Global Health Watch 3
Examining the World’s Health from an Alternative Perspective
Call for Case Studies and Testimonies
Contribute to the Alternative World Health Report

The Global Health Watch provides a platform for activists  to share experiences and inform each other with practical examples and theoretical analyses  to strengthen local, national, regional and global campaigns towards  Health for All!

How you can voice your views:

The Global Health Watch is putting out a call for the submission of country or region specific case studies and testimonies. These case studies and testimonies will form part of the electronic platform of the alternative world health and selected case studies shall also be incorporated into the final document of Global Health Watch 3 – scheduled for publication in 2011.

Some suggestions:

•       Positive and negative examples of policies and actions to secure improved and equitable access to health care.

•       Examples of interventions to address public sector corruption and inefficiency.

•       Examples of effective, efficient and inclusive public health care systems.

•       Evidence showing the negative effects of commercialised health care on professional ethics.

•       Case studies on what is driving good and bad processes of decentralisation, with some analysis illustrative case studies of where deconcentration, devolution and delegation have worked, where it hasn’t worked and why.

•       The good and bad practices bilateral and multi-lateral donors on public health stewardship and on the performance of health care systems.

•       Examples of civil society resistance to the effect of privatised public water and electricity utilities on equitable and fair access.

•       Case studies of the positive and negative impact of multi-national corporations on health policy.

•       Case studies of the difficulty that country governments have in responding to the needs and demands of multiple international agencies (creditors such as the World Bank, traditional bilateral donors, relatively new institutions such as GAVI and the Global Fund).

All case studies, pictures and videos will be published on the website of PHM Global with pictures

Guidelines

We are looking for short and concise submissions of 1000 -2000 words with pictures
Please indicate:
•       your organisation
•       your locality/country/region
•       whether you want your submission to be anonymous and why
•       Ensure a clear link of your case study with one of the subjects covered by the course or issue mentioned above.
•       Pictures or videos

Looking forward reading your stories, experiences, analysis and observations!!

We should receive the first draft by 30th August, 2010.

Please write back to asengupta@phmovement.org

Why should you get involved

The Global Health Watch is a non-government initiative aimed at supporting civil society to more effectively campaign and lobby for ‘health for all’ and equitable access to health care. This is not a matter of finding a technical or economic prescription, but is one that requires political mobilisation to shift resources and attention towards the needs of the poor, and to reform the very political and social institutions that have generated the state of ill health today.

Promote the accountability of governments and global institutions that affect health (such as the World Health Organisation, UNICEF and the World Bank)

Identify policies and practices at the global and national levels that are unfair, unjust and bad for health

Highlight the needs of the poor and reinvigorate the principle of ‘health for all’

Shift the health policy agenda to recognize the political, social and economic barriers to better health and to advocate alternatives to market-driven approaches to health and health care

You can get more information about the Global Health watch at: http://www.ghwatch.org/

The answer is yes if you ask Carina Lupica.

Carina is Executive Director of Fundación Observatorio de la Maternidad (OM), an entrant in this year’s Healthy Mothers, Strong World competition. The competition, jointly sponsored by Ashoka and the Maternal Health Task Force, seeks to identify maternal health innovations from around the world. OM is a globally unique organization that is dedicated to using data as a policy advocacy tool for maternal health in Argentina.

Argentina’s maternal mortality ratio (MMR) – 44 deaths per 100,000 live births in 2007 – is much lower than high maternal mortality countries, but it is high when compared to other national indicators (Ramos et al., WHO Bulletin, 2007). In 2007, OM identified a lack of quality data focused on maternal health issues as a key gap in Argentina. OM has responded to this gap by aggregating data from various sources to develop a comprehensive understanding of the maternal health landscape in Argentina. OM maintains a holistic view of maternal health, including environmental factors and social issues, such as access to clean drinking water and the increasing frequency of single mothers.

As Carina writes by email, “This is brand new information that contributes to a complete diagnosis of the state of motherhood, which constitutes the necessary grounds for any public policy proposal.”

The organization’s focus on policymakers is having a real and significant impact. In 2009, OM research helped to pass national law 1914-D-2009: Universal Payments to Children and Adolescents (link in Spanish), a conditional cash transfer program that aims to reduce poverty and improve family health. This program was based on OM research showing that poorer mothers are more likely to contribute a higher share of household income, 72.5% in the lowest income group.

