribing_Chaos_in_Global_Health_full_report.pdf" style="color: #954f72;">Prescribing Chaos in Global Health: The Global Gag Rule from 1984 to 2018.</a></span><o:p></o:p></span></div>
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<span style="font-family: "calibri" , sans-serif;">“Throughout this report, CHANGE seeks to document the breadth of the GGR’s impacts on civil society and health systems. For example, CHANGE provides evidence that the GGR under President George W. Bush had consequences outside family planning programs, and that it adversely impacted a wider range of health services provided by foreign NGOs. Some of these impacts were mitigated when President Barack Obama rescinded the policy, but the harmful effects have been shown to linger, particularly as each iteration has become more oppressive, culminating now with the Trump GGR.” <o:p></o:p></span></div>
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The policy is having exactly the effect the Trump Administration intended it to have – women are losing health services, programs are being down-sized or closed and advocacy work disrupted. Because of poor communication and miscommunication coming from the U.S. government and prime partners, the CHANGE report says, many organizations are over-interpreting the policy, and going further than they really need to go, out of fear of losing funding and alienating an important donor (the U.S. government).<br />
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The GGR requires that foreign NGOs (including both foreign nonprofit and for-profit organizations) cannot receive U.S. foreign assistance for family planning if they perform or actively promote abortion as a method of family planning, even if they pay for such activities with their own, non-U.S. funds.<o:p></o:p></div>
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<span style="color: #333333;">Abortion rates are similar in countries where it is mostly legal and where it is highly restrictive – 37 abortions take place for every 1,000 women in the most restrictive countries and 34 where it is least restrictive, according to </span><span class="MsoHyperlink" style="color: blue; text-decoration: underline;"><a href="https://www.guttmacher.org/report/abortion-worldwide-2017" style="color: #954f72;">a report by the Guttmacher Institute</a></span><span style="color: #333333;">. The report says: “Highly restrictive laws do not eliminate the practice of abortion, but make those that do occur more likely to be unsafe.”<o:p></o:p></span></div>
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Since its advent in 1984, GGR has applied only to international family planning assistance – until Donald Trump became president. On May 15, 2017, the policy was expanded to include virtually all global health areas, including global health security, health system strengthening, HIV/AIDS, malaria, non-communicable disease, nutrition, tuberculosis and water, sanitation and hygiene. The expanded GGR applies to $8.8 billion in global health funding, according to the CHANGE report.<o:p></o:p></div>
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The report gives examples of the impact of Trump’s GGR. One of them is from Zimbabwe where the DREAMS Partnership has reduced new HIV infections in young women by 25-40 percent in 41 districts in 10 African countries since 2015.<o:p></o:p></div>
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<span style="font-family: "calibri" , sans-serif;">Southern African HIV and AIDS Information Dissemination Service (SAfAIDS) is a regional NGO that promotes effective responses to reproductive health, tuberculosis and HIV. Before Trump reinstated the GGR, nearly half of SAfAIDS’ budget was from USAID and most of that went to support DREAMS. <o:p></o:p></span></div>
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<span style="font-family: "calibri" , sans-serif;">One of SAfAIDS’ sub-grantees —Roots (Real Open Opportunities for Transformation Support) — had a five-year agreement with SAfAIDS that made up 60 percent of their budget. Both SAfAIDS and Roots decided they could not comply with the Trump GGR. Roots’ funding was being used for interventions that were focused on keeping girls in school or getting them back in school, in rural, agricultural, mining towns, where adolescent girls and young women are particularly vulnerable to HIV infection. <o:p></o:p></span></div>
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<span style="font-family: "calibri" , sans-serif;">The initiative included education and providing safe spaces, as well as training in income-generating activities such as manufacturing detergent and floor polish. They anticipated undertaking some agricultural projects. These activities stopped in October 2017 because of the GGR. <o:p></o:p></span></div>
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One DREAMS beneficiary supported by Roots said:<o:p></o:p></div>
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“Roots used to come to our rural communities and give us information … Some of us were sex workers only because we come from poverty – we had no money … when DREAMS came, it [helped] us do projects so that we could become empowered. Now all of that has stopped. Girls were benefitting from savings club, but now that has stopped – they don’t have money anymore. We were anticipating starting agricultural projects but DREAMS stopped, so that isn’t going to happen.”<o:p></o:p></div>
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<span style="font-family: "calibri" , sans-serif;">Another DREAMS beneficiary said that without these savings clubs, they face barriers to earning money. “You hear a young girl saying, ‘For me to buy one [menstrual] pad, I need to sleep with two men.’” <o:p></o:p></span></div>
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The Trump GGR does have <span class="MsoHyperlink" style="color: blue; text-decoration: underline;"><a href="https://www.npr.org/sections/goatsandsoda/2018/06/13/616906884/trumps-ban-on-funding-for-overseas-abortions-has-some-little-known-exceptions" style="color: #954f72;">some exceptions</a> </span>in the case of rape, incest and if the woman’s life is in danger. It also has some other exceptions that are not well known. <o:p></o:p></div>
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One of them is referred to as “passive referrals” for abortion in countries where abortion is legal for reasons broader than rape, incest and life endangerment. If these four criteria are met, a health provider may tell a woman where she can get an abortion: 1) The woman is pregnant; 2) she must state that she has already decided to have a legal abortion; 3) she must ask where a safe and legal abortion can be obtained; and 4) the provider must believe that the ethics of the medical profession require this information to be disclosed.<o:p></o:p></div>
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CHANGE makes several recommendations to the Trump Administration for improving the current abysmal communication on the GGR. But its main recommendation is to Congress: Use legislative action to end “the most extreme and sweeping iteration of a policy that has fomented confusion, fear and harm for NGOs and health care providers around the world since 1984 and over six U.S. presidential administrations.<o:p></o:p></div>
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The U.S. State Department did conduct <span class="MsoHyperlink" style="color: blue; text-decoration: underline;"><a href="https://www.state.gov/f/releases/other/278012.htm" style="color: #954f72;">a six-month review of the Protecting Life in Global Health Assistance</a> </span>but found that, with less than six months of implementation, it was “too early to <span style="background-color: white; color: #1e3351;">assess the full range of benefits and challenges” of the policy. It called for a further review </span><span style="color: #1e3351;">of the policy by December</span><span style="background-color: white; color: #1e3351;"> </span><span style="color: #1e3351;">15, 2018, “when more extensive experience will enable a more thorough examination of the benefits and challenges.”</span><o:p></o:p></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-56354794605458694862018-09-12T10:13:00.000-07:002018-09-12T10:14:26.804-07:00Brazil anti-tobacco forces score yet another victory but work is not yet done<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;"><b>ACT and their anti-tobacco coalition after an advocacy activity at the National Congress in Brasilia. Photo: ACT Promoção da Saúde</b></td></tr>
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<i>This was originally published on Global Health TV on May 30, 2018.</i></div>
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RIO DE JANEIRO, Brazil — This country has one of the best tobacco control programs in the world, resulting in a series of laws to protect non-smokers that the Brazilian government been put into place over 20 years. During this time, cigarette smoking has fallen by more than half.<o:p></o:p></div>
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And yet smoking is still a huge problem. Almost 15 percent of adult Brazilians still smoke, according to the Ministry of Health, causing <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://g1.globo.com/bemestar/noticia/tabagismo-mata-mais-de-156-mil-pessoas-por-ano-em-2015.ghtml" style="color: #954f72;">156,000 deaths per year</a></span>. Every day, second-hand smoke kills <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://saude.estadao.com.br/noticias/geral,fumo-passivo-mata-mais-de-sete-brasileiros-ao-dia-diz-estudo,228951" style="color: #954f72;">seven Brazilians</a></span>.<o:p></o:p></div>
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Though smoking has fallen dramatically among both men and women, there are still 21.5 million smokers in Brazil, which puts it in the top 10 countries in terms of number of smokers. And for every success achieved by the tobacco control movement – and there have been many – the cigarette industry fights back with all of the considerable resources at its disposal.</div>
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The latest victory for the anti-tobacco forces occurred on February 1<sup>st</sup>, when the Supreme Court made a historic ruling that affirmed the authority of the Brazilian Health Regulatory Agency (ANVISA) to prohibit additives in cigarettes (including flavors like mint and cinnamon). Anti-tobacco groups believe these additives make the products more attractive to children and adolescents.<o:p></o:p></div>
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The vote was a close as it could be – a 5-5 tie. Under Brazilian law, a tie vote in the Supreme Court means the ANVISA regulation is constitutional. This ruling has made Brazil one of the first countries in the world to have a complete ban on additives.<o:p></o:p></div>
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This month I visited <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://actbr.org.br/" style="color: #954f72;">ACT Promoção da Saúde</a> </span>(ACT Health Promotion), founded in 2006, one of the organizations at the forefront of the war against tobacco at their offices here, a block from Copacabana Beach. <o:p></o:p></div>
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Anti-tobacco work began two decades ago when <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.who.int/fctc/dacostaesilvacv/en/" style="color: #954f72;">Dr. Vera Luiza da Costa e Silva</a> </span>started a movement coordinating tobacco control for the Ministry of Health’s National Cancer Institute in 25 states and helped ban tobacco advertising in mass media in 1999. Dr. da Costa e Silva is now head of the secretariat at the World Health Organization’s Framework Convention on Tobacco Control.<o:p></o:p></div>
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In 2007, ACT and its civil society allies started work to enact a national law banning smoking in public places but got strong push-back from the tobacco industry, said Daniela Guedes, ACT’s director of campaigns and mobilization. So they regrouped and decided to focus on the state of São Paulo, the largest state in Brazil (with a 2018 population of 45 million). One of their first activities was to create a sign to promote smoke-free policies at companies and restaurants. <o:p></o:p></div>
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ACT conducted a public opinion poll that showed that 88% of the population supported a smoke-free law in São Paulo state (the percentage was almost as high among smokers). Polling is an important part of ACT’s work – it helps attract the attention of the media and lawmakers.<o:p></o:p></div>
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Their initial advocacy efforts focused on then-São Paulo Governor <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://en.wikipedia.org/wiki/Jos%C3%A9_Serra" style="color: #954f72;">José Serra</a></span>, a former minister of health. He wanted more evidence before joining their forces, said Guedes, and anti-tobacco advocates gave it to him. Their strongest evidence was the seven people who die from second-hand smoke every day (one of the slogans of an early campaign was “He who doesn’t smoke is not obliged to smoke”). One month later, Serra proposed a ban on public smoking in São Paulo state. Despite massive resistance from the tobacco industry, the bill was passed.<o:p></o:p></div>
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This created a “cascade effect,” said Guedes, prompting many other states and municipalities to pass similar bans. And it stimulated much discussion of this issue in local and national media.<o:p></o:p></div>
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ACT and its allies then set their sights on a national smoke-free law. After much resistance from the tobacco industry, the ban was passed and signed by of then-President Dilma Rousseff in 2011. It took another three years for the law to be implemented, with the tobacco industry fighting back every step of the way. But the public smoking ban became the law of the land across Brazil.<o:p></o:p></div>
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Lately, ACT and its allies have been working against the tobacco industry’s efforts to make cigarettes seductive to children and adolescents. For example, <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.google.com/url?hl=en&q=https://www.youtube.com/watch?v%3D7vsBGTFUgd0&source=gmail&ust=1527109653305000&usg=AFQjCNF0jMWI0bZmlaBftuwT6yQf6249tw" style="color: #954f72;">this TV spot</a></span>, makes the case against adding flavors to cigarettes and displaying them alongside of candy. On the second day it was aired, the largest Brazilian tobacco company sued ACT, asking for damages of 500,000 reales per day. The tobacco company lost and the TV campaign continued.<o:p></o:p></div>
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The number of adult smokers has decreased from 35 percent in 1989 to 15 percent in 2013, according to National Health Surveys of the Ministry of Health (scroll down to first table <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www2.inca.gov.br/wps/wcm/connect/observatorio_controle_tabaco/site/home/dados_numeros/prevalencia-de-tabagismo" style="color: #954f72;">here</a></span>). So the fight against tobacco in Brazil, despite these many triumphs, is not yet finished.<o:p></o:p></div>
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“We still have more work to do,” said Guedes. “We need to fully implement the additives ban and ban point-of-sale displays that still show cigarette packaging. This is why it is so important to pass a law mandating plain packaging – cigarette packaging is still so attractive, especially to youngsters.”<o:p></o:p></div>
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In 2015, José Serra – who by then had become a senator from São Paulo – proposed another national tobacco control bill to ban additives, advertising at point of sale, smoking in cars with children and mandate plain packaging. These steps represent the next steps in tobacco control. After three years, this bill is still going through the legislative process.<o:p></o:p></div>
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ACT is still very much engaged in the ongoing fight against tobacco but three years ago they took on another one of the risk factors of non-communicable disease – overweight and obesity. In Brazil, 25 percent of girls and 26 percent of boys are overweight, according to <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.worldobesity.org/data/" style="color: #954f72;">World Obesity</a></span>.<o:p></o:p></div>
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<i>See more details of tobacco in Brazil on the <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://tobaccoatlas.org/country/brazil/" style="color: #954f72;">Brazil page</a> </span>of the 2018 Tobacco Atlas.<o:p></o:p></i></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-18180045397156287402018-09-11T06:14:00.000-07:002018-09-11T06:14:18.030-07:00Obesity is rising almost everywhere, spurring a rise in chronic disease<div dir="ltr" style="text-align: left;" trbidi="on">
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-_HW64BRhUq4/W5e991uSyNI/AAAAAAAAD8A/_3g27cnN858rKHA-8_CRwKAB5naSWI8TwCLcBGAs/s1600/My%2BThali.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="697" data-original-width="980" height="283" src="https://1.bp.blogspot.com/-_HW64BRhUq4/W5e991uSyNI/AAAAAAAAD8A/_3g27cnN858rKHA-8_CRwKAB5naSWI8TwCLcBGAs/s400/My%2BThali.jpeg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b>This shows MyThali (My Plate), a new campaign of Arogya World to show urban Indian women a healthy diet in order to fight obesity and associated non-communicable diseases. Photo: Arogya World</b></td></tr>
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<i style="font-family: Arial, sans-serif;">This was originally published on Global Health TV on April 27, 2018.</i><br />
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<span style="font-family: Arial, sans-serif;">The picture above shows the ideal, healthy plate of food for an urban adult woman in India – one cup of vegetable, one cup of rice, one and a half pieces of chapatti, one cup of protein (meat, lentil or sambar) and a half cup of yogurt. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">But too often this is not the typical meal of an Indian. Some people eat too much and become overweight or obese, particularly in urban areas. Obesity increases people’s likelihood of <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.nytimes.com/2017/12/26/health/india-diabetes-junk-food.html?action=click&contentCollection=U.S.&module=Trending&version=Full&region=Marginalia&pgtype=article&_r=0" style="color: #954f72;">developing diabetes</a></span>, to which Indians are predisposed. Meanwhile, some people, particularly rural adolescent girls, eat too little putting themselves at risk when they become pregnant at an early age.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">So Arogya World, a U.S.-based organization committed to changing the course of non-communicable diseases (NCDs) in India, created <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://arogyaworld.org/mythali/" style="color: #954f72;">MyThali</a> </span>(“My Plate”), inspired by the U.S. Department of Agriculture’s “My Plate” campaign and using the guidelines from India’s National Institute of Nutrition to encourage them to make healthier choices. Arogya World is aggressively implementing this campaign in workplaces across India.</span></div>
<a name='more'></a><o:p></o:p><br />
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<span style="font-family: Arial, sans-serif;">India and China continue to have the largest number of underweight people in the word, according to the <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://timesofindia.indiatimes.com/india/No-1-in-underweight-population-India-among-top-5-in-obesity/articleshow/51656193.cms" style="color: #954f72;">Times of India</a></span>, but they also have broken into the top five countries in the world in terms of obesity, The Lancet has found. This double burden of disease is becoming more common not only in India and China but also in sub-Saharan Africa and other low- and middle-income countries (LMICs). In fact, most of the world now lives in countries where overweight and obesity kill more people than underweight, according to the <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight" style="color: #954f72;">World Health Organization (WHO)</a></span>.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">Worldwide obesity has tripled since 1975. In 2016, the WHO estimated that more than 1.9 billion adults – a quarter of the entire population – are overweight and 650 million of these were obese. <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">Obesity is becoming more common in LMICs like <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.nytimes.com/2017/10/02/health/ghana-kfc-obesity.html" style="color: #954f72;">Ghana</a> </span>and <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.latimes.com/world/global-development/la-fg-global-zambia-obesity-20171221-story.html" style="color: #954f72;">Zambia</a> </span>as growing economies cause people to develop habits for fast food and soft drinks, become more sedentary and <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.theguardian.com/global-development/2017/oct/03/supermarkets-creating-obesity-crisis-african-countries-experts-warn-middle-class-malnutrition" style="color: #954f72;">buy food from supermarkets</a> </span>rather than growing it themselves.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">NCDs first achieved a global platform when the first UN High-Level Meeting on NCDs was held in 2011. In 2013, global health leaders enacted the <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://apps.who.int/iris/bitstream/handle/10665/94384/9789241506236_eng.pdf;jsessionid=E2C43870E77B68FAD82553A3C320BED3?sequence=1" style="color: #954f72;">Global Action Plan for the Prevention and Control of NCDs, 2013-2010</a></span>, which had nine voluntary global targets. One of them was to “halt the rise of diabetes and obesity.” <o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">“We’ve failed badly [in achieving that target],” said Johanna Ralston, chief executive of <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.worldobesity.org/" style="color: #954f72;">World Obesity</a></span>, which represents professional members of the scientific, medical and research communities from over 50 regional and national obesity associations. “Things are getting worse, and obesity is growing, especially in low- and middle-income countries. <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.devex.com/news/cities-and-ncds-the-growing-threat-of-childhood-obesity-in-quito-92510?access_key=3c6c9615f6c57eb1d847ef34fdb3772b539b419b&mkt_tok=eyJpIjoiWm1JNE9XVmhabU00TVRJNCIsInQiOiJHakhjc3hxaEQwYXhWSG9vaUdtejMzUmxyOERTNW9vSzlMMU04bWlEM2RCWjhmWmR1WHlSait3SUU2MjU4QzZIQ25MWG5pTUZpMlU1dld2VXRKajZYSG5cL3dDMWZPc01OVkY0U3dWaXNiRGo3RzdORVRNU25KTitUQlpjbTBcL2t5In0%3D" style="color: #954f72;">Childhood obesity</a> </span>has increased ten-fold in the past four decades. This represents a failure of civilization because obesity is so driven by how we live and work and move.”<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">Ralston says that obesity is inextricably linked to a variety of NCDs. It is a disease itself but also a major risk factor for cardiovascular disease (the leading cause of death in the world), diabetes, many cancers and other NCDs, according to the <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.who.int/mediacentre/factsheets/fs311/en/" style="color: #954f72;">WHO</a></span>. “If you don’t address obesity, you won’t address NCDs. And if you do address it, a lot of lives can be saved and health improved.”<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">But obesity is not just a health problem; it’s also an economic problem. “If we don’t take urgent action, the annual global medical bill for treating the diseases that follow directly from obesity is expected to reach $1.2 trillion in 2025, according to <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://www.obesityday.worldobesity.org/world-obesity-day-2017" style="color: #954f72;">the World Obesity Day website</a></span>.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">The only country Ralston could think of where obesity is falling was Venezuela, which is afflicted with political crisis and food shortages, “but that’s not the way you want to solve obesity.”<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">Ralston also sees glimmers of hope on an otherwise bleak landscape of obesity. In 2014, Mexico imposed an 8% tax on junk foods. <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.vox.com/2018/1/17/16870014/junk-food-tax" style="color: #954f72;">Recent evidence</a> </span>suggests that the tax has led to decreases in purchases of junk food by unhealthy people. Consumption of sugary beverages is doing down and childhood obesity is starting to plateau, she says. Last year, <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.livemint.com/Industry/5enLiWHCIu06ocHOk31KyM/GST-rates-Aerated-drinks-to-attract-40-tax-industry-body.html" style="color: #954f72;">India levied a tax on soft drinks and flavored waters</a> </span>that reaches as high as 43%.