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Archives for Global Health

Technologies to Keep Mothers Safe

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

This Sunday—Mother’s Day in the United States—will be a day of light hearts and laughter for many. At PATH, we’re dedicated to developing simple, affordable technology to make sure becoming a mother is a time of joy the world over.

Elizabeth Abu-Haydar, right, with a mother in a prenatal clinic in Rajasthan, India. Photo Credit: PATH/Noah Perin

In some parts of the world—notably sub-Saharan Africa—childbirth remains an extremely dangerous time in a woman’s life. Some 300,000 women worldwide die each year just before or after delivery. Excessive obstetric bleeding— postpartum hemorrhage—causes 1 in 4 of these deaths. And mothers who survive aren’t out of danger. Those who live through severe postpartum hemorrhage are significantly more likely than other mothers to die within a year’s time, leaving their babies and families alone.

Elizabeth Abu-Haydar, public health specialist with our Technology Solutions program, looks for ways technology can make childbirth safer. On May 28, she’ll be presenting her work at Women Deliver, an international conference focused on improving the health and well-being of girls and women. To celebrate Mother’s Day, we asked Elizabeth about some of the technologies that hold promise for making childbirth safer.

What will you talk about at Women Deliver?

I’m going to highlight some of the technologies we’re working on to fill a gap that occurs when women experience severe postpartum hemorrhage. There’s a clear protocol that’s followed when a woman starts bleeding after delivery: She’s given medication and her abdomen is massaged, and in 62 percent of the cases, that works to stop the bleeding. But in those other roughly 40 percent of cases, the woman could potentially continue bleeding, and if she’s bleeding severely, even a healthy woman can die within two hours. Most of these women are not as healthy as they could be, and the biggest problem is that many of them are anemic.

Why does anemia make the problem worse?

These women have low iron stores, and the body during pregnancy requires more iron. If a woman starts bleeding and she doesn’t have iron stores, she’s likely to go into heart failure and shock much more rapidly than a woman who is healthy. In sub-Saharan Africa, where 40 to 50 percent of the women are anemic, that’s a huge problem.

What can we do about it?

We’ve been testing a device that makes it very easy to assess whether a woman is iron deficient or not. We call it a noninvasive anemia screening device. The device measures iron levels using a clip that attaches to the woman’s finger. Ideally, you would use it every time she comes in for her prenatal visit. If there’s a problem, you can start treatment and monitoring. The screening doesn’t require blood, it gives a reading in less than a minute, it doesn’t hurt, and it’s visual, so that it becomes a way to talk about iron with the woman. Plus, there are no sharps and no waste and no resupply issues either, which is a big, big deal.

What do you do to stop the bleeding once it starts?

One option is the balloon tamponade. It’s basically tubing attached to a vessel, such as a condom, that is inflated by pumping water into it. It’s inserted into the uterus and filled until it stops the bleeding. It is very effective and it’s very affordable.

Another option is the antishock garment, which looks a bit like a tight wetsuit. Its main purpose is to reverse shock. If a woman has bled profusely and her organs are shutting down, she starts going into shock. That’s when the antishock garment gets wrapped around her in a sequential manner starting from her legs up so that the blood is pushed to her vital organs. You can combine the antishock garment with the balloon tamponade. It’s a beautiful combination!

You sound very motivated—even though developing technologies is a long haul. What keeps you going?

You know, I was in Kenya in August, visiting 13 clinics that were run by midwives—not fancy, these were serving the slums of Nairobi. We talked about the balloon tamponade, and a couple of midwives had used it. They talk about the woman who came in to give birth, and they really thought she was going to die, and there was no way she was going to make it to the hospital, and somebody said, “Why don’t we use this balloon thing they were telling us about?” And they try it. And the woman survives. And she comes back a week later with her baby. That inspires me. That’s very exciting, I think.

