Blogging4GlobalDevelopment

Bringing the Avon Lady Philosophy to Rural Ghana

2011-12-05T09:28:00.000-08:00

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

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


Daniel Mensah, head of HealthKeepers

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

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

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

As a big fan of using the private sector to improve health (I worked 17 years managing and promoting health social marketing programs), I was thrilled to see such an innovative, entrepreneurial program in rural Ghana (next door to Togo, where I was a Peace Corps volunteer in the 1980s). But I was also worried because, at that time, HealthKeepers was almost out of funding and Daniel Mensah, its executive director, didn’t know how it could continue operating much longer without new funding.

So I was pleased to find HealthKeepers at last week’s 2011 International Conference on Family Planning in Dakar, Senegal in a session entitled “Increasing access to family planning methods and other health products in Ghanaian rural communities.”

I discovered that HealthKeepers had received a two-year grant from the U.S. Agency for International Development through World Learning in April 2010 to expand its work in 18 districts of the Central, Western and Greater Accra Regions. The goal is to reach 1.8 million people by improving access to condoms, oral contraceptive pills and other health products and thereby reducing sexually-transmitted infections (including HIV), teenage pregnancy and maternal mortality.

The results presented in Dakar last week showed that 215 women out of the projected 480 have been recruited and trained by HealthKeepers Network, and they are reaching 45% of the goal of 1.8 million less than a year after the project started.

Not everything has gone smoothly. The abstract addressed two issues in particular:

The Network has had problems recruiting HealthKeepers and has engaged “finders” — usually from the district assemblies’ offices — to help identify potential candidates.

Some HealthKeepers are shy about promoting condoms. The Network has begun applying peer-to-peer support in which successful condom and pill sellers are invited to group meetings to share their selling techniques with their colleagues.

But overall, the project seems to be going well, and many of the HealthKeepers are endearing themselves to the villagers by educating them on use of contraceptives and other family planning methods, according to the conference abstract. “I have been able to create a cordial relationship with my customers, making it easy for them to approach me for the contraceptives,” said HealthKeeper Mabel Martesu.

Visit the HealthKeepers page on Facebook.

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

2011-10-16T06:51:00.000-07:00

This article was originally published in The Huffington Post on Oct. 4, 2011.

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

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

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

"In Kenya, I saw two very different areas -- Turkana, in northwest Kenya, very rural with almost no access to clean water and virtually no infrastructure, and Kibera, a hyper-urbanized slum area in the middle of Nairobi," she said. "But the effects of the drought were equally devastating to families. During the past six months, food prices have skyrocketed, by 24% alone in the month of July, and are beyond the means of most families to pay."

In Turkana, AMREF is responding by providing access to clean drinking water; promoting sanitation and hygiene in schools and households to prevent the outbreak of major diseases such as cholera; distributing food supplements to malnourished children, pregnant women and the elderly; and have created temporary community health centers and medical camps for those most in need.

In conjunction with the recent opening of the 66th session of the U.N. General Assembly, AMREF USA held a briefing on mitigating the effects of recurring droughts and famines. Several important points emerged:

• Drought is inevitable, but famine is not.

• Early warning systems put into place after the last famine predicted this one was coming well before it arrived. Despite that, the U.N. did not formally declare a disaster until July.

• Too often there's an absence of people affected by crises (particularly women) who are engaged in planning interventions.

• There needs to be real commitment to mainstreaming gender into all humanitarian and development programs.

• People need to be assisted where they live instead of forcing them to flee days or weeks of walking from their homes. Displacement makes people more vulnerable to violence, theft, disease and other harmful effects.

• Too often during a humanitarian crisis, donor countries "cherry-pick" interventions, rather than forging an integrated and balanced approach.

• Humanitarian responses, while absolutely necessary, do not substitute for long-term and sustainable solutions.

• Investing in adequate training, motivation and retention of health personnel now is essential.

Sadly, this disaster is not over. The rainy season is coming, warned Phillipe Lazzarini of the UN Office for the Coordination of Humanitarian Affairs. That will bring deaths from communicable diseases like diarrhea and cholera, which will exacerbate an already tragic situation.

But two developments show how things could have been worse in the present, and how they could be better in the future.

First, because of PlumpyNut, a food product made from peanut butter, milk powder and micronutrients popularized by UNIFEF and others the last few years, the effects of this famine are much less severe than they would have been in 2005, according to Werner Schultink of UNICEF.

Second, PepsiCo announced a new initiative aiming to increase its supply of chickpeas and expanding production of the crop in Ethiopia. Of course, that announcement will make no difference to the people suffering now, but the company's partners, the World Food Program and the U.S. Agency for International Development, say the project has the potential to reduce famine in Africa over the long term.

It is encouraging to see the growing role of technological innovation and private sector investment in alleviating famine now and in the future. We need many more such long-term and sustainable solutions -- from the public and private sectors including non-governmental organizations, and from African and donor governments alike -- to erase such disasters permanently from the face of the earth.

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

2011-09-23T17:46:00.000-07:00

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

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

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

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

In July, the Associated Press reported that hospitals in Swaziland do not provide chemotherapy or radiation treatment and that the country's cash-strapped government announced it had run out of money to send its cancer patients to neighboring South Africa.

Cancer is on the rise in Africa and, in most cases, countries have little or no means for dealing with it. Of particular concern are the AIDS-defining cancers -- cervical cancer, Kaposi sarcoma and lymphoma -- according to Dr. Sam Mbulaiteye of the U.S. National Cancer Institute. HIV-positive Africans have a 30-90 times higher risk of Kaposi sarcoma, a 5-times higher risk of lymphoma and at least twice the risk for cervical cancer compared to HIV-negative Africans.

Yet most African languages don't have a word for cancer. Breast and cervical cancer are the two most common cancers among African women. Cervical cancer is "at the intersection of infectious diseases (HPV), reproductive health and cancer, " according to "Understanding the Burden of Cancer in Developing Countries," published by the Global Health Council, but is exacerbated by a lack of reproductive health information and access to treatment in many parts of Africa.

About 2 million women develop breast or cervical cancer every year, according to a report published last week by the Seattle-based Institute of Health Metrics and Evaluation, and much of the growth has been in poor countries, especially in north Africa, West Africa, the Middle East, Oceania, southeast Asia and Central America. The report warned that these two cancers could overtake maternal mortality as a cause of death in younger women.

At least it's finally being recognized and addressed. In April, Rwanda launched a cervical cancer vaccination program for all of its 12- to 15-years-old girls, the first comprehensive national program in all of Africa. There were already pilot projects in Kenya, Cameroon, Ghana, Lesotho, Tanzania and Uganda, according to Cervical Cancer in Action, but Rwanda is aiming for total coverage, an impressive undertaking even in a small country like Rwanda.

And last week, just ahead of the U.N. High Level Meeting on Non-Communicable Diseases (NCDs) Sept. 19-20, former President George W. Bush announced a new $75 million initiative called Pink Ribbon Red Ribbon to fight breast and cervical cancer by expanding the availability of cervical cancer screening and treatment and breast care education in Africa and Latin America over five years.

"It's time to take the next step in building on the progress that has been made over the past decade in the fight against HIV and AIDS," said Bush in a statement. "Many women who seek AIDS services also face the challenge of cancer. It's not enough to save a woman from AIDS, if she is then left to die of another very preventable disease."

Pink Ribbon Red Ribbon will capitalize on the vast infrastructure of clinics and health workers financed by the President's Emergency Plan for AIDS Relief, which Bush launched in 2003. The goals are "to reduce deaths from cervical cancer by 25% among women screened and treated, significantly increase access to breast and cervical cancer prevention, screening and treatment programs and create innovative models that can be scaled up and used globally."

In addition to the health and human impact of cancer, its economic dimensions are profound. Last year,an American Cancer Society report estimated the total economic impact from premature death and disability from cancer worldwide was $895 billion, representing 1.5% of the world's gross domestic product. In low-income countries, cervical cancer accounted for more than 10% of the economic loss, second only to mouth and throat cancer.

The High-Level Meeting on NCDs taking place this week is our biggest opportunity yet to address the scourge of cancer in Africa -- and everywhere -- in a global way.

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

2011-09-20T07:41:00.000-07:00

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

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

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

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

One thing that is different about this vaccine campaign is that it goes beyond the usual message of “saving a life,” important as that is. It contrasts the normal steps of an American child who is vaccinated (“first smile, first tooth, first step, first word, first day of school”) with the plight of a child not vaccinated (“signs of illness, disease diagnosis, symptoms worsen, misses school, another life cut short”). It is about saving a life, but it is also about improving the quality of a life.

Seth Berkley, the new CEO of the GAVI Alliance, said that GAVI is rolling out a lot of new vaccines right now and has received 74 applications from 50 countries. He believes that vaccines could be a bipartisan issue at a time when bipartisanship is in short supply.

Which is why two former senators will be supporting Shot@Life — Robert Bennett, Republican of Utah, and Chris Dodd, Democrat of Connecticut.

The main diseases targeted by Shot@Life include measles, mumps, rubella and polio, which is poised to become the second disease ever eradicated. The Bill & Melinda Gates Foundation developed a wonderfully creative video narrated by Bill Gates that explains the problem, and the particular challenge of polio.

Another fact I learned is that polio was only eradicated in the U.S. in 1979 but children here still have to be vaccinated against it to prevent its re-emergence. The same will be true once it is eradicated in the last four countries where it still exists — Afghanistan, India, Nigeria and Pakistan.

Shot@Life’s new website explains how the campaign will work:

Shot@Life educates, connects and empowers Americans to champion vaccines as one of the most cost-effective ways to save the lives of children in developing countries. A national call to action for this global cause, the campaign rallies the American public, members of Congress, and civil society partners around the fact that together, we can save a child’s life every 20 seconds by expanding access to vaccines. By encouraging Americans to learn about, advocate for, and donate vaccines, the United Nations Foundation's Shot@Life campaign will decrease vaccine-preventable childhood deaths and give children a shot at a healthy life.

Shot@Life is supported by the Gates Foundation, UNICEF, GAVI Alliance, American Academy of Pediatrics, American Red Cross and ABC News.

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

2011-09-16T11:58:00.000-07:00

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

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

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

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

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

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

The Center had wisely anticipated the lack of appetite for major new spending on a major new global health challenge and had just published “Affordable Interventions to Prevent Noncommunicable Disease Worldwide.” In the middle of all of this bad news, the Center found a bit of good: Much of the NCD burden can be prevented through interventions that are low-cost or no-cost:

* End tariff-reducing trade practices for tobacco.

* Partner with public and private donors.

* Leverage U.S. influence in multilateral development institutions.

* Exploit synergies between disease control and other development projects.

* Encourage evidence-informed budget allocation.

So what is the U.S. role in this fight against NCDs?

Clearly, it will not be financial. All four U.S. government speakers emphasized the U.S. commitment to fighting NCDs and to the process leading up the U.N. High-Level Meeting to take place next week. But none of them promised new funds.

“Many were hoping to replicate the High-Level Meeting on AIDS 10 years ago [which opened the door to major funding for HIV/AIDS],” said Holly Wong of the U.S. Department of Health and Human Services. “We now recognize that will not happen.”

Wong represented the U.S. in the negotiations over the political declaration on NCDs recently concluded in New York, and which will be ratified at the HLM.

“We were pretty happy with it,” she said. “We got in some of our language on the Framework Convention on Tobacco Control, including tax measures to reduce consumption and accelerated implementation of the Framework.”

The NCD Alliance acknowledged the importance of that language but was critical on other issues in their official reaction: “The language on curbing the harmful use of alcohol is particularly weak, with no reference at all to essential measures on the price and availability of alcohol. Regrettably, Member States have ignored calls from the NCD Alliance to agree measures to protect children from the marketing of alcohol but have committed to implement WHO recommendations to restrict the marketing to children of foods high in fats, sugar and salt; and to reverse the rising trends of obesity in children, youth and adults.”

Patricia Simone of the U.S. Centers for Disease Control and Prevention (CDC) said that in NCDs, the CDC emphasizes improving health policy “as that is the most cost-effective way of improving health.” She listed a number of examples all over the world where CDC was addressing NCDs (for example, in expanding its malaria surveillance to NCDs) but when pressed to give the financial value of this assistance, she admitted it is “quite small” and mostly in the form on in-kind staff time.

The speakers were clear that there will be no new U.S. money for NCDs in this economic and political climate: Instead, Wong said that the U.S. government’s focus at the HLM next week will be to show how the U.S. will build on existing initiatives.”

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

2011-09-13T09:52:00.000-07:00

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

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

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

The four-day agenda is packed with a mix of celebrities promoting their particular health issues (Ted Turner, Lance Armstrong, Barbara Bush, Geena Davis, Christy Turlington Burns, Mandy Moore), development champions (Raj Shah, Jeffrey Sachs and Muhammad Yunus) and technological innovators, like the heads of Mashable, R to Z Media, Skype and many others.

Kathy Calvin, CEO of the UN Foundation, said that the Social Good Summit is an example of the kind of things that “UNF does to support the United Nations that the UN would not be able to do easily on its own. In this case, to highlight new technologies that help have more development impact for less cost.”

Calvin said that the global health issues focused on by the Summit include non-communicable diseases (the High-Level Meeting on NCDs Sept. 19-20 is a highlight of the week) and maternal and child health, including malaria, polio and measles.

"This is no longer a question of whether social media can change the world — we know it can," said Randi Zuckerberg, founder of R to Z Media and the moderator of the briefing. She hopes the Summit will allow people to share very specific case studies of efforts that have worked.: “How do we mobilize more people to use new technologies to achieve concrete actions?”

