Ridding Senegal of malaria

Womanholds a young child on her hip. In the background, a swath of mosquito netting above a single bed is visible. Photo: PATH/Gabe Bienczyck.

Bednets, like the one here, are part of a strategy to eliminate malaria, region by region. Photo: PATH/Gabe Bienczycki.

In 2005, a coalition of partners, including Senegal’s National Malaria Program and PATH, began scaling up the availability of malaria diagnostics and medications in the country. They distributed more than 7 million insecticide-treated bednets—in a country with a population of about 13 million—to protect people from the mosquito-borne malaria parasite. Results were dramatic. From 2006 to 2013, malaria death rates in Senegal dropped by 62 percent.

Now, the partners have set their sights on eliminating malaria from the country all together, one community at a time.

In a blog post published recently on our sister website, Making Malaria History, three coauthors (Dr. Mady Ba of Senegal’s National Malaria Program; Phillipe Guinot, leader of PATH’s Senegal office; and Dr. Yakou Dieye of the Malaria Control and Evaluation Partnership in Africa, a program at PATH) outline a strategy for eliminating malaria in Senegal. It involves driving down infection through “broad use of diagnostics and treatment, maintenance of high levels of coverage with bednets, and the use of advanced surveillance methods to track and treat the remaining cases of the disease.”

Malaria-free Senegal

The northern district of Richard Toll is an area of first focus. With the help of private- and public-sector partners, the team has already established areas in the district with zero malaria transmission. A special media gallery tells the story of the remarkable and encouraging advances in Richard Toll.

Now, the partners write, they are aiming to gradually expand the malaria-free areas “until entire provinces are free from the disease.”

“Decreasing the number of people who get malaria is no longer enough,” they write. “We want to continue to prioritize improving the health of our people by developing strategies to end the burden of the disease once and for all.”

More information

•    Our work in malaria.

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Target the “poorest of poor?”

Smiling woman in a yellow sari holds a cup of water to her lips as she poses by a water container and filter.

It may be better to market global health products initially to people who have some means. Here, a woman in India poses with her home water filter. Photo: PATH/Gabe Bienczycki.

Are the “poorest of the poor” always the right market to target with global health innovations? Joel Segrè, an independent strategy consultant focused on product development and distribution challenges in global health, took on that question during a recent panel discussion organized by our Drug Development Program. Here’s an excerpt, first published on the Drug Development blog.

Q: There seems to be a tension between targeting the “poorest of the poor” and other market segments. Who should be our first target users for global health innovations?

Portrait of Joel Segre.

Joel Segrè argues that marketing to the poorest market segment may not always be the best course.

A: Many global health organizations strive to target the “poorest of the poor” with various health services and technological innovations. If we are truly working to improve the lives of the maximum number of people, this “poorest of the poor” approach may be a mistake for two reasons.

The first has to do with cost-effectiveness. For most health innovations, it will almost always be more cost-effective to address the needs of urban poor or those who live within a reasonable walking distance of care—and these people have real needs that we can address immediately.

The second reason to question the “poorest of the poor” approach has to do with diffusion of innovation. Technological innovations that really take off almost never start by serving the most downtrodden users. Instead, innovation and uptake often begins with users who are easier to reach and present a market opportunity. Then, over years, the innovation finds its way to all economic strata.

Often private-sector providers find a profitable way to extend reach beyond what anyone thought possible. Mobile phones are the classic example. Let us innovate with a long-term view to serving all people, but a short-term view to addressing the needs that can be met most cost-effectively.

 

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Myth: malaria is unstoppable

A man wears a shirt with the words, "Stop malaria: sleep under treated net."

Tools like insecticide-treated bednets are helping to eliminate malaria. Photo: PATH/Eric Becker.

Recently, Bill and Melinda Gates released their annual letter, which took on three persistent myths that block progress for the poor. In the same spirit, this week we’re debunking six myths that impede progress in global health. Today we take on:

Malaria will always be with us.

Portrait of Kent Campbell.

Dr. Kent Campbell sees a future free of the threat of malaria. Photo: PATH/Patrick McKern.

Mythbuster: Dr. Kent Campbell, director of PATH’s Malaria Control Program.

Malaria, transmitted by mosquitoes, has been sickening and killing people literally forever. It’s been happening for so long, in fact, that many communities have come to believe that malaria is just a fact of life. They’ve come to accept as inevitable the immense health toll that the disease extracts—killing children, sapping the strength of adults, and impeding social and economic development. And tragically, until recently this perception was true.

