Innovating to address malnutrition’s triple burden

Girls eating rice from a plate.

In contrast to many other health-related issues, malnutrition is 100 percent preventable. Photo: PATH/Satvir Malhotra.

Following is an excerpt of an article by Dr. David Fleming, vice president of Public Health Impact at PATH, illustrating how the private sector and global health sector can develop the innovations needed to address global malnutrition. This post originally appeared on the Global Food For Thought blog.

The world faces a triple burden of malnutrition. Acute and chronic undernutrition contribute to the deaths of some 3 million children each year. More than 2 billion people suffer from vitamin and mineral deficiencies, which compromise immune systems and physical and cognitive development. And now obesity is contributing to a host of health problems, from diabetes to heart disease. Continue reading »

Jonas Salk through the eyes of his assistant

Kathleen Murray and Dr. Salk in 1994.

Kathleen Murray worked with Dr. Salk from 1989 until his death in 1995. In 2015, Salk’s inactivated polio vaccine will be introduced in 126 countries—the largest vaccine rollout in history. Photo: Kathleen Murray.

Today, on the 60th anniversary of Dr. Jonas Salk’s inactivated polio vaccine being declared “safe, effective and potent,” we profile Kathleen Murray, Dr. Salk’s assistant at the Salk Institute for Biological Studies. The vaccine continues to make history today as a critical tool to achieve global polio eradication.

Q: Tell us about your connection to Dr. Salk.

A: I had been at the Salk Institute for about one year when Dr. Salk asked to see me. Because his assistant of 45 years was retiring, he was looking for someone to manage his office. He began our first meeting by saying, “To determine whether we would be a good match, let’s get together like this from time to time and get to know each other.” However, at the end of that first conversation he stood up and said, “Well I’m comfortable—if you are—that we can work well together.” And with that, I became assistant to one of the twentieth century’s greatest heroes. Continue reading »

Friday Think: this “leechbook” recipe may battle MRSA infections

Two pages from "Bald's Leechbook."

The 1,000-year-old Bald’s Leechbook contains a recipe that may be used as a potential agent against Methicillin-resistant Staphylococcus aureus (MRSA). Photo: British Library, United Kingdom.

When researchers and academics at the University of Nottingham peeked inside the leather-bound cover of Bald’s Leechbook, they found some useful recipes with a few unusual ingredients.

  • Mouse cells: the run-of-the-mill variety.
  • Oxgall: bile from a cow’s stomach.
  • Alliums: garlic, plus either a leek or onion.
  • One brass vessel.

Oh, and lest we forget, wine from a vineyard that has existed since the ninth century.

It’s not what you’d expect from a recipe, but then again, 1,000-year-old tomes don’t get uncovered every day. And this particular recipe had some surprising benefits: it killed over 90 percent of a bacteria known as Methicillin-resistant Staphylococcus aureus (MRSA). Continue reading »

Unsung heroes in neighborhoods around the world

Pharmacist standing near open window with a customer's hands holding medication.

Pharmacists and druggists are often the first and sometimes only point of contact with the health care system for many people—particularly in low- and lower middle-income countries. Photo: PATH/Felix Masi.

Quotes from people who use pharmacies.

Portrait of Jane Hutchings.

Author Jane Hutchings is director of Reproductive Health Programs at PATH. Photo: PATH.

When we think of health workers, we often envision physicians or nurses in clinics and hospitals, or community health workers who provide primary health care services to their neighbors. And while these providers, so intrinsic to our traditional view of health care, play essential roles, the private-sector pharmacist and druggist are very often the first and sometimes only point of contact with the health care system for many people—particularly in low- and lower middle-income countries (LMIC).

Male health worker standing outside of the pharmacy window at a hospital.

Pharmacists have enormous reach into communities, but they are regularly excluded from public health strategies. Photo: PATH/Eric Becker.

The third annual World Health Worker Week provides us an opportunity to stand back, recognize, support, and raise awareness of the important role health workers play everywhere.

And yet, in an overlooked sector, pharmacists and druggists may be the least recognized providers of all, even though people rely on them every day.

  • Consumers value the accessibility, convenience, and potential for cost savings and, in some cases, the anonymity of pharmacies and drug shops.
  • People appreciate that needed medicines often are in stock and waiting times are short.
  • In many cases, commercial pharmacists and druggists already are administering key health services and distributing products to improve the health of women, children, and families—such as contraceptives for family planning or oral rehydration solution to prevent child deaths from diarrhea.
A person wearing a helmet talks to a woman behind a counter.

