Below is a press release from the CDC, USA. I have written to the CDC to ask what is the financial commitment made by the US, and how this new Center will complement the work of WHO and WHO Africa Regional Office, who currently hold responsibility for disease surveillance. I was surprised WHO is not even mentioned in in the press release. One hopes this initiative is fully coordinated with existing efforts, and that there has been a risk-benefit comparison between spending on a new African CDC versus spending to strengthen a chronically underfunded WHO.  

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African Union and U.S. CDC Partner to Launch African CDC

The African CDC will be a public health institute supporting the whole continent of Africa

Washington, DC –A Memorandum of Cooperation (MOC) signed today by U.S. Secretary of State John Kerry and Nkosazana Dlamini Zuma, M.B. Ch.B., chairperson of the African Union Commission, formalizes a collaboration between the African Union Commission and the U.S. Centers for Disease Control and Prevention in creating the African Centres for Disease Control and Prevention (African CDC).

“The West African Ebola epidemic reaffirmed the need for a public health institute to support African ministries of health and other health agencies in their efforts to prevent, detect, and respond to any disease outbreak,” said CDC Director Tom Frieden, M.D., M.P.H. “This memorandum solidifies the commitment by the United States to advance public health across Africa and global health security.”

The need for an African CDC was recognized at the African Union Special Summit on HIV and AIDS, TB, and Malaria in Abuja in July 2013. The concept has since moved through various stages of development, stakeholder review, and approval. The African CDC is slated to launch later this year with the establishment of an African Surveillance and Response Unit, which will include an Emergency Operations Center.

“The African Centres for Disease Control and Prevention (African CDC) will help African countries effectively monitor public health, respond to public health emergencies, address complex health challenges, and build needed capacity,”  Dr. Dlamini-Zuma said.

The African CDC Surveillance and Response Unit will provide technical expertise and response coordination during emergencies. Through the AU Support for Ebola Outbreak in West Africa (ASEOWA) mission, the African Union sent over 800 medical volunteers and public health responders to fight the Ebola epidemic in Guinea, Liberia, and Sierra Leone from September 2014 to February 2015. With the African CDC in place, these volunteers and others can be organized to form a deployable force ready to serve Member States during future health emergency responses on the continent.

The African CDC will identify five Regional Collaborating Centers in the five AU geographic regions to work with the African CDC Coordinating Center in Addis Ababa, Ethiopia. Field epidemiologists will be among the technical staff supporting both the Regional Collaborating Centers and the African CDC Coordinating Center. The field epidemiologists will be responsible for disease surveillance, investigations, analysis, and reporting trends and anomalies.

“The U.S. CDC applauds the African Union and Member States in their leadership of this historic initiative,” said Tom Kenyon, M.D., M.P.H., director of the CDC’s Center for Global Health. “This is a landmark event in African ownership of improving health across the continent. The U.S. CDC looks forward to engaging in this partnership for many years to come.”

Through the MOC, the U.S. CDC will provide technical expertise for the African CDC Surveillance and Response Unit, as well as advise African CDC leadership in strategic planning for future development. Specifically, two public health experts from the U.S. CDC will be co-located at the African Union to serve as long-term technical advisors to the African CDC.  Additionally, the U.S. CDC will support fellowships for 10 African epidemiologists to help staff the African CDC Coordinating and Regional Collaborating Centers.

The African CDC will seek ongoing collaboration of other public health entities across the African continent and globally to elevate health outcomes for all African citizens.  Partners may assist by implementing activities, supporting the establishment of the Regional Collaborating Centers, advising the African CDC leadership and staff, or by providing technical assistance. African CDC partners may also strategically support professional associations to coordinate programmatic activities across the public health domains.

