Archive for category: Health

Information and stories on health topics.

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New Efforts to End TB

New Efforts to End TB
Tuberculosis (TB) is a disease that is largely associated with countries’ health care systems and with other factors relating to health such as nutrition, sanitation and housing. Therefore, it is crucial to help combat TB in developing countries, especially where the disease continues to be a problem.

In 2014, the World Health Assembly approved the End TB Strategy, which aims to end the epidemic of Tuberculosis by 2035. Because of this, the Stop TB Partnership Task Force is developing a plan to make significant progress toward the End TB Strategy goal.

Additionally, Ministers of Health from Brazil, Russia, India, China and South Africa (BRICS) developed a strategy to help end Tuberculosis in their countries. The Ministers established a plan that would provide universal access to medicines for all people with Tuberculosis in BRICS countries, as well as low or middle-income countries. Also, they developed a 90-90-90 goal. In BRICS countries, 90 percent of people should be screened for Tuberculosis, 90 percent should be diagnosed and started on treatment and 90 percent of treatments should be successful. Scientific research on things like drug-resistant strains of Tuberculosis and service delivery of TB were also agreed upon by the Ministers. Given that 50 percent of all TB cases and about 60 percent of MDR-TB cases occur in BRICS countries, these efforts could make a large impact.

There are also two new drugs that can be used to treat Tuberculosis: bedaquiline and delamanid. These drugs can help fight TB strains that are resistant to other antibiotics. The United States Agency for International Development (USAID) and the Johnson & Johnson affiliate, Janssen Therapeutics, will provide bedaquiline to patients for free in more than 100 low and middle-income countries where people are suffering from strains of Tuberculosis that are resistant to two or more antibiotics.

Tuberculosis is still a problem in developing countries. There are 24,000 new cases and 4,000 deaths from the disease every day. Recently, however, there have been many new efforts that aim to end TB. If we continue to try and combat Tuberculosis, the tides will change in the war against this disease.

– Ella Cady

Sources: Impatient Optimists, Stop TB, WHO
Photo: Stop TB

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What We Learned from Ebola: Preparing for the Next Epidemic

What We Learned from Ebola: Global Infection Preparedness
Ebola took the world by storm: global health and response systems were unprepared for it in numerous ways. As the world slowly recovers from the Ebola epidemic, what have we learned, and what can we do differently moving forward?

A recent World Bank survey showed that most people across France, Germany, Japan, the UK, and the US consider “global infectious diseases” the worldwide health issue they are most worried about. However, Jim Yong Kim, President of the World Bank Group, points out that a sense of concern will lead to forward momentum. “This heightened concern also translates into strong support for investments to strengthen health systems in vulnerable countries.”

And so, with public support to back up the move towards preparedness, what steps need to be taken to be sure that next time, the public health sector is ready?

In an article for the New England Journal of Medicine, Bill Gates offers several suggestions, likening the preparedness for epidemics to the preparedness governments might have for war. “NATO countries,” he points out, “participate in joint exercises in which they work our logistics such as how fuel and food will be provided, what language they will speak, and what radio frequencies will be used. Few, if any, such measures are in place for response to an epidemic.”

He suggests that health systems in general need to be reinforced. Having solid programs and infrastructure in place can increase measures of preventative care, and also allow for more effective combat of disease outbreaks when they do happen.

He also feels that more people need to be trained in how to respond to an epidemic quickly. Tools to detect, track, and treat disease should be developed ahead of time, and a global plan should be established so that more countries can be involved in the fight against future epidemics.

There are already plenty of organizations working towards toward these exact goals. The World Bank and the World Health Organization (WHO) are working with other partners to increase preparedness for similar situations in the future.

In a talk given at Georgetown University as a part of the university’s Global Future Initiative, Jim Yong Kim (World Bank president) compares the approach to HIV treatment at the turn of the century to the treatment of future pandemics.

Although some looked at the cost of treatment for the disease and proclaimed the fight against HIV “impossible,” Kim emphasizes the link he has seen time and time again between global health and economic prosperity. He references a paper by Larry Summers (former president of Harvard and former Secretary of State) that showed from 2000-2011, 24 percent of growth in the income of developing countries was a result of improvements in health.

He also emphasizes the importance of communication between governments, NGOs, the private sector, and organizations across the board. “From the perspective of pandemics, we are all living on the same planet,” he says, “and we have got to make sure that all these conversations happen.”

