Accelerating MDG progress in Africa: 6 important global health commitments

Young African woman in a classroom turns and smiles at the camera.

Since the launch of the Millennium Development Goals in 2000, we’ve seen remarkable global progress. But work remains to be done. Photo: PATH/Gabe Bienczycki.

This post’s author, Heather Ignatius, is a senior advocacy and policy officer at PATH.

Portrait of Heather Ignatius.

Heather Ignatius is a senior advocacy and policy officer. Photo: courtesy of H. Ignatius.

This week we move into the final 500 days of the Millennium Development Goals (MDGs), which were established in 2000 with a 15-year timeframe.

Since the launch of the MDGs, we’ve seen remarkable global progress toward reduced child mortality, better maternal health, and control of HIV/AIDS, malaria and other diseases. The number of deaths of under-five children has been halved. There has been a 40% reduction in the number of women dying due to complications in child birth. And, there are significantly fewer deaths from AIDS, tuberculosis, and malaria.

But there is still considerable work to be done. Too many mothers and children continue to die, and the majority of these deaths are preventable. In this final 500 day push, we must accelerate progress towards ending preventable maternal, child, and newborn death in the world’s most vulnerable areas.

Graphic of the MDGs

The MDGs are eight international development goals established in 2000.

World leaders must prioritize health issues within their countries to achieve MDG success. Earlier this month, over 40 African heads of state joined President Obama at the US-Africa Leaders Summit to explore new cooperation and partnerships for progress in Africa, including health.

US-Africa Leaders Summit Provides Six Key Commitments

Trade and private sector investments as drivers for economic growth emerged as the primary focus of the Summit, a theme we first saw when President Obama traveled to Africa last summer. While trade and investment are important tools for development, and US policies and partnerships in this area have been notably lacking, market-based solutions do not always reach Africa’s most vulnerable people, particularly for health.

Foreign aid must continue be a strong component of US cooperation with Africa in order to make changes that save lives and achieve the MDGs. At the Summit, over $37 billion dollars in commitments were announced by the US government and multi-sector investors to further development in Africa. They included key global health commitments that will advance efforts to end preventable maternal, child, and newborn deaths:

  1. The United States commitment to save 8 million children and 350,000 mothers by 2020. “Accelerate Action in Africa”, launched by the Obama Administration, will build on the vision outlined in USAID’s Acting on the Call report and create a policy and financing framework to meet its ambitious targets for lives saved.
  2. A recommitment to the Global Alliance for Vaccines and Immunization (GAVI) and broader immunization coverage. Since 2000, GAVI has supported the immunization of 390 million children worldwide. Immunization is the most cost-effective health intervention, saving an estimated two to three million lives every year.
  3. Scale-up of malaria interventions. Renewed support for the US President’s Malaria Initiative. With assistance from the US, scale-up of malaria interventions over the past decade has saved 3.3 million lives, 90 percent of which were under-five children in sub-Saharan Africa.
  4. A $200 million commitment to antiretroviral therapy (ART) for African children. The U.S. President’s Emergency Plan for AIDS Relief, with the Children’s Investment Fund Foundation, will double the number of children receiving ART across ten priority African countries over the next two years.
  5. Regulatory harmonization for lifesaving medicines. The US government committed $1.5 million to support a new initiative in East Africa to harmonize regulatory processes for medicines. This is an important step in ensuring access to lifesaving and innovative treatments.
  6. Recognition of good governance and an engaged citizenry as priorities in African countries. Building capacity for stronger in-country advocates will help citizens hold their governments accountable for health commitments to accelerate progress toward the MDGs. Later this month, PATH will roll out Advocacy Impact for Health. The new initiative will give citizens and community groups the tools necessary to become successful advocates for policy change.

These important commitments will save lives and improve health in the areas where such efforts are needed most. The progress towards MDGs, and the ongoing global commitment to health equity and poverty eradication, are cause for cautious optimism. We must continue to accelerate efforts if we are to achieve a world where all people truly have an opportunity to live healthy lives with dignity.

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Immunize mosquitoes? A radical approach to stopping the spread of malaria

Close up of a mosquito biting into skin against a green background.

Could a human vaccine to protect malaria-transmitting mosquitoes break the cycle of disease transmission? Photo: Penn State/James Gathany.

This post’s author, Ashley J. Birkett, leads PATH’s Malaria Vaccine Initiative.

Portrait of smiling man.

Ashley Birkett left the private sector for the PATH Malaria Vaccine Initiative. Photo: Genelle Quarles/Burness Communications.

