Global Health - Change.org

Friday Futures: The Growing Threat of Malaria

Published July 03, 2009 @ 11:51AM PT

(Photo Credit: Hugh Sturrock. Wellcome Images)

Malaria is already a global health problem; there were 240 million cases of malaria in 2006, and every 30 seconds a child dies of malaria. It is going to get worse. Climate change, extinctions, and resistance to malarial drugs will leave us with some very ugly choices to make.

Climate change is going to have a major effect on malaria. Right now, malaria a tropical illness. It needs a climate friendly to mosquitoes and the malaria parasite that lives in them. Those parasites cannot survive in temperatures under 68 degrees Fahrenheit (20 degrees Celsius). That limits where malaria can spread, but global warming is going to bring a lot more of the world into the temperature range where malaria can survive.

In addition, we are starting to witness large-scale die-offs of frogs and bats. This may be a result of climate change, or it may result from environmental pollution. Whatever the cause, it will lead to a lot more mosquitoes, which means a lot more hosts for malaria parasites.

Finally, First-line malaria drugs are starting to fail, as a result of resistance. We're seeing resistance in Cambodia right now. That resistance will spread as the parasites spread, and new kinds of resistance will pop up because of self-dosing with inadequate anti-malarials and the widespread problem of counterfeit drugs.

This is going to leave us with an ugly choice between extensive spraying for mosquitoes and the environmental contamination it entails, and the continued spread of drug-resistant malaria.

Supporting Physicians to Improve Health Care

by Alanna Shaikh

Published July 02, 2009 @ 10:38AM PT

(photo credit: arantxamex)

In my post on the future of Health Care, Wendy Leonard felt that I was attacking physicians. I didn't mean to do that. Physicians are highly educated people with a commitment to the health of their patients. But they are human, and human beings are fallible. We've got a lot of data in the United States to prove that. We've seen that prescribing errors are common in hospitals. Between 44,000 and 98,000 Americans die each year in U.S. hospitals from preventable medical errors.

How do we reduce that problem? Computers. Software that tracks and analyses prescriptions can prevent drug interactions and erroneous prescribing. Websites that help with knowledge sharing. Any time we can support health care providers with useful technology, we can improve care. (Please note that I said useful technology. It has to be easy to use and understand.) Bar coding medications and providing hand-held devices are examples of that useful technology. Two VA hospitals in Kansas found these devices reduced medication error rates by 70 percent over a 5-year period. Nurse training has also been shown to reduce medical errors. So does reducing physicians' on-call time.

We can't let medical care hinge on just one person. Physicians alone cannot carry the health care system. They are part of a team that includes a wide variety of other health care providers and technological tools. The more you build out that team, the better you make medical care. Recognizing that fact is no insult to doctors.

Being Productive

by Alanna Shaikh

category: Global Health Jobs

Published July 01, 2009 @ 11:01AM PT

(photo credit: AYUM i Love Live Laugh)

Megan215 on Twitter asked me to write about productivity. I'm no expert, but I have figured out three tricks. Two big ones, and a little one - but the little one might be the most useful.

1. Love what you do. When you love your work, you think about it all the time. You're planning, processing, figuring things out in the back of your head, no matter what else you are doing. Sometimes I sit down to write global health blog posts, and I realize I have the entire text mapped out already, written unconsciously as I went through my day. A few years ago, I woke up one morning with the text and layout of a success story fully drafted in my head. (Yes, that link is to the actual story.)

2. Know your strengths and weaknesses. I am not a morning person, so I schedule easier stuff for mornings - meetings with people I like, short email responses, and catching up on news and information. I hit my stride in the afternoon, so that's when I do the challenging stuff. I don't really like Wednesdays, and I love writing career posts, so that's why you get careers on Wednesday here.

3. Turn off your email indicator. This is the little one. You know that tiny envelope that Outlook shows in the corner of your screen when you've got new mail? Turn it off. Email is more exciting than anything else you do, because you never know what amazing or fascinating message you'll get. Checking your email when you know something is there is irresistible. If you turn off the indicator, you are free to check your email when you need a break from your current task, or according to a specific schedule.