But during the past decade, we’ve made dramatic progress in fighting the disease. Major infusions of financial and political support have reinvigorated national malaria programs across sub-Saharan Africa, the region hardest hit by the disease. These programs have supported massive efforts to protect millions of people with insecticide-treated bednets, treatments, diagnostics, and other lifesaving tools. The result? In just a short period of time, malaria rates in young children have been cut by more than 50 percent, resulting in more than 3.3 million lives saved from the disease. By the late 1990s, this global effort also completely eliminated transmission of the disease in ten countries, with nine more on the way to achieving that status.

On to elimination

Bolstered by these successes, governments in sub-Saharan Africa are now committing resources in partnership with global funders to pursue the ambitious goal of malaria elimination. These governments are working with key partners like PATH to leverage new tools and strategies to accelerate the fight to eliminate the disease in some of the most difficult to reach places. And science is on our side: with innovative strategies, effective new drugs—including the promise of a single-dose cure—powerful point-of-care diagnostics, and the encouraging potential of vaccine candidates, we are fighting the malaria parasite better and smarter than ever before.

So how do we know that we can defeat malaria? Because we are already doing it. The disease has long been an unacceptable burden on many of the poorest countries in the world, but together, we are working to make malaria history.

The series:

Women don’t need a condom.

Diseases like cancer don’t affect low-income countries.

Diarrhea is rarely fatal.

Women don’t die in childbirth anymore.

There aren’t enough lifesaving ideas.

Malaria is unstoppable.

More information

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Myth: there aren’t enough lifesaving ideas

A man writes on a whiteboard while a woman and a man watch.

It’s a long road between the whiteboard and implementation. Photo: PATH/Patrick McKern.

Recently, Bill and Melinda Gates released their annual letter, which took on three persistent myths that block progress for the poor. In the same spirit, this week we’re debunking six myths that impede progress in global health. Today we take on:

To improve the lives of the world’s poorest people, we need more good ideas.

Portrait of Anurag Mairal.

Anurag Mairal says a good idea is only the beginning. Photo: PATH/Patrick McKern.

Mythbuster: Anurag Mairal, leader of the Technology Solutions Program at PATH.

While creative new ideas are important, the landscape of the global health and development sector is littered with really great and innovative ideas that ultimately did not reach the people who might have benefited.

We do not lack for good ideas. The real challenge comes in moving the best ideas through the innovation pipeline to reach the ultimate goal: scaled, manufactured, commercialized, and community-accepted interventions that improve thousands or millions of lives.

From idea to implementation

As a technologist, I have seen countless great ideas sketched on whiteboards. But there are many hills and roadblocks on the long road between the whiteboard and implementation: engineering, prototyping, testing, manufacturing, regulatory approval, market-shaping and commercialization, supply chain management, community acceptance, and adoption, to name but a few.

It takes a smart and diverse team to move even the best ideas through these difficult stages. It takes inventors and scientists, but also public health experts, project managers, commercialization and supply chain experts, policy wonks and advocates, lawyers and intellectual property specialists, marketers, and more. We need all of them working in partnership with the target community at every stage to ensure that, at the end of the road, the bright idea finds acceptance in homes, clinics, or commercial markets.

Toast the real successes

PATH has been moving innovation along this road to implementation for almost four decades, and we have learned that the moment to pop the champagne is not when brilliance is sketched on a napkin. It’s the moment when the hundredth prototype solves a key design issue and drops the unit price in half, finally making a lifesaving solution affordable for the people who need it. Or when the perfect manufacturing partner comes aboard. Or when a government or agency grants regulatory approval or changes a policy to enable more efficient distribution to remote clinics. Or when local shop owners in affected communities eagerly stock the new product, helping their neighbors while simultaneously raising their own fortunes by earning a fair profit.

We will always need new ideas. But ideas are just the beginning.

The series:

Women don’t need a condom.

Diseases like cancer don’t affect low-income countries.

Diarrhea is rarely fatal.

Women don’t die in childbirth anymore.

There aren’t enough lifesaving ideas.

Malaria is unstoppable.

More information

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Myth: women don’t die in childbirth anymore

Smiling mother in a pink and white head scarf holds her infant.

Women still face the threat of death during childbirth, but solutions exist to protect them and their babies. Photo: PATH/Gabe Bienczycki.

