PREAMBLE: Diarrhoea remains the second leading cause of death among children under five globally, surpassed only by pneumonia, the most common cause. Nearly one in five child deaths – about 1.5 million each year – is due to diarrhoea. It kills more young children than AIDS, malaria and measles combined.
PacificSci wishes to draw attention to a recently released joint report from UNICEF and WHO that addresses this perennial global pandemic. Diarrhoeal disease, no longer a scourge in developed countries, attracts comparatively little attention from the international donor community, when compared with conditions such as HIV/AIDS, TB and malaria. And today, the media spotlight has shifted to H1N1 influenza, with little sense of proportionality in terms of continuing real disease burdens globally.
Acknowledgement: The material used in this edition of Global Perspectives is drawn almost verbatim from the Executive Summary of the joint UNICEF/WHO report, as referenced below.
THE REPORT:
In 2006, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) issued a report highlighting the most common cause of death among children (Pneumonia: The Forgotten Killer of Children). The purpose was to raise the profile of that neglected disease. This new report is written with the same intent – to focus attention on the prevention and management of diarrhoeal diseases as central to improving child survival. Together, pneumonia and diarrhoea are responsible for an estimated 40 per cent of all child deaths around the world each year.
There are lessons to be learned from past experience. An international commitment to tackle childhood diarrhoea in the 1970s and 1980s resulted in a major reduction in child deaths. This came about largely through the scaling up of oral rehydration therapy, coupled with programmes to educate caregivers on its appropriate use. But these efforts lost momentum as the world turned its attention to other global emergencies. Today, only 39 per cent of children with diarrhoea in developing countries receive the recommended treatment, and limited trend data suggest that there has been little progress since 2000.
This report examines the latest available information on the burden and distribution of childhood diarrhoea. It also analyses how well countries are doing in making available key interventions proven to reduce its toll. Most importantly, it lays out a new strategy for diarrhoea control, one that is based on interventions drawn from different sectors that have demonstrated potential to save children’s lives. It sets out a 7-point plan that includes a treatment package to reduce childhood diarrhoea deaths, as well as a prevention package to make a lasting reduction in the diarrhoea burden in the medium to long term.
New aspects of this approach include vaccinations for rotavirus, which is estimated to cause about 40 per cent of hospital admissions due to diarrhea among children under five worldwide.3 In terms of community-wide sanitation, new approaches to increase demand to stop open defecation have proven more effective than previous strategies. It has been estimated that 88 per cent of diarrhoeal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene.
Actions needed to take interventions to scale
In many countries, progress has been made in the delivery or promotion of several of these interventions, particularly vitamin A supplementation and exclusive breastfeeding. However, a substantial reduction in the diarrhoea burden will require greater emphasis on the following actions:
■ Ensure wide availability of low-osmolarity ORS and zinc, which could have a profound impact on child deaths from diarrhoea if scaled up immediately. Possible strategies to increase their uptake and availability could include the development of smaller ORS packets and flavoured formulas, as well as delivering zinc and low-osmolarity ORS together in diarrhoea treatment kits.
■ Include rotavirus vaccine in national immunization programmes worldwide, which was recently recommended by the World Health Organization.
A 7-point plan for comprehensive diarrhoea control is outlined immediately below: two (#1 and #2) elements are contained with a treatment package”, while five (#3 to #7) are contained within a prevention package.
Treatment Package
The treatment package focuses on two main elements, as outlined in a 2004 joint statement from UNICEF and WHO: 1) fluid replacement to prevent dehydration and 2) zinc treatment. Oral rehydration therapy – which has been heralded as one of the most important medical advances of the 20th century – is the cornerstone of fluid replacement.
New aspects of this approach include low-osmolarity oral rehydration salts (ORS), which are more effective at replacing fluids than the original ORS formulation, and zinc treatment, which decreases diarrhea severity and duration. Important additional components of the package are continued feeding, including breastfeeding, during diarrhoea episodes and the use of appropriate fluids available in the home if ORS are not available, along with increased fluids in general.
Prevention Package
The prevention package highlights five main elements that require a concerted approach in their implementation. The package includes: 3) rotavirus and measles vaccinations, 4) promotion of early and exclusive breastfeeding and vitamin A supplementation, 5) promotion of handwashing with soap, 6) improved water supply quantity and quality, including treatment and safe storage of household water, and 7) community-wide sanitation promotion.
Key strategic elements include:■ Develop and implement behaviour change interventions, such as face-to-face counselling, to encourage exclusive breastfeeding.
■ Ensure sustained high levels of vitamin A supplementation, such as by combining its delivery, where effective, with other high-impact health and nutrition interventions.
