Stepping up fight against malaria in Asia to protect gains made everywhere

A mother from Myanmar and her child waiting to be seen at the Wang Pha clinic near Mae Sot, Thailand, near the Thai–Myanmar border. Her son has symptoms of malaria. Photo: Mark Tuschman 

This was originally published on Global Health TV on August. 31, 2018

The future of malaria in sub-Saharan Africa and everywhere else may depend on whether we can stop drug resistant malaria in five countries of the Greater Mekong subregion of Southeast Asia and whether new vaccines will work against it.

Great progress has been made against malaria on both continents. The incidence rate of malaria has decreased 18% globally between 2010 and 2016, according to the World Health Organization. The WHO South-East Region recorded the largest decline (48%) followed by the African Region (20%). Malaria cases worldwide have fallen from 237 million in 2010 to 216 million in 2016.

Two years ago, Sri Lanka became the first country in the region to eradicate malaria. Six more countries (Bhutan, China, Malaysia, Nepal, South Korea, and Timor-Leste) are on track to eradicate it by 2020 and the other 15 nations are targeting 2030. But a few of those 15 countries are struggling – malaria cases increased in six of them in 2016. India has the third largest burden of malaria in the world, accounting for 89% of malaria cases in the Southeast Asia Region.

“We’ve made extraordinary progress in the Asia-Pacific Region,” says Dr. Ben Rolfe, CEO of the Asia Pacific Leaders Malaria Alliance based in Singapore. “Malaria has been halved, and then halved again. Even Myanmar has made extraordinary progress in the most difficult of circumstances. The downside is that we have only bitten off the easy fruit. We are now getting down to dealing with remote communities with very little access to health services. It gets exponentially harder to reach those places.”

Obesity is rising almost everywhere, spurring a rise in chronic disease

This shows MyThali (My Plate), a new campaign of Arogya World to show urban Indian women a healthy diet in order to fight obesity and associated non-communicable diseases. Photo: Arogya World

This was originally published on Global Health TV on April 27, 2018.

The picture above shows the ideal, healthy plate of food for an urban adult woman in India – one cup of vegetable, one cup of rice, one and a half pieces of chapatti, one cup of protein (meat, lentil or sambar) and a half cup of yogurt. 

But too often this is not the typical meal of an Indian. Some people eat too much and become overweight or obese, particularly in urban areas. Obesity increases people’s likelihood of developing diabetes, to which Indians are predisposed. Meanwhile, some people, particularly rural adolescent girls, eat too little putting themselves at risk when they become pregnant at an early age.

So Arogya World, a U.S.-based organization committed to changing the course of non-communicable diseases (NCDs) in India, created MyThali (“My Plate”), inspired by the U.S. Department of Agriculture’s “My Plate” campaign and using the guidelines from India’s National Institute of Nutrition to encourage them to make healthier choices. Arogya World is aggressively implementing this campaign in workplaces across India.

Amid a flurry of high-tech approaches, some find merit in low-tech techniques

DKT street theater provides family planning information in Bihar.

This was originally published on Humanosphere blog on March 7, 2016.

Because of the meteoric rise of the internet and cell phones in many developing countries, many global health programs have been rushing to embrace these technologies as efficient ways of reaching large numbers of people with information on such issues as family planning, HIV prevention and maternal and child health.

This is happening in countries like India, Tanzania, South Africa, and Ethiopia, where technologies like the internet, mobile phones, social media and geographic positioning systems are bringing health delivery into the 21^st century.

But some programs are eschewing high tech and sticking with low tech as the best way to bring vital health information to their low-income consumers, at least for now.

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.

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).

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

We will not banish AIDS until we banish stigma

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

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

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

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

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

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

New momentum to end preventable child and maternal deaths by 2013

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

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

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

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

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

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

Do you think you know where faith groups stand on family planning? Think again

This husband and wife are World Vision-trained community health workers in India who advocate birth spacing. They began using family planning when their son (right) was born.

NOTE: This blog was originally published on Impatient Optimists, the blog of the Bill & Melinda Gates Foundation, on April 3, 2012.

Religious leaders from a diversity of faiths—Muslims, Buddhists, Christians, and Hindus—have come together to profess support for family planning access around the world. This multi-faith support for family planning is something we simply don’t hear enough about in the United States. But we should.

Last year in Kenya, an interfaith meeting led by Christian Connections for International Health (CCIH) of the U.S., Deutsche Stiftung Weltbevoelkerung of Germany, and Muhammadiyah of Indonesia resulted in an “Interfaith Declaration” unanimously endorsed by well over 200 Catholic, Protestant, Muslim, Hindu, and Buddhist religious leaders.

The declaration expressed clear support for providing couples with the information and means to plan the timing and spacing of their children “consistent with their faith,” and called on others to support this initiative to influence government and donor policies and funding.

The truth is that faith-based organizations have been providing health care and even family planning for decades.