Looking ahead to a new day

The Bill & Melinda Gates Foundation is matching all donations to PATH through December 31st. Watch this 1-minute video to learn more. Video: PATH.

Picture this: We can radically improve the course of human development and balance the scales of health equity. We can work to make it unheard of for a child to die of malaria. We can help ensure that no child dies of preventable diarrhea. Imagine that day.

At PATH, we not only imagine that day, but see it getting closer all the time. A day when all people have the tools they need to thrive no matter where they live.

By coming together, we can impact global outcomes

Portrait of Steve Davis.

Steve Davis, president and CEO of PATH. Photo: PATH/Auston James.

I believe that many of the problems we still face in the 21st century—eliminating polio, mitigating climate change, or making sure both girls and boys get a quality education—will be solved by multisector partnerships and innovation. If you believe that too, I invite you to partner with us and be part of the solution.

At PATH, we target the leading health problems in low- and middle-income countries by tackling them from every angle—prevention, detection, and treatment—using a “toolkit of innovation.” To make that happen, our work almost always involves teams from across PATH and partners from governments, industry, and local community organizations.

On a personal level, I’ve always been interested in bringing people and ideas together to solve challenges. And that’s what PATH does: we use the power of innovation to improve the trajectory of communities and individuals, so everyone has the opportunity to thrive.

We have a great opportunity to enact change, now

With staff and partners on the ground around the world, especially across Africa and Asia, and an emphasis on finding innovative solutions, we often need to move quickly, to take experimental approaches, to support proof-of-concept work, to pilot transformative strategies.

Woman holds a young girl in a fancy white dress.

Donations helped make it possible for thousands of children in Southeast Asia to avoid permanent neurological damage each year from Japanese encephalitis. Photo: PATH/Aaron Joel Santos.

For instance, PATH developed a partnership to advance an affordable vaccine with the potential to safeguard millions of people against a fast-moving brain infection called Japanese encephalitis. Donations from our supporters helped make it possible for thousands of children in Southeast Asia to avoid permanent neurological damage each year from the disease.

We invite you to be our collaborator

We know that by coming together, we can have the greatest impact.

This is why we need your support, to continue making a difference as we find lifesaving solutions, to bring the most promising of these to scale.

Help us realize a new day, together.

Through December 31, the Bill & Melinda Gates Foundation will match your gift to PATH up to $375,000

The Bill & Melinda Gates Foundation—our longtime partner and supporter—has generously offered to match every dollar of every donation toward our $375,000 goal, but only until December 31. Send your gift today or donate online. Your gift will be doubled, helping PATH work to develop breakthrough health solutions that reach millions of people in more than 70 countries worldwide.

Bringing health care to everyone

A nurse holding a diagram of the female reproductive system speaks to a group.

Although Universal Health Coverage (UHC) may be particularly challenging to implement in low- and middle-income countries, that’s where the potential benefits are greatest. Photo: PATH/Will Boase.

Today is the first-ever Universal Health Coverage Day

Here at PATH, we’re not strangers to health-focused observation days. In fact, we often commemorate these days by recommending ways in which high-quality health care and its delivery systems can be integrated and strengthened. I’m thrilled that for the first time in history, the world is calling attention to that solution in an official way.

About 1 billion people around the world lack access to basic health care. An estimated 2 billion people lack regular access to essential medicines.

More equitable health coverage would go a long way in preventing the deaths of children and women. Expanding coverage has been shown to prolong life, especially among underserved populations. But we must also ensure that all people obtain the high-quality health services they need without suffering undue financial hardship.

The cost of inaction is high

Although Universal Health Coverage (UHC) may be particularly challenging to implement in low- and middle-income countries, that’s where the potential benefits are greatest, specifically among the poorest and most rural communities.

Support among global development thought leaders is widespread. World Bank Group President Dr. Jim Yong Kim declared UHC to be central to reaching their global goal to end extreme poverty by 2030. And World Health Organization Director-General Dr. Margaret Chan has declared that “universal health coverage is the single most powerful concept that public health has to offer.”

Group of children smiling and laughing.

More equitable health coverage would go a long way in preventing the deaths of children and women. Photo: PATH/Siri Wood.