In some countries, youth are far more likely to visit a pharmacy for services than they are to visit a clinic. Photo: PATH/Jolene Beitz.

Pharmacists and their staff, or drug shop workers, have enormous reach into communities, but they are regularly excluded from public health strategies.

Public health systems and programs will be stronger and more communities will thrive if we recognize the value of pharmacists and druggists and bolster their ability to meet the health care needs of the people they serve.

Repeatedly, research has found that properly trained and supported pharmacists and druggists with an expanded scope of practice can provide quality services including:

  • Health education.
  • Diagnosis and treatment of sexually transmitted infections, malaria, and diarrhea.
  • Referral for HIV/AIDS and tuberculosis.
Two men talk to a woman standing behind a counter.

Some people do not go to clinics because the fee is high and they are located far from home. Photo: PATH/Ngo Thi Than Thuy.

The role pharmacists and druggists can play in the management of noncommunicable diseases in lower middle-income countries will continue to be substantial. Their dedication is crucial to the well-being, success, and stability of individuals, families, communities, and nations.

As we work toward universal health care and undertake efforts to strengthen the health workforce worldwide, this group of providers is too important to forget. Including them in policy dialogue or advocacy for human resources for health—and strengthening their capacity—will help us achieve stronger health systems that can be sustained by communities.

Guest contributor Jane Hutchings is the director of our Reproductive Health Program at PATH.

What we mean when we say “innovation”

Steve Davis gesturing and speaking with colleagues.

Steve Davis, president and CEO of PATH, shares his insight on how we view innovation. PATH/Fatou Kande-Senghor.

Innovation that matters has been our mantra for nearly 40 years

There are innovations, and then there are innovations that matter. In global health, bright ideas and eureka moments are important for propelling us forward, but they won’t truly make a difference until they reach the people who need them and start transforming their lives. Some of these game-changers are as specific as a new drug or vaccine formulation with the power to save hundreds of thousands of babies, while others involve redesigning complex systems and rethinking the decisions we make each day to solve age-old problems.

Two women giving a little boy rehydration fluids from a green cup.

Finding fast treatment for diarrheal diseases. Photo: PATH/Sara Watson.

Since PATH’s founding nearly 40 years ago, we have advanced evidence-based approaches and tools to solve the world’s most difficult health problems, setting our sights well beyond new gadgets and gizmos to delivering solutions with staying power.

Disrupting the cycle of poor health is at the core of PATH’s work as we seek to improve the lives of women and children in poor countries. We know that health innovations can drive massive improvements in health worldwide. We work across five platforms—vaccines, drugs, diagnostics, devices, and system and service innovations—to advance hundreds of technological and social service interventions in our pipeline. To take these innovations to scale, we work with partners in the private sector, funders, and governments to deliver measurable results and achieve impact.

Kenyan man hammering red-hot forged steel.

Will the most crucial innovations in the next 15 years be forged of steel, built of silicon chips, coded from zeros and ones, or planted in the ground? Photo: Flickr/Eric Hersman.

We’re passionate about big ideas at all stages of development, from research and development to delivering solutions to millions of people in the world’s most vulnerable communities—and we’re especially focused on the complex “middle” of the value chain where innovations tend to stall and die. PATH’s brand of innovation means sticking with good ideas until the end, making sure the mechanisms and support are in place to bring them through research, development, and introduction and to scale them up to reach as many people as possible. It also means adapting to geopolitical and technological evolutions, and working across borders and sectors to turn great ideas into transformational changes.

For example, PATH worked with our partners in China for more than a decade to bring a much-needed vaccine against Japanese encephalitis (JE) to communities across Asia and the Western Pacific. China had safely used the vaccine to protect millions of its children against the debilitating disease, and we saw its potential to dramatically change the face of JE in other countries. We used an innovative systems approach to make it happen, including strengthening disease surveillance in countries at risk, negotiating an affordable public-sector price, and then providing technical expertise to private-sector partners to achieve international regulatory approval that will make the vaccine broadly accessible and sustainable.

How do you define innovation in global health? The Journey of Innovation: learn more.

This post is part of a multi-part series, Mapping the Journey, which explores how PATH turns ideas into solutions that bring equity, dignity, and health to women, children, and families worldwide. This article originally appeared on the Guardian and was written by Steve Davis, president and CEO at PATH.

Other posts in this series

This is how we ensure the safety of a vaccine

A young girl is held by another girl.

To ensure a vaccine is safe and effective, it must be carefully studied in the laboratory and go through several rigorous phases of clinical trials. If safety is not assured at any point, the vaccine candidate simply does not advance. Photo: PATH/Gabe Bienczycki.