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">Similarly, <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.nytimes.com/2018/02/07/health/obesity-chile-sugar-regulations.html?action=click&contentCollection=health&module=NextInCollection&region=Footer&pgtype=article&version=series&rref=collection%2Fseries%2Fobesity-epidemic" style="color: #954f72;">Chile mandated packaging redesigns and labeling rules</a> </span>to help people make decisions about food in stores. The law prohibits the sale of junk food in school and from being advertised on TV programs or websites focused on young audiences.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">Although obesity is no longer limited to rich countries, the rates of adult obesity are still higher in high-income countries of the Americas and Europe than in LMICs. In the U.K., <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.telegraph.co.uk/news/2016/06/07/more-spent-on-treating-obesity-related-conditions-than-on-the-po/" style="color: #954f72;">more money is spent fighting obesity</a> </span>than on the police and fire services combined.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: Arial, sans-serif;">This month, The Lancet declared that </span><span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><span style="font-family: Arial, sans-serif;"><a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30674-3/fulltext" style="color: #954f72;">“2018 must be the year for action against NCDs.”</a> </span></span><span style="color: #222222; font-family: Arial, sans-serif;">“Since 2011, and despite much exclamatory rhetoric, momentum behind efforts to mobilise action against NCDs has stalled (and that is putting it mildly),” writes The Lancet. In September 2018, the UN will have its </span><span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><span style="font-family: Arial, sans-serif;"><a href="http://www.who.int/ncds/governance/third-un-meeting/en/" style="color: #954f72;">Third High-Level Meeting on NCDs</a></span></span><span style="color: #222222; font-family: Arial, sans-serif;">.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: Arial, sans-serif;">Public health messages about diet, calorie intake and physical activity are important but </span><span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><span style="font-family: Arial, sans-serif;"><a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30053-7/fulltext?code=lancet-site" style="color: #954f72;">The Lancet says it is not enough</a></span></span><span style="color: #222222; font-family: Arial, sans-serif;">. “A great disconnect remains between policy makers who issue recommendations and communities themselves </span><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: #333333; font-family: Arial, sans-serif;">that struggle with obesity — specifically, communities living in low-socioeconomic settings or suffering high levels of unemployment and social deprivation … What is sorely needed is political advocacy and action to disrupt entrenched cycles that maintain poverty and prevent ready access to healthy choices.”</span><span style="font-family: Arial, sans-serif;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: Arial, sans-serif;">But Dr. Nalini Saligram, the founder & CEO of Arogya World, the group that developed MyThali, believes that education also has an important role to play.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;">“I really believe we can change the way Indians think about food,” says Saligram. “Food is such a cultural thing – you feed your guests, you celebrate cultural festivals, you do so many things with food. And, in India, food is largely carbohydrates. But we can’t fight this chronic disease epidemic by wringing our hands and saying the problem is too big. We can start with something completely fundamental and, in 10 years, maybe we can make a difference.”<o:p></o:p></span></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-14594247016299094302018-04-09T08:48:00.001-07:002018-04-09T08:53:57.177-07:00Facing two water crises: Having enough water and ensuring it's safe to drink<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-0ojfM7oV0xY/WsuGtdS4x5I/AAAAAAAAD2s/Vw9OprzqYhEtJuiqCv141tndAlTqf5ThgCLcBGAs/s1600/Market%2Bvendor%2Bwith%2BAquatabs.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1024" data-original-width="768" height="400" src="https://2.bp.blogspot.com/-0ojfM7oV0xY/WsuGtdS4x5I/AAAAAAAAD2s/Vw9OprzqYhEtJuiqCv141tndAlTqf5ThgCLcBGAs/s400/Market%2Bvendor%2Bwith%2BAquatabs.jpg" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A market vendor in Bamako, Mali buys Aquatabs water purification tablets for her shop from a Palladium sales promoter. The tablets are one of several solutions for ensuring safe water at point of use. Photo: David J. Olson</td></tr>
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<i>This was originally published on Global Health TV on March 29, 2018.</i><br />
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We talk about a world water crisis like there’s only one but there are really two. The first crisis we see playing out in Cape Town – the growing number of places that do not have enough water of any kind. The second crisis is ensuring that the water people do have is safe to drink.<o:p></o:p></div>
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The city of Cape Town has just dodged a bullet – at least for 2018. <a href="http://resource.capetown.gov.za/documentcentre/Documents/Procedures%2c%20guidelines%20and%20regulations/Day%20Zero%20FAQs.pdf" style="color: #954f72;">Day Zero</a> -- the day when dams levels reach 13.5% of capacity and the taps are turned off – was originally expected to take place in April, then pushed back to July. Now it has been postponed to 2019. <a href="http://video.nationalgeographic.com/video/news/how-cape-towns-residents-are-surviving-the-water-crisisfor-now" style="color: #954f72;">This video</a> shows how Capetonians are dealing with the crisis.<o:p></o:p></div>
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The three-year long drought hasn’t ended but severe water rationing has helped postpone disaster. The combined levels of dams supplying Cape Town is down to 22.7%, according to the <a href="http://coct.co/water-dashboard/" style="color: #954f72;">city’s water dashboard</a>. Capetonians have been asked to limit their water use to 50 liters (13 gallons) per person per day, and many have risen to the occasion (as a point of comparison, the <a href="https://water.usgs.gov/edu/qa-home-percapita.html" style="color: #954f72;">average U.S. resident uses 367 liters per day, or 100 gallons)</a>.<o:p></o:p></div>
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Unfortunately, Cape Town is not an anomaly: Fourteen of the world’s megacities now experience water scarcity or drought conditions, according to <a href="https://www.trucost.com/trucost-blog/business-growth-water-scarcity-revenue-risk/" style="color: #954f72;">Ecolab’s Water Risk Monetizer</a>. </div>
<a name='more'></a><o:p></o:p><br />
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How can we reduce floods, droughts and water pollution? By using solutions already found in nature, things called “nature-based solutions,” like restoring forests and natural wetlands and reconnecting rivers to floodplains. That is why the theme of last week’s World Water Day was “Nature for Water,” an opportunity to <a href="http://worldwaterday.org/app/uploads/2018/02/fact_sheet_WWD2017_EN_2.pdf" style="color: #954f72;">explore using nature</a> to overcome our challenges.<o:p></o:p></div>
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Under the Millennium Development Goals (MDGs), we did an excellent job of meeting half of <a href="http://www.un.org/millenniumgoals/environ.shtml" style="color: #954f72;">Goal 7, Target 7.C:</a> “Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation.” The world met the safe water target. In fact, we did it five years ahead of schedule. Between 1990 and 2015, 2.6 billion people gained access to improved drinking water sources.<o:p></o:p></div>
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<span style="background-color: white; color: #222222;">“The world did great with increasing access to improved water sources under the MDGs, and now needs to make sure that water is safe to drink at the point of consumption,” said Tim Neville, who is based in Zambia for </span><a href="http://www.impactwater.co/" style="color: #954f72;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial;">Impact Water</span></a><span style="background-color: white; color: #222222;">. “And the solution to that will inevitably involve a multisector approach – government, NGOs and the private sector.”<o:p></o:p></span></div>
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Earlier this month, the <a href="https://youtu.be/jTkv-lYOLK0" style="color: #954f72;">High-Level Panel on Water</a> -- made up of 11 heads of state and a special advisor – released the report <a href="https://sustainabledevelopment.un.org/content/documents/17825HLPW_Outcome.pdf" style="color: #954f72;">Making Every Drop Count</a> that called for a fundamental shift in the way the world manages water. Maintaining the status quo, they found, will not get the job done. <o:p></o:p></div>
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About 36% of the world’s population live in water-scarce regions where more than 20% of the global GDP is produced, the report says. By 2050, more than half of the world’s population -- and about half of global grain production – will be at risk due to water stress. Intense water scarcity may displace as many as 700 million people by 2030.<o:p></o:p></div>
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Technology will be important in solving this problem, but technical solutions alone will not be enough. We will need integrated approaches addressing technical, institutional, financial, social and environmental issues. Addressing all of these areas simultaneously will require leadership well beyond the water community, and also require political leadership.<o:p></o:p></div>
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One very tangible thing we can do – less daunting than restoring forests and wetlands – is providing <a href="http://www.who.int/water_sanitation_health/monitoring/coverage/jmp_fast_facts/en/" style="color: #954f72;">safe water, sanitation and hygiene</a>(also called WASH) at health care facilities.<o:p></o:p></div>
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John Oldfield, principal of Global Water 2020, says lack of <a href="https://www.washinhcf.org/home/" style="color: #954f72;">WASH in health care facilities</a> is “sorely unrecognized, sorely uncovered in the media and sorely undercapitalized in human, technical and financial terms. It’s really serious and it’s really solvable.”<o:p></o:p></div>
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He said the problem applies to all types of health care facilities in low- and middle-income countries – public, private and faith-based. <o:p></o:p></div>
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“Anytime a person gets sick at any level – from a huge urban government hospital down to a guy sitting under a baobab tree with a box of Band-Aids – every single one of those contexts requires access to safe drinking water, adequate sanitation facilities, hand-washing stations and waste management services. And very few of them do.” <o:p></o:p></div>
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The <a href="https://www.sciencedirect.com/science/article/pii/S1438463917303760" style="color: #954f72;">latest reporting</a> coming out of University of North Carolina’s Water Institute indicates that 50% of health care facilities in Bangladesh, Haiti, Malawi, Nepal, Senegal and Tanzania lack piped water, 33% lack improved toilets, 39% lack handwashing, and only 2% have access to those three things plus waste management services. <o:p></o:p></div>
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U.N. Secretary-General António Guterres <a href="https://www.un.org/sg/en/content/sg/statement/2018-03-22/secretary-generals-remarks-launch-international-decade-action-water" style="color: #954f72;">highlighted this issue</a> at the launch of International Decade for Action on Water for Sustainable Development:<o:p></o:p></div>
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<span style="background-color: white; color: #333333;">“I am using the launch of the Water Action Decade to make a global call to action for water, sanitation and hygiene in all health care facilities. A recent survey of 100,000 facilities found that more than half lack simple necessities, such as running water and soap - and they are supposed to be health care facilities.</span><span style="color: #333333;"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial;">The result is more infections, prolonged hospital stays and sometimes death. We must work to prevent the spread of disease.</span><span style="background-color: white; background-position: initial initial; background-repeat: initial initial;">Improved water, sanitation and hygiene in health facilities is critical to this effort.”</span><br /><span style="background-color: white; background-position: initial initial; background-repeat: initial initial;"> </span></span><o:p></o:p></div>
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An important part of the solution proposed by the High-Level Panel is Universal Access to Safe Water and Sanitation. Over the last 20 years, some programs have implemented water treatment at the household or institutional level by promoting and distributing point-of-use treatment products. <o:p></o:p></div>
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PSI has implemented <a href="http://www.psi.org/health-area/water-sanitation/water-treatment/#about" style="color: #954f72;">point-of-use water treatment programs</a> in its social marketing programs in Africa, Asia and Latin America since the late 1990s. It now has national scale water treatment programs in more than 30 countries, and markets liquid chlorine solution and <i style="color: #954f72;"><a href="http://www.aquatabs.com/home/" style="color: #954f72;">Aquatabs</a> </i>water purification tablets. <o:p></o:p></div>
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Impact Water,<span style="background-color: white; color: #222222;">a social business, sells, installs and maintains water purification systems that use technologies like UV treatment, ultrafiltration and ceramic filters to schools in Kenya, Nigeria and Uganda. They have installed such systems in over 2,500 schools to date and plan to reach over 5,000 more in 2018 alone. </span><o:p></o:p></div>
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Palladium manages social marketing programs in Mali, where it markets <i>Aquatabs</i>, and Zambia, where it distributes two brands of water purification solution, <i>Klori-Safe</i>and <i>Klori-Pure</i>. In 2017, Palladium sold over 7.5 million <i>Aquatabs </i>tablets in Mali, enough to purify 150 million liters of water.<o:p></o:p></div>
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These are only three examples of point-of-use water treatment. Taking safe water to the next level will require all of this and a whole lot more.<o:p></o:p></div>
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<span style="background-color: white; color: #222222;">“To ensure water is microbiologically safe to drink, point-of-use treatment technologies need to be in place and this is a massive endeavor,” said Neville. “One way is to have more, low-cost, effective institutional and household technologies made available but unless they are user-friendly and often aspirational they won't yield sufficient uptake and consistent use.”<o:p></o:p></span></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com1tag:blogger.com,1999:blog-7782254203352865878.post-66831893987940676882018-04-06T05:32:00.000-07:002018-04-06T05:35:09.357-07:00Mental health still grossly underfunded but there are glimmers of hope<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td style="text-align: center;"><a href="https://4.bp.blogspot.com/-FZ42usM0_p8/Wsdn0OIFKfI/AAAAAAAAD2I/EfnZ1lJZC28p6vg1bzSo8PU7sp1ic7R2gCLcBGAs/s1600/StrongMinds%2BMental%2BHealth%2BFacilitator%2Bspeaks%2Bwith%2Bformer%2Bpatients.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1067" data-original-width="1600" height="266" src="https://4.bp.blogspot.com/-FZ42usM0_p8/Wsdn0OIFKfI/AAAAAAAAD2I/EfnZ1lJZC28p6vg1bzSo8PU7sp1ic7R2gCLcBGAs/s400/StrongMinds%2BMental%2BHealth%2BFacilitator%2Bspeaks%2Bwith%2Bformer%2Bpatients.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A StrongMinds mental health facilitator (center) speaks with former patients in Uganda. StrongMinds has treated more than 25,000 Ugandan women for depression with group talk therapy. Photo: Kevin Di Salvo</td></tr>
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<i>This was originally published on Global Health TV on February 28, 2018.</i><br />
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">The problem with
mental health and substance abuse in Africa and other developing countries is
not that awareness has not been raised about these huge contributors to the
global burden of disability. <o:p></o:p></span></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Annually since
2009, the World Health Organization (WHO) </span><a href="http://www.who.int/mental_health/mhgap/en/"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Mental Health Gap Action
Programme</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"> has been meeting to scale up
services for mental, neurological and substance use disorders.<o:p></o:p></span></div>
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In 2013, the World Health Assembly
adopted the <a href="http://www.who.int/mental_health/action_plan_2013/en/">WHO’s
Mental Health Action Plan 2013-2020</a>, which is designed to provide guidance
for national action plans in all resource settings.<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">And most notably in
2015, world leaders recognized the importance of mental health and substance
abuse in the newly minted </span><a href="http://www.who.int/mental_health/action_plan_2013/en/"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Sustainable
Development Goals</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">. Within Goal 3 (the health goal) of
the 17 SDGs, there is a target for mental health and another target for
substance abuse. </span><a href="http://www.un.org/sustainabledevelopment/health/"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Here</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"> are the Goal 3 targets. <o:p></o:p></span></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">So mental health
has finally been given a hard-fought and much-deserved seat at the global
health table. It just has not been given much money or resources.</span></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="color: #222222;">As this </span><a href="http://www.who.int/mental_health/evidence/atlas/interactive_infographic_2015.pdf?ua=1">WHO
infographic shows</a><span style="color: #222222;">, only 1 percent of the global health
workforce works in mental health and the median public expenditure on mental
health per person is only $2 in low- and lower-middle income countries. </span><a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001846">This
paper</a><span style="color: #222222;"> asserts that the amount of
development assistance for health is “paltry,” with less than 1 percent
specifically earmarked for people with mental disorders.</span><br />
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<span style="background: white; color: #222222;">“Sadly,
I don’t see that the funding gap for mental health has changed much from the
recent past,” said Sean Mayberry, founder and executive director of </span><a href="https://strongminds.org/"><span style="background: white; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">StrongMinds</span></a><span style="background: white; color: #222222;">, a non-profit organization that treats </span><a href="https://www.youtube.com/watch?time_continue=105&v=Ylc6D4Ghim8"><span style="background: white; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">African women with depression through group talk therapy</span></a><span style="background: white; color: #222222;"> led by community workers. “The World Bank and
WHO made big declarations about prioritizing global mental health in 2016 but
they never put any money against it, so we are still in the same spot.”</span><span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Yet Mayberry also
sees glimmers of hope that resources may be in the early stages of catching up
with the rhetoric.<o:p></o:p></span></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">StrongMinds’ own
efforts have resulted in more than 25,000 Ugandan women treated for depression
with 75% of them depression-free at the end of treatment and 72%
depression-free six months after treatment. This was done by cost-effective group
talk therapy conducted by trained community health workers. <o:p></o:p></span></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">“Most donors don’t
fund mental health because they think mental health interventions are super
costly and take forever,” said Mayberry. “These interventions are working and
more would be reached if more donors ponied up.”<o:p></o:p></span></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">In Liberia, the Carter
Center </span><a href="https://www.cartercenter.org/news/pr/liberia-091517.html"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">has
trained 230 clinicians in mental health</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">, with 64
specializing in the needs of children and adolescents, said Janice Cooper
project lead for the Liberia </span><a href="https://www.cartercenter.org/health/mental_health/index.html"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Mental
Health Program</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">. These graduates will provide mental
health and psychosocial care in schools, clinics and other youth settings. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%;">
<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">The Carter Center
also fights against mental health stigma in Liberia by focusing on mental
health service users and their families, religious and traditional leaders,
journalists, health care workers, and trains law enforcement officers in crisis
intervention – an evidence-based intervention also used by law enforcement in
the U.S., said Cooper.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%;">
<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">The Carter Center
says Liberia is “on course to expand mental health care to 70 percent of its
population within the next few years.”<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%;">
<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">The Bill &
Melinda Gates Foundation, which has long ignored non-communicable diseases
(NCDs), including mental health (see first question </span><a href="https://www.devex.com/news/opinion-the-global-development-community-asks-tough-questions-here-are-the-answers-92135"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">here</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">), has just put out </span><a href="https://gcgh.grandchallenges.org/challenge/healthy-minds-adolescent-mothers-achieving-healthy-outcomes-family-round-20"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">a
call for funding</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"> in its Global Grand Challenges to
promote </span><a href="https://www.impatientoptimists.org/Posts/2017/10/Strong-Minds-for-Stronger-Adolescent-and-Young-Mothers#.WpQv0maZNBx"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">“Strong
Minds for Stronger Adolescent and Young Mothers,”</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"> the first of its kind that mental health advocates can recall. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%;">
<span style="color: black; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">A new initiative called </span><a href="http://cities-rise.org/"><span style="mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">citiesRISE</span></a><span style="color: black; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"> </span><span style="background: white; color: #222222;">brings
together international and national leaders in mental health to drive a new
level of progress through its networks, experience and expertise at previously
unattainable scale. </span><span style="background: white; color: black;">citiesRISE
has started working to develop a variety of community-based models and new
strategies in Bogota, Chennai, Nairobi, Seattle and Singapore, and is looking
for more cities.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">In 2014, the </span><a href="http://apps.who.int/iris/bitstream/10665/178879/1/9789241565011_eng.pdf?ua=1&ua=1"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Mental
Health Atlas</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">, published by WHO, reported very mixed
progress in mental health in Africa since its last atlas in 2011:</span></div>
<div class="MsoNormal" style="line-height: 115%;">
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<ul style="text-align: left;">
<li><span style="color: #222222; text-indent: -0.25in;">There was an increase of 34 percent
in the number of psychiatrists in the Africa region and 27% in the Southeast
Asia region (which includes Bangladesh, India and Indonesia), although these increases
are from abysmally low bases.</span></li>
<li><span style="color: #222222; text-indent: -0.25in;">However, the number of nurses working
in mental health in these two regions fell by 8 and 6 percent respectively.</span></li>
<li><span style="color: #222222; text-indent: -0.25in;">In the Africa region, the number of
mental hospital beds fell by 15%, the same drop as with general hospital beds.
