New video: Care of the Cord

Global Health Media Project will be releasing a new set of newborn care and childbirth videos over the next several weeks. The first—Care of the Cord—is now available in English, French, and Spanish, and may be accessed at http://globalhealthmedia.org/videos/  This video shows how to tightly tie or clamp the cord, several aspects of cord care, and how to apply chlorhexidine gel. Chlorhexidine gel has been shown to be effective in reducing newborn deaths from sepsis, and is now recommended in some areas of the world where newborns are at greatest risk of infection.

This video is intended for frontline health workers in the developing world. All of our videos can be downloaded free-of-charge for use in low-resource settings.

We are grateful for the collaboration of partners throughout the world who help make this work possible, many who we’ve connected with through the HIFA/CHILD networks: content experts, clinical site hosts, field-testers, and translators and narrators.  

As always, we value your feedback and would appreciate receiving any comments about how you use the videos in your training.

Thanks and kind regards,

Deb

Deborah Van Dyke, Director

Global Health Media Project

802-496-7556

The Lancet: Can mass media interventions reduce child mortality?

In October 2014, HIFA member Will Snell reported the midline results of a three-year randomised controlled trial in Burkina Faso, testing the proposition that a radio campaign focused on child health can reduce under-five mortality.

http://www.hifavoices.org/quotation/development-media-international-midline-results-update

The Lancet has today published a paper by Will and his colleagues, and the full text is freely available here:

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736%2814%2961649-4.pdf

Can mass media interventions reduce child mortality?

Roy Head, Joanna Murray, Sophie Sarrassat, Will Snell, Nicolas Meda, Moctar Ouedraogo, Laurent Deboise, Simon Cousens

Lancet February 13, 2015 http://dx.doi.org/10.1016/S0140-6736(14)61649-4

ABSTRACT: ‘Many people recognise that mass media is important in promoting public health but there have been few attempts to measure how important. An ongoing trial in Burkina Faso (ClinicalTrials.gov, NCT01517230) is an attempt to bring together the very different worlds of mass media and epidemiology: to measure rigorously, using a cluster-randomised design, how many lives mass media can save in a low-income country, and at what cost. Application of the Lives Saved Tool predicts that saturation-based media campaigns could reduce child mortality by 10–20%, at a cost per disability-adjusted life-year that is as low as any existing health intervention. In this Viewpoint we explain the scientific reasoning behind the trial, while stressing the importance of the media methodology used.’

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

The African Health Observatory: a comprehensive health information resource

The World Health Organization’s Regional Office for Africa (AFRO), based in Brazzaville, Republic of Congo, has created its African Health Observatory website at http://www.aho.afro.who.int/ .

Apart from providing free access to key statistics (live in an online database, and through providing the full text of such major publications as the Atlas of African Health Statistics 2014 and the African Regional Health Report 2014) an interesting and unique element of the Observatory website is the country profiles that are being created (in English, French and Portuguese) for each of the 47 countries of the African Region. This is a work in progress, as each profile seeks to act as an analytical review of the entire health system in each country. Using the same wiki software at the heart of Wikipedia, but with restricted ability for outsiders to edit the text, WHO has provided profiles some 70 or 80 pages long, when extracted (you can download “books” containing the full text).

Also available through the Observatory is the African Health Monitor ? an illustrated, peeer-reviewed journal covering all aspects of health in Africa.

Thanks to Chris Zielinski for this post about AHO

Jean Shaw, Phi

Global health e-platforms for participatory and peer to peer exchange and learning

Below is the citation and description of a report by the Training and Research Support Centre ( http://www.tarsc.org/ ) of EQUINET, the Regional Network on Equity in Health in Southern Africa.

The report includes a 2-page description of HIFA and several useful references on lessons learned in knowledge sharing and communities of practice (below).

CITATION: Annotated bibliography of e-platforms used in participatory and peer to peer exchange and learning

by T Loewenson, R Loewenson, Barbara Kaim et al.

Training and Research Support Centre (TARSC) in the Regional Nework for Equity in Health in East and Southern Africa (EQUINET), December 2014

54pp.6.9 MB:

http://www.equinetafrica.org/bibl/docs/Ann%20bib%20of%20e-%20platforms%20%20Dec2014.pdf

‘Visual and information technologies are now more diversified and widely accessible. Internet based resources point to the possibilities for information technology to support peer to peer learning and participatory action research to overcome the ‘local’ nature of processes and link groups with shared interest. To support discussion on these areas this work aimed to provide an annotated description of existing internet resources that have features that may guide out thinking in developing an e-platform for participatory reflection and action across similar groups in different areas.’

Best wishes,

Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Examples of references in the above report:

Understanding Knowledge-Sharing in Online Communities of Practice

URL: http://www.ejkm.com/issue/download.html?idArticle=32

Online Communities of Practice

URL: http://wp.comminfo.rutgers.edu/knowledgeinstitute/wpcontent/uploads/sites/30/2014/04/Knowledge.pdf#page=114

A theoretical framework for building online communities of practice with social networking tools

URL: http://www.tandfonline.com/doi/abs/10.1080/09523980802588626#.VJ2ukD0A

__________

Innovation in health service delivery: integrating community health assitants into the health system at district level in Zambia

Below is the citation and abstract of a new paper in the open-access journal BMC Health Services Research. Underneath I have added some illustrative quotes from participants in the research. This is a crucial subject and I have invited the authors to join us and explore further on HIFA-Zambia.

CITATION: Innovation in health service delivery: integrating community health assitants into the health system at district level in Zambia

by Joseph Mumba Zulu, Anna-Karin Hurtig, John Kinsman et al.