■ Apply results of existing consumer research on how to motivate people to wash their hands with soap to increase this beneficial and cost-effective health practice. Handwashing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent.
■ Adopt household water treatment and safe storage systems, such as chlorination and
filtration, in both development and emergency situations to support reductions in the number of diarrhoea cases.
■ Implement approaches that increase demand to stop community-wide open defecation. As with handwashing, the new approach employs behavioural triggers, such as pride, shame and disgust, to motivate action, and leads to greater ownership and sustainability of programmes.
The report states: “We know what works to immediately reduce deaths from childhood diarrhoea. We also know what actions will make a lasting contribution to reducing the toll of diarrhoeal diseases for years to come. But strengthened efforts on both fronts must begin right away.”
The following actions are needed to take the 7-point plan to scale:
■ Mobilize and allocate resources for diarrhea control.
■ Reinstate diarrhoea prevention and treatment as a cornerstone of community-based primary health care.
■ Ensure that low-osmolarity ORS and zinc are adopted as policy in all countries.
■ Reach every child with effective interventions.
■ Accelerate the provision of basic water and sanitation services.
■ Use innovative strategies to increase the adoption of proven measures against diarrhoea.
■ Change behaviours through community involvement, education and health-promotion activities.
■ Make health systems work to control diarrhoea.
■ Monitor progress at all levels, and make the results count.
■ Make the prevention and treatment of diarrhea everybody’s business.
The Executive Summary to the report concludes with the statement that "There is no better time than now. Political momentum is building to address the leading causes of child deaths, including pneumonia and diarrhoea, to achieve measurable gains in child survival. The year 2008 marked the 30th anniversary of the Alma- Ata Declaration, with reinvigorated calls to focus on primary health care. Lessening the burden of childhood diarrhoea fits squarely with this emphasis, and is essential for achieving Millennium Development Goal 4: reduce child mortality, whose target date is now only six years away."
SOURCE: Executive Summary. Diarrhoea :Why children are still dying and what can be done. The United Nations Children’s Fund (UNICEF)/World Health Organization (WHO), 2009. http://whqlibdoc.who.int/publications/2009/9789241598415_eng.pdf
Showing posts with label Africa. Show all posts
Showing posts with label Africa. Show all posts
Thursday, 15 October 2009
Saturday, 1 September 2007
THIRD WORLD AID TO FIRST WORLD COUNTRIES... The “Brain Drain”
PREAMBLE: In this issue we feature the "brain drain" (migration of professionals from low-resource settings to more developed ones) from sub-Saharan Africa. The report was developed by Juan Ramos, Program Coordinator of ProCOR, a web community focusing on cardiovascular disease problems in the developing world, that offers free-ranging debate on a range of related health and social issues (SEE: Recommended Links in sidebar, adjacent to June 1 blog below). The crisis is enormous, and some potential solutions are outlined in the report. It is to be hoped that there will be some practical response to these, such as striving for better compensation for indigenous health professionals, attention to policies that determine recruitment and retention of health professions in low income countries, fixing the ethics of western firms that raid poor countries to meet the service demands of rich ones, and finding ways to compensate third world "donor" countries for their loss of human resources. Through official inaction, "first world" countries benefit from a massive subsidy from the "third world", equal to the direct and indirect costs of their investment in this health human resource, and the opportunity costs entailed by its loss.
Also in the main section below we elevate an item previously presented in our sidebar: on "Corporate Hybrids". Your host, Pacific Health & Development Sciences Inc. (PacificSci), is an example of such an organization, now in its 4th year of operation.
In our sidebar: Once again we focus on Canada's political scene, with a brief capsule on Prime Minister Stephen Harper’s limited popularity, as revealed in a recent poll. We then focus on a troubling police action that may have been politically directed. Whether or not one agrees or disagrees with opposition on any given policy issue, the legal and democratic right to protest is supposed to be protected in our society. However, the recent undermining of a legal protest in a designated area adjacent to the “Security and Prosperity Summit” (involving the leadership of Canada, Mexico and the US) through use of agents provocateurs has alarmed our civil society. That Canada’s police forces were used to discredit the use of this right is cause for serious concern, and it is disturbing that the Honourable Stockwell Day, Minister for Public Security is ignoring calls for a public inquiry, issuing statements designed to diminish political accountability.
BRAIN DRAIN FROM SUBSAHARAN AFRICA
Significant numbers of African-trained health workers migrate every year to developed regions, leaving severely crippled health systems in countries where life expectancy is only age 50 and 16% of children die before age five. However, the critical shortage of health care workers in many parts of the world is beginning to receive attention from donors and international agencies. Donors are increasingly realizing that without enough trained workers to deliver drugs, vaccines and care, funding projects will not have the desired effects.
