This will be my  last post from the Global Health Council conference, but likely not the last from our team. This one is from a morning session I attended “Postpartum Hemorrhage: New Findings and Innovative Technologies” (session F4). From the conference website:

Presenters Discuss: possible risk factors for postpartum hemorrhage (PPH) and the impact of active management of the third stage of labor and its components on postpartum blood loss (Global: Egypt, Ecuador, Turkey, Burkina Faso and Turkey); a demonstration project to assess feasibility, acceptability, and safety of oxytocin in Uniject as a first step to introducing the device on a national scale, and strategies for scaling up use of oxytocin-Uniject™ devices with time-temperature indicator (TTI) for the prevention of PPH (Mali); techniques for estimating blood loss for the early and accurate diagnosis of PPH and cost-effective and reliable techniques for improved blood loss estimation in rural settings (India, Tanzania) and the importance of obstetric hemorrhage as a cause of maternal mortality and morbidity in low-resource settings, the potential contribution of the non-pneumatic anti-shock harment (NASG) to reducing death and disability from obstetric hemorrhage (Nigeria). 

The session was moderated by Suellen Miller of UCSF – who works on NASG among other projects. The panelists, in order of presentation:

• Jill Durocher – Gynuity Health Projects, Determinants of Postpartum Hemorrhage [AMTSL]
• Stacie Geller, PhD – University of Illinois-Chicago, Accessible Techniques for Improved Estimation of Blood Loss [blood drape]
• Dosu Ojengbede – University College Hospital, Ibadan, Nigeria, Non-pneumatic Anti-shock Garment’s Potential for Obstetric Hemorrhage in Africa for Improved Estimation of Blood Loss [NASG]
• Susheela Engelbrecht, CNM – PATH, Implementation Challenges on a Larger Scale [Uniject+oxytocin]

If you think you don’t know enough about PPH, check out this wikipedia entry.

By this point in the conference, I’m sure I’ve exposed my biases- I’m interested in exploring themes across projects, with a particular emphasis on opportunities for innovation. This session was no different. Two key themes emerged: (1) these innovations are not magic bullets – larger supporting systems need to be in place for them to be effective, and (2) there are opportunities for improving outcomes by improving the usability of these products.

No magic bullets

Susheela Engelbrecht’s wording in reference to Uniject syringes preloaded with oxytocin was a bit different: “It is a magic bullet, but many other things need to be in place”. With the NASG, the technology buys critical time but is not a “definitive treatment” alone – it still requires patient monitoring, for which appropriate staffing and essential drugs are essential. The multi-country AMTSL (active management of the third stage of labor) study suggests that steps such as controlled cord contraction and fundal massage are only effective in the context of uterotonic drug administration.

Improving usability

The technological innovations presented all show significant promise. The Nigeria study, using a pre/post intervention design, showed a reduction in blood loss of 61% and a reduction in mortality of 60%. The morbidity numbers were too small to make any inferences. A randomized controlled trial showed that, compared to a gold standard measure, the blood drape (Geller) was 33% more accurate than visual estimation.

Uterotonic drugs were shown to play a critical role in AMTSL and the Uniject+oxytocin solution allows administration at the point-of-care to avoid many of the pitfalls associated with ampoule+oxytocin+syringe administration; however, there are some outstanding issues with cost and policy:

• cost: the Uniject solution will “always” be more expensive, currently a bit less than US$1 based on an Argentine formulation
• policy: at what levels of the health system should this be used? should it be used only for AMTSL or also for PPH?

As we begin to move toward scaling these technologies, it will be important to understand how people will use (and misuse) these technologies in environments that are not subject to the scrutiny of research studies.