Global knowledge can help solve local problems

Where do we start? Although UHC solutions must be locally tailored for each country, there are recommendations all countries can take to ensure progress is made. Here are a few:

  • Committed: A primary health care system must receive a long-term commitment from national and local leadership, as well as support from donors and investors.
  • Accessible: Not only must health care be accessible to those seeking it, but the shared knowledge and resources needed by those providing care must also be available.
  • Measurable: Measurement and monitoring of health data must be strengthened to better understand health gaps and enact policies to ensure equitable health coverage.
  • Accountable: Mechanisms at local, national, regional, and global levels must be in place to ensure that policymakers deliver on promises and resources are used efficiently.

At PATH, we’re constantly looking for new and innovative ways to provide health equity, channeling the tremendous potential of inventive ideas, scientific discovery, and collaborations into better health and opportunity for all.

I encourage the global health community to talk about UHC as a realistic solution to ending preventable illnesses and deaths around the world.

Our guest contributor, Heather Ignatius, is a senior policy and advocacy officer in PATH’s Advocacy and Public Policy department.

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Friday Think: two field lessons on huddles

Friday Think logoThis week’s innovation story is actually a twofer with origins harkening back to a huddle on a football field in the 1890s.

That’s when Paul Hubbard, the quarterback for Gallaudet—at the time a college for deaf students in Washington, DC, and now a university—had his offense form a tight circle around him so they could discuss plays in sign language without the other team catching on to their strategy. Innovation born out of necessity which, coincidentally, led to a successful season.

Football players gather in a huddle.

Teams that innovate well, focus on the end game. Photo: Sean Murphy/Getty Images.

Fast forward to 1921 when University of Illinois started their own mini-strategy sessions on the field. It must have worked because the Fighting Illini went on to win the national championship two years later by changing the way the game was played.

What happened after these two teams innovated on the field? Everyone followed.

Here’s an excerpt from Harrold Sirkin’s article on innovation in Bloomberg Businessweek:

Today it would be unimaginable to play a football game without huddles–except, of course, when teams use a “no-huddle” offense, a back-to-the-future innovation the Cincinnati Bengals introduced in 1988. The Bengals won the AFC Championship that year, and quarterback Boomer Esiason was named the NFL’s Most Valuable Player.

The simple lesson here is that innovation can give you a competitive advantage, even put you on top—but only until others copy what you’ve done or the Next Big Thing replaces it. Innovation must be an ongoing process.

Sirkin then takes on how innovation in the corporate world aligns with innovation on the field and the value of strong support systems to continued success.

But sustaining innovation can be a challenge. Some companies do it well; others struggle. This is especially true among newer companies without strong support systems to keep the momentum going. As a result, companies that show great promise sometimes end up like “one-hit wonders” in music: They achieve a lot of success early on, then lose their mojo. . . .

There’s an important distinction between strong innovators and breakthrough innovators. The latter put a higher priority on innovation than other companies, cast “a wider net for ideas,” emphasize business model innovation as well as product innovation, and develop company cultures “geared toward breakthrough success.”

Read the full story on the Bloomberg Businessweek website.

Digital health at scale: getting beyond pilot projects

Nurse uses a laptop in a clinic in the Democratic Republic of Congo.

A nurse manages patient data in a clinic in the Democratic Republic of Congo. Photo: PATH/Yori Matumona.

It took almost 20 years for barcodes to be fully adopted across the grocery industry. Today they’re in use worldwide, delivering efficiency and automation on a massive scale.

It took the efforts of a dedicated visionary to show the impact that a single, universal-sized shipping container would bring to the trucking and freight industry. Today, shippers around the globe can be sure that a standard-sized container will fit on the truck that delivers it to the port in Mombasa and on the truck that unloads it in Seattle.

In a paper being released this week by PATH, commissioned by the Bill & Melinda Gates Foundation, we describe the journey our global community needs to take to shift the use of digital tools for health from a series of one-off projects to an institutionalized common practice—much like grocery barcodes and shipping containers impacted their industries’ common practices.

Cargo ship with containers.

An ocean freighter transports standard-sized containers. Photo: Flickr/GP1974.