About the African Union

The African Union spearheads Africa’s development and integration in close collaboration with African Union Member States, the Regional Economic Communities and African citizens. The AU’s vision is to accelerate progress towards an integrated, prosperous and inclusive Africa, at peace with itself, playing a dynamic role in the continental and global arena, effectively driven by an accountable, efficient and responsive Commission. Learn more at: http://www.au.int/en/

Wynne Musabayana, MUSABAYANAW@africa-union.org

+251 115-182-555

About the CDC

CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. Whether these threats are chronic or acute, manmade or natural, human error or deliberate attack, global or domestic, CDC is the U.S. health protection agency.  For more information about the agency’s global health security work, visit CDC’s website.

CDC Media Relations, media@cdc.gov

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News feature: http://keranews.org/post/disease-detection-gets-boost-plans-cdc-africa

Press release: http://www.cdc.gov/media/releases/2015/p0413-african-union.html

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

We have recently posted a feature on CHW Central: Improving the performance of CHW: What can we learn from the literature?

http://www.chwcentral.org/blog/improving-performance-community-health-workers-what-can-be-learned-literature

It looks at the contextual factors that affect CHW performance and how intervention design and the health system factors can impact performance.  The review conducted by Maryse Kok et al at KIT describes her findings and how the research can be applied at local levels.  There is a video presentation plus a written summary and a connection to the full document.  As you think through how to support CHWs, this may provide some evidence to assist you in that process.

Thanks

Donna Bjerregaard, Initiatives Inc. and CHW Central

Donna Bjerregaard

Senior Technical Advisor

Initiatives Inc.

264 Beacon Street

Boston, MA 02116

Tel:  617 262 0293

Fax: 617 262 2514

www.initiativesinc.com

www.chwcentral.org

LAST Saturday (and Sunday in some parts of the country), Nigerians went to the polling stations to participate in the presidential election which was eventually won by four-time presidential candidate and former military ruler Muhammadu Buhari…..more

Some useful resources can be accessed from the broad reach website ! broadreach educational material

Yesterday, the Chiawelo community practice team attended a fascinating discussion on Neuroplasticity, reading Catherine Malabou’s book called What should we do with our brain.

In the chapter : the central power in crisis, we explored the question: What is the main transition point between the neuronal and the political?

If the biological and the social mirror in each other, how do we think around health promotion, behavior change, and a change in social networking that enables the health revolution at CCP?

Amartya Sen makes a compelling case for Universal Health coverage.

The pandemic of Ebola has brought health systems strengthening and universal coverage on the agenda.

Do you agree that universal health coverage is both a global and local solution for LMI countries?

Universal healthcare: the affordable dream

Plague – Madagascar

Disease outbreak news

21 November 2014

http://www.who.int/csr/don/21-november-2014-plague/en/

21 NOVEMBER 2014 – On 4 November 2014, WHO was notified by the Ministry of Health of Madagascar of an outbreak of plague. The first case, a male from Soamahatamana village in the district of Tsiroanomandidy, was identified on 31 August. The patient died on 3 September.

As of 16 November, a total of 119 cases of plague have been confirmed, including 40 deaths. Only 2% of reported cases are of the pneumonic form.

Cases have been reported in 16 districts of seven regions. Antananarivo, the capital and largest city in Madagascar, has also been affected with 2 recorded cases of plague, including 1 death. There is now a risk of a rapid spread of the disease due to the city’s high population density and the weakness of the healthcare system. The situation is further complicated by the high level of resistance to deltamethrin (an insecticide used to control fleas) that has been observed in the country.

Public health response

The national task force has been activated to manage the outbreak. With support from partners – including WHO, the Pasteur Institute of Madagascar, the “Commune urbaine d’Antananarivo” and the Red Cross – the government of Madagascar has put in place effective strategies to control the outbreak. Thanks to financial assistance from the African Development Bank, a 200,000 US dollars response project has been developed. WHO is providing technical expertise and human resources support. Measures for the control and prevention of plague are being thoroughly implemented in the affected districts. Personal protective equipment, insecticides, spray materials and antibiotics have been made available in those areas.

