27 December 2012

Top of 2012 List

Rather than provide a retrospective post that relates to this blog, my work or even aid in development I want to end the year with a lighthearted post. Therefore, I present my top tracks from 2012. I really dug into Frank Ocean's channel ORANGE over the past week or so and I am obsessed to put it mildly.

Grimes has to be what I find to be the most surprising artist, for myself, this year. Her sound is layered upon almost entirely unintelligible lyrics. She is almost the exact opposite of the stripped down track Laura by Bat for Lashes and everything song by The XX. For some reason the experimentation that goes only as far as a pop song can go makes for some captivating songs.

I am taking advantage of the slow pace that characterizes the end of the year to listen to as much 2012 music as possible. It is what allowed me to find Grimes and will ultimately lead me to more tracks that will soon join the initial 30.

If you listen to one song, make it Frank Ocean's performance of Thinkin Bout You from SNL this fall (video at the top). You will thank me later.

Feel free to offer up other suggestions and even criticize my selections.

Happy New Year and back to the regularly scheduled program in 2013

25 December 2012

The Dominance of the Muppet Christmas Carol

The Muppet Christmas Carol is the best of the adaptations of the famous Dickens novel, at least according to Amazon sales and my personal opinion. Can't really pass up a wonkish Christmas-related chart from the Economist.

Merry Christmas to all who celebrate today.

20 December 2012

Clean Cookstoves Continue Stumbling Through Failures

The pursuit of clean cookstoves is a topic that is frequently met with equal measures of promise and skepticism. Smoke inhalation is considered a public health problem since it affects some 3 billion people and is estimated to lead to 2 million deaths each year. People have tried to tackle the problem for decades to little success and a new study published in the American Journal of Tropical Medicine and Hygiene finds that ceramic cookstoves used in rural Kenya did not reduce the incidence of pneumonia among children.

The mothers who used the ceramic "upesi jiko" (quick stove) reported that there was less smoke in the home and noticed a decrease in physical irritation caused by smoke when cooking. However, the researchers found that the pneumonia incidence rate of children under three years old was not significantly lower in households that uses upesi jiko as compared to homes that use the traditional three-stone method.

2010 saw the revival of the cookstove with the announcement of the $60 million Global Alliance for Clean Cookstoves . The initiative, led by the UN Foundation, now has hundreds of partners from governments to donors to the private sector. Secretary of State used her 2010 CGI remarks to focus on cookstoves where she highlighted that the technology was available to tackle the problem. 

"But today, because of technological breakthroughs, new carbon financing tools, and growing private sector engagement, we can finally envision a future in which open fires and dirty stoves are replaced by clean, efficient, and affordable stoves and fuels all over the world – stoves that still cost as little as $25," said Clinton

The initiative set out the ambitious goal to support the adaptation of clean and efficient cookstoves in 100 million households by 2020. Some worried that the idea was too aspirational and missed the  missteps by prior efforts to introduce clean cookstoves. "The major flaw in previous cookstove efforts was focusing too much on good design from a designer’s perspective, and not enough from a user perspective," said Alanna Shaikh in a blog post for Aid Watch.

It appears that the technology is also still a problem. The Kenya study findings show that the cookstove used is still not efficient enough to make an impact. “Despite requiring less fuel, these stoves may not be efficient enough,” Robert Quick, MD, MPH, a researcher in the Division of Waterborne, Foodborne,
and Enteric Diseases at the U.S. Centers for Disease Control and Prevention in the press release. “The belief is that you need much more efficiency, maybe a reduction of 50 percent or more, to really observe the health benefits.”

Quick added that the believes that efficient and clean cookstoves are needed, but the evidence of their efficacy is insufficient. A part of the challenge, as alluded to by Shaikh, is people transitioning from traditional cooking methods to using cookstoves. A five year study in Orissa, India by researchers Rema Hanna, Esther Duflo and Michael Greenstone found that the cookstoves were effective in the short term, but provided little improvement over the long term.