On August 20 the world marks World Mosquito Day—so called to commemorate the 1897 discovery by British doctor Sir Ronald Ross that malaria in people is transmitted to and from mosquitoes. Dr. Ross went on to win the Nobel Prize for his discovery, and since then, mosquitoes have been enemy number one when it comes to defeating a disease that takes a life every single minute—most of them young children in sub-Saharan Africa.

On this historic day, let’s focus on approaching malaria in a surprising new way: with a vaccine to protect those malaria-transmitting mosquitoes. That’s right—a vaccine to stop humans from giving malaria to mosquitoes.

If we can do this, we might finally stop malaria once and for all.

So, why protect mosquitoes from humans? First, you have to understand the vicious cycle of malaria, which works like this: a mosquito bites a girl and transmits the malaria parasite, perhaps causing her to get very sick. But it doesn’t stop there. A week later, a noninfected mosquito feeds on the same child, yet this time, it is the girl who passes the parasite to the mosquito. Soon, that mosquito—now carrying malaria parasites and buzzing around the same area, as mosquitoes typically do—bites the girl’s father, passing the parasite to him. Even if he shows no symptoms of malaria and doesn’t get sick, he can still pass parasites on to another mosquito that…well, you get the picture.

That’s where a vaccine comes in.

Zambian mother holding her infant.

Malaria is one of the most severe public health problems worldwide. It is a leading cause of death and disease in many developing countries, where young children and pregnant women are the most affected. Photo: PATH/David Jacobs.

A vaccine—we call it a transmission-blocking vaccine (TBV)—could break this never-ending and often deadly cycle. This type of vaccine actually prevents the mosquito that bites the malaria-infected person from getting infected, thus stopping the parasite’s life cycle in its tracks. If the mosquito doesn’t get infected, it can’t give malaria to another person.

Of course, vaccinating humans to protect mosquitoes from malaria might sound a little crazy. From polio to smallpox, we think of vaccines as preventing people from getting a disease. This type of vaccine wouldn’t protect someone bitten by an infected mosquito from getting malaria or lessen its symptoms.

But what it would do is help protect that person’s family and community. And if almost everyone in a community received such a vaccine, over time, the entire community would benefit by having fewer and fewer infected mosquitoes flying around and, therefore, fewer cases of malaria. Ultimately, this would create “community immunity” and eliminate malaria altogether from these areas. This long-term approach for the greater good—rather than immediate, personal protection—seems a bit novel, but the outcome would benefit us all: eradication of malaria.

Graphic of vaccines and the malaria lifecycle.

Three stages in the malaria lifecycle where vaccines could have an impact. Click to see larger graphic. Credit: PATH.

We’ve made remarkable progress, but innovation is still needed

While we’ve made extraordinary progress over the last decade in reducing malaria deaths, the wily malaria parasite is rapidly becoming resistant to some of our best tools—drugs and insecticide sprays. Another tool to break the cycle of transmission could help tip the balance against malaria, and history tells us that a disease is unlikely to be eradicated without a vaccine.

To reach the end game, we need a suite of new tools that would work together—a suite that includes a vaccine.

There are a number of potential transmission-blocking vaccines in early development. The program that I direct, PATH’s Malaria Vaccine Initiative (MVI), is working with partners to research a number of vaccine approaches. In collaboration with Fraunhofer USA, we have advanced their transmission-blocking vaccine candidate through early-stage clinical trials, and the National Institutes of Health is also testing at least one vaccine approach in early-stage trials. The Malaria Vaccine Technology Roadmap, updated by the international community in 2013, has called for vaccines by the year 2030 that reduce transmission to help eradicate malaria.

Should a transmission-blocking vaccine become a reality, it would be another critical tool that paves the way for eliminating and eradicating malaria.

So on World Mosquito Day, I’m calling for a vaccine to protect mosquitoes. Because ultimately, a world of malaria-free mosquitoes means a world of malaria-free people.

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New, faster HPV test frees up resources for more cervical cancer screening

Eight-five percent of cervical cancer cases occur in the developing world. Increasing prevention, screening, and care is essential in countries like Nicaragua. Photo: PATH/Mike Wang.

This week Seattle is proud to host The 29th International Papillomavirus Conference & Clinical Workshop, and will be sharing two blog posts on our cervical cancer work. This post’s author, Dr. José Jerónimo, is PATH’s senior advisor for women’s cancers. 

Recently, we’ve seen tremendous progress in the availability of new, potentially game-changing technologies that promise to help us screen more women for cervical cancer, no matter where they live, and to effectively treat those with precancer.

Portrait of José Jerónimo.

Dr. José Jerónimo says self-screening for HPV can dramatically increase the ability of clinics and hospitals to treat more women with precancer. Photo: Courtesy J. Jerónimo.

