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Aid

New study on Americans’ opinions on the role of the US in global health

May 21, 2012
Aid, Aid Work, Global Health, Health Financing
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Today, the Kaiser Family Foundation released a new study on the role of the US (and our donor dollars) in global health. Reassuringly, it seems that messaging around just how small the global health and foreign aid budget is, as a proportion of the full USG budget, is starting to get through. Approximately 39% of respondents think we spend less than 5% of the US budget on global health; the real figure is less than 0.5%, but that’s more hopeful to me than the inflated figures Americans espoused we spent on foreign aid in the recent World Opinion Poll.

Even better, two-thirds of Americans believe we are spending the right amount, or too little, on global health—somewhat ironic given that Congress just slashed the global health budget for FY2013 for the first time in years recently. If the vast majority of Americans support global health spending, maintaining the global health budget in an election year shouldn’t be as great of a controversy as it seems to be.

A nice snapshot of the results was published by KFF President Dr. Drew Altman, including this useful graph summarizing some of the key findings on the predictors of support for increased global health spending calculated by the survey.

I’d be interested in looking at crosstabs of some of the results; for example, are people who have traveled to developing countries even more likely to believe that spending on global health leads to progress? I’m delighted (and not terribly surprised) to see young people showing increased support for global health programs compared to their elders.

From my cursory review of the report and the summary findings circulated by KFF, efforts to educate Americans on the impact of our spending on global health must continue. Technical partners, implementors, advocates, think tanks, and donors each have stories (and data) to share illustrating the impact of global health programs; making those stories and that data accessible and compelling seems critical at this juncture.

Often times, championing the successes of our programs through peer reviewed journal publications, success stories, blog posts, and other outlets can be tough to manage when the end of a project is fast approaching and our time and efforts have been invested in maintaining the technical rigor of the project rather than communicating what we’ve achieved.  The results from the KFF survey, showing that “the ultimate obstacle to greater public support is the need to make the case effectively that aid is not ripped off and makes a difference,” place the onus on us, as global health professionals and advocates, to share our successes widely, rigorously and with enthusiasm.

State of the World’s Mothers Report released

May 8, 2012
Aid, Women's Health
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The State of the World’s Mothers report has been released by Save the Children. This year, the report focuses on nutrition in the first 1,000 days of life, and includes country rankings for the best and worst places to be a mother, taking into account health, education, and economic indicators for women and children. You can read the interactive report here.

While the rankings aren’t surprising, per say, seeing countries indexed against each other is always curious. How different indicators are weighted in making the composite numbers can have a huge impact on where someone lands. For example, Mali ranks in the bottom 10; it’s also a country with historically complexities in measuring the percent of women who deliver with a skilled attendant, due to the wide use of matrones (traditional trained birth attendants) at delivery. Timing of the data collection and aggregation also plays a role; while the data here are published for 2012, they don’t take into account recent events (like the coup and ensuing civil unrest in Mali).

I’d be interested in comparing these numbers and rankings with the overall UNDP Human Development Index rankings, but that’s a task to undertake sometime other than my early lunch.

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Born Too Soon: Landmark report & new data on global pre-term births

May 2, 2012
Aid, Global Health, Health Systems, Women's Health
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Each year, 15 million babies around the world are born prematurely, and 1 million of those die as a result of their preterm birth  New findings highlight how even in countries like the US – where we often hear about “million dollar babies” – preterm birth is a huge challenge as public health and clinical experts work to help every child reach his or her fifth birthday and beyond.

Born Too Soon: The Global Action Report on Preterm Birth provides the first-ever national, regional and global estimates of preterm birth. The report shows the extent to which preterm birth is on the rise in most countries, and is now the second leading cause of death globally for children under five, after pneumonia.

Addressing preterm birth is now an urgent priority for reaching Millennium Development Goal 4, calling for the reduction of child deaths by two-thirds by 2015. This report shows that rapid change is possible and identifies priority actions for everyone.

The report is a joint effort of almost 50 international, regional and national organizations, led by the March of Dimes, The Partnership for Maternal, Newborn & Child Health, Save the Children and the World Health Organization in support of the Every Woman Every Child effort, launched by UN Secretary-General Ban Ki-moon. 

