The biggest global health stories of 2015, and one untold story

A billboard warning about Ebola in Bamako, Mali.

This was originally published on Global Health TV on December 17, 2015

There seemed to be a lot of good global health news in 2015, especially when compared to 2014, when Ebola was ravaging West Africa and scaring the rest of the world. In the last 12 months, Ebola has mostly passed, progress was made against malaria and AIDS and the climate deal in Paris raised hopes that less climate change could improve global health.  Here are what I consider some of the top global health stories of the year, not necessarily in order of priority:

Ebola on the Decline: A year ago, Ebola was raging. As of Dec. 16, there have been 11,315 deaths and 28,640 cases of Ebola. But Ebola has not disappeared entirely. It re-emerged in Liberia after having earlier been declared Ebola-free. Dr. David Nabarro, the UN special envoy on Ebola, said that he expects transmission in Guinea to finish before the end of 2015 and in Liberia in early 2016. Here’s an update on Ebola in an interview with Dr. Nabarro.

The social marketing legacy of Phil Harvey

This originally appeared on the Huffington Post on December 15, 2015.

From 1992 to 2001, I did some of the most important – and fun – work of my life: I managed social marketing programs for the nonprofit PSI in Zambia, Bangladesh and Paraguay. Social marketing is a technique that uses the tools of social marketing to achieve a social outcome – in PSI’s case, that outcome is improved health. The programs I worked on were HIV prevention, family planning and child health but social marketing can also be applied to other disciplines as well.

I owe that singular experience to Phil Harvey, who founded PSI in 1970 to promote family planning through the social marketing mechanism. In 1989, he founded DKT International, another social marketing organization more tightly focused on reproductive health mainly in very large countries (in order to have cost-effective impact at greater scale). Harvey has also served, and continues to serve, for many years on the board of directors of Marie Stopes International, another organization that uses social marketing.

Phil Harvey is introduced as “a visionary, pioneer and titan in the world of social marketing” in this new video interview. Harvey describes his early work in India, the roots of social marketing, his creation of two social marketing organizations, his legal battle with the State of New York over reproductive health issues (that went all the way to the U.S. Supreme Court) and the impact of social marketing.

Social marketing contributes 20% of all contraception in developing countries (excluding China)

A DKT Indonesia midwife counsels a client in her clinic in Jember, East Java. In 2014, this network of nearly 5,000 midwife clinics helped DKT Indonesia become the Number 1 contraceptive social marketing program in the world.

This was originally published on the Huffington Post on December 1, 2015.

If there was still any doubt about social marketing’s ability to make a major contribution to family planning and HIV prevention, those doubts were dispelled in 2014, when 84 social marketing programs in 62 countries delivered 69 million couple years of protection (CYPs), according to the 2014 Contraceptive Social Marketing Statistics just published by DKT International. DKT says these 69 million CYPs represent an estimated 20% of all women using modern contraception in the developing world, excluding China. (A “couple year of protection” is the amount of contraception needed to protect one couple for one year).

“These are remarkable numbers and a testament to the many organizations and individuals who strive to make a wide range of health products and services available to women around the world,” said Chris Purdy, president and CEO of DKT International.

The report provides details of these 84 contraceptive social marketing programs, all of which are helping provide modern contraception and reduce unmet need for family planning among women and families in their countries, largely through the private sector.

Killing 5 million a year, diabetes becomes major menace to global health

This was originally published on Global Health TV on November 23, 2015.

Over the last 25 years, diabetes has emerged as a major threat – and growing consumer of precious global health resources – in the developing world. In 1990, according to the Institute for Health Metrics and Evaluation (IHME), it was not even in the top ten leading causes of death globally.  Now it is number nine on the list.

In the seventh edition of its Diabetes Atlas, the International Diabetes Federation (IDF), an umbrella organization of over 240 national diabetes associations, says that diabetes kills almost 5 million people every year and that every six seconds a person dies from diabetes. This compares to those who die each year from AIDS (1.5 million), tuberculosis (1.5 million) and malaria (600,000).

The latest version of the Diabetes Atlas, which will be published on Dec. 1, calls diabetes “one of the largest global health emergencies of the 21^st century.” Currently, 415 million people have it (1 in 11). By 2040, if current trends continue, 642 million will have it (1 in 10).