An example is “Spread the Buzz to Stop the Spread of Malaria: An Interactive Facebook Town Hall.” That Zuckerberg will moderate and will feature Mandy Moore, malaria ambassador for PSI.

I am looking forward to blogging from the Digital Media Lounge at the 92nd Street Y all next week. I was at the first Social Good Summit last year for a day, and wished I had spent more time there. You can apply here.

And for those who either can’t get into the Social Good Summit or can’t get enough of social media, ONE, Women Deliver, and Vestergaard Frandsen are organizing another event to prove that social media can be a powerful tool to educate, inform, inspire, and make real change on issues like HIV/AIDS, maternal health, child health, clean water and environmental sustainability. The event, “Blogging for Good: Connecting Online Audiences to Offline Actions for Women” will be held 6:30 to9:00 pm at Westin at Times Square and you can RSVP here.

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

2011-08-01T20:07:00.000-07:00

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

Demonstrators in the IAS Media Centre in Rome
demand fast action on a microbicide.
(Photo by David J. Olson)

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

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

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

But I heard little mention of the role of the private (commercial) sector in all of this (apart from several references to Gilead, the manufacturer of Tenofovir gel, the active ingredient in the microbide tested in CAPRISA). And I heard no reference at all to social marketing which is really what the speakers were talking about when they emphasized the need to find innovative delivery strategies. For over four decades, social marketing has proven its ability to deliver a variety of products (condoms, contraceptives, bednets, vitamins) to a variety of places (grocery shops, bars, street vendors) and by innovative means (Coca-Cola delivery trucks, boats and peer educators ranging from sex workers, hairdressers, soldiers, adolescents and prisoners).

So we are hardly without experience in this area, though none of this was acknowledged in the event, despite the clear and repeated need for innovative strategies. Perhaps that was because, despite the presence of 13 speakers from the scientific and research communities, there was not one person from the private sector or the social marketing world.

Pretty much everyone assumes that once the microbicide is introduced, it will be an instant hit and women will snap it up. I fervently hope that it is so, but I think it would be a mistake to assume that. One woman in the audience raised this uncomfortable possibility, by reminding us of the female condom, another female-controlled device introduced to much acclaim almost 20 years ago which has not realized its potential.

Why was that? Do we really understand the reasons? Certainly, it’s a more obtrusive product that was off-putting to some men (and women), there were pricing issues and some donors did not provide the funding required to make it a success. But do we truly understand the lessons of the female condom, and other unsuccessful health products, so that we do not repeat them with a microbicide? I am not sure we do.
Fortunately, we still have time. So let’s absorb those lessons, let’s recruit the private sector and social marketing as critical partners in our efforts to find innovative strategies for delivering a microbicide, once it is on the market, and ensure that it is used correctly.

Farewell to Deauville: How did global health fare?

2011-08-01T19:58:00.000-07:00

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

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

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

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

But we also pointed out the significant criticism the G8 has received over its Deauville Accountability Report where it reportedly inflated the foreign aid it has delivered since the Gleneagles Summit of 2005. And we pointed out that the Deauville Declaration all but declared that its critics were correct in saying that there is a $19 billion gap in constant dollars between the development assistance that the G8 and other donors promised to deliver and what was actually delivered in those five years.

My last blog from Deauville gave credit for that remarkable candor in the declaration to British Prime Minister David Cameron, my new G8 hero, for calling out the G8 for its lack of accountability and his fellow heads of state for not making international development more of an issue.

The Toronto Globe and Mail reported that Canadian Prime Minister Stephen Harper arrived in Deauville Thursday announcing “his hope of squeezing promised but undelivered maternal-health aid funds out of the world’s major leaders, but his hopes of getting the world to deliver on its commitments are at odds with the deep fiscal emergencies that have eclipsed most other issues for the largely European group of leaders.”

The issue that very much dominated this summit in the mainstream media — both French and international — was aid to the emerging Arab democracies of Egypt and Tunisia. This trend was dubbed “Arab Spring,” or “les Printemps Arabes,” and was undoubtedly the most common phrase in media coverage of the summit.
G8 leaders announced plans for $40 billion in aid for the emerging democracies — $10 billion from the G8 itself, $10 billion from wealthy Arab countries like Saudi Arabia and $20 billion from multilateral agencies like the World Bank.

But Christi Parsons of the Los Angeles Times reported the view that many of us in civil society held: If the G8 is still $19 billion short of the $50 billion they committed to deliver to developing countries by 2010, why should we believe that they are now sincere about committing $40 billion more for the Arab Spring?

And also — unspoken but surely contemplated by the NGOs — will this new $40 billion commitment further compromise, or negate, the G8’s ability to meet the existing $50 billion commitment of Gleneagles 2005?
Except for Cameron and Harper, I heard no head of state mention global health, or even international development. I sat through two press conferences of French President Nicholas Sarkozy and heard him make only one comment on these issues, a brief reference to his commitment to innovative financing for development (and indeed, he is a champion on this issue, although it was not evident in Deauville).

Of particular note was the very low profile of HIV/AIDS in contrast to past summits. Yes, it’s true that French First Lady Carla Bruni-Sarkozy, who is also the global ambassador for the Protection of Mothers and Children against HIV/AIDS, gave a working lunch Friday for G8 spouses on the protection of mothers and children against AIDS. But I saw no statement or media coverage of that lunch.

No G8 leader save Cameron made any mention of HIV/AIDS. And there were opportunities for journalists to engage on the issue. In addition to the spouses’ working lunch, Global Fund Executive Director Michel Kazatchkine and UNAIDS Executive Director Michel Sidibé made a compelling case for “this historic opportunity to eliminate mother-to-child transmission” in a press conference. Sidibé even made the economic case for elimination. Unfortunately, this press conference attracted all of 10 people (not including myself). Someone later told me that only two of these were legitimate journalists; the rest were NGO representatives like us.

How do we get old issues like HIV/AIDS and new issues like maternal and child health (not to mention non-communicable diseases) more firmly on the G8 agenda? And is there any hope of getting these issues on the G20 agenda? France is also hosting the G20 this year five months from now. If these issues do not come out strongly at the G8 — their traditional venue — how do we expect them to get any traction on the G20 agenda?

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

2011-05-31T19:09:00.000-07:00

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

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

A young girl swims through the flooded streets of Dhaka
with a packet of oral rehydration salts clenched in her teeth.

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

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

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

What happened? After the success of ORT in the 1980s and 1990s, the global health agenda shifted to AIDS and malaria and that increase in resources was not matched by other leading causes of childhood deaths, including diarrhea, even though diarrhea accounts for 14% of child deaths, compared to malaria with 8% and HIV with 2%.

“The Control Diarrheal Disease program generated both supply and demand for ORS and ORT through mass campaigns, training, procurement and distribution,” said Evan Simpson, a program officer of PATH who works on diarrheal disease. “All the pieces were there. But it was all built on support for the public sector from donors, and may not have created a true and sustainable market.”

Later this week, the G8 Summit will be held in Deauville, France and leaders will face a plethora of pressing issues. One of them will be whether or not they will sustain their support for the Muskoka Intiative, a $7.3 billion maternal, child and reproductive health plan launched with much fanfare and promises of more to come. But so far, the G8 host, French President Nicholas Sarkozy, has shown zero interest in the Muskoka Initiative even though his wife, Carla Bruni-Sarkozy, wrote this at the 2009 L’Aquila G8: “G8 leaders sparked a revolution in health for the poor. They must now resist the economic pressure to undo it.” However, health is barely mentioned in the G8 priorities of the French presidency. Yet ORT is a perfect example of the kind of proven intervention that the G8 could easily scale up in order to save millions of children’s lives cost-effectively.

I looked at two countries that showed very different trends in the 2008 analysis — Bangladesh, one of the countries where ORS use increased (albeit, slightly) between 2000 and 2004, and Kenya, where it declined by 32%, the largest of any of the 34 countries studied.

“It is an unfortunate case with diarrhea treatment in Kenya,” my friend Rehana Ahmed, a Pakistani physician who has been living eight years in Kenya, told me. “There was a huge push around ORT in the 1980s and 1990s — diarrheal disease control programs supported by the Ministry of Health, countries starting their own local production of ORS and a strong global commitment around improving diarrhea treatment. But with the move towards Integrated Management of Childhood Illnesses, the diarrheal disease control programs lost leadership at the country level and interest at the global level. It’s really unfortunately that we have an effective, easily delivered approach that has lost its flavor.”

Bangladesh has long been considered one of the world’s greatest ORT successes. At the UN Summit on the Millennium Development Goals (MDGs) last year, the UN bestowed an award on Bangladesh for significant progress in reducing child mortality.

I played a small role in ORT popularization in Bangladesh in the late 1990s when I served as the resident advisor to the Social Marketing Company, a large Bangladeshi non-profit organization that made a huge contribution to both home preparation of ORT and the social marketing of ORS at subsidized prices in retail outlets.

Although SMC sold more than 226 million sachets of ORS last year, ORT use overall has dwindled in Bangladesh. The 2007 Demographic and Health Survey showed that, since 2004, use of commercial ORS had increased 10% but the percent of children receiving ORT had changed little. And the percent receiving fluids decreased slightly.

My former colleague Perveen Rasheed, a former managing director of the SMC, recalls that the three pillars of Bangladesh’s success in maternal and child health were family planning, immunization and ORT. “The three worked in tandem,” she said. “The governments were committed, the donors were putting funds in the right places, at the right time, in the right amounts through the right implementers and programs. The hugely popular immunization and ORT brought the trust parents needed. Children were not dying in frightening numbers. Thus, adoption of family planning made sense.”

ORT use took off after a cyclone and tidal wave hit Bangladesh in 1991 and continued to grow through the 1990s. But in the 2000s, Perveen said, two things happened: First, donors cut back on communications (“Every year, a new cohort of people become parents. To suppose that they know about ORT because almost everyone else does was not strategic.”) Second, some of the communications around the introduction of zinc tablets was confusing and discouraged people from using ORS in conjunction with them.

As global health priorities shifted, so did attention away from diarrheal disease. Although diarrhea is one of the leading killers of children, it was no longer treated as a global priority, according to a 2009 PATH report: “A 2008 research study conducted by PATH to evaluate global health funding and the policy landscape found that diarrheal disease ranked last among a list of other global health issues…Widespread adoption of proven, existing water, sanitation, hygiene and health interventions has been hampered by the lack of political leadership and commitment to fight diarrheal disease. In turn, this has led to a decline in funding and research.”

How do we turn this around and restore ORT to its rightful role as a deadly weapon against diarrheal disease? UNICEF says we have to “reinstate diarrhea prevention and treatment as a cornerstone of community-based primary health care.”

The good news is that there is nothing complicated about that doing that. We already have the technology, we know how to use it and it doesn’t cost much. All we have to do is find the political will to get it done. The G8 leaders are in an excellent position to make that happen next week in Deauville.

See a video of how oral rehydration therapy is done from the PBS series, RX for Survival.

Mali: One of many African malaria success stories

2011-05-31T19:04:00.000-07:00

This blog was published on The Huffington Post on April 25, 2011.

One night, as a young development worker in Mali 20 years ago, I engaged in high-risk behavior in a village west of Bamako -- I slept without a mosquito net in the middle of the rainy season.

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

David as a young development worker in Africa.

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

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

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

On World Malaria Day 2011, we pause to note that Mali is only one piece of an even bigger and happier story: The report reveals that the lives of almost three quarters of a million children in these 34 countries were saved in the last 10 years through the use of insecticide-treated mosquito nets, indoor residual spraying and preventive treatment of malaria during pregnancy.

A total of 43 malaria endemic countries showed a greater than 50% reduction in either confirmed malaria cases or malaria admissions and deaths over the past decade, according to the World Malaria Report 2010. In 2009, Morocco and Turkmenistan were certified by the World Health Organization as having eliminated malaria and the WHO European Region reported no cases of Plasmodium falciparum malaria for the first time.

The Roll Back Malaria report estimates that an additional 3 million lives could be saved by 2015 if the world continues to increase these highly cost-effective measures for tackling the disease and that what is required is that U.S. and other donors should continue investing in malaria control the way they have been doing the last few year.

See the Global Health Council's Position Paper on Malaria to see what needs to be done to keep that momentum going.

My condom wars with Catholics on three continents

2010-12-03T18:18:00.000-08:00

This blog was first published in the Huffington Post on Dec. 3, 2010.

Pope Benedict XVI’s comments last month that condom use can be justified in some cases to help curb the spread of AIDS were surprising to me only because they came from the very top of the Catholic Church. But in my 10 years of managing condom social marketing programs for HIV prevention and family planning, I have come across shocking discrimination as well as enlightenment and compassion from Catholics working with people at the grass roots.

Almost precisely 18 years ago, on World AIDS Day 1992, I launched “Maximum” condoms (“Strong for Maximum Protection, Sensitive for Maximum Pleasure”) in Zambia, a country that had double digit HIV prevalence but no reliable source of high quality, low-priced condoms. Zambia also had a newly-elected president, Frederick Chiluba, who was a born-again Christian and stridently anti-condom.

We had a big launch event at the Pamodzi Hotel with lots of speeches and exhortations on the importance of using condoms. Surprisingly to me, we also had a Catholic priest and nun in attendance. They had come separately and neither was wearing religious attire.

The nun worked in the Copperbelt region of Zambia where she was fighting AIDS among miners . And the priest was Father Michael Kelly, an Irish Jesuit who had founded Kara Counseling, Zambia’s first HIV counseling and testing center, and later became a good friend.

