We are delighted to release our latest film, about an antiseptic gel called chlorhexidine: Chlorhexidine for Umbilical Cord Care.  This film has been produced for the global Chlorhexidine Working Group with support from GSK.7.1% Chlorhexidine has been shown to be highly effective in reducing neonatal mortality related to newborn sepsis as well as umbilical cord infection.  We’ve produced this short animation for the Chlorhexidine Working Group to demonstrate how to provide safe umbilical cord care using this simple and effective, life-saving antiseptic.

Click here to view and download the film: http://medicalaidfilms.org/our-films/newborn-child-health/?v=135684121

The Chlorhexidine Working Group (CWG) is an international collaboration of organizations committed to the use of 7.1% chlorhexidine digluconate (delivering 4% chlorhexidine) for umbilical cord care in low income countries through advocacy and technical assistance.  To learn more, visit the Chlorhexidine for Umbilical Cord Care Hub: http://www.healthynewbornnetwork.org/page/chlorhexidine-umbilical-cord-care-hub

This film is intended to inform health workers and communities across Sub-Saharan Africa and other low resource settings about chlorhexidine, and how it should be used as part of safe umbilical cord care immediately after birth.

With thanks to GSK who generously supported this film, and to the Chlorhexidine Working Group for their input and expertise.

Please let us know what you think by sending us your feedback to josie@medicalaidfilms.org

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Josie Gallo

Content Co-ordinator Medical Aid Films

Office: +44 (0) 20 7396 5327 Mobile: +44 (0) 7790 047694

16 Lincoln’s Inn Fields, London, WC2A 3ED, UK www.medicalaidfilms.org

There is considerable excitement about the Sustainable Development Goals and their relevance to child health and child rights. This was the focus of the recent International Society for Social Pediatrics and Child Health meeting in Geneva which was addressed by the new Director of Maternal, Newborn, Child and Adolescent Health at WHO, Dr Anthony Costello.

The first of the new Goals is to end poverty in all its forms everywhere, and Goal 10 is to reduce inequality within and among countries. All would agree with these goals and the increase in inequalities across the globe and within most countries, including industrialised countries, is stark. Many would feel that the increase in wealth, whereby now (according to a January 2014 report by Oxfam) the 85 wealthiest individuals in the world have a combined wealth equal to that of the bottom 50% of the world’s population, or about 3.5 billion people, is a criminal injustice.

Can inequalities in health and severe poverty be eradicated simply by creating more growth,as the Goals seem to suggest?

Here is another anomaly in the Goals, how to combine growth (Goal 8 Promote sustained, inclusive and sustainable economic growth) with action to tackle climate change (Goal 13 Take urgent action to combat climate change and its impacts). Sustainable growth is hard to define but certainly can’t include using more fossil fuels or scarce resources or increased consumption, without massive increase in carbon emissions.

Is it possible to both reduce poverty and tackle climate change? Indeed it is – but only if wealth is seen as part of the problem rather than the solution. I recommend an excellent article in the Guardian this week by Zoe Williams and the cartoon she describes by a Swedish band – together with the more academic paper by Woodward on Incrementum ad Absurdum.

I encourage CHIFA members to provide some answers to these difficult questions.

http://wer.worldeconomicsassociation.org/files/WEA-WER-4-Woodward.pdf

http://www.filmsforaction.org/articles/swedish-band-the-knife-nail-central-flaw-of-the-uns-sustainable-development-goals/

http://www.theguardian.com/commentisfree/2015/oct/19/un-poor-wealth-sustainable-development-goals

https://www.oxfam.org/en/pressroom/pressreleases/2014-01-20/rigged-rules-mean-economic-growth-increasingly-winner-takes-all

Tony Waterston

A paper in The Lancet (10 October 2015) looks at the quality of cardiovascular health care in China. Below is the citation and summary. I also reproduce here the authors’ succinct description of the broader concept of ‘quality of care’:

‘In a health system with high quality of care, patients get the care they need at the right time, without having to undergo unnecessary or inappropriate treatments. High-quality care not only provides patients with the best opportunity to achieve the outcomes they seek, but also avoids inefficiency and waste. Countries with few resources especially need to focus on what care is best and how it is provided, and strengthen health-care delivery systems to produce high-level performance as efficiently as possible.’