Breakdowns, improper use and poor maintenance all contributed to the failure of the cookstoves, said the researchers. Furthermore, the cookstoves did not reduce fuel use. "While households overwhelmingly claimed that the stoves used less wood, fuel use remained unchanged, and if anything, somewhat increased," wrote Hanna, Duflo and Greenstone in the conclusions. "The lack of obvious benefits may explain why households were not interested in using the stoves optimally."

Behavior change is an important aspect in implementing new technologies and the Hanna study illustrated that challenge. "[S]olving intractable social problems requires fundamental changes in the target population. It also needs a supportive institutional framework to reinforce the right behaviour. Technology can complement this process, but it is no substitute for the human element," argued SC in The Economist citing the Hanna study and the failure of One Laptop Per Child.

End of the Wold Predictions

Tomorrow is the supposed end of the Maya calendar which means the world will end. According to Isaac Newtown there is still time left before the world ends, so all is good. Better yet, there have been many predictions of the end of the world in the past and we keep persevering  The Economist provides a nice chart of some of the more notable failed doomsday predictions.

19 December 2012

How a Simple Blog Post on a UN Announcement Uncovered a Misleading Initiative

Earlier last week, the UN held an announcement regarding new funding towards eradicating cholera in Haiti and the Dominican Republic. I have been keeping tabs on the situation in Haiti because the evidence strongly points towards the UN peacekeepers as the source of the outbreak, but the UN has both neglected shoulder responsibility nor has it fully mobilized a response to the spread of cholera on the island.

I set out to read about the announcement a few days after it happened and write a post based on what was new with some clips of how people reacted. I knew that these announcements are met with strong responses, so it would make for an easy and interesting blog post.

The reports from the AP and Reuters indicated that the UN unveiled a $2.2 billion initiative. I went back to the press release and the statement from Secretary General Ban ki-Moon to get some quotes and further information for the post. Curiously, the UN information that was provided made no mention of $2.2 billion. I searched around and kept coming back to the reports in the news media about the numbers, but saw nothing else.

I used Twitter to ask around and finally pinged former AP reporter Jonathan Katz. He and I spoke awhile back about Haiti and have kept in touch regarding the ongoing response to the outbreak. He began digging around and confirmed my discovery. The UN did not launch a $2.2 billion initiative, it was announcing $23.5 million in new funding and the reallocation of $215 million from bilateral donors.

A bit more digging revealed that the language of the announcement likely misled news outlets and the UN did nothing to correct the error. Katz and I co-wrote an article that published in Foreign Policy yesterday that covers our findings and calls into question how the $2.2 billion initiative that will be announced in January by the UN is going to be funded.

Here is an excerpt:
In the 25 months since Vibrio cholerae El Torbacteria was confirmed in Haiti for the first time, 7,805 people have died, along more than 400 in the neighboring Dominican Republic. The waterborne pathogen has contaminated nearly every mountain village and barrio stream on the Caribbean island. Yet Ban told reporters at the event that eradicating the disease was a matter of will. "Science," the secretary-general explained, "tells us it can be done." 
This would have been the second surprise. Throughout the epidemic, science has been the last thing the U.N.'s political leaders have wanted to talk about. 
The crisis began in October 2010, when Haitians began dying en masse along the rural Artibonite River. As Haiti had no known history with cholera -- there had never been a confirmed case before -- suspicion quickly focused on the horrendous sanitation at a U.N. base. The installation was home to a detachment of Nepalese soldiers, next to one of the river's main tributaries. U.N. officials in Port-au-Prince actively tried to dismiss the claims as pernicious rumors while mounting a clandestine and amateurish investigation behind the scenes. Within days of the outbreak, stories in the international press already showed not only that the Haitian rumors about the base were true and that the U.N. was dissembling, but that the strain of cholera matched a current outbreak in Nepal. The soldiers had traveled from that outbreak to Haiti just before Haiti's epidemic began.
Read the whole article here

18 December 2012

Twitter and AlertNet #AskValerie About Africa, Syria and More

AlertNet hosted a twitter chat with UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Valerie Amos. Amos answered questions from AlertNet and Twitter users through the #AskValerie hashtag. Here is the transcript of the discussion.