Before a drop of an oral immunization reaches a newborn’s mouth or a syringe delivers a first shot, vaccines have cleared a multitude of hurdles, each carefully designed to ensure that they are safe and effective.

“It takes a village to raise a child,” the saying goes, and one of the first instances of collective care a child receives is immunization. Bringing a vaccine through research and into the clinic or field takes a veritable village of scientists, experts, and ethicists, and a rigorous process that ensures they collaborate at the highest standards.'From the initial stages of early research and clinical development through regulatory approval and use, vaccines are painstakingly evaluated for safety and efficacy.' -John Donnelly

My role as director of the Vaccine Development Program at PATH, and a long career in vaccine research and development, have afforded me valuable insight on the need for vaccines throughout the world and the commitment of scientists in making sure vaccines safely protect our children.

From the initial stages of early research and clinical development through regulatory approval and use, vaccines are painstakingly evaluated for safety and efficacy. By the time a physician prepares an injection and administers it to stimulate a child’s immune system, the vaccine contained within has been carefully studied in the laboratory and through several phases of clinical trials.

Each phase builds on the information received from the previous one, and if safety is not assured at any point, the vaccine candidate simply does not advance. Continue reading »

Friday Think: this $20 device could save a mother’s life

A pregnant woman cradles her stomach with her hands.

Maternal mortality rates around the world could be cut by 70,000 lives each year with a new diagnostic. Photo: PATH/Evelyn Hockstein.

A lifesaver that replicates a traffic light

A new technology has been given a green light in England. And a red and yellow light as well. It’s a device that could deliver lifesaving impact to thousands of women during childbirth. Using simple traffic light signals, health care workers are alerted if a woman needs additional care during childbirth: Green means a woman is doing fine; yellow means that her blood pressure is elevated; red means she should be moved to a hospital immediately for lifesaving care.

When new technologies emerge that are easy to use and affordable, they eventually become part of a larger toolkit of solutions that can save lives in rural and low-income areas. As Charlie Cooper reports in the Independent, these devices also help identify warning signs that might go unnoticed by busy health workers.

Invented by doctors at one of London’s leading hospitals, the device is the first in the world that can detect whether a woman is likely to go into shock after blood loss during childbirth.

High blood pressure during pregnancy can be an early-warning sign of pre-eclampsia, which is potentially fatal for mother and baby. In the UK [and other rich countries], regular blood pressure checks identify those at risk, who are then carefully monitored and given medication. But in more remote towns and villages in the developing world, stretched health workers may miss warning signs. . . .

For inventor Professor Shennan, the device is the culmination of 20 years’ work. “We’re very proud of this device,” he said. “Not only can it accurately detect when a woman is in danger from high blood pressure or shock, but it also indicates to untrained people when to act on this. I use it in my clinic, as it is superior to most existing devices for measuring blood pressure.” Friday Think logo

You can read the article in its entirety at the Independent.

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.

In Ethiopia, a PATH leader strives for health equity

Meet Tirsit Grishaw Legesse, PATH’s new country program leader in Ethiopia. She serves on the Ethiopia Ministry of Health’s working groups on sexual and reproductive health.

Tirsit Grishaw Legesse.

Tirsit Grishaw Legesse is PATH’s new country program leader in Ethiopia. Photo: PATH/Patrick McKern.

Q: You have many years of experience addressing health inequity in a variety of arenas. Are there any factors that you think are overlooked or misunderstood?

A: Increasing access to health services is critical to improving the health of women and children in low-income countries like Ethiopia. Often, when we talk about access, we look at services provided in a particular geographic area. We measure success by comparing the location and number of health facilities to the population served.

However, the physical availability of health facilities doesn’t always guarantee that they are used. Factors such as transportation and community perceptions about services, cost, and waiting times can deter people. Their use of services is influenced by a variety of factors, such as which services are offered at which location, the direct and indirect costs of health care (e.g., service fees and the costs people pay to travel to health facilities), cultural issues, and providers’ attitudes and competencies. Continue reading »

Friday Think: what Disney World and systems strengthening have in common

Last week, Bill Gates penned an op-ed for the New York Times discussing how the global health community was ill-prepared to respond to the Ebola epidemic and remains ill-prepared to respond to similar global health epidemics in the future.

Kate Wilson

Guest contributor is Kate Wilson, director of Digital Health Solutions at PATH. Photo: PATH.