Background

Plague is a bacterial disease caused by Yersinia pestis, which primarily affects wild rodents. It is spread from one rodent to another by fleas. Humans bitten by an infected flea usually develop a bubonic form of plague, which produces the characteristic plague bubo (a swelling of the lymph node). If the bacteria reach the lungs, the patient develops pneumonia (pneumonic plague), which is then transmissible from person to person through infected droplets spread by coughing. If diagnosed early, bubonic plague can be successfully treated with antibiotics. Pneumonic plague, on the other hand, is one of the most deadly infectious diseases; patients can die 24 hours after infection. The mortality rate depends on how soon treatment is started, but is always very high.

WHO recommendations

WHO does not recommend any travel or trade restriction based on the current information available. In urban areas, such as Antananarivo, the surveillance of epidemic risk indicators is highly recommended for the implementation of preventive vector control activities.

Dr Najeeb Al-Shorbaji, Director of Knowledge, Ethics and Research at WHO headquarters, Geneva, talks to Isabelle Wachsmuth-Huguet (Coordinator of HIFA-EVIPNet-French) about knowledge management and sharing for global health, and the role of HIFA in English, French, Portuguese and other languages.

http://www.hifa2015.org/2014/11/24/dr-najeeb-al-shorbaji-who-knowledge-management-and-sharing-for-health/

Transcript in English

http://www.who.int/evidence/forum/InterviewNajeebMohamedAlShorbajiEN.pdf

Transcript in French

http://www.who.int/evidence/forum/InterviewNajeebAlShorbaji.pdf?ua=1

Video (8 minutes)

https://www.youtube.com/watch?v=wVJaBX49_nU

Best wishes,

Neil

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

The International Telecommunications Union has issued its report: ‘Measuring the Information Society Report 2014’.

This 240 page report can be freely downloaded here:

http://www.itu.int/en/ITU-D/Statistics/Documents/publications/mis2014/MIS2014_without_Annex_4.pdf

It is interesting for what it says and for what it doesn’t say.

Here are two extracts from the Foreword:

‘Over the past year, the world witnessed continued growth in the uptake of ICT and, by end 2014, almost 3 billion people will be using the Internet, up from 2.7 billion at end 2013. While the growth in mobile-cellular subscriptions is slowing as the market reaches saturation levels, mobile broadband remains the fastest growing market segment, with continuous double-digit growth rates in 2014 and an estimated global penetration rate of 32 per cent – four times the penetration rate recorded just five years earlier. International bandwidth has also grown steeply, at 45 per cent annually between 2001 and 2013, and the developing countries’ share of total international bandwidth increased from around 9 per cent in 2004 to almost 30 per cent in 2013. Overall, almost all of the 166 countries included in the IDI improved their values in the last year. Despite this encouraging progress, there are important digital divides that need to be addressed: 4.3 billion people are still not online, and 90 per cent of them live in the developing world.

‘While the prices of fixed and mobile services continue to decrease globally, in most developing countries the cost of a fixed-broadband plan represents more than 5 per cent of GNI per capita, and mobile broadband is six times more affordable in developed countries than in developing countries.’

I have not had time to read the report in detail, but it appears to say very little, if anything, about content. I could find no mention of the problem of information overload, nor of the predominance of English and a few other languages; no mention of the prevalence of poor quality information and deliberate misinformation; no mention of the difficulties to differentiate reliable from unreliable information; no mention of the controversy around the ‘commercialisation’of top-level domains such as .health; and no mention of the potential for communities of practice (such as HIFA) to enable wider engagement in international health and development.

It is to be expected that ITU would have a primary focus on the technical. But the scope of this publication is far less than promised in the title: ‘Measuring the Information Society’.

Best wishes,

Neil

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

This overview of systematic reviews identified 25 systematic reviews that fulfilled the search criteria, each review looking at 10 to 235 primary studies (median 28). Unfortunately the authors do not describe where the primary studies were undertaken. It is probable that the large majority were done in high-income countries, and any conclusions drawn may not be applicable to low-resource settings.