Additional Resources

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Improved TB Diagnosis & Treatment: Research and Innovation Urgently Needed to Address Global Epidemic

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

In 1882, Dr. Robert Koch discovered Mycobacterium tuberculosis, the bacteria that causes TB. In 1952, the first combination of antibiotics was used to treat. Today, thoughout the world, most people with TB are diagnosed with the same simple microscopy method that Koch used to identify the bacteria. Additionally, almost all are treated with the same basic antibiotics that have been used since mid-20th century. During the same time period, the HIV epidemic and spread of drug resistant TB have complicated diagnosis of TB. People with HIV who become sick with TB are less likely to be diagnosed correctly using simple microscopy, and this technique does not tell us whether or not the bacteria is resistant to anti-TB drugs. Moreover, with the alarming increase in drug resistant cases in recent years, we see the limits of available treatment. The drugs used to treat multi-drug resistant TB are not very effective and extremely toxic, and patients must take them for up to two years to achieve cure.

But the past decade has brought significant new tools to the fight against TB, including the Xpert MTB/RIF® diagnostic platform and potential new regimens to shorten the length of treatment. The Xpert test for TB diagnosis can tell us whether or not a person has TB AND whether or not the bacteria is resistant to Rifampicin, one of the most powerful anti-TB drugs, in less than two hours. Without Xpert, it can take up to two months to confirm drug resistance, which results in a long delay in starting appropriate treatment. Xpert is a relatively simple test that can be implemented with minimal training and infection control requirements, and recent negotiations with the manufacturer have resulted in a significant decrease in the price. The US government is supporting countries in regions with high HIV prevalence and high levels of drug resistance to introduce and implement this new diagnostic test.

On the treatment side of the equation, the U.S. government is supporting late stage research to test new regimens for multi-drug resistant TB that will reduce the treatment time from 18 to 24 months to 6 to 9 months. Additionally, we are working with global leaders to develop guidelines for the introduction of bedaquiline, the first new anti-TB drug in 50 years, to existing treatment regimens.

EXPOSED: The Race Against Tuberculosis (Official Trailer) from Aeras on Vimeo.

Despite these promising new tools, we need additional point of care TB diagnosis tools and shorter, less toxic regimens to reduce the treatment time even further and with fewer side effects, which can be debilitating for those on treatment for drug-resistant TB. The U.S. government will continue working with global leaders, national TB programs, civil society and at community level to support this critical work in the fight against TB.

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The Promise of MPTs: An Integrated Approach to Women’s Health

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

In recent years, the global community has intensified its focus on women’s health and rights. This reflects a universal recognition that women and girls are fundamental to the health and well-being of societies worldwide — and that we still have significant challenges to overcome before reaching essential development goals.

HIV and maternal mortaility, and their frequent intersection, are  among the greatest obstacles to women’s health and development. Together, they consisitute the two leading causes of death among women of reproductive age.

A woman holding a ring. Photo Credit: USAID

Women are disproportionately affected by HIV/AIDS due to a combination of biology, gender inequality and sociocultural norms. In sub-Saharan Africa, the epicenter of the AIDS epidemic, young women are twice as likely to become infected with HIV as young men.

At the same time, a lack of access to modern contraceptives in developing countries remains a major contributor to global maternal deaths. An estimated 222 million women worldwide want to delay or avoid pregnancy but aren’t using a modern method of family planning. Contraceptives allow women to space and limit their pregnancies,  leading to better health, education and economic outcomes for women and families.

Women in areas with high rates of HIV often have the greatest unmet need for contraception. New multipurpose prevention technologies (MPTs) now being developed address these dual risks, and may give women tools they can use to protect their health and better their lives.

While existing MPTs such as male and female condoms are extremely effective when they can be used, many women cannot negotiate condom use. New MPTs in development — including vaginal gels, long-acting rings and new types of barrier devices — could expand options for discreet, female-initiated prevention methods. In addition, because women’s perceived risk of HIV is low compared to their perceived risk for pregnancy, and given potential stigma around receiving HIV services, combined technologies may be widely used. As such, new MPTs may also help promote increased integration in health care delivery.

With leadership and support from USAID, the International Partnership for Microbicides is applying its experience in HIV prevention to the development of a 60-day MPT vaginal ring that would offer protection against HIV and unintended pregnancy. Now in preclinical stages, the ring would deliver an antiretroviral drug called dapivirine along with the hormonal contraceptive levonorgestrel. Clinical studies are planned for 2014.