His concerns resonated with me as they are fundamentally cross-cutting systems issues that deal with national infrastructure—the same ones that the Digital Health Solutions and other groups at PATH are working to overcome. We regularly ask, how can we help countries identify and implement integrated health systems?

“The problem isn’t so much that the system didn’t work well enough. The problem is that we hardly have a system at all.” —Bill Gates

Walt Disney World Cinderella Castle.

Walt Disney World Cinderella Castle. Photo: Katie Rommel-Esham.

This is where Disney World comes in

Before leaving the private sector, I was an early employee developing a large online gaming platform. The analogy we used when envisioning this future system was Disney World. When people think about Disney, they focus on the rides, the food, maybe the ticket cost, but they don’t think about the underlying infrastructure–everything just works. Continue reading »

Task-shifting: an effective way to protect expecting mothers from malaria

A woman's hand next to a newborn infant lying on a bed.

When a pregnant woman has access to preventive malaria care, it can lead to improved health outcomes for her and her newborn. Photo: PATH/Gabe Bienczycki.

Malaria is a life-threatening illness for anyone. But what are the consequences when a pregnant woman gets malaria?

During pregnancy, it can cause serious, life-threatening risks for a woman and her baby. Common problems include maternal anemia, miscarriage, prematurity, stillbirth, and low birthweight in newborns.

Safe and effective treatment to prevent malaria in pregnancy is available, but it is often out of reach for those at risk. Task-shifting—or moving specific tasks from trained medical providers to community health workers—is a low-cost, effective way to improve access to health services that save lives.

Women hold insecticide-treated nets in a lobby; a woman getting tested for malaria; a woman standing outside.

Clockwise from left: Women receive insecticide-treated nets during antenatal care visits; a woman gets tested for malaria using a rapid diagnostic test; a woman from Kisumu West makes her way to a health facility for antenatal care. Photos: PATH/Gena Morgan, PATH/Gena Morgan, PATH/Eric Becker.

In Kenya, a pilot study in Kisumu West sub-county is showing the positive impact of new policies that allow health workers to provide health services and administer certain medicines at the community level to better protect expecting mothers and their newborns from malaria.

Protective malaria treatment is often out of reach

Sulfadoxine-pyrimethamine (IPTp-SP) is a safe and effective intervention that can be administered during antenatal care visits to reduce malaria-caused health complications in expecting mothers and their newborns. Unfortunately, long distances to health facilities and a lack of access to high-quality care can deter many pregnant women in resource-limited settings from seeking early care or completing four recommended health care visits.

In Kenya, where many women remain at risk of malaria in pregnancy, current policies limit IPTp-SP administration to skilled health workers. As a result, critical antimalarial treatment remains out of reach for many mothers who have difficulty accessing facility-level care.

The success of a new task-shifting policy in one area could improve the situation.

Health system innovation for improved community care

Task-shifting extends the reach of the health system, successfully bridging the gap between communities and health facilities.

Through the pilot study in Kenya, PATH (in partnership with USAID-funded APHIAplus and the Bill & Melinda Gates Foundation) has shown that community health workers can effectively deliver treatment and care to expecting mothers to better prevent malaria.

Report cover of "Policies and Actions for Improved Malaria in Pregnancy Efforts in Communities."

Download Policies and Actions for Improved Malaria in Pregnancy Efforts in Communities, which details the results of a pilot program addressing malaria in pregnancy. Photo: PATH.

The pilot study has already demonstrated an increase in the number of women receiving IPTp-SP preventive treatment. And, in pilot health clinics where community health workers administered the medicine, 25% more women completed the recommended four antenatal care visits for a safer pregnancy.

Evidence for advocacy impact

Similar research has emerged from other regions of Kenya and multiple sub-Saharan African countries.

In order to share this new evidence and build support for community-based approaches to prevent malaria in pregnancy, PATH hosted a stakeholders’ forum in Nairobi, which brought together technical experts, government officials, and civil society representatives. After presentations on global recommendations and country-level research, participants identified policy change recommendations that—if implemented—would ensure a community-centered approach to safeguarding women from malaria in pregnancy.

The results of the forum—detailed in the newly released report Policies and Actions for Improved Malaria in Pregnancy Efforts in Communities—will be shared with key Ministry of Health leaders in Kenya to demonstrate the positive health impact of community distribution of IPTp-SP.

PATH is committed to engaging with decision-makers and carrying this agenda forward with our partners; we believe that by turning the emerging evidence into policy action, we can ensure that no woman is left unprotected from malaria in pregnancy.

This post was written by guest contributor Wanjiku Manguyu, family health advocacy officer at PATH in Kenya.

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