In the past few years several new human papillomavirus (HPV) tests have become available, including the careHPV test developed by QIAGEN, an international medical device manufacturer, with support from PATH. We’ve completed trials of that field-friendly and inexpensive test, and it is now time to scale it up to reach all of the women who need it. We also have learned that teaching women to use careHPV to gather screening samples themselves frees up the time of busy health workers and can dramatically increase the ability of clinics and hospitals to treat more women with precancer, and thereby prevent cervical cancer.

HPV, the virus that causes cervical cancer (it also can cause penile, anal, and throat cancers) infects nearly every sexually active person, but most of us don’t experience advanced disease because our bodies are able to clear the infection. However, in some women the infection persists, and the disease advances over 10–20 years to a precancerous stage (when it is easy to treat), and years later to invasive cervical cancer. About 266,000 women die from cervical cancer every year, with 85 percent of mortality occurring in the developing world.

That is where PATH is focusing its efforts: low-resource settings in Africa, Asia, and my home region of Latin America.

Guatemala, Honduras, and Nicaragua have declared their interest in partnering with PATH in a project to deploy HPV testing, and related treatment options, through their public health systems. This is big! In the first project year, PATH will “seed” each country with 110,000 careHPV tests, and will work with the respective ministries of health to develop systems for effectively using the test in pilot settings. In subsequent years the countries will purchase careHPV themselves and expand availability. Through the course of the project, we estimate that more than half a million women who would not otherwise have been screened will benefit from the service.

Three lab machines set on a blank white backdrop.

QIAGEN began development of the careHPV test in 2004 with support from PATH. The careHPV test addresses health care challenges that many women face in developing countries, particularly women living in areas where medical care is infrequent and hard to access. Photo: QIAGEN.

Self-sampling—the key to universal screening?

In addition to increased sensitivity compared to the Pap test or visual inspection, a major benefit of careHPV screening is that it gives good results even with vaginal samples women collect themselves. We have found that when women “self-sample,” the test works nearly as well as when doctors or nurses gather cervical mucus samples during a pelvic examination. Pelvic exams are a rate limiter—the exam takes time, limiting the number of women who can be seen by each trained provider.

Self-sampling has the potential to dramatically increase the number of screenings clinics can organize, and allows them to focus pelvic exam resources on treating the women who test positive for HPV. This is what we mean when we talk about game-changers. Mexico and Argentina already are using self-sampling, and the three PATH project countries will do the same.

To make screening more affordable to countries over the long term, we also are working with the Pan American Health Organization (PAHO) and other partners to create a regional procurement system for screening and treatment products. PAHO member countries already save a lot of money by purchasing vaccines together in bulk orders, and we intend to garner similar savings for cervical cancer prevention equipment too.

New treatment devices overcome old obstacles

That said, screening without treatment is pointless, so we’re looking at both sides of the equation. For years PATH has been recommending cryotherapy (freezing) to treat precancerous tissue, but we also are aware of the challenges related to traditional “cryo” equipment—such as the recurring cost of gas. We are working with the Peruvian Cancer Institute and other partners to assess the performance of a new technology, CryoPen, that freezes tissue but without needing to regularly replace the gas. We’re also collaborating with a US manufacturer of an alternate treatment device that uses heat to destroy precancerous tissue (confusingly called “cold coagulation”), and which can treat up to 30 women with power from a single, portable, rechargeable battery. Working on multiple treatment options increases our chances of success and will give countries a choice.

It feels like many different factors are coming together in the fight against cervical cancer, and this is nowhere more evident than in Latin America. PATH is proud to be in that fight.

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A new era for malaria treatment

Woman in stock room looks at paper with shelves of medicines.

A pharmacist checks a stock of malaria drugs at the Gwembe District Medical Office in Zambia. Photo: PATH/Laura Newman.

Malaria drugs made with semisynthetic artemisinin make their way to patients

Portrait of David Kaslow.

Post author Dr. David Kaslow leads our drug development efforts. Photo: Merck.

This month, after nearly ten years of effort, the first batch of malaria drugs manufactured with a new, semisynthetic form of the key ingredient, artemisinin, will start reaching African countries battling the disease. The lifesaving drugs, manufactured by our partner Sanofi, a French pharmaceutical company, are the first of their kind to use semisynthetic artemisinin (ssART) in place of the plant-derived form of artemisinin used in the past. The new shipment marks a milestone in global health, potentially improving access to treatment for the millions of people, mostly African children, sickened by malaria every year.

The story of ssART—and the bold partnership that brought it from concept to use—highlights the crucial role international markets play in shaping global health, and the power of collaborative innovation to improve the systems that bring lifesaving products to the people who need them.