Recently, Bill and Melinda Gates released their annual letter, which took on three persistent myths that block progress for the poor. In the same spirit, this week we’re debunking six myths that impede progress in global health. Today we take on:

In the 21st century, women don’t die while giving birth.

Portrait of Elesha Kingshott.

Elesha Kingshott outlines causes of maternal death—and their potential solutions. Photo: PATH.

Mythbuster: Elesha Kingshott, senior policy and advocacy associate for reproductive, maternal, and newborn health at PATH.

We may be well into the 21st century, but devastating maternal deaths are not yet a thing of the past. About 800 women die every day from complications due to pregnancy or childbirth. Almost all of them live in poor countries, and most of their deaths could be prevented.

Let me give you just a few examples of how we can change pregnancy and childbirth from a time of worry to a time of joy.

Solutions that save lives

It’s estimated that 40 million women in less-developed countries give birth at home, with no skilled birth attendant to help. Helping women gain access to health facilities and teaching community members to watch for danger signs and handle emergencies—as  PATH’s Sure Start project did in India—leads to fewer complications for mothers and their babies.

About a third of maternal deaths could be avoided by delaying pregnancy, spacing births, preventing unintended pregnancy, and avoiding unsafely performed abortions. One solution is to help women access effective and convenient contraception to control the timing and spacing of their children.

Excessive bleeding during or just after childbirth accounts for about a quarter of all maternal deaths. It’s also a complication with proven interventions. Medicines such as oxytocin and misoprostol, for example, can prevent excessive bleeding for less than US$1 a dose. And the nonpneumatic antishock garment has the potential to keep a mother experiencing excessive bleeding alive until she can be transported to a health facility with a higher level of care.

These and other innovations make a difference. From 1990 to 2010, the annual number of maternal deaths worldwide dropped by 47 percent. While women still do die while giving birth, we’re working toward the day when all mothers have the help they need to deliver their babies safely, no matter where they live.

The series:

Women don’t need a condom.

Diseases like cancer don’t affect low-income countries.

Diarrhea is rarely fatal.

Women don’t die in childbirth anymore.

There aren’t enough lifesaving ideas.

Malaria is unstoppable.

More information

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Myth: diarrhea is rarely fatal

Woman cradles her baby while holding a red cup to its lips.

A mother in Malawi gives her baby oral rehydration solution to treat dehydration caused by diarrhea. Photo: PATH/Amy Gottlieb.

Recently, Bill and Melinda Gates released their annual letter, which took on three persistent myths that block progress for the poor. In the same spirit, this week we’re debunking six myths that impede progress in global health. Today we tackle:

Diarrhea is no more serious than the common cold.

Portrait of Alfred Ochola.

Dr. Alfred Ochola knows diarrhea can kill. Photo: PATH.

Mythbuster: Dr. Alfred Ochola, technical advisor for child survival and development for PATH’s Kenya Program.

As a doctor and as a father, I am saddened by this myth because it costs many innocent children their lives. Even though diarrhea is a leading killer of children here in Kenya, mothers believe that it is “just diarrhea”—that it is not a serious problem. In fact, it is because of this myth that parents often bring their children to the hospital with complications like dehydration only after it is too late.

The reason diarrhea is a killer of children less than five years old is because dehydration is dangerously rapid in young children—often developing within just a few hours. And to make it worse, mothers believe other dangerous myths, for example, that one should withhold fluids from a child with diarrhea. Nothing could be worse!

See how oral rehydration therapy corners are saving children’s lives in Kenya.

No myth: preventable and treatable

The good news is that diarrhea is preventable and treatable. Throughout rural Kenya, my colleagues and I have set up 365 oral rehydration therapy corners in clinics, where children receive a simple mixture of sugar, water, and salt called oral rehydration solution that quickly treats dehydration, along with zinc tablets. It is amazing to see their eyes become bright and cheerful after just a few hours, especially after their situations were so dire.

The hours children spend in oral rehydration therapy corners also provide an opportunity to teach mothers about the importance of breastfeeding, hygiene, and other ways to prevent dangerous diarrhea from recurring. We also use radio programs and community health workers as opportunities to share these important health messages with the community.

Political will is important to continue the fight, and I am thrilled that the Government of Kenya adopted a national policy for diarrheal disease prevention and treatment. We have the solutions. What we need is improved access and greater awareness to fight dangerous myths and practices. All children get diarrhea, but I hope for a day where no child will die from it.