Diarrhea deaths are falling but ORS use still stagnant

This was originally published on Global Health TV on October 28, 2015.

I’m grateful to Chelsea Clinton for her admission that she is “obsessed with diarrhea,” and her total lack of embarrassment in bringing it up repeatedly. In an interview with Fast Company, it was the first thing she wanted to talk about.

I’m grateful to her because she is, as far, as I know, the only well-known public figure to champion the prevention and treatment of diarrhea, the world’s second biggest killer of children under five years old, even though we have cheap and effective ways of dealing with it.

“It’s completely unacceptable that more than 750,000 children die every year because of severe dehydration due to diarrhea,” said Clinton last year. “I just think that’s unconscionable.”

We need more champions of the diarrhea issue.

Four years ago, I wrote a blog bemoaning the fact that oral rehydration therapy (ORT) seemed to be on life support, even though The Lancet once called it “the most important medical advance of the 20^th century.” ORT and its practical application, oral rehydration solution (ORS), have long been found to be both effective and cost-effective in treating the dehydration caused by diarrhea.

How does global health fare in the Sustainability Development Goals?

This originally appeared on Global Health TV on Sept. 28, 2015.

Last weekend in New York City, world leaders formally approved the Sustainability Development Goals (SDGs), which will guide development efforts over the next 15 years. They replace the Millennium Development Goals (MDGs) that were signed in 2000 and expire on Dec. 31, 2015.

The MDGs were terrific for global health, both in raising money, and raising its profile on the global agenda.

Eight goals made up the MDGs, and three of them were entirely focused on health. In addition, two other goals included health-related targets. Eight (38%) of the 21 total MDG targets were health-related, and seven of those targets were numerical (i.e. reduce maternal mortality by three quarters).

Between 2000 and 2014, $228 billion was allocated to address the three health-related MDGs, according to the Institute for Health Metrics and Evaluation (IHME) 

More importantly than how much was raised, serious progress was made on many of these health fronts. For example, two weeks ago, the World Health Organization announced that malaria death rates have plunged by 60% since 2000 and that the malaria target to have halted and begun to reverse the incidence of malaria by 2015 has been met “convincingly.” Most people think the Target 1A to halve the proportion of people living on less than $1.25 has been met.

But where is health in the SDGs? The answer to that question contains both good and bad news for global health advocates.

It's too soon to declare victory over Ebola

This was originally published at Global Health TV on Aug. 24, 2015.

There has been a welcome spate of good news coming out of West Africa in recent weeks on the apparent demise of Ebola, which has caused the region nothing but misery, illness (27,952 reported cases) and death (11,284 reported deaths) for over a year.

Ebola cases continue to fall. For the week ending Aug. 16, no new cases were reported in Liberia and Sierra Leone, for the first time, has gone one full week without any new cases. Guinea was the only country to report any new cases — but just three.

And The Lancet published “interim results” from research on the efficacy of an Ebola vaccine in Guinea showing a vaccine efficacy of 100%.

The news is undeniably good. In the last week, I read these headlines:

Associated Press: “UN official: Ebola epidemic could be defeated by end of 2015.”

Scientific American: “Does This Ebola Vaccine Herald the End of the Virus?”

National Public Radio: “Zero Ebola Cases Reported in Sierra Leone as Epidemic Peters Out”

This is all welcome news but if you go beyond the headlines you quickly realize that this epidemic is not yet over.

Global health funding: Huge increases since 2000, but also huge disparities

This was originally published on Global Health TV on July 27, 2015.

As the end of the era of the Millennium Development Goals (MDGs) (2000-2015) draws near, we who work in global health can look back with some satisfaction at the $228 billion that was allocated to address the three health-related MDGs during that time.

Although spending grew rapidly in the first ten years, it was stagnant between 2010 and 2014, and actually decreased by 1.6% between 2013 and 2014. Global health funding in 2014 amounted to $36 billion in 2014 (of which $1 billion was for Ebola).

That information comes from Financing Global Health 2014: Shifts in Funding as the MDG Era Closes, the annual report of global health funding published last month by the Institute for Health Metrics and Evaluation (IHME).