Soothing a volatile market

Asian sweet wormwood plant with green, feathery leaves.

Artemisia annua, or Asian sweet wormwood. Photo: Flickr/Scamperdale.

In 2004, doctors worldwide were increasingly using a powerful group of drugs called artemisinin-based combination therapies (ACTs), to treat malaria infection. That was good news for children and families everywhere. But as more countries sought ACTs, the supply and price of artemisinin, which was derived only from a slow-growing plant called Artemisia annua, or Asian sweet wormwood, fluctuated wildly. Changes in demand and supply from year to year created a volatile up-and-down cycle of pricing and supply. In 2005, for example, the price of artemisinin was at a high of US$1,100 per kilogram. That price sparked more farmers to plant sweet wormwood, creating an oversupply in 2007 that caused the price to plummet to just $180 per kilogram. That cut the incentive to grow sweet wormwood again, which resulted in a 2009 shortage that drove prices back up over the next two years, to an average of $530 per kilogram in 2011. These fluctuations strained markets, and made it difficult for leaders, manufacturers, and others to stabilize and plan global supply, risking a global shortage.

In short, the lifesaving drugs that millions of children, families, and communities relied upon were tied to a supply structure struggling under the push and pull of a volatile market.

Worldwide, a market challenge had turned into a crucial global health imperative.

Graphic showing time to grow (10 months) versus synthesize (3 months) artemesinin.

Producing semisynthetic artemisinin takes just three months, helping ensure a more stable supply to meet demand for ACTs. Graphic: PATH.

A groundbreaking partnership

Solving the challenge took a groundbreaking partnership, led by PATH’s Drug Development program, that brought together experts in research, pharmaceutical product development, and public health. In 2004, the partnership set out to develop a new manufacturing process to produce high quality, year-round, and affordable artemisinin to supplement the plant-based supply. Over a decade of work, our combined innovation and vision brought a promising concept from small laboratory batches, to large-scale production, and on to global markets.

Technician in protective gear holding an ACT antimalarial tablet.

Sanofi’s gold-standard ACT made with semisynthetic artemisinin, pictured here at the manufacturing plant in Morocco, is making its way to customers. Photo: Sanofi.

Now, as the first shipment of ssART-based malaria drugs—1.7 million treatments of Sanofi’s gold-standard ACT, Artesunate Amodiaquine Winthrop®—make their way to customers for the first time, we’ve reached the goal we set out to achieve ten years ago. Semisynthetic artemisinin opens a new future for the global artemisinin market. In doing so, it offers new security for the millions of people who rely on ACTs in countries where malaria is a constant threat. By providing a year-round source, ssART helps to manage imbalances in supply and demand, maintain stable and affordable pricing, and keep the market on an even course—ultimately expanding access to ACTs.

The future

Of course, ssART is only one part of the solution. Eliminating and controlling malaria requires a highly integrated strategy, including new vaccines and diagnostics, expanded surveillance and control, strong partnerships with governments, and much more.

I think I can speak for all of our partners when I say that we won’t be satisfied until that very last patient is cured of malaria. Until then, however, the sustained production of ssART, and the careful integration of our product into global markets, has the potential to change the landscape of global health. For the first time in history, artemisinin shouldn’t be a limiting factor in our work to develop and deploy lifesaving treatments. Even more, ssART provides clear evidence that with expertise, hope, and tenacity, it is possible for public and private sector leaders to achieve a bold humanitarian goal.

Together, we’re paving the way for a robust, reliable supply of antimalarial drugs.  And by continuing to work together, we can create a market where supply chains, farmers, extractors, manufacturers, and funders all align to create a healthier future for women and children worldwide.

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Going local: four reasons we’re investing in strengthening innovation ecosystems worldwide

Man in white lab coat sitting in front of a list of lab tests written on a wall.

The sign behind this clinician at a hospital in Kenya indicates the wait times for various lab tests. How can innovation improve this system or reduce the need to travel to a hospital for these tests? Photo: PATH/Gabe Bienczycki.

Through PATH’s new Global Health Innovation Hubs, we are collaborating with local partners and governments—starting in South Africa—to make sure that locally originated innovation translates into a healthier future for women and children everywhere. Dr. Anurag Mairal, a leader of this effort for PATH, explains.

Portrait of Anurag Mairal.

Dr. Anurag Mairal thinks innovation hubs can change the trajectory of health for women and children in communities with the greatest needs. Photo: PATH/Patrick McKern.