In the Southeast Asia region, there were increases in both categories.</span></li>
<li><span style="color: #222222; text-indent: -0.25in;">The number of admissions to mental
hospitals and psychiatric wards of general hospitals increased by 13% in the Africa
region and 26% in Southeast Asia region</span></li>
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<br />
<div class="MsoNormal" style="line-height: 115%;">
<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Mental health
legislation is a key component of good mental health system governance, and 63
percent of those countries that responded to the 2014 Mental Health Atlas said
they had a stand-alone law for mental health (the rate was 55% in Africa and
60% in Southeast Asia).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%;">
<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Perhaps the most
recent country to enact a stand-along mental health law is Liberia, where
former President Ellen Johnson Sirleaf signed </span><a href="https://www.cartercenter.org/news/pr/liberia-113017.html"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">the
bill</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">, which will protect people living
with mental health disorders from discrimination and will give access to
quality mental health care in all 15 counties, before she left office last
month. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">It wasn’t that long
ago that NCDs got almost no attention at the global level. Yet in September,
the United Nations General Assembly will stage its </span><a href="http://www.who.int/ncds/governance/third-un-meeting/en/"><span style="mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">third
high-level meeting on the prevention and control of NCDs</span></a><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"> – although much of this focuses on the more high profile NCDs,
like heart and lung disease, cancers and diabetes. Let’s hope that with this
event, and others like it, the resources soon start to catch up with the
rhetoric.<o:p></o:p></span></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-90276640954124678912018-04-05T06:04:00.001-07:002018-04-05T06:06:21.178-07:00Global contraceptive use rising but more progress needed to reach target<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-jRXptfcy4Pk/WsYdEfku2vI/AAAAAAAAD1c/P0HaQkBb_5wAg0QTgolH1_fAGzO2bgNzwCLcBGAs/s1600/Bariga%2Bevent16.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="730" data-original-width="1077" height="270" src="https://2.bp.blogspot.com/-jRXptfcy4Pk/WsYdEfku2vI/AAAAAAAAD1c/P0HaQkBb_5wAg0QTgolH1_fAGzO2bgNzwCLcBGAs/s400/Bariga%2Bevent16.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A DKT Nigeria counselor talks to a group of women in a low-income neighborhood of Lagos, Nigeria about their contraceptive options. Photo: David J. Olson<br />
<br />
<div style="text-align: left;">
<i>This was originally published on Global Health TV on January 30, 2018.</i></div>
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UnhideWhenUsed="true" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 9"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 9"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="header"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footer"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index heading"/>
<w:LsdException Locked="false" Priority="35" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of figures"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope return"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="line number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of authorities"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="macro"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
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By July 2017, more than 309 million women and girls were
using modern contraception in 69 focus countries identified by Family Planning
2020 (FP2020), a movement created in 2012 by four core partners, 38.8 million
more than in 2012. <o:p></o:p></div>
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This information came out in FP2020’s annual report <a href="http://progress.familyplanning2020.org/en">“The Way Ahead, 2016-2017,”</a>
released in December. It reported that use of modern contraception in these 69
countries from July 2016-July 2017 prevented 84 million unintended pregnancies,
26 million unsafe abortions and 125,000 maternal deaths. This is all great
news.<o:p></o:p></div>
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It came with some less-than-great news. FP 2020 has set the
goal of reaching 120 million new users in the eight years between 2012 and 2020
– or 15 million every year. By that measure, we should have reached 75 million new
users by mid-2017, and 38.8 million is only 52% of that.<o:p></o:p></div>
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Clearly, we have a lot more work to do to reach the 120
million target.</div>
<a name='more'></a>One of the things that can help us make more progress
towards is new and renewed commitments. At the 2017 Family Planning Summit in
London, 75 commitment-makers stepped forward with commitments – including 25
partners making commitments for the first time.<br />
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<o:p></o:p></div>
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Beth Schlachter, executive director of FP2020, says the 120
million target is still relevant, though unlikely to be met by 2020. But she said
that “we are an estimated 30 percent over the progress level that would have
happened had there not been the FP2020 partnership.”<o:p></o:p></div>
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Schlachter says the <a href="http://progress.familyplanning2020.org/en/measurement-section/fp2020-and-the-pace-of-progress-core-indicators-1-2-additional-users-and-mcpr">S-Curve
pattern</a> of modern contraceptive growth presented in the report is a good
way to spot opportunities for future growth. The S-Curve divides the 69
countries between 15 countries with “high prevalence and growth slowing and
leveling off,” 13 countries with “low prevalence and slow growth” and 41
countries where rapid growth can occur. It is in these 41 countries – half of
which are in sub-Saharan Africa – where rapid growth is likely to occur which
can propel us to the 120 million target.<o:p></o:p></div>
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But the international family planning community also faces
new challenges.<o:p></o:p></div>
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A <a href="https://www.kff.org/global-health-policy/report/donor-government-funding-for-family-planning-in-2016/">Kaiser
Family Foundation report</a> released in December found that donor government
funding for family planning fell in 2016 for the second year in a row, dropping
from $1.34 billion in 2015 to $1.19 billion in 2016. Much of this decrease was
due to exchange rate fluctuations and the timing of donor disbursements but 22
percent of it came from actual cuts in funding from donor countries including
the U.S. and the U.K., the two largest donors. <o:p></o:p></div>
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Related challenges have come from the Trump Administration —the
re-imposition of the <a href="https://www.kff.org/global-health-policy/fact-sheet/mexico-city-policy-explainer/">Global
Gag Rule, or the Mexico City Policy</a>, trying to cut U.S. funding for family
planning to zero and cuts in support for the U.N. Population Fund (UNFPA).<o:p></o:p></div>
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However, congressional appropriators ignored Trump’s request
to zero out international family planning and reproductive health (FP/RH) programs
in his proposed Fiscal Year (FY) 2018 budget request and so the U.S. government
is still operating at FY 2017 levels requested by the Obama Administration and
signed by the Trump Administration, according to Craig Lasher, senior fellow at
Population Action International. The House of Representatives has appropriated
$461 million and the Senate $622.5 million for FP/RH for FY 2018 but those
amounts will have to be reconciled in a final budget bill (the FY 2017
appropriated level for FP/RH was $607.5 million).<o:p></o:p></div>
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In the meantime, says Lasher, there have been a growing
number of reports of funding shortfalls at the field level in some countries
across health and development sectors.<o:p></o:p></div>
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The reinstatement and expansion of the Global Gag Rule,
which occurred on Jan. 23, 2017, <a href="https://www.devex.com/news/one-year-on-full-impact-of-global-gag-rule-begins-to-emerge-91902?utm_source=Global+Health+NOW+Main+List&utm_campaign=e6c3a6c70c-EMAIL_CAMPAIGN_2018_01_22&utm_medium=email&utm_term=0_8d0d062dbd-e6c3a6c70c-860275">is
starting to make its impact known</a>. One organization that has been
particularly hard hit is Marie Stopes International, which estimates that 2
million women it would otherwise have served will be denied sexual and
reproductive health services as a result of the order. Poor communities in
Madagascar, Zimbabwe and Uganda are already feeling the effects of the expanded
policy. The International Planned Parenthood Federation says that it stands to
lose $100 million and that its member organizations are feeling the impact in
29 countries.<o:p></o:p></div>
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The significant contribution of social marketing should also
be highlighted. In 2017, the social marketing organization DKT International
released its <a href="https://www.dktinternational.org/contraceptive-social-marketing-statistics/">annual
report on contraceptive social marketing statistics</a> showing that 97
contraceptive social marketing programs in 59 countries delivered 74.9 million
couple years of protection (CYPs) in 2016. This is 9.4 million CYPs more than
the 65.5 million CYPs generated in 2012, when FP2020 was launched. <o:p></o:p></div>
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DKT President & CEO Chris Purdy says that the focus
should be on stimulating demand for modern contraception. “I continue to
believe that the emphasis needs to be on education and behavior change,” he
said. “The supply chain will rise to meet demand, but investments to increase
uptake among women and men are needed.”<o:p></o:p></div>
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Schlachter says the key to reaching 120 million is better
alignment of resources and working together to shape ambitious and achievable
programs at the country level and getting partners to unite behind them.<o:p></o:p></div>
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<i>This </i><a href="http://www.familyplanning2020.org/articles/21700?utm_source=Global+Health+NOW+Main+List&utm_campaign=d227ce1688-EMAIL_CAMPAIGN_2018_01_10&utm_medium=email&utm_term=0_8d0d062dbd-d227ce1688-860275"><i>FP2020 press release</i></a><i> summarizes the report.</i></div>
</div>
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</div>
David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-88615018813268864692018-04-04T06:06:00.000-07:002018-04-04T06:06:09.597-07:00For global health, 2017 was a year of progress, near triumphs and threats<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-__rLH2Gd-2g/WsTMYwaEklI/AAAAAAAAD1A/m98uD3DQdwce6Ggu96P2OPYhKvrx_BEJACLcBGAs/s1600/38207-1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="799" data-original-width="1200" height="266" src="https://2.bp.blogspot.com/-__rLH2Gd-2g/WsTMYwaEklI/AAAAAAAAD1A/m98uD3DQdwce6Ggu96P2OPYhKvrx_BEJACLcBGAs/s400/38207-1.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A trained community health workers in Bangalore, India takes photos of an oral lesion with a mobile phone during an oral cancer screening. Cancer is growing everywhere in the world. Photo: Biocon Foundation, Courtesy of Photoshare.</td></tr>
</tbody></table>
<i>This was originally published on Global Health TV on Jan. 2, 2018.</i><br />
<i><br /></i>
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In looking back over my last 12 blog posts here at Global
Health TV, it is clear that 2017 was a year of progress, near triumphs and
threats to global health.<o:p></o:p></div>
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<a href="http://www.globalhealthtv.com/#/article/Dramatic-Global-Health-Improvements-Save-Lives-But-New-Threats-Emerge/">In
September</a>, I reported that great progress has been made against diseases
and health conditions that kill us (like respiratory infections, diarrhea,
neonatal preterm deaths and communicable diseases like AIDS and <a href="http://www.globalhealthtv.com/#/article/Tremendous-Progress-Against-Malaria-Seen-But-Challenges-Remain/">malaria</a>)
while new threats had emerged <span style="mso-spacerun: yes;"> </span>that are
generally less fatal — things like obesity and mental illness.<o:p></o:p></div>
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<br /></div>
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In particular, we have made progress against communicable
diseases but now face a rising tide of non-communicable diseases (NCDs) like
cancer, diabetes, hypertension and cardiovascular diseases, as <a href="http://www.globalhealthtv.com/#/article/As-Infectious-Disease-Falls-Chronic-Disease-Increases-Possible-Solutions-Emerge-/">I
wrote at the beginning of 2017</a>. <span style="mso-spacerun: yes;"> </span>Cancer
is growing almost everywhere in the world. For example, cervical cancer causes
over 500,000 new cases every year, even though vaccination, early screening and
treatment of precancerous lesions can prevent most cases.</div>
<a name='more'></a><o:p></o:p><br />
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<br /></div>
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Fortunately, more and more pharmaceutical companies are
trying to address both communicable and non-communicable diseases with
innovative access-to-medicine initiatives, and organizations like the <a href="https://accesstomedicineindex.org/">Access to Medicine Index</a> are
keeping them honest. I also learned that <a href="http://www.globalhealthtv.com/#/article/Initiatives-to-Expand-Access-To-Medicine-on-the-Rise-But-Need-Better-Evaluation/">many
access-to-medicine initiatives are poorly evaluated</a> (or not evaluated at
all) and need to do a better job of measuring the impact (or lack thereof) of
such initiatives.<o:p></o:p></div>
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<br /></div>
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After many years of annual increases in funding for global
health and development, global health progress came under threat in 2017 with
the administrations of Donald Trump in the U.S. and Theresa May in the U.K. <o:p></o:p></div>
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<br /></div>
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In May, Trump released his Fiscal Year 2018 budget request
to Congress that includes $2.5 billion in cuts to global health. At year’s end,
the fate of such cuts is still unclear, although they have plenty of opposition
in the U.S. Congress, both by Republicans and Democrats. The Kaiser Family
Foundation <a href="https://www.healthaffairs.org/do/10.1377/hblog20170726.061209/full/">predicts
dire consequences</a> if such cuts are retained.<o:p></o:p></div>
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<br /></div>
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In the UK, Penny Mordaunt, the Brexit-backing disabilities
minister, <a href="https://www.theguardian.com/politics/2017/nov/09/penny-mordaunt-replaces-priti-patel-as-international-development-secretary">was
appointed international development secretary</a> to replace Priti Patel who
resigned in November under pressure after holding unauthorized meetings with
Israeli officials. Mordaunt has said that <a href="https://www.theguardian.com/global-development/2017/nov/30/penny-mordaunt-champions-disability-rights-global-summit-london-july-2018">she
will place discrimination against disabled people</a> at the heart of her
development strategy but hasn’t said if she will recommit to having 0.7% of
national income spent on international development.<o:p></o:p></div>
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The near triumphs of 2017 are that we are still close to
eliminating both <a href="http://www.globalhealthtv.com/#/article/Polio-Vaccine-Switchover-An-Untold-Success-Story-In-Global-Public-Health/">polio</a>
(17 cases the week of Dec. 13) and Guinea worm (26 cases) but it did not happen
in 2017. Maybe 2018. <o:p></o:p></div>
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<br /></div>
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The fight against <a href="http://www.globalhealthtv.com/#/article/The-End-of-Trachoma-World%E2%80%99s-Leading-Cause-Of-Blindness-Is-in-Sight/">trachoma</a>,
the world’s leading infectious cause of blindness, continues but we are a
little further away from elimination than we are with polio and Guinea worm.