CITATION: Implement Sci. 2014 Oct 6;9:152. doi: 10.1186/s13012-014-0152-6.

Are multifaceted interventions more effective than single-component interventions in changing health-care professionals’ behaviours? An overview of systematic reviews. Squires JE, Sullivan K, Eccles MP, Worswick J, Grimshaw JM.

http://www.implementationscience.com/content/9/1/152 (open access)

Abstract

BACKGROUND: One of the greatest challenges in healthcare is how to best translate research evidence into clinical practice, which includes how to change health-care professionals’ behaviours. A commonly held view is that multifaceted interventions are more effective than single-component interventions. The purpose of this study was to conduct an overview of systematic reviews to evaluate the effectiveness of multifaceted interventions in comparison to single-component interventions in changing health-care professionals’ behaviour in clinical settings.

METHODS: The Rx for Change database, which consists of quality-appraised systematic reviews of interventions to change health-care professional behaviour, was used to identify systematic reviews for the overview. Dual, independent screening and data extraction was conducted. Included reviews used three different approaches (of varying methodological robustness) to evaluate the effectiveness of multifaceted interventions: (1) effect size/dose-response statistical analyses, (2) direct (non-statistical) comparisons of multifaceted to single interventions and (3) indirect comparisons of multifaceted to single interventions.

RESULTS: Twenty-five reviews were included in the overview. Three reviews provided effect size/dose-response statistical analyses of the effectiveness of multifaceted interventions; no statistical evidence of a relationship between the number of intervention components and the effect size was found. Eight reviews reported direct (non-statistical) comparisons of multifaceted to single-component interventions; four of these reviews found multifaceted interventions to be generally effective compared to single interventions, while the remaining four reviews found that multifaceted interventions had either mixed effects or were generally ineffective compared to single interventions. Twenty-three reviews indirectly compared the effectiveness of multifaceted to single interventions; nine of which also reported either a statistical (dose-response) analysis (N = 2) or a non-statistical direct comparison (N = 7). The majority (N = 15) of reviews reporting indirect comparisons of multifaceted to single interventions showed similar effectiveness for multifaceted and single interventions when compared to controls. Of the remaining eight reviews, six found single interventions to be generally effective while multifaceted had mixed effectiveness.

CONCLUSION: This overview of systematic reviews offers no compelling evidence that multifaceted interventions are more effective than single-component interventions.

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

Below is the plain language summary of a new Cochrane review – highly relevant to recent HIFA discussions on polio and tetanus.

You can read it online here:

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010232.pub2/abstract;jsessionid=34BCBCD0BDF587E5416A493FBD413233.f02t04

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PLAIN LANGUAGE SUMMARY

Interventions aimed at communities for informing and/or educating about early childhood vaccination

Researchers in The Cochrane Collaboration conducted a review of the effect of informing or educating members of the community about early childhood vaccination. After searching for all relevant studies, they found two studies, published in 2007 and 2009. Their findings are summarised below.

What are interventions aimed at communities for childhood immunisation?

Childhood vaccinations can prevent illness and death, but many children do not get vaccinated. There are a number of reasons for this. One reason may be that families lack knowledge about the diseases that vaccines can prevent, how vaccinations work, or how, where or when to get their children vaccinated. People may also have concerns (or may be misinformed) about the benefits and harms of different vaccines.

Giving people information or education so that they can make informed decisions about their health is an important part of all health systems. Vaccine information and education aims to increase people’s knowledge of and change their attitudes to vaccines and the diseases that these vaccines can prevent. Vaccine information or education is often given face-to-face to individual parents, for instance during home visits or at the clinic. Another Cochrane Review assessed the impact of this sort of information. But this information can also be given to larger groups in the community, for instance at public meetings and women’s clubs, through television or radio programmes, or through posters and leaflets. In this review, we have looked at information or education that targeted whole communities rather than individual parents or caregivers.