As a personal comment, I find this a pragmatic definition, and would be interested to know how embedded this approach is in different countries. I suspect that many if not most governments turn a blind eye to, or actively support, treatments that have not been demonstrated to be effective. There was recent controvery in the UK, for example, when it emerged that the UK National Health Service spends over 70 million US dollars a year on homeopathy, despite the lack of evidence that it works any better than placebo…

The current Lancet review article on cardiovascular care in China points out that around 290 million people in China are affected by cardiovascular disease. The quality of care they receive (and, even more important, their smoking behaviour) will have a massive impact not only on China, but on the global health target for NCDs: “3.4. By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”

CITATION: Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system. Lixin Jiang, Harlan M Krumholz, Xi Li, Jing Li, Shengshou Hu. The Lancet Volume 386, No. 10002, p1493–1505, 10 October 2015

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00343-8/fulltext

SUMMARY

‘China has an immediate need to address the rapidly growing population with cardiovascular disease events and the increasing number of people living with this illness. Despite progress in increasing access to services, China faces the dual challenge of addressing gaps in quality of care and producing more evidence to support clinical practice. In this Review, we address opportunities to strengthen performance measurement, programmes to improve quality of care, and national capacity to produce high-impact knowledge for clinical practice. Moreover, we propose recommendations, with implications for other diseases, for how China can immediately make use of its Hospital Quality-Monitoring System and other existing national platforms to assess and improve performance of medical care, and to generate new knowledge to inform clinical decisions and national policies.’

Interestingly, the authors do not suggest a role for traditional Chinese medicine. It would be interesting to know more about health professionals’ and health policymakers’ attitudes to Chinese traditional medicine, which continues to be a huge industry in China, presumably much of it funded by the Chinese public health system.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

This new paper in The Lancet emphasises the importance of evidence synthesis (especially systematic reviews). As a personal comment, it could be argued that far more priority should be given to synthesising the existing research literature. Indeed, others have proposed that no new research should be undertaken without first synthesising the existing evidence from past research.

CITATION: Responsibility and accountability for well informed health-care decisions: a global challenge

Gro Jamtvedt, Marianne Klemp, Berit Mørland, Magne Nylenna

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60855-8/fulltext

EXTRACTS (selected by Neil PW)

‘Despite large investments during past decades in health-care research, evidence synthesis, and clinical practice guidelines, too much research is wasted1 and too many decisions are still not well informed.2 Why is this, and what can we do about it? The following four conditions must be met.

‘First, relevant and reliable health-care research must exist and be disseminated…

‘Second, decision makers and patients must have access to reliable and relevant evidence synthesis…

‘Third, patients, clinicians, and policy makers must be encouraged to ask for and use evidence synthesis…

‘Fourth, to improve patient outcomes, recommendations and decisions must be put into action and be implemented in policy and practice…

‘John Eisenberg’s statement from 2002 is still relevant: “Globalize the evidence, localize the decision”.’

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

We are happy to announce another new brief, Adolescent-Friendly Contraceptive Services (AFCS): Mainstreaming Adolescent-Friendly Elements Into Existing Contraceptive Services. [https://www.fphighimpactpractices.org/afcs] This brief focuses on the elements of AFCS that are typically implemented within a service delivery setting. It describes how mainstreaming AFCS can address key challenges for contraceptive programs, discusses the existing evidence of adolescent-friendly elements, outlines key issues for planning and implementation, and identifies knowledge gaps.

The accompanying Improving Sexual and Reproductive Health of Young People: A Strategic Planning Guide [https://www.fphighimpactpractices.org/sites/fphips/files/asrh_strategic_planning_tool.pdf] is intended to lead program managers, planners, and decision makers through a strategic process to identify the most effective and efficient investments for improving the sexual and reproductive health of young people.

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Anne Ballard, MPH Program Officer

Johns Hopkins Bloomberg School of Public Health

111 Market Place, Suite 310 Baltimore, Maryland 21202

Phone: 410-659-2643  | Skype: anneballard.ccp

Email: anne.ballard@jhu.edu Web: ccp.jhu.edu | www.k4health.org

HIFA profile: Anne Ballard is a Program Officer at the John Hopkins Center for Communication Programs  in the United States. Email address: anne.ballard AT jhu.edu

A fundamental requirement for success to achieve the new global health targets of the SDGs is agreement on the terminology used, as well as time-bound goals. Target 3.8. – Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all – seems problematic in this respect. Unlike other targets, there is no set date. Also, it seems the definition of Universal Health Coverage is still open to interpretation?

The concept of Universal Health Coverage has been promoted by WHO for over 10 years, and until recently the emphasis has been been on financial affordability rather than quality of healthcare services. Access to surgical care, for example, was not ‘officially’ included until May 2015, when the 68th World Health Assembly passed a resolution on 22nd May 2015 on ‘Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage’.