In many of the 70-plus countries where PATH works, entrepreneurs and innovators are conceiving and refining much-needed health technologies. But what’s often missing is the technical expertise to move these solutions to market through a complex process that includes product development, evidence building, manufacturing, and market introduction. This is especially an issue for innovations designed to improve the lives of the poorest and most isolated communities. As a result, too many lifesaving ideas never make it from a smart concept to lifesaving tools.

PATH’s newly launched Global Health Innovation Hub effort is closing the gap. This week we launch the Global Health Innovation Accelerator Initiative (GHIA) in South Africa, and we are preparing to establish a second hub in India. The idea is to combine PATH’s almost 40 years of experience in selecting and advancing high-impact technologies for low-resource settings; the capabilities of local entrepreneurs, academics, business leaders, and others; and the resources and political will of governments; in order to put more innovative technologies and solutions into the hands of the people who need them.

We think innovation hubs can change the trajectory of health for women and children in communities with the greatest needs—and that there has never been a better time. Here are four reasons why:

  1. We’ve reached a historic moment in global health.

The world is on the cusp of a sea change in how—and wherehealth technologies are developed. With the right support, countries worldwide have the economic drive, top-notch research and engineering resources, universities, companies, and entrepreneurs to bring their best ideas to life. Local innovation hubs meet the clear and urgent need to coordinate and accelerate that potential.

  1. We can save millions of lives—if we act now.

We know that innovation saves lives. Between 1990 and 2012, global efforts cut the number of children dying before the age of 5 by half. And a recent study by the Institute for Health Metrics and Evaluation showed that 4.2 million fewer children died in 2013 compared with 1990 as a result of new vaccines, drugs, diagnostics, and other innovations.

The catch? Many of the technologies that made that possible were already in development 15 years ago. We have a tremendous opportunity speed progress and save millions more lives in the next 15 years. But to do so, we must accelerate more locally appropriate health technologies, more quickly. Strengthening local innovation ecosystems is crucial to that effort.

  1. Innovation hubs are a smart investment.

First, accelerating technologies that improve the health of women is always a best bet. When women thrive, their children, families, communities, and countries thrive.

Second, innovation hubs can leverage investments already made in research and early development. By creating a clear path between these early activities and the crucial later-stage work of regulation, testing, and introduction, the hubs help early investments grow into useable products—unlocking their full potential and saving lives.

In South Africa, for example, the GHIA is working with local entrepreneurs and a US-based multinational to advance a device that can help health care workers diagnose and treat anemia (low blood iron) quickly, painlessly, and without a blood test. The investment in this technology, which is available and demonstrated to work in the developed world, is being leveraged by the local organization to create a product with appropriate features and price point for low-income communities in South Africa and beyond—saving more mothers and babies from life-threatening anemia-related complications in childbirth.

  1. Innovation hubs strengthen local systems, economies, and workforces.

Innovation hubs strengthen the national systems necessary to produce lifesaving technologies long into the future; support local and national economies; and create a legacy of investment in the health of vulnerable women and children. In addition, technologies developed and produced in hub countries have the potential to help people not only locally, but throughout their regions—increasing our impact exponentially while creating new markets and entrepreneurial ecosystems. Finally, as our network of hubs grows, countries can deepen their reach and impact by sharing expertise and resources.

The Global Innovation Hub project promotes a new paradigm in global health—one that shifts the nexus of innovation to the people who know their country’s needs best: its communities, entrepreneurs, and institutions. By tapping their resources and insight, the Hubs will strengthen the link between local needs and technology development, increase access to lifesaving technologies, improve social and economic conditions, and give millions more women, children, and families the chance to thrive.

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Human milk banking: making a powerful investment in newborn health

Hadija Akongo breastfeeding her baby.

Kenyan mother Hadija Akongo breastfeeds her infant, Ruth. Photo: PATH/Evelyn Hockstein.

August 1-7, 2014 is World Breastfeeding Week. This post’s author, Kiersten Israel-Ballard, MPH, PhD, leads PATH’s work on human milk banking. 

Breast milk is the natural first food for newborns; it provides all the energy and nutrients that the infant needs for the first months of life. One of the best things mothers can do for their newborn’s health is to initiate breastfeeding in the first hour of life, and maintain exclusive breastfeeding for the first six months of life.

Two incubators in a neonatal intensive care unit. Photo: PATH/Amy MacIver.

A neonatal intensive care unit. Photo: PATH/Amy MacIver.

But what about babies who are orphaned? Or who are isolated in neonatal intensive care units? Or whose mothers are too ill to breastfeed? Or who face other challenges in accessing breast milk?

“When I see children dying of malnutrition or HIV and I know that an intervention like breastfeeding can increase their chances of survival,” says PATH’s Sophy Mbasa, who works on the issue in South Africa, “it really pushes me to do more.”