Trachoma continues to plague about 50 countries where 192 million people are at
risk, according to the Carter Center, which has set a goal of eliminating it by
2020 in Mali, Niger, Sudan, Uganda and the Amhara Region of Ethiopia where it
has programs. Several other countries may also achieve elimination by 2020. <o:p></o:p></div>
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<br /></div>
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My first blog of 2018 will be about how more women and girls
have access to modern contraception than ever before. This month, FP2020
released <a href="http://progress.familyplanning2020.org/en/introductory-material/executive-summary">its
annual report</a> showing that 309 million women and girls are now using modern
contraception in 69 FP2020 focus countries. I <a href="http://www.globalhealthtv.com/#/article/Promoting-Contraceptives-To-Adolescents-in-Mexico-Make-the-Campaigns-Fun/">told
this story from Mexico</a> where I met an NGO that has changed the way it
promotes contraceptives to young people by being less preachy and more fun.<o:p></o:p></div>
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<br /></div>
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A <a href="http://www.globalhealthtv.com/#/article/Health-Workers-Facilities-Under-Attack-in-23-Nations-UN-Accused-of-Inaction/">report
released in 2017</a> told of the appalling increase in violence perpetrated against
health workers and facilities. The extent and intensity of such violence
“remained alarmingly high,” said the report, which found that accountability
for committing such attacked remains inadequate or non-existent. The report blamed
the United Nations for failing to follow through on its own recommendations for
preventing attacks and ensuring accountability for those who commit them.<o:p></o:p></div>
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<br /></div>
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In an extreme form of task shifting, I recounted the <a href="http://www.globalhealthtv.com/#/article/Teaching-Surgery-in-Africa-Compelling-Book-Reveals-Neglected-Area-of-Health/">story
of American surgeon Dilan Ellegala</a> who went to Africa to do brain surgery
and ended up teaching lower level health cadres how to do it, an approach he
calls “train-forward,” as recounted in the book “A Surgeon in the Village: An
American Doctor Teaches Brain Surgery in Africa.” The book highlighted the
larger problem of a lack of surgeons in low- and middle-income countries.<o:p></o:p></div>
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And to end on a happy note, I was delighted to tell <a href="http://www.globalhealthtv.com/#/article/Suelen-and-Her-Family-A-Brazil-Child-Health-Success-Story/">the
story of Suelen</a>, a black Brazilian woman who fought her way out of extreme
poverty and now has a thriving food truck business and is going to law school
so that she can defend the rights of other black women who are being oppressed.
What’s the link with global health? She got on the track to success after her
infant daughter came down with pneumonia and asthma and found treatment in a
child health program run by Saúde Criança (Child Health). That’s a good place
to end 2017.<o:p></o:p></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-29976945508149851022018-04-02T06:05:00.001-07:002018-04-02T06:06:46.997-07:00Polio vaccine switchover: An untold success story in global health<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-vWxgYwxlaV8/WsIpewVHk6I/AAAAAAAAD0g/83M34PxCrVwY_XlmIADDmKCtGb9pYmv9wCLcBGAs/s1600/Latis%2Bat%2Bpolio%2Bcenter.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="768" data-original-width="1024" height="300" src="https://3.bp.blogspot.com/-vWxgYwxlaV8/WsIpewVHk6I/AAAAAAAAD0g/83M34PxCrVwY_XlmIADDmKCtGb9pYmv9wCLcBGAs/s400/Latis%2Bat%2Bpolio%2Bcenter.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Syed Latif, a polio vaccinator and activist, hands out polio information at the Mansehra Polio Resource Center in Mansehra, Khyber Pakhtunkhwa Province of Pakistan. Photo: Mansehra Polion Research Center.</td></tr>
</tbody></table>
<i>This was originally published on Global Health TV on November 28, 2017.</i><br />
<i><br /></i>
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In April 2016, something extraordinary happened in global
health. Thousands of community health workers in more than 120 countries — from
African villages to the Himalayas to the Pacific Islands — all mobilized and
synchronized their efforts to switch from one oral polio vaccine to another.
Any slip-ups could have resulted in creating more “vaccine-derived” poliovirus
cases at a moment when we are down to our last few cases of polio.<o:p></o:p></div>
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The fact that many children receiving such oral vaccines were
living in areas of high conflict and low development (which means low levels of
health infrastructure) made the accomplishment all the more remarkable.<o:p></o:p></div>
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The feat was accomplished in a single day (each country was
told to pick one day within a two-week period in April 2016 to make the change).<o:p></o:p></div>
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The story of this amazing <a href="http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/oral_polio_vaccine/en/">synchronized
switch</a> constitutes an untold global health success story and can be told
with the backdrop of the <a href="http://polioeradication.org/polio-today/polio-now/this-week/">current
number of wild poliovirus type 1 cases</a> down to only 15 — 10 in Afghanistan
and 5 in <a href="https://www.devex.com/news/how-pakistan-got-to-near-zero-on-polio-91521">Pakistan</a>.
The polio eradication community had hoped that we would be down to zero by 2017.
Now they are hoping it will happen in 2018.</div>
<a name='more'></a><o:p></o:p><br />
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“It was a great achievement, especially when you understand
the scope, because it happened in more than 120 countries,” said Joël Calmet,
senior director of communication for polio of Sanofi Pasteur, a pharmaceutical
company which produces 500 million polio vaccines annually. “I was surprised by
two things – the fact that it went well almost everywhere and the fact that no
poliovirus type 2 has been detected following the removal of the outdated
trivalent oral vaccine.”<o:p></o:p></div>
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The Polio Eradication and Endgame Strategic Plan 2013-2018,
approved by the World Health Organization (WHO) in 2013, calls for the <a href="http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/oral_polio_vaccine/OPVswitch-briefing-note-Feb2015.pdf?ua=1">removal
of all oral polio vaccines (OPVs)</a> by 2019-2020, including the trivalent OPV
(which protects against three strains of poliovirus) that was replaced in April
2016 and the bivalent OPV (which protects against two strains) now being used. <o:p></o:p></div>
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Eventually, the bivalent OPV will be replaced by an
injectable polio vaccine. Until polio is eradicated, using both injectable and
oral vaccines provide the best form of protection, according to the Polio
Global Eradication Initiative. But by 2019-2010, the plan is to use only the
injectable vaccine.<o:p></o:p></div>
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The obsolete trivalent OPV contained all three poliovirus
serotypes (1, 2 and 3) and led to the eradication of wild poliovirus 2 in 1999.
The last detected case of wild polio virus 3 was in 2012. Now we are down to
the last 15 cases of wild poliovirus 1 and those last few cases are proving the
most difficult to eliminate. Even after wild poliovirus 1 is “eliminated,”
three more years will be required before WHO can verify that it has been
“eradicated.”<o:p></o:p></div>
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When that happens, it will be only the second human disease
ever eradicated, after smallpox, which was declared eradicated in 1980.<span style="mso-spacerun: yes;"> </span>Guinea worm is also close to eradication with
<a href="https://www.cartercenter.org/resources/gallery/images/highres/guinea-worm-current-case-count-by-country-chart.pdf">the
Carter Center reporting</a> only 26 cases reported in 2017 in Chad and
Ethiopia.<o:p></o:p></div>
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There are also 80 cases of circulating vaccine-derived polio
virus cases – 70 in Syria and 10 in the Democratic Republic of Congo – but
these are believed by WHO to be “ancient strains” and not related to the
switchover in OPVs, according to Calmet.<o:p></o:p></div>
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Frank Conlon, director of the Core Group Polio Project,
recalls the destruction of the poliovirus type 2 in Kenya. “<span style="background: white; color: #222222;">I was one of the honored guests last year at
the Kenya Medical Research Institute laboratory to witness the destruction of
their final stocks of Type 2 poliovirus that were contained in the laboratory.
It was a big event for Kenya, and it was widely attended by the press.”<o:p></o:p></span></div>
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<span style="background: white; color: #222222;">The Bill
& Melinda Gates Foundation, which has been a key player in the polio
eradication effort, is now looking into the future to see how lessons learned
from polio eradication can be be applied to other diseases. To that end, </span><a href="https://www.devex.com/news/exclusive-the-gates-foundation-picks-a-partner-to-share-lessons-learned-from-polio-eradication-91535?mkt_tok=eyJpIjoiT1dNNU9EWTVZV0ZrTXpGaCIsInQiOiJlTXhQdFwvM2FOc0JcL0xQeWpmK2VhdTRkR1JMeHAwQ2xPRGxjdnlSejhNU3pDYkwyeE1Cc21"><span style="background: white; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">the Foundation has just awarded the Johns Hopkins Bloomberg
School of Public Health with a $3.7 million grant</span></a><span style="background: white; color: #222222;"> “to capture the lessons learned from polio
eradication and prevent this knowledge from being lost, so that systems and
strategies can be repurposed, not recreated.” </span><span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="header"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footer"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="35" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="line number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="page number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of authorities"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="macro"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
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<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
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<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
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<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
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<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
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<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
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<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
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<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
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<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-77347139312947819112018-03-31T14:37:00.000-07:002018-03-31T14:39:27.492-07:00Suelen and her family: A Brazil child health success story<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-YybbC9HF6RM/Wr_-nuXzT7I/AAAAAAAAD0E/8IfK-VI2yJEHGyjr_ZV0L65bDCFMhRPhACLcBGAs/s1600/PA250628.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="300" src="https://1.bp.blogspot.com/-YybbC9HF6RM/Wr_-nuXzT7I/AAAAAAAAD0E/8IfK-VI2yJEHGyjr_ZV0L65bDCFMhRPhACLcBGAs/s400/PA250628.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ricardo, Ana Luiza, Suelen and Luis Ricardo in their newly renovated home in Nova Iguaçu, Brazil. Ana Luiza has a successful food truck and is going to law school but still doesn't feel middle class. Photo: David J. Olson</td></tr>
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<i>This was originally published on Global Health TV on October 31, 2017.</i><br />
<i><br /></i>
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NOVA IGUAÇU, Rio de Janeiro State, Brazil — In 2012, Suelen
hit rock bottom. <span style="color: #1d2129; letter-spacing: -0.1pt;">She
was living in extreme poverty with her husband and young son in a dilapidated
house with a roof that was leaking water. While she was pregnant with her
second child, her husband left her. When that child, Ana Luiza, was born, she
was sick with pneumonia and asthma. <o:p></o:p></span></div>
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<br /></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">Suelen
was at her wit’s end. Every day was a struggle. She made a living selling
empanadas out of a canvas tent here in this city of 800,000 about 40 minutes
from downtown Rio de Janeiro. “I was working all the time every day just to pay
for food for the next day,” said Suelen. “I didn’t think about the future, just
how I was going to eat tomorrow.”<o:p></o:p></span></div>
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<br /></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">Today,
the situation of the family is the reverse of what it was five years ago. The
health and wealth of the family is thriving. They have a highly successful food
truck (that is expanding to home delivery). The children are going to good
schools. And Suelen is going to law school so she can defend the rights of
other black women who are being oppressed.</span></div>
<a name='more'></a><br /><o:p></o:p>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">The
moment when it all turned around for Suelen was during one of her daughter’s
visits to Lagoa Federal Hospital in Rio, when she came into contact with </span><a href="http://www.saudecrianca.org.br/en/"><span style="letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "\.SFNSText-Regular";">Associação Saúde Crianća</span></a><span style="color: #1d2129; letter-spacing: -0.1pt;"> (Child Health Association), a social organization that
has improved the lives of 70,000 people in the poorest families in Brazil since
it was founded in 1991. It has been named one of the </span><a href="http://www.saudecrianca.org.br/en/novidades/saude-crianca-e-uma-das-100-melhores-ongs-do-brasil/"><span style="letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "\.SFNSText-Regular";">best NGOs in Brazil</span></a><span style="color: #1d2129; letter-spacing: -0.1pt;">, and one of the </span><a href="http://www.saudecrianca.org.br/en/novidades/saude-crianca-e-eleita-uma-das-ongs-mais-influentes-do-mundo/"><span style="letter-spacing: -.1pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "\.SFNSText-Regular";">500 best NGOs in the world</span></a><span style="color: #1d2129; letter-spacing: -0.1pt;">.<o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">Through
12 hospitals in Brazil, Saùde Criança identifies unhealthy children and their
families living below the poverty line. They are interviewed and assessed.
Based on this information, a family action plan is developed with objectives
and indicators in five major areas – health, citizenship, housing, education
and family income. The program offers direct assistance, technical support,
professional training and citizenship support (with lawyers assisting with
issues such as obtaining identity cards, divorces, government benefits, etc.).<o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">Every
month, the mothers come to Saùde Criança’s offices for evaluations to check on
the progress of the families against their plans. Saùde Criança assists the
families for around two years, the amount of time deemed necessary to solve the
families’ major problems and to set them on a sustainable path. Sometimes, such
as in the case of Suelen, more time is needed.<o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">Saùde
Criança has diversified funding that doesn’t permit it to become too dependent
on one or two donors. About 54 percent of its funding comes from Brazilian and
international companies such as Praxair Foundation, Johnson & Johnson and
Repsol Sinopec Brasil as well as social entrepreneur organizations like Ashoka,
the Skoll Foundation and Schwab Foundation for Social Entrepreneurship. The
other 46 percent comes from individual donations.<o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">That
encounter at Lagoa Hospital changed everything for Suelen and her family. Her
husband Ricardo came back and has become an important part of the family. Ana
Luiza’s health problems have been stabilized. <o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">The
family’s desperate financial situation has turned around. Suelen took Saúde
Criança’s cooking course and bought a trailer, which she used to sell her food
close to home. Later, with the help of Saúde Criança, she upgraded to a food
truck. Recently, Suelen and Ricardo bought a motorcycle to initiate home food
deliveries. She benefited from training in bookkeeping and marketing.<o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">Saúde
Criança’s housing program repaired the leaking roof, which was contributing to
Ana Luiza’s poor health. With help from the family and their relatives, a
second floor was added with one bedroom for the parents and one for the
children (previously, the parents had been sleeping in the living room, with
the children next to them on a mattress on the floor). <o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">“The
most important thing to me is that my daughter’s health has stabilized,” says
Suelen. “Today I can live and stand on my own two feet, because Ana made it.”<o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">They
now have a beautiful house and appear to have arrived in the middle class. But
when I asked them if they feel middle class, they laughed and said “No, we want
to accomplish more.” They have escaped extreme poverty, they say, but are still
poor. For one thing, they want to own their own home.<o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">Suelen
and Ana Luiza graduated from Saúde Crianca earlier this year so the family is
now on their own. Ana Luiza attends the Instituto Nacional Santo Antônio, one
of the best schools in Nova Iguaçu, where she has a 100% scholarship.<o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">Even
though the food truck is a huge success and provides a good income for the
family, Suelen wanted more. So she applied, and was accepted, into law school,
with a 70% scholarship. <o:p></o:p></span></div>
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<br /></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">“Much
of my motivation comes from the fact that as a black woman in Brazil, I have
been suffering from prejudice all of my life,” she says. “And I have seen black
friends suffering prejudice and who fought back, because they had the
knowledge. I wanted to do this, too, because I am a black woman with black
children and I want a better world for them.”<br />
<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">Though
the family is prospering, their new lifestyle demands a lot of Suelen and
Ricardo. They have to get up early to get the children off to school. Then they
are preparing the food truck and operating it from early evening until early in
the morning. They get to bed at 3 am, and then get up and start all over again.
Suelen goes to law school four days a week.<o:p></o:p></span></div>
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<span style="color: #1d2129; letter-spacing: -0.1pt;">Luis
Ricardo, the 10-year-old son, says that other people can’t believe how hard
they all work to achieve their new-found success. They tell him their family
are brave fighters.<o:p></o:p></span></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-91736676407633141962018-03-30T07:29:00.001-07:002018-03-30T07:29:40.186-07:0010 lessons we've learned from AIDS that we can apply to chronic diseases<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-u4tALup6yoc/Wr5HrbN6yoI/AAAAAAAADzU/PLvZI0ARjIIrL8iMq8FJddzKe0WZgUwHwCEwYBhgL/s1600/Yaounde%25CC%2581%2B%2528Cameroon%2529%252C%2B12%2BSeptember%2B2017.%2BAn%2Bassistant%2Btaking%2Ba%2Bblood%2Bsample%2Bat%2Bthe%2BEtoug-Ebe%2BBaptist%2Bhospital%252C%2Ba%2Bsubsidiary%2Bof%2Bthe%2BCameroon%2BBaptist%2BConvention%2BHealth%2BServices.%25C2%25A9Anne%2BMireille%2BNzouankeu.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="900" data-original-width="1600" height="225" src="https://1.bp.blogspot.com/-u4tALup6yoc/Wr5HrbN6yoI/AAAAAAAADzU/PLvZI0ARjIIrL8iMq8FJddzKe0WZgUwHwCEwYBhgL/s400/Yaounde%25CC%2581%2B%2528Cameroon%2529%252C%2B12%2BSeptember%2B2017.%2BAn%2Bassistant%2Btaking%2Ba%2Bblood%2Bsample%2Bat%2Bthe%2BEtoug-Ebe%2BBaptist%2Bhospital%252C%2Ba%2Bsubsidiary%2Bof%2Bthe%2BCameroon%2BBaptist%2BConvention%2BHealth%2BServices.%25C2%25A9Anne%2BMireille%2BNzouankeu.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">An assistant at the Etoug-Ebe Baptist Hospital, a subsidiary of the Cameroon Baptist Convention Health Services, takes a blood sample of a patient participating in the Novartis Access program to fight non-communicable disease. Photo: Anne Mireille Nzouanekeu</td></tr>
</tbody></table>
<br />
<i>This was originally published on the Huffington Post on October 30, 2017.</i><br />
<i><br /></i>
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Communicable diseases like HIV/AIDS and malaria have taken a
terrible toll on Kenya and other African countries over the last 20 years. In
2010, <a href="https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/kenya">an
estimated 51,000 Kenyans died from AIDS</a> but that number has declined
steadily, to 36,000 in 2016. Kenya is now considered <a href="http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2016/may/20160531_Global-AIDS-Update-2016">an
HIV success story</a>. The same is true in many other countries.<o:p></o:p></div>
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Now there is a new epidemic of non-communicable diseases (NCDs)
that is rising just as the world is starting to get a handle on communicable
diseases, according to the Institute for Health Metrics and Evaluation. <a href="http://www.healthdata.org/news-release/new-global-study-finds-countries-saving-more-lives-despite-%E2%80%98triad-troubles%E2%80%99-obesity">The
Institute reports</a> that the largest contributors to the loss of healthy life
are now high blood pressure, smoking, high blood sugar and <a href="https://www.nytimes.com/2017/10/02/health/ghana-kfc-obesity.html?_r=1&utm_content=buffer36267&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer">excess
body weight</a>.<o:p></o:p></div>
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But <a href="https://www.huffingtonpost.com/entry/a-christian-warrior-for-h_b_10484034.html">Dr.