Malaria Fight Losing Momentum, Warns WHO

The leveling of funding for malaria prevention and treatment since 2010 has led to a slowing of promising progress against the deadly impact of the disease finds a new WHO report. The World Malaria Report 2012 finds that 1.1 million lives were saved over the past decade thanks to broad efforts to stem the impact of malaria. More than half of the averted deaths, 58% to be precise, took place in the 10 countries with the greatest malaria burden. However, slowing funding, warns the report, could threaten much of the decade's building momentum.

The WHO estimated that $ 5.1 billion is needed every year until 2020 in order to achieve universal access to malaria interventions. Present funding comes in at only $ 2.3 billion per year, less than half of the estimated need. "There is an urgent need to identify new funding sources in order to further scale up and sustain malaria control efforts, and to protect the investments made in the last decade," says WHO Director-General Helen Chan in her introduction of the report. "We also need to examine new ways to make existing funds stretch further by increasing the value for money of malaria commodities and the efficiency of service delivery."

In 2010, 219 million people were infected by malaria. Of that number, 660,000 died. The greatest burden of malaria deaths falls on children in Africa. However, the good news is that deaths caused by malaria are preventable. Long-lasting insecticidal nets (LLINs) provide protection when people are sleeping and malaria-carrying mosquitoes are active and indoor residual spraying helps to keep more mosquitoes out of households. The development of artemisinin-based combination therapy (ACT) has helped to bring about effective treatment for people who contract malaria, but there are growing concerns regarding the emergence of ACT resistance in southeast Asia.

17 December 2012

Shining a Light on Cancer in the Developing World

The impact of cancer in low- and middle-income countries is rapidly taking hold with fewer children dying and more people living longer. In fact, more people die from cancer each year than of AIDS, TB and malaria combined. Meanwhile, cancer spending by aid donors is a fraction of what is spent when compared to other health challenges.

"I think cancer and other noncommunicable diseases have been under-recognized and they have been neglected, but that’s not a malicious neglect," explained Lancet editor Richard Horton to Public Radio International's The World. "It’s because there’s just been this overwhelming burden of other problems." 

"In many parts of the developing world, particularly in sub-Saharan Africa, the overwhelming burden for many decades has been preventable maternal and child deaths, malaria, tuberculosis, and, over recent decades, HIV/AIDS. And that burden has been so overwhelming to families and to governments that it’s been very hard to see anything else through that very thick fog of death," continued Horton.

14 December 2012

Playing with IHME Data Visuals

I decided to play around with the data visualizations that came out of the IHME release of the burden of disease and what kills people around the world. One of the most striking things is the sudden spike in deaths for children over 10 years old as the result of the earthquake in Haiti. It is no surprise that the burdens shift from high mortality in young people in Asian and sub-Saharan African countries to a greater burden of NCDs in the West as people get older.

Here are some things I did. You can dig deeper into the Guardian's visualization here and check out what the Washington Post did here.

13 December 2012

IHME Report Shows Shifting Causes and Overall Decline in Global Mortality

Good news today from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Their new report, Global Burden of Disease Study 2010 (GBD 2010), looks at the changing mortality trends from 1990 to 2010 and find that fewer people are dying each year, but the fact that more people are staying alive means that long term risks and problems like mental health disorders and obesity are playing an increasing role in global health.

“We’re finding that very few people are walking around with perfect health and that, as people age, they accumulate health conditions,” said Dr. Christopher Murray, Director of IHME and one of the founders of the Global Burden of Disease in a press release. “At an individual level, this means we should recalibrate what life will be like for us in our 70s and 80s. It also has profound implications for health systems as they set priorities."

12 December 2012

Experts Mixed on PEPFAR's Blueprint to End AIDS

The United States government continued its priority of realizing a world without HIV/AIDS. “Now, make no mistake about it: HIV may well be with us into the future. But the disease that it causes need not be,” said Secretary of State Clinton at a press conference marking this month’s World AIDS day. “We can reach a point where virtually no children are born with the virus, and as these children become teenagers and adults, they are at a far lower risk of becoming infected than they are today.”