Nicole Lurie, Assistant Secretary for Preparedness and Response at the U.S. Department of Health, voices similar considerations to both Gates and Kim. With Ebola, there were a lot of disagreements on how to organize clinical trials quickly and effectively. There were also problems with technology, which is needed both to transmit information and to communicate. Thus, there are improvements to be made in terms of making predetermined plans and use of technology.

She also voices her opinion on the importance of communication. In the age of social media, it is more important than ever to coordinate messages between the government, NGOs, and the media broadcasted to the public so that they are consistent. Although the instantaneous transmission of information that comes with social media can lead to the perpetuation of rumors, if utilized correctly, social media can be a helpful tool in the fight against pandemics.

If communication improves, the urgency of the situation can be conveyed to the public while still taking care not to cause panic and irrational actions.

A lot of lessons have been learned by prominent global leaders due to the Ebola epidemic, and hopefully, if we follow some of their suggestions about improving programs, training people, changing public mindset, and improving communication and technology, the next outbreak will be stomped out quickly.

– Em Dieckman

Sources: Georgetown University, Nejm 1, Nejm 2, World Bank
Photo: Wired

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Keeping Africa Polio Free: Looking Toward the Future

polio
Polio can have devastating effects on victims. Usually with little or no symptoms, the disease cripples and eventually paralyzes its victims. In a 2013-14 Polio outbreak in the Horn of Africa, 223 children were paralyzed due to Polio.

The disease is transmitted through human feces, which often gets mixed with drinking sources. According to the World Health Organization (WHO), 2.4 billion people worldwide do not have access to improved sanitation facilities.

Due to this, polio has been one of the most persistent diseases to plague the developing world. Vaccines have existed for some time now and have become more and more accessible to developing nations due to aggressive world health initiatives. Since there is no cure, strategies to immunize children have been utilized to eradicate the disease.

There is hope now that complete elimination is right around the corner. On August 11, 2015, the continent of Africa celebrated being polio free for one year, with the last reported case in Somalia last year on August 11. Polio virus surveillance has improved significantly over the years and Nigeria, a hotspot for the virus, reported its last case of polio over a year ago in July of 2014.

With Africa becoming polio free for the last year, the last two remaining nations to report infections are now Afghanistan and Pakistan. With more resources now able to target those nations, protocols in Africa must continue to be implemented on a consistent basis to prevent a relapse.

For that to happen, four tasks must be implemented.

First, surveillance methods must continue to be built upon and improved. Dr Hamid Jafari, Director of the Global Polio Eradication Initiative at WHO, warns that there is no guarantee that zero reported infections means the fight is won. He is quoted saying, “in the past we have had year-long periods when we thought the polio virus had gone from the Horn of Africa and central Africa, only to find out that we were simply missing transmission because our surveillance systems were not strong enough to spot cases.”

The second task requires creating programs to reach missing children. There are still pockets of children not vaccinated in rural areas in Africa. Security issues have kept health officials from reaching them. Any child without the vaccine is vulnerable to the virus. Increasing vaccination must remain a top priority.

Thirdly, routine immunization efforts must continue to ensure no relapse. It is not enough to just immunize the current generation. Children of the future must be continuously immunized to prevent the virus from reemerging.

According to WHO this can be done “in Africa: Angola, Chad, DRC, Ethiopia, Nigeria, Somalia and South Sudan, by partnering notably with such organizations as Gavi, the Vaccine Alliance. Strengthening routine immunization in these countries will help to reach the significant numbers of children who remain unvaccinated there, giving the poliovirus less opportunity than ever to circulate.”

Lastly, strong leadership is needed to ensure that initiatives stay in place and countries stay steadfast to the cause. Key contributors such as the UK, Saudi Arabia and the United States must continue to provide aid and support local efforts in Africa. Much is still needed to completely eradicate polio in Africa, but the night is always darkest before the dawn.

– Adnan Khalid

Sources: Business Day Live, Global Polio Eradication Initiative, World Health Organization
Photo: Seattle Times

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Fight Against Malaria in Myanmar

Myanmar
In the global fight against Malaria, the drug, artemisinin, has been a common theme. However, with the ongoing rise of resistance to the drug, new approaches are needed. As the resistance spreads, it threatens to enter Myanmar by India, which then puts the entire African continent at risk.