The review found two studies. The first study took place in India. Here, families, teachers, children and village leaders were encouraged to attend information meetings where they were given information about childhood vaccination and could ask questions. Posters and leaflets were also distributed in the community. The second study was from Pakistan. Here, people who were considered to be trusted in the community were invited to meetings where they discussed the current rates of vaccine coverage in their community and the costs and benefits of childhood vaccination. They were also asked to develop local action plans, to share the information they had been given and continue the discussions with households in their communities.

What happens when members of the community are informed or educated about vaccines?

The studies showed that community-based information or education:

– may improve knowledge of vaccines or vaccine-preventable diseases;

– probably increases the number of children who get vaccinated (both the study in India and the study in Pakistan showed that there is probably an increase in the number of vaccinated children);

– may make little or no difference to the involvement of mothers in decision-making about vaccination;

– may change attitudes in favour of vaccination among parents with young children;

We assessed all of this evidence to be of low or moderate certainty.

The studies did not assess whether this type of information or education led to better knowledge among participants about vaccine service delivery or increased their confidence in the decision made. Nor did the studies assess how much this information and education cost or whether it led to any unintended harms.

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

‘Mental healthcare in low and middle income countries should not replicate the inefficient, inaccessible, and insensitive Western model’, says an editorial in this week’s BMJ (29 November 2014).

The full text is available here (restricted access):

http://www.bmj.com/content/349/bmj.g7086

Below are the citation and selected extracts.

CITATION: Drake R et al. Mental healthcare in low and middle income countries

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g7086 (Published 25 November 2014)

Cite this as: BMJ 2014;349:g7086

‘Low and middle income countries could develop alternative behavioural health systems by emphasising a few strategies. They should start by listening to people and empowering citizens, families, traditional supports, lay health workers, cultures, and communities to define their needs and design systems they want. Well informed patients and families can express preferences and participate in creating systems of care, including technology tools, that respond to personal and community needs.6 Mental health should be for everyone: all people benefit from maternal and child health, strong families, education, stress management training, social support, meaningful work, and self management.7 Local stakeholders understand context and prefer spending limited resources on these local services. Local learning communities could monitor outcomes, learn from data, engage in continuous quality improvement, and perhaps prevent medical fraud…

‘Finally, low and middle income countries should embrace new technologies that can provide education, prevention, assessment, treatment of acute illnesses, and management of long term illnesses.10 These tools extend the reach of healthcare workers and are often effective by themselves—generally as effective as well trained mental health professionals.10 Most people with mental disorders accept and value these tools highly; the tools can be translated to other languages and cultures; and the mobile phone infrastructure to deliver them broadly exists already.’

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

A few weeks ago James Heilman shared a message with us on the theme of ‘Requesting WHO to Consider the Use of an Open License’. The responses indicate two main concerns – (1) affordability and (2) concerns about how content may be re-used. I would like to unpack these concerns further…

AFFORDABILITY

‘The idea is fine, but when I raised this years ago, shortly after the Budapest Open Access Initiative (2001), I was told WHO found itself in a quandary, since its sales of publications in some countries funds the free distribution of publications in others, through a “revolving sales fund”, which also pays for most of the staff in the WHO publications distribution service. It is more complicated than that, but that’s the general idea.’ Chris Zielinski, Zambia

Q1. What evidence is there that making WHO publications open access would make any difference to print sales?

Q2. How much does WHO get from sales of its publications at present?

Q3. Is it not an anachronism that WHO continues to have a commercial mindest for its book publishing activities?

Q4. How much will WHO stand to lose from print sales if it were to make its publications open access? (Indeed, it is possible that print sales could *increase* as a result of this move)

Q5. Assuming that the amount is relatively small (a few millions of dollars per year?), would this not be an opportunity for a funding agency such as the Gates Foundation to step up to the plate and underpin the costs of WHO moving to open access?