The contraceptive field has long taught us that no single product will address women’s unique needs and preferences. While some women may prefer to use a gel around the time of sex, others may find that a longer-acting ring is more convenient and encourages consistent use. USAID is working on a number of new technologies to expand contraceptive options for women and couples across the globe. Learn more about these new contraceptives and multipurpose prevention technologies under development in this slideshow.

While at least several years away, new integrated solutions like these could result in significant health gains for women by reducing rates of HIV transmission, STIs, and maternal and newborn death associated with unintended pregnancies. As a result, MPTs could help advance progress on multiple development goals related to health, poverty and gender equality — and give women and girls a chance to reach their full potential.

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Catching Mosquitoes, Not Fish: Returning Bed Nets to their Proper Use in the DRC

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

It is 1 p.m. in the village of Kavimvira. The sun is high over Lake Tanganyika, at the foot of the Mitumba Mountain, in scenic South Kivu. Frank Baraka has packed the bounty of the morning fishing trip and folded his nets, when his cell phone chimes to signal an incoming text message: : “Sleep every night under an Insecticide-Treated Net (ITN), to protect your family from malaria,” he reads out loud, amused, to his fishing companion.

Frank Baraka sewing a bed net that he will use as a fishing net. Photo Credit: USAID

“This is exactly the message my wife has been pounding at home lately,” Roger Amisi responds. “She says that she heard it at the ETL (Education-Through-Listening) meeting, with Nathalie, you know, the primary school teacher.”

Delaying his lunch, Frank hurries to Nathalie Niéla’s compound to find out about the messages.  “Malaria kills children in our community,” Nathalie says. “Sleep under a net every night, to live safe from malaria,” she confirms.

This is the call to action of the Malaria 3+1 Campaign implemented by USAID’s Democratic Republic of Congo-Integrated Health Project (DRC-IHP), in partnership with C-Change. An estimated 140,949 Congolese from 194 villages were exposed to campaign messages on malaria awareness and prevention. In a country where only five percent of pregnant women receive proper preventive malaria therapy, and malaria accounts for nearly 40 percent of child deaths, prevention is a critical priority.

Nathalie is one of 37 women ETL facilitators recently trained in the DRC-IHP’s field office of Uvira.  “Thanks to ETL, our husbands no longer use the nets to fish or to protect vegetable gardens,” she affirms proudly. “Nets now serve their purpose of protecting children and pregnant women from mosquito bites.”

ETL is one pillar of IHP’s Tuendeni-Kumpala Behavior Change Communication strategy which empowers communities to adopt health-seeking behaviors. Tuendeni-Kumpala which means “moving forward” in Swahili and Tshiluba (two local languages), is an integrated strategy in which ETL facilitators work in synergy with other innovative communication approaches such as mobile technology, to increase the reach and enhance the behavioral impact of project interventions such as malaria prevention and use of reproductive health services.

Through this partnership between USAID, DRC-IHP and C-Change, a total of 64,584 ITNs were distributed across Bukavu, Kolwezi, Uvira, and Kamina, supporting the effort to boost the number of people using insecticide-treated nets.  Campaign results from two health zones point to the value of ETL, in terms of actual ITN use. After four months, 89 percent of the 9,471 households exposed to campaign activities in Uvira slept every night under an ITN.  By contrast, 82 percent of the 12,965 households involved in Kamina (Katanga province) reported adoption of the preventive behavior. When the campaign was launched in June 2012, ETL was not yet rolled out in Kamina.

For the project’s communication team, the difference illustrates the powerful effect of ETL. “ETL truly shows results here,” said Donat Ngoyi, DRC-IHP Communication Expert in Uvira.  “This approach will, no doubt, help us meet our malaria prevention and treatment goals.”

The DRC-Integrated Health Project (DRC-IHP) — a five-year USAID cooperative agreement led by Management Sciences for Health in partnership with the International Rescue Committee, and Overseas Strategic Consulting, Ltd — is strengthening the leadership and governance capacity of people working in the health sector to improve the access, availability, and quality of services within 80 target health zones.