The series:

Women don’t need a condom.

Diseases like cancer don’t affect low-income countries.

Diarrhea is rarely fatal.

Women don’t die in childbirth anymore.

There aren’t enough lifesaving ideas.

Malaria is unstoppable.

More information

Bookmark and Share

Myth: diseases like cancer don’t affect low-income countries

Five women wearing headscarves printed with a red cross stand on a muddy road.

Epidemiological evidence shows the growing threat of noncommunicable diseases, such as cancer, in low-income countries. Photo: PATH/Gabe Bienczycki.

Earlier this year, Bill and Melinda Gates released their annual letter, which took on three persistent myths that block progress for the poor. In the same spirit, this week we’re debunking six myths that impede progress in global health. In honor of World Cancer Day, today we’re taking on:

Noncommunicable diseases like cancer don’t affect low-income countries.

Portrait of Helen McGuire.

Helen McGuire says countries face a double burden of disease: communicable and noncommunicable. Photo: PATH.

Mythbuster: Helen McGuire, director of noncommunicable diseases at PATH.

Most work to improve health in low-resource settings has understandably centered on serious communicable diseases, like AIDS and malaria. So it’s not surprising some people think problems such as cardiovascular disease, chronic lung diseases, diabetes, and cancer don’t affect people outside of wealthy countries. In fact, epidemiological evidence has been building for years that shows noncommunicable diseases are a serious and growing problem in poorer countries, just as they are in wealthier ones.

In these poorer countries, however, awareness is low, people do not always seek care, and when they do, health systems are not always prepared to respond. As a result, diagnosis and treatment comes much too late. The impact on individuals and families is devastating.

A heavy burden of cancer

Take cancer, for example. New statistics from the World Health Organization (WHO) show that in 2012, more than half of all cancers occurred in less-developed regions of the world, and six out of every ten people who died from cancer lived in these regions. The new statistics reveal that breast cancer is the leading cause of cancer deaths for women in low-income countries. And almost 70 percent of the global burden of cervical cancer—which is preventable—falls on these countries, too.

We must provide prevention programs and timely services that respond to both communicable and noncommunicable diseases. At PATH, we’re stopping cervical cancer through immunization and better screening and bringing breast cancer early detection, diagnosis, treatment, and support services closer to women in their communities.We’re also leveraging our successes in communicable diseases to discover new solutions for noncommunicable diseases, for example, finding opportunities to  integrate noncommunicable diseases into existing health services.

It will take creativity and collaboration to reorient health systems to respond to communicable and noncommunicable diseases. This new focus on noncommunicable diseases in low-income countries raises hope that more comprehensive health services will be accessible, supporting people to maintain their health and productivity.

The series:

Women don’t need a condom.

Diseases like cancer don’t affect low-income countries.

Diarrhea is rarely fatal.

Women don’t die in childbirth anymore.

There aren’t enough lifesaving ideas.

Malaria is unstoppable.

 

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Myth: women don’t need a condom

Hand holding the Woman's Condom, a tightly wrapped tube with a bag-like end.

In surveys, more women than in previous years are saying current methods of contraception don’t meet their needs. Above, PATH’s Woman’s Condom. Photo: PATH/Glenn Austin.

Recently, Bill and Melinda Gates released their annual letter, which took on three persistent myths that block progress for the poor. In the same spirit, this week we’re debunking six myths that impede progress in global health. Today we’re taking on:

Portrait of a smiling Jane Hutchings.

Jane Hutchings sees a change in the reasons women don’t use contraceptives. Photo: PATH.

There are enough contraceptive choices, if only people would use them.

Mythbuster: Jane Hutchings, leader of the Reproductive Health Program at PATH.

Family planning efforts have been so successful in educating women about contraceptives and providing access to them that it’s easy to see why people might think this is true. In surveys of women who say they don’t want to be pregnant but who aren’t using contraception, it used to be that many said they were unaware of contraception or they didn’t have access to methods. Now, more women say they don’t use contraception because current methods don’t meet their needs.

That doesn’t mean there still aren’t challenges in access and education, but it does indicate that family planning programs have made progress there. We need to make similar progress in improving methods of contraception.

Contraception “on demand”

In surveys, for example, women say they are interested in more “on demand” methods of contraception—that is, contraceptives you use only when you have sex. At PATH, we’re working with partners on several products that fall into this category: the Woman’s Condom, the SILCS diaphragm, and an oral contraceptive pill that women could take only before or after they have sex.  Another contraceptive innovation—Sayana Press—will enhance access by making it easier for a range of providers, and perhaps even a women herself, to administer contraceptive injections good for three months.