Just this month the Lancet published a study that estimated that there were 343,000 maternal deaths in 2008. Included in this study were detailed estimates for individual countries, including success stories such as China, Egypt, and Bolivia. Study lead Christopher Murray remarks, ”Finding out why a country such as Egypt has had such enormous success in driving down the number of women dying from pregnancy-related causes could enable us to export that success to countries that have been lagging behind.” As with OM, this comment suggests that better data can result in better maternal and child health.

Can better data save the lives of mothers? Absolutely.

The important question now is this: Can the OM model be replicated globally?

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Yesterday we were invited to sit in and meet the CEO of GSK, Andrew Witty, as he announced the new GlaxoSmithKline Open Innovation Strategy To Aid Poor Countries. The following entry is by one of our new bloggers, Sarah Searle (@sarahsearle on twitter) from the Johns Hopkins International Health program:

“Big Pharma as a Catalyst for Change”: GSK “Open Innovation” strategy

It’s estimated that one-third of the world’s population go without essential drugs–often drugs for treating diseases that disproportionately affect the world’s poorest. The pharmaceutical world proves to be especially difficult to navigate for those seeking to provide such medicines to underserved populations, however. Pharmaceutical science is a field with billions of dollars in R&D, ironclad patents and intellectual property rights that are prohibitive to making drugs available to the poor. Andrew Witty, CEO of GlaxoSmithKline, claims that he’s looking to change this nature of big pharma, in the same way that the open source movement has revolutionized the tech world.

I love the word “innovation” combined with anything related to global health, so the prospect of sitting in on a blogger’s roundtable with GlaxoSmithKline CEO Andrew Witty was exciting enough just from the topic at hand: “Breaking Down Barriers to Innovation and Access to Medicines in the Developing World.”

The ante was upped in a press conference this morning, when Andrew Witty announced GSK’s “Open Innovation” strategy to make drugs more available and break down barriers to access. This strategy includes several components.

“Open Lab” initiative
$8 million in seed funding has been provided establish an “Open Lab” at GlaxoSmithKline’s research facility in Spain. As many as 60 scientists from around the world will be able to work at this lab, which will be devoted to research for drugs that target diseases of the developing world.

13,500 malaria-combating compounds in the public domain
This is perhaps the most exciting announcement. GlaxoSmithKline has been collaborating for years with PATH and other organizations in the development of a malaria vaccine. Scientists at GSK have screened all compounds that have ever been created in their labs, and identified 13,500 compounds that successfully combat P. faciparum, the deadliest form of malaria. The big news? The chemical structures and other recorded data regarding these compounds will be open sourced, in hopes that malaria vaccine research will be accelerated.

New pricing model for GSK’s malaria vaccine candidate
GlaxoSmithKline is in the process of developing the world’s most advanced candidate for a malaria vaccine—it’s the only vaccine in Phase III clinical trials, and could be available to the public as early as 2012. Maintaining that a tiered pricing model simply isn’t feasible for a drug which is needed almost exclusively by the world’s poor, Witty announced a pricing model for the vaccine which covers the cost of the vaccine with a marginal return for GSK, all of which will supposedly be channeled back into R&D for “next-generation” malaria vaccines.

It goes without saying that some present at the roundtable were wary of the corporate world’s ability to selflessly decide change the mechanics of drug information and pricing in order to benefit the world’s poor. Witty has struck a nice balance between acknowledging that GSK is a profit-driven company but maintaining that he strives to keep a “restless” socially-conscious agenda.

And let’s be honest—GSK won’t be suffering much financially with this move. First of all, the malaria drug market isn’t very competitive to begin with, because of the very fact that it is a poor person’s disease. Secondly, GSK is already the developer of the leading candidate for a malaria vaccine. It’s unlikely that, even with the compound information made publicly available, anyone can come up with a vaccine to rival GSK’s in any short amount of time.

Indeed, as Witty acknowledged, making drugs and drug knowledge more universally available is an investment in the future. Drugs will not be provided for free, he stressed, but rather provided at a marginal price that won’t completely alienate other pharmaceutical companies from healthy competition for lifesaving drugs.

Regardless of motivation, it’s refreshing to see big pharma recognizing the issues of access to medicines for the world’s poor. Moreover, Witty’s emphasis on being in step with progressive intellectual property movements is laudable. Whether or not GSK’s initiatives will stimulate other pharmaceutical companies to follow suit remains to be seen.