Using these examples as case studies, we discuss how we can move past an era of small-scale pilots, towards more comprehensive efforts that align systems and allow for much larger-scale impact.

Changing how we think about scale

We often use “going to scale” in development efforts as a goal for moving projects beyond the pilot phase. Yet despite a decade of investment, there are only a handful of “scaled” digital health interventions to count, and no single shared definition of scale.Marcel Proust quote: We must never be afraid to go too far, for success lies just beyond.

We believe a digital product or service can only be considered successful after it’s become embedded into a health system workflow or an individual’s daily habits.

This embedding or “institutionalization” of digital health solutions is the end goal we focus on in our report, one we hope becomes more broadly shared. When a digital innovation becomes institutionalized, discussions of mHealth and eHealth will cease and our focus will simply be on health impact.

Can you imagine an entrepreneur anywhere in the world considering opening a grocery store without bar code equipment? That level of institutionalization is also possible with digital health solutions, but our stakes are much higher than groceries: we have the potential to save lives, while bringing efficiencies to health systems that could most benefit from savings.

What if automatic reminders could be sent to caregivers or community health workers notifying them when a child is due for vaccines? And what if that system integrated the local availability of vaccines and immunizations? Furthermore, what if suppliers used barcodes so health officials could track and efficiently distribute stock?

PATH’s Better Immunization Data (BID) Initiative is one example of bringing efficiencies to country-wide health systems. Supported by a grant from the Bill & Melinda Gates Foundation, the BID Initiative will help countries strengthen their immunization programs through improved data quality, collection, and use by identifying practical, country-owned, country-led digital health solutions.

Moving towards consensus in 2015

We are emerging from a period marked by great enthusiasm and innovation in digital health, but one with a very fragmented landscape of hundreds of small digital health pilot projects.

Of those, a very small proportion, fewer than 1 percent, have gone to scale or achieved institutionalization.

However, our digital health community is rich with creative, persistent, and passionate innovators who recognize that “it is not about us, it is not about technology, it is not about money, it’s about impact.”

Consensus is emerging among donors and governments that digital health institutionalization is the outcome we collectively seek, as well as a willingness to share the journey together. Now is the time for us to pause in our individual journeys, assess the current landscape, and align on a common path forward.

Editor’s note: guest contributor Kate Wilson, director of Digital Health Solutions at PATH, announces the release of a new paper at this week’s Global mHealth Forum.

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First comes love, then marriage, then making a difference

A table setting at Charles Dorner and Srilata Remala's wedding.

Charles Dorner and Srilata Remala gave all their wedding guests bracelets with the message “PATH.org: Innovation to save lives.” Photo: Bradley Hanson Photography.

He works for Amazon as a prototyper. Although he can never talk about his work, I am sure it is very interesting.

She’s a talented get-it-done woman in health care consulting who can be incredibly goofy. Her interests include supporting charities making a real difference in the world.

Charles Dorner and Srilata Remala on their wedding day.

Charles and Srilata shared their commitment to each other—and their commitment to making an impact through PATH. Photo: Bradley Hanson Photography.

That’s how Charles Dorner and Srilata Remala describe each other on their wedding website. They met three years ago through OkCupid, the online dating site. One of the topics of conversation on their first date: organizations that interested them.

On Srilata’s list was PATH, because, she says, “PATH is breaking boundaries and innovating solutions in the developing world.” PATH also turned out to be a good fit for Charles.

As they set a wedding date and made plans to make a life together, their shared interest in PATH led to an inspired gift registry for all their friends and family.

Where simple tools can save lives

Srilata discovered PATH when she was just 21 and researching health organizations for her family’s foundation, the Satya and Rao Remala Foundation. She was struck by the ingenuity of one of PATH’s early technologies: a compact clean-delivery kit filled with inexpensive tools to help mothers and babies avoid infection during childbirth. “You could take it to a village and ensure that a baby is born safely,” Srilata remembers. “It spoke volumes to how a little tool can save so many lives.”

Both Srilata and Charles know just how hard it can be to survive in developing countries. Charles’ grandfather was born in a simple hut in Kenya in 1912 with only a village midwife to ensure he was born safely. His mother refused to have any more children in those circumstances, returning to British India to have her next children.