I asked Father Michael what he was doing there given his church’s stance on contraception. He was not there to support condoms for contraceptive purposes, he said, which was banned by the Vatican. But he felt that good Catholics should always fight disease, and that condoms used for HIV prevention do that. So he saw no contradiction between condoms for HIV prevention and his Catholic faith. His argument was actually evidence-based, since research showed that Zambians who did use condoms used them overwhelmingly for HIV prevention, not family planning.

In Zambia, our project had a fund-raising dinner dance, and we donated the proceeds to an AIDS orphanage. The Catholic sisters were only too happy to receive the much needed funds for children who had lost both parents to AIDS. But when the photo of the presentation of the check came out in the newspaper, the Catholic hierarchy was enraged that the orphanage had taken “tainted money,” and made the sisters give it back.

In Bangladesh, a strongly Muslim country, I had no problem whatsoever with the government or religious leaders. Although HIV/AIDS was not yet considered a big problem there, everyone (including successive governments of rival political parties) understood the threat of overpopulation in a country the size of Wisconsin with 140 million people, and fully supported our work promoting condoms and other contraceptives for family planning.

Paraguay, a strongly Catholic country where I lived from 1997 to 2001, was more complicated. I heard of priests visiting patients in Catholic hospitals who would stand in the doorways of the rooms of AIDS patients and not enter. I had the personal experience of one of my condom sales agents, Marcos Frutos, telling me that his priest had not allowed him to become godfather to a family member because of Marcos’ job. I know that hurt Marcos very much, but he did not back down.

But I also knew of Catholic priests and nuns at the local level in Paraguay who supported our work and, in some cases, even distributed condoms to their parishioners.

And I found that it was possible to find common ground with opponents. We ran afoul of a group of Catholic parents who were offended by a sex education booklet we had published called “Hablemos Claro Sobre Sexo” for our adolescent program. They thought it overemphasized condoms and underemphasized abstinence. They were probably right. We heard them out, made most of the changes they requested and then continued happily in our work targeting adolescents.

In 2002, I spent two days with Kenneth Kaunda, the father of Zambian independence and the first president of Zambia, to create a series of HIV prevention public service announcements, including one promoting condoms. I knew President Kaunda was a man of faith, and I asked him how he could he could justify condom promotion in light of that faith. I also knew he had lost a son to AIDS in the 1980s, when he was still president and there was a lot of stigma against HIV-positive Zambians, and that he was very public about the fact that his son had died of AIDS. In response, he gave me the most original religious justification for condoms I have ever heard:

Condoms can prolong life, President Kaunda said. Some people more time than others to find God and get close to him. If their life is cut short by AIDS, they may never find God. Condoms give them the extra time they need in their life to get right with God.

YouTube + Wikipedia = Social Change

2010-11-25T06:52:00.000-08:00

WASHINGTON, DC -- What do you get if you combine the video-sharing power of YouTube, the depth of information of Wikipedia and the social change aspirations of an advocacy website? Something called ViewChange.org, as I found out last week when I attended its formal launch at AED headquarters here.

U.S. independent television broadcaster, Link TV, launched “the next generation multimedia platform for global development” that combines powerful video stories with the latest “semantic” technology that allows a person, after viewing one of the many powerful short videos showing "good news" development stories, to extract more information about that issue, and then to take action in a variety of ways. ViewChange.org is funded by the Bill & Melinda Gates Foundation.

After watching a video, you have three options: “Watch More” (as in, watch more videos), “In the News” (to explore an issue in more depth) and “Take Action” (which presents you with a variety of concrete actions ranging from taking political action, donating to a cause or writing a letter to the editor). Every video is tied specific actions that the viewer can take.

ViewChange.org goes way beyond YouTube, where the end point is the merely emotion elicited by the video. With ViewChange.org, the idea is that after the viewer is moved emotionally, the viewer will be moved practically to action.

We got a taste of how good some of the videos are at the AED event when Link TV announced the winners of the ViewChange Online Film Contest. The $25,000 Grand Prize Winner went to a film that tells the highly inspiring story of Kakenya Ntaiya who makes her dream of becoming the first girl from her Maasai village in Kenya to go to college come true. And then she goes one step further. You have to check out this amazing film called “Vital Voices: Kakenya.” After this film was screened, Kakenya stepped forward and told how the film has changed her life.

I was especially captivated by a film called “Burning in the Sun” about Daniel Dembele who returns to Mali to start what is believed to be the first company in West Africa to produce solar panels from local materials. I have a special place in my heart for the beautiful country of Mali, where I spent five years and funded several projects in appropriate technologies like improved stoves and solar fruit dryers.

View all the contest winners in the categories of empowerment, leadership, local/global and sustainability.

A questioner in the audience pointed out that it is possible to make similarly inspiring films on the cheap, without sending out the film crews that were employed for some of these professionally made films. One of the panelists readily agreed and even pointed out that over-produced films can sometimes be counter-productive to the goals of evoking emotions and provoking actions.

People and organizations can share these stories with a variety of audiences, including directly with media and policymakers. They can collect relevant videos, articles and actions into playlists, which can then be shared with appropriate communities via social networks and email. The site offers HTML5 video, adding standards-based support for mobile devices and browsers that do not support Flash.

I am still trying to find out how global health non-profits might be able to take advantage of the power of ViewChange.org. For example, I was told that ViewChange.org will have a constant need to update its videos and I want to find out how we can submit original videos to tap into the power of ViewChange.org. There are many non-profits with powerful stories to be told, and who have not told them.

Has a new era of video-inspired advocacy action been born? We shall see, and I intend to find out more about this technology and how it can be used, especially for smaller non-profits that lack the means to tell their

Two continents, one AIDS epidemic

2010-10-29T20:06:00.001-07:00

WASHINGTON, D.C. - The speakers talked about a society with an AIDS epidemic driven by a devaluation of girls and women, young people denied evidence-based sex education, parents in denial about their children’s behavior and religious leaders who sometimes do more harm than good.

They were talking about sub-Saharan Africa.

And they were also talking about the District of Columbia.

The most striking fact to emerge from a panel discussion at Howard University this week on “UN Millennium Development Goal #6: Combating HIV/AIDS” was how similar some of the drivers of HIV/AIDS are in Africa and in Washington, D.C. Indeed, it was said several times that D.C. has the HIV prevalence of a developing country. The event was organized by the D.C. League of Women Voters, Howard University Hospital and the United Nations Association in observance of United Nations Day.

I was at the event at the request of my good friend, Pauline Muchina, the senior partnership advisor at UNAIDS, who is from the Rift Valley of Kenya and has lost a cousin, an uncle and nine good friends to AIDS. Pauline gave a sweeping panorama of the African AIDS epidemic and attributed much of the cause for the high rate of HIV and AIDS among women and girls in Sub-Saharan Africa to cultural and social norms, the failure to address major drivers of the AIDS epidemic such as discrimination and violence against women and girls and taboos about openly discussing and educating youth about human sexuality. She said religious leaders have done a lot in the AIDS epidemic, but some have undermined the global AIDS response by perpetuating stigma and discrimination and rejecting appropriate sex education in their religious institutions, schools and communities around the world.

Later, an Ethiopian man in the audience referred to religious leaders as "gatekeepers of ignorance."

Marilyn Johnson, who trains health providers in the District on HIV/AIDS, finds it frustrating that high school nurses cannot initiate discussions of on sex with students, but only in response to questions. She is the director of provider outreach for Howard University Local Performance Site of the Pennsylvania/Mid Atlantic AIDS Education and Training Center.

Johnson said that Washington, despite having the highest adult HIV prevalence rate of any city in the nation, has no requirement that doctors receive HIV/AIDS training in order to be licensed. Florida requires it, and she is working to ensure that D.C. does too. She sees doctors as part of the problem (recounting the story of a doctor who wanted nothing to do with HIV/AIDS) and also the solution (“Doctors have more credibility than anyone else in the African-American community”).

Walter Smith is the executive director of DC Appleseed Center which, since 2005, has been issuing report cards that evaluates the District’s progress in implementing the recommendations in DC Appleseed’s report. Report Card No. 5, issued last year, shows important progress has been made in a number of areas:

The city’s HIV/AIDS strategy is now driven by data. “Those data show the city’s HIV/AIDS cases are staggeringly high, but at least we now know what we face and where our efforts need to be focused,” said Smith.
The District has dramatically improved its testing for HIV/AIDS. In fact, the number of tests conducted in the District is exceeded only by New York City and Florida.
The needs of some of the most at-risk populations are being better addressed. The D.C. Jail is cited as a national leader in HIV testing and support for those who test positive. And the overturning of the needle exchange ban by the federal government has allowed the city to significantly increase its efforts at reducing HIV/AIDS among drug users.
The D.C. public schools have instituted a health curriculum that includes age-appropriate lessons on HIV/AIDS.
Condom distribution in the district has dramatically expanded, from a little over 100,000 in 2006 to nearly 3 million in 2009.

The District got four As in Report Card No. 5: An A in HIV Surveillance, HIV testing and HIV/AIDS Among the Incarcerated, and an A- for Interagency Coordination. All the rest of the grades were Bs, except for a C+ in Public Education in the District.

Smith said the result of all this good activity has been a “dip” in the absolute number of new AIDS cases. But, with a prevalence of 3.2%, the district is still “at epidemic levels.”

He praised the progress that has been made under Mayor Adrian M. Fenty and seemed equally optimistic about the incoming administration of Vincent Gray and a majority of the City Council.

The audience of about 25 was not what I would have expected at a Howard University event. About two-thirds were white-haired older white women (members of the DC League of Women Voters or the UN Association) and the other third were female Howard students who are also peer educators working in District high schools to educate adolescents on HIV/AIDS.

One of them spoke passionately about another contributor to Washington’s AIDS problems — parents. She said parents were in denial about their children’s behavior , resulting in parents’ preventing their children from getting the HIV/AIDS education they needed to make informed decisions.

Except for a reporter from The Hilltop, the Howard University student newspaper, there was a total absence of male students, and that itself drew the attention of several speakers at the event, who said that to address seriously the AIDS epidemic — in Africa and the District — boys and young men would need to be engaged much more than is the case now. The event at Howard was a good proxy for that lack of male engagement.

Dr. Sohail Rana, a native Pakistani who has taught pediatrics and hematology at Howard University for 30 years, spoke movingly about his experience dealing with HIV/AIDS at Howard and the oppressive stigma that still impedes an effective response to people with HIV or at risk of HIV infection. Such is his concern about stigma, that he is helping organize a one-day “International Conference on HIV-Related Stigma: The Attitude that Spreads HIV” on World AIDS Day on Dec. 1. The conference will feature top HIV/AIDS experts and activists.

Women heroes of conservation are also improving health

2010-10-20T18:55:00.000-07:00

WASHINGTON, D.C. - Earlier this month, I stepped out out of my comfort zone and went to an event on Capitol Hill that had nothing to do with global health, at least not directly. The event, “Women Heroes of Global Conservation,” honored six women who had done extraordinary things to save the planet.

Truth be told, I went to see Wangari Maathai, the 2004 Nobel Peace Prize winner for her work transforming women’s lives and the environment of her country Kenya through the Green Belt Movement she founded in 1977 and which has spread to 15 countries in Africa. Ms. Maathai was ill and could not be present but I heard from five other equally amazing women.

The overall event reinforced my perception that conservation and the environment has a lot to do with health. More and more, I see the links between health, climate change and the environment. We heard from these “Women Heroes of Global Conservation”:

* Mary Mavanza, Tanzania, manager of the TACARE program of the Jane Goodall Institute, has helped hundreds of Tanzanian women start environmentally sustainable business through microcredit loans and training. By improving economic conditions among women in and around Gombe National Park, the TACARE program has protected nearly 200,000 acres of forests and worked with 22 villages to create land use plans.

* Suzan Baptiste, Trinidad, founded Nature Seekers in 1990 and stopped turtle poaching. NatureSeekers is the largest employer in her region of Trinidad and has reforested large areas by hiring women to rehabilitate areas that were destroyed by fires or logging companies. She was named a CNN Hero in 2009.

* Sangduen “Lek” Chailert, Thailand, challenged and transformed traditional wildlife management techniques by setting up elephant sanctuaries and ecotourism program in northern Thailand, a country where there were once 300,000 elephants and now are not more than 3,000. Ms. Chailert has expanded this work to other areas of Thailand.

* Habiba Sarabi, Afghanistan, is the governor of Bamyan Province, the country’s first and only female governor. To improve the lot of women and communities, Governor Sarabi has increased tourism through conservation by creating Afghanistan’s first national Park, Band-e-Amir, protecting 220 square miles of pristine lakes and limestone canyons.

* Lucy Aquino, Paraguay: I was especially keen to hear from Ms. Aquino, who comes from Paraguay, a country where I lived four years and which has a special place in my heart. As the Paraguay director of the World Wildlife Fund, she has improved conservation and empowered women and communities for nearly 30 years. Paraguay once had had one of the highest rates of deforestation in the world in the Atlantic Forest Region, a highly threatened region where indigenous communities have been displaced with the men often going to work on cattle ranches or soybean farms, while their wives and children go to the cities to engage in begging, or worse. Ms. Aquino helped establish a Zero Deforestation Law, which resulted in a reduction in deforestation rates by 85%.

