Information and stories on health topics.

Peace Corps Case Study Helps Senegal’s Pharmacies

Peace Corps Case Study Senegal Pharmacy
In the wake of AidData’s unveiling of the huge data set of tracking Chinese Aid to Africa, there has been a rather unsettling backlash against the use of data in development. Data is not the problem, it is the overgeneralization of data that is problematic. The Peace Corps case study detailed here focuses on site and project and is time and space specific, resulting in quantifiable success.

One of the latest case studies out of Senegal is about a health system in Karang that was consistently out of stock of urgently needed medications. This Peace Corps Case Study of the Senegalese town on the northern border of the Gambia details the problem and data-driven solutions. The Karang health system has been under the charge of Pauline Sene for 12 years. During this period over 20,000 individuals have been impacted by out of stock medication. The privately owned pharmacy has brand name drugs that are far too expensive for many residents.

Peace Corps Volunteer William Leborgne and Ms. Sene undertook the case study to identify the problems, trends, and solutions to the stock outs.

Ms. Sene and the head pharmacist identified the problems. Peace Corps Volunteer, Mr. Leborgne, aided in research design, data collection, and proposing solutions.

The problems consisted of three parts. First, there was little oversight. The management structure of the health system gave Ms. Sene little ability to oversee the purchasing and daily needs of the medication distribution centers. Second, there was no inventory management system in place to alert upcoming shortages. Finally, the supplier also had stock outs.

The first stage of the case study was data collection. Data collection was conducted over a year and consisted of reorganizing the medicine cabinets, cataloging the inventory, and collecting data on monthly usage. Excel was used for data entry and management. Monthly minimums of medication stock were determined by minimum monthly consumption. Peace Corps Volunteer Leborgne set up an algorithm to alert the staff when a reorder was necessary. By using some of the most common software and accounting available to US retail establishments, Leborgne helped solve the first two problems: oversight and inventory management.

The second stage of the case study was calculating how to minimize stock outs of important medications. Important medications were determined by manipulating the data collected over the year to find peak medication consumption periods. Peace Corps Volunteer Leborgne used the Senegalese government priorities for the medication categories of Malaria prevention, family planning, diarrhea prevention, and high blood pressure.

Findings and recommendations were as follows:
• “The two peak sales periods are Feb-May and Sept-Oct, the biggest month being Oct with sales of half a million CFA – purchasing price (approx. $1000).
• “The base months are Jul-Aug and Nov-Dec where sales drop drastically. The lowest month is December with half the sales of October – approx. $500.
• “We discern a gap in Sept and the start of Oct as these were the peak stock out periods, which coincides with the peak sales periods. This demonstrates the lack of foresight and planning for these peak sales periods.
• “We observe here that 90% of the sales are for just 10 of the 60+ types of medication for sale.”

Spotlighting the 10 medications and using predetermined categories provided by the Ministry of Health, Peace Corps Volunteer Leborgne made the following recommendations:

• “Completely restock the entire inventory in January and August, before the two peak sales cycles.
• “For the 10 top sellers – utilize the data to create an alert system immediately before their peak sales period.
• “Take into consideration the pinnacles of certain illnesses and prepare accordingly, e.g. resupply on Malaria prevention medication in August and Anti-Diarrheal in May.
• “When ordering more, consider the top sellers and the most likely to have shortages – order additional units of these as a precaution.
• “Exploit the alert algorithm within the Excel file in order to keep track of pharmacy stock and re order in a timely fashion.
• “If possible create a 2 month buffer’s worth of medication for the 30 top sellers to counteract the stock outs at the Sokone Hospital (their supplier).”

The grass-roots level of integrated collaboration between the Peace Corps Volunteer Mr. Leborgne, Senegal Government Health Post Ms. Sene, and local pharmacist Salimata Baudian made data collection and commitment to the solution successful. Once implemented by Ms. Sene and the pharmacists, Leborgne’s recommendations proved effective in mitigating stock outs. Between January –April 2013, there have not been any stock outs.

– Katherine Zobre

Source: Peace Corps
Photo: Senegal Health Institute

Editor’s note: PCV William Leborgne gratefully acknowledges the assistance of the AP Statistics classroom at the Edmund Burke School in Washington DC: teacher Rachel Braun, and students Enesh Annaberdieva, and Elizabeth Bennett. As a side benefit, seeking their assistance in the production of statistical tables and summaries has allowed Mr. Leborgne to nurture enthusiasm for international public health among American high school students.

Cook It, Wash It, Peel It or Forget It

How to avoid getting sick overseas
As any traveler knows, after a long plane, train, and/or bus ride, all you want to do is take a shower, change your clothes, take a nap and get some grub! The last thing you want is to wind up back in bed or the bathroom with a sour stomach…or worse, the hospital. While there are several sources of health risk to travelers, the most common is contaminated food and water. Travelers trying exotic and exciting foods should follow these simple rules: cook it, wash it, peel it or forget it! And do not forget about ice. Freezing water does not remove contaminants and even alcoholic drinks are risky with contaminated ice.