Sophy speaking to breakfast audience.

Sophy Mbasa was invited to speak at PATH’s Breakfast For Global Health event, where she told an audience of PATH’s supporters about her work on newborn nutrition and human milk banking in South Africa. Photo: PATH.

Banking and distributing donated milk for at-risk babies

A technician handles small plastic bottles full of breast milk.

A human milk bank. Photo: Chelsea Milk Bank

Human milk banks, which rely on donated mothers’ milk, play an important part in ensuring that safe, pasteurized breast milk is available to babies whose mothers are unable to provide it. The banks are even more crucial for vulnerable babies—those who are premature, underweight at birth, severely malnourished, or orphaned. These babies are at high risk of illness and death.

However, scaling up this lifesaving intervention has been difficult in some poor countries—the very places where HIV, malnutrition, and other challenges lead to the highest numbers of at-risk infants.

PATH has become a global leader on this issue: partnering with milk banking organizations and experts around the world, developing guidance documents, and working to scale up innovative technologies that simplify milk bank processes to make them more low cost, efficient and effective.

FoneAstra device and smartphone monitoring the temperature of bottles of breast milk.

A prototype of the FoneAstra device for monitoring the pasteurization temperature of breast milk using a smartphone. Photo: PATH/Steffanie Chritz.

In honor of World Breastfeeding Week, we’re sharing a roundup of resources and stories to help accelerate the scale-up of human milk banks globally. Because we like to think of human milk banks as the most powerful kind of investment bank—investing in a a healthy start at life for all newborns.

PATH resources on human milk banking

Global breast feeding and human milk banking resources

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How to spur affordable, lifesaving health innovations

Two people in scrubs working on laptops and a large printed spreadsheet.

Improving health information systems leads to better outcomes. Here, nurses in Democratic Republic of Congo enter data to help monitor HIV patient care. Photo: PATH.

On August 18, 2014, we will be 500 days away from the target date to achieve the Millennium Development Goals (MDGs). Reflecting on this deadline, PATH president and CEO Steve Davis contributed an article to Devex entitled “Innovation Knows No Borders: Delivering on the Health MDGs.” This is an excerpt; read the full article at Devex.

Portrait of Steve Davis.

Steve Davis. Photo: Auston James.

How can we make it unheard of for a woman to die in childbirth? Or a child to die of diarrhea? How can we radically improve the course of human development? As we look to 2015 and beyond to the next phase—the UN’s Sustainable Development Goals—we need four things to spur affordable, lifesaving innovations:

  1. Financial and political support by UN member states for research, development, and delivery of new and improved health tools that target the leading killers in low- and middle-income countries. Continued investment in science, technology, and innovation is essential to building on the gains of the MDGs.
  2. Governments must integrate research into their strategic plans to achieve global health and development goals. By prioritizing and elevating science, research, and innovation, both developed and developing countries can help spur new vaccines, drugs, devices, and diagnostics.
  3. Increased collaboration between the private and public sectors and nongovernmental organizations. “Tri-sector” partnerships leverage the unique strengths of each partner to generate broad-scale impact that none could have achieved individually.
  4. Better use of data to inform policies, products, and health interventions. Improving health information systems and strengthening capability for monitoring and evaluation will support decision-making based on evidence and enable citizens to hold governments accountable.

With 500 days to go, we stand at a sensational juncture. Poised to build upon—and learn from—the MDGs, we have the opportunity to chart our future course and, in the process, make history.

Read the full article at the Devex site.

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With the Every Newborn action plan launched, what’s next for newborn health?

Newborn baby crying as his umbilical cord is tied off.

A newborn baby at the Lugube Primary Health Center in Nigeria. Photo: PATH/Evelyn Hockstein.

On June 30, Pauline Irungu, PATH’s senior policy and advocacy officer in Kenya, took part in the launch of the Every Newborn action plan in Johannesburg, South Africa.

Since the launch of the Every Newborn action plan, I feel more optimistic than ever about the future of newborn health, globally and in Kenya. At the Partnership for Maternal, Newborn & Child Health Partners’ Forum in Johannesburg last month, I joined hundreds of advocates, each deeply invested in the health of the world’s women, children, and newborns. We gathered to discuss the final months of the Millennium Development Goals (MDGs) and potential new health targets as the world transitions from the MDGs to the Sustainable Development Goals.

Portrait of Pauline Irungu.

Pauline Irungu is a senior policy and advocacy officer in our Kenya office. Photo courtesy of Pauline Irungu.