Myanmar has a longstanding history of rigid ethnic division and an overall lack of cooperation in both domestic and international politics. However, the imminent danger posed by the potential for the spread of artemisinin-resistant Malaria could be bringing about a new era of cooperation. Since Malaria is a problem that everyone in the country is facing, the structure encouraged by conflict and the history of segregation is being weakened by necessity. People are beginning to realize that the risks posed by the resistance are so imminent and dramatic that there is no time to waste in upholding such strict separations.

With an election coming up in November, these discussions held between the opposing political parties are important. As the public sees that the government as a whole is making serious efforts to combat Malaria, there will likely be less distrust and suspicion, which could encourage participation in the elections. It is widely understood by both sides that the fight against malaria should not and cannot be subject to the ups and downs of political turmoil in the country.

Additionally, because most deaths from malaria are occurring in marginalized ethnic communities that have long battled the government, which has affected the access to and quality of medical care in those areas, the new view on and cooperation in the fight against Malaria will have to address the issue in order to reach the goal of eliminating Malaria by 2025. Myanmar has made an effort to prove to the U.S. that they are taking Malaria seriously so as to encourage foreign aid by inviting members of various ethnic groups and central government departments to convene in a meeting in Washington D.C. this past week, the timid first step towards collaboration to eradicate Malaria in Myanmar and to prevent the spread of the artemisinin-resistance to larger, vulnerable populations.

– Emma Dowd

Sources: Bangkok Post 1, Bangkok Post 2
Photo: Bangkok Post

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Anthropologist Comments on Malnutrition in Kenya

Interview With Anthropologist on Malnutrition in Kenya
In Kenya, over 1.5 million people are facing food shortages and high levels of malnutrition. Most of these people live in rural areas, particularly in northern Kenya. The fact that these people are so far away from the more industrialized areas of Nairobi and Mombasa means that they are both more difficult to reach and easier for a country to ignore. Some people live away from areas that are accessible by any sort of road and many people are only reachable by dirt roads, which are often treacherous.

When some people are reached the food is often things such as beans and corn, which do not offer all of the nutrients that people need.

To find out more, I talked to anthropologist Professor Jon Holtzman about his research regarding nutrition in Northern Kenya.

Q: What nutritional research have you done in Kenya?

A: I studied the Samburu in Nothern Kenya. They are pastoralists. They traditionally rely on their herds.

Q: What did you find in the gender differences in nutrition?

A: Both men and women were less well off as they aged, but men tended to be more adversely affected by aging. They tended to get more malnourished as they aged.

Q: Why do you think these differences occur?

A: There’re generally food shortages among the Samburu and although men have more political power, women control the distribution of food in the house. The food is sometimes scarce.

Q: How has the rising population changed the nutrition of the Samburu?

A: They no longer have enough cows to rely on the products of their herds, particularly milk. In 1950 there were probably about 50,000 Samburu and they had about 350,000 cows, so each person could get enough milk. Now there are about 200,000 Samburu and about 200,000 cows, so it isn’t possible to get enough milk. They just sell livestock to buy things like maize meal, which aren’t very nutritious and are low in key nutrients, such as protein.

Q: How is this affecting the health of the Samburu?

A: Generally they are very thin and their growth rate is reduced. They are very vulnerable to diseases associated with poor nutrition, such as tuberculosis and other infectious diseases.

Q: What sort of assistance would be best to help this population?

A: It isn’t an easy problem to solve. More support for health care and programs that bring new and sustainable economic activities to remote areas could be the best hope.

Groups like UNICEF and USAID are doing work to try to help people with low access to nutritious foods and potable water. But without the necessary funding, there is only so much that can be done.

– Clare Holtzman

Sources: UNICEF
Photo: Flickr

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Ready for the Next Global Epidemic?

global_epidemic
Less than one year ago, the Ebola outbreak scared the world and killed over 10,000 people. A recent poll taken by The World Bank Group reports that there are still concerns regarding the policies that are supposed to prevent another outbreak. Citizens in five different countries – France, Germany, Japan, the United States and the United Kingdom – say they are not convinced that the world leaders have taken the proper steps and protocols to prepare their countries for another global epidemic.