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• Glaxo’s Witty Tries To Fix An Industry Problem (invivoblog.blogspot.com)
• Drug firm boost to malaria fight (news.bbc.co.uk)
• Glaxo offers free access to potential malaria cures (guardian.co.uk)
• GSK offers to share data to help fight malaria fight (telegraph.co.uk)
• GSK offers scientists labs, data to fight malaria (seattletimes.nwsource.com)
• Malaria researchers given crucial data (cbc.ca)
• GlaxoPfizer tieup opens new era in Aids battle (telegraph.co.uk)

The Global Forum for Health Research Forum 2009: Innovating for the Health of All took place in Havana, Cuba from 16-20 November. This is the fifth in a series of posts from the conference. Only one or two more after this one.

My reason for attending Forum 2009 was to participate in a session title “Innovation for Remote Populations”. This post is a about that session. What follows is taken from my recent report to the Global Forum for Health Research – edited only slightly.

Innovation for Remote Populations

Thurs-19-Nov-2009, 14:00-15:45, Global Café, Palacio de Convenciones, La Habana, Cuba

Coordinators/Facilitators:

• Patricia Mechael, mHealth and Telemedicine Advisor, Millennium Villages Project, Earth Institute, Columbia University, USA & Egypt (organizer & facilitator)
• Tim Hurson, Facilitators Without Borders (facilitator)
• Charles Gardner, Global Forum for Health Research (focal point)

Speakers (alphabetical order):

• Simon Adebola, NEPAD Council Global Health Commission, Geneva
• Najeeb al-Shorbaji, Director, Knowledge Management and Sharing, WHO
• Caren Serra Bavaresco, Student, Epidemiology, Universidade Federal do Rio Grande do Sul, Brazil
• Karl Brown, Associate Director, Rockefeller Foundation
• Arul Chib, Assistant Professor, Wee Kim Wee School of Communication, and Assistant Director, Singapore Internet Research Center, Nanyang Technological University
• Dziedzom Komi de Souza, Ph.D. Student and Research Assistant, Parasitology, Noguchi Memorial Institute for Medical Research, Ghana
• Bastiaan Hoefman, co-Founder, Text2Change
• Bernardita Labarca, Project Coordinator, Zoltner Consulting Group, Chile
• Claire O’Neill, Chairperson, Cell-Life-South Africa
• Ravi Ram, Head, Monitoring & Evaluation, African Medical Research and Research Foundation (AMREF), Nairobi Kenya
• Marco Salmen, OHR-GMCP Initiative for HIV/AIDS, Global Micro-Clinic Project, United States
• Jaspal S. Sandhu, Design Researcher, College of Engineering, University of California, Berkeley, USA
• Joel Selanikio, co-Founder and Director, Datadyne.org, USA
• Garance Upham, General Secretary, Direction, Safe Observer International, France

Additional participants – from the audience:

• Elmer Zelaya – Fundación Chica/Nicaragua
• Timothy Dye – SUNY Upstate Medical School/USA
• Jane Kengeya – WHO
• Oyewale Tomori – Redeemer’s University/Nigeria
• Lishandu/Zambia (full name/affiliation not available)
• Vargas/USA (full name/affiliation not available)

Summary:

1. Diverse users and uses: The speakers presented a variety of mHealth/eHealth applications involving a wide variety of users, including both the health workforce and community members, e.g. educating teenagers about HIV/AIDS in South Africa (O’Neill), Internet access in western Kenya to improve uptake of HIV VCT (Salmen), mobile emergency response systems in Aceh (Chib), electronic IMCI in Tanzania (Brown), text-based health education and health service promotion in Uganda (Hoefman), training for health workers as a downloadable game package for phones in Kenya (Ram), telemedicine to improve the skills of health workers at primary levels in Brazil (Bavaresco), delivery of health information to communities in Chile (Labarca), a general set of tools for mobile data collection being used worldwide (Selanikio), and handheld computers to support rural healthcare delivery in Mongolia (Sandhu).
2. mHealth/eHealth is about enabling access: A common theme across diverse applications was that information and communication technologies are being used to enable access to health information and services in places where access is difficult because of remoteness and/or cost.
3. Coordination among the various players: Coordination among donors and projects is necessary to avoid unnecessary duplication of effort and to share what works. This is the role of the mHealth Alliance, supported by Rockefeller Foundation among others (Brown). While there were questions from the program side as to what data donors want (Chib), there was a simultaneous sentiment that donors need “stepwise” guidance (al-Shorbaji).
4. De-emphasizing technology: The mHealth Alliance has recently been discussing development of an “mHealth Toolkit”, to provide a common technical architecture and platform for those planning to implement mHealth programs (Brown). The existence of free technology platforms – in this case DataDyne’s tool – enables programs to focus on developing health content (Labarca). It is important to have a generalizable tool, as DataDyne has done, that can be used by anyone; if individual governments must approve technology “you’ve lost the battle” (Selanikio). Programs must focus on understanding people and applications more than technology; in response to a question from Dye about the use of ethnography in this field, three examples were given: ethnography of teen chat rooms in South Africa (O’Neill), multi-year ethnographic fieldwork as the basis for the program in western Kenya (Salmen), and design ethnography of the information management practices of rural health workers in Mongolia (Sandhu).
5. Defining good evaluation: There are challenges to seeing change in population health outcomes (Chib). It is difficult to measure behavior change (Hoefman) and to evaluate systems that provide health content to people (Labarca). Ethnography should be considered more seriously as a complementary evaluation strategy in mHealth (Sandhu). In evaluation, the metrics should match the intervention – mHealth is another intervention; in addition, we want to see the unintended effects of technology (Ram).
6. New modalities of engaging people: Mobile phones enable fundamentally new ways of engaging with people. As opposed to mass communication that is often used in social marketing, phones allow for interpersonal communication that can be tailored and cost-effective (O’Neill). There are two modalities, moving messages out to people and demand-driven services, where people demand the information that they need (Ram). Salmen lent his support to the importance of demand-driven services and argued that phones will bring more equity. This is all supporting the shift to citizen-centered healthcare (Mechael).
7. Cautions moving forward: In natural disasters, the cellular network is the first to go (Zelaya). An open question: Who owns the data? (al-Shorbaji). Nobody is thinking about “real sustainability” (Adebola). Reliable phone networks are a challenge (Lishandu). We should be careful that we don’t become too dependent on one tool (al-Shorbaji).
8. Need to think more creatively: We should be bolder with approaches; if we are, poor countries “could leapfrog” in health and development terms (Upham). Many of the applications discussed focused on SMS and telephony capabilities; we should think about leveraging more advanced capabilities of mobile phones (Kengeya).
9. Who should design technology? There is an assumption that Africans cannot develop software, but that is not true (Adebola). DataDyne software was already developed by Africans (Selanikio). Africans should develop software, but they shouldn’t redesign what has already been built (Brown).

Conclusions/Recommendations:

1. There is a need for increased knowledge-sharing about mHealth/eHealth within the global health community. This should definitely include policymakers. As Prof. Tomori elegantly stated, while we are thinking about how to reach remote populations, we should think about “hard-to-reach” African leaders.
2. While there was discussion of both eHealth and mHealth, the discussion focused primarily on the latter.
3. There is a need for a continuing dialogue about mHealth. It is unrealistic to expect policy recommendations to come out of this meeting given the state of the field (many open issues) and the limited engagement at the meeting.
4. Major mHealth topics to be discussed at future meetings: definitions; standards, including how to conduct evaluation; and successes and failures from the field.
5. The value of the meeting was threefold: (1) it helped extend the network of those working in mHealth; (2) it provided those outside the field with an understanding of the opportunities and challenges of using mobile phones to improve population health; and (3) it placed a much-needed emphasis on prioritizing people and applications over technology.
6. Mechael suggested reviving the Mobile Metrics and Evaluation Group as a means of maintaining an active mHealth community discussion outside of official meetings.

Other observations:

1. The fishbowl format was successful in eliciting relevant commentary from a large group of speakers as well as from the audience. Time was an issue, though, as several invited speakers only spoke once and several audience members had comments or questions that they were unable to share.
2. One key issue that was not explored – as I stated at the end of the session – was the link between social entrepreneurship and mHealth. This is especially relevant to issues of demand, incentivization, and sustainability.
3. There is a need for an ongoing discussion of these issues at Forum 2010 and beyond – while the conversation will continue in other settings, the Global Forum for Health Research should continue to be involved because of its systems focus, its emphasis on actionable research, and the unique mix of parties (policymakers, donors, implementers) it brings together.