Several speakers, including Ms. Maathai, lamented the fact that the U.S. does not have a conservation strategy. “The U.S. has a thoughtful strategy for improving the well-being of women and girls around the world,” wrote Ms. Maathai in her statement. “It also has a global food security strategy, a global health strategy and a global climate change strategy. It will soon have a global development strategy. But because natural resources underpin each of these goals, there must also be a conservation strategy. None of these other strategies can truly succeed over the long term with one.”

To that end, Democrats and Republicans in the Senate and the House have come together to propose the Global Conservation Act of 2010 to prevent the destruction of our world’s forests, reefs and other ecosystems. On June 17, 2010, Senators Tom Udall, a liberal Democrat, and Sam Brownback, a conservative Republican, introduced legislation that would coordinate the work of all U.S. agencies involved in international conservation and establish a national strategy for promoting conservation.

According to the Alliance for Global Conservation, the main organizer of this event, health is one of the major benefits of conservation. Half of the new drugs created in the past 25 years have an ingredient derived from nature, according to the Alliance, and over 70% of all cancer drugs are based on natural compounds.

As the most senior representative of the U.S. government at the event, Undersecretary of State for Democracy and Global Affairs Maria Otero recounted a personal manifestation of climate change: The mountain she used to ski on when she was a child in her native Bolivia is now brown and barren of snow, she said.

Undersecretary Otero said that the U.S. is committed to international conservation, spending $300 million on it every year, and mentioned one recent example — the announcement of a Global Alliance for Clean Cookstoves, a public-private partnership led by the United Nations Foundation and several U.S. government agencies, to save lives, improve livelihoods, empower women and combat climate change by creating a market for clean and efficient cookstoves. Exposure to smoke from traditional stoves and open fires accounts for nearly 2 million premature deaths annually, with women and young children the most affected, according to the World Health Organization. This is one of the many ways conservation can improve human health.

So if you support global conservation, you are also supporting global health.

What does Syrah wine have to do with pneumonia?

2010-10-08T20:41:00.000-07:00

NEW YORK, NY — In June, New York Times Wine Critic Eric Asimov started his wine column with a joke: “What’s the difference between a case of syrah and a case of pneumonia? You can get rid of the pneumonia.”

That column, which analyzed why American Syrah wine, which can be superb, had never achieved much success, has led to one of the strangest partnerships in global health — a coalition fighting child pneumonia and the Rhone Rangers, America’s leading non-profit organization dedicated to promoting American Rhone varietal wines such as Syrah.

Last month, I witnessed the partnership in a wonderful event in the New York Times Center here on the first day of the United Nations Summit on the Millennium Development Goals cleverly marketed as “Pneumonia’s Last Syrah,” a wine reception and photography exhibit, which displayed striking images and stories that provided a window into the human face of pneumonia and the burden of the disease.

After sampling the wares of the 12 Syrah producers present at the event (11 from California, one from Virginia) , which were all excellent, the audience was educated about pneumonia:

* It is the leading cause of death among children under 5, with more than 1.5 million dying from it every year.

* Vaccines against two of the main causes of life-threatening pneumonia are used throughout the developed world. However, millions of children in developing countries still lack access to these vaccines.

* Life-saving antibiotic treatment for serious pneumonia typically costs less than one dollar. However, only an estimated one of every five children with pneumonia receives antibiotics.

Wine Critic Asimov, who helped ferment this partnership, spoke at the reception, saying he was humbled to be part of such a significant issue while he usually spent his time worrying about nothing more than excessive oakiness in chardonnay.

The Global Coalition against Child Pneumonia, made up of more than 100 organizations, will mark World Pneumonia Day on Nov. 12 to bring attention to pneumonia and promote policies that will prevent the millions of avoidable deaths.

The Global Coalition suggests five things people can do to take action. One of those things is to buy a case of American Syrah wine during the month of November from one of these producers, and they will donate $10 to provide pneumonia vaccines to children in the world’s poorest countries.

This will help save the American Syrah wine industry, but it will produce the even happier effect of saving the lives of children who might have died from pneumonia.

Disclaimer: I won a large bottle of Syrah wine in the raffle at the event but these opinions were in no way influenced by that fact. I was going to write this anyway.

High tech TEDx event shows that child health is within reach

2010-09-23T20:48:00.000-07:00

NEW YORK, NY — On the opening day of the United National Summit on the Millennium Development Goals (MDGs) Monday, I participated in a most unusual media and educational event organized by TEDxChange, a collaboration between TEDx and the Bill & Melinda Gates Foundation.

The live event from the Paley Center for Media on 52nd Street featured Melinda Gates, Hans Rosling, Mechai Viravaidya and Graça Machel in front of a live audience of, as TEDx host Chris Anderson put it, luminaries and changemakers (Ted Turner was in the audience along with NGO and foundation leaders). A live webcast of the event was viewed my millions around the world, and from 82 TEDx events, several of which we saw on camera in live shots, and and is now available to view online.

I viewed the event from “Bloggers’ Alley,” several floors above the event, with about 20 other bloggers and new media journalists, most of whom had laptops and smart phones to extend the salient facts of the event even further into the world. We viewed the event on two screens at either end of the room. And we had a third screen, which displayed a constant stream of all tweets including the #TEDxChange hashtag. The deluge of the Twitterstream produced a continuous stream of concise Tweets that came about one per second for the entire 90 minutes of the event and even after it ended.

It was a fabulous display of what is possible with communications technology in the 21st century. But the content revealed at the event several floors below was even more compelling.

The speakers were all terrific – Melinda Gates and Graça Machel displayed their passion and commitment to improving the world and Hans Rosling and Mechai Viravaidya (Mr. Condom of Thailand) regaled us with their knowledge, energy and sense of humor.

I particularly enjoyed Dr. Rosling, a professor of international health and co-founder of the Gapminder Foundation, who dazzled us with his computer graphics, which convert international statistics into moving interactive graphics showing us the history of child mortality.

In one part of his presentation, Dr. Rosling showed us the fall in child mortality in Sweden (starting with 400 child deaths per 1,000 born in 1800), Egypt (with 300 deaths in 1960) and Thailand (with 150 deaths in 1960), and ending with all three countries ending with roughly the same low level of child mortality.

Later, he presented a graph of the relationship between child mortality and family size in 1960, with “developing countries” clumped together in the upper right (high mortality and high family size) and the “Western” countries in the lower left (low mortality and low family size). Then, in an amazing and awe-inspiring display of computer graphics, he made the graph come alive and move through time to 2000. Many of those developing countries in the upper right moved rapidly into the lower left quadrant, with Dr. Rosling urging them on: “Come over to our side,” he exclaimed. “Welcome to a decent life.”

The conclusion of his presentation, which made clear the association between child mortality and falling family size: “The MDG on child mortality is fully possible.”

It was an inspiring way to begin the MDG Summit.

NOTE: Some of Dr. Rosling’s amazing graphics are available are available at Gapminder World and on this website.

In malaria prevention, positive change in Mali, and elsewhere

2010-09-14T19:23:00.000-07:00

WASHINGTON, DC — As a young development worker for Lutheran World Relief in Mali 20 years ago, I engaged in high-risk behavior occasionally. In my extended journeys around the country, I slept in villages from the Sahara Desert in the north to the Niger River Delta and Dogon Country in the center to the southern savanna, but rarely with a mosquito net hanging over me, and certainly not an insecticide-treated one.

I paid for my sins: I was struck down by malaria after an overnight stay in a southern Mali village in the middle of the rainy season. Malaria made me feel so awful, so lethargic, that I thought I might die and worse, I didn’t much care. In those days, mosquito nets were hard to come by, especially if you were a poor, rural Malian. And most Malians are poor and rural.

But a lot has changed in 20 years. Today, a new report unveiled at the National Press Club shows that Mali is an important part of a pan-African malaria success story. In 2000, there were an estimated 22,663 malaria deaths among children 1 to 59 months in Mali. From 2001 to 2010, the global investment in malaria control prevented 65,065 malaria deaths, the most of any of the 34 malaria endemic countries in Africa.

And Mali is only one piece of an even bigger story: The new report "Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals" — authored by Tulane University, Johns Hopkins University, the World Health Organization and PATH and published today by Roll Back Malaria — reveals that the lives of almost three quarters of a million children in these 34 countries were saved in the last 10 years through the use of insecticide-treated mosquito nets and other preventive measures.

Most importantly, the report estimates that an additional 3 million lives could be saved by 2015 if the world continues to increase investment in tackling the disease.

This should provide a clarion call for world leaders who gather in New York next week for the UN Summit on the Millennium Development Goals as they seek ways to meet the eight goals in the five years remaining in the 15-year timeline of the MDGs.

The report shows clearly what is required: U.S. and other international donors should just keep investing in malaria control the way they have been doing the last few years, and 3 million more lives could be saved in the next five years.

Here is the press release on the report.

Male circumcision, a proven HIV prevention strategy, overshadowed by another one years from fruition

2010-07-24T09:54:00.000-07:00

VIENNA, Austria – Much of the buzz at the XVIII International AIDS Conference that just finished here was around the encouraging news of a microbicidal gel that trials have shown to be almost 40% effective, although we are still years away from having a product on the market. Meanwhile, male circumcision (MC), a proven and effective HIV strategy that reduces transmission by nearly 60% and is already available, got much less attention, though it finally got some, and for that we can be grateful.

Two years ago in Mexico City, nary a word was said about male circumcision — and certainly not in a plenary meeting — despite its proven effectiveness. I organized a press conference on male circumcision for PSI, which was successful in generating some media buzz and attention, including The Economist, which called it the one bright spot in prevention at the conference. In fact, I think that press conference resulted in an improved environment for MC. However, donors and governments, for the most part, continued to do nothing to scale up an intervention that could have saved millions of lives with one notable exception.

In December 2008, the Gates Foundation became the first donor to scale up MC, quietly providing funding for PSI to expand its male circumcision pilot project in Zambia to two other countries (a third country was added later). There was no fanfare, no announcement, as everyone was concerned about provoking a negative reaction for an intervention that addressed long-standing cultural practices.

However, there was no significant negative reaction and now the environment seems to have changed. MC seems to be going mainstream. Both Bill Clinton and Bill Gates mentioned MC in their speeches in Vienna. In particular, Bill Gates could hardly stop talking about the wonders of MC, calling it and prevention of mother-to-child transmission two of the interventions that “are so effective that in endemic countries it is more expensive not to pursue them.” While more than 41 million men in sub-Saharan Africa could benefit from the procedure, he said, just 150,000 have been circumcised in the past few years.

“I have to admit: When it comes to circumcision, I used to be one of the sceptics,” he said in his speech. “I thought: ‘Sure, it reduces transmission by nearly 60%. But there’s no way that large numbers of men will sign up for it. I’m glad to say I was wrong. Wherever there are clinics available, men are volunteering to be circumcised in far greater numbers than I ever expected.”

The Council attempted to monitor the major media coverage of this conference, and our unscientific analysis showed male circumcision to be the second most covered story on the first two days of the conference (after the microbicidal study, of course), with stories in Agence France Presse, Bloomberg News, Los Angeles Times, The Guardian, die Presse, Frankfurter Rundschau, Le Point, Le Figaro, Prensa Latina, Radio Canada, Radio France Internationale and Reuters, among others.

It wasn’t quite that high profile at the conference itself but it was certainly more evident than in Mexico City, with a number of oral and poster presentations on different aspects of MC. This has not come a day too soon. For every man we reach with male circumcision services that he already wants, the fewer new HIV infections will be produced in the future. It is an intervention whose time seems to have come.

AIDS activists need new communications strategies

2010-07-20T08:36:00.001-07:00

VIENNA, Austria — In the history of AIDS, activists certainly deserve a place of honor for their persistence in pushing governments and donors to do more than they would have done on their own or, at least, not done as fast. But the new generation of AIDS activists sure don’t seem to be winning over the rest of non-activists here at the XVIII International AIDS Conference. And they could use some communications training.

At the opening ceremony on Sunday, they annoyed the vast majority of the audience — many of whom had arrived early to secure good seats — by disrupting the screening of a film produced by the Global Fund to shout for more funding. Ironically, the whole point of the Global Fund film was to raise awareness about the need for more funding in this, the third round of Global Fund replenishment. The Global Fund film makes this point more eloquently and convincingly than the protestors. But I know that only because I had seen the film previously, without disruptions; the audience could not hear the film because of the continuous chanting.

Another irony was that the official speakers at the podium continually agreed with the protestors, and agreed with great patience and politeness. And even some of these speakers were shouted down by much less articulate and more impolite activists. When the protestors finally left the state after an interminable period of time, the audience applauded, not in support but for gratitude that they were finally leaving.

Today, in the Media Centre, I witnessed another disruption, this one even more strident. A couple dozen demonstrators were allowed into the Media Centre — I’m not quite sure how the super alert security staff allowed them in when they don’t normally anyone, however inoffensive, to enter without media credentials — to disrupt a PSI press conference on male circumcision.

Now the demonstrators had no beef with PSI, nor with male circumcision. They were offended by the presence of U.S. Global AIDS Coordinator Eric Goosby, who was on the panel and who they blame for “the ongoing harm of PEPFAR’s anti-prostitution pledge requirement.”

Their indignation over the requirement is justified; their tactics are not. They were aggressive, they were rude. One or two of them sounded hysterical, screaming at Goosby, for 10-15 minutes.

This is the same Eric Goosby to whom former President Bill Clinton gave a huge shout-out in the opening plenary on Monday: “This man is your friend. He’s been working on AIDS since before the youngest people in this room were born. He is a good man.” Apparently, the demonstrators did not get that message, or chose to ignore it. The journalists working in the Media Centre were not impressed and mainly just ignored them, and deservedly so.