Some notes I jotted down about usability innovations and challenges from the talks:

• The blood drape had the unanticipated benefit of keeping things clean (containing blood), from the perspectives of women, birth attendants, and families
• The original blood drape showed quantities (cc) of blood using a numerical scale, but a later version simply used a yellow line (alert) and red line (action) to identify risk level
• For the blood drape, the alert and action values were not based on WHO standards, which are designed for equipped, clinical settings, but were calibrated based on data from deliveries in rural India (e.g. WHO standard was 500cc for alert, and the value used with the blood drape was 350cc)
• Birth attendants and families using the blood drape for home deliveries on the floor came up with the idea of propping up the mother’s head with a dupatta to encourage the blood to flow into the drape
• The blood drape must be placed under the women after birth, so that it doesn’t accumulate amniotic fluid (this is after all postpartum hemorrhaging)
• With NASG the challenges include washing (decontaminating), drying, and folding – if this isn’t done in time, the benefit of the garment may be lost for the next patient – whether it is sent somewhere for decontamination or if it is done locally
• The Uniject+oxytocin solution requires more space in the cold chain since the syringe and packaging takes up more space than standard ampoules for the same volume
• With Uniject+oxytocin, some women though they were receiving a contraceptive injection against their will since their prior experience with pre-loaded syringes was with Depo-Provera
• “Training was a non-issue” with Uniject+oxytocin. Those who read the instructions felt as comfortable as those who were trained by demonstration.

During the Q&A there was one more. Professor Ojengbede mentioned a case where a woman wore the NASG for four days in order to wait for a blood transfusion. As soon as the bleeding stopped, she continued to wear the garment and walked around the ward. In response to a question about complications from wearing such a garment, the team indicated that there were no cases of deep vein thrombosis or pulmonary embolism. Note: the Nigeria study will soon be published in the Journal of Obstetrics and Gynecology.

This morning I attended “On the Move: Mobile Health” (session D2). From the conference website:

Presenters Discuss: the overall strategic approach to mHealth taken by the Millennium Villages Project and use the experiences of pilot testing and implementing mHealth activities and applications in Ruhiira Uganda (Uganda, Africa Region); the present use of mobile phone technology in the microfinance industry (MFI) and new and expanded applications for mobile-based services (India); why the mHealth Alliance was created and how it will develop and incubate the framework and solutions for the nascent mHealth sector (global); and how rapid HIV tests and handheld technologies are being used for population-wide door-to-door HIV screening (Kenya).

The cast:

• Moderator: Neal Lesh, PhD – D-tree International

Presenters and talk titles:

• Anita Katusiime – Millennium Villages Project-Uganda, Mobile Health Implementation Experiences
• Janine Schooley, MPH – Project Concern International, Connecting India to Disconnect Poverty and Improve Health
• Mitul Shah – United Nations Foundation, Inc., Development of a Mobile Technology Alliance for Health [multi-country]
• Martin Were, MD – Regenstrief Institute, Inc and Indiana University, Incorporating Technological Advances In Population-Wide HIV Screening [Kenya]

The issue of trust came up explicitly during two of the four presentations. In the Millennium villages project, one of the major challenges was CHWs “failure to explain the tool to household members”. In India, PCI found that the majority (~70%) of beneficiaries of a microfinance program felt the mobile phone based solution would increase trust.

During the Q&A Ashifi Gogo probed further – he asked about the perceptions people had about their health information when it was collected using mobile devices. The panel answers were largely focused on technological measures to safeguard the data, so I thought it appropriate to mention Karen Cheng’s Angola study, last featured in the Bulletin of the WHO. I’m happy that I did because Patricia Garcia brought up a recent study she co-authored (Bernabe et al., 2008), a study that I didn’t know about, and a study that showed the opposite result. This Peruvian study examined the quality of data using PDAs to collect sensitive data compared to paper-based surveys. The results: there was a high level of agreement among PDA and paper-based responses and there were fewer inconsistencies within individual respondent surveys. [Note: I've only skimmed the paper this afternoon and plan to read it more carefully soon.] 

