Image Collections Page

The Image Collections Page is available here:

It lists and describes 8 image collections:

  • Google: Image Search
  • Health Communication Materials Database (Focus on Low-Income Countries)
  • HONmedia
  • Images From the History of Medicine
  • Medical Images on the Web
  • Photoshare (Focus on Low-Income Countries)
  • Public Health Resources Library
  • Urbana Atlas of Pathology

Scientific Animations Without Borders

My name is Anna, and I am a member of Scientific Animations Without Borders. Here are the links for SAWBO’s Newsletter and Ebola Prevention video. Let me now if you have any problem with the links.

Newsletter Link:

Ebola Prevention:

PS: if you have a minute we would really appreciate if you subscribe to SAWBO’s Newsletter. Just click ak at the bottom link.

Anna Perez Sabater

Scientific Animations Without Borders™ (SAWBO))

SAWBO’s Website:

SAWBO’s Newsletter:

HIFA profile: Anna Perez Sabater works with Scientific Animations Without Borders (SAWBO), USA. anna.perez.sabater AT

WHO Disease outbreak news: Plague in Madagascar

Plague – Madagascar

Disease outbreak news

21 November 2014

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.


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.

Knowledge management and sharing for global health

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.

Transcript in English

Transcript in French

Video (8 minutes)

Best wishes,


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Measuring the Information Society Report 2014

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

This 240 page report can be freely downloaded here:

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,


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

Are multifaceted interventions more effective than single-component interventions in changing health-care professionals’ behaviours? An overview of systematic reviews

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. (open access)


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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Do interventions aimed at communities to inform and educate about childhood vaccination improve outcomes?

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:;jsessionid=34BCBCD0BDF587E5416A493FBD413233.f02t04


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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BMJ: Mental healthcare in low and middle income countries

‘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):

Below are the citation and selected extracts.

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

BMJ 2014; 349 doi: (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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WHO concerns about open access

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…


‘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.

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).


‘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?

Best wishes, Neil

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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

Public servants’ pay ‘ate borrowings’

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

State work programme provides ‘real work, creates real value,’ says Cronin

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

The rise of the quiet teen

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

US federal government to mandate more calorie counts in US

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

Aids could be over by 2030 – or it could get worse than it is now

The Joint United Nations Programme on HIV and Aids (UNAids) announced on Tuesday that the Aids epidemic could be something of the past by 2030. “Ending the Aids epidemic as a global health threat is no longer a dream. It can be a reality within 15 years if we accelerate action today,” the agency said in a press release. In its 2014 World Aids Day report, which reveals the latest global HIV statistics, UNAids authors reveal “this confidence is based on a combination of major scientific breakthroughs and accumulated lessons learned over more than a decade of scaling up the Aids response worldwide”…..more

The rural doctor who came home to live, love and heal

Early on a Saturday afternoon in Ladismith in the Little Karoo, just after lunchtime, Llewellyn Volmink’s little body stiffened when he heard the adults screaming in terror. The truck full of farmworkers had just arrived. They climbed from the vehicle in dribs and drabs, grocery bags in their hands.   It was time to begin the weekend with bellies full of food and wine. It was time to forget the week’s hard labour, and all of life’s many problems. The midsummer heat hung heavy in the air. The farm’s ostriches lay languidly under wooden shading…..more

How officials are milking the state

Blatant demands for bribes in exchange for tenders are commonplace in Limpopo and Mpumalanga. “You can get the tender. All you have to do is pay me the fee.” The local government official is speaking calmly, sure of himself. The office door is not closed. A colleague pops his head in to ask whether he wants anything from the shop. “It will be 10% of the project fee,” he continues. “But then you get immediate sign-off and you can start work.”….more