A recent analysis of unmet need for family planning estimates that 222 million women worldwide who want to avoid pregnancy aren’t using modern contraceptives. For many of them, the current choices aren’t enough. With any other health issue, I don’t think we’d tell them, “You’ve got enough choices; make them work. We don’t need further innovation in this field.” We certainly shouldn’t do that with something as important to the health of women and children as contraception.

The series:

Women don’t need a condom.

Diseases like cancer don’t affect low-income countries.

Diarrhea is rarely fatal.

Women don’t die in childbirth anymore.

There aren’t enough lifesaving ideas.

Malaria is unstoppable.

More information

Bookmark and Share

In Ethiopia, Muslim leaders encourage vaccination

A woman in pink head scarf readies a syringe while a woman in green head scarf holding a young child watches.

Nurse Sister Sofia Benti makes monthly vaccination visits to the community of Awash Fentale in the Afar region of Ethiopia, which has one of the lowest levels of immunization in the country. Photo: PATH/Jiro Ose.

Guest contributor Metchal Gebreyesus is immunization partnership and technical communication officer for PATH’s program in Ethiopia. He works with the Vaccine Implementation Technical Assistance Consortium to improve access to one of public health’s most effective interventions, childhood vaccines. Today, Metchal reports on efforts to enlist Ethiopia’s Islamic religious leaders in encouraging parents to vaccinate their children.

Portrait of Metchal Gebreyesus.

Metchal Gebreyesus. Photo: PATH.

My country, Ethiopia, is large with a very diverse population and geography. The region of Afar, which is predominantly Muslim, particularly struggles to immunize its children. In some of the most remote communities, as few as 12 percent of children have received all of their basic vaccines. That is a big gap from the 94 percent who have been vaccinated in Addis Ababa, Ethiopia’s capital city.

Parents need to be encouraged to bring their children to health workers for their shots. In some cases, it’s a question of lack of information or poor education, but in Afar it is often more complex. Some parents are reluctant to vaccinate their children due to fear of vaccines.

A call for religious leaders

I work closely with the Government of Ethiopia to improve access to vaccines, including helping with the introduction of those that protect against rotavirus and meningitis A, and with an emergency campaign last year to address an outbreak of polio. But I also work with Islamic and Christian religious leaders who are highly trusted and influential in their communities. I am helping them take a leading role in making sure children are protected from diseases that can make them ill, disable them, or even kill them. Continue reading »

Mike Eisenstein: design, build, test, innovate

Bearded man in plaid shirt and safety glasses presses buttons on keypad of large silver machine.

Mike Eisenstein at work in our product development shop. Photo: PATH/Patrick McKern.

When Mike Eisenstein arrives at work, he pulls on a faded blue apron and tucks his essential tools—pen, highlighter, safety goggles—into the pockets.

“I’ve ruined a lot of clothes,” he explains.

Wardrobe destruction is a byproduct of managing PATH’s state-of-the-art product development shop in Seattle. Among an impressive array of machinery, Mike and his colleagues devise and adapt technologies with the potential to improve health care in developing countries.

Follow the bouncing idea

Ideas bounce around like ping-pong balls as engineers, technical experts, and others working in the shop come up with new ways to look at devices and products. For example:

Could an infusion pump that delivers antibiotics to hospital patients in the United States deliver anesthesia to patients in remote clinics in poor countries? Mike and his colleagues are developing a new, portable, battery-free infusion pump that could serve that purpose.

Could phase-change material that maintains temperatures in building construction also be used to protect vaccines during transport? Mike and others are advancing a project to develop a portable vaccine carrier that prevents vaccines from freezing or overheating.

A lifetime of fixing things

Managing the PATH shop is exactly where Mike hoped to land when he joined our organization in 2008. Newly married and with a unique résumé—from fixing bikes to running operations at a tech start-up to servicing wildlife tracking equipment to managing operations for a wine distributor—Mike worked first as a computer support specialist, then as a program assistant until PATH’s longtime shop manager, Bill Van Lew, announced his retirement. Bill, an expert model-maker, took Mike under his wing and guided him into the role.

It didn’t hurt that Mike had a lifetime of hands-on experience under his tool belt. Continue reading »