One of the key challenges Mitul Shah highlighted during his talk was better understanding the relation between people and technology. In his words, we need more “basic market research” and “impact evaluations”. Understanding how cultural perceptions of technology impact social desirability bias seems to be a critical gap since we’ve focused so many of our efforts on issues like cost-effectiveness, efficiency, and technological interoperability. That the Cheng and Bernabe studies showed such different results indicates that context matters. It’s not just a matter of phone (PDA) vs no-phone (np-PDA) – culture, age, gender all matter, too. If we can begin to understand these local factors, we can plan accordingly – e.g. how we train data collectors to prepare survey respondents – to achieve the gains we want in efficiency and cost.

No network in the big conference hall this morning, so no #GHC36 tweets from the Hans Rosling plenary. If you don’t know who he is, check out Gapminder.org and his TED talk. Here’s what I would have tweeted (rough transcription, emphasis is Rosling’s):

• “We need to be more thoughtful [in global health]“
• “Macro levels are always dangerous”
• “War does not explain the high rates [of HIV in Africa]“
• “We have to start to use data in global health”
• “People should be forbidden from talking about ‘HIV in Africa’”
• “There’s no such thing as ‘HIV in Africa’ – it’s so different from country to country”

I attended a session this morning called “Transformations: Discovering New Strategies Using Proven [mHealth] Technologies” but the truth of the matter is my attendance was clearly based on my constant desire to be enveloped in mHealth concepts, which the line-up of Paul Meyer (Voxiva), Ashifi Gogo (mPedigree), and Andrew Zolli (Pop!Tech) clearly satisfied.

Paul Meyer was a great speaker to have at the top of the lineup.  It was great to be reminded that mHealth strategies have been around since 2001.  And sustainability?  They’re already sustainable because the subscriptions are already paid for, but now that people are beginning to recognize how over 4 billion mobile phone subscriptions exist worldwide (to complement the world’s population of ~6.7 billion), we should all think a little bit harder about our models of improving health outcomes and design them so they can be scalable.

To complement this blog post regarding the same session (http://www.capacityproject.org/hris/blog/index.php/2009/05/ghc-conference-talking-about-mobile-health/), I want to draw some attention to some critical concepts presented by each of the individuals above.  The first remark is to develop some thoughts on counterfeit drugs after this morning’s session, as well as to express the importance of strong collaboration as exhibited by Project Masiluleke.

Back in February, I had the privilege of meeting Bright Simons and Kathryn Boateng, who are both on the mPedigree team with Ashifi Gogo.  What they are doing is a huge undertaking with complex dynamics.  The market system of drugs and medications are only becoming increasingly complex with further globalization, and current information and supply management systems are not in place to withstand this expansion.  Not only is the infrastructure weak to withstand worldwide drug pressures, but counterfeit drugs have important public health implications.

Malaria control, for example, consists of drug treatment – once chloroquine, now artemisinin and sulfadoxine-pyrimethamine.  Gogo made the statement that 20% of deaths associated with malaria could be prevented with mHealth strategies.  As more counterfeit drugs infiltrate the market, clinically effective drugs will be crowded out on the individual level, the community level, and the population level – perpetuating the difficulty for disease control.  On the individual level, drug resistance aggravated by cross resistance among different drugs which then requires chemically different drugs to be in the R&D pipelines at pharmaceutical companies – that is, if pharmaceutical companies have an incentive to divert funds to malaria control.  On the community level, some regions are more at risk than others.  In rural Ghana, when individuals are sick, the first point-of-contact for health care and/or treatment are often chemical sellers, which can be fake or licensed.  Only recently has the government and other agencies made an active effort in pushing licenses on chemical sellers with proper training in symptom-based treatment and drug selling.  In Nigeria, a similar drug market exists with what are called patent medical vendors, and as Gogo mentioned, a study in Lagos, Nigeria found 4 out of 5 drugs to be counterfeit.  Lastly, on the population level, a flood of counterfeit drugs inhibits the ability for herd immunity to occur, further complicating malaria control.  mPedigree is working on the issue of counterfeit drugs by collaborating with drug makers who are producing real drugs, and offering individuals the opportunity to send a text message to verify whether or not a drug they purchased is legitimate (“Yes”) or fake (“No”).