Srilata’s father, Rao, grew up in a mud house with no running water in southeastern India and had to walk six miles to school each day. Her mother, Satya, was only 13 when her own mother died from uterine cancer.

“I could be living in India right now, facing some of the issues PATH is trying to solve,” says Srilata, who lives in Seattle. “I’m lucky. I know that when I have children they’ll be born in a hospital with good health care.”

A wedding becomes a platform for impact

When Charles and Srilata were planning their wedding, they realized they had a golden opportunity to express not only their commitment to each other, but their commitment to make an impact.

“You have all your family and friends in one room,” Srilata explains. “You’re sharing how much you care about them, but you also have a platform to share why you care about this amazing organization, which is even bigger.”

A closeup of table decorations at Charles Dorner and Srilata Remala's wedding.

Nearly 300 guests at Charles and Srilata’s wedding were honored through a donation to PATH. Photo: Bradley Hanson Photography.

So Charles and Srilata made a donation to PATH on behalf of their nearly 300 guests, and encouraged them to make donations as well. They even gave each guest a red silicone bracelet with the message “PATH.org: Innovation to save lives.”

The guests loved it.

“They learned something new about PATH and about us,” Srilata says. “A lot of people know what we do for a living but don’t realize we have such a strong interest in making a difference.”

A family tradition

Srilata developed her philanthropic side thanks to her parents, who encouraged their children to use the family foundation as a way to make the world a better place. Srilata and her older sister, Srilakshmi, now drive the vision for the family foundation. Srilata is a specialist in electronic health care for the consulting firm Point B and is the family’s advocate for health organizations.

Srilata also counts herself fortunate to have found a mate who shares her family’s values. “For us, giving back is here and now,” she says.

Charles agrees. “Being able to have an impact through PATH is important to me. And getting to have our friends and families make a difference is really valuable.”

Add yourself to the list of people supporting PATH

Right now, every dollar of every donation toward our $375,000 goal will be matched, but only until December 31. Send your gift today or donate online. Your gift will be doubled, helping PATH work to develop breakthrough health solutions that reach millions of people in more than 70 countries worldwide.

Friday Think: innovation meets sanitation workers at city hall

Friday Think logoWhen Eric Garcetti, mayor of Los Angeles, set up a $1 million innovation fund for city employees to take smart risks, improve operations, and break down bureaucracies, his requests were met with a degree of resistance if not downright consternation.

There was confusion about what smart risks really meant during a time when departments were understaffed. Thousands of jobs had been cut and left unfilled during the recession. Plus technological advances had been put on hold, saddling City Hall with outdated systems, some of which dated back decades.

All this added up to concerns that some government services could falter and possibly fail.

Failing forward: what’s it really mean?

Sanitation Bureau employee Sal Aquilar proved that smart risks, or what the mayor calls “failing forward,” could pay off after he won the mayor’s first innovation award.

A sanitation department driver sitting in his truck and using a smartphone app.

LA sanitation drivers now use a smartphone app instead of printed Thomas Guides. Photo: Allen J. Schaben/Los Angeles Times.

Here’s an excerpt from the Los Angeles Times article by Soumya Karlamangla:

Sal Aguilar, who works in the Sanitation Bureau, was given Garcetti’s first innovation award this month for what might appear to be a fairly obvious step toward improving efficiency: switching the unit that picks up unwanted furniture from using printed Thomas Guide map books to a GIS-based smartphone routing app.

But even that idea—supported by sanitation drivers—took months to clear bureaucratic hurdles.

“Some of us around them resisted,” said bureau director Enrique Zaldivar.

To implement the change, Aguilar ultimately needed the help of Bob Stone, who joined the administration last year to break down bureaucratic barriers at City Hall, and Garcetti himself.

Smartphone app for sanitation workers.

A smartphone app for L.A. sanitation drivers. Photo: Los Angeles Times/Allen J. Schaben.

For many public agencies, there’s a tension between innovating and keeping up with the demands for service, said Mark Greninger, a Los Angeles County expert on utilizing GIS-technology to improve public services.