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Health and Economic Returns on Science and Innovation Investments for Global Health

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

In the past decade, U.S. investments in science, technology and innovation have led to critical breakthroughs in prevention, diagnosis and treatment of deadly global diseases. We now have a meningitis vaccine for African populations, a new test that can quickly diagnose drug-resistant TB and promising data indicating that a vaccine could prevent HIV infection. We have developed desperately needed new drugs for neglected diseases and have determined pathways to expand access to treatment for millions through programs like PEPFAR and USAID’s Neglected Tropical Disease (NTD) program.

Doctor prepares malaria treatment. Photo credit: IMAD

However, there is still much work to be done. Global diseases like HIV/AIDS, malaria and tuberculosis take eight lives per minute. And so many young lives are taken, compounding the tragic loss of human potential – almost one in five of all global health deaths each year are in children under the age of five. In addition to the devastating health consequences, these diseases perpetuate the cycle of poverty. For example, the average TB patient loses 3-4 months of work and 30% of yearly household earnings because of the disease. Trachoma, a neglected tropical disease that is the world’s leading cause of preventable blindness, results in an estimated $2.9 billion in lost productivity each year. Developing new tools to combat these diseases is critical not only for saving lives, but also for allowing individuals to achieve their earning potential and enabling impoverished nations to develop sustainable economies.

As we look ahead, a plethora of new technologies are poised to transform the way that we prevent, diagnose and treat global diseases. For example, advances in mobile technology are leading to a new generation of mobile health tools that will dramatically increase access to healthcare. Advances in genomics mean that scientists can track diseases on a molecular level, allowing them to identify outbreaks, understand patterns of disease transmission and develop targeted drugs and vaccines. We are truly on the brink of remarkable breakthroughs and have the opportunity to revolutionize global health. To seize this opportunity, we must call for continued investment to save lives, combat extreme poverty and accelerate progress.

Additional resource:

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Use of Technology in Malaria Prevention and Control Activities

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

More than ever, the world relies on technology for everyday activities in the work place. Technology brings us a host of efficiencies – saving us time, resources, and providing real-time response capabilities. Within the realm of global health, programs in the field are finding ways to use new technology for monitoring and evaluation, rapid exchanges of critical data and information, and general logistical purposes. Such efficiencies can equate to lives saved and reduced morbidity, drastically increasing the impact programs have on populations in need.

RTI has implemented a number of technology-based solutions to support the U.S. President’s Malaria Initiative (PMI) malaria prevention and control efforts throughout Africa.

Zanzibar District Malaria Surveillance staff visiting malaria positive households during a training session, June 2012. Photo credit: Mike McKay, RTI

Funding by PMI and other stakeholders, together with the leadership of the Zanzibar Malaria Control Program (ZMCP), has resulted in a dramatic decrease in malaria prevalence in Zanzibar. However, persistence of malaria transmission in surrounding areas (Tanzania mainland and Kenya) leaves the island vulnerable to sudden outbreaks and the re-establishment of ongoing, perennial malaria transmission. Through the USAID-funded Tanzania Vector Control Scale-Up Program, RTI International has worked closely with the ZMCP and PMI to develop Coconut Surveillance, a mobile application that builds on the Malaria Early Epidemic Detection System (MEEDS). MEEDS is an innovative mHealth system used by health facilities to report new malaria cases via simple-feature phone handsets, which ensures that epidemic outbreaks are identified within two weeks of their onset. Coconut Surveillance works through the MEED system by alerting district malaria officers to new local case reports. ZMCP district malaria officers are then guided through an active case detection protocol by Coconut Surveillance, which includes the following steps:

  1. Collect additional case data at reporting health facility,
  2. Visit household to collect family member data and test for malaria infection, and
  3. Record GPS-based household location.

Malaria surveillance officer interviewing woman from malaria positive household in Zanzibar, June 2012. Photo credit: Mike McKay, RTI

The accumulated data are synchronized with a shared database, enabling program officials to monitor results in real time, detecting cases, identifying localized outbreaks, responding within two weeks of case detection, and developing better strategies for disease elimination. ZMCP officers equipped with Coconut Surveillance on tablet computers receive new case alerts from MEEDS, and use Coconut Surveillance to collect additional data as they follow up on each new case.