A good question was asked during Q&A (side note: the session moderator prioritized questions through twitter over questions directly from the audience) about how mPedigree was assuring that the sellers couldn’t trick or take advantage of the system.  Gogo remarked that the goal of mPedigree is to make it economically difficult to counterfeit, and that if a counterfeit drug was masked to be legitimate, the system could quickly deactivate its authenticity.  I believe this is definitely a step in the right direction.

Andrew Zolli from Pop!Tech described another mHealth strategy in South Africa called Project Masiluleke (mah-sah-loo-lick-ay) which has a wise approach towards reinvigorating HIV/AIDS messages by sending 1 to 1.5 million “Please Call Me”s a day through SMS.  Zolli mentioned how misinformation, disinformation, and competing theories and narratives of HIV/AIDS have all played a role in fueling the stigma that has made HIV and AIDS so difficult to prevent, treat, care, and mitigate.   Through the power of “Please Call Me” tactics, Project M has increased the average call volume to the National AIDS hotline by threefold with the help of MTN mobile network service provider, and has done a remarkable job at enhancing the meaning of collaboration to have a global and local impact.  Project M should be applauded because of its large-scale effectiveness, tailored approach to the population it targets, and active exploration of user friendly, at-home HIV testing kits.  This last element, working with frogdesign, is an exhibition of the movement towards ultra low-cost, distributive diagnostics.  The collective interest of all those involved in Project M is impressive (http://www.poptech.org/project_m_partners/), and the global collaboration has made a service – the largest of its kind – that has broken through the difficult barrier of stigma.

(If you are still curious, check this – http://www.frogdesign.com/services/project-masiluleke.html – out for a closer peek at how collaborations and collective interest can target effective behavior change.  At the bottom is an imbedded presentation designed by frogdesign that is great to flip through.)

So, in summary, what is important for new strategies and proven technologies?  Context.  Collective Interest.  Strong Collaboration. [Measured Impact.]

As with the last post, I’m copying the description of the session I just attended – Vouchers for Health (Session C3) - from the conference website:

Presenters Discuss: the potential of competitive vouchers in increasing access to priority services for currently underserved populations (Nicaragua); how subsidized, targeted vouchers can achieve the goal of improving health of poor women and children, elements that improve access to high quality health care services, how targeted voucher subsidies help meet the goal of contributing to development of a national social health insurance system that is accessible, affordable and acceptable (Kenya); a nationwide, high transaction distribution project for insecticide treated nets (ITNs) that has given rise to the application of technologies in the use of a relational database as a means to track each voucher transaction, ensuring security and traceability, providing spatial analysis using GPS coordinates, leveraging data from this project to others by providing a central data repository to government, and exploring SMS and mobile phones for automating voucher transactions and gathering patient information (Tanzania); and how poor pregnant women were selected for vouchers jointly by field workers and community support group members, how the institutionalization process for the voucher scheme was implemented, and how the health facilities were strengthened to provide quality maternal health care (Bangladesh).

Why should we care about voucher schemes? Three reasons from where I sit. These schemes provide:

1. An attractive model for extending the reach of services without significant infrastructural investment
2. Incentives for competition to improve the quality of service delivery
3. A mechanism for reducing financial barriers for the poor

Despite this promise, my experience over the last few years – including stumbling through a poster presentation about vouchers in Uganda for Ben at APHA in Boston a couple years back – has taught me that the concept tends to be elusive to “outsiders”. The World Bank’s Private Sector Development Blog has a concise overview of output-based aid for those that aren’t familiar. I won’t try to explain myself, since I’ll probably make some errors.

This session brought together diversity in geography – the talks covered Latin America, Africa, and Asia - and in services – anti-malarial bednets, safe motherhood, family planning, STI prevention and treatment. What was most interesting to me then was not the details of any specific program, but what we might be able to learn from having these different experts in the same room.

So what were the common themes?