“We can’t really fail,” he said. “You’re going to be run over the coals if all of a sudden trash stops being picked up because you tried to implement a new system.”

But Garcetti said he wants employees to take smart risks and “fail forward.”

Read the full story in the Los Angeles Times.

Each week, we scour the news for the hottest stories on innovation. Our weekly feature, The Friday Think, highlights one we’ve found particularly fascinating.

An immunization delivers a brighter future

A group of women with children.

A group of women wait outside a clinic so their children can receive immunizations protecting them from Japanese encephalitis and other diseases. Photo: PATH/Sanjay Kumar Chauhan.

Editor’s note: PATH friends and board members traveled to India to see programs that improve children’s nutrition, immunize children against the deadly Japanese encephalitis virus, and help women’s groups save and borrow money to bolster their families’ health, education, and earnings. This is the final report in a three-part series.

Friday, November 14Kaushalya Devi was first in line at the Kurkuri Village health clinic in Bihar, holding her 3-year-old granddaughter, Meni.

A young girl sitting in her grandmother's lap receives a JE vaccination.

The Japanese encephalitis vaccine has the potential to safeguard billions of people. Photo: PATH/Sanjay Kumar Chauhan.

When asked why she was there, Kaushalya said she was afraid of Japanese encephalitis (JE) and wanted Meni to get vaccinated.

Sitting next to her on the ground outside the clinic, several dozen other women and children waited their turn.

The fields of moist rice paddies in Bihar provide jobs and income for the state’s residents. They also breed the mosquitoes that carry the deadly JE virus that kills and disables their children.

“When the mosquito bites, the virus enters the bloodstream and can travel to the brain, causing the tissue to swell,” said Dr. Pritu Dhalaria, PATH’s senior team leader for JE in India. “Children who fall ill typically experience a severe fever and headache, which can lead to convulsions, coma, and death.”

Roughly one-third of people with symptoms die, and another third suffer permanent disabilities, such as paralysis or deafness. There is no cure for the disease, so treatment focuses on providing oxygen and keeping the person in a dark, quiet setting that does not further stimulate the brain. Because treatment options are limited, preventing exposure to JE is all the more important.

Boy receives vaccination in arm from woman.

A boy in India is immunized against Japanese encephalitis during a 2006 campaign. Photo: PATH/Julie Jacobson.

A 2005 outbreak killed 1,500 children in just four months in the north Indian state of Uttar Pradesh, and killed many others in Bihar and Nepal. In response, the Indian government asked PATH and other experts to find a vaccine that could be produced inexpensively and in large quantities.

“China had been using a Chinese-produced vaccine since 1998,” Dhalaria said. “PATH and others convinced the government of India that this could be the solution here.”

Bringing the vaccine to India and beyond

In advance of India licensing the vaccine in 2006, PATH collaborated with vaccine manufacturer Chengdu Institute of Biological Products Co., Ltd. (CDIBP); the World Health Organization (WHO); and ministries of health on clinical trials to prove the vaccine was safe and effective for widespread immunization campaigns.

Dhalaria recalled the multiple ways that PATH shepherded the vaccine through the process:

“We worked with CDIBP to negotiate a favorable price for public use. We helped them build a new manufacturing facility to ensure a high-quality, stable supply. And we provided technical and financial support so they would meet the international manufacturing standards required by WHO for ‘prequalification.'”

This final step, achieved in October 2013, allowed United Nations procurement agencies to purchase the vaccine while serving as an endorsement of quality for countries interested in adopting it. It was a milestone marking the first time a Chinese manufacturer received WHO prequalification, signaling China’s entry as a global vaccine supplier.

Protecting the children

Meanwhile, between 2006 and 2012, PATH helped the Indian government implement a system to immunize more than 100 million children across the country, and we worked with the government to integrate the JE vaccine into the routine immunization schedule.

During this time frame, JE immunization coverage increased from 25 to 68 percent, and the JE “positivity rate” in Bihar, where Meni lives, dropped from 19 cases in 2006 to 2 cases in 2014.

“PATH’s role in India’s program was supposed to end in 2012, but the government of India did not allow us to go,” said Dhalaria.