You can access the report and other key resources on the following sites:

#5thBDay: Newborn Health

April 30, 2012
Aid, Global Health
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Good morning & happy Monday! Today kicks off the second full week of the Every Child Deserves a Fifth Birthday campaign, with a week of facts, stats, tweets, and posts about newborn health.

With our newest little one at Mudzini Kwetu, on my recent visit in early April.

Having just returned from a visit to Mudzini Kwetu, the home supported by One Home Many Hopes and seeing our youngest arrival (only two weeks old at the time of my visit), I was reminded just how precious and fragile life is in those early weeks, and global statistics underscore the fragility of the health and life of newborns in startling ways. According to global estimates, more than one million newborns dying annually due to pre-term birth, and the neonatal period (a baby’s first 28 days of life) accounts for 41% of all child deaths.

It’s impossible to talk about reducing child mortality without shining focused attention on the number of lives that could be saved in those first 28 days of life with basic interventions. Simple cleaning of the umbilical cord has been shown to reduce newborn mortality by approximately 38%. Diarrheal diseases are easily treated with oral rehydration therapy, including salts and supplemental feeding, reducing the severity of diarrhea by 40% and the duration by 20%, ultimately saving lives. Plus, diarrhea and pneumonia can often be prevented by providing a child with a vaccine (rotavirus and pneumoccocal vaccines, respectively).

We have the technology. We have the knowledge. Now we just need to make sure we maintain our commitments - financial and otherwise – to saving the lives of the smallest of children.

Watch #5thbday on Twitter and get excited for the May 2 launch of the landmark Born Too Soon report, providing the first global estimates of child mortality related to pre-term birth. To target resources and solutions at a problem, we need these kind of global figures, as challenging as they may sometimes be to read.

What it takes to deliver a $5 net.

April 30, 2012
Aid, Global Health
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Thanks to Tom Murphy (of View from the Cave fame) for the opportunity to write a post for the PSI Healthy Lives blog for World Malaria Day last week. I wrote a post on the importance of strong logistics and supply chain systems in the delivery of bednets to the right people, highlighting the USAID DELIVER PROJECT. I was delighted to see the post cross posted over at USAID Impact, and highlighted on the Kaiser Family Foundation Global Health Policy Daily.

Kaiser did a great job excerpting the post:

Amanda Makulec, USAID’s “IMPACTblog“: “Without a robust logistics system, bednets could easily remain unopened and packaged for transport, rather than hanging over the beds of small children and pregnant women in rural Uganda or elsewhere; [artemisinin-based combination therapies (ACTs)] may not be delivered to rural health facilities and remain in a warehouse; and [rapid diagnostic tests (RDTs)] may never be provided to community health workers to enable them to rapidly diagnose malaria in a child’s blood using only a small sample,” Makulec, a monitoring and evaluation associate with John Snow, Inc., writes. She describes the USAID | DELIVER PROJECT, implemented by John Snow, Inc. and various partners, which is responsible for procuring and delivering malaria commodities for the President’s Malaria Initiative (PMI). “On this World Malaria Day, let’s celebrate the achievements that have been made not only in the number of bednets procured and distributed, but also the immense achievements of the people and programs who make it possible to get the bednets and other commodities to the places they’re most needed,” she writes (4/25).

Photo copyright John Snow Inc.

“If you give a country a dollar…”: Subadditionality in Global Health Financing

January 25, 2012
Aid, Health Financing, Health Systems
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Two themes in global health programming make the question of how countries change their spending on health in response to receiving donor funding (substitutability or subadditionality*, if you’re being fancy or technical) particularly important today.

  1. As global health budgets have become more uncertain in recent years (though, globally, have not decreased) contemplating how countries will respond if donor funding shrinks becomes more of a necessity than a fleeting consideration, and
  2. Emphasis on country ownership begs the question: how can countries respond with appropriate funds from their own coffers as donor budgets are drawn down over time and countries take responsibility for financing their own health programs.

Michael Herman addressed the issue of subadditionality at the recent Global Health Council event highlighting findings of the IHME Financing Global Health 2011 report.  Literature from the past 30 years conducted by economists has “concluded that sector-specific foreign assistance to governments.” More recent studies have also found that receiving sector-specific aid money (i.e. donor dollars tied to a specific area like health) causes recipient countries to shift their own spending away from the sector that receives the aid. But at what levels? How much spending shifts away for each dollar invested?