MEEDS is currently used by all of Zanzibar’s 150 health facilities. From July to December 2012, Coconut Surveillance followed-up (PDF) on 980 newly reported cases, tested 3,228 household members, and identified 223 previously unidentified malaria cases in Zanzibar. MEEDS and Coconut Surveillance are helping Zanzibar to identify and treat many otherwise undiagnosed malaria cases, identifying hot spots and transmission patterns, and responding rapidly to new outbreaks. These mHealth applications are helping Zanzibar to sustain the remarkable gains it has made against this dangerous and debilitating disease.

Opportunities exist to expand on the lessons learned from these technology-based activities in malaria programs and introduce them as solutions to other global health projects that encounter similar challenges. The value added by these tools offers the opportunity to greatly increase efficiency, accuracy, and impact across the global health spectrum.

Watch MEEDS in action.

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Better Diagnostics Critical to the Fight against Typhoid

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

The lack of a robust, sensitive, and easy-to-use diagnostic test is one of the most serious barriers to the control and prevention of typhoid fever.

Typhoid fever is a severe bacterial infection spread through water or food that has been contaminated with human waste. The disease causes high fever, flu-like symptoms, abdominal pain, and systemic illness that can result in severe morbidity or death.

An estimated 21 million people fall ill due to typhoid each year, and unfortunately, the burden of disease is greatest among the most vulnerable: school- and pre-school-age children. These children primarily live in poverty throughout Asia and Africa, typically in crowded and unsanitary conditions without access to safe water or basic sanitation.

Women and children in Bihar state, India. Photo credit: Esther Havens

When they fall ill with typhoid, recovery is no guarantee. WHO estimates at least 216,000 people die from typhoid each year. The disease can be treated with antibiotics, but resistance to common drugs is widespread and increasing.

The lack of effective diagnostics means it is more difficult to identify patients, provide effective treatment and prevent the disease from spreading, especially for drug resistant typhoid. It also hinders our ability to conduct surveillance and to identify high-burden and at-risk populations. For policymakers, ministries of health, and others, this lack of diagnostics obscures the true impact of the disease, and reduces the sense of urgency that is required to address it.

There are vaccines available to prevent typhoid; however, they have limitations. Existing vaccines are only moderately effective and provide limited protection to young children. But without a more trusted method for identifying patients, it is also more difficult to conduct efficacy trials of next generation vaccines and clinical therapies. The lack of a sensitive diagnostic test increases the number of patients that must be recruited for these trials and, as a result, dramatically increases the associated costs and time. As a result, in the past few decades, the field has moved forward only with public sector investment.

We don’t have to wait for next generation diagnostics to make a strong case that international organizations and national governments should invest in the control and prevention of typhoid. Timely case identification and management with antibiotics has dramatically reduced case fatality rates, and access to clean water and basic sanitation will provide the best long-term solution.

But at the same time, we know that next generation vaccines providing high levels of lasting protection as early as infancy and effective clinical care may not become available to the children that would benefit most because the cost of needed trials is too high. And when children’s lives are at stake, we need to move quickly.  That’s why we need to rise to the challenge of developing better typhoid diagnostics, and soon.

Learn more about typhoid fever and how to get involved at

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Embracing Innovation and Discovery to Accelerate Global Health Progress

Ariel Pablos-Mendez, PhD, serves as assistant administrator for Global Health

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

Improving women’s and children’s health is critical to the development of successful economies and stable communities. It not only saves lives, but it helps communities move themselves out of poverty. Yet every year, 6.9 million children die of preventable causes and more than 287,000 women die from complications of pregnancy and childbirth.

In his State of the Union Address earlier this year, President Obama set forth a vision to, within the next two decades, achieve some of the greatest contributions to human progress in history– eliminate extreme poverty, ensure an AIDS-free generation, and end preventable child and maternal deaths.

To many, these goals seem impossible. They seem like nothing more than a catchy statement, in a political speech. But in reality, these goals are achievable, and we’ve already begun to see tremendous progress.   For example, we’ve supported the scale up of a simplified newborn resuscitation program, “Helping Babies Breathe” through a public-private partnership. The partnership has trained and equipped 100,000 health providers in 50 countries in the last two years. This past year, USAID reached more than 84 million women with family planning information and services. By enabling women to delay and space pregnancy, this helped to prevent 15,000 maternal deaths and save the lives of more than 230,000 infants. These are just a couple examples of the recent advancements we’ve made.