At the event, Secretary Clinton unveiled the new plan from the President’s Emergency Plan for AIDS Relief (PEPFAR) that establishes a blueprint for creating an AIDS-free generation. It sets out to end new infections of aids by achieving the following five goals: 1) scaling up treatment and prevention; 2) targeting at-risk populations; 3) promoting sustainable, effective and efficient solutions that maximize every dollar spent; 4) supporting country leadership; 5) continuing efforts in science and research.

10 December 2012

K'Naan's Struggle to Reclaim his Voice

Musician K'naan penned a revealing and honest OpEd in the New York Times over the weekend where he argued that he was convinced to believe that he had to censor himself and his views in order to reach a larger audience in the United States.
A war was going on, I was told, and some songs had meanings the government did not want deciphered. Those “anti songs” were different from love songs, or folk songs. You had to take care in dressing the words. In love songs, words could preen in bright colors; in anti songs, they attacked in camouflage. And from that, I got a hint of the power of lyrics — to encapsulate magic, or to spread alarm.
K'naan explains the personal development of his music and lyrics over the development of his first two albums. His third album, released this past September, was the follow up to the worldwide success that he achieved after his track 'Wavin Flag' became the anthem of the 2010 World Cup in South Africa.
On my second album, I had sung about my mother’s having to leave my cousin behind in Somalia’s war — “How bitter when she had to choose who to take with her...” Now I was left, in “Is Anybody Out There?” — a very American song about the evils of drugs — with only “His name was Adam, when his mom had ’im.” 
The first felt to me like a soul with a paintbrush; the other a body with no soul at all. 
So I had not made my Marley or my Dylan, or even my K’naan; I had made an album in which a few genuine songs are all but drowned out by the loud siren of ambition. Fatima had become Mary, and Mohamed, Adam.

07 December 2012

Shameless Audience Bleg - IRP Fellowship

The International Reporting Project (IRP) out of Johns Hopkins University is offering a new media fellowship for 2013. They are looking for journalists and media figures who are using new media and social media to report on health, development and innovation. I think that what I have been doing on A View From the Cave both here and on Twitter fits quite well into with IRP wants for the fellowship.

So, I am humbly asking all of you for some help. I want to launch a mini-campaign to help convince IRP that I should be one of their fellows next year. All I ask is for a few kind words directed at the IRP Twitter feed @IRPChirps (#fellowshipforthecave), or a comment on their Facebook Page, or a comment right here on this blog post.

I have been working on this space for free for a few years now and would love to dedicate even more time to covering aid and development. The grant will allow for that effort since it will provide a modest financial injection. If I get the fellowship, my goal will be to provide you with more reporting, information and analysis while focusing in on some large stories. Specifically  I would pursue stories regarding the development of the Post-2015 agenda and investigate the development and innovations within the water sector.

Thanks, as always, for reading and I appreciate your support.

06 December 2012

Embed Women and Girls into mHealth, says Dr Sadik

Washington DC - A marginal part of the recent mHealth Summit, global health took center stage on the final day with keynote addresses and discussions from global health leaders. Dr Nafis Sadik, UN Foundation Board Member and former head of United Nation's Population Fund used her time in the spotlight to issue a challenge for embedding women and girls into mHealth.

Dr Sadik spoke directly to the mHealth Alliance, a convening group for coordinating mHealth that involves multiple stakeholders from the public, private and NGO sectors. She commended the work done by the Alliance to bring people to the table in order to improve health outcomes through mobile technologies.

The promise of rapid technological growth makes Dr Sadik feel optimistic, but she was careful to point out that there are still significant gaps in the technologies and health solutions reaching women. "Whole groups are left out of the hi-tech revolution, notably the poor, and especially poor women," she said. "Women in general are less likely than men to have access to mobile technology – in South Asia, nearly 40% less likely."

Allison Stone of MoTeCh illustrated this very problem at last year's mHealth Summit and the NYC FailFaire. A project in Ghana that used mobile phones to support pre-natal and ante-natal care for women. Both the mothers and the community health workers were meant to use phones in order to enter information and receive SMS reminders. An initial survey found that women had high access to phones.