The World Bank Group’s article states that the poll reports nearly 6 in 10 people support investments and policy changes in developing countries that will help protect their own country from global epidemics. The first cases of Ebola during the outbreak were seen in some of the poorest countries in the world. These countries lacked the financial resources and manpower to deal with an outbreak that spread past rural villages and major cities, and quickly crossed borders.

What steps need to be taken to bring attention back to the fact that many countries are unprepared? Some responses from the poll state that by raising awareness about policies that help bring doctors, nurses and clinics to developing countries, epidemics can be prevented and policies can be developed to better prepare hospitals in our own countries as well. Policies that strengthen health care and stop a disease before it becomes an outbreak are needed.

With the risk of global outbreaks becoming increasingly common due to an overly connected world, the fact is that a batch of bad fruit on a cargo ship or a single sick person on a crowded airplane can start an outbreak.

– Elizabeth Steadman

Sources: The World Bank, PBS 1, PBS 2
Photo: Flickr

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The Color Blue Puts an End to Sleeping Sickness in Africa

sleeping_sickness
For rural Sub-Saharan Africans, a walk to the riverbank to wash clothes, gather firewood or collect water is a risky business. About 1 in 1,000 Tsetse flies, which swarm by the river’s edge, are carriers of a parasitic disease called sleeping sickness, which eventually infects the victim’s brains, driving them mad before killing them. In 2013, at least 7,000 cases of this rabies-like disease were reported.

Due to vague early symptoms such as headache, joint pain and bouts of fever, the disease is difficult to diagnose in the beginning. Although it is curable with drugs, patients are often experiencing its later stages before they realize they have been infected. True to its name, patients find it impossible to sleep during the night and impossible to remain awake during the daylight in its later stages.

Those living in rural areas may not make it to hospitals because of the far distance, but thankfully today, researchers have found that the number of individuals suffering from sleeping disease in the region of Uganda has been cut by 90 percent. The reason? Scientists have discovered a weakness for these insects with a lethal bite: the color blue. Because these flies search for something to bite which contrasts with green vegetation, bright colors, especially bright blue, drives them crazy.

With this newfound knowledge, along the riverbanks in the West Nile region in Uganda, handkerchief-sized blue squares attached to wooden stakes netted with insecticide are staked about every 50 yards. It only takes 3 minutes before these flies will drop dead. These life-saving fly traps are relatively cheap and have significantly contributed to a decrease in the number of people being affected by the disease. Last year, fewer than 10,000 cases were reported versus about 300,000 cases reported by the World Health Organization (WHO) during the height of its epidemic in the late 1990s.

WHO hopes to eliminate flies carrying the disease within five to six years. Ministry of Health worker Dr. Charles Wamboga has seen fewer cases and believes that a future free from this deadly disease is possible for a people whose very lifeline flows within their rivers.

– Nikki Schaffer

Sources: NPR, WHO
Photo: Flickr

“Internet Hospital” in China Helps Patients Access Care

The "Internet Hospital" in China Helps Patients Access Care
The Internet has proven a great advancement in many fields of work with recent trends of globalization. We are more connected than ever, and access to the Internet is not dependent on economic status. For example, people living in developing countries can access the Internet through inexpensive mobile phones.

What if patients could receive healthcare services via the Internet?

This concept has been actualized in the Guangdong province of China with the innovation of an “Internet Hospital.”

This “hospital” provides outpatient service delivery. Patients only need to travel short distances from their homes to local medical consultation facilities. At the facility, the patient is able to meet with a doctor from a high-level hospital that is more central to the city. The consultation occurs with a webcam and instant messaging.

The doctors ask questions of the patient, who can also send or show images of medical checks. While this takes place, the patient’s body temperature, blood pressure and other medical information are collected. It is then sent to the doctor, who can use the data in combination with the webcam interaction to diagnose the patient and write a prescription immediately.

This type of healthcare service is ideal in China because high-level hospitals are often overcrowded expensive. Patients are less likely to visit local health clinics because they are perceived to provide low-quality care. To some extent, skilled doctors also choose not to work in small communities with fewer opportunities for career growth and increased salaries.

The advantages of the Internet hospital include high-quality and personalized health care accessed from more convenient locations. In high-level hospitals, doctors are likely to spend only a couple of minutes which each patient; however, the Internet hospital allows these same doctors to spend more than 10 minutes with each patient. Furthermore, the average cost of drugs from local clinics is only a quarter of that of drugs purchased at top-level hospitals. While the same skilled doctor writes the prescription, the medicine is purchased from the local clinic versus the large hospital.