A key goal is to reduce the number of preventable newborn deaths. Over the past two decades, improvements in newborn death rates have failed to keep pace with improvements for older children. There is a growing commitment among the global health community to address this failure, and an understanding of what needs to be done to save these young lives. As a major, worldwide, first step, the landmark Every Newborn action plan outlines a strategy to prevent 2.9 million newborn deaths and 2.6 million stillbirths each year.

Where do we go from here?

Attention to newborn health is especially necessary in sub-Saharan African countries, which are making the slowest progress in reducing newborn deaths. I’ve already seen a dramatic increase in commitment to newborn health in Kenya as global initiatives like the MDGs, the Every Newborn action plan, and the UN Commission for Life-Saving Commodities for Women’s and Children’s Health have raised the profile of newborns and highlighted countries’ lagging progress toward health goals.

Newborn baby wrapped in printed cloth.

Photo: PATH/Evelyn Hockstein.

On behalf of PATH, I’ve been collaborating with partners and the Kenyan government to push forward two groundbreaking initiatives. The first is the Maternal and Newborn Health Scale-Up Strategy and Implementation Plan, which is set to become Kenya’s first policy to focus on key interventions for the three leading causes of newborn deaths: prematurity, sepsis, and birth asphyxia. The second is the development of maternal, newborn, and child health legislation that provides a legal framework to prioritize reducing the deaths of women, newborns, and children. Among other key provisions, the legislation will institutionalize the tracking of newborn deaths, which will help Kenya identify—and fix—gaps in its health system.

As a member of the Every Newborn Political Advocacy Working Group, which seeks to coordinate advocacy action and push for country-level policies that support the plan, I am excited to see Kenya make such strong commitments to newborn health.

Baby being admired with out of focus mother resting in background.

Photo: PATH/Evelyn Hockstein.

Action through innovation

Moving forward, we will need to harness the motivation I witnessed in Johannesburg and direct it toward technological, social, and systems innovations that can contribute to the end of preventable deaths. Kenya, for example, needs creative methods to get all mothers to give birth in health care facilities (40 percent still don’t). We also need inventive ways to keep babies warm in places with limited electricity, to transport newborns from remote locations to health care facilities, to develop technologies to help newborns breathe, and to ensure the financial sustainability of maternal, newborn, and child health services.

Watch Pauline Irungu speak about the importance of innovation for newborn health at the Partner’s Forum.

PATH is working on health innovations that promise to drive down newborn and maternal deaths. More than half of premature babies struggle to breathe, which is one of the reasons premature birth is the leading cause of newborn death. PATH is advancing an affordable bubble continuous positive airway pressure device that can save lives by gently flowing pressurized air into babies’ lungs. We’re also working on solutions for postpartum hemorrhage and preeclampsia/eclampsia—two of the leading causes of maternal death. Five of these groundbreaking newborn health innovations will be featured at USAID’s Saving Lives at Birth: A Grand Challenge for Development event from July 30 to August 1 in Washington, DC. These tools will save the lives of newborns as well as women, because babies are less likely to survive when their mothers don’t. According to the action plan, investments in quality care at birth could save the lives of millions of babies and women who die needlessly each year.

Though we—the global health community—have much work to do to end preventable newborn deaths, I am energized about global commitments and the motivating force of the Early Newborn action plan. This motivation will be critical to create real and lasting change for the world’s newborns.

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South Africa: scaling up care for community caregivers

Children play jumprope on a dirt road.

Children, including ten-year-old Itumeleng, play with friends in a township near Johannesburg, South Africa. Photo: PATH/Lynn Heinisch.

Editor’s note: This is the first of a three-part series of blog posts by PATH’s president and CEO Steve Davis about his experiences visiting PATH programs in three African countries this July.

In an impoverished township 35 miles east of Johannesburg, I met Dimakatso Sibeko. Wrapped in a wool blanket, the grieving 42-year-old mother sat in the dirt, leaning against the wall of her home, surrounded by other women. Last week, she buried her two-year-old daughter. A year ago, she buried her husband.  All she has left is her ten-year-old daughter, Itumeleng.

Woman and daughter in the sun.

Sibeko and her daughter Itumeleng. Photo: PATH/Lynn Heinisch.

While PATH is best known for our innovations in vaccines, drugs, devices and diagnostics, the only way these tools will have their intended impact is in the context of strengthened systems and services.

In fact, many of our programs focus on system and service innovations (PATH’s fifth platform”). Here in South Africa, we’re designing models and building evidence to improve the lives of orphans and vulnerable children like Itumeleng.

House-to-house community caregiving

Sibeko’s family lives in a makeshift settlement, bordered by a brick wall with barbed wire on top. Small, dark shacks with corrugated tin roofs crowd together on red dirt, with streams of water and sewage running down the streets where children play.

