Save the Children Video: Ade from Indonesia – Save the Children Introduces a local health worker

For the past 15 years, Ade has been the person whom mothers turn to when they are pregnant, when they are giving birth and when their children become sick. From house calls to training exercises, Ade cares for the women in her community with hands-on help when they need it most.

Maternal Health Taskforce Open Forum

This announcement may be of particular interest to those of you interested in reproductive and/or maternal health.

Women Deliver has been running a series of blog posts addressing the expiration of the Millennium Development Goals in 2015. A number of experts have offered thoughts on a global framework for health after the MDGs. Now is your chance to add to the discussion as Women Deliver is hosting an online discussion starting next week to address reproductive and maternal health:

With the deadlines for the Millennium Development Goals and the International Conference on Population and Development’s Program of Action fast approaching, Women Deliver is calling on the entire reproductive and maternal health community—from policymakers to health workers to advocates—to participate in an online discussion to shape the future of our field. Join this critical global conversation at www.knowledge-gateway.org/womendeliver and weigh in on where we are, where we need to be, and how we need to get there.
 
This means taking stock of lessons learned, challenges ahead, and tackling the critical question: What will—and what must—happen to the MDGs and ICPD after 2015? Through a series of weekly, e-mail-based discussions, you will have the chance to share your thoughts, experience, and views on specific questions, like the effectiveness of global versus regional MDG targets, the role of civil society in shaping development goals, and the appropriate maternal and reproductive health indicator of tomorrow.

The forum will be open from November 7th to November 23rd, so be sure to make your voice heard!

Global Health News, Week of September 26-30

SECTION NEWS
The Advocacy/Policy Committee would like to invite you to participate in our first Advocacy Day, led in partnership with the Global Health Council. The day, scheduled for Thursday, November 3rd, 2011, immediately following the annual meeting in Washington, D.C., will be an opportunity for us to voice support for a continued focus on international health to our elected officials. With the intense Congressional pressure to cut the budget, our voices can make a real difference. As a participant during this exciting day, you will be provided with training materials on effective advocacy techniques to ensure your message is clearly heard. Even if you do not have advocacy experience, you need not hesitate to sign up because you will be teamed with others. Please consider joining your fellow International Health Section members on Thursday, November 3rd, 2011 on Capitol Hill to advocate for a healthy globe. Interested parties should register here. Please note that registration will close on October 14th. Any questions should be directed to Peter Freeman, Advocacy/Policy Committee Chair, at pffreeman@gmail.com or 773.318.4842.

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The University of Washington has launched the first full year of its Global Health Minor program!

POLITICS AND POLICY

• Tobacco companies knew that cigarettes contained a radioactive substance called polonium-210, but hid that knowledge from the public for over four decades, a new study of historical documents revealed.
• Latin American leaders have agreed to accelerate their efforts to address maternal health at the 51st Directing Council of the Pan American Health Organization/World Health Organization.
• Journalist Georgianne Nienaber looks at the impact of PEPFAR and how it may be impacted by budget battles in Congress.
• Earlier this week, the World Health Organization released a report analyzing air pollution levels in nearly 1100 cities in 91 countries. The analysis was based on air particulate levels between 2003 and 2010.
• When it came out a while ago that the CIA had used a fake vaccination scheme to try to find out where Osama bin Laden might be in Pakistan, many said it would undermine real health and humanitarian efforts. Here’s one group’s story.
• Foreign aid has acquired a bad reputation in recent years, as something usually wasteful and useless. Yet all this sound and fury has overshadowed the evidence that aid often can work.
• A report by the Partnership for Maternal, Newborn & Child Health finds that over 100 countries have increased financing for maternal and child health initiatives.
• The humanitarian impact of the world economic crisis became clearer this week, as the UN warned of huge job losses, a rise in the number of people afflicted by chronic undernourishment, and the “extraordinary price” being paid by children as “austerity programs” constrict the developing world.
• There is enough water in the world’s rivers to meet the demands of the expanding global population, but the rivers have to be better managed, according to a series of studies released today at the 14th World Water Congress in Porto de Galinhas, Brazil.
• UNICEF has called on the IMF and World Bank to ensure that children are not negatively impacted by austerity measures carried out by various countries.

PROGRAMS

• The New York Times shows how male circumcision is one of the most effective and simple solutions in HIV reduction, but has so far been hard to implement.  Meanwhile, a group of economists, including Bjorn Lomborg, are casting doubt on the cost-effectiveness of voluntary male circumcision campaigns as an HIV prevention measure.
• The New York Times features an article about the simple innovation of using vinegar to detect if a woman has cervical cancer by applying it with a brush to the cervix.
• The Global Fund, the world’s largest funder of global health, is set to radically shake up the way it disburses and manages donor money, in a move to boost efficiency that could reallocate a third of its financing in order to save more lives.
• On Tuesday, the Global Alliance for Vaccines and Immunization announced that it will be expanding its target vaccine areas to directly address diarrhea and pneumonia.
• UNFPA has announced that it is now collaborating with UNICEF to combat Female Genital Mutilation.

