How Is Haiti Faring Five Years After the Earthquake?

Five years ago today, a magnitude 7.0 earthquake destroyed large regions of Haiti especially Port-au-Prince and Jacmel. For the poorest country in the western hemisphere, the earthquake only exacerbated poverty matters for its citizens and its standing in the world economy. An estimated 230,000 people lost their lives and 1.5 million more were displaced. Since 2010, $13 billion has been raised to aid the small Caribbean island country, but where has the money gone?

By most accounts, Haiti is doing much better than it was five years ago, and yet there is still a long way to go to provide permanent housing for its citizens and finally do away with the tent cities that became ubiquitous with a slow-going recovery effort.

“Haiti’s recovery has not been easy. There have been – and continue to be – setbacks along the way, and there is much work still to be done to ensure political and institutional stability, democratic governance and sustainable development,” said the UN chief, Ban Ki Moon in a statement commemorating the five year anniversary of the earthquake.

While some Haitians have moved into permanent housing outside of Port-au-Prince many complain that the new homes, while much better than living in squalid tent cities, are too far away from Haiti’s capital to work. Jobs were promised near their new homes, but those have not yet materialized. And, there is still a looming question about the 8,000 cholera deaths that occurred after human waste was inadvertently dumped into major waterways by Nepalese UN workers in 2010. 700,000 people were also sickened by the disease and continue to be plagued today. Haitian groups have tried since 2013 to sue the United Nations because of the cholera epidemic, but last week, a judge ruled that the UN could not be sued.

Continue reading How Is Haiti Faring Five Years After the Earthquake?

Infographic of the Week: 2015 African Elections

This year, Africa will see 16 general, parliamentary, or presidential elections. We are particularly interested in the elections in Nigeria, Sudan, South Sudan, Ethiopia, and Zambia and will follow them this year. Of note, Zambia’s election is on January 20 and Nigeria will hold their elections on February 14.

After the sudden death of Zambia’s former president, Michael Sata, last October, Zambia had 90 days in which to elect a new president. Many believe that the leading candidate Edgar Lungu for the Patriotic Front party, which Sata founded in 2001, will win handedly, but there is already hate speech and what looks like potential looming violence as the election date nears.

Nigeria’s elections are sure to grab countless headlines as Goodluck Jonathan seeks another presidential term. But upon the backdrop of the 200 missing girls who were taken last year by Boko Haram and their continued violence in Northern Nigeria, the election will likely be mired by threats of violence and potential civil unrest.

Goodluck officially launched his reelection campaign on January 8.

The infographic is from Brookings’ latest Africa report: Foresight Africa: Top Priorities for the Continent in 2015.
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Ethiopian Health Workers Receive Influx of Family Planning Training

In sub-Saharan Africa, 49 million women use traditional methods of family of no family planning methods at all. In Ethiopia, 39.1 percent of women use modern contraceptives up from 15 percent in 2005. The current low rate of contraceptive use in Ethiopia is a result of a combination of factors: cultural biases as well as a lack of trained health workers that can reach every woman in the country. Ethiopia is Africa’s second-most populated country behind Nigeria with 90 million people and only has a few hundred OBGYNs. There is currently only one obstetrician for 1.8 million women in Ethiopia.

That said, Ethiopia’s federal government has done an exceptional job training health workers since its Health Extension Workers program officially launched in 2003. Now 34,000 women strong, Ethiopians are afforded access to skilled health workers in their villages and cities, but there is still an unmet need for reproductive health and family planning services from health professionals.

The University of Michigan was recently gifted an anonymous $25 million dollar grant to train Ethiopian doctors in reproductive health services.  University of Michigan’s new Center for International Reproductive Health Training will train incoming doctors, nurses and midwives in comprehensive family planning services at seven medical schools across Ethiopia. The first phase of the grant will be used to build upon the work the University of Michigan is already doing at St. Paul Hospital Millennium Medical College in Addis Ababa.

Thomas Mekuria, third-year resident in OB/GYN at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia.
Thomas Mekuria, third-year resident in OB/GYN at St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia.

“Every day, women across the globe are dying and suffering from poor health outcomes because they don’t have access to high quality, comprehensive reproductive health care,” says Senait Fisseha, M.D., J.D., the center’s director in a statement.  Fisseha, who was born in Ethiopia, is a reproductive endocrinology and infertility specialist at the U-M Health System.

“We are overwhelmingly grateful for this extraordinary grant that allows us to build on our strong foundation of global reproductive health programs and continue to pursue a longtime dream to provide all women a full scope of high quality reproductive health care when and where they need it.”

With a maternal mortality ratio of 420 per 100,000 live births in Ethiopia, family planning services are essential to keep more mothers alive, especially teenage mothers who are not prepared physically to bear children. The average Ethiopian woman has 5.5 children according to the most recent demographic data.

“Our center will help empower women to make their own decisions about their own reproductive health, thereby choosing whether and when to start a family,” Dr. Fisseha continued. “Our ultimate goal is to help train future generations of capable and competent health care providers in many parts of Africa and South Asia who can deliver comprehensive reproductive health services, and also be advocates for the safest and best health care possible at every stage of a woman’s life.”

Uganda Moves Closer to Using Misoprostol to Curb Postpartum Hemorrhage

In low- and middle-income countries women continue to die each day during and immediately after childbirth mainly due to postpartum hemorrhaging (PPH). In fact, most maternal deaths in sub-Saharan Africa (440 every day) are caused by PPH.