But while we have tools and knowledge that can save and improve lives today, we must also look toward the future. Millions around the globe still do not have adequate access to reproductive, maternal and child health services. There is no guarantee that today’s tools will meet tomorrow’s challenges. We must not become complacent.

USAID and the broader global health community invest in innovation, science & technology to find game-changing solutions. Solutions that will help accelerate the goal of ending preventable child and maternal deaths, and creating an AIDS-free generation.

Through the Grand Challenges for Development, Development Innovation Ventures, and the Higher Education Solutions Network, USAID is helping to drive breakthroughs in science and technology that can transform development challenges. Recently, we launched the Center for Accelerating Innovation and Impact in Global Health to help promote and discover innovative, business-minded approaches to address key bottlenecks in the development, introduction and scale-up of global health technologies and interventions.

And since 2011, Saving Lives at Birth has supported 39 exciting and potentially transformational solutions to women’s and newborns’ health. The innovative ideas include an instrument-free, low-cost, rapid point-of-care CD4 test; a postpartum intrauterine device simulation training model; a counterfeit and substandard drug detector device for use in the developing world; and a low-cost, sustainable health cooperative.

At USAID, we are committed to finding innovative solutions to global health  problems (PDF) and if the global health community can harness science, technology and innovation for the poorest communities in the world, we can leave an unparalleled legacy in global health in this next decade. Over the next few days, we will be blogging about some of the latest cutting-edge solutions that are changing the global health arena. By working together to discover and build new solutions, we can maximize our impact and expand what is possible in development.

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Religious Leaders “Noisy About Malaria” in Mozambique

Each year, World Malaria Day (April 25) commemorates the global fight toward zero malaria deaths and mobilizes action to combat malaria. This year’s theme is “Invest in the Future: Defeat Malaria.”

Anglican Bishop Dinis Sengulane’s message isn’t exactly what one might expect from a typical religious leader. Then again, Bishop Sengulane, who has presided over Mozambique’s Lebombo Diocese since 1976, is not a typical leader, religious or otherwise. The large cross that hangs from a chain around his neck is fashioned from components of disassembled weapons surrendered by combatants after the Mozambique civil war, a prolonged conflict that he and other religious leaders played an integral role in bringing to an end in the mid-1990s.

Bishop Dinis Sengulane addresses the crowd at Coca Missava village about the importance of net retreament and malaria prevention. Photo credit: Bita Rodrigues/USAID

Today, Bishop Sengulane is fighting to bring an end to another destructive force in his nation: Malaria. The disease steals 650,000 lives around the world each year, devastating entire communities and undermining opportunities for prosperity and growth — and disproportionately affecting the African continent.

At a gathering hosted by USAID last month in Washington, DC Bishop Sengulane was joined by Rear Admiral Tim Ziemer of the President’s Malaria Initiative (PMI), leadership from USAID’s Global Health Bureau and representatives from a number of faith-based and community organizations, including Christian and Muslim groups. The Bishop’s message was simple and clear: “[Mozambique] reached peace 20 years ago. But 10 years ago we said there is something else that is killing day and night. Its name is Malaria. Let’s stop it. Let’s start working on that as communities of faith because we know this is not God’s will.”

In 2006 the Bishop helped launch a nationwide campaign to end malaria called PIRCOM (Programa Inter Religioso Contra a Malaria) alongside leaders from Christian, Muslim and Baha’i faith backgrounds. Their ambitious goal: train thousands of religious leaders across the country with basic malariaprevention and control messages, equipping them with the resources and tools needed to bring these messages to their communities. 

“People in Mozambique know that I often say ‘Let’s be noisy about malaria’. That’s actually how PIRCOM started… people heard us saying could we give them a platform to address even more people on their concerns about malaria.”