However, the implementation of the project revealed that access was loosely defined. Some women relied on neighbors to charge a phone or would borrow the phone with the permission of the husband. That meant that messages were not reaching women at the right time or at all. The truth was that cell phone use was much lower than what the survey revealed.

At a summit where major telecoms companies like Verizon presented new technologies for mHealth, Dr Sadik made the argument that access is central to ensuring that women around the world have access to health services. "For the mHealth Alliance to be fully successful, it must reach the women most in need, the less privileged and more excluded: precisely the women least likely to have access to mobile technology," she advised.

Reaching women also includes finding ways to bring men on board and in some cases change their attitudes. When I asked Dr Sadik after her remarks what she wanted to see done about including men in women's health she uncomfortably laughed saying that she had no idea how to do it. Then she switched to a serious tone as she reiterated that men can be a barrier to women's health and must be included in the effort.

To be successful, the mHealth Alliance must not only directly engage with women and girls, but address their needs and tackle the obstacles to better health, Dr Sadik argued. "Whatever opportunity exists we should be giving the maximum opportunity for that person," she said. 

Dr Sadik. stressed that it goes well beyond access to technologies. Women need to be able to access comprehensive services, rather than fractured or specific health interventions. "In the real world, women don’t have separate boxes for family planning and HIV prevention. They don’t know why the HIV clinic supplies condoms but not contraceptive pills, she explained. "They don’t know why they have to go to different places on different days for family planning, pregnancy testing, ante-natal care, cervical cancer screening, and all the other services they need."

Empowerment is at the base of Dr Sadik's argument. "It is not about me taking your power," she said to me. "It is about equal value. I believe everyone has equal value." The end goal is to ensure that women have the ability to make their own decisions in their lives.

At the conclusion of her prepared remarks, Dr Sadik challenged the mHealth alliance to do three things: 1) Involve women directly; 2) support gender equity and women's empowerment; 3) remove the obstacles to participation. "This is both a matter of basic human rights and a contribution to peace, justice and prosperity. Women are half the world. With our help, women will change the world," she concluded.

04 December 2012

Rwanda's Butaro Cancer Center: Realizing Francine's Wish

The following post is written in conjunction with PRI The World's series on cancer and builds on yesterday's post covering Rwanda's efforts to take on cervical cancer.

When Nicole first arrived at the Butaro Cancer Center of Excellence she could no longer stand because she was so sick from leukemia. She received intense treatment for acute lymphoblastic leukemia at the center over a two month period. Over the course of her treatment, Nicole regained her strength and was speaking to health staff in her native Kinyarwandan and English. 

Five weeks ago, Nicole was discharged from the center with oral chemotherapy to return home to her mother and sister. Her family will have to return to the center once a month for the next 30 months to continue the treatment. They will travel the roughly 77 kilometers North towards the border with Uganda to the only center capable of treating Nicole’s cancer in Rwanda. 

Butaro Cancer Center of Excellence, Credit: PIH
One year ago, Nicole never would have accessed the treatment that could save her life. The Butaro Cancer Center of Excellence was inaugurated this past July as the first cancer ward in rural East Africa. The establishment of the hospital represents a step forward towards turning cancer from a death sentence into a treatable illness. 

“Some childhood cancers have cure rates of 80 percent in the US, but in most parts of Africa cancer is a death sentence because treatment simply isn't available. We want to change that paradigm and bring world class cancer care to the world's poorest children, using a replicable and sustainable model,” said Peter Drobac, Rwanda PIH/IMB Country Director, in marking the inauguration of the center. 

Equity in Stone 

“There are tremendous barriers to patients in the rural setting to access specialty care services including for cancer,” explained Dr. Neo Tapela, Partners in Health's (PIH) Director of the NCD Program in Rwanda. Rwanda’s four referral centers exist in urban settings, but 80% of the population lives in rural parts of the country. The center will provide comprehensive cancer services including screening, diagnosis, chemotherapy, surgery, patient follow-up, and palliative care. 