The World Health Organization’s strong recommendation to save mothers who experience PPH is to administer oxytocin, the most effective drug to stop hemorrhaging. The problem, however, is oxytocin must be kept refrigerated. Most health centers and hospitals in low resource areas lack electricity or have spotty service making the use of oxytocin improbable to impossible. Oxytocin must also be injected by a skilled health worker which causes another barrier to its universal use. For African women, who likely live great distances from their closest health center, the chances of delivering their baby with a skilled health professional are increasingly low.

Scientists in Uganda recently conducted a double-blind, randomized trial where they compared the use of oxytocin and misoprostol, an oral drug that also stops postpartum hemorrhaging. They found that misoprostol can effectively be used against PPH because it can be taken as a pill and does not need to be refrigerated. In cases where oxytocin  and health workers are not available the World Health Organization has also recommended the use of misoprostol. This recommendation has stood since 2011.

Although misoprostol has been used and distributed to health centers in Uganda since 2010 the researchers acknowledge that the drug has been illegally abused because it can also be used for abortions. Researchers also admit that oxytocin is a superior drug to reduce PPH because misoprostol often causes shivering and fevers in addition to stopping hemorrhages.

While misoprostol seems to be the likely alternative to oxytocin in resource-poor settings, researchers in Australia at Monash University as well as their global partners Glaxo Smith Kline, McCall MacBain Foundation, Grand Challenges Canada and Planet Wheeler Foundation are currently collaborating on an inhaled oxytocin product that does not require refrigeration while still saving mothers’ lives.

Photo: United Nations

 

 

5 Global Health Stories We’re Following This Year

2015 will be an interesting year in global health primarily because this is the year when the Millennium Development Goals should ideally be reached. Global health experts admit that many of the goals, for example MDG5, will not be reached globally even though some of them have already been reached on a country level.

Ethiopia effectively reached MDG4 along with Bangladesh, Liberia, Malawi, Nepal, and Tanzania according to a 2013 report in the Guardian and UN data. Globally, the proportion of people having access to safe drinking water was reached in 2012. That is cause for celebration.

The overarching theme this year will be how the global health community will save more lives in low and middle-income countries in the best ways possible. This does not necessarily mean substantive goals, target dates, and data measurements will be scaled back. Rather, improved approaches to global health will be devised to streamline processes and programs.

While there are many global health stories that deserve following in great detail here are our top five picks for 2015.

1. The Effect of Ebola on Maternal Health: While Ebola is being fought in Sierra Leone, Guinea, and Liberia there must also be an enhanced emphasis on women who are pregnant and need to deliver their babies in a hospital setting. As it is, with low resources and crippled health systems in these three countries, women still need to be afforded quality care during pregnancy and delivery while health workers also care for those stricken with Ebola.

As the year goes on it is probable that key data will emerge from lessons learned during the Ebola response. According to Scientific American, the WHO, UNICEF, and Save the Children have already devised best practices and protocols for safe delivery.

2. Global Immunizations: This year we will watch the increase in rotavirus vaccine roll-outs across poor countries. Why? Diarrhea is one of the top three leading causes of deaths for children under five, and yet the rotavirus vaccine isn’t accessible in the volume of some the other vaccines. That said, rotavirus roll-outs have increased substantially since 2011. There is more good news. With increased GAVI funding, the rotavirus vaccine will be introduced in 30 countries this year.

rotavirus

We will also look at the progress of the Ebola vaccine. GAVI has announced that it is ready to purchase a million doses of the vaccine as soon as the World Health Organization approves its use. Today, Johnson & Johnson announced that they have already begun clinical Ebola vaccine trials with volunteers in Africa.

3. Country Commitments to the Every Newborn Action Plan (ENAP): Last year saw the official adoption of the plan during last year’s World Health Assembly and the launch of the Every Newborn Action Plan in Johannesburg during the Partners Forum. Upon its launch there were already 40 commitments (PDF) to save more newborns globally. That said, this year we will also look for increased commitments, particularly country commitments, to the ENAP especially since 2.9 million newborns die every year due to largely preventable causes.

4. Scaling Up of Frontline Health Workers: Did you know there is a global shortage of 7.2 million frontline health workers? That key data has been widely shown by the lack of health workers in  Ebola stricken countries. It’s the lack of health workers that has made fighting Ebola harder than it should be and why many health workers outside of Africa have had to pick up the slack.

Scaling up health workers is a large expense, but it bears repeating that in order for countries to provide quality health care to their citizens there must first be enough health workers. Ethiopia is touted time and again as an excellent example of a poor country that effectively scaled health worker coverage across the country through a government-led effort. Other countries’ health ministers have traveled to Ethiopia to see best practices for scaling up their own frontline health force. The second step after key learnings, however, is making sure actions are taken besides pure lip service. In 2015 we will look at evidence from other low- and middle-income countries, particularly in sub-Saharan Africa, that will introduce better national health worker programs.

5. Food Security in Conflict Areas: At the end of 2014, the World Food Programme said that it had suspended food aid to 1.7 million refugees in Syria due to a lack of donor funding. And previous to that, the WFP split vouchers in half to stretch funds according to the New York Times. Even though the World Food Programme received an emergency influx of funds after their voucher suspension announcement last month, it is never a good sign to see that there are not enough donor dollars to feed the world especially those who are living in conflict areas. Food security in not only conflict zones, but also in West Africa will be on our must-follow list this year.

Which global health stories are you following this year?

 UN Photo/Martine Perret