A recent Lancet Commission on Global Surgery reports findings from an international, multidisciplinary team of 25 commissioners, supported by advisors and collaborators in more than 110 countries and six continents.

CITATION: Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development

John G Meara et al. The Lancet, Volume 386, No. 9993, p569–624, 8 August 2015

Contact: john.meara@childrens.harvard.edu

Below are selected extracts. The full text is freely available here (after free registration): http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60160-X/fulltext

‘5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. Access is worst in low-income and lower-middle-income countries, where nine of ten people cannot access basic surgical care…’

‘Investing in surgical services in LMICs is affordable, saves lives, and promotes economic growth…’

‘Universal health coverage and the health aspirations set out in the post-2015 Sustainable Development Goals will be impossible to achieve without ensuring that surgical and anaesthesia care is available, accessible, safe, timely, and affordable…’

‘Maintenance of a motivated workforce in low-resource environments is essential for service provision, and ministries of health and professional societies should take active steps to ensure these clinicians are celebrated instead of neglected. To ensure that providers have the necessary instruments to practise is imperative, as are opportunities for continuing education and professional development. These resources include access to the internet, online clinical management resources, textbooks, and research literature…’

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Whether or not the new global health targets are achieved will depend largely on progress with the SDGs as a whole – the SDGs are interdependent.

To many observers, perhaps the most distinctive and innovative attribute of the SDGs is its basic principle of interconnectedness. “No goal stands alone”, says Amina Mohammed, special adviser to the UN Secretary-General on post-2015 development planning. “Every goal is inextricably linked to the rest.”

This creates a huge opportunity but also a huge challenge.

Jefferey Sachs (Earth Institute): “Governments are going to have to become multi-dimensional, multi-faceted. And that’s going to be difficult.” As a personal comment, it is not at all clear how governments in low- and middle-income countries will be supported to do this. Do any HIFA members have information on this?

Jefferey Sachs again: “What is deeply missing in the SDG agenda is concern about the financing of countries’ health systems”.

Source: UN set to change the world with new development goals. John Maurice.

The Lancet, Volume 386, No. 9999, p1121–1124, 19 September 2015

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00251-2/fulltext

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

On Tuesday, November 10th, 2015 from 11:30AM to 1:00PM ET, we will present a free webinar:

CSPro: Census and Survey Processing System

The Census and Survey Processing System (CSPro) is a public domain software package used by hundreds of organizations and tens of thousands of individuals in over 160 countries for entering, editing, tabulating, and disseminating census and survey data. CSPro is designed to be as user-friendly as possible, yet powerful enough to handle the most complex applications. It can be used by a wide range of people, from non-technical staff assistants to senior demographers and programmers.

CSPro now supports data collection on mobile devices including Android tablets and smart phones as well as Windows tablets.

Leading statistical agencies in the developing world use CSPro to process census and survey data. Non-governmental organizations (NGOs),colleges and universities, hospitals, acid:image001.png@01D10FD8.94DA1D90nd private sector groups also use CSPro for survey work. CSPro can be used to process censuses and surveys of any size and has been used to process the census data for both Djibouti (less than one million people) and Indonesia (more than 235 million).

Examples of uses of CSPro include:

• Censuses (population and housing; agriculture; and economic)
• Demographic and labor force surveys
• Household income and expenditure surveys
• Major international projects such as the Demographic and Health Surveys (DHS), Living Standards Measurement Study (LSMS), and Multiple Indicator Cluster Survey (MICS)
• Join Glenn Ferri, Assistant Division Chief, International Programs, Population Division at the U.S. Census Bureau, Stan Mierzwa, Director, Information Technology at Population Council, and their colleagues as they share the features and benefits of CSPro, especially for an iNGO audience.

To register for this free webinar: https://goo.gl/b0FS1h

Please feel free to share this webinar information with others at your organization that may have an interest in this topic.

‘Noncommunicable diseases have become the most common cause of morbidity and mortality worldwide. Consortium of Universities for Global Health Chair Dr Timothy Brewer highlights the organisation’s efforts to address these and  other global health challenges through research, training and advocacy’

‘THE CONSORTIUM OF Universities for Global Health (CUGH) was formed in 2008 to create a platform for academic-based individuals conducting global health research, global health education and global health service programmes to come together and share ideas and best practices. Essentially, the CUGH enables academics to exchange knowledge to better address complex and challenging health problems.’