When Not to Go to Grad School

by Alanna Shaikh

category: Global Health Jobs

Published July 01, 2009 @ 10:39AM PT

(photo credit: Hoyasmeg)

1. When you don't know what to do next and you think grad school will help you figure it out. It will help, but you might spend two years and $60,000 to figure out that you just got the wrong degree and what you really want is medical school or an MBA. (I actually did my MPH because I didn't know what to do next, and it worked for me, but I am an anomaly)

2. When you're fresh out of college. You don't know what you want yet. Really. I promise. You might get it right, but the odds are not in your favor. Take a couple years and work. It will give you some time to figure out what you need from grad school, or if you need grad school at all.

3. When you just finished Peace Corps. You are already used to being poor, and you've got better language skills than you'll ever have again. Get an in-country internship and start building connections and relevant experience. Then use that to go to a top flight grad school and a jump-start on your post-grad school career.

4. When you're pregnant (or your partner is). Graduate school seems like it will be a flexible time to have a baby and/or a toddler. It's not. Your professors will notice when you miss class, and the constant feeling that you have work you ought to be doing is not especially compatible with parenthood.

5. January. Even if your school lets you start in spring semester, the majority are not set up for students to begin that way. Most of the classes offered will require prerequisites offered in the fall. And the other students will all know each other already; you'll miss the September friend-making rush.

More Health for the Money?

by Alanna Shaikh

Published June 30, 2009 @ 11:05AM PT

(photo credit: Brooks Elliott)

The second half of the Final Taskforce Report on Innovative Financing for Health Systems focused on making health dollars go farther - getting more impact for the money. It focuses on strong leadership for the health system, and funding ways to pool and unify fragmented donor aid. Here are some key quotes:

In low-income countries, governance reform is best promoted through incremental, small-scale and flexible responses to domestically-driven reform agendas based on long-term visions for public administration and accountability arrangements rather than complex structural reforms.

A financial strategy needs to be part of the national health strategy, and external assistance and domestic financing should ideally be pooled together to spread risk, reduce volatility of income, and allow for predictable finance.

Out-of-pocket payment is the least desirable form of revenue raising.

The Taskforce recognizes the enormous potential of the private sector contribution to health in low-income countries. Areas that merit more exploration and testing include private sector involvement in supply-chain management for the public sector, private training schools, low-cost clinic chains for the low-income employed in urban areas, low-cost pharmacy chains and diagnostic labs.

A substantial proportion of international resources today is spent on technical assistance. It consisted of 42% of all development assistance for health in 2002-2006. Technical assistance represents an enormous opportunity for efficiency gains. The current inefficient approaches to supplying technical assistance should be replaced by strategies that promote long-term institutional capacity development and skills.

All external funds should support one national health strategy.

Innovative Financing Mechanisms for Health Systems, But No Magic Bullet

by Alanna Shaikh

category: Global Health News

Published June 30, 2009 @ 10:17AM PT

(photo credit: Photos8.com)

To follow up on yesterday's post on innovative financing mechanisms for health systems, I looked into the first two innovative mechanisms mentioned, the mandatory solidarity levy on airline tickets and expanding the use of the International Financing Facility for Immunization and other approaches to ensure predictability.

The mandatory solidarity levy, (that's a mouthful of a name, isn't it? From now on I'll just say "the levy") as currently conceived, is a tax placed on airline tickets to raise money for development programs. Imposed by a country's government, the levy is added to the cost of airline tickets and the funds raised go directly to a dedicated account for international development programs. The logic is that air travel benefits most from globalization, and that a mandatory levy has little effect on travel patterns. The idea was pushed heavily by the French government, but has not gained much traction so far. The US refused to sign on; so far only seven countries have - Chile, Côte d'Ivoire, France, Republic of Korea, Madagascar, Mauritius and Niger. The levy has, however, funded 72% of the budget for UNITAID in 2008.

The International Financing Facility for Immunization raises money for vaccination by issuing bonds based on donor pledges of future aid. This lets recipient countries receive their aid more quickly, and as lump sums rather than over a period of years. (more detail here) They repay the bondholders using the aid as it comes in.

I really like the idea of innovative financing mechanisms for health. I really do. But I think we're looking for magic bullets where they don't exist. You don't get money from nothing. The mandatory solidarity levy seems close to neutral in its impact. I think that the International Financial Facility for Immunization may actually be harmful. Recipient countries get their money sooner, but they get less of it, and I am not sold on the advantages of a big infusion of money as fast as possible.