Posts Tagged ‘World Health Organization’

Dr. Prakash Mishra, director of the Regional TB Centre in Pokhara, Nepal, looks at a chest X-ray of a patient. Photo by Kiran Panday

KATHMANDU, Nepal – In a walk-up doctor’s office, off a busy street in Kathmandu, Dr. Dirgh Singh Bam sees patients every day in relative anonymity. His walls, though, reveal a history of being in the limelight: plaques and ribbons and framed photographs covering every inch, highlighting Dr. Bam’s efforts in leading Nepal’s TB control program from 1995 to 2004.

With assistance from the World Health Organization, Bam and a dedicated team of health workers ushered in an era of DOTS – directly observed treatment, short-course – by traveling all around the mountainous country to ensure that the strategy was followed. Health workers had to watch each patient swallow their TB pills every day.

“We made sure we had a DOTS committee in every sub-health post, every health post, every district hospital and the central hospital,’’ Bam said. “We went to mosques, temples, churches, all religious organizations, just to make sure they supported us.’’

In five years, Nepal installed the DOTS strategy across the country. In 1995, Nepal’s TB cure TB rate was around 45 percent; today it is 90 percent.

These advances made Nepal a model country around the world in TB control. But the question today is whether the country can remain a leader.

It has a major new challenge: controlling the spread of multi-drug resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB). (more…)

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Laura Hoemeke is Director of Strategic Communications at IntraHealth International, based in Chapel Hill, N.C. This post follows a discussion Monday at Aspen Institute on women’s health.

The Aspen Institute’s Ministerial Leadership Initiative panel discussion on Women and Health taught, or maybe reminded me, of three important lessons, among countless others.

Laura Hoemeke

First, as Dr. Susan Brems noted, policies and programs that successfully address the health of women do not treat them as “the vulnerable ones” or silent “beneficiaries,” but listen to women, respect women, and work with them as resilient agents of social change.

Second, as Dr. Tonya Nyagiro pointed out, ensuring that programs support infants, children and adolescents is just as important as supporting services for adult women that meet their health needs.

Third, as Dr. Julio Frenk and Michele Moloney-Kitts and other panelists reminded us, in developing policies and implementing programs, we need to remember that health workers and health systems are not only providing treatment and offering care, but also are offering primary health care, including health education and prevention (like family planning services!), and therefore need to supported in these roles and in light of their larger social and cultural networks.

It was invigorating to be a part of this celebration of International Women’s Day, and of the release of WHO’s new report, Women and Health: Today’s Evidence, Tomorrow’s Agenda. Dr. Frenk pointed out the importance of talking about “women and health” rather than “women’s health,” noting that women play many roles in influencing health, serving not only as caretakers, but also as members of the workforce and, especially the health workforce.

Moloney-Kitts emphasized the importance of making sure that “women’s voices influence our policies,” reminding us that violence against women still too often silences some of those voices. (With USAID support, IntraHealth has been able to work on some stimulating initiatives addressing the prevention and response to gender-based violence: http://www.intrahealth.org/page/gender-equality-1)

Moloney-Kitts also reminded us that too many women are still dying from HIV and AIDS—and that it’s not the time to pat ourselves on the back and cross our arms. All of the panelists agreed that family planning efforts need to continue, too, including innovations and support for new contraceptive technologies—ones that involve men as well as women.

The new WHO report, which includes an impressive compendium of information, should be read and consulted widely, and truly inform and influence public policy. As Dr. Brems noted, we need to roll out the tried and tested approaches—and ensure that innovations are truly innovative. (For example, is providing setups that allow women to deliver while they are squatting or not in a bed or wearing some of their clothes, preferences impacting health seeking behavior that were documented years ago, really an innovation today? When we know that something works, we don’t need to re-innovate, but to figure out how make it happen.)