They need to find a more effective way of making their point, which is actually a point Clinton made in his speech: “You have two options here. You can demonstrate and call the President names or we can go get some more votes in Congress to get some money. My experience is that the second choice is a better one with a far better payoff.”

Yesterday, in the Media Center, the activists won no friends; they might have lost a few.

My take on the G8/G20 summits in Toronto

2010-06-27T13:22:00.000-07:00

TORONTO, Canada — It’s been a raucous and, in some ways, surprising three days here at the overlapping G8 and G20 Canadian summits. I was struck by four issues that emerged at the summits — logistics, media access, NGO reaction and media interest in maternal and child health

First, there have never been two summits at the same time in the same country. The G8 ran Friday and Saturday in a remote area two hours north of here by road called Muskoka, in the town of Huntsville. Because of the limited facilities there, very few journalists (and no NGO representative that I know of) had access and those few that did had to be up at 3:00 am to go through security and catch the bus in Toronto for the long trip north to Huntsville. Reporters on these buses did one of two things — sleep and work on their laptops and cell phones — and so the only sound in the buses was the clacking of keys on electronic devices. And the G20 was Saturday and Sunday in Toronto, but the leaders were still separated from the media and NGOs, albeit by one mile instead of 200.

Second, the issue of media access to NGOs has been a big issue for the NGOs throughout the summits and continues to be. At recent summits, including both of those last year in Italy and Pittsburgh, NGOs, for the most part, had full access to the international media. This worked to the advantage of both parties and ensured that journalists had just as much access to civil society as they did to governmental delegations who, understandably, want to spin things in their favor (as does civil society).

For some reason which no one understands, the Canadian government thought this was a bad idea and decided to put the NGOs in an “Alternative Media Center” and segregate the two groups in separate buildings across the street from each other. The difference is that the one for the media is surrounded by a high fence and concrete barriers and NGOs are not allowed in without an invitation from someone with proper media credentials. Most of us in civil society have not been invited across the street, and few reporters leave the comfort of their media center to come to us.

The Global Health Council was one of 12 non-governmental organizations that put out a statement critical of the Canadian government for this “media apartheid” which produced an article in Saturday's Toronto Star.

But another aspect of media and civil society access was less commented upon. At the 2009 G8 in L’Aquila, Italy, we all — journalists and NGOs — had access to the heads of state and the country delegations. That is, we were all in the same facility, inside the same perimeter. Because of that, I was able to attend a press conference with President Obama, Prime Minister Harper and other G8 leaders without going through security again. That was not the case in Pittsburgh. And here in Toronto, even most of the mainstream media does not have access to the heads of state, who are in the Toronto Convention Center a mile away from here. In a press briefing this morning by South Korea, the host of the next G20 in November, we were told that Seoul will revert to the L’Aquila model, where we are all together in the same location.

Third, it was interesting to see the different reactions in the NGO community to the announcement of the $7.3 billion, five-year Muskoka Initiative on maternal, newborn, child and reproductive health championed by Canadian Prime Minister Stephen Harper. Even though this is a huge win for global health advocates, given the relative attention that global health attracted at the 2009 summits, the NGO reaction was somewhat, though not uniformly, negative. Generally, the pure advocacy organizations (like the ONE Campaign) and the large implementing organizations that work in many areas of development (like Save the Children and Oxfam) were negative. But the organizations which focus on health,like the Global Health Council and the Partnership for Maternal, Newborn and Child Health, both organizations representing hundreds of other organizations, were much more upbeat about the Muskoka Initiative. As was the African Medical and Relief Foundation (AMREF), the only indigenous African health organization present in Toronto

The Washington Post, one of the few U.S. mainstream media outlets to give this story any legs, published a story entitled “Aid group slams lack of financial support for maternal and child health initiative.” based on quotes only from Save the Children and Oxfam, two of the NGOs that did get into the media center. Other organizations, with more positive perspectives, were not interviewed because they were not in the media center to be interviewed. The Post later published my letter expressing my concerns about that situation.

In this case, it appears that the Canadian government strategy backfired as they might have gotten a better story out on their flagship G8 initiative if they had allowed full access between media and NGOs.

Finally, the Muskoka Initiative on maternal and child health got very good media coverage in Canada (it was front page news on the front of The Globe and Mail, Canada’s premier newspaper, on Saturday, and it was surprisingly prominent in the Canadian TV coverage that I saw). People on the street knew about it; my taxi driver on Saturday night, originally from Bangladesh, told me it was the best story coming out of the G8 and would improve a lot of lives.

I understand why this initiative was a big story in Canada since it is a Canadian initiative and the summits are taking place in Canada. But I wish that the U.S. media had paid more attention to what may be the only truly positive story coming out of the summits. And I wish the NGO community had been more welcoming of what is a highly positive development and a step — if not a leap — in the right direction.

Stephen Harper said something in his press conference on Friday night about the Muskoka Initiative that I liked so much I put it in our G8 press release: "Of all things we could spend our money on, who wouldn't want to spend to save the life of a mother who would otherwise die?"

NGOs feeling mixed as Canadian summits open

2010-06-25T08:12:00.000-07:00

TORONTO, Canada — As world leaders arrive in Canada for the twin G8 and G20 summits, we, in the NGO community who advocate for global health, have decidedly mixed feelings about the annual gatherings of world leaders.

On the one hand, we are excited that Canadian Prime Minister Stephen Harper is pushing for a $1 billion Canadian initiative on maternal, newborn and child health (MNCH), a surprising development when it was announced in January since Harper is not known as a champion of international development, and since MNCH was almost completely ignored at the 2009 G8 in Italy and G20 in Pittsburgh. We are grateful to our colleagues in Canadian civil society for their efforts in making that happen.

At the same, NGOs are profoundly disappointed with the tone the same Canadian government has set by barring NGOs and civil society from the international media center for the first time in recent history. In both L’Aquila, Italy and Pittsburgh last year, NGOs and media shared the same media center in a way that was mutually beneficial for both parties.

We don’t understand why the Canadian government felt it necessary to segregate the NGOS in separate facilities. The International Media Center — the “real” media center — is across the street from the “Alternative” Media Center (where the NGOs are congregated and from where I write this) but the “real” center is surrounded by a wire fence and concrete barriers, apparently to impede aggressive NGO representatives, who have to be invited in by journalists.

The Harper government seems to be going in a different direction from the United Nations, which last week opened its process leading to September’s summit on the Millennium Development Goals to civil society and the private sector for the first time, with informal and interactive hearings to get various perspectives on how to accelerate progress towards achieving the MDGs.

Interaction, the coalition of U.S. NGOs with which Global Health Council shares reciprocal membership), felt so strongly about this adverse development that they decided not to send anyone to Toronto, even though it normally coordinates the U.S. civil society presence at these summits. Yesterday, Interaction issued a statement critical of this lack of access, which makes it more difficult to achieve a “transparent monitoring system” that is needed to evaluate if donor countries actually honor their commitments.

U.S. President Barack Obama just arrived at Toronto airport, the last G8 leader to arrive, and is helicoptering to Muskoka, the remote resort area north of here, for the beginning of the G8 Summit. The G20 Summit starts here in Toronto tomorrow.

For great background information and useful links on the G8 and G20 summits, go to the Council's special G8G20 webpage.

World Health Assembly has its frustrations, but we have to try

2010-05-22T14:28:00.000-07:00

GENEVA, Switzerland — My first World Health Assembly closed yesterday and I am trying to assess what difference it made, how the Global Health Council fits in and whether it is worth our time. I don’t even think I knew what WHA was when I was at PSI. I had heard of it — barely — but had no real idea what it did or why PSI should care.

I have since found out that the WHA is the mechanism through which the World Health Organization (WHO) is governed by its 193 member states, and is the world's highest health policy-setting body. The main tasks of the WHA are to approve the WHO program and budget for the next two years, and to decide major health policy issues.

I came away skeptical of our odds of influencing very much the global health dialogue that takes place in Geneva every may. But I also came away convinced that we — as leaders of civil society on global health issues — have to make every effort on behalf of our members who care about these issues, and very few of whom can come to Geneva themselves. That is one of the many things that they pay us to do when they sign on as members.

And just as I now feel that it is difficult for GHC — or any other member of civil society — to influence the G8 or G20, it is a very appropriate role for us to play as convener and representative of civil society on global health.

I was appalled at how civil society was marginalized (or even ignored) in the larger plenary meetings, where we were confined to an area that was way too small and where we could not hear anything if we did not have headphones, most of which did not work anyway.

But I was delighted that in other “special meetings” and “side events,” we could be sitting next to the health minister of Cambodia or Tanzania, and have just as good a chance of them as being called upon by the moderator to ask a question.

And, in the end, the Global Health Council got three minutes to address all 193 country members of the WHO: http://tinyurl.com/28m5kye. Where else would be get that opportunity?

Hillary's ICPD speech was stirring, but short on specifics

2010-01-10T22:03:00.000-08:00

WASHINGTON, DC -- My arrival at the State Department for Hillary Clinton’s much anticipated speech Friday marking the 15th year of the International Conference on Population and Development (ICPD) started with a chilly reception – literally. We were required to line up in the 30-something January weather and wait to get into the security area of the main State Department building. My only consolation was that I was in auspicious company: In front of me, United Nations Foundation President Tim Wirth, who led the U.S. government delegation to ICPD during the Clinton Administration, a fact that was later acknowledged by Secretary Clinton). Behind me was Her Excellency Hawa Olga Ndilowe, Malawi ambassador to the U.S. Both of them mentioned to me how cold they were.

However, all of that was forgotten fifteen minutes later when we all – foundation presidents, ambassadors and mere mortals like myself – walked into the splendors of the Benjamin Franklin State Dining Room on the eighth floor. The Ben Franklin Room, the largest of the State Department’s diplomatic reception rooms, was redesigned in the classical manner and completed in 1985. This monumental room has free-standing Corinthian columns along the walls and the Great Seal of the United States, depicted in plaster and gilt, in the center of the ceiling, along with eight Adam-style cut-glass chandeliers. In sharp contrast to the ugly experior of the building we were in, I now felt like I was in Versailles.

This event had already been postponed twice – once when Hillary had to travel to Copenhagen with President Obama for the climate change summit and again when the federal government shut down on Dec. 21 after a historic snowfall. But it finally happened and Hillary did not disappoint.

She delivered a passionate message about the importance of the ICPD goals (“one woman dies every minute of every day in pregnancy or childbirth, and for every woman who dies, another 20 suffer from injury, infection or disease every minute”) and the difference their realization could make not only in health, but also in other spheres of development like education, climate change and agriculture.

But it would have been hard to find a better example of speaking to the choir than Secretary Clinton speaking to this committed crowd of people who had made the ICPD their lives work. Most of what she said, we already knew.

What I wanted to know is: What would we do to achieve the ICPD goal? And I thought that is what Hillary would lay out when she said, early in her speech: “Part of the reason we wanted to have this commemoration is not only to look backwards, but to look forward. What is it we will do between now and 2015?”

But Hillary never answered that question in any specificity. So we wait for the details of President Obama’s Global Health Initiative, which we hope will answer those questions and provide more guidance on how we can achieve the vision of ICPD by 2015.

Hillary gave an excellent speech in the magnificence of the Benjamin Franklin Room and we celebrated afterwards with champagne and hors d’oeuvres. And now we return to the real world, and get down to the business of achieving ICPD in the next five years.

How committed is Hillary to reproductive health?

2010-01-05T20:43:00.000-08:00

Last year in Berlin, I attended an NGO forum on the the 15th anniversary of the International Conference on Population and Development which was trying to figure out how to achieve the ICPD targets set in 1994 on universal access to reproductive health. I met several people there who had been delegates to the 1994 summit in Cairo and one of them recollected how the stars had aligned that year to produce something important in sexual and reproductive health amid a sea of “bad years.” She cited three developments that made this historic alignment possible:

- The existence of a charismatic, committed and politically saavy leader in the person of Undersecretary of State Tim Wirth (now the president of the United Nations Foundation), who was unrelenting in pushing forward the agenda of the ICPD;

- A supportive U.S. administration and Congress: Bill Clinton had been in office for less than two years and had given reproductive health higher priority than it had for many years; and

- An increasingly sophisticated non-governmental organization movement which played a leading role in making ICPD a reality.

This unprecedented alignment started falling apart later that same year when conservative Republicans took control of Congress and the Clinton Administration lost its early momentum.

This ICPD delegate told me she saw a similar aligning of the stars happening now – a progressive and supportive American administration and Congress — after eight long years — and an even more sophisticated civil society than was the case in 1994. The only thing missing, she said, was a charismatic and committed leader like Tim Wirth.

Later that same day, I talked to another person who had been in Cairo in 1994 as a senior U.S. government official. He agreed with this scenario and thought that Secretary of State Hillary Clinton could be that leader that some believe will be necessary to finally ensure universal access to reproductive health.

This Friday, Secretary Clinton is making a major speech marking the 15th annniversary of ICPD in Washington. That speech might give us a glimpse of whether she has the passion and the commitment to not only reaffirm the 2015 goals and targets of ICPD, which she will undoubtedly do, but take the cause to the next level, providing the leadership to inspire others to actually achieve the vision of ICPD over the remaining five years. Those of us who care about family planning and reproductive health are looking forward to watching Secretary Clinton this week and are ready to support her in this effort.