And two weeks ago, the Kaiser Family Foundation and UNAIDS issued a report that showed that although there was only a slight increase in funding for HIV in low- and middle-income countries in 2014 (less than 2%), seven of 14 donor countries actually decreased funding despite the recent gains made against the epidemic.

In Africa, gap between need and funding of mental health is huge

Adolescent boys in talk therapy group near Kampala, Uganda. Credit: StrongMinds

This was originally published on Global Health TV on June 29, 2015.

Sean Mayberry has spent his entire life surrounded by mental illness. As a child and an adult, people close to him have endured this affliction. But he had an epiphany when he happened upon a young man behind a farmhouse in Uganda, sitting in his own excrement and digging in the dirt.

“It was a turning point for me,” he recalls. “I left that young man knowing that I had to do something for the mental health of that continent.  He gave me the courage to try to make a difference for some of his mentally ill brothers and sisters.”

Pauline Muchina is dealing with mental illness in her family in Kenya. Her 50-something sister lost her job due to depression and had to come home to live with her mother. She is now on medication and attends counseling.

Muchina also has a nephew suffering from depression. While in a government hospital, he was chained to a bed for one week and his condition got worse. Now the family has found a private rehabilitation center for him. He is getting better but it is costing the family $2,500 for six months. Muchina’s family is middle-class and can pay the treatment (with difficulty), but the vast majority of Kenyans could never afford such expensive treatment.

Mental disorders and substance abuse are the third greatest contributor to the global burden of disability with 23% of the burden – greater than cardiovascular disease or cancer.

Women trying to regain dignity by ending fistula

Djantou

This blog was originally published on Global Health TV on May 27, 2015.

BAMAKO, Mali — Djantou came here from Fangala, her village northwest of Bamako, to repair her fistula, a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed labor without adequate treatment. Djantou’s fistula occurred while she was in labor during her first pregnancy. Her child was stillborn. She wants to have children in the future but she is afraid — both of the operation and of childbirth. Djantou is 15 years old.

Rokia

Rokia is from the village of Tarasso, near the border with Burkina Faso. Twenty years ago, she also developed fistula during her first pregnancy. The baby was stillborn. “The urine would not stop,” she said. Rokia has had two operations but both failed. She is now awaiting her third operation. Although she is 40 years old, she still very much wants to have children.

Fistula is a tragic condition that leaves women leaking urine, feces or both. It can lead to chronic medical problems and cause social exclusion. Women are often abandoned by their husbands and sometimes by their own families because of their incontinence and unpleasant smell. They face depression and social isolation — either self-imposed or by their sometimes unforgiving communities.

New development goal falls short of protecting those most at risk of HIV

This ISHTAR wellness center in Nairobi works to ensure that gay men have access to non-discriminatory HIV and sexual health services. Credit: Corrie Wingate for the International HIV/AIDS Alliance.

This blog was originally published by The Huffington Post on May 8, 2015.

Dominique, 26, realized he was gay in his early adolescence and now sells sex to other men to survive and to support his relatives in Kisii, in western Kenya. He goes regularly to a drop-in center outside Nairobi run by the Kenya AIDS NGO Consortium (KANCO) where he gets a holistic package of HIV and sexual and reproductive health services.  As a result, he is HIV-negative.

Dominique is a good example of why we need to support people most vulnerable to HIV. Yet the language currently proposed in the Sustainable Development Goals (SDGs) falls short of prioritizing the most marginalized and vulnerable groups (the SDGs are the new development goals replacing the Millennium Development goals which expire later this year).

Goal 3 of the SDGs is to “ensure healthy lives and promote well-being for all ages.” Target 3.8 under this goal commits to Universal Health Coverage (UHC). Unfortunately, the UHC target and indicators do not meet the specific needs of the most marginalized, stigmatized and underserved people in the world — like men who have sex with men (who are 19 times more likely to contract HIV than the general population) and transgender women (who are up to 49 times more likely to acquire HIV than all adults of reproductive age).

How Mali conquered Ebola

These signs — which say “Stop the Ebola virus: Wash your hands regularly with soap” are still ubiquitous around Bamako three months after WHO declared Mali Ebola-free.