PATH then supported the government to open 104 24-hour encephalitis treatment centers, establish an ambulance system to transport patients, and train 20,000 health personnel. Ideally, centers were no further than six miles apart, so transport would take less than 30 minutes.

The vaccine’s journey—from China to Meni

The vaccine that Meni received this morning was part of a logistics operation that transported the vaccine from Chengdu to Kurkuri, more than 1,100 miles away.

A group of PATH visitors talk to a man man holding an insulated carrier used to transport vaccines.

PATH Journey visitors study a vaccine for Japanese encephalitis that arrived in a temperature-controlled carrier. Photo: PATH/Sanjay Kumar Chauhan.

PATH technologies played a critical role in this supply chain—from the vaccine vial monitor that indicated the potency of the vaccine once it reached the clinic, to protection of the necessary “cold chain” with refrigeration and temperature-monitoring technologies that support the safe transport of vaccines (for example, simple modifications to make vaccine carriers less likely to expose contents to freezing).

In Bihar, we met people who contribute to the process all along the line—from chronicling the arrival, storage, and subsequent distribution of the vaccines at the central health clinic; to packing the vaccine carrier for transport to satellite clinics; to teaching waiting families about the disease and the vaccine; and finally delivering the shot into the tiniest of arms.

As is the case everywhere in the world, the little ones on the receiving end despised it. The parents did their best to soothe, knowing that the temporary pain would safeguard their children for a brighter future.

The overall impact has been felt well beyond India

By 2013, the vaccine had been supplied to 11 countries outside China, reaching more than 200 million people.

The PATH Journeys program offers donors an opportunity to experience firsthand the health innovations they support and to meet the people whose lives they are changing.

This is the final report in a three-part series from Lynn Heinisch, director of Executive and Internal Communications at PATH.

Posts in this series

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7 reasons why PATH loves Giving Tuesday

Group of children standing in a grass field and holding empty water containers over their heads.

Your support funds programs that ensure children receive clean water so that fewer cases of pneumonia and diarrhea occur, the two most common killers of young children. Photo: PATH/Teresa Guillien.

By now you’ve digested your Thanksgiving dinner. Which means it’s time to pass the good will around by donating to PATH. Last year, we were able to help millions, thanks to donors who gave generously.

Here’s a closer look at who those women, men, and children were that PATH helped:

7. 219 million people. That’s how many people PATH programs were able to touch in 2013.

Uterine balloon tamponade: a rubber balloon attached to a large syringe with a rubber tube.

Uterine balloon tamponade. Photo: PATH/Patrick McKern.

6. 78,000 mothers. Childbirth shouldn’t be deadly—yet that’s how many mothers still die each year as a result of complications in pregnancy and childbirth. That’s why PATH is advancing a device called a uterine balloon tamponade, which can halt postpartum bleeding in as few as five minutes.

Woman inspecting shelves stocked with malaria drugs.

A health care worker checks the available stock of malaria drugs at her facility. Photo: PATH/Laura Newman.

5. Nearly 600,000 people. Eliminating malaria, which still kills 600,000 people annually, requires a powerful plan. Donor support is allowing PATH to optimize our strategy and develop the next generation of tools to fight this disease and save lives.

4. Millions who need care. A dramatic increase in poverty, disability, and deaths from noncommunicable diseases (NCDs) is challenging developing countries, where millions of people lack access to prevention, diagnosis, and care. Thanks to generous donors, PATH is advancing prevention and care for type 2 diabetes, hypertension, and breast and cervical cancer.

A baby held by her smiling father looks at the camera.

Thanks to PATH programs, many people are living healthier lives. Photo: PATH/M. Dorgabekova.

3. 180 million people at risk. A new test was introduced to battle river blindness, thanks to donor investments in PATH’s technology program. The disease is caused by small blackflies that leave larvae in the skin of the people they bite. Repeated infections can eventually cause blindness. PATH’s easy-to-use diagnostic will support elimination programs by detecting signs of reinfection or reemergence.

2. New innovation hubs in Africa and South Asia. We’re connecting talented locals who have the insight, talent, and will to develop technologies that can save women and children with the funding, expertise, and networks necessary to turn their ideas into mature technologies that can have widespread impact.