The research question to be tackled: Do governments replace grants for health at the same rate or a slower rate when assistance funding is lost?

The overall findings: Preliminary research indicates replacement happens at a slower rate. “Subadditionality persists,” said Herman. When countries receive development assistance for health (DAH) from donors, they spend less of their own financial resources on health.  The complete findings are fleshed out in Chapter 4 of the IHME report.

I think technical terms can be intimidating, so I’ve created an infographic of an example (with simple numbers) presented by Herman, highlighting three scenarios: no donor funding & funds increase as expected year by year, an injection of donor funding where the country decreases the amount it plans to spend on health, and an injection of donor funding where the country does not decrease the amount it plans to spend on health.


How this plays out in real terms varies by region, country, and DAH recipient. The report provides an example from East Africa, showing what happens in 2006-2007 and 2008-2009 in response to fluctuations in donor funding. First, we see that in 2006-07 DAH to the government (DAH-G) appears to have decreased government health expenditure as a source of funds (GHE-S), while DAH to NGOs (DAH-NG) appears to have sparked an increase in GHE-S by $57 million.

The following two year period (2008-09), a decrease in DAH-G sparked an increase in GHE-S though.

Because of the complexities of the financial flows, researchers found it difficult to understand how the different flows of DAH (government and NGO) ultimately affect health outcomes in a country. As such, you cannot generalize that giving to an NGO is more effective than giving to governments, and you need to ask the harder questions around what happens when you provide donor dollars to cover health expenditures. Do you increase the cost of doing business in a country due to rules and regulations? Provide investment to underscore the importance of spending on health? The list could go on.

What does all of this financial back-and-forth mean for populations living in developing countries, who often rely on health services funded jointly by the government and donor resources though? Herman suggested the following:

  • the impact on health outcomes remains important, and having resources available to finance health programs is essential improve outcomes;
  • don’t lose sight of the context in which all of the financial data is being crunched; just because on the surface it appears assistance to NGOs creates a positive response (more government spending on health) and assistance to governments creates a negative one (less government spending on health) does not mean it’s necessarily better to give money to NGOs;
  • in 2012, continued progress on the Millennium Development Goals for health depends on the trajectory of DAH growth and the response of Ministries of Finance in recipient countries;
  • And finally, from what we’ve seen in the past, when budgets are cut, child mortality ultimately increases, which is something none of us want to see.

*IHME’s quick summary of subadditionality: “Last year, we studied the relationship between DAH and public domestic health spending. We found that for every $1 of DAH channeled through government (DAH-G) that flowed to a country, governments on average took $0.43 to $1.14 of their own money away from the health sector. We call this phenomenon “subadditionality,” which occurs when DAH to government partially or fully substitutes for public domestic health spending. The opposite phenomenon, or “additionality,” happens when DAH-G fully supplements [government health expenditure as the source].”

More on the general findings of the report in this post  from last week. This post is the second of four on the IHME Financing Global Health in 2011 report and a related event at the Global Health Council.

Community Health Workers: Champions in the Fight against Child Pneumonia

November 11, 2011
Aid, Health Systems
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While the social media sphere has been abuzz with updates and tweets about 11/11/11 – and rightly so, given that it’s Veteran’s Day – the global health community has its eye on the day after.

November 12th marks the annual World Pneumonia Day  for advocacy about the leading cause of death for children under five around the globe.  1.4 million children die each year as a result of pneumonia, and most of those deaths could be averted through simple treatment.

In remote areas, though, families often don’t have the time, money or other resources to access facility-based care. Choosing between taking a child 30 kilometers to a health facility when they show signs of illness and putting food on the table is a reality for many families throughout the developing world. According to Dr. Elizabeth Mason from the World Health Organization, only 30% of children in need of treatment for pneumonia actually receive it. A solution to that challenge of access comes in a form familiar to those in global health sphere:  community-based treatment.

By training health workers to provide simple interventions at the community level, famliies with no immediate access to a health facility could receive care without an undue burden of cost or time.  Well-timed with World Pneumonia Day, The Lancet published a study supported by USAID and conducted by Save the Children, the Boston University Center for Global Health and Development, and the World Health Organization clearly documenting the success of community-based treatment of child pneumonia in Pakistan. Researchers found that the risk of discontinuing or failing to receive treatment was significantly lower for those in the intervention group (receiving community-based care) compared to the control group (only received facility-based care).