This blog originally appeared on Global Health TV on April 28, 2015.

BAMAKO, Mali — In the year-old Ebola epidemic, most of the attention has justifiably been focused on Guinea, Liberia and Sierra Leone, where the vast majority of the cases (26,044) and deaths (10,808) have taken place. But what about those countries that have successfully controlled Ebola — Mali, Nigeria, Senegal, Spain, the UK and the US — which account for only 35 cases and 15 deaths? 

I am spending two months in one of those countries and wondered how Mali conquered Ebola. Even though the World Health Organization (WHO) had declared Mali Ebola-free in January, I had barely stepped off my airplane at Bamako–Sénou International Airport on March 14 when I encountered Ebola control: I was scanned for a fever and offered hand sanitizer before entering the airport terminal.

Mali went on high alert after confirming its first case of Ebola in late October of last year, when a 2-year-old girl who had traveled from Guinea to Mali died. The country moved quickly in what the government considered an emergency situation. The child, who was symptomatic upon her arrival in Mali, had traveled extensively in the country using public transportation. Aggressive contact tracing was undertaken but none of the contacts showed symptoms.

It looked like the country had dodged a bullet, with only one death. But then an imam from Guinea was admitted to Bamako’s prestigious Pasteur Clinic with a diagnosis of acute kidney failure, and died on Oct. 27. That case set off a chain of transmission that led to seven additional Ebola cases and five deaths, including a doctor and nurse who had treated the imam. He was buried with full traditional rites, including washing of his highly contagious body, which may have exposed mourners to the virus.

Three world-changers: Drones, sanitary pads and schools

This blog originally appeared on Humanosphere on April 20, 2015.

On the Pacific archipelago nation of Vanuatu, a “digital humanitarian” has been using drones to carry out a detailed assessment of the damage caused by Cyclone Pam last month.

In Rwanda, a young African woman is improving the lives of other young women by the simple act of providing them with locally made sanitary pads so they don’t miss work and school.

And in Kenya, a man who grew up in extreme poverty, without formal education, is building schools and fighting poverty and gender inequality in the worst slums of Nairobi. New York Times Columnist Nicholas Kristof says he might be the next Mandela.

All of these young people are trying to change the world in very different ways. Along with at least 50 others, they will be in Saxapahaw, North Carolina April 23-24 for the fourth annual SwitchPoint, a global gathering organized by IntraHealth International (which I need to disclose is one of my clients).

West Africa finally starting to embrace family planning

A health worker counsels a client in rural Senegal on family planning options. Photo courtesy of IntraHealth International, © 2014 by Jonathan Torgovnik/Reportage by Getty Images

This blog originally appeared on Global Health TV on March 24, 2015.

BAMAKO, Mali — When my wife and I lived here in the late 1980s and early 1990s, our housekeeper, Korotumu, hid her birth control pills on the top shelf in our kitchen, so her husband would not find out she was using contraception. He was unemployed and they had two children. Koro figured that two was enough, at least as long as her husband was not working.

I didn’t realize it then, but Koro was in a progressive minority of Malian women at that time. The 1987 Demographic and Health Survey of Mali revealed only 1.3% of married women were using modern contraception and the fertility rate (the average number of children a woman has in her lifetime) was 7.1. Koro was part of that 1.3%.

Flash forward a quarter of a century and what has happened in Mali? Use of modern contraception has increased to 9.9% and the fertility rate has dropped from 7.1 to 6.1.

Reaching the unreached with family planning in India

A Janani mobile family planning van registers new users in India.

This blog was first published by Impatient Optimists blog on March 13, 2015.

By the time the brightly colored family planning van pulls into the government health center in a village in northern India, a group of young women is waiting. They have come to adopt a high quality modern method of contraception. They have already been pre-screened and most have chosen either an intrauterine device (IUD) or tubal ligation but the van also offers methods like condoms, oral contraceptives, injectables and emergency contraceptives, according to their needs.

Some of them have three, four or more children, and want no more. For many of them, it is the first time they have practiced family planning. The fertility rate in the states of Bihar and Uttar Pradesh, according to the last India National Family Health Survey 2005-2006, was 4.0 and 3.82 children respectively, the highest and second highest in all of India.