RESEARCH AND INNOVATION

• Spanish researchers are pleased by the results from the MVA-B vaccine trials, but this ABC report warns that there is still work to be done until a complete vaccine can be discovered.
• A slew of mobile initiatives are revolutionizing the way that healthcare is delivered in Africa and other developing communities. Doctors and hospitals in remote areas are getting information and assistance to improve health services in poor communities across the continent.
• New research suggests that coffee may help ward off depression over the long term, especially for women.
• A way to protect newborns against the flu, say researchers, is for mothers to be vaccinated while pregnant.
• A vaccine that triggers the body to start fighting malaria earlier is being developed by a group of researchers and students at Michigan State University.
• The drug industry is increasingly running trials in the developing world because its cheaper, regulations aren’t as onerous, patient recruitment is easier and informed consent is less clearly defined.
• Unprotected sex is up and knowledge about contraceptives is down among global youth, says a recent survey.
• AIDS Vaccine Advocacy Coalition Mitchell Warren says many folks ask whether an AIDS vaccine is still needed and if the search for an AIDS vaccine is affordable in today’s economic climate. The answer is yes, and Warren explains why.

DISEASES AND DISASTERS

• Roads may accelerate spread of antibiotic resistance: Samples from villages by major roads in Ecuador compared to more rural villages shows antibiotic resistant E. coli is spreading along roads.
• The recent heavy flooding caused by the monsoon in Pakistan, most devastating in Sindh, has affected the lives of over five million people. The Health and Nutrition Cluster is appealing for US$45.9 million. WHO requires US$14.8 for response for Health, Nutrition and Water and Sanitation intervention.
• New enterovirus causes respiratory disease: Promed reports on 6 clusters of respiratory illness associated with human enterovirus 68 in Asia, Europe, and the United States during 2008–2010.
• More than 20 percent of the population of Latin America and the Caribbean lacks basic sanitation and 15 percent has no access to drinking water because of poor management, said experts at a meeting that ended Thursday in Brazil.
• The likelihood of water-borne disease outbreaks is high in areas in Philippines recently devastated by Typhoon Nesat.
• Aid groups are criticizing the U.S.government delay on deciding whether to resume large-scale food donations to North Korea. The charities warn that many vulnerable people in the impoverished communist state could die from starvation.
• In a new report on rabies, the WHO finds that 45% of cases in the world take place in Southeast Asia.
• A decade-long study of 135,000 men found that those who did not have children had a higher risk of dying from heart disease than those who did, raising new questions over the links between fertility and overall health,U.S. researchers said on Monday.
• More money is needed to save lives in famine-ravaged East Africa, with the UN saying it’s something like $700 million through year’s end. The World Bank announced from Washington it would boost its aid to area countries to nearly $1.9 billion.  As if famine weren’t enough, Nick Kristoff tells us that as Somalis stream across the border into Kenya, at a rate of about 1,000 a day, they are frequently prey to armed bandits who rob men and rape women in the 50-mile stretch before they reach Dadaab, now the world’s largest refugee camp.
• An explosion of new technologies and treatments for cancer coupled with a rapid rise in cases of the disease worldwide mean cancer care is rapidly becoming unaffordable in many developed countries, oncology experts said on Monday.

TOTALLY UNRELATED TO ANYTHING – Twitter knows what you’re feeling!

Global Health News Last Week

SECTION NEWS
The Advocacy/Policy Committee would like to invite you to participate in our first Advocacy Day, led in partnership with the Global Health Council. The day, scheduled for Thursday, November 3rd, 2011, immediately following the annual meeting in Washington, D.C., will be an opportunity for us to voice support for a continued focus on international health to our elected officials. With the intense Congressional pressure to cut the budget, our voices can make a real difference. As a participant during this exciting day, you will be provided with training materials on effective advocacy techniques to ensure your message is clearly heard. Even if you do not have advocacy experience, you need not hesitate to sign up because you will be teamed with others. Please consider joining your fellow International Health Section members on Thursday, November 3rd, 2011 on Capitol Hill to advocate for a healthy globe.  Interested parties should register here.  Please note that registration will close on October 14th.  Any questions should be directed to Peter Freeman, Advocacy/Policy Committee Chair, at pffreeman@gmail.com or 773.318.4842.

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POLITICS AND POLICY

• GOP Presidential hopeful Michelle Bachmann has been slammed by scientists, doctors and others for claiming that the HPV (human papilloma virus) vaccine can cause mental retardation. An ethicist has now put up money behind his challenge to her claim.
• A commitment by G20 nations to strengthen agricultural research in developing countries will help reduce food insecurity as long as it focuses on small farmers and their needs, officials and experts said at a G20-backed conference this week.