Promoting health benefits of clean energy at the White House

2009-11-20T16:41:00.000-08:00

WASHINGTON, DC -- Today I spent four hours at the White House on a beautiful autumn day being briefed on the public health benefits of clean energy in the U.S. The Obama Administration — ably represented by Secretary of Health & Human Services Kathleen Sebelius, Environmental Protection Agency Administrator Lisa Jackson and other senior officials of both departments — made a strong case for the many health reasons we should move to clean energy as quickly as possible, in addition to the environmental and economic ones we already know about.

As just one example of the price we pay for unclean energy, Administrator Jackson said that one in every 10 American kids suffer from asthma. She connects with this issue in a very personal way: She has a 13-year-old son who has been asthmatic since infancy and could not always go outside because of air quality.

The hundred or so people attending the summit came from all over the country on relatively short notice. There were business and community leaders, advocates, activists, academics and nonprofit leaders from California, Alabama, Louisiana, Michigan, Massachusetts and my home state of Minnesota, among many other places.

I saw only one other person there from my world of global health and wondered whether the White House might have invited me by mistake. But it dawned on me that just about everything that was said about the health benefits for the U.S. also applies to the developing countries that I care about. Secretary Sebelius raised it once, when she said that global warming was increasing malaria, dengue and salmonella.

I wondered whether this new partnership to promote the benefits of clean energy in the U.S. would manifest itself in the Global Health Initiative proposed by President Obama in May. I hope so because just like the most vulnerable Americans are hit hardest by climate change, the most vulnerable and poorest people in developing countries are most affected. These people in the poorest countries in the world would probably benefit even more from clean energy than the poor in the U.S.

My organization and I look forward to working with the Obama Administration to highlight the public health benefits of clean energy not only in the U.S. but in the developing world as well.

Return to Peace Corps village delivers surprises, and a lesson

2009-10-05T15:02:00.000-07:00

BAGUIDA, Togo – Falling asleep to African drums and waking up to a torrential rain pounding on the roof, as I did last night, was like going back in time to my 20s, when I lived in this village for two years and my life was more tied to the movements of the sun, than to the movements of the hands of a clock.

I was an agriculture teacher in a secondary school and my job was to make things grow and to teach others to make things grow. At my school, I started a garden, a hog farm and a library. Outside of school, I had my own garden next to my house (and worked with students there) and I helped others start gardens and my prize student, Bada André Kokou, start a rabbit-raising project. The last time I was there, only a year after I had left, everything was working well. But that was 1986 – 23 years ago. Would there be any evidence left of of my two years of work?

Today was the day I was to find out, and I approached it with trepidation and excitement. It proved to be a day of surprises.

I was pretty sure the hog farm and the rabbit-raising project were gone. The school let the hog farm die in 1988, and André had to sell the rabbits when he went into political exile in Nigeria.

Yesterday afternoon, I went to the home of Kofi Mawusi, my former assistant headmaster, and his lovely wife, and had my first surprise. He reminded me that I had brought two grafted mango trees with me from the verdant hills of Kpalimé after I had spent six weeks in training there, and planted one of them in his courtyard and the other at the school.

He had to cut down this tree a few years ago because it had grown so large it was threatening one of their buildings. Madame Mawusi said that the mangos would drop on the roof of the house and make a terrible racket. But it provided their family with delicious fruit for many years. Was the other mango tree I planted at the school still there? They were not sure.

This morning I visited the school. As expected, the hog farm was gone. The school garden was gone. I asked to see the library and the “librarian,” if you can call him that, took me into a room of utter chaos, with books falling off the shelves onto the floor. I suppose some of the books I had ordered and had shipped from the U.S. might have been there but I did not trouble myself to look for them. I was angry that they could not have kept the library going; I considered the librarian a disgrace to the profession. Monsieur Mawusi told me the library was still intact when he retired as headmaster in 1995.

But the mango tree that I had forgotten still lived and was doing well. I was told that the tree provided both mangos for the children to eat and extra income for the school. I had a photo take of myself under my glorious mango tree. I went into one of the classrooms and talked to the schoolchildren. Monsieur Mawusi introduced me to them as the man who had planted the mango tree at the school. One of the male students told me how much he enjoyed eating those mangos.

As we walked around the village, I kept running into my former students and Monsieur Mawusi always reminded them that I was the one who planted the mango tree at the school. They always smiled broadly.

Then I found out that the rabbit-raising project was not dead. When André went into political exile, he sold the rabbits to another student of mine. We visited that student’s home and we saw the rabbit project was alive and well, providing good income for his family.

We went to the house where I had lived for two years and where had started a garden out of sand. Someone was still gardening there commercially. My garden lives on! As I was leaving, I ran into two people (now adults) who used to work with me in that garden when they were children. They had fond memories of those times.

I also found out that a gardening project outside of the village that I had started with the U.S. Ambassador’s Self-Help Fund in 1985 is still going strong, with the same young man – now not-so-young – who had started it. He has become a commercial gardener. Again, I had completely forgotten about this aspect of my work and I was totally thrilled.

What have I learned from all this? I’m still absorbing it but I think it suggests that I was overly optimistic to rely on institutions to make a mark on my village. My institution – my school – let me down. I do not mean to say that institutions should be ignored. Indeed, I believe that one of the major challenges of development is figuring out a way to make institutions efficient and effective and serve the needs of their citizens.

But for me, my school did not make an important contribution to any formal success that I achieved during my Peace Corps service. It came from finding motivated people to work with outside of the school, helping provide resources to realize their dreams and then turning them loose.

The exception was that glorious mango tree at my school which the institution managed not to kill. And the handful of 30-somethings who greeted me by name as I walked through the village -- they were my former students, and their beaming faces were my best reward. One of them is the village midwife and delivers all the babies. And for their smiles, I am grateful and blessed.

Here are my photos of my village on Facebook.

Togo capital is not what it was in 1980s

2009-10-04T01:54:00.000-07:00

LOMÉ, Togo – I’m back in Togo, almost exactly 24 years after I left. I lived here for two years as a Peace Corps volunteer teaching agriculture in a secondary school in the seaside village of Baguida just a few kilometers east of here.

As I write this, my former student Bada André Kokou is coming to Lomé to meet me and take me to Baguida. But yesterday was spent rediscovering Lomé, the Togolese capital that I knew well in the 1980s, too see if it has any of traces of the considerable charm and allure I remember from that special time.

This time, I entered the country through the Ghanaian border on the west side of Lomé. My Togolese traveling companion’s claim that the Ghanaian officials would hit us up for bribes and the Togolese would not be a problem turned out not to be true: The Ghanaians were polite and professional and the Togolese authorities were stern and unfriendly. But no one hit us up for a bribe on either side of the border and we arrived on Togolese soil after about 45 minutes.

We jumped into a taxi and I immediately noticed that Lomé’s oceanfront road is being completely rebuilt. My friend told me that ECOWAS, the Economic Community of West African States was paying for the project the entire 50 kilometers from the Ghanaian to the Beninese border. That was pretty much the only sign of progress I saw during my three days in Togo.

The bad news is that the rest of Lomé – or at least the little I saw of it today – is deteriorating and a shadow of its former self. I had planned to spend my first night in the Hotel du Golfe, where I once stayed and have fond memories of it as a charming, colonial place with a lovely pool. When my taxi pulled up to it this afternoon, I immediately knew something was wrong. It didn’t look right outside, or inside. I could not see the pool. And the charm was nowhere to be seen.

I headed over to Hotel Ibis (called Hotel le Bénin in my day). I also have fond memories of it and, unlike the Hotel du Golfe, it still looks pretty much as I remember it. I never stayed here but I used its lovely pool several times, as did many other Peace Corps volunteers of the time, and it all looked vaguely familiar. From my room, I could see the still highest skyscraper in Lomé -- the Hotel 2 Février, once the swankiest hotel in town and now closed and a sad reminder of what Lomé used to be.

I headed for the Grande Marché in search of the Restaurant de l’Amitié, where I used to have a plate of chicken, rice and peanut sauce washed down with a cold bottle of Biere du Bénin most Fridays after finishing at the school. I walked along the coast road and saw that many of the fine old colonial buildings that I remember are being neglected and are falling down.

I saw a man urinating in public, not uncommon in Togo, even in crowded areas. I once had a friend who had lived in Togo and had developed a unique index of development. One of the criteria was degree of public urination and she rated Lomé very high in this regard. Indeed, I think it has increased, if anything, since I left Togo (I later saw full-frontal urination, something I had never seen before).

When I got into the bustling market area, I had the unmistakable sensation that I had gone back in time to the mid-1980s. Everything was exactly the same: The bustle of people buying and selling. The cars and motorcycles weaving their way through impossibly narrow and clogged streets, blaring their horns. The tantalizing smell of Togolese street food. The faint (and sometimes strong) stench of urine. The women calling me “yovo” (white person). Yes, this was all familiar.

But after 30 minutes of trying to find the Restaurant de l’Amitié, I gave up. It was gone. I later found out the Lebanese owner had moved to Mali. I tried to find Le Phenicien, where I learned to love Lebanese food, and its incredibly obese owner Romeo, who always reminded me of a villain in a James Bond movie. I found out later he had died and the restaurant had closed. I came upon a supermarket which I was sure was SGGG, where I used to shop as a volunteer, and went inside. But the Lebanese owner told me that this was not the supermarket I remembered, and that it was in another location and had closed as well.

I also could not find my favorite Lomé restaurant, Relais de la Poste. This was shocking to me as it was a virtual institution, the best place for simple French cooking. I loved their "avocat vinagrette" as an appetizer and their "Lobster Thermidor" and "Steak au poivre" was so good I don't think I ever ate anything else.

I did find one thing I was looking for – great leather sandals. I bought three pair, and was pleased to see that they have survived.

In the evening, I headed over to the eastern side of the Boulevard Circulaire to find Café des Arts, the popular watering hole of the Peace Corps volunteers of my day. I was pretty sure it did not exist anymore and my instincts proved sound: I could not find it but I did find that this part of the Boulevard Circulaire has become a center of Lomé nightlife with dozens of bars, nightclubs and restaurants of all types crowding both sides of the street for a kilometer or more. But none of them could replace the charm and the ambiance of Café des Arts that I remember on a lovely evening in Lomé in the mid-1980s.

See my Lomé photo album on Facebook.

Accra to Lome: 200 kilometers and 24 years

2009-10-03T12:19:00.000-07:00

ACCRA, Ghana to LOME, Togo – Today I traveled 200 kilometers and 24 years, from the booming capital of Ghana with its pothole-free roads and growing economy to the decaying capital of Togo, where I was a Peace Corps volunteer from 1983 to 1985, a place and time that holds an affectionate place in my memories.

During the four hours I was on the road, I experienced a jumble of emotions – hope, fear, nostalgia and sadness.

Hope was what I experienced in Ghana, a country whose economy is growing and which recently experienced a peaceful transfer of power from one party to another, despite a close election, something of a rarity in Africa. This is the hope that brought President Obama here in July on his first presidential visit to Africa. We drove out of Accra on a motorway – the likes of which I have seen in Africa only in Abuja, Nigeria and South Africa – and past a blur of gleaming buildings and a new shopping center. It gave me hope that positive change is possible in West Africa.

The fear came from our driver who, like me, had a Biblical name (Isaac) and succeeded in putting the fear of God in me. He tried to keep the speedometer at 140 kilometers per hour (85 mph) as often as possible, including through villages with a posted speed limit of 50 kph. I said a silent prayer for myself, my Togolese companions and any careless pedestrians who wandered into the road.

It was evident that the driver knew the road extremely well as he braked only for speed bumps and police stops (all the police stops had signs sponsored by a bank that warned “It is an offense to bribe a police officer,” something else that gave me hope). And he knew exactly where to brake. As Isaac was slowing in one village, someone along the road yelled at him and Isaac threw a one-cedi note out the window, perhaps repaying an old debt.

I was astounded by the quality of the Ghanaian roads for the first 170 kilometers. I have never seen such excellent roads outside of an African city except in South Africa. It was only because of the quality of these roads that we were able to maintain such high speeds.

But the closer we got to the Togolese border, the worse the roads got and the more the scenery reminded me of the coastal village in Togo where I spent two years. The last few kilometers to Aflao, the last town in Ghana before the border, were terrible, deteriorating from pothole-pocked roads to no pavement at all.

The nostalgia came as the scenery became prettier and prettier, reminding me so much of the Togolese village of Baguida that I will see tomorrow. I also felt gratitude that I had the good fortune to live in such a charming seaside village for two years.

The sadness came when I arrived in Lome and saw that while Ghana has flourished, Togo has deteriorated. More on that in my next post.

Ghanaian AIDS orphans touch our hearts

2009-10-03T12:08:00.000-07:00

ACCRA, Ghana — My heart and those of the members of the International AIDS Candlelight Memorial Advisory Board were moved Wednesday when we visited the AIDS orphans and the HIV-positive adults cared for by the Pathfinders Outreach Ministry, a Ghanaian non-governmental organization working and struggling with minimum resources in a poor area on the outskirts of Accra: http://www.pom-ghana.org

As the adorable toddlers scampered into their arms and our laps, we heard Becklyn Ulzen-Christian, Pathfinders executive director, describe the care she and her staff provide for orphans and vulnerable children and HIV-positive adults in the face of limited resources, great stigma against HIV-positive people and other challenges.

Pathfinders looks after 70 children, 13 of whom lives at the facility, and many HIV-positive adults who have been rejected by their families and friends. We talked to Felicia, a middle-aged woman whose hard life is etched on her face, who has been HIV-positive for 17 years. She said she has found a new life in the warmth of Pathfinders and now has a purpose to her life.