Samuel Mwenda</a>, who knows a thing or two about both epidemics, believes
there are lessons we have learned in the fight against communicable diseases
that can now be applied to NCDs. Mwenda is general secretary and CEO of the
Christian Health Association of Kenya (CHAK), a network of Protestant health
facilities in Kenya. CHAK now supports 46,000 people living with HIV with
antiretroviral therapy, representing about 9 percent of the total number of patients
nationally. <o:p></o:p></div>
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In 2015, CHAK turned its attention to NCDs: With the support
of <a href="https://www.novartis.com/about-us/corporate-responsibility/expanding-access-healthcare/novartis-social-business/novartis-access">Novartis
Access</a>, it began offering a portfolio of 15 products to treat
cardiovascular disease, diabetes, respiratory illness and breast cancer at a
price to governments, NGOs and other institutional customers not to exceed
$1.00 per treatment per month. Since then, Novartis Access has also started working
in Cameroon, Ethiopia, Pakistan, Rwanda and Uganda.</div>
<a name='more'></a><o:p></o:p><br />
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Here are ten of the lessons Mwenda says CHAK and other
organizations have learned from communicable disease can also be applied to NCDs:</div>
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</div>
<ol style="text-align: left;">
<li><b><span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Create partnerships:
</span></b><span style="color: #222222;">Partnerships are key.<b> </b>CHAK
works with </span><span style="color: #222222;">national and local governments, plus
the private sector, academia, professional bodies and supply chain
organizations.</span></li>
<li><b><span style="color: #222222; mso-bidi-font-family: Arial;">Mobilize and increase
awareness:</span></b><span style="color: #222222;"> We
must highlight lifestyle issues such as exposure to smoking and poor diet just
like we did with HIV, TB and malaria. Once people are aware, provide screening
to identify those with high blood pressure and abnormal blood sugars.</span></li>
<li><b><span style="color: #222222; mso-bidi-font-family: Arial;">Refer patients:</span></b><span style="color: #222222;"> Once you have flagged people,
they must be linked with health facilities where they can get further
assessment, diagnosis and care and treatment plans. </span></li>
<li><b><span style="color: #222222; mso-bidi-font-family: Arial;">Make treatment
available</span></b><span style="color: #222222;">:
It’s imperative to have a reliable source of treatment. People will come to the
facilities when they know they will get good quality medication. Novartis plays
the key role in ensuring there are no stock-outs.</span></li>
<li><b><span style="color: #222222; mso-bidi-font-family: Arial;">Foster psycho-social
support: </span></b><span style="color: #222222;">In
diabetes, CHAK started working with the Kenya Defeat Diabetes Association to
mobilize people living with diabetes, helping them form groups for education,
encouragement and advocacy.</span></li>
<li><b><span style="color: #222222; mso-bidi-font-family: Arial;">Work with faith groups and
communities:</span></b><span style="color: #222222;"> In
rolling out screening, CHAK links health facilities with churches and
communities. This has helped CHAK reach many people at very little cost.</span></li>
<li><b><span style="color: #222222; mso-bidi-font-family: Arial;">Understand it’s a lifelong
commitment:</span></b><span style="color: #222222;"> We
need to commit to taking care of people their entire lives to ensure retention.
As in HIV, this requires a lot of hard work in terms of following up to ensure
that people come back for treatment.</span></li>
<li><b><span style="color: #222222; mso-bidi-font-family: Arial;">Train health providers</span></b><span style="color: #222222;">: Lower level health cadres
like nurses and clinical officers must be trained so they are able to handle
diagnosis and treatment of NCDs.</span></li>
<li><b><span style="color: #222222; mso-bidi-font-family: Arial;">Emphasize integration:</span></b><span style="color: #222222;"> It’s important to
integrate because those with communicable diseases are vulnerable to NCDs and
we have begun to screen for hypertension and cervical cancer in HIV programs.</span></li>
<li><b><span style="color: #222222; mso-bidi-font-family: Arial;">Prioritize data</span></b><span style="color: #222222;">: It’s very important to
maintain data so we can track the magnitude of the burden and also inform
policy and advocate for allocation of resources.</span></li>
</ol>
<br />
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Similarly, Novartis’s work in malaria prompted the company
to go into NCDs. “Our work in malaria gave us the experience where we could
build on the lessons learned,” says Dr. Nathan Mulure, cluster head for
Novartis Social Business for East and Southern Africa. “We brought out a
product that was only reaching 100,000 treatments per year and increased that
to 100 million treatments. We figured that kind of scaling gave us the
experience we needed to try the same thing with NCDs.” <o:p></o:p></div>
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<br /></div>
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<span style="background: white; color: #500050; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">"At ministries of
health, I am often asked ‘Why are you doing this? What’s in it for Novartis?
Are you sure you’re not hiding anything?’ and I always tell them ‘There is
nothing hidden. This is a social business model, with low profit, but high
turnover, which will help the program to sustain itself over the long term. We
hope that if it catches fire, then many more patients will be able to access
high quality medicines at prices they can afford."</span><span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<br /></div>
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<i style="mso-bidi-font-style: normal;">This article was
developed from a session at the 2017 Conference of </i><a href="http://www.ccih.org/"><i style="mso-bidi-font-style: normal;">Christian
Connections for International Health</i></a><i style="mso-bidi-font-style: normal;">
on “Lessons from HIV and Malaria for Faith-Based Organizations in Africa’s
Transition to Managing NCDs.”<o:p></o:p></i></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Mention"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-72441272440210038692018-03-29T05:47:00.000-07:002018-03-29T05:49:12.047-07:00Dramatic global health improvements save lives but new threats emerge<div dir="ltr" style="text-align: left;" trbidi="on">
<i>This was originally published on the Global Health TV on September 26, 2017.</i><br />
<br />
Over the last decade, we’ve made great progress against
diseases and health conditions that can kill people, especially children under
5, but because of political and budget challenges, we risk backsliding on those
gains. And we’re facing a tsunami from health issues that do not always kills
us – namely, obesity, conflict and mental illness – but cause poor health.<br />
<div class="MsoNormal">
<o:p></o:p></div>
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<br /></div>
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Those are my take-aways from two major reports that came out
this month, one tracking how we are doing against the Sustainability
Development Goals, particularly in global health, and the other a scientific
study focused solely on global health.<o:p></o:p></div>
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<br /></div>
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<span style="background: white; color: #333333;">“Goalkeepers: The Stories Behind the Data 2017,”
a<span class="apple-converted-space"> </span></span><a href="http://www.globalgoals.org/goalkeepers/datareport/" title="Goalkeepers report"><span style="color: #326891; mso-fareast-font-family: "Times New Roman";">report</span></a><span class="apple-converted-space"><span style="background: white; color: #333333;"> from
the Bill & Melinda Gates Foundation, was aimed at last week’s </span></span><span style="background: white; color: #333333;">United
Nations General Assembly. To draw attention to the report, the Gateses held a
high-profile event featuring </span><a href="https://www.youtube.com/watch?v=kDU_9Ms9-Sw&feature=youtu.be"><span style="background: white; mso-fareast-font-family: "Times New Roman";">former
President Barack Obama</span></a><span style="background: white; color: #333333;">. The report touts the many global health
advances that have been made but also cautions about the risks of complacency.</span></div>
<a name='more'></a><o:p></o:p><br />
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<br /></div>
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The Goalkeepers report plans to track 18 data points in the
Sustainability Development Goals every year until 2030. The Gateses say their
goal is “to accelerate progress by diagnosing urgent problems, identifying
solutions, measuring results and spreading best practices.” <o:p></o:p></div>
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<br /></div>
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“Candidly, we are unlikely to reach every target – some are
more realistic and some are more aspirational – but that doesn’t absolve us of
the responsibility to get as close as we can,” write the Gateses.<o:p></o:p></div>
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<br /></div>
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The other report, the annual Global Burden of Disease (GBD)
Study 2016, found that substantial progress has been made in driving down death
rates from diseases and health conditions like lower respiratory infections,
diarrhea, neonatal preterm birth, HIV/AIDS and malaria, which all declined by
30% or more in just ten years, <a href="http://www.healthdata.org/news-release/new-global-study-finds-countries-saving-more-lives-despite-%E2%80%98triad-troubles%E2%80%99-obesity">according
to the Institute for Health Metrics and Evaluation</a><span class="MsoHyperlink">
(IHME)</span> which coordinated this year’s study.<o:p></o:p></div>
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<br /></div>
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<span style="color: black; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: text1;">“Death
is a powerful motivator, both for individuals and for countries, to address
diseases that have been killing us at high rates,” said Dr. Christopher Murray,
IHME director. “But, we’ve been much less motivated to address issues leading
to illnesses. A triad of troubles – obesity, conflict, and mental illness,
including substance use disorders – poses a stubborn and persistent barrier to
active and vigorous lifestyles.”<o:p></o:p></span></div>
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<br /></div>
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The Gateses highlight excellent global health and
development news in Gatekeepers:</div>
<div class="MsoNormal">
</div>
<ul style="text-align: left;">
<li><span style="text-indent: -0.25in;">The number of people living in extreme poverty (less
than US $1.90/day) has declined from 35% in 1990 to 9% in 2016, with many of
these decreases in China and India.</span></li>
<li><span style="text-indent: -0.25in;">After peaking in 2005, global HIV deaths per
1,000 people dropped dramatically from 0.3 deaths per 1,000 people to 0.14.</span></li>
<li><span style="text-indent: -0.25in;">The number of children under 5 dying dropped
from 11.2 million in 1990 to 5 million in 2016.</span></li>
<li><span style="text-indent: -0.25in;">300 million women now have access to contraception</span></li>
</ul>
<br />
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The <a href="http://www.globalgoals.org/goalkeepers/datareport/case-studies/hiv">fight
against HIV</a> is increasingly seen as a global health success story. “2005
was when the world made the commitment to get low-cost drugs out to as many
people as possible and something wondrous took place,” Bill Gates said at the
event with Barack Obama. “The number of AIDS deaths came down dramatically. We
had funding, we had commitments, we had people thinking about how to get those
drugs out there. But now there really is a risk that the death rate could go
back up. So we are challenged to maintain the funding.”<o:p></o:p></div>
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<br /></div>
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<a href="http://www.globalgoals.org/goalkeepers/datareport/case-studies/child-mortality">Child
health</a> is another bright spot. In 2016, for the first time in modern
history, fewer than 5 million children under age 5 died in one year<span style="font-size: 11.0pt;">. </span><span style="color: black; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: text1;">Researchers
attribute this accomplishment to a variety of factors </span>–<span style="color: black; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: text1;"> improvements in education of mothers, rising
per capita incomes, declining fertility, increased vaccination, mass
distribution of insecticide-treated bed nets, improved water and sanitation and
other factors. But if we regress, says the report, we will lose an additional
800,000 children under 5 per year by 2030.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="color: black; mso-themecolor: text1;">The “triad of
trouble” cited in the GBD Study 2016 points to the growing and pernicious
effects of non-communicable diseases (NCDs) in developing countries.</span></div>
<div class="MsoNormal">
</div>
<ul style="text-align: left;">
<li><b style="text-indent: -0.25in;">Obesity:</b><span style="text-indent: -0.25in;"> The
rate of illness related to people weighing too much is rising quickly. High
body mass index is the fourth contributor to the loss of health life (after
high blood pressure, smoking and high blood sugar).</span></li>
<li><b style="text-indent: -0.25in;">Conflict:</b><span style="text-indent: -0.25in;"> Deaths over the past decade due to
conflict and terrorism have more than doubled. Last week at the UN General
Assembly, </span><span style="text-indent: -0.25in;">Secretary-General
Antonio Guterres and World Bank President Jim Yong Kim launched</span><span style="background-color: white; text-indent: -0.25in;"> a report calling for greater political and
financial commitments to prevent conflict. The bank and the U.N. are focusing
on mitigating famine conditions in South Sudan, Yemen, Somalia and Nigeria.</span></li>
<li><b style="text-indent: -0.25in;">Mental illness and substance abuse: </b><span style="text-indent: -0.25in;">These disorders continue to contribute to the loss of
healthy life in 2016, affecting both rich and poor countries. Treatment rates
remain low and even in rich countries, prevalence of the most common disorders
has not changed.</span></li>
</ul>
<br />
<div class="MsoNormal">
<span style="color: black; mso-themecolor: text1;">The study
found much other evidence on the growing impact of NCDs including the fact that
NCDs were responsible for 72% of all deaths worldwide in 2016, as compared to
only 58% in 1990. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<i style="mso-bidi-font-style: normal;">The full Gatekeepers
report can be found </i><a href="http://www.globalgoals.org/goalkeepers/datareport/assets/downloads/Stories_behind_the_data_2017.pdf"><i style="mso-bidi-font-style: normal;">here</i></a><i style="mso-bidi-font-style: normal;">. The Global Burden of Disease 2016 study was published in </i><a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32336-X/fulltext"><i style="mso-bidi-font-style: normal;">The Lancet</i></a><i style="mso-bidi-font-style: normal;">. <o:p></o:p></i></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-70611721099950400622018-03-28T06:42:00.001-07:002018-03-28T06:42:34.465-07:00Initiatives to expand access to medicine on the rise, but need better evaluation<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-WIqWznVkHec/WruaiuJMpMI/AAAAAAAADyw/ttdk4WVOwes1Ct5hz1B8aIVCMPt3h6LsACLcBGAs/s1600/Kenya%2Bmedicines.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="900" data-original-width="1200" height="300" src="https://2.bp.blogspot.com/-WIqWznVkHec/WruaiuJMpMI/AAAAAAAADyw/ttdk4WVOwes1Ct5hz1B8aIVCMPt3h6LsACLcBGAs/s400/Kenya%2Bmedicines.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">In Nairobi, Kenya, parents receive prescription medicines for their children as part of a free medical camp operated by Slums Information Development & Resources Centers. Photo: George Onyango, Courtesy of Photoshare</td></tr>
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<br />
<i>This was originally published on Global Health TV on August 31, 2018.</i><br />
<i><br /></i>
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In the 1990s and 2000s, AIDS activists and other global
health advocates started pressuring pharmaceutical companies to share their
largesse with low- and middle-income countries (LMICs) by supplying critical
medicines for free or at subsidized prices, especially for HIV/AIDS. The
pressure was successful, and led to a series of access-to-medicine (AtM)
initiatives. <o:p></o:p></div>
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<br /></div>
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The international community increasingly recognizes that the
pharmaceutical industry must play a leading role in improving access to
medicines. And apparently pharma companies themselves also acknowledge this
responsibility, according to a study <a href="http://content.healthaffairs.org/gca?allch=&submit=Go&gca=healthaff%3B36%2F4%2F706">published
in Health Affairs</a> by a team of researchers at Boston University Department
of Global Health. That study found that the number of these initiatives grew from
17 in 2000 to 102 in 2015. The researchers called this “clear evidence” that
pharmaceutical companies had responded to calls to increase their commitment to
improving access to medicines.</div>
<a name='more'></a><o:p></o:p><br />
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The industry’s role was first articulated when the
Millennium Development Goals (MDGs) were drafted in 2015. Goal 8, Target 8E read:
“In cooperation with pharmaceutical companies, provide access to affordable,
essential drugs in developing countries.”<o:p></o:p></div>
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The Sustainability Development Goals, which replaced the
MDGs in 2016, further enshrined that idea in Goal 3.8 which aims to “achieve
universal health coverage, including financial risk protection, access to
quality essential health care services and access to safe, effective, quality
and affordable essential medicines and vaccines for all.”<o:p></o:p></div>
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The Health Affairs study identified 385 health initiatives
across 21 companies. Of these, 120 were categorized as AtM initiatives.
