The best buys in global health

Boy receives vaccination in arm from woman.

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

Guest contributor Amie Batson is chief strategy officer at PATH. This post was updated on March 19, 2014.

Portrait of Amie Batson

Amie Batson. Photo: PATH/Patrick McKern.

On March 19, I joined a panel of international leaders, researchers, and health colleagues to dig deeply into a crucial question: which investments will help us save the lives of more women and children?

The event, organized by PATH, Devex, PSI, and partners, introduced “Best Buys in Global Health,” a special issue of Impact magazine. As I prepared for the event, I thought about some of my own top choices. The great return on investing in women, as I’ve written here before, stands out as an unquestionable best buy in my mind. So do a few others: Continue reading »

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What does PATH stand for?

Nametag  with text reading, "Hello my name is PATH."ds, "HelloThroughout our 40-year history, people have asked us what our acronym stands for. In the beginning, it stood for a mouthful: Program for the Introduction and Adaptation of Contraceptive Technology, or PIACT. Later, we changed to Program for Appropriate Technology in Health, or PATH. For the last few decades, our partners and colleagues around the world have simply known us as PATH.

And now, it’s legal. Our name is PATH. Full stop.

So now when people ask us what PATH stands for, the answer is easy. PATH stands for the type of transformative innovation that save lives and improves health, especially among women and children. We stand for accelerating innovation and making the world a more equitable place.

We’re proud—and grateful—that you stand with us.

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Why we think vaccines can outwit pneumonia

Five children look up at the photographer, smiling.

Pneumonia is the leading killer of children under five years old. Photo: PATH/Lesley Reed.

Guest contributor Mark Alderson is director of PATH’s Pneumococcal Vaccine Project.

Portrait of Mark Alderson

Mark Alderson directs our Pneumococcal Vaccine Project. Photo: PATH.

Pneumonia is a clever killer, responsible each year for the deaths of more than a million children under five years old, most of them in the developing world. If you want to know how serious this respiratory disease is, consider one fact: pneumonia kills more young children worldwide than any other disease.

Because pneumonia has many different causes, no one intervention is enough to outsmart it. We need a diverse set of defenses to beat pneumonia, and vaccines top the list as the most cost-effective means of prevention. If we’re to outwit pneumonia over the long term, however, the vaccines we have now must continue to evolve and improve.

Taming a complex killer

Vaccination against the leading cause of pneumonia, the pneumococcus bacterium, is essential for controlling pneumonia. In fact, vaccines against pneumococcus help save thousands of children each year—children who likely would have died before these vaccines became available more than a decade ago.

Pneumococcus, however, is a complex bacterium, with more than 90 varieties that vary by region. As a result, prevention to date has required the development of complex vaccines. Pneumococcal vaccines available today use an elaborate and expensive manufacturing process that essentially combines vaccines for either 10 or 13 pneumococcal varieties into a single injection.  While these vaccines are saving many lives, they do not provide universal coverage against all disease-causing pneumococcal strains. In addition, it’s hard for low-income countries to afford them. Continue reading »

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3 reasons investing in women’s health is smart

Three women wearing head scarves with red cross insignia and smiling.

When improvements in global health focus on women, you might be surprised at what happens to men. Photo: PATH/Gabe Bienczycki.

Guest contributor Amie Batson is PATH’s chief strategy officer.

As a woman who has been working in global health for two decades and the mother of two girls, I think a lot about how to remove the roadblocks that hold women back. At PATH, health equality for women and children is a top priority—and it’s been a passion of mine throughout my career.

Portrait of Amie Batson

Amie Batson explains how helping women helps men. Photo: PATH/Patrick McKern.

Yet there’s one question I’m often asked when I talk about women’s health: what about men?

The reasons we focus on women and children are compelling, driven by a wealth of data, and include good news for men. So today, as we look toward International Women’s Day on Saturday, I’d like to offer three reasons why investing in women is smart strategy and good practice.

No. 1: investing in women yields gains for everyone

There’s no question that girls and women bear the brunt of poverty and poor health, and that millions miss out on education, opportunities, and health care. In sub-Saharan Africa, twice as many young women are living with HIV as young men. An estimated 222 million women want but can’t access appropriate family planning. When food is scarce, women—even pregnant women—are still frequently the last to eat. And a woman dies every two minutes from complications in pregnancy and childbirth—almost always in a poor country, and often from causes that we already know how to prevent and treat. Continue reading »

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Pharmacies on the frontline of sexual and reproductive health

Jane Hutchings, Jen Drake, and Jill Keesbury of PATH’s Reproductive Health Program recently wrote this post for The Guardian’s Global Development Professionals Network.