PROGRAMS

• The Gates Foundation is often, not always fairly, criticized for being a techno-fix bunch. Melinda Gates heralds the value of community health workers in poor communities and their powerful, inexpensive ability to save lives.
• One of the international community’s goals is to eliminate mother-to-child-transmission of HIV by 2015 by expanding access to drugs for HIV-infected mothers and pregnant women.
• A primary school in the South African city of Port Elizabeth has given girls a contraceptive injection to prevent early pregnancies, angering some parents.
• Andrew Harmer reflects on what will happen to the MDGs as the original 2015 deadline draws nearer and draws some parallels to the traditional Cooper’s Hill Cheese Rolling.

• The Gates Foundation has presented the Harvard School of Public Health with a $12 million grant to support its maternal health task force.
• USAID is teaming up with former President George Bush to reduce cervical cancer deaths by 25% in five years for target developing countries.
• The magic number may be $6 billion to make a real dent in ending the spread of AIDS.
• A collaboration between UK and US funding agencies has announced more than £3.5M new funding for research aimed at controlling the transmission of diseases amongst humans, animals and the environment.

RESEARCH AND INNOVATION

• The number of African countries with national policies on traditional medicine increased almost fivefold between 2001 and 2010, according to a report on a decade of traditional medicine on the continent.
• The recently published results from two malaria vaccine trials appear to show that scientists are getting closer to developing a vaccine against the mosquito-borne illness.
• Effective nursing is the backbone of a high quality health care delivery system. GHDonline’s nursing community will discuss how ongoing mentoring and training programs can enhance nursing in an expert panel discussion September 19-23.
• The number of young women with breast cancer has more than doubled worldwide since 1980, say researchers at Seattle’s Institute for Health Metrics and Evaluation.
• After 2 years of analyzing the results of the largest AIDS vaccine clinical trial ever held, the so-called Thai prime-boost trial, and the only one so far to show some protection against HIV, researchers say they have discovered insights that could lead to an effective vaccine.
• IUDs can prevent cervical cancer, finds a study published in the Lancet.
• Reducing the incidence of malaria could also drastically reduce the number of deaths from bacterial infections among children in Africa, a study has found.

DISEASES AND DISASTERS

• Authorities worry that tropical mosquitoes found in San Gabriel Valley could spread disease if they gained a foothold in Southern California.
• A human rights investigator for the United Nations says up to a quarter of the world’s trash from hospitals, clinics, labs, blood banks and mortuaries is hazardous and much more needs to be done to regulate it.
• A report from UNICEF and the WHO shows the decrease in the rate of deaths for children under the age of five.
• The WHO warns that thousands may die if multi-drug resistant and forms of tuberculosis continue to spread throughoutEurope.
• One of the scientific advisers to the new blockbuster movie “Contagion” says the “risks are very real — and are increasing drastically… Our vulnerability to such diseases has been heightened by the growth in international travel and the globalization of food production.”

FOCUS – NON-COMMUNICABLE DISEASES

• Cancer, cardiovascular disease, respiratory illness and diabetes account for 63 percent of all global deaths, yet up to half could be prevented, according to a new report, Noncommunicable Diseases Country Profiles 2011, released Wednesday by the  World Health Organization.
• The WHO released a 207 page “global score card” on the prevention of chronic illness, one week ahead of the NCD summit at the UN.
• Eli Lilly and Company has committed $30 million to the Global Health Initiative. The Lilly NCD Partnership will work to identify comprehensive, sustainable approaches to patient care. Initially it will concentrate on diabetes.

Thanks to Tom Murphy and Mark Leon Goldberg, Tom Paulson, Isobel Hoskins, and Public Health Newswire.

Global Health News Last Week

POLITICS AND POLICY

• South Africa’s government has set out its plans to introduce a universal health care scheme with a pilot program in 10 areas by 2012 and nationally over the next 14 years.
• The U.N. must make reducing salt intake a global health priority, sayUK scientists. Writing in the British Medical Journal they say a 15% cut in consumption could save 8.5 million lives around the world over the next decade.
• IRIN reports on the story of Daniel Ng’etich, a Kenyan man who was arrested and jailed for not continuing his TB treatment.
• Dr. Jill Biden is leading a high level American delegation toKenya, which includes Raj Shah, to look into the American response to the famine crisis in the Horn of Africa.
• A report on the state of maternal health in South Africa by Human Rights Watch has uncovered some alarming trends.

PROGRAMS

• WHO has launched a new website to help those combating malnutrition. eLENA, a new e-library, gathers together evidence-informed guidelines for an expanding list of nutrition interventions. It is a single point of reference for the latest nutrition guidelines, recommendations and related information.

RESEARCH

• A TB vaccine designed for those with HIV enters phase IIb trials this week in Senegal. The vaccine works by boosting response of T cells already stimulated by the traditional BCG vaccine.
• Female smokers are more at risk for heart disease than male smokers, finds a systematic review and meta-analysis published in the Lancet.  This is a concern, as smoking rates are increasing in young women worldwide.
• Scientists are in the second phase of research into using microwaves to kill malaria parasites in mice.
• A USC researcher has developed a lentiviral vector that can track down HIV infected cells which can potentially act as a marker for targeted elimination of infected cells.
• People living with HIV who receive the proper ARV treatment have no greater risk of death compared to people without HIV, finds Danish researchers.
• Around 30 genetic risk factors for developing multiple sclerosis have been discovered by a UK-led team.
• A new study, showing that a simple blood test can accurately determine the sex of a fetus 95 percent of the time, is great news for parents at high risk of having a baby with rare genetic diseases. But it is bad news to those concerned that the tests could be used to abort a fetus based on gender.
• British researchers have discovered that the introduction of spermless male mosquitoes can lead to fewer malaria carrying females.
• A device which can test blood for HIV/AIDS in a matter of minutes has been developed by University of Columbia scientists.