Novartis was first with 14 initiatives, Sanofi was second with 13 and Roche was
third with 10 (21 were multi-company partnerships).<o:p></o:p></div>
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Eighty-eight percent of these initiatives focused on infectious
disease (including HIV and neglected tropical diseases), 52 percent addressed
non-communicable disease and 33 percent focused on maternal and child health
(some initiatives focused on multiple health areas).<o:p></o:p></div>
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The <a href="https://accesstomedicinefoundation.org/">Access
to Medicine Foundation</a>, funded by the Bill & Melinda Gates Foundation
and the UK and Dutch governments, compiles an index on the progress made by
pharma companies to make their medicines accessible. Every two years since
2008, the Foundation has published the <a href="http://accesstomedicineindex.org/">Access to Medicine Index</a>. In 2016,
Glaxo Smith Kline, Johnson & Johnson and Novartis were named as the leading
companies. <o:p></o:p></div>
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<span style="color: #434343; mso-bidi-font-family: OpenSans;">The
Health Affairs article says the index has created an incentive for expanding
AtM initiatives, as well as for more transparent reporting. But it also says
that the index’s ranking methodology does not include a rigorous review of the
evidence and should be improved to hold companies more accountable. <o:p></o:p></span></div>
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The Boston University researchers found that few of these
initiatives evaluate their activities well. Of the 102 AtM initiatives
identified, the researchers found published evaluations for only seven. From
those seven, the researchers found 47 articles that met their inclusion
criteria but determined that 62 percent of these were low quality, 32 percent
were very low quality and 6 percent were moderate quality. None of them were
rated high quality.<o:p></o:p></div>
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“Overall, our findings suggest that current efforts to
evaluate the impact of industry-led access-to-medicines initiatives are
inadequate,” they write.<o:p></o:p></div>
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Boston University is now monitoring and evaluating an AtM
initiative in Kenya to address these concerns. The initiative, called <a href="https://www.novartis.com/about-us/corporate-responsibility/expanding-access-healthcare/novartis-access">Novartis
Access</a>, seeks to provide 15 medicines to address breast cancer,
cardiovascular disease, type 2 diabetes and respiratory illnesses at a cost of
USD $1 per treatment per month. The project started in Kenya in 2015 and plans
to expand to 30 countries in coming years. Novartis Access hopes to reach 20
million people per year by 2020.<o:p></o:p></div>
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From the beginning, Novartis Access sought the help of
Boston University to evaluate its impact and the prices of these medicines at
health facilities and households in Kenya in an objective and transparent
manner. Novartis has no control over the evaluation process and Boston
University publishes protocols, agreements and all the results on <a href="http://sites.bu.edu/evaluatingaccess-novartisaccess/">this website</a>.<o:p></o:p></div>
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“One things we know about programs offering low-priced
products – not just medicines but also food or fuel – is that it’s often not
the poorest people who benefit, but the middle-income groups who know how to
access the medicines and appropriate treatment,” <a href="https://www.novartis.com/stories/global-impact/novartis-invites-scrutiny-of-effort-to-improve-access-to-medicine">said
Richard Laing</a>, a professor at Boston University who is involved in the
evaluation. “For that reason, we’re very keen to find out what happens at the
household level, particularly to the poorest families.”<o:p></o:p></div>
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Laing said this evaluation is different because past efforts
to measure the impact of AtM programs have almost always occurred after the
fact: “The problem with these evaluations is that you don’t know what the
situation was like before, and there is often no control group, so the
evaluations have tended to be weak even when the best interventions have take
place.”<o:p></o:p></div>
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<span style="background: white; color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">The Access to
Medicine Foundation welcomes additional efforts to evaluate the impact of
access to medicine programs, said Danny Edwards, research program manager for
the foundation.<o:p></o:p></span></div>
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<span style="background: white; color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">“We've noticed an
increasing orientation of companies in this direction over recent years, from
University College London's independent evaluation of Novo Nordisk's Base of
the Pyramid Program, to Novartis Access, to the explicit commitment of companies
participating in Access Accelerated to evaluate and share the impact of the
work taking place under that umbrella, which includes Boston University, Union
of International Cancer Control and the World Bank."<o:p></o:p></span></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-1452517759072425882018-03-27T05:50:00.000-07:002018-03-27T05:50:23.587-07:00Most access-to-medicine initiatives are poorly evaluated but moves are afoot to change that<div dir="ltr" style="text-align: left;" trbidi="on">
<i>This was originally published on The Lancet Global Health Blog on August 11, 2017.</i><div>
<i><br /></i></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="macro"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
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<div class="MsoNormal">
Two decades ago the World Health Organization and health
activists were pressuring global pharmaceutical companies to launch more
“access-to-medicine” (AtM) initiatives in low- and middle-income countries. The
good news: That has started to happen. The bad news: Startlingly few of these
initiatives have any idea what kind of impact they are making.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Those are some of the conclusions of a new study, <a href="http://content.healthaffairs.org/gca?allch=&submit=Go&gca=healthaff%3B36%2F4%2F706">published
in Health Affairs</a> in April. A team of researchers associated with the
Boston University Department of Global Health discovered that the number of AtM
initiatives from 21 companies had grown from 17 in 2000 to 102 in 2015 but they
found published evaluations for only seven of them.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
From those seven evaluations, the researchers found 47
articles that met their inclusion criteria for evidence, and all of them were
published in peer-reviewed journals. They determined that 62 percent of these
were low quality, 32 percent were very low quality and 6 percent were moderate
quality. None of them were rated high quality.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The bottom line of the study: “Overall, our findings suggest
that current efforts to evaluate the impact of industry-led access-to-medicines
initiatives are inadequate.”</div>
<a name='more'></a><o:p></o:p><br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The researchers found “clear evidence” that pharmaceutical
companies had responded to calls that they increase their commitment to
improving access to medicines. But they also found that “the processes that
companies use to determine initiative strategies and set priorities are not
transparent, which raises questions about whether the resources involved are
being allocated in line with the countries’ national priorities.”<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But Boston University is not just identifying a problem, it
is also leading the way for a possible new model to address these concerns by
providing a measurable and transparent way of monitoring and evaluating an AtM
initiative in Kenya. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
That initiative, called <a href="https://www.novartis.com/about-us/corporate-responsibility/expanding-access-healthcare/novartis-access">Novartis
Access</a>, seeks to provide 15 medicines to address breast cancer,
cardiovascular disease, type 2 diabetes and respiratory illnesses at a cost of
USD $1 per treatment per month. The project started in Kenya in 2015 and plans
to expand to 30 countries in coming years. Novartis Access hopes to reach 20
million patients per year by 2020.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In an effort to avoid some of the mistakes described in the
Health Affairs article, Novartis Access – from the beginning – sought out the
help of Boston University to evaluate its impact and the prices of these
medicines at health facilities and households in Kenya in a completely
objective and transparent fashion. Novartis has no control over the evaluation
process and Boston University publishes protocols, agreements and all the
results (positive or negative) on <a href="http://sites.bu.edu/evaluatingaccess-novartisaccess/">this website</a>
for all to see.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Why evaluate programs like Novartis Access? In addition to
satisfying the need of generating evidence of whether such programs are having
the intended impact, there is a need to know who is using these medicines.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“One things we know about programs offering low-priced
products – not just medicines but also food or fuel – is that it’s often not
the poorest people who benefit, but the middle-income groups who know how to
access the medicines and the appropriate treatment,” <a href="https://www.novartis.com/stories/global-impact/novartis-invites-scrutiny-of-effort-to-improve-access-to-medicine">writes
Richard Laing</a>, a professor at Boston University who is involved in the
evaluation. “For that reason, we’re very keen to find out what happens at the
household level, particularly to the poorest families.”<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Laing said that what makes this evaluation different from
previous efforts to measure the impact of AtM programs is that past efforts
have almost always taken place after the fact: “The problem with these
evaluations is that you don’t know what the situation was like before, and
there is often no control group, so the evaluations have tended to be weak even
when the best interventions have take place.”<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Dr. Harald Nusser, head of Novartis Access, is excited about
the evaluation and its potential to serve a model. “Healthcare companies,
including my own, have had a long experience in measuring inputs (how many
dollars we invest) and outputs (how many patients we reach, how many doctors we
train),” <a href="https://www.linkedin.com/pulse/how-independent-measurement-access-programs-can-help-ensure-nusser?articleId=6270346809030385664#comments-6270346809030385664&trk=prof-post">he
writes</a>. “But we have not demonstrated the same agility in measuring
outcomes or impact when this is the most meaningful way to evaluate public
health improvement.”<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #1a1a1a; mso-bidi-font-family: Arial;">"Probably
the thing I am most excited about is the potential of this evaluation methodology
to be used by other pharmaceutical companies to measure their
access-to-medicine programs," said Nusser. "Since Boston University
is posting all of the protocols and methodologies on their website for all to
see, anyone can easily adapt the model to their own needs."<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Indeed, Laing said that other companies are already coming
to Boston University saying they would like to do a similar study. “By agreeing
to this open approach, Novartis has set the standard for others to follow,”
said Laing.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The <a href="https://accesstomedicinefoundation.org/">Access
to Medicine Foundation</a>, funded by the Bill & Melinda Gates Foundation
and the UK and Dutch governments, also helps to keep AtM initiatives honest by
compiling an index of the progress made by pharmaceutical companies to make
their medicines available. Every two years since 2008, the Foundation has
published the <a href="http://accesstomedicineindex.org/">Access to Medicine
Index</a>. In 2016, Glaxo Smith Kline, Johnson & Johnson and Novartis were
named as the leading companies. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #434343; mso-bidi-font-family: OpenSans;">The
Health Affairs article opines that the index “appears to have created an incentive
for expanding AtM initiatives, as well as for more transparent reporting.” But it
also says that the index’s ranking methodology does not include a rigorous
review of the evidence and should be improved to hold companies more
accountable.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<!--EndFragment--></div>
</div>
David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-70908715799796444002018-03-26T06:30:00.001-07:002018-03-26T06:30:12.574-07:00Teaching brain surgery in Africa: Compelling book reveals neglected area of health<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-DuZJdEE7ETM/Wrj0a96kkTI/AAAAAAAADyQ/n01IoA7VoCoZClf2GD2CHDUDdXf6zDY1ACLcBGAs/s1600/Dilan%2BEllegala%2BPhoto%2BCredit%2BTony%2BBartelme%2Bcopy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="851" data-original-width="1280" height="265" src="https://2.bp.blogspot.com/-DuZJdEE7ETM/Wrj0a96kkTI/AAAAAAAADyQ/n01IoA7VoCoZClf2GD2CHDUDdXf6zDY1ACLcBGAs/s400/Dilan%2BEllegala%2BPhoto%2BCredit%2BTony%2BBartelme%2Bcopy.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dilan Ellegala (left), the central character in "A Surgeon in the Village," supervising brain surgery in Tanzania. Photo: Tony Bartelme</td></tr>
</tbody></table>
<br />
<i>This was originally published on Global Health TV on August 3, 2017.</i><br />
<br />
<div class="MsoNormal">
“In early 2010 Bill Hawkins, then executive editor of the
Post and Courier in Charleston, South Carolina, told me, ‘I met this crazy
brain surgeon who opened a guy’s head with a wire saw in Africa. Check him out.
Maybe we’ll send you to Tanzania.’ Not many reporters get such an invitation,
but thanks to Bill, I was soon on my way.’”<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So writes Tony Bartelme in <a href="http://www.beacon.org/A-Surgeon-in-the-Village-P1251.aspx">“A Surgeon in
the Village: An American Doctor Teaches Brain Surgery in Africa,”</a> an
informative and highly engaging book about a neglected area of global health –
the dearth of surgeons in low- and middle-income countries. The book, published
in March, is based on hundreds of hours of interviews that the author conducted
in the U.S. and during five trips to Tanzania between 2010 and 2015.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When I started reading this book, I approached it as an
obligation – something I had to do to inform myself, and possibly my readers, about
an area of global health I knew nothing about.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But to my great surprise, I not only found it informative, I
enjoyed it. The book is written in short chapters and in more of a novelistic
style than most pieces of non-fiction. What I thought would be a chore turned
into a pleasure. Perhaps that is because Bartelme is an experienced journalist
who knows how to tell a good yarn.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<a name='more'></a><br />
<div class="MsoNormal">
Bartelme tells the story of Dilan Ellegala, a Sri
Lankan-born American, who ignores his father’s advice to become a family doctor
(“You should have a life”) and becomes a brain surgeon because he had "fallen in
love with the brain" (in medical school, he kept a brain in a glass jar in his
room so he could pull it out, hold it up to the light and study it). <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
He goes to Haydom Lutheran Hospital in a remote, rural part
of Tanzania for six months of medical sabbatical. He finds out that Tanzania, a
country of 42 million people, has just three brain surgeons in the country, all
of them in Dar es Salaam. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
One day a farmer came to the hospital, who had bashed his
head in a fall. He was in serious condition but Ellegala knew he could save him
if he could get inside the man’s head to stop the bleeding. But he had no way
of opening his skull due to a lack of a Gigli saw (which goes for twenty bucks
in the United States).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
He told himself that the farmer was going to die. “Nothing I
can do. Let it go,” he told himself. So he went for a run in the bush to clear
his mind and encountered a man cutting a tree limb with a wire saw. He bought
the saw off the man, rushed back to the hospital and saved the man’s life.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Ellegala quickly realizes that despite the well-intentioned
efforts of rich country doctors who travel to developing countries on
short-term assignments, this approach will never address the underlying problem
in these countries – the lack of surgeons.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Apart from a small number of global health leaders, Bartelme
writes, there was no public outcry over the shortage of surgeons at the time:
“None of the U.N. Millennium Development Goals mentioned the shortage of
surgeons and other skilled health care workers. The United Nations’ 356-page
update in 2005 didn’t use the words <i style="mso-bidi-font-style: normal;">surgery</i>
or <i style="mso-bidi-font-style: normal;">surgeons</i> once.”<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Yet 17 million people die every year because of the shortage
of surgeons, more than AIDS, malaria and tuberculosis combined. In 2006, Haile
Debas, the director of the University of California Global Health Institute,
and some colleagues published a study that showed 11 percent of the world’s
global burden of diseases could be averted or treated with surgery.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In 2015, the <a href="http://www.lancetglobalsurgery.org/?utm_campaign=8417b6ffa0-EMAIL_CAMPAIGN_2017_07_10&utm_medium=email&utm_source=Global%2BHealth%2BNOW%2BMain%2BList&utm_term=0_8d0d062dbd-8417b6ffa0-860275">Lancet
Commission on Global Surgery</a> produced the report Global Surgery 2030, with
five key messages:</div>
<div class="MsoNormal">
</div>
<ul style="text-align: left;">
<li><span style="text-indent: -0.25in;">1.5 billion people lack access to safe
affordable surgical and anesthesia care.</span></li>
<li><span style="text-indent: -0.25in;">143 million additional surgical procedures are
needed each year to save lives and prevent disability.</span></li>
<li><span style="text-indent: -0.25in;">33 million individuals face catastrophic health
expenditure due to payment for surgery and anesthesia each year.</span></li>
<li><span style="text-indent: -0.25in;">Investment in surgical and anesthesia services
is affordable, saves lives and promotes economic growth.</span></li>
<li><span style="text-indent: -0.25in;">Surgery is an indivisible, indispensable part of
health care.</span></li>
</ul>
<br />
<div class="MsoNormal">
The Commission found that 5 billion people worldwide are
unable to reach surgical services, and over half the global population cannot
access the treatment they need should they, for example, hemorrhage after
childbirth, suffer a burn or develop cancer. And access to care is even worse
for those in low- and middle-income countries.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #222222; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Ellegala
came to believe that the only way to solve this problem in a sustainable way
was to use Western surgeons not to do the surgery, but to teach Tanzanians to
do it themselves – and not doctors – who are also in short supply -- but lower
level health cadres. He calls this approach “train-forward.” That is what
Ellegala does with Emmanuel Mayegga, an assistant medical officer, who had
never done any kind of surgery before, let alone brain surgery. But it works,
and Mayegga becomes a credible brain surgeon.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #222222; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Before
Ellegala returns to the U.S., he tells Mayegga he must teach someone else brain
surgery. So he trains Emmanuel Nuwas who, in turn, trains another. “Train-forward”
in action.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #222222; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Eventually,
Ellegala, his wife Carin Hoek, a pediatrician from the Netherlands, and others
create </span><a href="https://www.madaktari.org/"><span style="mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Madaktari Africa</span></a><span style="color: #222222; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">
(Madaktari means “doctors” in Swahili) </span><span style="color: #222222; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">”) — a
group that sends hundreds of doctors around the world to serve as mentors and
to create a sustainable new model for global health. Madaktari’s story is told </span><a href="https://www.madaktari.org/who-we-are/our-story/"><span style="mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">here</span></a><span style="color: #222222; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #222222; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">“A Surgeon in the
Village” is an excellent read, even to non-global health aficionados, and sheds
much-needed light on a neglected area of global health.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i style="mso-bidi-font-style: normal;"><span style="color: #222222; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">The Lancet Commission on Global
Surgery has produced a report called Global Surgery 2030. The commission
produced this </span></i><a href="http://docs.wixstatic.com/ugd/346076_713dd3f8bb594739810d84c1928ef61a.pdf"><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">report
overview</span></i></a><i style="mso-bidi-font-style: normal;"><span style="color: #222222; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"> and this </span></i><a href="http://docs.wixstatic.com/ugd/346076_23b4c3a24c594888a8f0e077195dc5d8.pdf"><i style="mso-bidi-font-style: normal;"><span style="mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">policy brief</span></i></a><i style="mso-bidi-font-style: normal;"><span style="color: #222222; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">.<o:p></o:p></span></i></div>
<div class="MsoNormal">
<br /></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-27630997366617647932018-03-23T07:29:00.002-07:002018-03-23T07:33:10.370-07:00How to promote contraceptives to teens in Latin America? Don't be boring<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://4.bp.blogspot.com/-BMKBSkzrRLc/WrUOSGd0ewI/AAAAAAAADxw/HjHZB94aJGc-BWw44VYL2x1wPSt-8Ht2wCLcBGAs/s1600/Victor%2Bwith%2Bhigh%2Bschool%2Bstudents2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="300" src="https://4.bp.blogspot.com/-BMKBSkzrRLc/WrUOSGd0ewI/AAAAAAAADxw/HjHZB94aJGc-BWw44VYL2x1wPSt-8Ht2wCLcBGAs/s400/Victor%2Bwith%2Bhigh%2Bschool%2Bstudents2.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "proximanova" , "helvetica neue" , "helvetica" , "roboto" , "arial" , sans-serif; font-size: 12px; text-align: left;">DKT Health Counselor Victor Tapia Orijel (center, white shirt) and a group of high school students who attended his sex talk in the Iztacalco neighborhood of Mexico City. Photo: David J. Olson</span></td></tr>
</tbody></table>
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<i>This was originally published on the Huffington Post on August 1, 2017.</i></div>
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MEXICO CITY, Mexico — Health Counselor Victor Tapia Orijel starts
his presentation almost like a stand-up comedian, humorously citing different
situations in the reproductive life of a teenager, from first sexual relations
to different contraceptive methods.</div>
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<ul style="text-align: left;">
<li><span style="text-indent: -0.25in;">“If you get horny in school or your best
friend’s house, you need to carry condoms.”</span></li>
<li><span style="text-indent: -0.25in;"> “If you make a booty call, it’s obvious you need
condoms."</span></li>
<li><span style="text-indent: -0.25in;">“If you drink a lot and then have a one-night
stand and don’t remember if you used a condom or not, you should get emergency
contraception and condoms.”</span></li>
</ul>
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<o:p></o:p></div>
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His audience was a roomful of 65 high school students in the
Iztacalco delegation of Mexico City. They were entertained and educated at the
same time.</div>
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<o:p></o:p></div>
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“Most of these young
people learned about sex from their friends,” said Orijel. “It is difficult for
them to talk about sex with their family. The women are the least likely to
talk to their families, due to the burden of machismo that we live with in
Mexico.”<o:p></o:p></div>
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That lack of information is prevalent throughout Latin
America and the Caribbean: Almost three-quarters of pregnancies among
adolescents aged 15-19 in the region are unplanned, <a href="https://www.guttmacher.org/fact-sheet/adding-it-meeting-contraceptive-needs-of-adolescents-latin-america-and-caribbean">according
to the Guttmacher Institute</a>, and about half of those end in abortion. Among
all women 15-19 who need contraceptives, 36% of them are not using a modern
method. In Central America, 46% of sexually active adolescents who want to
avoid pregnancy are not using modern contraceptives.</div>
<a name='more'></a><br />
<o:p></o:p>
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Orijel, 30 years old, is a counselor with <a href="https://www.dkt.com.mx/">DKT México</a>, a non-governmental organization
that uses social marketing to prevent HIV and promote contraception in Latin
America and the Caribbean. This high school event is part of <a href="https://www.dkt.com.mx/DKTSCHOOL/">DKT School</a>, which seeks to provide
information on contraception and reproductive health to young people in high
school, college and university. Since it started in February 2016, DKT School
has reached 250,000 students.<o:p></o:p></div>
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DKT School is one example of how DKT México has completely
revamped their approach to reproductive health education after their first
campaign failed to meet expectations.<o:p></o:p></div>
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In 2015, DKT México launched a family planning campaign focused
on increasing awareness of pregnancy among teenagers and young adults. They
opted for a serious, medical campaign in traditional pharmaceutical company
style — talking about the bad effects of unwanted pregnancy and the myths of
various contraceptives.<o:p></o:p></div>
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Few young people attended their events or engaged their
digital media. Their messages did not resonate with young people. This translated
into poor contraceptive sales. The campaign failed.<o:p></o:p></div>
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At the same time, they were having a highly successful <i style="mso-bidi-font-style: normal;">Prudence</i> condom campaign with well
attended events, <a href="https://www.facebook.com/preservativos.prudence/?ref=aymt_homepage_panel&brand_redir=370524206322206">a
Facebook page</a> with 2 million followers and a <a href="https://twitter.com/PrudenceMexico">Twitter account</a> with 47,500
followers. Their condom sales tripled between 2012 and 2016.<o:p></o:p></div>
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The contrast between the two campaigns showed DKT México they
had to apply the same fun strategy of talking about sex in their family
planning work as they were doing in their condom work. So they made major
changes to their campaign:</div>
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<ul style="text-align: left;">
<li><span style="text-indent: -0.25in;">They started talking about the positive results
of contraception instead of focusing on the myths and the bad results.</span></li>
<li><span style="text-indent: -0.25in;">They started talking about “unplanned
pregnancies” instead of “unwanted pregnancies” after realizing that most Mexicans
think of babies as a blessing from God and how those unplanned pregnancies can
disrupt education, travel and careers.</span></li>
<li><span style="text-indent: -0.25in;">They started talking about “life planning”
instead of “family planning” which does not resonate with this age group. Marriage
and children are not even on their radar screen yet. What they are interested
in is planning their education, careers and other life goals.</span></li>
<li>Above all, they stopped being preachy and boring.</li>
</ul>
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“We started being fun, adopting the same entertaining
messages and approaches we were using to market <i style="mso-bidi-font-style: normal;">Prudence</i> condoms at schools, concerts and fairs,” said Karina de la
Vega Millor, director general of DKT México. “The main message became ‘Have
sex, have fun, but use double protection against a sexually-transmitted disease
or an unplanned pregnancy that will change the course of your life.’” <o:p></o:p></div>
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DKT México created “Planficame Esta” (“Plan me this”), a
lively digital platform with <a href="https://www.planificameesta.org/">a website</a>,
and a presence on <a href="https://www.facebook.com/planificameesta">Facebook</a>,
<a href="https://www.instagram.com/planificamesta/">Instagram</a> and <a href="https://www.youtube.com/channel/UC2vorAMvKediWnXvmmCv4QQ">YouTube</a>.<o:p></o:p></div>
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“These tools give fun messages about the importance of
having a life plan and avoiding pregnancy until you are ready, said Millor. “There
are plenty of ribald jokes, frank discussions and flirty talk full of double
entendres to engage our audiences. Our Facebook page now has more than 1.1
million followers, and more engagement than any Facebook page dedicated to
contraception in all of Latin America.” <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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<br /></div>
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Good sexual and reproductive healthcare is hard to come by
in Mexico, especially for adolescents, according to <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173342&utm_source=Global+Health+NOW+Main+List&utm_campaign=2815efa879-EMAIL_CAMPAIGN_2017_03_08&utm_medium=email&utm_term=0_8d0d062dbd-2815efa879-860275">a
recent study</a>. That is why DKT México also set up <a href="https://www.dkt.com.mx/reddkt.php"><span style="mso-bidi-font-family: ABeeZee-Regular;">RED DKT</span></a><span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;"> (DKT Network) a year ago to improve sexual and reproductive
health and encourage use of long-acting reversible contraceptives like IUDs. RED
DKT requires its clinics to be welcoming to adolescents and young adults.<o:p></o:p></span></div>
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<span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;">DKT México learned from its first campaign. The new campaign has
resulted in more young people viewing DKT websites and social media platforms,
sharing information with their friends and coming to DKT events and clinics to
get information and products. <o:p></o:p></span></div>
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<span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;">And more of them are actually using contraception to avoid
unplanned pregnancy. Millor says that DKT México has increased almost
eight-fold its number of couple years of protection (the amount of contraception
to protect a couple for one year) between 2012 and 2016. <o:p></o:p></span></div>
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<span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;">For Millor, this work is personal. She got pregnant when was 23
and single, and had a terrible time getting the counseling she desperately needed.