A young woman stands before a counter in a Cambodian pharmacy, reading materials. A pharmacy staff member stands behind the counter.

Pharmacy staff in Cambodia, often frontline health care providers, received training to better serve young clients. Photo: PATH/Jolene Beitz.

Every day, young people make critical decisions about their health, sexuality, and well-being—often in settings where just talking about sex, condoms, or contraception is taboo. Studies have shown that youth across Africa—including in Ghana, Kenya, Nigeria, and Uganda—prefer to access health services through pharmacies.

Pharmacies are their first, and often only, point of service for health care. In Ghana, for example, nearly 60 percent of adolescents who use family planning obtain their chosen method through pharmacies and drug shops.

Youth face distinct reproductive health challenges. Data from across the globe show that sexually transmitted infections are most common among young people. Complications from pregnancy, childbirth, and unsafe abortions are major causes of death for adolescent girls in developing countries. Equipping young people with the knowledge and tools they need to promote and protect their own health is critical to achieving broader global goals to empower women, improve maternal and child health, and reduce HIV/AIDS.

As first steps in maximizing the contribution of pharmacies to youth sexual and reproductive health, we should strengthen their capacity as frontline service providers, mobilize the skills of young pharmacists and pharmacy students, and improve the diversity of contraceptives available to youth through pharmacies. In each area, partnering with both the private and public sectors will be key. Continue reading »

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How can a government policy help save lives?

A smiling mother holds an inant swaddled in a bright orange blanket.

A policy addition in Zambia means a better chance at health for newborns in the country. Photo: David Jacobs.

Guest contributor O’Brien Mashinkila is a family health advocacy officer with our Zambia Program.

Just before ringing in 2014, my country made a groundbreaking commitment to end preventable newborn deaths. After a year of collaboration with PATH and other newborn health advocates, Zambia’s government signed off on a policy that includes newborn care in the national Integrated Management of Childhood Illness strategy.

The strategy ensures that health systems focus on the well-being of the whole child to correctly diagnose and treat the leading killers of children. In the case of Zambia, it now includes the unique needs of newborns, including sepsis and umbilical cord infection.

I’ve seen the need for this firsthand. My country has made great progress in lowering the child mortality rate, but many newborns still die—34 for every 1,000 babies born. Expanding programs and policies aimed at helping babies survive the first days and weeks of life will enable us to move toward ending preventable child deaths.

How policy changes lives

How can a policy change like revising Zambia’s Integrated Management of Childhood Illness strategy save lives? One example is its inclusion of chlorhexidine, a low-cost medicine to prevent umbilical cord infection. As secretariat of the Chlorhexidine Working Group, PATH has worked with other organizations to adapt this decades-old antiseptic into a new formulation for umbilical cord use. When the medicine is readily available, as many as 23 percent of babies who die before they reach 28 days old can be saved—for less than 50 cents a dose.

In this video, PATH’s Trish Coffey explains how for less than 50 cents a dose, chlorhexidine could save an estimated 422,000 newborns over the next five years.

Here’s to Zambia

Change came about because PATH and other advocates for newborn health—including Save the Children, UNICEF, the World Health Organization, and the Zambia Pediatrics Association—joined with the government of Zambia to launch a framework to reduce newborn death and illness by 2015. We then brought stakeholders together to revive the national strategy. With tremendous support from Zambia’s Ministry of Community Development and Ministry of Health, we made sure the strategy prioritized integration of newborn care.

I’m incredibly proud to see my country show leadership in caring for our newborns. Zambia’s next task is to ensure that the strategy translates to action at the community level. For now, however, congratulations to Zambia for answering the global call to end preventable newborn deaths.

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Anurag Mairal: technology innovator’s surprising path to global health

Anurag Mairal, leader of PATH’s Technology Solutions Program, will speak on “Accelerating Innovation to Save Lives and Improve Health in Low-Resource Settings” at 5:30 p.m. Thursday as part of the Washington Global Health Alliance’s Discovery Series. The lecture takes place in Foege Auditorium, room S-060 at the University of Washington. For more information, contact the Global Health Resource Center at ghrc@u.washington.edu or see the Washington Global Health Alliance’s website.