‘CUGH members are working with partners to build healthcare capacity in low-resource settings and to create research programmes addressing pressing societal questions relating to health. These could include new treatments for chronic diseases, for example. Eighty per cent of all deaths in the world from noncommunicable diseases occur in low- and middle-income countries, and there are inadequate systems in place to treat pain, cancer or cardiovascular disease. CUGH-affiliated universities explore these and other topics. Our job is to generate knowledge and to train the next generation of researchers, educators and practitioners; that is what we do. At CUGH our aim is to bring together people who share common interests and make discoveries that result in practical solutions for the world’s challenges.’

I was interested to learn more about CUGH through a recent article by the chair of the CUGH board, Dr Timothy Brewer. He outlines how CUGH is working to build global  healthcare capacity to address non-communicable disease. You can download his article here: http://www.internationalinnovation.com/building-global-healthcare-capacity-2/

CITATION: Identifying Interprofessional Global Health Competencies for 21st-Century Health Professionals.

Kristen Jogerst, BS, Brian Callender, MD, Virginia Adams, RN, PhD, Jessica Evert, MD, Elise Fields, PharmD, Thomas Hall, MD, DrPH, Jody Olsen, PhD, MSW, Virginia Rowthorn, JD, Sharon Rudy, PhD, Jiabin Shen, M.Ed, Lisa Simon, DMD, Herica Torres, MSN, Anvar Velji, MD, Lynda L. Wilson, MSN, PhD.

http://www.sciencedirect.com/science/article/pii/S221499961501156X

Email contact: LyndaWilson@uab.edu

ABSTRACT

Background: At the 2008 inaugural meeting of the Consortium of Universities for Global Health (CUGH), participants discussed the rapid expansion of global health programs and the lack of standardized competencies and curricula to guide these programs. In 2013, CUGH appointed a Global Health Competency Subcommittee and charged this subcommittee with identifying broad global health core competencies applicable across disciplines.

Objectives: The purpose of this paper is to describe the Subcommittee’s work and proposed list of interprofessional global health competencies.

Methods: After agreeing on a definition of global health to guide the Subcommittee’s work, members conducted an extensive literature review to identify existing competencies in all fields relevant to global health. Subcommittee members initially identified 82 competencies in 12 separate domains, and proposed four different competency levels. The proposed competencies and domains were discussed during multiple conference calls, and subcommittee members voted to determine the final competencies to be included in two of the four proposed competency levels (global citizen and basic operational level – program oriented).

Findings: The final proposed list included a total of 13 competencies across 8 domains for the Global Citizen Level and 39 competencies across 11 domains for the Basic Operational Program-Oriented Level.

Conclusions: There is a need for continued debate and dialog to validate the proposed set of competencies, and a need for further research to identify best strategies for incorporating these competencies into global health educational programs. Future research should focus on implementation and evaluation of these competencies across a range of educational programs, and further delineating the competencies needed across all four proposed competency levels.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

I wanted to share some exciting news, the Economist has launched a short-film series.

Of relevance to the group are:

What would the world be like if Malaria Drugs Stop Working? (15min)

Health without Wealth – can doctors save lives at the same time as saving money? (Preview)

24 and Ready to Die – Emily is 24 years old and physically healthy. But she wants her doctors to end her life. Exploring the right to die (Preview).

Check them out at http://www.films.economist.com/

All the best,

Rob Davies MPH

Senior Health Research Analyst Bazian Ltd, an Economist Intelligence Unit business

20 Cabot Square, London E14 4QW +44 (0)20 7576 8164

‘Mass media play an important role in documenting national responses to crises like Ebola. Reviewing media documentation helps a country better prepare for current and future public health challenges. Ebola articles first appeared in the Liberian press in March 2014. Our objectives were to determine the frequency of newspaper accounts and the major issues covered…’

‘News reports frequency paralleled the incidence pattern of the disease. Major themes included the state of the epidemic, health care, psychosocial issues, international aid, political response, prevention, and local support. Overall political response to Ebola and the impact of Ebola on health workers received the most attention. In the early days common themes were border security and requests for aid…’

Full text: http://malariamatters.org/documenting-the-response-to-the-ebola-epidemic-in-liberia-through-the-perspective-of-the-local-press/

As a personal comment, I would be very interested to know something about the quality and reliability of practical healthcare information disseminated by the newspapers in Ebola-affected countries. To what extent did the newspapers promote health behaviours that would help prevent spread of the disease and encourage early referral for treatment? How might the MoH’s in affected countries be better supported in future to collaborate with the mass media?