She is determined that other young women not go through what she had to go
through.<o:p></o:p></span></div>
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<span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;">“This is why I am so passionate about my work, and try to pass
this passion with my team and our customers,” she said. DKT México is now
expanding into Central America, the Caribbean and northern South America and Millor
plans to apply these lessons to those countries.<o:p></o:p></span></div>
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UnhideWhenUsed="true" QFormat="true" Name="heading 6"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="heading 7"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="heading 9"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 9"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 9"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="header"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footer"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index heading"/>
<w:LsdException Locked="false" Priority="35" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="caption"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of figures"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of authorities"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
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<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
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<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
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<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-60705261227527559042018-03-22T05:51:00.000-07:002018-03-22T05:54:33.623-07:00Budget debates in US, UK could augur poorly for global health funding<div dir="ltr" style="text-align: left;" trbidi="on">
<i>This was originally published in Global Health TV on July 25, 2017.</i><br />
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<span style="font-family: arial, helvetica, sans-serif; font-size: 12px;">Global health financing has not been in such jeopardy since the large investments in it started in 1991 – the year in which global health funding started an upward trajectory that moved higher in all but three years.</span><br />
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In particular, the rise of Donald Trump of the United States and Theresa May of the United Kingdom <span class="dash" style="margin: 0px;">—</span>the leaders of the two largest donor nations <span class="dash" style="margin: 0px;">—</span> have raised concerns about the prospects for development assistance broadly, and global health specifically.</div>
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In 2016, development assistance for health (DAH) reached $37.6 billion, eking out a miniscule 0.1% increase from 2015 that followed a pattern of little growth since 2010 (DAH grew 11.4% annually from 2000 to 2010 but only 1.8% since 2010), according to <a href="http://www.healthdata.org/policy-report/financing-global-health-2016-development-assistance-public-and-private-health-spending" style="margin: 0px; text-decoration: none;">“Financing Global Health 2016,”</a> published by the Institute for Health Metrics and Evaluation in April. DAH peaked at $38 billion in 2013, dropped to $36 billion in 2014 and has recovered slightly in the two subsequent years. <a href="http://www.healthdata.org/infographic/financing-global-health-infographic" style="margin: 0px; text-decoration: none;">This infographic</a> provides a snapshot.</div>
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The U.S. and the U.K. have been the two top contributors to DAH but both countries have political environments that have called into question their future commitments to foreign aid and global health.</div>
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: 12px;">Trump’s 2018 budget request to Congress contains unprecedented cuts (more than $2 billion) to global health. If those cuts are enacted, writes the Kaiser Family Foundation, they will bring funding below 2008 levels. Family planning support would be eliminated. </span><a href="http://www.kff.org/global-health-policy/issue-brief/what-could-us-budget-cuts-mean-for-global-health/" style="font-family: arial, helvetica, sans-serif; font-size: 12px; margin: 0px; text-decoration: none;">Kaiser predicts</a><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: 12px;"> the cuts could result in the following scenarios starting in 2018:</span><br />
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<li>Additional new HIV infections between 49,100 to 198,700;</li>
<li>Women and couples receiving contraceptives would decline from 6.5 million to almost 25 million; and</li>
<li>Additional abortions between 819,000 and more than 3 million.</li>
</ul>
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More than half of the $2 billion in cuts to global health would come from international HIV/AIDS programs. In <a href="https://csis-prod.s3.amazonaws.com/s3fs-public/publication/170621_Allinder_USLeadershipGlobalHIV_Web.pdf?utm_source=Global+Health+NOW+Main+List&utm_campaign=93f015beb5-EMAIL_CAMPAIGN_2017_06_22&utm_medium=email&utm_term=0_8d0d062dbd-93f015beb5-860" style="margin: 0px; text-decoration: none;">a new paper</a>, the Center for Strategic and International Studies says the cuts would jeopardize U.S. leadership on HIV/AIDS and “raise the possibility that the pandemic will reignite, threatening U.S. and global health security.”</div>
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However, in the U.S. political system, Congress has the last word on the budget, and even Republican senators say these cuts will not stand. But however the final budget turns out, it could still perpetuate the recent stagnation in global health financing.</div>
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A series of hearings earlier this month featuring Secretary of State Rex Tillerson and U.S. Agency for International Development Administrator-designate Mark Green <a href="https://www.cgdev.org/blog/where-is-trump-headed-on-foreign-aid-five-takeaways-from-tillerson-green-hearings" style="margin: 0px; text-decoration: none;">revealed how the Trump Administration is of two minds about foreign aid</a>.</div>
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Tillerson testified at four hearings on the proposed budget cuts. Republicans and Democrats alike lambasted the proposed cuts. Sen. Lindsay Graham, the Republican chairman of the Senate subcommittee that oversees foreign aid, said these cuts would put lives at risk. Tillerson defended the cuts, saying “Our budget will never determine our ability to be effective. Our people will.”</div>
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<a href="http://www.usglc.org/2017/06/22/reasons-for-optimism-at-usaid/?mkt_tok=eyJpIjoiTW1ObE1EVTJOR1V3WlRCaSIsInQiOiJtbm85S3JHMlhZd2JMRytEVGFyN0dVUmU2b1FPSmJQVVJzY0VUM3pYZzYwNHNnalhQVWp3MUw4clEzd0haWjZxTjhYczhwdStLK1dmTVQ3Sjl2MmFXcldjaGgyK2dQQlRxd2FTUGZh" style="margin: 0px; text-decoration: none;">Good news came with the nomination</a> of former Ambassador and Congressman Mark Green to lead USAID. Green was well received by both political parties in <a href="https://www.devex.com/news/nominee-for-usaid-administrator-mark-green-sails-through-senate-hearing-90499?mkt_tok=eyJpIjoiTmpNelltTm1aalU0TlRjeSIsInQiOiJnTm14Mm5mSEx5SUlqZnEwdDlHUmRjQjEyVVFUZFRCOER4QjdcL0lPRURJVTJ5R29jWFEwZGJIbDBkNHRHM28xdjg4Y3FWSG" style="margin: 0px; text-decoration: none;">his testimony before the Senate Foreign Relations Committee</a> on June 15, and he talked with pride about the work of USAID (we also learned that his parents were born South African and British).</div>
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For global health advocates, one of the most worrisome aspects of Trump Administration policy has been the reinstatement and expansion of the <a href="http://www.kff.org/global-health-policy/fact-sheet/mexico-city-policy-explainer/" style="margin: 0px; text-decoration: none;">Mexico City Policy</a>. This policy requires foreign non-governmental organizations to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source as a condition for receiving U.S. family planning assistance.</div>
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Green tried to calm concerns about the policy. “The State Department is undertaking an intensive six-month review to study the impacts of the expanded policy and whether it leads to interruption of services on the ground,” <a href="https://www.foreign.senate.gov/hearings/nominations-061517" style="margin: 0px; text-decoration: none;">said Green in his testimony</a>. “USAID will be part of that and we will play it straight. You can count on us to be honest brokers in that process.”</div>
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In the U.K., meanwhile, a different scenario has been playing out. In 2013, the UK became the fifth country to reach the UN goal of dedicating 0.7% of its gross national income to foreign aid, driven in large part by former Prime Minister David Cameron. But after the Brexit upset in 2016, Theresa May became prime minister and appointed conservative Member of Parliament Priti Patel as her international development secretary.</div>
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At the time, Patel roundly criticized British aid as being a waste of money and promised a major overhaul of the aid budget, according to the <a href="http://www.dailymail.co.uk/news/article-3788162/My-fury-wasted-foreign-aid-International-development-secretary-Priti-Patel-pledges-major-overhaul-12billion-budget.html" style="margin: 0px; text-decoration: none;">Daily Mail</a>.</div>
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“My approach will be built on some core conservative principles <span class="dash" style="margin: 0px;">—</span> that the way to end poverty is wealth creation, not aid dependency; that wealth is ultimately created by people, not by the state; that poor countries need more investment and trade, not less,” <a href="https://www.theguardian.com/politics/2016/sep/14/priti-patel-plans-foreign-aid-overhaul-based-on-core-tory-values" style="margin: 0px; text-decoration: none;">she was quoted in The Guardian</a>. “And we need to empower the poorest to work and trade their way out of poverty, not treat them as passive recipients of our support.”</div>
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In March 2017, a cross-party parliamentary committee on international development <a href="https://www.publications.parliament.uk/pa/cm201617/cmselect/cmintdev/100/10003.htm#_idTextAnchor003" style="margin: 0px; text-decoration: none;">concluded</a> that “ODA [official development assistance] spending is in the national interest and is a strong investment contributing to create a more prosperous world, which pays far-reaching dividends including to UK taxpayers at home.” The committee did not find evidence of wasteful spending. In fact, they found the spending to be effective.</div>
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Recently, Patel <a href="https://www.theguardian.com/politics/2017/jun/18/exclusive-priti-patel-insists-uks-aid-influence-is-massive?mkt_tok=eyJpIjoiWkRNNU9EUXdNemhtTjJaayIsInQiOiJKOVRGNmFUcWs3eHRtaEZHZCtscVVZV0pIOFwvNGxvVUQ3enhyUkx3YWNnVlhOZ1JGNndibWVWMm03VVMyRjVxN1RtTjI" style="margin: 0px; text-decoration: none;">has struck a more positive tone</a> about ODA. She announced a new aid package for east Africa, boasted about the scale of UK development assistance and, when asked about the future of UK aid, said: “It’s never been so needed. We face more global challenges in 2017 than every before.”</div>
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We don’t know if global health funding will go up or down but one thing is clear: Green and Patel are both interested in finding approaches to foreign aid that go beyond treating people as passive recipients of cash and that spark more economic investment and trade. It will be interesting to see what that means for global health.</div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-16099323126261723582018-03-21T12:06:00.001-07:002018-03-21T12:08:17.420-07:00Health workers, facilities under attack in 23 nations; UN accused of inaction<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://4.bp.blogspot.com/-hxip3ScTSHc/WrKrux_tAmI/AAAAAAAADxI/v0VuEZI9oDIHwGlxbAzfzEeWSUKsmH9vgCLcBGAs/s1600/Damaged%2Bhospital%2Bin%2BTurkey.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1067" data-original-width="1600" height="266" src="https://4.bp.blogspot.com/-hxip3ScTSHc/WrKrux_tAmI/AAAAAAAADxI/v0VuEZI9oDIHwGlxbAzfzEeWSUKsmH9vgCLcBGAs/s400/Damaged%2Bhospital%2Bin%2BTurkey.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This hospital was damaged by clashes during a 79-day curfew from late 2015 to early 2016 in the city of Cizre in southeastern Turkey. Photo: Physicians for Human Rights.</td></tr>
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<i>This was originally published on Global Health TV on May 23, 2017.</i><br />
<br />
In 2012, two Pakistani health workers were out vaccinating
children against polio when they were both shot by extremists. One of them
died. The other, shot in the leg, had 11 metal rods inserted into his leg and
was hospitalized for three months.</div>
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In November, I met this remarkable man named Latif (his
surname is withheld to protect his security). He is now fully recovered and
back to work on the polio vaccination campaign. He told me he never considered
giving up. Pakistan reported only two cases of wild poliovirus in 2017 <a href="http://polioeradication.org/polio-today/polio-now/this-week/">as of May
17</a> and Latif is determined to see the polio campaign through to the end.<o:p></o:p></div>
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The attack on Latif is only one example of a tragic
phenomenon that is not getting better – <a href="http://www.who.int/hac/techguidance/attacks_on_health_care_q_a/en/">violence
against heath workers and health facilities</a>. In 2016, the extent and
intensity of such violence “remained alarmingly high,” according to a new report
released by the <a href="https://www.safeguardinghealth.org/">Safeguarding
Health in Conflict Coalition</a>.” The report also found that accountability
for committing these attacks remains inadequate or non-existent.<o:p></o:p></div>
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The violence isn’t always perpetrated by terrorists.
Sometimes it is committed by the police or the country’s military —
institutions that should be ensuring tranquility.<o:p></o:p></div>
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<a name='more'></a><br />
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Most of us have heard of hospitals and clinics getting blown
up or polio vaccinators getting shot but the report indicates that attacks on
health care take many forms. It names eight different forms of violence:</div>
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<ul style="text-align: left;">
<li><span style="text-indent: -0.25in;">Bombing and shelling of health facilities
(reported in 10 countries in 2016)</span></li>
<li><span style="text-indent: -0.25in;">Looting of health facilities (11)</span></li>
<li><span style="text-indent: -0.25in;">Killing of health workers, emergency medical
personnel and patients (11)</span></li>
<li><span style="text-indent: -0.25in;">Intimidation, assault and arrest of health
workers and patients (20)</span></li>
<li><span style="text-indent: -0.25in;">Abduction of health workers (11)</span></li>
<li><span style="text-indent: -0.25in;">Obstruction of access to care including blockage
of and attacks on ambulances (10)</span></li>
<li><span style="text-indent: -0.25in;">Takeover and occupation of health facilities by
police, military or other armed actors (7)</span></li>
<li><span style="text-indent: -0.25in;">Attacks on and blockage of humanitarian actors,
supplies and transports (15)</span></li>
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<o:p> </o:p>The report documents attacks on health care in 23 countries
in 2016. Most of the countries are in Africa and the Middle East but there are
a few exceptions (Armenia, India, Myanmar and Ukraine). The report was released
on May 3, the first anniversary of the UN Security Council’s adoption of <a href="https://www.safeguardinghealth.org/how-act-security-council-resolution">Resolution
2286</a> that set out a roadmap to the protection of health workers in
conflict.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The Safeguarding Health in Conflict Coalition says the UN
Security Council has failed to follow through on its own recommendations for
preventing attacks and providing accountability for those who commit them.
These recommendations include regular reporting to the UN on actions take to
prevent attacks, to investigate attacks, and to hold perpetrators accountable.