Implementation of the Internet hospital has proven successful. More than 500 patients are seen every day and there are now over 1,000 sites for the medical consulting facilities. These facilities have high satisfaction scores.

While health insurance, quality control and the cases of diagnoses that cannot be made via the Internet all pose potential challenges for the Internet hospital, it has helped many people and continues to make healthcare more affordable and accessible.

– Iliana Lang

Sources: The Lancet Global Health, The Journal of Health Economics
Photo: Global Times

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Twin Pregnancy in Developing Countries

Twin_births
Multiple births, two or more babies born at the same time, are a relatively small percentage of all the births worldwide. Twins represent only 3.3 percent of births in the United States (CDC) and, depending on the global region looked at, the rate is even lower in the developing world.

But even with such small numbers, twin births can present a large health concern for both mother and unborn children alike. The risks are even more pronounced in the developing world.

Twins have a much higher chance of being born prematurely, and they can be underweight, which often leads to more time in the NICU. Also, twin-twin transfusion, “when identical twins share a placenta and one baby gets too much blood flow, while the other baby doesn’t get enough,” is a possibility. The most startling statistic is that in the developing world, “among stillbirths, the proportion of twins is probably somewhat higher than among live births, as fetal (and neonatal) mortality is higher among twins.”

Complications arise when mothers do not receive adequate prenatal care. Women in the developing world often do not receive enough care when they are pregnant with a single child, let alone the need for additional monitoring and ultrasounds when having a multiple birth.

A study conducted in urban Guinea-Bissau found that “sixty-five percent (245/375) of the mothers who delivered at the hospital were unaware of their twin pregnancy.” Sometimes a mother will not measure larger than average to indicate a twin pregnancy, a second heartbeat is not always discernable, and/or bloodwork is not drawn to measure hCG (pregnancy hormone). Even if any of those previous criteria were met, only an ultrasound can confirm a multiple birth.

The unborn children are not the only ones at risk; mothers also face pregnancy complications at a higher rate when carrying multiple children, like pre-term labor, anemia, gestational diabetes, preeclampsia, hyperemesis gravidarum (severe morning sickness), polyhydramnios (too much amniotic fluid), miscarriage/stillbirth, postpartum depression and postpartum hemorrhage.

While these issues have the possibility to affect all mothers experiencing a multiple birth, the complications can be exacerbated when they live in poverty. Access to a hospital for an emergency may not be possible, especially in regions that are remote. Finances to afford a hospital stay can also be an issue, especially since many multiple births are delivered through c-section.

A 2008 study done in a rural mission tertiary hospital in Nigeria found that of the twin deliveries that happened there, 60 percent of the twins were delivered c-section, 36.4 percent were vaginal deliveries and the remaining 4 percent had vacuum deliveries. C-sections are often performed due to emergencies, premature delivery and fetal malpresentation.

Even though it seems like twin pregnancy is bleak, the opposite can be true. The UN’s fifth Millennium Development Goal is to improve maternal health. While multiple births are not specifically addressed, the positive improvements to help mothers and their unborn babies will also help those pregnant with twins. Multiple births must be monitored as a high-risk pregnancy but not all (or any) complications may occur. But with improved medical care, when those complications do arise they can be addressed and the rate of stillborn twins can decline even further.

– Megan Ivy

Sources: NIH 1, CDC, March of Dimes, UN, NIH 2, NIH 3
Photo: Babies Magz

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5 Ways to Ensure Effective Health Aid Dispersal

Health AidNot all aid is created equal. In the fight against global poverty, ensuring sufficient funds for aid programs is only half the battle. The other half is ensuring that aid is results-oriented, transparent, expedient and cost-effective.

During the second High-Level Forum on Aid Effectiveness in Paris in 2005, the Organization for Economic Cooperation and Development (OECD) countries formulated the Paris Declaration. This declaration was meant to set benchmarks for how to measure the five key categories of effective aid: ownership, alignment, harmonization, results and mutual accountability.

While these five categories are intended to measure the effectiveness of all kinds of aid, they are particularly pertinent to health aid. Developing public health infrastructure in poorer countries is the “gift that keeps on giving,” ideally continuing to serve local populations well after aid has ceased. Thus, a robust public health outcome is an ideal metric to judge the quality of aid using the five categories of the Paris Declaration.