DISEASES AND DISASTERS

• As if it did not have enough problems already, Somalia is now facing cholera epidemic, World Health Organization officials said.
• In an August 4 article, Trustlaw’s Lisa Anderson exposes the “silent health emergency” faced by child brides around the globe.  Not yet physically mature, they face grave danger in childbirth, due to narrow pelvises. Girls younger than 15 years of age have a five times greater risk of dying during delivery than women over 20; most of these deaths occur in developing countries that lack adequate and accessible pre- and postnatal care.
• Amid contradictory government statistics, a volunteer group in Japan has recorded 500,000 radiation points across the country.
• A Mexican teenager is the first officially known person to die from vampire bat induced human rabies infection. The 19-year-old victim was a migrant farm worker in theUnited States.
• An estimated 500,000 people in West Africaare infected with lassa fever every year, the World Health Organization (WHO) said on Wednesday, amid calls for more money to be spent on preventing its spread.
• Over at Global Pulse, Human Rights Watch researcher Katherine Todrys guest blogs on the HIV epidemic in Uganda’s penitentiaries.Uganda, she explains, has often been presented as a success story in the global fight against HIV/AIDS, and has received over $1 billion from the US for AIDS programs. Many HIV-positive Ugandans have been excluded from these efforts, though, including gay men, drug users, sex workers, and prisoners.
• Sleep apnea, a fairly common and treatable disorder that causes people to stop breathing momentarily while they sleep, may lead to cognitive impairment and even dementia.
• Although cases of sexual violence have been under-counted during some wars, during others, such as the ongoing unrest in Libya, they have been vastly over-counted.
• All patients getting cancer treatment should be told to do two and a half hours of physical exercise every week, says a report by Macmillan Cancer Support.

Fellowship: Jacaranda Health Maternal Health Fellowship (Nairobi)

Jacaranda Health: Maternal Health Fellowship

Background
Jacaranda Health is a start up social enterprise that aims to set a new a new standard for maternity care in East Africa. We are combining business and clinical innovations to create a self-sustaining and scalable chain of clinics that provide reproductive health services to poor urban women. Our model is a combination of two tightly-integrated services (a) Jacaranda Maternities near the slums where women can go for respectful obstetric care, safe delivery, and postnatal care; and (b) mobile vans that create a direct link with our patients, generate demand and healthy outcomes through antenatal care and birth preparedness. Jacaranda has received awards for its model, and we are also planning to work as an “innovation laboratory” for new approaches in improving maternal health, from outreach and marketing, to low-cost mobile technologies

We are piloting the model in Nairobi with a Jacaranda Maternity and mobile unit. We have just launched our first mobile clinic and are providing services to women in peri-urban Nairobi. We are working quickly to prepare to launch a fixed clinic for deliveries and basic emergency obstetric care.

Job Summary
Jacaranda Health is looking for a medical student or MPH with experience and interest in maternal health to help us develop evidence-based protocols for our new maternity clinic. This is an opportunity for an ambitious student or recent graduate to spend three to six months working with some of the most exciting innovations in maternal health. We have a great team in Nairobi, and good advisors internationally, and would like to have some help from someone who has a combination of a clinical and public health research background

Responsibilities
The Maternal Health Fellow would work with our international clinical advisors, our front-line clinical staff, and our operations manager to help develop a set of clinical protocols that are truly world-class and evidence based. This will require research, compiling protocols from our library of protocols and academic research in maternal health, and vetting them with our clinical staff in the field. We want to take the best practices from maternal health globally and translate it into a set of protocols that provide clear checklists and decision support for our frontline nursing staff. There will also be an opportunity to get involved in other clinical activities, such as systematizing our clinic processes, working with our partners at Harvard School of Public Health on our impact evaluation, and some of the new technologies that Jacaranda is piloting.

Timing
This is a full-time three to six month position, preferably based in Nairobi. Start date as soon as possible: August or September through November. The position is a volunteer fellowship, but Jacaranda can offer a stipend for expenses and housing.

Qualifications

• MPH or medical resident, with experience working in maternal health, ideally from both a clinical and a research perspective
• Highly resourceful, independent, and self-starting
• Demonstrated professional experience and an interest in maternal health
• Flexible and easy-going enough to work in a fluid, cross-cultural startup environment in Nairobi
• Ability to communicate findings compellingly to colleagues and advisors
• Desired: experience working in East Africa

Benefits

• Opportunity to work with our advisors and partners from obstetricians at Harvard and internationally, to experienced nurses and midwives in Kenya
• Exposure to all facets of building innovative maternal health organization. You will have a chance to see first hand the clinical, operations, marketing, technology, and business elements that go into building a successful social enterprise
• Learn about maternity experience and clinical challenges faced by low-income mothers in peri-urban areas
• Significant responsibility and independence

Additional Comments
Interested candidates may apply by email with an up to date CV and cover letter to jobs@jacarandahealth.org. Please put “Maternal Health Fellowship” in the subject line.