The population of sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. The continent bears 24% of the global burden of disease but has only 3% of the health care workforce and 1% of the world's financial resources. Africa suffers more from brain drain due to economic conditions, wage differentials, rapid population growth among young people and conflict than any other continent.The worker shortage derives from a combination of underproduction, internal maldistribution and emigration of trained workers. Sub-Saharan Africa needs approximately 700,000 physicians to meet the Millennium Development Goals. Many African countries cannot meet widely accepted basic standards for health care coverage by physicians, nurses and midwives. An additional 2.4 million physicians, nurses and midwives are needed, along with an additional 1.9 million pharmacists, health aides, technicians and other auxiliary personnel.
Fewer health professionals from African countries than from other countries work in the US, according to the Least Developed Countries Report 2007. Data from the report demonstrate that the percentage of doctors practicing in the US relative to the total number of doctors back home range from 43% in Liberia to 10% in Zambia. This would not be a problem if the number of doctors remaining in their country of origin was sufficient to meet the needs of the population, but this is not the case. For example, Zambia has only seven doctors per 100,000 people, compared with the US level, which is close to 300. Even though the absolute number of professionals from the poorest countries working abroad may be small, the impact on professional services back home can be severe.
Efforts to retain workers focus on health care systems. For example, Swaziland provides HIV/AIDS services for health care workers who, practicing in high-prevalence areas with minimal resources for safety measures, are at an increased risk for occupational exposure. Other efforts build on the belief that providing workers with needed resources for care motivates them to stay and work in their home countries.Improved wages are also a key to retention. Salary support can help motivate health care workers to remain in their countries, even if it means working with fewer resources. Other types of inducements have been offered, such as lunch allowances, care loans and affordable housing.Some countries have begun to recruit trainees from rural areas. In South Africa, local students can receive scholarships for health care training on the condition they agree to return to their home district to practice. A study of the program found that trainees from rural areas were three to eight times as likely as those from urban areas to practice in rural regions after graduation.
The documented shortage of health care workers has inspired the American Public Health Association to pass a policy statement on "Ethical Restrictions on International Recruitment of Health Professionals to the United States." The policy addresses the role of the US in exacerbating the international crisis, calling on employers to adopt voluntary codes for ethical recruitment and on the government to contract only with employers who have done so. The future of global health and development in the 21st century lies in the management of the crisis in human resources for health.
More information is available from these resources on brain drain:
* "Providing the providers-remedying Africa's shortage of health care workers." N Engl J Med 2007; 356(25): 2564-67.http://content.nejm.org/cgi/content/extract/356/25/2564
* The Brain Drain of Health Professionals from Sub-Saharan Africa to Canada (3.5 MB):http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_2.pdf
* The Least Developed Countries Report 2007 (2.54 MB):http://www.unctad.org/en/docs/ldc2007_en.pdf
Source: Juan Ramos. ProCOR. Aug 9, 2007 Jramos3@partners.org
NOTE: To visit ProCOR, scan column at right to locate URL under “Recommended Links”.
CORPORATE HYBRIDS
“… organizations driven by both social purpose and financial promise that fall somewhere between traditional companies and charities…distinct from those operating in the government, business and non-profit sectors…Whatever participants call it, the fourth sector faces challenges. Current legal and tax structures draw strict lines between for-profits and non-profits… The social benefits that fourth-sector firm seek to unlock are not easily quantified and often take decades, not quarters, to attain.”
Reference: Stephanie Strom. The New York Times. May 6, 2007.
COMMENT: By definition, PacificSci is a hybrid or "fourth sector" organization. Ineligible for grants available to non-profits, nor driven by the bottom line as a purely business enterprise, nor financially underwritten by the tax payer as are universities, government bodies and international agencies, yet our contractual work, advocacy efforts and pro bono activities are all guided by our secular humanist mission: seeking solutions to the health and social impacts of development. Now in its 4th year, our philosophical model is proving operationally viable and productive.
Also in the main section below we elevate an item previously presented in our sidebar: on "Corporate Hybrids". Your host, Pacific Health & Development Sciences Inc. (PacificSci), is an example of such an organization, now in its 4th year of operation.
In our sidebar: Once again we focus on Canada's political scene, with a brief capsule on Prime Minister Stephen Harper’s limited popularity, as revealed in a recent poll. We then focus on a troubling police action that may have been politically directed. Whether or not one agrees or disagrees with opposition on any given policy issue, the legal and democratic right to protest is supposed to be protected in our society. However, the recent undermining of a legal protest in a designated area adjacent to the “Security and Prosperity Summit” (involving the leadership of Canada, Mexico and the US) through use of agents provocateurs has alarmed our civil society. That Canada’s police forces were used to discredit the use of this right is cause for serious concern, and it is disturbing that the Honourable Stockwell Day, Minister for Public Security is ignoring calls for a public inquiry, issuing statements designed to diminish political accountability.