As part of PATH’s project, a community caregiver named Nomakhwezi Bafo visits Sibeko’s family a few times a month. She believes that Sibeko’s daughter and husband both died from AIDS. She says Sibeko is on antiretroviral drugs but doesn’t take them consistently, because she lacks food to eat with the medicine and can’t afford to travel to the clinic.

“The only thing I am sure of is the poverty. They had nothing. We used to find them eating pap [corn porridge] given to them by a neighbor,” Bafo said.

Steve Davis speaking with PATh staffer.

PATH staff member Yolanda Moyo described the toll that this work can have on the caregivers’ psychosocial well-being. Photo: PATH/Lynn Heinisch.

Bafo provides psychosocial support to 15 area families raising orphans and vulnerable children. Some of them are widows like Sibeko; others are grandparents, aunts, or neighbors who care for children who have lost parents; some are children who are heads of households. Bafo walks miles each weekday, checking on the families, listening to their needs, and referring them to resources when possible.

“It’s very emotional. It takes everything in you. When you meet with these families it takes you back to your past and it haunts you,” Bafo said. “You need to be professional. You need to be strong for them. They’ve got nothing.”

Caring for the caregivers

PATH partners with a community organization that provides training on psychosocial well-being for caregivers like Bafo so that they are better equipped to care for and protect children. This training is provided in all nine South African provinces, helping caregivers to hone their coping skills and access resources to support themselves and the families.

A workbook with blue ink and illustrations.

Part of the curriculum delivered to caregivers. Photo: PATH/Lynn Heinisch.

“They’ve got emotional burnout and pain. People are dying and they don’t know what to do,” said Sibongile Tloubatla, a psychologist who trains the caregivers. “They come back to visit the family after two days and the person has died. And how do you handle children who are in pain?”

Caregivers themselves can become traumatized and depressed, she said, so they learn in training how to manage the stress.

“They look after other people but they don’t look after themselves,” Tloubatla said. “We help them take care of themselves, so they can be effective in their work.”

Designing the best program for national scale-up

Given PATH’s emphasis on large-scale impact and partnering with the countries where we work, we will continue to test our models, design best approaches, and then transition this program to the government of South Africa late next year, so that it can be scaled up. In preparation, we are conducting studies on the effectiveness of the approach.

An estimated 2.5 million South African children have lost one or both parents to AIDS. The lives of the families I met this week are stark illustrations of the cyclical link between poor health and poverty. Some 20 percent of South Africans, roughly 10 million people, are unable to purchase enough food for an adequate diet. This extreme poverty both contributes to and is compounded by the AIDS crisis.

Talking with Bafo, Tloubatla, and the women who run the program, I was once again so impressed and inspired by the dedication, intelligence and compassion of community leaders and volunteers who are working so hard to improve the lives of children devastated by AIDS and poverty, and the people who care for them.

With the scope of the challenge, their one-by-one impact seems like a drop in the bucket. Yet, we all know that for any individual, just one person can make all the difference in the world. Our task then, is to leverage these results to have the greatest possible impact.

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If polio is on the run, why do we need new tools to help prevent it?

A baby held on mother's lap opens mouth to receive a drop of polio vaccine.

An infant receives oral polio vaccine in India, which was declared polio-free earlier this year. Photo: PATH/Gabe Bienczycki.

Guest contributor Laura Anderson is an editor at PATH.

In the past 25 years, global immunization efforts have eliminated polio from most regions of the world. Over the last two decades, the number of cases has dropped by more than 99 percent, bringing in sight the goal of eradication—no one with polio, anywhere.

This week, PATH and our partners announced a new contribution to this effort. A grant from the Paul G. Allen Family Foundation will help expand use of two new polio detection tools: a system to make it easier to check for polio in waste water and a simplified diagnostic test to find the virus in people.

Why do we need new tools when we’re already so close to wiping out polio? Dr. David Boyle, a PATH senior researcher, explains.

Not missing the polio virus—anywhere

Especially now, when eradication is within sight, we need to be sure we’re not missing the virus anywhere. Polio is very contagious, so a new epidemic can start with just one infection. Just this May, the World Health Organization (WHO) issued a formal warning that the virus is spreading internationally from Cameroon, Pakistan, and Syria, where conflict and other factors have interfered with elimination efforts. That puts progress at risk: it could spark new epidemics if leaders don’t step up to stop polio.

Aggressively looking for the virus allows us to adjust our strategy, catch outbreaks early, and respond quickly. It also tells us whether immunization strategies are working. Basically, we’re always asking, “Is the virus really not here or are we just not seeing it?” There’s no way to treat polio, so it’s important to keep people from getting it in the first place. Continue reading »

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