Notes on IH Section Conference Call: Current Developments in MCNH (June 27, 2011)

The IH Section held its third topic-focused conference call on Current Developments in MCNH on Monday, June 27, 2011 from 1:00 to 2:00 EST. We had several members of the IH section offer their commentary and expertise on current issues concerning maternal and child health.

Speakers
Laura Altobelli (Future Generations)
Elvira Beracochea (Midego)
Carol Dabbs (U.S. Department of State)
Miriam Labbock (Carolina Global Breastfeeding Insititute)
Mary Anne Mercer (University of Washington)

Laura Altobelli: Brief presentation of the APHA policy resolution proposal submitted by the IH section entitled, “Call to Action to Reduce Global Maternal, Neonatal, and Child Morbidity and Mortality.”
Laura discussed the new APHA policy proposal on MCH. There was nothing previously on the APHA policy regarding global action on this issue per se – one previously existing resolution focuses on reducing maternal and child mortality in the US, and one focuses on breastfeeding and has both domestic and global aspects. This, then, is the first policy proposal on global MNCH. Justification for the policy proposal is lack of progress on the MDGs and lack of policy commitment to protect vulnerable populations. APHA will be joining important other organizations that are putting out strategies, including the Partnership for MNCH (WHO), and the UN, and attended global meetings in 2010 in observation of the Year of Maternal Health (some of these mentioned below). There is also an effort to increase attention to this in the Global Fund and GHI. Six other sections/forums are co-sponsoring the resolution.

Elvira Beracochea: Update on the Millennium Development Goals 4 and 5.
A factsheet has been sent out (available upon request – please contact jmkeralis [at] gmail [dot] com). These MDGs and their targets have served us well to measure our progress so far. There have been improvements, though progress has been uneven. MDGs 4 and 5 focus on reducing mortality but not necessarily on improving health, development and well-being, and we need to address this as well. We know where women and children die and how. We also have the knowledge to prevent these deaths. We need to coordinate work at global scale and have a concerted strategy to ensure the rights of all women and children are met. We need to take global health goals to a new level of effectiveness using efficient strategies and a human-rights-based approach. A rights-based approach does not focus on only survival, but also on development. We need new targets and indicators that measure not only deaths but also number of children whose right are fulfilled; the children that are breastfed, fully immunized, drink clean water, are protected from malaria, and that that attend school. We need targets and indicators that measure not only the number of women that died or delivered with assistance of a skilled attendant, but that also measure the number of pregnancy complications effectively treated. We need new MDGs and targets.

Miriam Labbok: An update on reproductive health continuum (birth, breastfeeding and birth spacing promotion, protection, support) as an essential MNCH intervention approach.
It is vital that we pay attention to the reproductive health continuum within the life-cycle approach: birth, breastfeeding and birth spacing. Programming must include not only promotion, but also skill- and capacity-building so that support can be provided. In addition, policy change is needed to: support treating women with dignity, provide NFP knowledge (at least for the times that family planning supplies run out), and create the capacity to support health-supportive birth, breastfeeding and spacing practices. All such programming and policy creation should be carried out with recognition of the rights of both women and children to the best possible health support and with attention to appropriate technologies, as one size does not necessarily fit all. In addition, programs that address cultural change and intimate family and social decisions demand the building of trust that comes with reliability and long-term relationships. Programming should be designed for the long term, with a strong base and phased in activities, and with excellence and sustainability as the focus.

Mary Anne Mercer: Partnership for Maternal, Neonatal and Child Health – what it does and how one can get involved.
The Partnership for Maternal, Neonatal and Child Health is a WHO-based coalition of organizations that support increased funding commitments to MDGs 4 and 5. Any organization that supports MCH can be a member simply by filling out an application from the PMNCH web site at www.who.int/pmnch/. Be sure your organization is a member (it’s free!) by checking the member list. Also check out the ‘Knowledge Portal’ that aims to maintain updated programmatic information on current approaches to improving MCH. I am on the Board of Directors of the Partnership as an NGO representative, and we will be electing a new member of the Board this year that will represent an Africa-based NGO or the Africa office of an international NGO — please let me know if you have any suggestions for good candidates for that position.