Pathfinders gets its support from three major sources – U.S. Agency for International Development for food aid; Global Fund for AIDS, TB and Malaria for behavior change communication and education in HIV, tuberculosis and malaria; and GHC member Academy for International Development (AED), though AED’s support is ending and Mrs. Ulzen-Christian has no idea how they will carry on without it.

The Advisory Board is in Accra for their annual meeting in which they are examining the Candlelight Memorial event from last May and planning for the next one in 2010. The Advisory Board is made up of two regional coordinators from each of the six regions in the world – North America, Latin American and Caribbean, Europe, West and Central Asia, East and South Asia and Africa.

Much has changed in Accra but not everything...

2009-09-27T06:02:00.000-07:00

ACCRA, Ghana -- The last time I was in Ghana was 1985, when I had just finished two years of Peace Corps service and my wife and I had traveled there from Togo in order to catch an Egypt Air flight to Cairo. Here's what I wrote in my diary on Oct. 13, 1985:

"We didn't particularly enjoy Accra. It's a decaying city where it's hard to find items we would take for granted in Lome. The first night we ate dinner at a Chinese restaurant. Fewer than half the items available on the menu were available. On the second day, we took a taxi into the decaying and filthy downtown and found a decaying hotel on the ocean. We looked down on a once-beautiful swimming pool that was now empty and decaying. We were very thirsty. All they had to drink was beer and tonic. I didn't want beer or tonic so I stayed thirsty. When I asked for a glass of water the water said 'It is finished.' That remark will be one of my strongest impressions of Ghana: 'The water is finished.'"

Note the number of times I used the word "decaying" in that short passage.

Those were the bad old days, when Ghana had a dysfunctional economy and food shortages so severe that Peace Corps Ghana had to truck in food from Togo for its volunteers. Fortunately, those days are gone and Ghana now has a vibrant economy and democracy that recently had a peaceful transfer of power after a closely contested election. That is why President Obama had chosen to make it the destination of his first trip to Africa as president.

I arrived here yesterday for my second visit. The Global Health Council manages the AIDS Candlelight Memorial, the world's largest and oldest AIDS awareness raising event, and we are meeting with our regional coordinators from around the world. I found that many things have changed, and for the better, but a few have not.

On my first night in Accra, my two colleagues and I went out to eat at Buku, an African restaurant in the Osu neighborhood, as the Lonely Planet Guide to West Africa had recommended it for its Ghanian, Nigerian, Togolese and Senegalese food. It was a lovely place but I ran into a similar problem from my first trip, albeit no quite so severe. They had no dressing for my salad, they had run out of guinea fowl and had no ginger beer. But they did have most things and we had a delicious dinner in the open air and under a straw roof. I had groundnut (peanut) stew with goat (instead of guinea fowl!), fried plantains and Star beer. All in all, Ghana is vasty improved and I am thrilled to be back in West Africa.

G20 proves frustrating but Pittsburghers a delight

2009-09-25T14:47:00.000-07:00

PITTSBURGH -- I just spent two days at the G20 Summit here trying to keep global health on the leaders' agenda, as it had been in Washington in November 2008 when they pledged to work on achieving the Millennium Development Goals. But it was completely absent from their agenda in Pittsburgh. This was a disappointment, but the incredible graciousness of Pittsburghers helped make up for it. A few examples:

The night before the opening of the summit, I was having a drink with a friend at a bar across the street from Pirates Stadium where the Pirates were playing the Reds. I would have like to have gone but we were headed for a party in a couple of hours. Imagine my delight when a man came by and dropped two free tickets on us. Five minutes later we were inside the stadium with a very sparse crowd (people were not coming downtown because of the G20) on a beautiful September evening sitting in very good seats!

We had to leave early to attend a party hosted by Teresa Heinz Kerry to raise support for the fight against global warming at the Andy Warhol Museum which, by the way is fantastic. There was great New Orleans music - Cajun, rock and jazz -- and great food and drink. Not to mention the art of Andy Warhol. When we were leaving about midnight, we could not find a taxi and when we called were told that one could not come in less than 45 minutes. A lovely couple overheard us and offered us a ride to our hotel -- even though it was in the opposite direction from their house!

And on the last day of the summit, two Save the Children colleagues and I were walking to the media center through downtown Pittsburgh with a very high level of security. Even though it was Friday, very few places were open. But when we spotted a coffee shop with the catchy name of "Crazy Mocha" we had to stop. When we walked into the shop, the two employees cheered and applauded us. They were so bored from the lack of customers, that they had to express their joy at seeing us!

Pittsburgh is a far more interesting city than I every imagined populated by warm, wonderful and quirky people and I would go back anytime. A very underated and very American city! I highly recommend it.

Berlin Delegates Demand Adoption of ICPD Agenda

2009-09-22T19:43:00.000-07:00

BERLIN, Germany – Four hundred delegates from 130 countries released the “Berlin Call to Action” earlier this month at the NGO Forum on Sexual and Reproductive Health and Development that followed up on the historic International Conference on Population & Development held in Cairo 15 years ago.

After long and sometimes heated discussions, the delegates demanded that donors and governments accelerate implementation of the ICPD Program of Action “as fundamental to achieving equality and equity, human rights and social and economic development.” They urged the following actions to be taken immediately:

1. Guarantee that sexual and reproductive rights, as human rights, are fully recognized and fulfilled. This reflects the delegates’ desire to go beyond the realm of public health and position sexual and reproductive rights as fundamental human rights.
2. Invest in comprehensive sexual and reproductive health (SRH) information, supplies and services as a priority in health system strengthening. The new idea here is to acknowledge the fact that the current aid architecture emphasizes health system strengthening and the delegates belief that associating SRH with health systems can help our cause.
3. Ensure the sexual and reproductive rights of adolescents and young people. Approximately 25% of all of the delegates were under the age of 30 and the focus on youth was a recurring theme of the conference. Jill Greer, chair of the Steering Group, said that it was vital that the movement develop new leaders for the future.
4. Create and implement formal mechanisms for meaningful civil society participation in programs, policy and budget decisions, monitoring and evaluation. The message here is that governments have to bring civil society organizations to the table as meaningful partners.
5. Ensure that donor contributions and national budgets and policies meet the needs of people for sexual and reproductive health and rights. This financial aspect was enhanced considerably from the earlier draft and reflects the delegates’ recognition that their lofty visions will not be realized without the financial resources to carry them out.

Sivananthi Thanenthiran, a co-chair of the Steering Group, recognized that the most intractable hurdle to overcome in finalizing the text was the split between those who preferred ICDP language, and those who preferred the language of the Millennium Development Goals. “We have positioned ourselves in the middle,” said Ms. Thanenthiran. “We want to move beyond Cairo and leverage the MDGs.”

Another key issue was toning down the rhetoric because of the fundamentalism of many countries where the legitimacy of governments is based on religion. To overcome this, the Drafting Committee tried to find language that would not offend.

Markets have a role in malaria treatment

2009-08-24T19:24:00.000-07:00

By sheer serendipity, I happened to pick up a copy of The Guardian (link text), my favorite British newspaper, in London last Thursday and saw an interesting piece on the challenges in providing malaria treatment by Sarah Boseley, the Guardian health editor. I thought Sarah captured very well the dire lack of Coartem malaria treatment in most of the country. But I was dismayed by the way she suddenly turned against the role of the market in providing such treatment at the very end of her story, even after admitting the failure of the public sector to do so and praising the ability of companies like Coca-Cola to make their products widely available.

So I felt compelled to challenge her dissing of the potential for markets to contribute to health care in developing countries, and today that letter was published in The Guardian. Here is that letter: link text

And here is the story of my own encounter with malaria treatment in Uganda based on my trip to Uganda in 2008, and which I cited in my letter: link text

AIDS prevention must be more of a priority

2009-08-08T16:54:00.000-07:00

Everyone working in HIV/AIDS -- as I have been for 17 years since I founded Society for Family Health, the leading HIV prevention organization in Zambia in 1992 -- has heard the aphorism "We can't treat our way out of this epidemic" and everyone knows that for every person that goes on treatment, there are several more new infections.

Both Randall Tobias and Mark Dybul, the first two PEPFAR coordinators, always said that HIV prevention was a priority. But in reality, prevention was never a priority with PEPFAR and could never be a priority since the law that created PEPFAR hamstrung prevention efforts by limiting them to 20% of the budget. And the bitter political battles swirling around HIV prevention during the eight Bush years prevented an evidence-based formula for measuring the number of HIV infections from being implemented. Instead, PEPFAR was reduced to measuring prevention with process indicators such as messages transmitted and campaigns conducted.

I thought of all of this today when reading the press accounts of the visit of Secretary of State Hilary Clinton to HIV/AIDS programs supported by the U.S. government in South Africa. Treatment dominated Secretary Clinton's visit and understandably so, given the fact that South Africa has more HIV-positive people than any other country in the world. But where is prevention in all of this? After all, even South Africa, with its vastly greater resources as compared to any other sub-Saharan African country, cannot treat its way out of its epidemic.

That is why I was so pleased to see, hidden at the end of today's Washington Post account of Secretary Clinton's visit to South Africa, the following paragraph:

"U.S. Rep. Nita M. Lowey (D-NY), the head of the House Appropriations subcommittee that funds foreign aid programs, said at the ceremony that she hopes to see more assistance going toward prevention, rather than just treatment."

Bless the heart of Rep. Lowey for reminding us of this simple fact: We will never get ahead of the AIDS pandemic until we focus more on prevention, which continues to be grossly neglected. It is so much easier -- although much, much less cost-effective -- to treat people after they have been infected than to prevent the infection in the first place.

And it is awfully messy -- not to mention politically perilous -- to protect injecting drug users, sex workers and the men who patronize them, and even more controversial when we direct efforts at adolescents who most adults would prefer to pretend will be celibate until marriage.

Thanks to Rep. Lowey for reminding us of the importance of prevention, and let's hope Eric Goosby, the incoming PEPFAR coordinator, hears her plea, and directs more PEPFAR resources into prevention, finally. The future of the pandemic depends on it.

My Final Thoughts from L'Aquila

2009-07-10T08:59:00.000-07:00

L'AQUILA, Italy -- I found out only eight days ago that I was coming to Italy to promote global health. I know global health and I know communications but I know little about the G8, and even less about how to budge this immense geo-politico-media mountain. But I came up with a plan and started learning quickly as soon as I hit Italian soil. Let me give you my plan, how I think I did and what I learned.

My communications plan was three-pronged: 1) Social media (mostly blogging), 2) major media relations and 3) U.S. government engagement.

1) The social media prong went brilliantly with lots of great support from colleagues in DC and Vermont. Earlier this week, I posted daily blogs. Once the summit began, I started posting multiple blogs per day. As I learned more and saw more, I had more and more ideas for blogs. Today, the last day, I have more ideas than I have time to write. I’ve been advised by the Council’s office in Washington that 700 people looked at my blog on Wednesday and I’ve received a dozen appreciative comments, some with questions, others with ideas. GHC/Vermont also had the idea of putting a link to the blog on our Facebook page, and we’ve received several comments there as well. We’ve also tweeted the G8, both from Italy and the U.S. and we’ve been “retweeted” by several GHC members like White Ribbon Alliance, PATH , Intrahealth, Women Deliver and others. Links to this blog have been placed on a number of other websites covering the G8 like this one put together by the Global Call for Action Against Poverty: link text

2) Major media engagement has been less successful even though all of us who work for non-governmental organizations are working out of the same media centres as the 3,500-some journalists covering this Summit. I heard from the diplomatic correspondent of the BBC the first day who wanted to talk to me about “backsliding” on the Millennium Development Goals. But I haven’t been able to get in touch with him since that first contact. I’ve also been trying to run down the phantom from the Financial Times (the friend of a friend) who staked out a computer in the media centre early on (marked “Financial Times”) but then never showed. Or at least I never saw him. Oddly, my single media success was when New York Times Columnist Nicholas Kristof, who was not at the Summit, wrote a column on the G8 using information supplied by me: link text

3) I failed totally to interact with the Administration except for the climate change briefing I attended by President Obama and five other G8 leaders yesterday which I don’t count because it had nothing to do with health (and, oh yeah, I didn’t actually talk to the President). There was absolutely no contact between the U.S. NGO delegation and the Administration of any kind during the Summit. In fact, we couldn’t get a meeting with them in Washington before the Summit either. The British NGOs met with their government. One member of our U.S. delegation even met with the head of the Japanese delegation. But none of us had any contact with our own government. This was surprising and disappointing.

The other thing that was surprising and disappointing is that neither global health nor water and sanitation came out very clearly in the comments of President Obama and his Administration or in the mainstream media except for two notable exceptions — the Kristof column already mentioned and French First Lady Carla Bruni-Sarkozy, who wrote a commentary in the Guardian of the U.K. Tuesday called “My Message to the G8 Leaders in L’Aquila,” one of them being her husband. As a global ambassador for the prevention of HIV in women and children, she wrote: ”Knowing that millions remain in need while effective interventions exist, I am more determined than ever to add my voice to the global effort to fight Aids and other infectious diseases.As the G8 meets in L’Aquila, leaders should feel proud of the revolution in global health they started eight years ago. I hope they will celebrate their achievements by expanding their investment in saving lives and reducing inequities. It is not only possible – it is happening, it works, and there is much more still to do.” Here is the commentary and check out the first comment following it: link text

As far as I know, that was the most prominent voice at the G8 advocating for global health, and I am grateful to Ms. Bruni-Sarkozy for that.