BMC Health Services Research 2015, 15:38 (28 January 2015)

ABSTRACT

Background: To address the huge human resources for health gap in Zambia, the Ministry of Health launched the National Community Health Assistant Strategy in 2010. The strategy aims to integrate community-based health workers into the health system by creating a new group of workers, called community health assistants (CHAs).

However, literature suggests that the integration process of national community-based health worker programmes into health systems has not been optimal. Conceptually informed by the diffusion of innovations theory, this paper qualitatively aimed to explore the factors that shaped the acceptability and adoption of CHAs into the health system at district level in Zambia during the pilot phase.

Methods: Data gathered through review of documents, 6 focus group discussions with community leaders, and 12 key informant interviews with CHA trainers, supervisors and members of the District Health Management Team were analysed using thematic analysis.

Results: The perceived relative advantage of CHAs over existing community-based health workers in terms of their quality of training and scope of responsibilities, and the perceived compatibility of CHAs with existing groups of health workers and community healthcare expectations positively facilitated the integration process.

However, limited integration of CHAs in the district health governance system hindered effective programme trialability, simplicity and observability at district level. Specific challenges at this level included a limited information flow and sense of programme ownership, and insufficient documentation of outcomes. The district also had difficulties in responding to emergent challenges such as delayed or non-payment of CHA incentives, as well as inadequate supervision and involvement of CHAs in the health posts where they are supposed to be working. Furthermore, failure of the health system to secure regular drug supplies affected health service delivery and acceptability of CHA services at community level.

Conclusion: The study has demonstrated that implementation of policy guidelines for integrating community-based health workers in the health system may not automatically guarantee successful integration at the local or district level, at least at the start of the process. The study reiterates the need for fully integrating such innovations into the district health governance system if they are to be effective.

QUOTES

“The most important thing to remember is that unlike the training for the other community health workers, the CHA’s training is longer…. It runs for 1 year.” (Neighbourhood health committee FGD 1, female participant 2).

“We have two CHAs who were trained. But to our surprise, they are not allowed to give medicines. They just watch support staff give medicines.” (Neighbourhood health committee FGD 2, male participant 1).

“But the complaint in the community is that CHAs are unable to treat some illnesses like malaria as they do not have drug kits.” (Neighbourhood health committee FGD 5, male participant 1).

“Sometimes CHAs come and ask for antibiotics to use. But am a little sceptical giving them drugs to administer because I don’t know the extent of their training.” (CHA supervisor 2, male).

“We are still waiting for monitors to come from the national level so that we can share with them some of challenges that we are experiencing in supervising CHAs.” CHA supervisor 4, female).

“We have been told that CHAs are under the Ministry of Health, but unlike other health workers, they are also controlled by the other groups. We are therefore not sure if they are totally under the Ministry of Health.” (CHA supervisor 3, female).

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Post-2015 Sustainable Development Goals

The Guardian (UK) newspaper has published an excellent interactive web page that describes the post-2015 Sustainable Development Goals – ‘changing the world in 17 steps’.

‘This year, the millennium development goals – launched in 2000 to make global progress on poverty, education, health, hunger and the environment – expire. UN member states are finalising the sustainable development goals that will replace them. But what do the SDGs aim to achieve? How do they differ from the MDGs? And did the MDGs make much progress? Browse how the MDGs have morphed into the SDGs, and explore each SDG in more detail.’

SDG 3 is ‘Ensure healthy lives and promote well-being for all at all ages’, and this comprises 13 components:

3.1: by 2030 reduce the global maternal mortality ratio to less than 70 per 100,000 live births

3.2: by 2030 end preventable deaths of newborns and under-five children, by 2030 end preventable deaths of newborns and under-five children

3.3: by 2030 end the epidemics of Aids, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases

3.4: by 2030 reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing

3.5: strengthen prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol

3.6: by 2020 halve global deaths and injuries from road traffic accidents

3.7: by 2030 ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes

3.8: achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all

3.9: by 2030 substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination

3.10: strengthen implementation of the Framework Convention on Tobacco Control in all countries as appropriate

3.11: support research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration which affirms the right of developing countries to use to the full the provisions in the TRIPS agreement regarding flexibilities to protect public health and, in particular, provide access to medicines for all

3.12: increase substantially health financing and the recruitment, development and training and retention of the health workforce in developing countries, especially in LDCs and SIDS

3.13: strengthen the capacity of all countries, particularly developing countries, for early warning, risk reduction, and management of national and global health risks.

Best wishes,

Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

UP venomous animals poisonous plants (VAPP) courses

Dear colleagues and friends,

Once again, I will be presenting 3 venomous animals poisonous plants (VAPP) courses this year. Last year our candidates had a wonderful time and the feedback was very positive. Make sure to register early since we only take 6 candidates on the course (d/t limited space in the combi during our afternoon field trip to view the plants)

If you have already attended this course, please pass on the VAPP Course information 2015 to other colleagues that may be interested.

Regards,

Prof Andreas Engelbrecht

Adjunct Professor, Head: Division of Emergency Medicine

Dept. of  Family Medicine, University of Pretoria/ Steve Biko Academic Hospital

Tel: +2712 354 2147 / Cell: +2784 789 7364

Should Everyone Start with Metformin?

This observational cohort study sought to determine the effect of initial oral glucose-lowering class on subsequent need for additional anti-hyperglycemia therapy. Participants included 15,516 patients who were not previously treated for diabetes, in whom therapy with metformin, a sulfonylurea (SU), a thiazolidinedione (TZD), or a dipeptidyl peptidase 4-inihibitor (DPP4) was initiated. The primary outcome was time to treatment intensification, defined as initiation of a different class of oral glucose-lowering medication…..more