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Below are extracts from an editorial in the November 2015 issue of the WHO Bulletin. While it has a focus on Ethiopia, it raises questions that are relevant to other LMICs. Notable is the conclusion:  ‘Policies for attaining the sustainable development goals should emphasize country ownership, promotion of local innovations and independence from outside donors’.  

As we enter our last week on discussion of SDGs ahead of the Global Health Conference in Montreal, I would like to invite people to comment – do you agree with this conclusion, and if so how might this approach be promoted? As a personal comment, I would add the words ‘the progressive realisation of’ after ’emphasise’ – it is vital that outside donors *increase* rather than withdraw their support where needed, while at the same time aiming progressively *in the longer term* to achieve the independence that the authors call for.

‘During the past two decades, access to primary health care has been dramatically improved in Ethiopia as a result of a national health extension programme. More than 40 000 community health extension workers have been trained to deliver preventive and basic curative interventions in villages across the nation…

‘Ethiopia is establishing an International Primary Health Care Institute, in close collaboration with international partners. The institute will promote south–south collaboration through training and research, with an emphasis on community engagement…

‘Over the last two decades, a range of simple innovations have transformed global health…

‘Innovations that respond to the local context require support, understanding and acceptance by partner organizations and international donors. Policies for attaining the sustainable development goals should emphasize country ownership, promotion of local innovations and independence from outside donors. After all, health is a basic human right that the government has a responsibility to support.’

The full text is available here:

Local innovations and country ownership for sustainable development

Taye Balcha, Haileyesus Getahun & Kestebirhan Admasu

Bulletin of the World Health Organization 2015;93:742. doi: http://dx.doi.org/10.2471/BLT.15.164483

http://www.who.int/bulletin/volumes/93/11/15-164483/en/

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

Family Medicine On Air is a series of live social media events that gives medical students across the country (USA) a chance to learn about hot topics in health care from family medicine leaders — all in 15 minutes or less. Each episode streams live on Google Plus and YouTube and is archived so that you can view it later or even stream to share with your medical student colleagues at an FMIG event. ….more

As the number of regionally based academic health faculties and clinical schools in Australia grows, it is imperative to assess the relevance of these programs for maintaining an adequate health workforce. This article describes James Cook University’s tracking system for medical graduates, which has resulted in a 98% complete longitudinal tracking database that enables exploration of the patterns of practice of its medical graduates….. http://www.rrh.org.au/articles/showarticlenew.asp?ArticleID=3542

‘Evaluating the impact of a community developed collaborative project for the prevention of early childhood caries: the Healthy Smile Happy Child project’  Is community development the answer to improve oral health? This article provides the details to show that it can be effective…..http://www.rrh.org.au/articles/showarticlenew.asp?ArticleID=3566

We have developed an asset to evaluate your interventions and teach students or patients!

Treatment Response and Client Tracking iPad Application (TRACT)

http://members.shaw.ca/igme/TRACT/TREATMENT_RESPONSE_AND_CLIENT_TRACKING_Application.html

Listed in WHO Compendium of Emerging Technologies

Yours, Prof. Cawthorpe

HIFA profile: David Cawthorpe is Adjunct Assistant Professor at the University of Calgary, Canada. His professional interests include: Human Development, Developmental Psychopathology, and Delivery of low bandwidth medical education curriculum. cawthord AT ucalgary.ca

Find out why 17 Medical Schools (McGill in 2015) went on probation! ‘The organization that accredits U.S. medical schools has become stricter in recent years and is doling out more serious actions against schools it deems have strayed too far from national standards… Violations differed among the schools. Among problems cited were a lack of policies to ensure diversity among students and faculty, no central management of clinical programs and a heavy reliance on lecture courses for the first two years of medical school.’

http://internationalgme.org/NewsAndEvents/IGME_News.htm#Probation

Make use of the content we have on www.childrenforhealth.org.

Hesperian Health Guides currently has one free app, available in Spanish and English, that provides free maternal health information. It is called the “Safe Pregnancy and Birth” app, and is available for Apple and android devices (http://hesperian.org/books-and-resources/safe-pregnancy-and-birth-mobile-app/ ).

We haven’t conducted very much quantitative research on the impact of this app, but if you would like for me to share any of our statistics on its use, please let me know. It has also been used in several trainings, such as a midwife training in Oaxaca, conducted by the Oaxacan Ministry of Health (http://hesperian.org/2015/08/19/bridging-the-healthcare-divide-6th-annual-midwife-training-2/).