Schoolgirl with a broad smile on her face recieves a shot in her upper arm as her schoolmates watch.

Every year, vaccines save the lives of between 2 and 3 million children. Photo: PATH/Aaron Joel Santos.

1. Tens of thousands of children. Before PATH developed a partnership to advance an affordable vaccine for Japanese encephalitis, thousands of children in Southeast Asia died or suffered permanent neurological damage each year from the disease. The vaccine against this fast-moving brain infection has the potential to safeguard billions of people.

Your donation will be doubled

We’re ready to accomplish more this year, and need your help to make that happen. Please, consider PATH on Giving Tuesday. Between now and December 31, your donation will be matched toward our $375,000 goal, effectively doubling your giving power.

Why we need better HIV prevention technologies to protect women and girls

An adolescent girl sits on a couch.

We need better female-controlled HIV prevention methods to meet the needs of women and girls. Photo: PATH/Eric Becker.

On World AIDS Day

In 2012, half of the estimated 35.3 million people living with HIV were women and girls. Today, adolescent girls in sub-Saharan Africa are at especially high risk, and they are seven times more likely to get infected than their male counterparts.

This population is highly vulnerable to HIV for a number of reasons, including underlying social norms that affect gender roles that can increase vulnerability to HIV infection. Women and girls may be unable to safely insist their partners use a condom—or reticent about independently reaching out for health information and care. Poverty, lack of education, and food insecurity also increase women’s and girl’s risk for HIV infection.

An adolescent girl stands in the foreground of a house and a group of people.

In sub-Saharan Africa, adolescent girls are roughly seven times more likely to contract HIV than boys. Photo: PATH/Eric Becker.

In search of solutions that women and girls control

Several developments hold great promise for female-controlled technologies that can be used discreetly and without requiring a partner’s permission or knowledge.

There are pre-exposure prophylaxis (PrEP) drugs that, if taken on a regular basis, reduce the risk of HIV infection for both men and women. Several studies have shown that young women may not take the drugs frequently enough to protect themselves, indicating a need for better tools to help young women adhere to PrEP regimens. PATH, along with the HIV Prevention Trials Network, pharmaceutical company Janssen, and the Division of AIDS at the National Institutes of Health is working on the development of a long-acting injection as a potential PrEP agent. It’s hoped that someday such injections will provide protection for HIV infection over a period of months, similar to injectable forms of contraception.

PATH has long advocated for low-cost delivery options for microbicides, products which could prevent or reduce the possibility of sexually transmitted infections, including HIV/AIDs, when applied intravaginally (watch our video In Our Own Hands: A Social Movement for Women-Initiated HIV prevention Options). PATH is currently partnering with colleagues at CONRAD and the Centre for the AIDS Programme of Research in South Africa (CAPRISA) to test paper applicators for delivering tenofovir gel—a candidate microbicide for HIV prevention. If acceptable to women, paper applicators will be less expensive to manufacture, allowing the gel to be more widely available in low-resource areas around the world. PATH will help design the study and analyze the results with its research partners.

We also led development of the “one-size fits most” SILCS diaphragm, which recently received market clearance from the United States Food and Drug Administration. The SILCS diaphragm is a comfortable, easy-to-use device that doesn’t require a pelvic exam to be fitted. Next steps for this innovation include plans to study the SILCS diaphragm as a possible delivery method for a microbicide gel. If effective, the SILCS diaphragm could be used as a multipurpose prevention system to protect women from both HIV and pregnancy.

A combination approach

PATH supports a combination approach to meet the HIV prevention needs of women and girls – including HIV testing, use of male and female condoms, providing oral PrEP to high-risk populations, and treating infected partners with lifesaving antiretroviral therapy.

Along with these methods, we also need to go more “upstream” to address the multitude of structural issues that put women and girls at greater risk for HIV, such as addressing the underlying economic and power inequalities that are often the root causes of gender disparities. Empowering women to take control of their reproductive health is an important step in that direction.

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A new spin on women’s groups

PATH visitors sitting outside with large group of village residents.