1. Vouchers work. Nicaragua saw increases in service utilization, condom utilization, family planning uptake, and KAP. Much of this across different subgroup analyses – age, level of sexual activity, type of residence. The others similarly all saw positive gains in what they were trying to achieve.
2. Institutions matter. In Tanzania, the market is being flooded with free ITNs (possibly LLINs) under a new policy to achieve universal coverage – the fate of the 7000 bednet retailers under the Tanzania National Voucher Scheme (TNVS) is unknown. In Kenya, Nairobi and Kiambu saw better results for the voucher scheme because of existing infrastructure. Nairobi actually had provided more voucher-based services than vouchers sold in Nairobi because of women coming in from outlying areas. Tanzania benefits from a manufacturing base that can produce ITNs and a system that encourages people to pay for a portion of their health care.
3. The system will be gamed. The much higher reimbursement for providers of C-sections than vaginal deliveries has led in some cases to higher rates of C-sections than is necessary. April Harding who was moderating said that multiple schemes have been used/proposed for dealing with this, including capitation (e.g. for 100 women, X% will be reimbursed for C-sections). Fraud is also a problem. While nobody discussed incidences of counterfeiting, the Tanzania program has taken big steps to prevent counterfeiting, including watermarks, microprinting, and a bar code. The bigger issue with fraud is related to ineligible participants obtaining and using vouchers intended for other populations, whether by income or geography. Which leads us to the next point…
4. Equitable distribution is hard. Ineligible participants seem to be a problem with all these programs. In Bangladesh they responded by bypassing governmental decisions about who would get vouchers and relied on CSGs (community support groups) to make the decisions. Another trend is that those who are more poor tend to utilize vouchers less – it is unclear if this due to cost, education, and interaction among the two, or something we’re not thinking about.
5. Understanding redemption is complicated. This was my one question. In both Tanzania and Kenya – the others didn’t present these numbers or I didn’t catch them - the rate of redemption (number of people receiving services under the voucher scheme divided by the total number of vouchers distributed) – was around 80%. After I asked the question and before the panelists responded, my neighbors said that: (1) 80% is pretty good, and (2) the Tanzanians unlike the Kenyans don’t pay for their vouchers until they use them. In Tanzania then, the reasons are grounded speculations: perceived value of the ITNs, access, cost. In Kenya, the majority of the outstanding 20% is due to accounting. The real utilization is expected to be much higher since the cutoff for the evaluation excluded women who had received vouchers, but had not yet delivered (safe motherhood program). Still a minor portion of this is due to women who are unable to deliver at contracted facilities due to a lack of transportation or the timing of the pregnancy.

Just attended session B6 “Not the Usual Suspects: Community Based Low Tech Interventions that Improve Child Health Outcomes”. Copying the description and presenter info from the conference website here:

Presenters Discuss: the value of pictorial representation of integrated management of childhood illness (IMCI) algorithms and child care best practices for the quality of care of illiterate community health workers (CHWs) (Afghanistan); steps to engage religious leaders in health promotion, capitalizing on traditional vehicles to provide funds to increase health-seeking behaviors, and building an effective rotating drug program (Ethiopia); the role of computer based tools for microplanning in routine immunization and the planning process using the tool (Jharkhand and Madhya Pradesh, India); and how introducing new medicines in Tanzania and the Democratic Republic of Congo (DRC) catalyzed policy changes and drove interventions to strengthen pharmaceutical management systems (Democratic Republic of Congo, Tanzania). 

First a quick recap of the presenters and what they talked about – and then what was most interesting.

One theme that weaved through the first three talks – and one of the most important – was that the success of “low-tech” technology in improving child health depended on an improved understanding of the people that use the technology.