President Obama left L’Aquila about an hour ago, took a helicopter direct to Vatican City and has now been received with much pomp and pageantry by Pope Benedict II as we can see on the monitors in the media centre. Later tonight, Air Force One will touch down in Ghana, his first visit to sub-Saharan Africa as president. We have heard that the President and First Lady will be visiting a USAID-funded maternal health project at an Accra hospital, and we will be watching carefully in hopes that that visit takes place so that the U.S. First Lady joins with her fellow first ladies Carla Bruni-Sarkozy and Sarah Brown as a global health advocate.

G8 Talks the Talk, but Breaks Prior Promises

2009-07-10T02:15:00.000-07:00

L’AQUILA, Italy — The G8 released its communiqué on health, water and sanitation commitments to Africa Wednesday and, as I predicted in an earlier blog, the NGO community here is not impressed. But neither are they surprised. The communique largely reaffirms previous promises, at which the G8 has become quite accomplished.

There are some things I like a lot, especially the G8’s pledge to ”accelerate progress” on combating child mortality and on maternal health, “including sexual and reproductive health care and services and voluntary family planning.” I think those areas of health have been long neglected but regret that the G8 countries did not establish a more formal mechanism from making those laudable goals reality.

I also like a reaffirmation of a $60 billion pledge to fight infectious diseases and strengthen health systems by 2012 and the establishment of a mechanism to monitor health commitments made at the last three summits, which may be the only significant new health commitment made here at L’Aquila.

What I don’t like, and this feeling is widespread among civil society representatives here, is the indisputable fact that the G8 has not come close to meeting past commitments. In fact, The DATA Report, the most credible source of information on this subject link text, says that the G8 had delivered only one-third of all assistance increases it had promised to deliver to Africa by the end of 2010. I write about this more in my last blog.

I must hasten to add, though, that the U.S. is one of the least guilty of the G8 members on this score. The DATA Report points out that the U.S. increased its assistance to Africa by 26% in 2008, a significant increase that outpaced the global average of 16%, and is now on track to meet or even exceed its 2010 target. It may surprise many that former President George W. Bush can take much credit for this development.

However, the NGOs represented at the G8, largely European, were not pleased with the communique’s language on global health, water and sanitation, climate change, education, and the economy as laid out in a letter to Italian Prime Minister Silvio Berlusconi and the other seven G8 leaders earlier this week.

“The communiqué is pretty disappointing with no real new initiatives or recognition of the dire state of the progress to meeting their previous commitments,” said Kel Currah, chair of the Global Call to Action Against Poverty G8 Working Group, which represents a broad cross-section of NGOs at the G8. “On the good side, they did produce an accountability annex but again, this was only for a few of their commitments and there are a lot of holes in the report.”

Is the G8 Meeting its Targets?

2009-07-09T13:22:00.000-07:00

L'AQUILA, Italy -- When I learned I was coming to the G8 Summit to promote global health, I sought advice from friends I thought might know about the arcane machinations of the annual summit. A British friend responded: "I'm rather disillusioned about the G8, to be honest. It seems like a PR event for world leaders to talk about the stuff they would do if only everyone else would get behind them!"

That pretty much reflected my own superficial views but I wanted to get beneath the surface and answer the question, "How is the G8 really doing in meeting the objectives it sets every year?" in an objective and unemotional way.

There is probably no better source of information than "The DATA Book," published annually by the ONE Campaign: link text The 2009 report, just out, analyzes the G8's progress on their commitments to Africa made at the 2005 Gleneagles Summit and since. They have good news and bad but, to my way of thinking, it is mostly bad.

At the end of 2008, the reports says, the G8 collectively had only delivered one-third of the Official Development Assistance increases it had promised by 2010. While the overall view is bleak, progress by specific countries in specific areas brings more cheer.

In 2005, for example, the G8 committed to help Africa by reducing the burden of HIV/AIDS, malaria, TB and polio and improving access to basic health care. In later summits, additional commitments were made to strengthen the disease-specific goals and support health system strengthening, the training and retention of health workers and the control or elimination of neglected tropical diseases.

Perhaps more than in any other sector, the report says, where concentrated investments have been made, measurable results have been delivered: HIV infections are declining and more people living with HIV are receiving care and treatment, rates of new cases of TB are declining, malaria mortality has been reduced in targeted countries and child mortality has declined.

However, Africa is seriously off the rails in terms of meeting the health MDGs especially in maternal and child health.

Similarly in water and sanitation, the G8 committed to a Water Action Plan at the 2003 Evian Summit and this plan was reaffirmed in the 2005 and 2008 summits. Despite this attention, the G8 has set no quantitative targets in the sector. And the report notes that "improvements in access to clean water and sanitation serve as a catalyst for progress in almost every other area of development, providing the foundation for good health, education and economic productivity." Meanwhile, more than 4,000 children die daily from diarrheal diseases, which are spread through dirty water and poor sanitation and hygiene.

The ONE Campaign also analyzed the performance of each country and found that Italy and France "are performing so poorly that they are threatening to cause the G8 as a whole to default." Indeed, in 2008, France fell behind Germany for the first time in terms of the quantity of aid it is delivering to Africa, where it was once a major colonial power.

They also found that the U.S., Canada and Japan were meeting or beating commitments (the U.S. is actually on track to exceed its 2010 target a year ahead of time) while the U.K. and Germany were pushing hard to meet more ambitious goals (the U.K. is on target to be the first G8 country to meet the UN goal of spending 0.7% of national income in ODA).

Mood of NGOs at L'Aquila Not Optimistic

2009-07-08T15:43:00.000-07:00

L'AQUILA, Italy -- The heads of state are arriving here for the G-8 Summit in the mountains northeast of Rome --- President Obama and Chancellor Merkel are already here and President Sarkozy is arriving as I write this at 3:00 PM -- but the non-governmental organizations are mainly frustrated, angry or both with a few notable exceptions.

This morning I talked to civil society experts in most of the main areas of concern -- global health, water and sanitation, education, food security, climate change and labor -- and all but one expressed varying levels of disquiet. Only a Dutch expert in food security -- who was one of the key speakers on this issue at a civil society meeting in Rome earlier this week -- said he was "slightly optimistic" about the prospects for food at this summit.

When I asked a long-time global health advocate (who has been involved in several G-8 summits over the last several years) how he was feeling about the prospects for global health, he gave me the thumbs down. He cited his opinion that since commiting to an additional $60 billion by 2011 to fight pandemics and strengthen health systems, as agreed at the G-8 Summit in Germany in 2007 and Japan in 2008, the G-8 has not produced even one additional dollar. This point is certainly debatable but this particular advocate apparently chose not to include the Global Fund, PEPFAR or PMI in his calculations.

Steve Cockburn of End Water Poverty UK observed at how one can walk around Rome and admire ancient aqueducts and sewage systems that were providing clean water and sanitary sewage disposal 2,000 years ago, services that are available in 2009 in huge parts of the developing world. He called the current draft of the communique on water and sanitation "very disappointing" and predicted the the Millennium Development Goal for "watsan" will not be met until 2109. The last G8 in Japan committed to concrete results by the end of 2009 and when the officials saw that was not going to happen, he said, they "watered" the language down to merely making "progress" by the end of 2009.

Those fighting against climate change are equally disillusioned after seeing the latest draft of the Summit communique this morning. They characterized the situation as the European Union countries doing the right thing -- and even offering to increase their commitments to reduced emissions -- while the other members of the G-8 -- notably the U.S., Canada, Russia and Japan -- dragging their feet. Furthermore, they say the non-Europeans' recalcitrance is discouraging developing countries like China, India and Brazil from committing than they already have. They don't blame President Obama for this but say his feet are tied by Congress.

Those of us who care about global health (in which we include water and sanitation) are waiting with bated breath to see the final communique on those two issues. We are hearing two rumors on its release -- either this afternoon or on Friday. I will pass along the information here as soon as it becomes available.

The Global Health Council view of the current language in the communique on global health is positive: We like the language on the need to strengthen health systems, the call for a comprehensive and integrated approach, the emphasis on maternal and child health and on sexual and reproductive health which, as I noted in my previous post, is back in the G-8 communique after eight years in the wilderness during the Bush Administration.

In my three days in Italy, I have heard some amazing statistics: One of the most amazing and disconcerting is this provided by Angela McClellan of Transparency International in Berlin: The financial industry has received almost 10 times more in bailout money in the last year than poor countries have received in aid in the last 49 years (source: UN Millennium Campaign).

G-8 Summit Opens Today in L'Aquila

2009-07-08T10:04:00.000-07:00

L'Aquila, Italy -- Driving to the site of the 2009 G-8 Summit this morning was an eerie experience. After numerous security checkpoints, there was no more traffic and, other than security personnel, no more people -- except for the tents housing the thousands of local people without homes.

Until April, the summit was going to be held at a luxurious seaside resort in Sardinia. But then a devastating earthquake hit L'Aquila, in the mountains northeast of Rome, killing 300 and leaving tens of thousands homeless.

So the Italian government moved the summit to an out-of-the-way military school here in L'Aquila to draw attention to the plight of the victims and give a boost to the local economy.

As a reminder of the forces of nature at work here, a powerful aftershock hit the town last Friday, just days ahead of the arrival of world leaders.

But there are few hotels here even in the best of times, and this is not the best of times. For that reason, the 3,000 to 3,500 journalists descending on this region to cover the summit -- as well as the 200 or so of us from civil society -- are being housed an hour-and-a-half drive from here in a "Mediterranean Village" built specially for the 2009 Mediterranean Games which just concluded a few days ago. The accommodations are comfortable but spartan -- though undoubtedly far superior to the tents of L'Aquila -- and we have almost round the clock access to computers, food and wine.

Here at the Summit, I am working out of one of several media centers. The one I am in has space for perhaps 200 journalists and is divided by the language of the journalists -- there are Arabic, French, Italian, Portuguese and Chinese sections among others. Initially, I settled in at an Arabic computer but I quickly discovered my mistake.

The summit will focus on the global economic distress but expected to produce more of a progress report than new policy. Iran, climate change, food security in Africa, Middle East peace and trade are also on the agenda.

L'Aquila is the capital of the Italian region called Abruzzo, and was the second most important town in southern Italy after Naples for centuries. This area, in the Abruzzo's desolate interior, is one of the least touristed parts of Italy even though it boasts considerable rewards, particularly if you are in search of wild mountains and villages where strangers a novelty.

Keeping Health on the G-8 Agenda

2009-07-05T13:37:00.000-07:00

ROME, Italy -- Judging by the numbers of people I saw frolicking in Trevi Fountain and on the Spanish Steps as I arrived here today on a sun-drenched summer afternoon, you would not think the industrialized countries of the world are in the throes of the worst economic crisis since the Great Depression. But that is exactly what will be on the minds of the heads of state of the G-8 when they come here later this week for their annual attempt to find some common ground for making the world a better place not only for the rich countries of the world, but also for the poor.

And that is why I am here - - to add the voice of the Global Health Council to other representatives of civil society, largely European, to try to keep global health from getting lost in the many other pressing issues of the day, such as the recession, Iran, climate change, food security in Africa, Middle East peace and trade.

It will not be easy: In the Civil Society Meeting that begins here in Rome on Monday, immediately preceding the Summit which begins on Wednesday, health is hard to find on the agenda. The meeting is comprised entirely of four roundtables on Food, World Economy and Finance, Climate Change and something called "Public Goods" which, presumably, might include something about health. But that is not at all clear, and my job here is to ensure that global health -- and particularly reproductive, maternal and child health - get a fair hearing as access to these health areas -- and lack thereof -- have enormous effects on the poor's ability to make progress in the other areas of concern to this G-8 Summit.

Mere Rain Does Not Extinguish Flame of Candlelight Memorial

2009-07-04T10:34:00.001-07:00

CAP HAITIEN, Haiti, May 16, 2009 -- On my first overseas assignment with the Global Health Council, I was privileged to be part of the opening ceremony of the 2009 International AIDS Candlelight Memorial, originally planned to take place in front of the spectacular ruins of Sans Souci Palace (a World Heritage site) in Milot, Haiti. The Council has been managing this event, the world's oldest and largest AIDS awareness-raising event, since 2000. Last year, for the first time, they took the opening ceremony overseas, to Malawi; this year, they chose Milot, a village a few kilometers from Cap Haitien, the second largest city in Haiti on its northern coast.

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Although the Milot event was rained out, the opening ceremony was still a great success when most of the events associated with it were held at the dinner that had already been scheduled for Cap Haitien after the event. The festivities started when Haitian Prime Minister Michele Duvivier Pierre-Louis arrived at Cap Haitien Airport in the afternoon and drove to Milot. She appeared before an enthusiastic crowd of local people at an event promoting the importance of getting tested for HIV.

Abbott Fund, one of the donors of the Candlelight Memorial, announced that it was donating 500,000 rapid HIV test kits as the kick-off of a nationwide HIV testing campaign. The testing initiative is a cooperative partnership between the Haitian government, the U.S. government, the Abbott Fund and Haitian health implementing organizations.

At the dinner, I had the pleasure of sharing a table with Prime Minister Pierre-Louis and her entourage, including the minister of tourism, who told us of his hopes to bring tourism back to the beautiful northern coast of Haiti, where Christopher Columbus landed in 1492 when he discovered America. The candle-lighting ceremony took place after the dinner, when Prime Minister Pierre-Louis and representatives of the two sponsors of the event -- Vice President Kathryn Guare of the Global Health Council and Dr. Myrna Eustache of Promoteurs Objectif Zero Sida (POZ) www.pozsida.org/ -- joined people living with HIV and AIDS to light the candles to remember those lost to AIDS, to advocate for improved programs and policies and to celebrate the courage of Haitians living with the disease.