A women’s group in India meets with PATH visitors. Photo: PATH/Sanjay Kumar Chauhan.

Editor’s note: PATH friends and board members traveled to India to see programs that improve children’s nutrition, immunize children against the deadly Japanese encephalitis virus, and help women’s groups save and borrow money to bolster their families’ health, education, and earnings. This is the second report in a three-part series.

Thursday, November 13—To meet the women of Anjani village in Bihar State, we walked narrow dirt alleys between their homes, stepping among cows and children.

We passed cakes of cow dung slapped on the walls next to us like rows of cookies baking to dry out and use later for cooking fuel.

A widow waved us into her home, eager to show us where she hosts meetings of a local women’s group. The dark, mud-brick shelter had a woven cot in a small room that sleeps five people. An adjoining room was for the family’s water buffalo that provides their livelihood, she told us, and a third room held fodder for the animal.

“In Bihar, we have a very strong caste system. Within that, we work with the most marginalized people,” said Tarun Vij, PATH’s country leader in India. “The families from the lower caste have all kinds of deprivations imposed upon them.”

Bihar is one of the country’s poorest states, with very high rates of maternal and newborn mortality and a literacy rate of just 64 percent. Anjani village sits along a tributary of the Ganges River and is home to some 500 families who work the nearby rice paddies.

Women sitting with their children on their laps.

The women’s groups pool their money—each contributing 40 rupees (the equivalent of US$.66)—in order to grant one another loans. Photo: PATH/Sanjay Kumar Chauhan.

Once a week, groups of 10 to 15 women gather to pool their money—each contributing 40 rupees (the equivalent of US$.66)—in order to grant one another loans. PATH works through these “self-help groups” to provide the women health tips on pregnancy, childbirth, family planning, nutrition, and sanitation, and to inform them of their rights to government services.

“We help them learn how to take collective actions and help other women,” Vij said. “If individually, you don’t have negotiating power or courage, you need to come together and access those services that you are entitled to.”

In Anjani, dozens of women gathered on the ground next to a temple to tell us how the groups have affected them. A 32-year-old mother of four said that she had delivered her first three children at home. When pregnant with her fourth, group members encouraged her to give birth in a facility where trained health workers offered best practices for her newborn’s health and development.

One woman said she joined the group to learn information that will help her children get into a better level of society, and to learn about sanitation and cleanliness so that her children will not get diseases.

“Coming to the group is like being together,” another said. “We feel happy that we come together and we get more information. Among us, unity has also improved.”

Such groups have been used successfully in many countries. What’s unique about PATH’s work in Bihar, which has the potential to transform lives for the state’s poorest people, is the use of data from the program to inform the government’s plans for 1 million self-help groups in the state.

“We have started to decode what is needed in this population. There’s a certain art to it,” said PATH’s Nityanand Deepak, who oversees knowledge management for the program. “They are starting to catch up to the higher caste level.”

Surveys of 3,800 group members in 2013 and 2014 found an impressive increase in key health indicators, such as immunization, breastfeeding, mothers’ skin-to-skin care for newborns, and delivering their children in institutions with health care providers instead of in homes.

“We need to sift the data, break the data down geographically, and try to understand the patterns,” said Dr. Lysander Menezes, team leader for maternal and child health and nutrition. “PATH is in the sweet spot of being the organization that can solve this for the country.”

In five years, PATH’s work has reached 225,000 women in 17,000 self-help groups across Bihar. PATH trains the trainers of the women who facilitate the groups, and oversees community monitoring to track facilitators’ performance.

PATH visitor Dorcas Mguge talks with a local man.

PATH’s work in Bihar has the potential to transform lives for the state’s poorest people. Photo: PATH/Sanjay Kumar Chauhan.

PATH also supports community health workers to strengthen village health committees to hold the health system accountable for services.

“We have lots of learning. Now it’s important to give that information to the government so they can scale up across all of Bihar,” said Deepak.

The PATH Journeys program offers donors an opportunity to experience firsthand the health innovations they support and to meet the people whose lives they are changing.

This is the second report in a three-part series from Lynn Heinisch, director of Executive and Internal Communications at PATH.

Coming next: An immunization delivers a brighter future.

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