Portrait of Anurag Mairal.

Anurag Mairal says everything he pursues “must make a tangible difference to society.” Photo: PATH/Patrick McKern.

Build it, and they will come. Too often, that is how global health technologies are developed, says Anurag Mairal, leader of PATH’s Technology Solutions Program. Projects lurch forward—delayed and accelerated according to the tides of donor funding—based on an assumption that, in the end, markets and users will embrace the technology.

Now Anurag and his team are transforming this process and pushing the global health community to think outside the box. And he’s bringing his own outside-the-box background to the task.

Mind the medical gap

“I grew up in India, in a state called Chhattisgarh,” Anurag explains. “The southern part of the state is extremely isolated. The first time I went there, I was blown away by how pristine it was, but also by how modern medicine hadn’t quite reached it. It was a different world.”

It would take decades, however, before Anurag would find himself addressing that medical gap. First, he became a chemical engineer, moved to the United States to get his PhD, and developed a passion for integrating disciplines and sectors.

Two boys stand in front of a table holding a car battery, a plastic water jug, and a blue plastic box. A man looks on.

Anurag Mairal, on a recent visit to a school in Kenya. He says regions in need of global health solutions are “rife with innovation.” Photo: PATH.

His PhD dissertation combined chemical engineering with physics and mechanical engineering to solve a costly problem in waste water treatment. His subsequent work in the biotech and then the medical device industries led to a flurry of patents in areas as diverse as water, energy, and medicine. Continue reading »

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Do vaccines always need to stay cold?

Smiling young woman gets an injection in her upper arm from a seated health worker.

A new study found vaccine against meningitis A remained viable even though it wasn’t constantly refrigerated. Photo: PATH/Gabe Bienczycki.

Maintaining the cold chain—a system to protect lifesaving vaccines from exposure to heat—has been a longstanding challenge to the success of vaccination campaigns, especially in remote, hard-to-reach areas where refrigeration isn’t a given.

Until now.

Two health workers in white uniforms stand behind a table holding a vaccine carrier and boxes of syringes.

Health workers, like these preparing for a meningitis A vaccination campaign, spend vast amounts of time keeping vaccines within a cool temperature range. Photo: PATH/Gabe Bienczycki.

The first mass vaccination campaign conducted in Africa with a vaccine that doesn’t require constant refrigeration provided complete coverage with MenAfriVac® vaccine. The vaccine was kept outside of the cold chain for up to four days and stayed viable even in temperatures up to 102°F (39°C), according to a study published online today in the journal Vaccine.

A vaccine breakthrough

Conducted as part of a ten-day meningitis A vaccination campaign in Benin in November 2012, the study represents a breakthrough not only for MenAfriVac®, but potentially for increasing the efficiency, coverage, and affordability of other vaccines. The approach could significantly reduce the workloads of health workers, who spend vast amounts of time ensuring that vaccines are kept cold, the study found. It could also extend vaccines to areas that are so far removed from access to electricity they could never be reached by the cold chain.

Since this video telling the story of MenAfriVac® was made, 151 million people been vaccinated, and some 250 million are expected to have received the vaccine by the end of 2014.

In addition, a separate study published in the Bulletin of the World Health Organization on the economic benefits of this approach found that the costs of administering the MenAfriVac® vaccine could drop by 50 percent.

PATH’s pioneering role

The MenAfriVac® vaccine was developed through the Meningitis Vaccine Project, a partnership between PATH and the World Health Organization. It used a unique vaccine development model that aimed at providing an effective, affordable, and long-term solution to epidemic meningitis in the African meningitis belt, a large area that stretches across the continent from Senegal to Ethiopia. Over the past century, hundreds of thousands of people were killed or permanently disabled by the cyclical epidemics of meningitis A, many of them children or young adults.

“Findings from these new studies show that it is possible to deliver vaccines more conveniently and at a lower cost when refrigeration is not needed every step of the way,” said Dr. David C. Kaslow, vice president of Product Development at PATH. “MenAfriVac® is helping to show a less expensive, simpler, and more convenient way for other current and future lifesaving vaccines to get to the hardest to reach people in need.”

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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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