Since I am expecting the arrival of my baby any week (day?) now, I am way beyond the point where people are afraid to ask if I am pregnant or not. I am now at the point where complete strangers will come up to me on the subway and ask if they can touch “it”. Unsurprisingly, these strangers almost always also ask if it is a boy or a girl (it is a boy) and whether it is my first one or not (it is not).

Surprisingly, however, many will also ask me where I plan to deliver. When I say where I plan to deliver, some acutally look surprised or even make an expression of disgust. It turns out that in NYC, where you deliver says a lot about who you are and where you stand in society. Unfortunately, not everyone can rent out the entire labor and delivery floor at Lenox Hill. Next time.

Fortunately, even the most basic facility available to me here in NYC is infinitely better staffed and better equipped than essentially any public hospital available to people in most developing countries. If you are like me and track global health data, you might have noticed that Measure DHS project, the organization that helps with the collection and dissemination of the Demographic and Health Surveys recently began releasing for the first time a set of surveys known as the Service Provision Assessments (SPAs), which collects information on a nationally representative set of health facilities in small number of developing countries. So far these surveys have been under-exploited for research.

Using this data, a recently published paper in Health Policy and Planning by Renee Hsia, Naboth Mbembati, Sarah Macfarlane and Margaret Kruk paints a pretty grim picture of the status of emergency and surgical facilities in Sub-Saharan African hospitals. They find:

The percentage of hospitals with dependable running water and electricity ranged from 22% to 46%. In countries analysed, only 19–50% of hospitals had the ability to provide 24-hour emergency care. For storage of medication, only 18% to 41% of facilities had unexpired drugs and current inventories. Availability of supplies to control infection and safely dispose of hazardous waste was generally poor (less than 50%) across all facilities. As few as 14% of hospitals (and as high as 76%) among those surveyed had training and supervision in place.

They conclude that not a single surveyed hospital in the entire sample of 2000+ facilities had “enough infrastructure to follow minimum standards and practices that the World Health Organization has deemed essential for the provision of emergency and surgical care”. I’ll think twice about complaining about the hospital food this time around.

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Few countries represent such a challenge when it comes to the scale up of immunizations than Nigeria. Consistently immunization rates have trailed behind neighboring countries. It is where we hear stories of whole communities rejecting immunization due to a misunderstanding about the purpose of these programs and mistaken belief about those running the programs.

At the same time, few countries stand to benefit as much from rapid scale up of these programs than Nigeria: child mortality rates are abysmal – on the order of twice as high as nearby neighboring countries such as Ghana. Barriers to immunization adoption have also stymied efforts to eradicate polio: it is one of the three countries in the world where the virus remains endemic. Even India – another vaccine basket case by historical standards – has managed to go polio free.

So I was not terribly surprised to hear that “Vaccine Summit” has been organized this week in Nigeria to bring together national and international leaders and experts to put increased emphasis on immunization in this country. This is what national and international leaders and experts do when things don’t seem to be working well.

What I was surprised to learn about, however, is new project that the Gates Foundation has launched in this country to help incentivize uptake of immunization. Called the Governor’s Immunization Challenge, the new program will reward a cash prize to the Governor that demonstrates the greatest leadership in improving both routine and polio immunization by the end of the year. This is not what the Foundation, which admits that it has a bias towards technological solutions to global health challenges, does. It seems like a departure from their regular business model of focusing on technical and operational barriers and an admission that things like leadership of health officials might matter a lot.

I wonder if this represents a new new direction for the Foundation in general? I sure hope so, as I believe it could be a very fruitful avenue to explore.

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Conference crowdout

On April 12, 2012, in Uncategorized, by Karen Grepin

I heard some rather surprising news this afternoon (on Twitter, where else?): after 40 years, the Global Health Council has decided to cancel its 2012 Global Health Conference in Washington, DC. In an email circulated this afternoon, the reason the organization gave was:

We appreciate that during tight budget times many members need to prioritize conferences they intend to attend and/or support. The same choices would need to be made by panelists, sponsors and participants. Rather than compete with other health causes and organizations whose missions we support, the Global Health Council Board has decided to cancel our 2012 Conference.

As most people know, the International AIDS conference is going to be held in Washington this summer, which is kind of a big deal. But with all of the global health types descending onto DC at the same time, one might have expected that enrollment at the GHC conference could have been even higher this year than in years past. Clearly not. The conference has been announced for nearly 2 years, so canceling with just under 3 months to go suggests that the situation must be pretty dire.

So what is going on? Are fiscal constraints really making people choose among conferences? Is this a sign that this particular organization, which has been facing some leadership challenges lately, has lost its relevance? Or is it a sign that HIV is the only real issue that most people care about? Or is it something more profound: might broad interest in global health issues be declining? Regardless, this is a worrying sign.

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