Just happened upon a great discussion about making data make sense quickly on the Innovation in Evaluation Blog over at good.is

What happens when we put people at the center of evaluation (as Jocelyn Wyatt puts it)? In this context, it means recognizing that people are preoccupied with more important tasks than spending long amounts of time in front of dashboards and data visualizations.

This is true in any setting, and in our case it was driving. The role of visualization should not be to demand full attention, but to support the priority task and improve it through feedback loops. The challenge is not just to display how you are doing right now, but also to figure out how you could do better. So, what does this mean for the visualization itself?

Every form of visualization should tell a story. Unfortunately there is limited attention and time to process all the stories. So the gist of the story, or its immediate impact, should be visible right away. The term I like to use for this principle is “glanceability.” What does a visualization tell us before we take time to analyze it? I invite you to look at the following chart and image for 10 seconds each and compare. What did you see? What did you feel?

Modified from Azar Askin’s reproduction of a poster by Muenster Planning Office, Germany

A followup post talks about understanding how data is presented. How can you tell what is fact and what is fiction? What basic questions should you ask of the graph? How do you know if you are being taken for a ride?

Super-cool. Now, if you’ll excuse me, I’m going to go curl up with some of the other posts here – How Can We Measure What’s Most Meaningful? and In Non-Profit World, Numbers Don’t Tell the Full Story.. (something a friend of mine always used to tell me).

Read all about it! @ Innovation in Evaluation.

I decided to fool around a bit to see if I could get any meaningful analysis out of analyzing a twitter hashtag for the conference we just attended at Mayo. Sadly after spending a decent amount of time it was a bit of a flop. It is kind of absurd that there is no easy to use website where you can check out trends and stats from twitter hashtags (will someone please develop this?). Chris did a great job that was time intensive from another health conference earlier this year. Definitely check out his presentation and what he found – great stuff: Health 2.0 Tweet Stream Analysis.

I went and grabbed what I think is 90%+ of the tweets from txfm09 and put them into a spreadsheet (after using notepad). There were over 1350 tweets as of this Friday (3 days post conference). For anyone who has more time and programming skills than I do, I have uploaded this dataset for anyone to grab at IBMs Many Eyes (thanks again to Chris for this tip). You can check the hashtag #txfm09 or if you want to see more cohesive thoughts by person, there is no shortage. The below is one visualization of 2 phrases (as opposed to 1 word) that is highly flawed (email me if you want details or ping me on twitter – @ghideas). Let me say this again – this graphic is highly flawed, but you can gather some very general overarching trends (it looks like there was lots of linking bcs of the prominence of bit ly and you can see the popularity of other terms and folks who were most prolific). Did I say this was flawed? For some reason the quality o of the picture below is poor, I have a slightly better and larger one, ping me if you want me to send it to you. Enjoy:

In a chilling expose today, Toxic Waters – Clean Water Laws are Neglected, at a Cost to Health, Charles DuHigg of the New York Times covers the impunity of polluters and lax regulation of clean water laws. The NYT then goes a step further – creating transparency through a public database of violations which is ‘more comprehensive than the states or the EPA‘, that you can access to find polluters near you on an interactive map. There is also a nice interactive graphic of the Clean Water Act enforcement record in all 50 states. Deep cuts were made in government funding, and now clearly our Environmental Health Monitoring system needs repair. Democracy needs a strong, free media who reports and then acts. Who knew the NYT would be a key environmental health policy innovator overnight?

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Beyond the current debate on US health reform, which has us all posting on Facebook “No one should die because they cannot afford health care, and no one should go broke because they get sick “, the fact of the matter is that the accident of your birth largely determines your future health.

And no, it isn’t fair. If you are born in Sierra Leone, 1 out of 6 babies do not survive. In the developed world, 1 out of 10,000 babies die.

The WHO released a landmark report last August on health equity “Closing the gap in a generation”

Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others….Within countries there are dramatic differences in health that are closely linked with degrees of social disadvantage. Differences of this magnitude, within and between countries, simply should never happen.

With a rapidly urbanizing world – projections of 60% of people will live in cities by 2015. Most of these people are escaping rural poverty, and will live in informal settlements in the developing world.

Guidelines must be developed to ensure health equity, but we also need tools to help us plan.

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