Carol Dabbs: Trends in US government funding levels for global MNCH.
Funding has increased and is overseen by the State Department. Global Health targets are to be achieved with funding from FY 09-14, generally for implementation in FY 10-15. The Global Health Initiative includes principles supporting country-led plans and to coordination with other partnerships and donors, as well as between USG agencies and health programs. Eight countries have been selected as “plus” countries (places to conduct learning laboratories): Ethiopia, Kenya, Mali, Malawi, Rwanda, Bangladesh, Nepal, and Guatemala. Almost all of the Global Health Initiative funding is from USAID and State (there is also some DHHS funding, but that was not included in this discussion). There are two stages in the fiscal year: requesting funds from Congress and appropriation of funds by Congress. Unfortunately, delays have been a reality this year. However, we should look at trends and context of the rest of foreign assistance and of overall health fundig. The budget now includes nutrition as a separate item, and it’s included in the MNCH numbers here. There has been a trend of increased funding; funding for MNCH has increased about by 22% over two years (FY 2008 to FY 2010), but the full year continuing resolution for FY 2011 allocation to MNCH is still pending. We do not know what the appropriations for FY 2012 and FY 2013 will be.

Discussion: Is this in addition to Dept of State HIV funds? Yes, there are additional funds in USAID for HIV/AIDS, as well as funds for MCH and the rest of the health programs.

A Golden Moment: Global Partners Unite to Expand Access to Skilled Birth Attendants

Guest Contributor: Conrad Person, Director of Corporate Contributions, Johnson & Johnson
As a record-setting 3,000 delegates from more than 111 countries gathered last week in Durban, South Africa for the 2011 International Confederation of Midwives Congress, I believe that we are witnessing a “golden moment” for the global campaign to realize the right of every woman to have access to the best possible health care during pregnancy and childbirth.

Two things give me hope. First, a new analysis from the United Nations Population Fund verifies what we’ve known for decades – only by expanding access to quality midwifery services, especially in the world’s most needy countries, can we curb maternal and newborn mortality. Second, the groundbreaking Millennium Cities Initiative (MCI) is demonstrating what is possible when we focus on improving health in the world’s poorest cities.

This “golden moment” was on full display on a recent blazing hot afternoon in the Jamestown section of Accra, Ghana. With the Jamestown Lighthouse looming in the background, I was reminded that this Ga fishing community was once the heart of historic Accra. But now, it is a poor neighborhood in a city where the mean household income is less than $4 U.S. a day. In a brick courtyard, about 300 women wearing the distinctive colors and patterns of West Africa sat beneath a canvas tent. While Ga drummers, famous the world over, quickly attracted an overflow crowd and the First Lady of Ghana and Accra’s Mayor also inspired the audience, the stars of the show were the babies these women held in their arms.

Five of the midwives took their places in the center of the courtyard. One pretended to be in labor and from beneath a blanket another extracted a mannequin baby. “The baby is not breathing,” she announced. The team quickly went into action to resuscitate the baby.

At this point a regional director for MCI, Abenaa Akuamoa-Boateng, whispered into my ear, “This is the golden minute. Success depends on acting swiftly.” In a minute or so, the mannequin seemed to give a cry like a lamb’s bleat. Even with babies in their arms, the audience clapped.

Each year, an estimated one million babies die from birth asphyxia, or the inability to breathe right after delivery. But skilled birth attendants can change that. More golden moments would be successful if more midwives and skilled attendants had the authority and support of their government to attend these births. MCI is working to tackle one aspect of this global campaign – bringing critical health care services to the most vulnerable mothers and newborns in the world’s poorest urban centers.

Much is made, rightly, of the plight of rural women and children, but MCI makes the case that the urban poor represent a great challenge as well. MDGs 4 and 5 simply can’t be achieved if major African population centers have persistently poor health outcomes for mothers and babies.

MCI addresses this problem through a Neonatal Survival Program, piloted during the past year in Accra and Kumasi, Ghana. This program has incorporated training for 120 frontline caregivers in neonatal resuscitation and infant care with follow-up outreach to and health education of more than 1,500 new mothers, demonstrably saving newborn lives. This program has had the support of Johnson & Johnson, AmeriCares, the American Academy of Pediatrics and local and national health agencies. Statistically, it’s all but certain that without this program, some of those 1,500 children would not have survived.

I left Jamestown with the strong conviction that if we are to meet the MDGs, we must treat every minute that we have left as a “golden minute.” I hope we take full advantage of this unique – and critical – moment to act.

Global Health TV Video: Nutrition, obesity and exercise in maternal and child health

At the 38th Annual International Conference on Global Health, four distinguished panelists — Mirta Roses Periago, Hon. Richard Visser, James Whitehead and Marc Van Ameringen — discuss the dual burden of undernutrition and obesity in developing countries.