From the first talk (Aitken, Afghanistan): The approach relied on a different type of literacy – a specific symbolic literacy making use of fingers and moons for time, and drawn images of children and mothers. During the formative research, the CHWs asked, in reference to a diagram showing a child being held by her mother, “Where’s the rest of the mother?” The next revision of the C-IMCI materials showed the entire mother, not just a cropping suggesting a mother. There’s a very strong analog to the Pull-Ups diaper case from the consumer packaged goods industry in the United States. First-hand design research with Huggies in the late 1980s showed the difference in perspectives between those producing diapers – exemplified by physical model of a baby without head, arms, or legs – and parents – who were concerned not with sanitation, but childhood development. [on short time now because of the conference - can provide reference later] 

From the second talk (Roy, Ethiopia): Working together with the Ethiopian Orthodox Church, CARE has been engaged in a comprehensive community-based program to improve child health in Ethiopia. The EOC priest delivers health messages after Sunday sermon, on significant holidays, and to 20-40 families that he routinely visits as a “confessor”. Within this framework there are a number of innovations that they have developed tailored to this specific program. The booklet that contains health information is a pamphlet in the same form factor as bibles that the priests carry with them (building trust). Yellow “referral tokens” allow the priest on his household visits to refer a sick child to a local clinic (utilizing non-health professionals for services). They also have a “data board” which publicly displays mortality and morbidity statistics (community information sharing) – it’s a chalkboard much like the community board from Ghana that was making the rounds recently. [can't remember where I saw this, but will add the link if I remember, or if someone reminds me] Finally, the program is extending the traditional economic practice of idir (a traditional membership-based funeral insurance scheme with democratically-elected leadership) to childhood health emergencies.

From the third talk (Sagar, India): The Microsoft Excel-based computer microplanning tool had unexpected positive consequences for those using it at district and sub-district levels. Where no microplanning had been present before, these small health organizations in Jharkand, Uttar Pradesh, and Madhya Pradesh have started to incorporate microplanning into routine activities. Technology for positive organizational change. And the innovation is diffusing organically – the speaker said he received word today that Bihar is starting to use a similar tool in planning routine immunizations.

Today was the opening day for the 36th Annual International Conference on Global Health (#GHC36), being held in Washington D.C. by the Global Health Council.  This conference looks like it will be a promising five-day dosage of:

(also known as this year’s theme)

After arriving in the morning, I caught the tail-end of an auxiliary event held by Chemonics International (www.chemonics.com), an international development consulting firm, that provided a snapshot of many of their multi-sectoral approaches in harnessing the facets of the private sector for health.  Chemonics was founded 34 years ago, and the firm is grounded by the acronym AIMS – achievement, innovating, measurable, sharing.  Interestingly, Chemonics uses a total market approach for one of their projects – the only project within USAID’s worldwide portfolio that does so.  In the international health space, cost-effectiveness analyses, willingness-to-pay studies, and other economic models seem to be increasing in use, and these were among several strategies for their activities.

Some of their other current activities include involving the private sector with:
•  DOTS – the tuberculosis strategy for control and prevention – in countries where the private sector is the health provider of choice (approximately 70% of individuals seek true care from the private sector in the Philippines)
•  HIV/AIDS prevention and treatment with capacity enhancement through economic rehabilitation
•  stimulating rural competitiveness in Bolivia and providing business support in Kosovo
•  management information systems with computers at each health clinic (in development: a $200, 1.6 gigabyte computer with capabilities to connect with a SIM card)
•  market access for rural development by increasing the value of agriculture and by encouraging gardens in Nepal

This last one got my mind working.  I read once that in Nepal, women carry heavy loads up to 20 kg for up to 20 kilometers for up to an estimated 20 hours a week to attempt to satisfy high household energy demands. Can you imagine?  (If you are curious, you can search for an image of a “doko” which is the contraption that allows women to carry such heavy loads.  Dokos are usually equipped with a carrying strap that can wrap around a woman’s forehead.)  Not only does a woman’s body require more caloric intake after retrieving wood for fuel and fetching water for the household, but the load lifting and carrying puts a strain on abdominal muscles.  This can lead to uterine prolapse and miscarriage if these household activities are performed during or after pregnancy. Encouraging gardens would improve nutrition, but if these gardens were linked with solar food dryers, households could benefit from having nutritious food year round and not just during harvest season.

