Brazil struggles to contain damage of mosquito that transmits Zika virus

Dr. Sylvia Lordello of Saúde Criança speaks to a group of parents about Zika.

This was originally published by Global Health TV on March 31, 2016.

RIO DE JANEIRO, Brazil — A group of about 20 poor parents (mostly women) from the slums gathered this month in the offices of Saúde Criança (“child health” in Portuguese), a social enterprise that works with impoverished children and their families in a holistic way. After a meditation, they got down to the main point of the meeting — the Zika virus and how to avoid it.

These poor young mothers are prime candidates for Zika. Aedes aegypti, the mosquito that transmits Zika, will suck anyone’s blood — rich or poor. But they thrive in the densely populated favelas of Rio and other Brazilian cities where few people have screened windows and where even mosquito repellant may be a luxury. Many people have water cisterns on their roofs, usually not covered, which makes an ideal breeding ground for Aedes aegypti.

Dr. Sylvia Lordello, a medical doctor on staff at Saúde Criança, told the parents that prevention starts at home and reviewed a series of steps that could be taken to make their homes less hospitable to mosquitoes, such as covering their cisterns and not leaving water in the plates under house plants.

“If the whole country fights Zika, the mosquito cannot win,” Dr. Lordello told the parents. “Zika is not stronger than the country.”

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).

Global health needs more strange bedfellows, unorthodox partnerships

Puppets walking into the audience at the SwitchPoint conference in Saxapahaw, North Carolina.

The was originally published on the Huffington Post on July 14, 2014.

In Tanzania, the non-profit group IntraHealth International works with a cotton gin to provide circumcision services to their male employees and collaborates with local police to bring together 400 motorcycle taxi drivers to learn about road safety and HIV prevention. Both projects are funded by the U.S. Centers for Disease Control and Prevention.

The African Christian Health Associations Platform, based in Kenya, is working with Novo Nordisk and Johnson & Johnson that provide Christian health associations in several countries with technical support, training and drugs to combat diseases like diabetes, HIV and opportunistic infections.

Those are examples of an increasingly common approach to development. It used to be that a donor would sit down with the ministry of health to work out the design and implementation of a new global health initiative, with no significant input or involvement of other stakeholders. Those days, thankfully, are long gone.

Nowadays, it's widely recognized that more stakeholders need to be consulted, both in the design and the execution of an intervention. Does this make the process more messy and complicated? It sure does, but this messiness is essential to take global health to the next level.

Kenyans struggle to come to terms with abortion and its impact on maternal health

This was originally published on The Huffington Post on Oct. 17, 2012.
 
NAIROBI, Kenya -- The abortion issue in Kenya is raucous, rancorous and highly emotional and political, just like in the U.S., but there is one major difference: In Kenya, abortion rights have been liberalized in certain cases in a Constitution approved in a public referendum two years ago.

I spent four weeks in Kenya this year working with the Reproductive Health and Rights Alliance, a coalition of six Kenyan organizations committed to improving maternal health, to communicate better to key groups the nature of those changes. I talked to some 40 doctors, gynecologists, nurses, lawyers, government bureaucrats and technocrats and non-governmental workers and journalists. And a few taxi drivers.

The issue of abortion is so sensitive and taboo in Kenya that it almost derailed the constitution-making process. I discovered that even though the debate was heavily covered by the Kenyan media leading up to the August 2010 referendum, there's still a lot of misinformation on what exactly the Constitution changed, or didn't change -- even among health providers. Some think the Constitution legalized abortion on demand. Others think it changed nothing and abortion remains virtually illegal. The truth lies somewhere in the middle.

Faith-based organizations hope to have a positive impact at London Family Planning Summit

Three African presidents and Melinda Gates at Family Planning Summit.

This article was originally published in the "On Faith" section of the Washington Post on July 10, 2012. 

When the British government and the Bill & Melinda Gates Foundation bring together governments, donors, civil society, the private sector and the research and development community in London on July 11 for a major summit that hopes to rekindle the neglected embers of family planning, there will be one constituency there that might surprise some people — people of faith, including Christians (Catholics, mainline Protestants, and evangelicals), Muslims and other faiths.

These religious leaders are working to mobilize the faith community to work with governments, donors and other secular partners to bring family planning back as a major force in maternal, child and community health, something that has been downplayed the past two decades, in part because AIDS and other health issues took precedence, and in part because of the religious and political sensitivities to sexuality and family planning.

This faith support for family planning ranges from progressive Christians to Catholics and evangelicals.

What NGOs want from the Mexico G20 on food security and nutrition

NGOs holding one of our two press conferences at the G20 at Los Cabos.

NOTE: This was originally published on the Huffington Post on June 18, 2012.
 
LOS CABOS, Mexico -- On the eve of the G20 Summit, which opens here on June 18, I've been looking into what nongovernmental organizations (NGOs) want to get out of the G20 Mexico on an issue that is a priority to NGOs as well as the Mexican presidency of the G20 -- "enhancing food security and addressing commodity price volatility," in the words of the Mexican government.

And I discovered that the biggest NGOs and NGO coalitions here in Los Cabos are advocating for many of the same food security and nutrition issues, but also have some differences.

In its paper titled Food Security: A G20 Priority, the Mexican government defines food security "not only as an increase in production, but also the availability of, and access to, food by the population."

In a sense, that is one of the highest priorities of NGOs advocating on this issue at Los Cabos -- to ensure that the G20 not only takes steps to increase food production but also to make sure that the most vulnerable, especially women and children, have access to it.

Bringing the Avon Lady Philosophy to Rural Ghana

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.

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

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.

High tech TEDx event shows that child health is within reach

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.

My take on the G8/G20 summits in Toronto

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

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.

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

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.