Building the center is a step by the government to reduce the barriers to treatment and ensuring equitable care. Equity is central to the Ministry of health. “Equity is written in stone in our hearts,” said Minister of Health Dr. Agnes Bingawaho with pride. “It is in our constitution.” Achieving equitable health care means taking steps to put skilled doctors in each district and bring cancer services to rural parts of the country. 

Paul Farmer, co-founder of PIH, addressed concerns about investments in cancer by recalling early opposition to funding for AIDS. “Just a few years ago we had no system or financing mechanism to diagnose and treat AIDS in Africa,” said Dr Farmer. “People said it was too expensive or too complicated. But today nearly 7 million people in developing countries are receiving treatment for HIV. We can do the same with cancer.” 

Global Effort 

The establishment of the center in Butaro is the result of a multi-stakeholder partnership between Rwanda’s Ministry of Health, PIH, the Jeff Gordon Children’s Foundation and the Dana-Farber/Brigham and Women's Cancer Center. A $1.5 million donation from the Jeff Gordon Children’s Foundation and comprehensive support from PIH led to the building of the center. The land was provided by the Rwandan army, Dana-Farber/Brigham will provide testing support, and the government will pay the staff. 

Specialty cancer nurses from Dana-Farber Cancer Institute serve as mentors for the nurses in the center to support their work with the patients. PIH will support the government efforts to implement a comprehensive cancer plan that will serve to inform and shape all of the country’s health systems. Not only will rural Rwandan’s have improved access to care, but the proximity to neighboring Burundi and Uganda means that the center will serve as a regional hub that extends beyond borders. PIH will support patients from other countries who do not have health insurance, explained Dr. Tapela. 

Anne Elperin , an oncology nurse from Boston who already participated in the program as a Dana-Farber fellow was struck by how eager the nurses were to learn. "The Rwandan nurses were very engaged and would come to my chemotherapy classes on their days off or after they had worked a full night shift," Elperin told nurse.com. "They took a lot of pride in the fact that they were doing something new for Rwanda." 

One example is the implementation of national cancer trainings for doctors and nurses beginning March 2012. Doing so, “provides baseline knowledge for doctors and nurses at all levels in cancer diagnosis, treatment and care,” said Dr Tapela. The work goes further to include curriculum development and training community health workers in chronic diseases. “We need to create a community of care providers to accelerate science and the transfer of skills,” said Dr Bingawaho. 

Francine’s Wish

The story of Nicole is illustrative of the center’s transformational power. Francine Tuyishime, only fifteen years old, was the first patient to receive chemotherapy in PIH-supported hospital in Rwinkwavu, Rwanda. Like Nicole, Francine arrived at the hospital when her family thought that she would likely die. When traditional healers failed, Francine’s father brought her to the hospital in Rwinkavu for treatment. 

“There was a time when I thought I would never make it, when they started the medications,” said Francine. “I wish others in this part of the world could be cured just like I was cured by the medicines I was given.” Enrollment at both centers in Butaro and Rwinkwavu has grown this year, especially in Butaro following its opening. The establishment of the Butaro Cancer Center of Excellence and the story of Nicole are realizations of Francine’s wish.

03 December 2012

Rwanda's Bold Focus on Cancer Starts with HPV

The following post is written in conjunction with PRI The World's series on cancer. Go here to see the series.

A recent WHO assessment of Rwanda’s capacity to address non-communicable diseases (NCDs) found that country failed on every measure. Except for having a branch in the Ministry of Health that addresses NCDs. In between the lines of the assessment, and captured within the Ministry of Health, is a major push by Rwanda to take on cancer.

The Rwandan Ministry of Health is implementing preventative structures to reduce the incidence of cancer. For women, that means improving access to breast cancer screenings and a national HPV plan. Cancer is responsible for 5% of deaths in Rwanda each year. As a point of comparison, cancer is accounts for 23% of all deaths in the United States.