Indeed, specifically for the Gates Foundation, this is an opportunity for them to respond to the “13th Grand Global health Challenge”, as described by global health leaders in The Lancet in 2006 (the year when HIFA was launched):

‘The Gates Foundation identified fourteen challenges but a fifteenth challenge stares us plainly in the face: The 15th challenge is to ensure that everyone in the world can have access to clean, clear, knowledge – a basic human right, and a public health need as important as access to clean, clear, water, and much more easily achievable.’

Tikki Pang (WHO), Muir Gray (NHS, UK), and Tim Evans (WHO): ‘A 15th grand challenge for global public health.’ The Lancet 2006;  367:284-286.

http://www.thelancet.com/journals/lancet/article/PIIS0140673606680501/fulltext

This is also aligned with the Gates Foundation’s recent announcement on open access, and with their support to organisations such as Hesperian Health Guides towards an open access model (a development that I believe has further enhanced Hesperian’s reputation and impact).

CONCERNS ABOUT HOW CONTENT MAY BE RE-USED

‘WHO is not planning to license the materials on its web site under the terms of a Creative Commons IGO licence for the time being because of concerns about how its information may be reused which may be contrary to its principles e.g. implying endorsement or to promote products/services, or how the authority and integrity of its information may be undermined by inappropriate adaptation its work. These are mainly the normative works.’ Najeeb Al-Shorbaji, Switzerland

Q1: Is there any evidence that works produced under an open access license are likely to be misused any more than works produced under a traditional licence?

Q2: There are perhaps some types of WHO publication where open access would have a greater positive benefit than others (eg practical manuals for health workers?). Would it make sense for WHO to test the waters by making a subset of its publications open access?

As Najeeb says: “We would welcome sharing with us some evidence-based research on how licensing works under the Creative Commons attribution licence has made an impact in the area of scientific, technical and medical publishing.”

Meanwhile, I think it is significant that another UN agency – UNESCO – has already decided to go open access. Perhaps we can learn from their experience?

http://en.unesco.org/open-access/

Best wishes, Neil

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

HIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and co-director of the Global Healthcare Information Network.

Courtesy HIFA2015

SA HAS “little to show” for its high debt levels because more of the money the government has borrowed over the past five years has been spent on paying public servants than on infrastructure programmes to induce growth. Sanlam financial services group economist Jac Laubscher said on Wednesday that money could have been better spent: “If that big increase in debt had gone into infrastructure instead of consumption expenditure then we would have had assets in return for the increasing debt.” ….more

DEPUTY Minister of Public Works Jeremy Cronin on Thursday defended the national government’s Expanded Public Works Programme (EPWP), saying it was “a global leader” among other state work programmes around the world. However, he said to sustain a longer duration of programmes the infrastructure component of the EPWP would extend its focus to maintenance to provide longer stints for participants. This was in response to calls for longer participation periods in some projects and an increase in payment in others….more

Nearly everyone aged 66 to 75 should consider taking cholesterol-lowering drugs called statins to reduce their risk of heart attack and stroke, new guidelines said…..more

Teenagers down the years have typically rebelled by drinking, smoking and taking drugs. Today they’re more likely to be found in their bedrooms surfing the web and playing video games on their computers, before sitting down to supper with their parents. Meet the “laptop generation” – the new, more sensible breed of adolescent…..more

CALORIC ignorance will no longer be bliss at many restaurants across the US starting next year. The Obama administration plans to unveil final labelling rules on Tuesday that require restaurants with at least 20 locations to display the calorie count of food items on their menus. The changes, part of the 2010 Affordable Care Act, will bring the type of calorie tallies on public view across New York City and Seattle to chain restaurants nationwide…..more

In 2009 a child was born with permanent brain damage at the Chris Hani Baragwanath Hospital, spokesman Prince Hamnca said in a statement. “Yesterday, the department processed a payment in excess of R7.6 million which includes interest after the High Court in Pretoria found the department liable for the damages claimed.”….more