Some 270 such “mobile family planning days” were conducted in 2013 and 2014 in a pilot project with one van, creating 2,800 new IUD clients, and counseling 1,600 women who came for follow-up visits. With support from The Bill & Melinda Gates Foundation — in partnership with CARE, the University of Manitoba and Marie Stopes International — this program has expanded from one to 20 outreach teams that provide IUD and sterilization services for women, and non scalpel vasectomy for men. The operation is run by Janani, an affiliate of the international social marketing organization DKT International.

Stymied by Less Smoking in Richer Countries, Big Tobacco Shifts Focus on Developing Countries

Anti-tobacco demonstrators in Brazil demand implementation of the national Tobacco Control Law. Credit: Aliança de Controle do Tabagismo

This was originally published by Global Health TV on March 2, 2015.

Between 1990 and 2009, cigarette consumption decreased by 26% in Western Europe, but in Africa and the Middle East, it increased 57%, according to the American Cancer Society (ACS). In response, many of these developing countries are stepping up their efforts to fight tobacco with new laws and restrictions. Big Tobacco is using its deep pockets to finance creative attempts to circumvent those laws.

The problem is so daunting that ACS named rising use of tobacco in developing countries as one of it “Three Top Cancer Challenges of the 21^st Century” earlier this month when it observed World Cancer Day. Comedian John Oliver covered the issue very well in this segment from his HBO show “Last Week Tonight.”

An estimated 8 million of the 14.1 million new cancer cases diagnosed in 2012 occurred in developing countries with 82% of the world’s population, according to Global Cancer Facts & Figures, 3^rd Edition. Smoking causes at least 12 types of cancer, according to the U.S. Surgeon General, and accounts for a fifth of all global cancer deaths. Tobacco use is the cause of nearly 6 million premature deaths annually, notes the report.

Family planning in India and Pakistan: Picking up the pace of change

Birula, living in Bihar, India, was all smiles about her sterilization. 
Photo: David J. Olson

This blog was originally published by Global Health TV on Jan. 27, 2015.

WALLAH, Pakistan and ARA, India -- Last month, I met Sumeera, 26, in a Dhanak clinic (“dhanak” means rainbow in Urdu) in the village of Wallah, in the rural Punjab of Pakistan. She and her husband have four children ages 7, 5, 3 and 1, and have agreed that four is enough. She had come for a pregnancy test and to secure a contraceptive method to keep her family from getting bigger. Her pregnancy test was negative, and she went away happily, with an intrauterine device inserted by her Dhanak midwife and clinic owner Kaneez Fatima. “Before we found Dhanak, my husband and I knew about family planning but did not have access to it,” Sumeera told me. “Dhanak made a big change in my life.”

One thousand four hundred kilometers to the southeast and a week later, I met Birula, 25, in a Surya clinic (“surya” is the Hindi word for sun) in Ara, a rural town about two hours outside of Patna, India, the capital of Bihar state. She has three children ages 7, 6 and 1½. The previous week she had been sterilized at this clinic; she was back to have her stitches removed. Her relief was palpable – she couldn’t stop smiling.

Sumeera and Birula come from different cultures in different countries but the problems they face are remarkably similar – too many children and too little ability to control the size of their. In India, women cannot always determine the size of their families because of a strong preference for the male child and male dominance in decision-making. In Pakistan, religion also plays an influential role. Both countries are confronting the problem, albeit in different ways and with varying degrees of success.

The top 10 in contraceptive social marketing

Two salesmen from DKT India make a pitch for contraceptives to the owner of a pharmacy in the Mumbai slums. In 2013, DKT India was the ninth biggest contraceptive social marketing program in the world. 
Photo: David J. Olson

This was originally published on the Knowledge4Health Blog on Dec. 23, 2014.

Social marketing organizations around the world delivered more impact than ever before in 2013 —70 million couple years of protection (CYPs), an increase of 6.8% from the 65.5 million CYPs produced in 2012, according to the 2013 Contraceptive Social Marketing Statistics just published by DKT International. (A couple year of protection is the amount of contraception needed to protect one couple for one year; see note at end of article for more details).