Major Development Gains

Rwanda has experienced a relatively rapid growth rate over the past few years. It was revealed earlier this year that 16 of 20 surveyed African countries by World Bank researchers are experiencing falling child mortality rates that are equal to or greater that what is set of the Millennium Development Goals. Rwanda’s 8% annual reduction stands at twice the rate of what is needed.

The gains are not limited to health. Roughly one million Rwandans are no longer living in poverty. The gains are a testament to the government, said Paul Collier, director of the Center for the Study of African Economies at Oxford University, at the time. “Basically, [President Paul] Kagame built a culture of performance at the top of the civil service. Ministers were well paid, but set targets. If they missed the targets there were consequences,” said Collier to the LA Times. “Each year, the government holds a whole-of-government retreat where these performances are reviewed: good performance rewarded, and poor performers required to explain themselves.”

All Eyes on NCDs

One of the focal points during the UN’s annual general assembly (UNGA) in September of 2011 was the rising global burden of NCDs. A resolution adopted by the General Assembly recognized the global problem and urged governments to work together, with donors and the WHO to support measures that will prevent and treat NCDs.

“Addressing NCDs is critical for global public health, but it will also be good for the economy; for the environment; for the global public good in the broadest sense,” said UN Secretary General Ban ki-Moon in his remarks to the UNGA in 2011. If we come together to tackle NCDs, we can do more than heal individuals – we can safeguard our very future.”

“According to the World Health Organization, deaths from NCDs will increase by 17% in the next decade. In Africa, that number will jump by 24%,” said Ban. The burden of NCDs will increase in low income countries like Rwanda as development gains eliminate avoidable child and maternal deaths.

Tackling HPV

HPV is almost entirely responsible for cases of cervical cancer. The three shots during adolescence will provide protection against HPV and all but eliminate the chances of developing cervical cancer when they get older.

“We are a government that is evidenced based and result oriented,” asserted Minister of Health Dr. Agnes Bingawaho. That is why Rwanda implemented one of the first widespread HPV vaccination campaigns for young girls in a low-income country.

For Rwanda’s older population, health clinics will undertake systematic screenings of women between the ages of 35 and 45 years old for cervical cancer. The solutions dominated approach has shaped the Rwandan cervical cancer program and the way that it developed. Bingawaho explained, “We always go for a policy first – the science in front of everything. We develop a strategy plan, followed by an implementation plan and then fundraise.”

Rwanda began working with Pharmaceutical giant Merck as far back as 2009 to develop a partnership that led to the signing of a three year memorandum of understanding in December 2010 to provide the vaccine at no cost. A paper authored by Dr Bingawaho covered the rollout of the vaccines for over 90,000 schoolgirls in April 2011. The researcher report over 90% coverage for all three vaccine rounds.

The authors answered questions regarding the allocation of resources towards the campaign by making a rights-based argument for vaccinating against HPV. They write, “High-level leaders are committed to ensuring the long-term integration of a rights-based cervical cancer prevention, care and treatment programme into the basic package of health services.” Prices will continue to fall, argue the authors, as more countries follow the lead of Rwanda and implement HPV vaccination campaigns.

Merck announced in June of 2011 that it would provide the GAVI Alliance, a global organization dedicated to improving access to vaccines, its HPV vaccine at two-thirds its market price of $15. GAVI followed up in November by officially announcing its intention to support that introduction of HPV vaccines in developing countries with the goal of vaccinating as many as 2 million girls in nine countries by 2015. “The HPV vaccine in particular is critical to women and girls in poorer countries because they usually do not have access to screening to detect cervical cancer and treatment available in richer nations,” said GAVI Alliance CEO Dr Seth Berkley in announcing the organization’s goals.

The Ministry of Health relies heavily upon community health workers to reach its citizens. Dr Bingawaho considers them to be the ‘echo’ of the ministry and an integral connection point to communities. There are three community health workers per village and they are selected by the village members. Doing so, explained Dr Bingawaho, engenders greater trust. That in turn leads to better health outcomes. “When people are given the opportunity to have better health, they are very responsive,” she said.

In tomorrow’s post I will talk about the development of Rwanda’s cancer referral center in Butaro.