New data supporting a promising practice to save lives are wonderful, but will raise questions around the next steps for the global health community, such as:

How does research like this translate into practice? The next challenge will be for WHO to consider revisions to its recommendations for treatment of child pneumonia and include home-based administration of oral antibiotics. Recommendations are made and revised based on large bodies of evidence, including studies like the one noted earlier. To act on any new recommendations will then require global health organizations leverage existing resources to support training community health workers  (CHWs)– either existing cadres or new ones – in this specific treatment protocol.  Notably, numerous organizations and donor agencies are already supporting many community-based programs; the USAID Child Survival and Health Grants Program has some great examples.

What needs to happen as recommendations are being considered and programs designed?  Any number of items, depending on who you are. Two important priorities should be better counting and mapping of existing CHWs and advocacy around why this approach is important – whether programs are implemented today or next year, they will require resources.

Why is mapping and counting CHWs so important? In order to identify where CHWs have already been trained and could be taught additional skills, updated data on the number and location of CHWs around the world is needed. Information is power, particularly when you’re working to deliver services in remote and underserved areas. The most recent data on how many CHWs work in various regions is outdated (more than 6 years old), particularly for an informal work sector with high turnover. That data indicated that more than half of the 100 million trained health workers documented were informal, rather than physicians, nurses, and midwives, according to Dr. Arial Pablo-Mendez, Assistant Administrator for Global Health at USAID. Efforts to document existing cadres of CHWs are moving forward though, which will hopefully provide much needed data on existing human resources for health and their distribution.

What kind of data do we have to advocate for community-based care? From a financial perspective, Mary Beth Powers from Save the Children, indicated it only cost around $300 per health worker for all of the required training around community case management of child pneumonia.  With funding for global health under attack, low-cost/high-impact interventions like these are essential to continue and scale up programs to maximize the number of lives saved.  In addition to saving children’s lives, the community health workers feel empowered, receive increased respect from the community after demonstrating how lives can be saved through their simple actions, and projects build local capacity that will live on beyond the life of the project.

Leaders in the global health community are supporting increases in community –based care for child pneumonia, and have the data to illustrate the potential in these programs. Next up: advocating for integrated community case management of childhood illness (iCCM), which has also been demonstrated to be highly effective and financially smart. On this World Pneumonia Day, consider lending your voice to help combat some of the 1.4 million child deaths that happen each year as a result of this disease.

Not just good PR, but good for HR too.

September 25, 2011
Aid, Aid Work, Reflections, Young Professional
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I don’t think anyone needs to be sold on the importance of public private partnerships, which are often part of a company’s corporate social responsibility (CSR) scheme, or on how useful it can be when organizations use business acumen for social good. This was highlighted repeatedly at the Social Good Summit last week, as reviewed in my most recent post, and the whole conversation seems to fit well with the timing for J’s first aid blog forum call for posts around CSR.

I’m not a business expert, nor have I worked extensively behind closed doors to see what makes companies tick, but I do know that one comment stuck with me from this past week. USAID Assistant Administrator for Global Health, Dr. Ariel Pablo-Mendez, said in a one-on-one interview that private sectors aren’t just giving back for the good public relations exposure (thought it can be damn good PR, particularly in the wake of media criticisms of other policies), but that these partnerships are good for HR too. Attracting new, particularly young, talent requires not just a lucrative paycheck and comprehensive health plan nowadays: it takes the promise of finding value in your job and not feeling like another cog in a wheel.

Source: Pew Charitable Trusts

For all of those MBA-ers and other business professionals out there who aren’t swapping over to the NGO/philanthropic capital/etc. sectors, finding a for-profit employer that has a cause as part of its bottom line equation matters. The Pew Charitable Trusts did a study last year about young people age 18-30 (Millennials) and their take on jobs, relationships, life goals, and a myriad of other topics. Among their findings, Pew found Millennials were more likely than previous generations to value meaning and purpose in a position and/or a company over higher pay than in previous generations. Perhaps this explains the near exponential growth of people seeking masters in areas like global health, and looking for careers in aid work and other similar people-oriented arenas. Look at the chart of values above: more than thirty percent more respondents indicated that “helping others in need” was their top priority compared to “having a high paying career” (though this is obviously not universally the case). And notably, the top two priorities that beat out helping others were both related to family: parenting and marriage.