The report provides details on 93 contraceptive social marketing programs in 66 countries, all of which are helping provide modern contraception and reduce unmet need for family planning among women and families in their countries.

The social marketing program producing the most CYPs in 2013 was DKT Indonesia, delivering 6.7 million CYPs, consisting of contraceptives sold through social marketing channels such as pharmacies, convenience stores and medical wholesalers. The second biggest program was the Government of India, with 5.8 million CYPs (although over 40% of these CYPs were for products given out for free, which was not the case with other programs in the Top 10). Here is the Top 10 list in contraceptive social marketing in 2013:

1. DKT Indonesia, 6.7 million CYPs

2. Government of India, 5.8 million CYPs

3. Social Marketing Company (SMC), Bangladesh, 4.44 million CYPs

4. Greenstar Social Marketing, Pakistan, 4.42

5. PSI India, 3.8 million CYPs

6. Society for Family Health, Nigeria, 3.4 million CYPs

7. Population Health Services India, 3.3 million CYPs

8. DKT Ethiopia, 3.1 million CYPs

9. DKT India, 2.89 million CYPs

10. Profamilia, Colombia, 2.87 million CYPs

The top 10 global health stories of 2014

This was originally published by Global Health TV on Dec. 22, 2014.

Ebola, the biggest global health story of the year, is one that no one could have predicted when the year dawned almost 12 months ago. It did something that few global health stories do: It entered the consciousness of the global public in an important way. Beyond Ebola, though, there was much to celebrate in 2014.

Ebola: That one word represented not only the biggest global health story of the year, but one of the biggest stories of the year, of any type. As of Dec. 17, the World Health Organization (WHO) reported 18,603 cases and 6,915 deaths. Late in the year, incidence was declining in Liberia, slowing in Sierra Leone and “fluctuating” in Guinea. Sierra Leone surpassed Liberia as the country with the most reported cases. As I wrote here on Global Health TV last month, Ebola has made the definitive case for stronger health systems and health workers in developing countries.

Reaching adolescents with the right kind of HIV and sexual health services

Pacifique, who was born HIV-positive, has finally found a safe space.

This was originally published on the ONE Blog on Dec. 4, 2014.

Pacifique is a 20-year-old student living in Bujumbura, Burundi, who found out he was born HIV-positive when he was 10 years old. He had been taking anti-retroviral medication for a year without knowing what it was for.

“My mum refused to disclose my status to me,” recalled Pacifique. “She told me I had a heart problem but that I would get better. I was frightened when I found out. I thought I would never get married. It hurt me to think I would never have children.”

Pacifique is hardly alone. There were an estimated 2.1 million adolescents living with HIV in 2012, with more than 80% of them living in sub-Saharan Africa. Many don’t know their HIV status. HIV is now the number one cause of adolescent mortality in Africa and the second biggest in the world (UNAIDS defines adolescents as ages 10-19). Between 2005 and 2012, HIV-related deaths among adolescents increased by 50%.

Young people most affected by HIV finally gain a seat at the table

Link Up aims to improve the sexual and reproductive health and rights of more than one million young people living with and most affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda. Here's a group of young people above in Ethiopia. Credit: International HIV/AIDS Alliance

This blog was originally published by the Huffington Post on Dec. 1, 2014.

Earlier this year, young Ugandans saw an opportunity to influence the HIV response in their country by coming together to determine their priorities for the New Funding Model of the Global Fund to Fight AIDS, Tuberculosis and Malaria, a major funder of HIV programs.

The meeting included young members of “key populations,” including people living with HIV, people who use drug, sex workers, transgender persons, men who have sex with men, fisher folk and truckers, and was facilitated by young women living with HIV. These young people are rarely consulted in a meaningful way in the design and implementation of HIV/AIDS programs, even programs targeting them, in Uganda and globally.

These priorities were eventually shared in the form of a Young Key Populations Priorities Charter. The priorities identified provided a template for action that, if accepted by the Global Fund, could lead to more effective programming for young people, increased engagement by young people in policy development and national planning processes and, ultimately, genuine change on the ground.

This is one example of how young people, and particularly those living with HIV and from these key populations, are starting to engage meaningfully in the design and implementation of HIV/AIDS programs meant to help them, something long past due.