The U.N. Press Office did not respond to my request for a comment.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #2b2c33; mso-bidi-font-family: SourceSansPro-Regular;">“Our findings cry out for a level of commitment and
follow-through by the international community and individual governments that
has been absent since the passage of Security Council Resolution 2286 a year
ago,” said Leonard S. Rubenstein, chair of the coalition and director of the
Program on Human Rights, Health and Conflict at Johns Hopkins University
Bloomberg School of Public Health in </span><a href="https://www.intrahealth.org/news/health-workers-and-facilities-23-conflict-ridden-countries-attacked-impunity-2016"><span style="mso-bidi-font-family: SourceSansPro-Regular;">a press release</span></a><span style="color: #2b2c33; mso-bidi-font-family: SourceSansPro-Regular;"> issued on the
anniversary.<o:p></o:p></span></div>
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<br /></div>
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<span style="color: #2b2c33; mso-bidi-font-family: SourceSansPro-Regular;">The International Committee of the Red Cross, which has had a
campaign called </span><a href="http://healthcareindanger.org/"><span style="mso-bidi-font-family: SourceSansPro-Regular;">Health Care in Danger</span></a><span style="color: #2b2c33; mso-bidi-font-family: SourceSansPro-Regular;"> since 2011, says
the attacks have increased despite the commitments. The slogan of the campaign
is “Everyone wounded or sick has the right to health care.”</span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In Pakistan, doctors supervising the polio vaccine campaigns
and police protecting community health workers were shot and often killed in a
number of attacks. Many of these attacks took place in areas where wild polio
virus is endemic. In August, a suicide attack at Quetta Civil Hospital in
Quetta left 74 civilians dead and up to 112 wounded. Though it targeted a group
of lawyers and journalists who were mourning a colleague, this bombing was one
of the deadliest attacks on a medical facility in the history of the region, according
to the report. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In Mali, Human Rights Watch reported that on at least six
occasions, ambulances and other vehicles used to transport patients and deliver
health care were attacked or robbed. In four of these incidents, sick
passengers, drivers and health workers were forced out of the vehicles and
robbed and the vehicles stolen. In another incident, an improvised explosive
device struck an ambulance that was headed to the scene of another IED attack
that killed two peacekeepers.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://www.safeguardinghealth.org/what-can-we-do-about-syria">Syria</a>
was the worse country in terms of intensity and impact of the attacks.
Physicians for Human Rights reported 108 attacks on health facilities in 2016,
most by the country’s own military and Russian forces, and the death of at
least 91 health workers. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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These are just a few examples of the many tragic incidents
in 23 countries detailed in the report.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is clear that these attacks can have profound effects on
the availability of health care. They result in:</div>
<div class="MsoNormal">
</div>
<ul style="text-align: left;">
<li><span style="text-indent: -0.25in;">Suspension of health programs</span></li>
<li><span style="text-indent: -0.25in;">Degradation of the health infrastructure</span></li>
<li><span style="text-indent: -0.25in;">Exodus of health workers concerned about their
security</span></li>
<li><span style="text-indent: -0.25in;">Outbreaks of disease and illness and inability
to treat existing conditions</span></li>
</ul>
<br />
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<o:p></o:p></div>
<div class="MsoNormal">
Accountability for such reports is largely absent, according
to the report. A review by Human Rights Watch of 25 major incidents of attacks
on health care between 2013 and 2016 found that either no investigations at all
were pursued, or the investigations were inadequate.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As bad as the situation is, the numbers noted in the report
may only be the tip of the iceberg because there are surely many attacks that
go unreported. And the danger goes beyond the health workers who bear the
initial brunt of the attacks.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“Although attacks on health workers are obviously dangerous
for the workers themselves, they are also a danger to the communities they
serve,” said Laura Hoemeke, director of communications and advocacy at
IntraHealth International, one of the key members of the coalition. “If they do
survive the attacks, many flee their communities and countries, leaving behind
people with even less access to health care. This limited access has a
particularly negative impact on maternal, newborn and child health.”<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is bad enough that anyone, anywhere has to do without
health care. But to deny healthcare to those living in a state of war or unrest
is unconscionable. As <a href="http://www.who.int/hrh/news/2017/lancet-article_syria-hw-attack/en/">The
Lancet commented</a>, “One attack on a health worker is one too many.”<o:p></o:p></div>
<div class="MsoNormal">
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-47161828513628617832017-05-10T06:25:00.001-07:002017-05-10T06:25:59.202-07:00Tremendous progress against malaria seen but challenges remain<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-0FEdaI3K7mU/WRMTfyCqG4I/AAAAAAAADb4/qoUCpeWzWl8S8freQsLhwNXyu_n7B6xVgCLcB/s1600/Tanzanian%2Btwins%2Bunder%2Bnet.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="265" src="https://2.bp.blogspot.com/-0FEdaI3K7mU/WRMTfyCqG4I/AAAAAAAADb4/qoUCpeWzWl8S8freQsLhwNXyu_n7B6xVgCLcB/s400/Tanzanian%2Btwins%2Bunder%2Bnet.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Twins Dorcas and Deborah Bendak, 7, under their mosquito net at their home in Musoma, Tanzania. Insecticide-treated bednets have become the cornerstone of malaria prevention efforts. Photo: Riccardo Gangale/VictorWorks, Courtesy of Photosphere</td></tr>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><i>This was originally published on Global Health TV on April 25, 2017.</i></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">When I was a
young development worker, I engaged in high risk behavior one night in a
village in Mali: I slept without a mosquito net. A week or so later I
contracted malaria.</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Of all the
diseases I have written about here, malaria is the only one with which I have
personal and intimate experience. And it was not pleasant. It was so
debilitating, so sapping of my energy, I remember not caring whether I lived or
died. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Fortunately, I was
an otherwise healthy young male and bounced back briskly after a week or so of
misery. In fact, I have lived long enough to see the beginning of the end (or
at least the decline) of this global killer: In December, the World Health
Organization (WHO) released the <a href="http://www.who.int/malaria/media/world-malaria-report-2016/en/">World Malaria Report 2016</a> in which it estimated that 1.3 billion
fewer malaria cases and 6.8 million fewer malaria deaths occurred between 2001
and 2015 than would have occurred had incidence and mortality remained the
same. About 97% of those deaths averted were for children under five years (who
are most vulnerable to the disease, along with pregnant women).</span><br />
<a name='more'></a><span style="font-family: "arial" , "helvetica" , sans-serif;"><o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Buried on Page
50 of the report is the gist of what makes this news so exciting: In WHO’s
Africa Region, these reduced malaria mortality rates have translated to a rise
in life expectancy at birth of 1.2 years, accounting for 12% of the total
increase in life expectancy of 9.4 years, from 50.6 years in 2000 to 60 in
2015. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">This means more
children — many more children — will survive the perils of childhood in Africa
and go on to lead productive lives as adults. This makes malaria control one of
the most exciting developments of many encouraging global health trends in
recent years.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Today we mark <a href="http://www.who.int/campaigns/malaria-day/2017/en/">World Malaria Day</a> with the message “Let’s close the gap”
in malaria prevention. It’s a time to celebrate the tremendous accomplishments
to date, but also to remember how many challenges remain. For example, an
estimated 43% of people at risk in sub-Saharan Africa are still not protected
from malaria, according to WHO. And there were still 212 million cases of
malaria worldwide in 2015.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Dr. Richard
Cibulskis, coordinator of Evidence and Economics of the WHO Global Malaria
Programme, told Global Health TV that we have good reason to be optimistic
about the fight against malaria. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">“We’ve
had huge success in bringing down malaria incidence and mortality rates over
the last fifteen years. We have effective tools to prevent, diagnose and treat
the disease, and coverage of these tools has been massively scaled up in many
countries. There are exciting new technologies under development, and more
countries than ever are making progress towards elimination.”<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">“But there are also some worrying trends, especially the
fact that global funding seems to be flat-lining. We can eliminate malaria, but
only if we can continue to harness the financial and political will needed to
accelerate progress and make new and existing tools available to all who need
them.”<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Insecticide-treated
bed nets are one of the biggest successes in malaria control. The World Malaria
Report found that 53% of the population at risk in Sub-Saharan Africa slept
under a net in 2015 compared to 30% in 2010. Furthermore, WHO found that people
who slept under nets had significantly lower rates of malaria infection than
those who did not use a net.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">And <a href="http://www.bbc.com/news/health-39666132">it
was announced yesterday</a>
that the world’s first vaccine against malaria will be tested in Ghana, Kenya
and Malawi in 2018. The vaccine has the potential to save tens of thousands of
lives but it is unclear if it is feasible to get parents to bring their babies
in four separate times to get the required doses.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Malaria control
has had solid bipartisan support in the U.S. for 15 years. The U.S. government
– the largest donor to global malaria efforts – has increased its support from
$146 million in 2001 to $861 million in 2016. Funding really took off after former
U.S. President George W. Bush launched the <a href="http://kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-malaria/">President’s Malaria Initiative</a> in 2005. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Last month, U.S.
President Donald Trump released a proposed budget that calls for close to a
one-third reduction in foreign assistance. We don’t know how those cuts – which
still have to be approved by a dubious Congress – would affect malaria control
but it does cause concern.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">What we do know
is that President Trump has announced plans to meet U.S. commitments to the
Global Fund for AIDS, TB and Malaria, according to <a href="http://www.theglobalfight.org/presidents-fy-2018-budget-blueprint-affirms-u-s-commitment-global-fund/">this analysis</a> by Friends of the Global Fight.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The <a href="http://www.who.int/malaria/publications/atoz/9789241564991/en/">WHO’s
Global Technical Strategy for Malaria</a> calls for malaria to be eliminated
in at least 35 countries by 2030. Dr. Cibulskis call this “an ambitious but
achievable target.”<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">“But even if this target is achieved, it could still leave
us with more than 50 countries in which malaria is endemic,” he says. “A
challenge will be maintaining robust funding and political commitment as we
continually make progress towards this goal.”<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">One of the problems the malaria control community worries about
is that once cases and deaths have decreased and the disease seems like less of
a threat, funding for malaria could be cut. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">“History has shown us that we must keep our levels of
investment high, or risk a resurgence of the disease and a reversal of progress
made to date,” says Dr. Cibulskis. “We cannot let up in our efforts until we
get the job done.” <o:p></o:p></span></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0tag:blogger.com,1999:blog-7782254203352865878.post-72577451283097998602017-05-08T05:48:00.000-07:002017-05-08T05:48:14.253-07:00Promoting contraceptives to adolescents in Mexico? Make the campaigns fun<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td style="text-align: center;"><a href="https://4.bp.blogspot.com/-UpCe4OSRnk4/WRBoKsoCNjI/AAAAAAAADbY/ndJLiWzcji4fX-ZfTmuNMMhdOws3m0ahQCLcB/s1600/P1260158.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://4.bp.blogspot.com/-UpCe4OSRnk4/WRBoKsoCNjI/AAAAAAAADbY/ndJLiWzcji4fX-ZfTmuNMMhdOws3m0ahQCLcB/s400/P1260158.jpg" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Monserrat, Ariantne and Isis and their children visit a<br />RED DKT clinic in the Iztapalapa borough of Mexico<br />City to find a contraceptive to space the birth of their<br />next child. Photo: David J. Olson</td></tr>
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<i style="font-family: Arial, Helvetica, sans-serif;">This was originally published on Global Health TV on March 21, 2017.</i></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><i><br /></i></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">MEXICO CITY, Mexico — I met the three young women at a
reproductive health clinic in Iztapalapa, the most populous and fastest-growing
borough of Mexico City, with a population of 1.8 million on the eastern side of
the capital city.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Ariatne and Isis, both 20 years old, each have one child.
Monserrat was their aunt, but didn’t look much older. She had three children.
All of them were looking for a way to space the birth of their next child. One
of them wanted to wait five years; another, ten years.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">All of them had chosen intrauterine devices (IUDs) as their
contraceptive, one of them told me, “because they are comfortable and secure.”<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Although unplanned pregnancy is a big problem in Mexico (and
the rest of Latin America), good sexual and reproductive healthcare is hard to
come by in Mexico, especially for adolescents, according to <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173342&utm_source=Global+Health+NOW+Main+List&utm_campaign=2815efa879-EMAIL_CAMPAIGN_2017_03_08&utm_medium=email&utm_term=0_8d0d062dbd-2815efa879-860275">a
recent study</a>.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Almost three-quarters of pregnancies among adolescents aged
15-19 in the region are unplanned, <a href="https://www.guttmacher.org/fact-sheet/adding-it-meeting-contraceptive-needs-of-adolescents-latin-america-and-caribbean">according
to the Guttmacher Institute</a>, and about half of those end in abortion. Among
all women 15-19 who need contraceptives, 36% of them are not using a modern
method. The unmet need is highest in Central America, where 46% of sexually
active adolescents who want to avoid pregnancy are not using modern
contraceptives. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.dkt.com.mx/">DKT México</a>, a
non-governmental organization that uses social marketing to prevent HIV and
promote contraception in Latin America and the Caribbean, has learned some
lessons about how to promote contraception to young people after success in
promoting condom use but failing to do the same with contraceptives after they
took a more traditional approach.</span></div>
<a name='more'></a><span style="font-family: Arial, Helvetica, sans-serif;"><o:p></o:p></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">In 2015, DKT México launched a family planning campaign focused
on increasing awareness of pregnancy among teenagers and young adults. They
opted for a serious, medical campaign in traditional pharmaceutical company
style — they talked in the negative and expounded on the myths of various
contraceptive methods.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The campaign failed. Few young people attended their events or
engaged their digital media. Their messages did not resonate with the audience
they were trying to reach. This translated into poor contraceptive sales.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">At the same time, they were having a highly successful <i style="mso-bidi-font-style: normal;">Prudence</i> condom campaign with well
attended events <a href="https://www.facebook.com/preservativos.prudence/?ref=aymt_homepage_panel&brand_redir=370524206322206">a
Facebook page</a> with 2 million followers and a <a href="https://twitter.com/PrudenceMexico">Twitter account</a> with 47,500
followers. Their condom sales tripled between 2012 and 2016.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The contrast between the two campaigns strongly suggested
that they had to apply the same fun strategy of openly talking about sex in
their family planning work as they were doing in their condom work. So they
made major changes to their campaign:<o:p></o:p></span></div>
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<li><span style="font-family: Arial, Helvetica, sans-serif; text-indent: -0.25in;">They avoided talking in the negative and
focusing on myths. Instead, they focused on the positive results of
contraception.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; text-indent: -0.25in;">They realized that most Mexicans think of babies
as a blessing from God, and it doesn’t help to talk of “unwanted” pregnancies,
so they changed to “unplanned pregnancy."</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; text-indent: -0.25in;">They shifted the focus to how these unplanned
pregnancies can interrupt education, travel and careers, things about which
young people care very much.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif; text-indent: -0.25in;">They stopped using the term “family planning” and
started talking about “life planning.” Young people do not think in terms of
family planning; they are more interested in planning their education, careers
and other life goals. This is true not only in Mexico but in other countries as
well, </span><a href="http://www.huffingtonpost.com/david-j-olson/beat-making-lab-in-ethiopia_b_4401221.html" style="font-family: Arial, Helvetica, sans-serif; text-indent: -0.25in;">something
I wrote about here</a><span style="font-family: Arial, Helvetica, sans-serif; text-indent: -0.25in;">.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;">“In short, we stopped being preachy and started being fun,
adopting the same entertaining messages and approaches we were using to market <i style="mso-bidi-font-style: normal;">Prudence</i> condoms at schools, concerts
and fairs,” said Karina de la Vega Millor, director general of DKT México. “The
main message became ‘Have sex, have fun, but use double protection against a
sexually-transmitted disease or an unplanned pregnancy that will change the
course of your life.’” <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">DKT México created “Planficame Esta” (“Plan me this”), a
lively digital platform with <a href="https://www.planificameesta.org/">a website</a>,
and a presence on <a href="https://www.facebook.com/planificameesta">Facebook</a>,
<a href="https://www.instagram.com/planificamesta/">Instagram</a> and <a href="https://www.youtube.com/channel/UC2vorAMvKediWnXvmmCv4QQ">YouTube</a>.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">“These tools give fun messages about the importance of
having a life plan and avoiding pregnancy until you are ready, said Millor. “There
are plenty of ribald jokes, frank discussions and flirty talk full of double
entendres to engage our audiences. Our Facebook page now has more than 1.1
million followers, and more engagement than any Facebook page dedicated to
contraception in all of Latin America.” <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;">The clinic I visited in </span>Iztapalapa, where a majority of
the residents are poor to middle class,<span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;"> is affiliated with </span><a href="https://www.dkt.com.mx/reddkt.php"><span style="mso-bidi-font-family: ABeeZee-Regular;">RED DKT</span></a><span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;"> (DKT Network) which DKT started in Mexico a year ago to improve
sexual and reproductive health and encourage use of long-acting reversible
contraceptives like IUDs. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;"><span style="font-family: Arial, Helvetica, sans-serif;">The bottom line is that DKT México learned from the mistakes of
its first campaign. This new campaign promotes life planning, not family
planning. It has resulted in more young people viewing DKT websites and social
media platforms, sharing information with their friends and coming to DKT
events and clinics to get information and products to help plan their lives. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;">And more of them are actually using contraception to avoid
unplanned pregnancy. Millor says that DKT México has increased almost
eight-fold its number of couple years of protection (the amount of
contraception to protect a couple for one year) between 2012 and 2016. She said
they estimate they contributed about 4% of all the couple years of protection
in Mexico in 2016, according to </span><a href="http://www.dktinternational.org/wp-content/uploads/2013/06/DKT-Contribution-to-CPR-by-Country-data.pdf"><span style="mso-bidi-font-family: ABeeZee-Regular;">DKT calculations</span></a><span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;">. That may not sound
like a lot until you realize that Mexico is the tenth most populous country in
the world, with </span><a href="http://www.prb.org/pdf16/prb-wpds2016-web-2016.pdf"><span style="mso-bidi-font-family: ABeeZee-Regular;">a population of 129 million</span></a><span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;">.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="color: #535353; mso-bidi-font-family: ABeeZee-Regular;"><span style="font-family: Arial, Helvetica, sans-serif;">DKT México is now expanding into Central America, the Caribbean
and northern South America and it will apply the lessons it has learned in
Mexico to these new countries.<o:p></o:p></span></span></div>
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David J. Olsonhttp://www.blogger.com/profile/02509116417343212336noreply@blogger.com0