The US Government’s new Global Health Initiative should ensure that “women’s voices influence our policies” and wholeheartedly make use all of the available evidence to meet its goal of “adopting a women and girl-centered approach” to the benefit of women, men and families and communities. The GHI has pledged to “support long-term systemic changes to remove barriers and increase access to quality services” for women, ensuring meaningful participation of women and girls in decision-making and involving men and boys in addressing gender equity. The right people, policies and programs can make this happen.

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The figures were shocking. A World Health Organization study of 11 countries found between 15 percent and 71 percent of women, depending on the country, had experienced physical or sexual violence by a husband or partner in their lifetime – and between 4 percent and 54 percent had experienced it within the previous year. Ethiopian women suffered the highest rates of violence among the 11 countries, followed by Peru, Bangladesh, and Tanzania.

The findings from Women and Health were presented by Dr. Tonya Nyagiro, Director of WHO’s Department of Gender, Women and Health and discussed at a forum Monday that was hosted by The Aspen Institute’s Ministerial Leadership Initiative for Global Health.

The event drew more than 100 people, including many eager to hear more details about the Obama administration’s new Global Health Initiative and how it would take evidence such as the figures on violence against women and turn it into action. The talk fit into a larger context of looking anew at approaches to global health issues and making sure that health issues pertaining to women were properly addressed.

“The violence data is much more pervasive than any of us really expected – and we knew it was high,’’ said Michele Moloney-Kitts, Assistant US Global AIDS Coordinator.

Moloney-Kitts, who has been a senior PEPFAR official since 2004, nearly since its inception, compared the stigma and discrimination against people with HIV or AIDS a decade ago to the fear today of women unable to speak up about domestic violence around the world. And after reading an article in the Independent newspaper about high rates of violence against women in the U.K., she emphasized that the problem was global – in rich and poor countries.

“Now we have here a new evidence base on violence that we never had before,’’ she told the Aspen audience, suggesting that policymakers could use the evidence to build programs aimed at reducing violence against women. “You cannot do public health without recognizing this is part of public health as well.’’

The discussion was wide-ranging, touching on the impact of the ramp-up of HIV/AIDS services on health systems to the administration’s increased focus on what was described as “women-centered programs’’ in the developing world.

Dr. Julio Frenk, the former Health Minister of Mexico and now the Dean of the School of Public Health at Harvard, said that many HIV/AIDS programs opened up new avenues to provide better health services for women and children. “The work in preventing mother-to-child transmission’’ has advanced the health of large numbers of women in many countries, he said.

Moloney-Kitts also noted that the WHO report showed that AIDS remained the leading cause of death among women aged 20 to 59, underscoring the enormity of the problem. “We have so much left to do,’’ she said. “Our attention is quick to move onto other directions (in global health), but the report grounds you to how much HIV/AIDS affects women.’’

She said that the PEPFAR program now was expanding into areas protecting women against violence, mentioning training programs for police and making rape kits available in primary health care facilities in developing countries. But so far, she said, “what we’ve done is really at a very small scale. The next step going forward is dealing with it more broadly.’’

On the question of violence against women, two audience members said that often policy leaves out men. They wondered why.

Frenk agreed that men are often left out, which he said was a mistake.

`Men are often a big part of the problem, but they are also a big part of the solution,’’ he said.

Frenk’s wife, Felicia Knoll, is a breast cancer survivor and has been a leader in a global effort to increase awareness of breast cancer in the developing world. In her work, she hears directly how men are often a problem for women seeking health care, he said. “A number of women will tell you they won’t do a mammogram because they are afraid if they are found to have breast cancer, their husband or partner will abandon them,’’ he said.
Several in the audience wanted to know more about the administration’s work in family planning globally.

Dr. Susan K. Brems, Deputy Assistant Administrator for USAID’s Global Health Bureau, said her agency has been a pioneer in family planning for years. But next year, she said, “we will have more money available. Family planning, time and again, has proven to be effective. When it comes to family planning, we will keep our eyes on the prize.’’

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