IH Section Conference Call: Current Developments in MCNH

Please join us for our next bi-monthly conference call!  The IH Section is hosting its topic-focused conference call for the month of June.  The call will be held on Monday, June 27 from 1:00 to 2:00 p.m. EST.  This call will be hosted by section members Miriam Labbock and Laura Altobelli, who will be discussing current developments in maternal, neonatal, and child health (MCNH).  The call will include:

• Brief presentation of the APHA policy resolution proposal submitted by the IHS entitled, “Call to Action to Reduce Global Maternal, Neonatal, and Child Morbidity and Mortality”
• Update on the Millenium Development Goals 4 and 5
• An update on breastfeeding and child spacing as essential MNCH interventions
• Update on the Global Alliance to Prevent Prematurity and Stillbirth
• Partnership for Maternal, Neonatal and Child Health – what it does and how one can get involved
• Trends in US government funding levels for global MNCH

Background information to review before the call includes:

• APHA policy resolution proposal submitted by the IHS entitled, “Call to Action to Reduce Global Maternal, Neonatal, and Child Morbidity and Mortality*
• Factsheet on the Millenium Development Goals 4 and 5*
• Innovations June 2011 (newsletter on maternal health)*
• Partnership for Maternal, Neonatal and Child Health
• Global Alliance to Prevent Prematurity and Stillbirth:
  1. The Lancet special series on Stillbirth came out in late April and all articles and comments are available for free from the series webpage. People may need to register on The Lancet website, but that is also free.*
  2. The Global Alliance to Prevent Prematurity and Stillbirth plans to launch additional advocacy around preterm and stillbirth and the GAPPS conference in July 2012 will highlight research and discovery needs around both PT and SB.*

*If you would like copies of these documents or have questions about these two issues, please contact Andrew E. Barrer, Ph.D., at aebarrer@gmail.com or (202) 674-9294.

 TOPIC: Current Developments in Maternal, Neonatal, and Child Health (MCNH)
DATE AND TIME: Monday, June 27, from 1:00 p.m. to 2:00 p.m. EST
PHONE NUMBER: (712) 432-1001 (please note that this is not a toll-free number)
PASSCODE: 477461343#

You are welcome to submit comments and questions for the speakers; however, we ask that you submit them in advance so that the panel can present them to the speaker. This will allow us to keep things organized. Please e-mail questions for the speakers to jmkeralis [at] gmail [dot] com  by Friday, June 24 at 8 p.m. EST (June 3, 2011).

“Driving out Trash”: Five years brings only more evictions for Harare’s slum-dwellers

Flickr, Sokwanele - Zimbabwe

The Shona word murambatsvina means “to drive out trash.” This was the word used to describe the Zimbabwean government’s campaign to forcibly clear out the slum areas around the country, under the pretense of combating illegal housing and reducing the spread of infectious disease. Zimbabwe’s current president has described the “urban renewal campaign” as “a vigorous clean-up campaign to restore sanity.” UNHCR has estimated that the forced evictions have directly affected at least 700,000 people, and that approximately 2.4 million more could have been indirectly affected in some way. The campaign was condemned by the UN and was called a crime against humanity.

Five years later, the evicted slum-dwellers still remain homeless. The few houses that were built as part of the re-housing scheme were given to government employees. Obvious human rights abuses aside (like torching people’s houses and belongings) aside, the campaign had serious health consequences for the evicted populations. HIV patients were cut off from clinics and antiretroviral medications. Thousands of IDPs are still living under emergency plastic sheeting with no medical services or clean water, no schools, no sanitation, and no source of income. Amnesty International has reported a shockingly high neonatal mortality rate among babies born to evicted mothers: in five months, there were 21 newborn deaths in Hopley, a settlement 10 km south of Harare. Most of the babies died within 48 hours of birth. The women have said that they were fully aware of the importance of maternal healthcare, and they all wanted to give birth in a hospital or with a trained birth attendant, but many could not afford the $50 required to register for antenatal care. The nearest maternity clinic is 8 km away. Some thought their babies had died because of minimal access to healthcare, while others suspected they had died of cold because they live in plastic shacks.

Amnesty International and other human rights groups have called for an investigation of the newborn deaths, but there seems to be little hope of a serious inquiry. Meanwhile, there are growing concerns of another eviction campaign: residents are again being forced to leave their homes because they cannot afford a(n arbitrarily-imposed) $140 “lease renewal fee.” Zimbabwe’s government of course denies this, but it a bit difficult to argue when the evidence consists of shacks on fire. Several MEPs have called for the Zimbabwean diplomat to the EU to be sent home in response to the evictions – but will it be enough?

This was also posted on Jessica’s Refugee Research Network blog.

International Health: A One-Way Trip?

Guest blogger: Dr. Teresa Nwachukwu

This is my first blog ever, thanks to a hard-bargaining Jessica.  I knew that the International Health section of APHA was the right place for me when I saw that one of the burning issues for the section is the challenge of recruiting hard-earned health workers from poorer countries by richer nations. Having registered for the IH section, I raced around that colossal conference centre in Denver, trying to locate meeting rooms.  As the meetings progressed, I was dismayed to find that “international health” basically meant America sending health, aid, services, materials, people, or whatever to Africa and other resource-poor continents. It seemed to me that poorer countries had nothing to offer the richer nations.  International health seemed like a one-way trip to these nations with no return visits. The question I asked myself was, does Africa have anything to offer, or has Africa ever given anything, to Europe or America? If so, have these gifts been widely acknowledged? 