1. Ownership

Ownership, according to the Paris Declaration, involves partner countries exercising “effective leadership over their development policies and strategies.” This category is a measurement of how much aid recipients are involved in developing and executing programs that actually take advantage of the aid they are receiving. Aid strategies have traditionally assumed that once a country reaches middle-income status, it will have sufficient resources and self-interest to invest in public health, but unfortunately, this is not always the case.

For example, Nigeria is technically a middle-income country, but it spends less on public health than Rwanda, which a low-income country. Health aid can really only be considered effective if countries take ownership of health programs that outlive donor support as the country transitions into middle-income status.

Ownership is especially important given a recent estimate by the World Health Organization that predicts that in the next few decades, there will be a global health workforce shortage of up to 12.9 million. Aid programs need to ensure that recipients are developing adequate long-term strategies, especially when it comes to investing in health training and education.

2. Alignment

The dimension of alignment measures how well aid matches up with recipient strategies for dispersal and development. Development experts often criticize “tied” aid. This is aid that is contingent on the recipient procuring health products from the donor country, using their distribution infrastructure, employing foreign personnel or involving some other condition which is often not the most cost-effective or desirable for the recipient. Alignment essentially means “untying” aid to make sure that it aligns closely with the national development strategy of the recipient country.

A topical example of the alignment of health aid in the Global Food Security Act of 2015. This bill, currently introduced to the House and awaiting consideration, encourages local procurement of food aid for U.S. aid programs (among other things). Traditionally, food aid dispersal from the U.S. has been tied, requiring that a certain percentage of that aid be procured from the U.S. and dispersed using the U.S. merchant marine.

However, this bill seeks to do away with those requirements and favors recipient-country producers. This encourages the growth of local agriculture and health aid infrastructure, rather than out-competing them. Additionally, local procurement is faster, and in the event of a humanitarian emergency, recipient populations would not have to wait as long for foreign aid to reach them.

3. Harmonization

Harmonization involves cutting down on the plurality of programs that may have the same goal yet interfere and undermine each other. An aid recipient country may be host to dozens of organizations or programs that target public health outcomes yet do not communicate with each other, thus creating redundancies or inefficiency.

Harmonization is especially critical to public health, more so in emergencies. Currently, there is no standard system whereby donors can track and share how much and to where health aid is going, making it difficult to determine where it is most needed. The recent Ebola epidemic was a particularly disastrous indication of the need for better logistics and donor coordination; it is difficult to tell if health aid has even reached a recipient population, much less if it is redundant, or necessary.

4. Results

Just as it is important to harmonize aid efforts, tracking the progress of health programs has also been an ongoing challenge for donors and recipients. Health aid, despite good intentions, can be totally ineffective when it isn’t results-oriented. Tracking public health outcomes generally involves better data collection and census practices, which can be incredibly difficult to implement in developing countries that lack basic infrastructure.

Very recently, the Girls Count Act passed the U.S. House of Representatives. This act directs the Secretary of State as well as the United States Agency for International Aid and Development (USAID) to work with developing countries to build adequate civil registration systems as well as create economic and social policies that are deliberately inclusive of women and girls. The idea is that better demographic data and inclusive policy can help traditionally marginalized populations (such as women) take advantage of existing social safety nets. Additionally, better demographic data would lead to more effective health aid, as donors often lack access to accurate census information and thus may be unaware of vulnerable populations, or unable to determine the impact of aid.

5. Mutual Accountability

The final category calls for recipients and donors to exercise “mutual accountability and transparency in the use of development resources.” This emphasis on accountability stems from a history of aid inefficiencies due to a lack of transparency, or even outright corruption in recipient countries. For example, millions of dollars in aid money were simply pocketed by corrupt dictator Mobutu Sese Seko of the Republic of Zaire (now the Democratic Republic of Congo) during the ’70s and ’80s.

Conversely, donor countries must be transparent about where aid flows are going in order to provide recipient countries (as well as other donors) with accurate information they can present to their citizens. In general, developing genuine partnerships between donors and recipients is crucial in ensuring that resulting health and development programs are effective and long-lasting.

– Derek Marion

Sources: Reuters, Devex, Partners in Health, OECD
Photo: OECD