There are several other sources of risk: poor sanitation and other diseases. Before you go, check out the World Health Organization (WHO) and with the Center for Disease Control (CDC) for risks at your destination. It is also extremely important to get any vaccinations recommended for your destination. The CDC has detailed documentation on requirements for each country.

Many diseases and infections are transferable between people. Sick people are also an indication that there may be a disease source near by—such as insects or poor sanitation. It is also important to be aware of how much sun/cold/oxygen you are exposed to. Too much sun exposure can lead to severe sunburns and dehydration. Sun block is expensive and not a common feature in many developing countries’ convenience stores. Observe local customs for avoiding the extreme weather and bring sunblock with you.

Most importantly for food, however, cook it, wash it, peel it or forget it.

– Katherine Zobre

Source: CNN
Photo: Lee-Reid Family Travels

Rosling Explores New Facts and Data on HIV

Hans Rosling, a professor of global health at Karolinska Institut, focuses on dispelling common myths about the so-called developing world and its relationship with HIV/AIDS.

In Hans Rosling’s TED Talk, he used very interesting and vivid graphs to explain how HIV spread throughout the past twenty-five years. The rate of those effected by HIV is not about poverty and undeveloped, although there are many reasons why one’s living conditions makes one more susceptible to the virus. An often understated fact, Rosling notes that even countries with a good economy and peaceful environment may be hard to drop the population of HIV-infected persons, because with good healthcare, HIV carriers can live ten to twenty years longer than those living in places with less access to effective healthcare.

– Caiqing Jin (Kelly)

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Collaboration is Key to Effective Aid

aid
The old model of aid consisted of rich countries bringing funds and ideas to poor countries and implementing plans to “save” the country.  Recent criticism has brought to light the idea that collaboration is key to effective aid. In the arena of healthcare, this is even more important as oftentimes, developing countries are given funds for healthcare uses, but told exactly what they have to do with it beforehand.

Ethiopia led the way in 2002 with their ambitious plan to provide primary healthcare to 85 million rural citizens. These citizens did not live within accessible distance of a doctor or hospital.  The Ministry of Health gave themselves 5 years to accomplish their goal.  Without resources or facilities to train the 30,000 community health workers necessary, Ethiopia embarked. Health workers were trained and sent out and since the program’s implementation, decreases in the number of women dying in childbirth and in the number of children dying before age 5 have been reported.  The relatively successful plan began with simple, community-level improvements.

Ethiopia is far from the regular standard as, typically, governments receiving outside aid do not start their own programs.  A representative from Rwanda’s Ministry of Finance and Economic Planning remarked that rarely do they get a say in where the money goes at all. Rwanda has requested money for low-income health insurance and was denied. Using tax money instead, Rwanda funded the pilot program and today over 90% of Rwandans have health insurance.

Developing countries are not being ungrateful for aid, but are slowly starting to speak up and question the potential of effectiveness for the money and programs involved in it.  The World Health Organization (WHO) is helping change the way aid is delivered by using coordination and collaboration. Donors are asked to contribute to health plans managed and implemented by the government rather than go in and start their own. The initiative is called the International Health Partnership. The goal is to allow developing countries a say in how and where the money is used, preventing rich countries from bullying or denigrating their plans and ideals.

As the economy continues to struggle and aid dollars are decreasing, collaboration and coordination are very important to continue to meet needs like adequate healthcare worldwide. Allowing developing nations to innovate and have a seat at the table will enable aid to be used more effectively and efficiently.

– Amanda Kloeppel

Source: The Atlantic

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Universal Health Care Can End Extreme Poverty

Universal Health Care Can End Extreme Poverty
Universal health care in all countries could help bring an end to extreme poverty by 2030, says World Bank President Jim Yong Kim. He explains that “every country in the world can improve the performance of its health system in the three dimensions of universal coverage: access, quality and affordability.” Last month Kim set the goal of ending extreme global poverty around the world, which means that nobody will be living on $1.25 or less each day by the year 2030. He claims that universal health coverage is essential to be able to reach this goal because it is costly to receive medical care, and many of the poorest families cannot afford these costs.

Health issues are a major reason people are in extreme poverty, putting 100 million people into extreme poverty as well as creating severe financial stress for an additional 150 million people around the world each year. Kim states that to create a valuable and helpful system, those in the public sector should take tips from private sector companies to be more efficient and provide “value-for-money health care.” He further explains that to create the best universal health care in poor, developing countries, point-of-service and out-of-pocket costs must be eliminated, because they hinder people’s ability to obtain the services they need but cannot afford.