I can think of a lot of things we are doing right. For instance, Nigeria still has an amazing maternal social support system. A nursing mother hardly ever has to go it alone. Rich or poor, there is a neighbour, friend, mother or mother–in-law, or sister who is delegated, or who takes it upon herself, to mother and pamper the new mama for months. Might a practice like this contribute to mothers’ mental health shortly after delivery in richer nations like the United States?

In a country with so many challenges, getting through a pregnancy, while highly desirable, is an alarmingly risky business. Can you begin to imagine what the infant and maternal mortality rates would have been like without a powerful communal support system for every new mother? Fully-paid maternity leave for four months has improved what would have been a colossal disaster if working mothers had to return to work a month after delivery, or lose their jobs.

 I live and work in Nigeria and have been in the United States for four whole months. The question I ask myself is, “What can I offer in terms of ‘international health’ to America?” Quite a lot, I have discovered. One of them has been sharing hands-on experiences about the public health practice in Africa from a different angle.  Believe me, it is better than reading it in the books. Also, I have found a community centre in my neighbourhood where I volunteer once a week to set tables and help feed the homeless.  (And yes, people, there are homeless folks in America.)  Really, the greatest gift these ‘poor’ countries can give the United States is to look within themselves and solve their problems so that America can redirect some of the outgoing resources inwards. In my opinion, international health should mean the practice of sharing health information and services by all peoples with all peoples and not a one way trip by the rich to the poor.  After all, what is a relationship, if one partner only gives and the other only receives?

Dr. Teresa Nwachukwu is a Humphrey Fellow at Tulane School of Public Health and Tropical Medicine. Her area of research is Health Systems Strengthening with special focus on the human resource component system.

Despite successes in reducing global maternal mortality, Yemen still struggles to provide adequate maternal care

The Lancet grabbed the attention of global health advocates this week when it published a study recording a significant drop in maternal mortality between 1980 and 2008.  The global maternal mortality rate has declined approximately 1.3% per year, due to a combination of lower pregnancy rates, higher income, more education for women, and higher availability of skilled birth attendants.¹  Though progress toward the fifth Millennium Development Goal varied significantly by country, the news is encouraging, particularly in a field where there has been a perception of no progress.

An Oxfam-trained midwife cleans up a newborn at Sayoun General Hospital, Yemen. Photo courtesy of Abby Trayler-Smith/Oxfam.

However, this positive finding also brings a new sense of urgency to countries where maternal mortality remains high.  Yemen in particular has a depressing maternal and child health record.  According to UNICEF, each Yemeni woman has 5.2 children on average, and the adjusted maternal mortality ratio was 430 per 100,000 live births.  Only 47% of women were attended by skilled health personnel even once during pregnancy from 2003-2008 (only 11% were attended four times or more), and a mere 36% gave birth with a skilled attendant present.²  In 2005, 1 in 39 women died from childbirth or related complications.  And yet maternal care is only one area where women suffer in Yemen: the country, which has attracted recent media attention for “child brides,”^3,4,5 is ranked last in the World Economic Forum’s global gender gap index.³

In the face of such dismal statistics, one intervention, supported by the Extending Service Delivery project at Ibn Khaldoun Hospital in Lahej, is working to reduce maternal mortality.  This intervention has greatly improved care given to mothers and newborns over the past year by implementing eight best obstetric practices:

• family planning counseling for women immediately after delivery
• Vitamin A provision to mothers after labor
• infection prevention controls
• kangaroo mother care for premature babies
• exclusive and immediate breastfeeding
• active management of the third stage of labor
• tetanus and polio vaccines for newborns
• newborn resuscitation

Through a partnering program, progressive religious leaders preach the merits of family planning in mosques and midwives meet with women’s groups to discuss contraceptive choices.  Prior exposure to these issues then increases couples’ acceptance of the best practices when they arrive at the hospital.  Dr. Jamila Raebi, Yemen’s deputy minister of health, is championing the program and has developed a plan to scale-up the practices to health facilities throughout the country.

The global-scale progress in maternal health currently being made highlights the need for progress in countries struggling with MDG5.  Though these interventions have demonstrated promising results, all Yemeni women desperately need improvements to their country’s maternal health capabilities.

‘Sure Start’ in India Mobilises Communities for Maternal and Neonatal Health

Expecting mothers and their mother-in-laws learn about how to safely sever the umbilical cord of a newborn at a Sure Start facilitated Mothers’ Group Meeting in Sabji Village, Rae Bareilly District, Uttar Pradesh, India

By Tania Lal

A report by UNICEF India in January 2009 found that about a million neonatal deaths occur in the country each year. Uttar Pradesh (U.P.) has the largest population of any state in India and continuing problems with neonatal mortality. In an effort to tackle this problem PATH India with funding from the Bill and Melinda Gates Foundation has initiated Sure Start, a five year project that works with a population of roughly 25 million. The program is described on our website at http://www.path.org/projects/sure-start.php.

A major contributor to these death rates is the lack of literacy and awareness that exists in the rural areas of the country. For example, the benefits of immediate and exclusive breastfeeding are not well understood. For this purpose Sure Start in U.P. works with  community health workers and facilitates the functioning of village health and sanitation committees.