This emphasis on weaving together the private sector can have positive effects on worldwide health and quality of life, but it is important that these approaches are evidence-based and involve collaborations with the public sector.  Through this snapshot of projects, Chemonics International demonstrated how new technologies and proven strategies with a multi-sectoral approach can lead to healthy communities.

–

Tomorrow, I am looking forward to hearing Ashifi Gogo speak during the plenary session on “Transformations: Discovering New Strategies using Proven Technologies”.  Gogo is a founder of mPedigree, a non-profit that advocates for mobile health solutions to counterfeit drugs – an issue that truly has global implications and demands a critical need for worldwide tracking.

On Thursday, the conference has Hans Rosling scheduled as the special keynote speaker, and he will be speaking about “Facts and Fiction about Global Health”.  If you haven’t seen Rosling lecture, he is quite animated and is pushing forward a movement towards user-friendly, global trend data visualization, on top of his 20-years of experience in global health research.

Our crew will be blogging and tweeting from the Global Health Conference annual meeting which is running today through Saturday. Our posts (GHC36) will be focused on the conference and you can follow us via twitter here:

http://twitter.com/jaspaldesign
http://twitter.com/kwantada

I thought I would kick off the conference blogging with some fun stuff. Heather LaGarde, IntraHealth and company have put together a phenomenal website linking together music + open source tech for health, check out the below and check out the website to hear the winner of their remix contest which was announced tonight at an event at GHC36. Some of the remixes of the song “Wake Up – It’s Africa Calling” are beautiful and powerful, make sure you tune in (one of my favorites was the 2nd place remix by Danny Hajek):

“Global non-profit IntraHealth International has launched a major campaign to raise funds and awareness for the IntraHealth OPEN initiative, a program created to address the most critical health issues in Africa by putting the latest open source technologies directly in the hands of health workers.”

“The campaign is rolling out the release of a charity album in partnership with Grammy Award-winning artist and internationally acclaimed humanitarian Youssou N’Dour.  The album titled “OPEN Remix” features remixes of N’Dour’s song “Wake Up – It’s Africa Calling” by Nas, Peter Buck of R.E.M., Duncan Sheik and other headline artists from around the world and will be released by major distributors including Rhapsody, iLike and Amazon MP3 as free downloads – a global remix contest will be launched with Indaba Music in April.”

“IntraHealth has been collaborating with African governments and private institutions to design and apply open source solutions to strengthen their ability to use health information for strategic health policy and planning.   Using mobile phones, pdas and taking advantage of growing connectivity across Africa, the initiative aims to increase fluency in open source systems and help support a new generation of eHealth workers, technology professionals and national leaders in Africa who understand, customize and apply open technologies to improve health.”

It has been a while since I did a global health blog link drop, here are some recent links of what’s has being discussed:

• Spare Change discusses swine flu communication, link

• Both the Guardian and Global Health @ Change.org are blogging about coke’s distribution expertise and how that might help with drug distribution in Africa, Guardian link, Mara’s take at Change.org. To read more about logistics in general, a great place to start would be Michael Keizer’s aid and logistics blog

• Nairobi – City toilets are now hubs of entertainment, link

• World Bank AIDS initiatives crowd out health programs, link

• And for a different take on AIDS Funding (there isn’t enough) see the PHR blog

• From Social Entrepreneurship to ‘Cure Entrepreneurship, link

• Winner of the 2009 Global Health Council Photography Contest, announcement, interview

• Malaria Matters on the global health e-learning center, link

• From Global Health Progress – A personal perspective on World AIDS Vaccine Day, link

• Want some juice (gossip) about global health happenings, then check out the Gorman Report

• Here is an award for the most sensational title of the month: Are the Only Innovations in Social Entrepreneurship Anglo-Saxon? link

• Interplast book review: The Life You Can Save Acting Now to End World Poverty, link

For a different type of approach see this animated short on the promotion of sanitation in Pakistan at the Sanitation Updates blog.