To date PIRCOM has trained over 27,000 religious leaders and reached nearly 2 million congregants with basic malaria education, made possible through funding from the President’s Malaria Initiative. The PIRCOM network now extends to 36 district councils and six provincial councils across Mozambique where efforts are coordinated. Reflecting on the unique role faith communities can play in saving lives through simple public awareness raising, Bishop Sengulane observed: “If a doctor talks about how important it is for you to have your home sprayed, of course he will talk about those things in those terms, because it is how he will get his salary. But when a leader of a mosque starts talking about health issues, about malaria, then people are ready to listen. [Religious leaders] have got a good audience.”

Echoing this theme, Rear Admiral Tim Ziemer added, “No matter what the cause, if you don’t have political, or community, or civil leadership behind, it isn’t going to go anywhere… these leaders represent a ‘flag pole’ for the cause.”

Still, there is much work to be done, especially in preventing deaths of children under five. Concluding his remarks, the Bishop acknowledged, “At the present moment we continue to have too many children dying of malaria. It’s very important that we ensure that with the under-fives, pregnant women and similar vulnerable groups, that we go back and do the very urgent work of providing them with whatever is needed so that malaria doesn’t kill, as we see happening too often.”

PIRCOM’s example reminds us that effective global development not only requires sound public policy and results-oriented programming, it is also a fundamental expression of our values, both as individuals and as a nation.

On this, World Malaria Day, let’s resolve to be noisy about malaria.

Malaria is a Marathon, Not a 50-yard Dash

Each year, World Malaria Day (April 25) commemorates the global fight toward zero malaria deaths and mobilizes action to combat malaria. This year’s theme is “Invest in the Future: Defeat Malaria.”

I used to call them “disease du jour” bills. As a staffer on the U.S. Senate committee with jurisdiction over public health issues, every time a Senator’s nephew or cousin or college roommate’s daughter got a terrible diagnosis, it was my job to explain why passing a one-time bill wasn’t the answer for every disease. Washington’s attention span tends to wane after the galas end, the celebrities leave town, and the surge of early funding and enthusiasm dries up.  Without unglamorous vigilance, the disease remains after the politicians and paparazzi move on to the next disease du jour. Global health was no different.  After working on malaria policy for several years, I noticed the buzz starting to shift to tuberculosis. Malaria control was just so… 2006.

For children under five, malaria mortality rates have fallen dramatically with scale-up of malaria control efforts. Photo credit: USAID

Surely the private sector wouldn’t be so fickle, right? I joined MosquitoZone International, a U.S.-based firm that offers malaria prevention services to companies with operations in endemic areas. How exciting to work with clients who were absolutely committed to keeping their workers and communities safe from malaria! It turns out, of course, that companies can sometimes be a lot like governments. They invest in controlling malaria and they make so much progress that pressure builds to redirect scarce resources into one of the other health and safety threats facing their workers and their bottom line. But malaria doesn’t go quietly into the night.

One of our clients started off doing everything right. They committed to eliminating malaria at a sub-Saharan African project site. They hired us to run a comprehensive vector control program and we don’t play around. Our entomologists knew every mosquito on that jobsite by name and killed it. By 2011, our client had zero new cases among non-immune expatriate workers and zero complicated cases among semi-immune local workers. They bragged about their success on the company web site. Problem solved.

Inevitably, the urgency of the need for investment in sophisticated entomology was questioned. After all, there were plenty of other problems clamoring for their health and safety resources. Unfortunately, when you stop putting experienced entomological eyeballs on surveillance data, the bugs get the upper hand. After we left, the company failed to respond to entomological data suggesting a major spike in the mosquito population that should have prompted a five-alarm investigation. The company recognized the problem, recommitted to entomological excellence and their success continues with MosquitoZone’s entomologists driving their prevention program today.

Time and again, we see the same predictable cycle in public and private sector programs all over the world. Success turns the volume down on the alarm bells that drive the investments that produced that success in the first place, and when that happens, only failure raises the alarm again. But failure isn’t just a technical abstraction about budget line-items or resistance data. Failure means babies dying, workers downed, and human productivity and potential plummeting.

When it comes to the wily mosquito, every day has to be World Malaria Day.

Katy French is the Vice President for Corporate Affairs at MosquitoZone International.

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