Kim knows that for the poorest people around the world, even what would seem like small costs to visit a doctor or receive a vaccine can be detrimental to a family’s financial stability, and could push some people back into poverty or extreme poverty. With universal health care, these individuals and families can receive these necessary health benefits without sacrificing other areas of life or worrying about being forced back into poverty.

– Katie Brockman
Source: Businessweek
Photo: World Health Coverage

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Meet One Doctor Healing the Blind

drsimjee
As a young child, Dr. Aisha Simjee contracted Trachoma, an eye disease that can lead to blindness if not treated.  Dr. Simjee grew up in Burma and as a 7 year-old was being prepared for a life as a housewife when she contracted the disease. She was cured by a folk remedy that consisted of having a local women squirt breast milk into her eye. The experience led Dr. Simjee to a life mission-healing the blind.  Her fascination with eye health led her to immigrate to the US and study to be an ophthalmologist in Orange Country, CA.

Now in her sixties with two grown children, Dr. Simjee has written a book reflecting on her life experience.  The experiences of a youth growing up in Burma impacted her and motivated her to do more than simply be a good doctor. She wanted to prevent blindness and eye disease in the world’s poor. Her book, “Hope in Sight: One Doctor’s Quest to Restore Eyesight and Dignity to the World’s Poor” tells of her journey and includes decades of personal journals and accounts from friends, families, and colleagues.  She wrote the book to motivate others to give back and encourage other young ophthalmologists to help others.

The World Health Organization reports that over three-quarters of all blindness worldwide can be prevented or treated.  Around 285 million people are visually impaired due to various treatable causes and about 90% of the world’s visually impaired people live in developing nations where there are little or no welfare services. Dr. Simjee has seen firsthand how eyesight can be a matter of survival.  She has served on more than 25 medical missions, often putting her private practice on hold and paying her own expenses.  Her trips have spanned Asia, South America, Eastern Europe, and Africa.  The 69-year-old persists  in taking the trips and she often serves in rural areas.  Her mission is not to travel to well-equipped capital cities, but to the villages miles and miles away from modern civilization.

She has worked with children suffering from wounds from knives, people who have walked miles to see her, prison inmates, and indigenous Indians.  Her goal is eyesight and helping people regardless of status. Her book focuses on hard facts and short anecdotes about her travels and the experiences she has had.  Dr. Simjee wants to motivate others to give their time and money to help others.  Dr. Simjee is a wonderful example of someone using their talents to serve the world’s under-resourced. Check out her book from White Spruce Press.

– Amanda Kloeppel
Source: Ophthalmology Times
Photo: Twitter

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Mobile Technology for Women is a Global Development Must

rsz_1mother
Closing the gender gap is high on the priorities of those working in global development and one way to accomplish this is through increasing the availability of mobile technology to women according to Patricia Mechael, Executive Director of mHealthAlliance.  In her years working in global health and development, she saw first hand the realities of poverty and gender inequality. The social status of women has a negative effect on their health and ability to care for their families. Problems such as maternal mortality and unintended pregnancies are often the result of poor maternal health care and poor gender representation in countries.

Mobile technology is working to reduce the gender gap and provide women around the globe a chance at a healthy life. Women who would force abortions to save themselves from another mouth to feed now have access to vital family planning information and commodities through the increase of mobile technology. While less than a decade ago, the mobile penetration rate was in the single digits among low-income nations, today reports indicate it stands at 89%.  The digital divide is shrinking between low and high-income nations, but women are still 21% less likely to own a mobile device compared to men. Millennium Development Goal #3 is to promote gender equality and empower women and providing them with mobile technology is a way to get closer to accomplishing that goal.

Beyond meeting MDG3, mobile technology is key in accomplishing MDG5, improving maternal health. The mHealth Alliance and the World Health Organization have worked to bring about mobile technology to improve maternal health. These projects use a variety of mobile technologies to provide everything from information about vaccines to improving access to essential medicine through reducing depletion of stock.

The advances in mobile technology have come a long way and will continue to be essential to promoting global development and accomplishing the MDGs.  In addition, Mechael is working with her company to come up with ways to further include women in the development and discussion of mobile technology and applications to serve and assist them.

– Amanda Kloeppel
Source: Forbes
Photo: WAHA

What is Uniject?

uniject
Uniject is a revolutionary new injection method. The idea behind Uniject is that it would be so simple to use, that even untrained health workers would be able to safely and effectively give injections. This idea would allow for prepackaged, low-cost syringes. Not only would Uniject provide a safer and more cost efficient method of administering vaccines, it would also cut down drastically on the amount of wasted vaccines. The new syringes would not be able to be reused, also eliminating the chance of HIV transmission.