BRAIN DRAIN FROM SUBSAHARAN AFRICA
Significant numbers of African-trained health workers migrate every year to developed regions, leaving severely crippled health systems in countries where life expectancy is only age 50 and 16% of children die before age five. However, the critical shortage of health care workers in many parts of the world is beginning to receive attention from donors and international agencies. Donors are increasingly realizing that without enough trained workers to deliver drugs, vaccines and care, funding projects will not have the desired effects.
The population of sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. The continent bears 24% of the global burden of disease but has only 3% of the health care workforce and 1% of the world's financial resources. Africa suffers more from brain drain due to economic conditions, wage differentials, rapid population growth among young people and conflict than any other continent.The worker shortage derives from a combination of underproduction, internal maldistribution and emigration of trained workers. Sub-Saharan Africa needs approximately 700,000 physicians to meet the Millennium Development Goals. Many African countries cannot meet widely accepted basic standards for health care coverage by physicians, nurses and midwives. An additional 2.4 million physicians, nurses and midwives are needed, along with an additional 1.9 million pharmacists, health aides, technicians and other auxiliary personnel.
Fewer health professionals from African countries than from other countries work in the US, according to the Least Developed Countries Report 2007. Data from the report demonstrate that the percentage of doctors practicing in the US relative to the total number of doctors back home range from 43% in Liberia to 10% in Zambia. This would not be a problem if the number of doctors remaining in their country of origin was sufficient to meet the needs of the population, but this is not the case. For example, Zambia has only seven doctors per 100,000 people, compared with the US level, which is close to 300. Even though the absolute number of professionals from the poorest countries working abroad may be small, the impact on professional services back home can be severe.
Efforts to retain workers focus on health care systems. For example, Swaziland provides HIV/AIDS services for health care workers who, practicing in high-prevalence areas with minimal resources for safety measures, are at an increased risk for occupational exposure. Other efforts build on the belief that providing workers with needed resources for care motivates them to stay and work in their home countries.Improved wages are also a key to retention. Salary support can help motivate health care workers to remain in their countries, even if it means working with fewer resources. Other types of inducements have been offered, such as lunch allowances, care loans and affordable housing.Some countries have begun to recruit trainees from rural areas. In South Africa, local students can receive scholarships for health care training on the condition they agree to return to their home district to practice. A study of the program found that trainees from rural areas were three to eight times as likely as those from urban areas to practice in rural regions after graduation.
The documented shortage of health care workers has inspired the American Public Health Association to pass a policy statement on "Ethical Restrictions on International Recruitment of Health Professionals to the United States." The policy addresses the role of the US in exacerbating the international crisis, calling on employers to adopt voluntary codes for ethical recruitment and on the government to contract only with employers who have done so. The future of global health and development in the 21st century lies in the management of the crisis in human resources for health.
More information is available from these resources on brain drain:
* "Providing the providers-remedying Africa's shortage of health care workers." N Engl J Med 2007; 356(25): 2564-67.http://content.nejm.org/cgi/content/extract/356/25/2564
* The Brain Drain of Health Professionals from Sub-Saharan Africa to Canada (3.5 MB):http://www.queensu.ca/samp/sampresources/samppublications/mad/MAD_2.pdf
* The Least Developed Countries Report 2007 (2.54 MB):http://www.unctad.org/en/docs/ldc2007_en.pdf
Source: Juan Ramos. ProCOR. Aug 9, 2007 Jramos3@partners.org
NOTE: To visit ProCOR, scan column at right to locate URL under “Recommended Links”.
CORPORATE HYBRIDS
“… organizations driven by both social purpose and financial promise that fall somewhere between traditional companies and charities…distinct from those operating in the government, business and non-profit sectors…Whatever participants call it, the fourth sector faces challenges. Current legal and tax structures draw strict lines between for-profits and non-profits… The social benefits that fourth-sector firm seek to unlock are not easily quantified and often take decades, not quarters, to attain.”
Reference: Stephanie Strom. The New York Times. May 6, 2007.
COMMENT: By definition, PacificSci is a hybrid or "fourth sector" organization. Ineligible for grants available to non-profits, nor driven by the bottom line as a purely business enterprise, nor financially underwritten by the tax payer as are universities, government bodies and international agencies, yet our contractual work, advocacy efforts and pro bono activities are all guided by our secular humanist mission: seeking solutions to the health and social impacts of development. Now in its 4th year, our philosophical model is proving operationally viable and productive.
Subscribe to:
Posts (Atom)