In order to attract those talented young people to the entry and mid-level jobs available in the corporate world, it’s become an imperative for many corporations to have a public means to show how they give back. I don’t think this is a bad thing, particularly if they’re applying their business expertise to a similar challenge or need in their own country or abroad. But I also don’t think it’s a selfless gesture of kindness: consumers have higher expectations for corporations, and employees have higher expectations for their employers than ever before. While this may seem ironic in a time of economic instability and recession, as profits and gains aren’t what they used to be in many sectors, it’s a shift I would love to see stick.

To more directly answer J’s query though, on what I’d like to see next from corporations and companies who believe in giving back (and want to attract young people, like myself): follow the model of some forward thinking companies founded and run by young people themselves (Ryan Allis’ iContact comes to mind) and give employees one or two days of paid leave specifically for volunteering and giving back in their local communities. Let employees connect with causes they care about, and give them a platform to share those passions with fellow staff members. Don’t just think about writing checks and forming partnerships that your employees only know through little posts on their Sharepoint or Intranet sites. I know that would get my attention when I read through a benefits package.

You can read the other fantastic reflections on CSR at the Aid Blog Forum on Corporate Social Responsibility.

New opportunities & exciting upcoming events.

September 13, 2011
Aid, Aid Work, Events, US Policy, Young Professional
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It’s been an exciting month: three tremendous new job opportunities (huge thanks to all who reached out with opportunities & support), one very exciting decision made, and day one at my new post completed. I’m now a Monitoring and Evaluation (M&E) Associate with the Center for Health Information and Monitoring and Evaluation (CHIME) at John Snow Inc (JSI). Yep, an M&E Associate with CHIME at JSI – acronym soup anyone? But exciting acronym soup at that, and I’m delighted to join the company.

In the coming week, I’ll be attending the Social Good Summit as part of UN Week in New York City, where I’ve been granted press credentials along with a number of other bloggers, communications staffers, and social media gurus. I’ll be posting blogs for MCHIP, USAID, and here, and am looking forward to the the global health & development related panels and some of the fantastic side events lined up for the week. You can stay connected to the Summit on Twitter with the hashtag #socialgood or through the live streams of presentations and panels.

So, watch for some interesting updates, keep an eye on Twitter, and let’s see how UN Week unfolds. Will real decisions around NCDs be made? Will an agenda be set? Or will some of the other challenges in America and the world overshadow what the supposed theme of the General Assembly meeting?

We’ll see…

 

An update on the foreign affairs budget.

August 16, 2011
Aid, Aid Work, US Policy
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The Global Health Council has continued to promote advocacy to counter the proposed budget cuts to the International Affairs budget. In today’s e-mail blast, they highlighted some of the predicted outcomes from the proposed cuts to the budget, which include significant reductions in both the operating budget for USAID and their affiliate programs. From GHC:

The House is currently proposing a 9% cut to global health programs from current funding levels. These cuts will have drastic impact on people’s lives:

  • 345,559 orphans and vulnerable children will potentially lose their food, education, and livelihood assistance.
  • AIDS treatment will be eliminated for 332,216 people.
  • 3.8 million fewer people will be treated for malaria.
  • 37,292 fewer people with tuberculosis (TB).
  • 1.6 (1,623,165) million fewer children could receive oral rehydration salts that can help save many of the 1.2 million who die needlessly from diarrhea.
  • More than 900,000 (910,158) children could not be immunized against measles, tetanus, and pertussis.
  • Almost 3 million more unintended pregnancies will occur.
  • 9.4 million fewer women and couples would have access to receiving contraceptive services.

I know we all are numb to statistics, particularly with the information coming out of the Horn of Africa, but the US Agency for International Development, the State Department (through PEPFAR), and their contractors have done incredible work around the world to improve the health, livelihoods, and general welfare of individuals and populations around the world.  Consider the numbers above and the importance of developing markets abroad for US goods and services before advocating for cutting the (already paltry) foreign affairs budget.

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