Uniject is an autodisable injection system created by PATH in Seattle. It is essentially a small bubble of plastic connected to a needle that contains whatever vaccine is desired. Health workers would be able to learn how to use this within two hours of training. The plastic bubble contains exactly one injection of vaccine, ensuring the correct dosage every single time.

PATH developed Uniject through funding from the US Agency for International Development. The idea has since been licensed to BD, which is the largest producer of syringes in the world. As part of this agreement, the technology must be given to pharmaceutical producers at preferential pricing for use in developing country programs. The development of Uniject has taken twenty years.

While Uniject was developed with the idea of providing low-cost effective syringes for use of vaccinations in developing countries, it also has the potential to help reduce poverty in other ways. Uniject could, down the road, also be used for other life saving drugs, as well as a potential contraception delivery method. The use of Uniject to deliver contraception could have an immense effect on the developing world and provide an extraordinarily important outlet for female empowerment and family planning in the developing world.

-Caitlin Zusy 
Source:

The 21st Century Global Health Technology Act

global-health-technology-act
The Global Health Technology Act amends the Health Technologies Program of the Foreign Assistance Act of 1961 under which the US Agency for International Development supports the development of technologies for global health and other purposes. The bill entered the house committee on Foreign Affairs on April 11, 2013 and was introduced by Congressmen Diaz-Balart of Florida.

The bill describes the importance of research and development in global health and explains how research and development on global health technology help break the cycle of dependency by creating sustainable solutions to long-term problems. The bill describes the progress and advances investments in global health have created. It details that funding global health technology today will save the United States a great deal of money in the long run, as well as how overall, the bill and global health technology can greatly benefit the US in terms of an inflated economy and increased national security.

The purpose of the act is to acknowledge USAID’s role in product development, introduction and up-scale of new global health tools and to authorize USAID’s Health Technologies program to improve global health, reduce maternal, newborn and child mortality rates, lower the incidence of HIV/AIDS, malaria, tuberculosis, and other infectious diseases, overcome technical, supply and policy hurdles to product introduction and scale-up, and to support research and development.

The creators of the bill would like to see the introduction of a new Health Technologies Program, which would function as a part of USAID. The program would be aimed at developing, advancing and introducing affordable, available, and appropriate late-stage technologies to the problems listed in the previous paragraph. Additionally, the bill codifies an agreement with USAID for support of the development of technologies for global health.

The act calls for Action Plans to incorporate global health research and development programs with support from coordinating agencies that establish metrics to measure progress. It also calls for Priority Global Health Interventions in order to accelerate the innovation and impact of USAID. The Global Health and Technology Act charges USAID to submit an annual report summarizing yearly research and development activities as well as submit to annual consultation with heads of other Federal agencies to improve alignment of USAID’s health-related research strategy with similar agencies.

-Caitlin Zusy
Source: GovTrack
Photo: Global Health Technologies Coalition

7 Things You Didn’t Know About Intrahealth International

seven-things-you-didnt-know-about-Intrahealth-international
Here are seven things you did not know about one of the World’s largest health system support organizations, Intrahealth International.

  1. For over 30 years in 90 countries, Intrahealth has empowered health workers to better serve communities in need through programs that foster local solutions to health care challenges such as health worker performance, strengthening health systems, harnessing technology, and leveraging partnerships worldwide.
  2. Intrahealth was founded in 1979 as the Intrah Program at the University of North Carolina School of Medicine and incorporated as an independent nonprofit organization in 2003.
  3. Intrahealth’s approach to improving health care calls for listening, analyzing, and collaborating with leaders and communities to develop the most effective solutions for a particular environment.
  4. Intrahealth’s mission statement says that it works to empower health workers to better serve communities in need around the world, including all of the individuals who support health workers in their jobs: from educators and software developers to health facility managers, lab technicians, and community leaders.
  5. Intrahealth partners with numerous governmental organizations and NGOs, as well as community, faith-based, and private groups. The organization also partners with US and international NGOs with compatible missions and programs.
  6. Currently Intrahealth works in more than 30 countries and territories, including: Angola, Belize, Benin, Botswana, Burundi, Costa Rica, Dominican Republic, DR Congo, El Salvador, Ethiopia, Ghana, Guatemala, Haiti, Honduras, India, Kenya, Laos, Madagascar, Malawi, Mali, Mongolia, Namibia, Nigeria, Panama, Rwanda, Senegal, Sierra Leone, South Africa, South Sudan, Tanzania, Uganda, West Bank/Gaza, Zambia, and Zimbabwe.
  7. The organization currently has a staff of nearly 600 employees working on programs in over 20 countries in Africa, the Americas, and Asia, with its main offices in Chapel Hill, North Carolina and Washington, DC. Opportunities for individual can be searched here.

– Kira Maixner
Source Intrahealth.org