News Flash 488: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 488

Weekly Snapshot of Public Health Challenges

 

Webinar recording 22 June 2022 Localisation of Aid; Decolonisation or Not?

WHO releases global COVID-19 vaccination strategy update to reach unprotected

Audio Interview: A Look at the U.S. Government’s Covid-19 Strategy

Sleepwalking into the next pandemic

With COVID-19 vaccine targets missed, WHO sets sights on highest risk

EMA reviewing data on sabizabulin for COVID-19

Monkeypox: WHO declares highest alert over outbreak

EMA recommends approval of Imvanex vaccine against monkeypox

EMA response to the monkeypox public health emergency

Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022

WHO moves to roll out first malaria vaccine in Africa

Acute Childhood Hepatitis Cases – Scottish Researchers May Have Unraveled Mystery

WHO: World Hepatitis day 2022

The role of low-income and middle-income country prisons in eliminating hepatitis C

What’s the Polio Endgame?

Cabotegravir: What are we waiting for?

South Sudan implements world-first outbreak response vaccination campaign for hepatitis E

MPP at #AIDS2022

GLOBAL PLAN TO END TB 2023-2030

Effect of comprehensive smoke-free legislation on neonatal mortality and infant mortality across 106 middle-income countries: a synthetic control study

The Key To Improving Population Health And Reducing Disparities: Primary Care Investment

REGISTER: Decolonizing global health through autonomous manufacturing in Africa August 3, 2022 9 a.m. ET | 3 p.m. CET

People’s Health Dispatch Bulletin #30: Health systems under transformation

For-profit health care might be damaging population health

Shadow Pandemic: Women’s Health in the Time of COVID-19 by Sevil Hakimi and Laura Neenan

Myanmar genocide case to go ahead after ICJ rejects objections

Human Rights Reader 639: GLOBAL HUMAN RIGHTS OBLIGATIONS ARE NOT BEING MET IN THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS: SEVEN REASONS WHY

Want More Infrastructure in Poor Countries? Help MCC Do More

We’re on the Cusp of the Most Catastrophic Food Crisis in 50 Years: Where Is the Global Response?

Water scarcity among top 10 food security threats – study

GI-ESCR participated in radio program to discuss the energy transition as a human rights and gender issue

Glaciers vanishing at record rate in Alps following heatwaves

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shadow Pandemic: Women’s Health in the Time of COVID-19

As researchers and actors in the maternal and child health space, Sevil Hakimi and Laura Neenan came together from two seemingly different parts of the world to reflect here on the state of women’s health in their countries relevant to domestic violence and mental status during COVID-19 pandemic

                                    By  Sevil Hakimi

RM. PhD. Associate Professor of maternal and newborn health. Tabriz University of Medical Science. Tabriz. Iran. hakimis@tbzmed.ac.ir

                                                     Laura Neenan

 BSc. MA. Teaching Assistant at School of Education. University of Limerick. Limerick. Ireland laura.neenan@ul.ie

Shadow Pandemic: Women’s Health in the Time of COVID-19

 

 The COVID-19 pandemic continues to overwhelm health systems both globally and locally in complex and nuanced ways. The fallout of the pandemic has greatly affected women and children in both developed and developing countries, including increases in domestic violence, child marriages, and rising mental health burden. COVID 19 has manifested itself in pervasive ways that have taken us back around 20 years on important progress that was being made across many fronts.

As researchers and actors in the maternal and child health space, we – Sevil Hakimi and Laura Neenan – came together from two seemingly different parts of the world to reflect on the state of women and children’s health in our countries, and the role of COVID-19 in shaping outcomes. Sevil is an associate professor of maternal and newborn health in Tabriz University of Medical Science in Iran, and Laura is a teaching assistant and former post graduate researcher in the area of suicide prevention at the University of Limerick in Ireland. Our countries could not be more different across cultures, income-levels, geopolitical situations, as well as health system capacities, yet we find similarities in issues close to our heart, around women and children’s health within our countries. While there are many more important themes within the broader topic of women and children’s health that are worthy of our collective attention, we will be focusing on domestic violence and Y here, given our own experiences and focused interests.

Domestic violence as a hidden issue in Ireland and Iran

Domestic violence is a critical issue that has a pervasive effect on the individual, and therefore the development of a nation at large. It also remains a largely ‘hidden issue’ given that women are often reluctant or unable to report cases due to a myriad of reasons ranging from cultural or social stigma, to lack of policy infrastructure, distrust of officials, or limited knowledge around pathways for seeking additional support. Following COVID-19 protective measures and “stay at home” policies, domestic violence rates increased against women and children around the world. While there is no clear data comparing domestic violence against women between developed and developing countries, evidence suggests that in both Ireland and Iran, domestic violence has risen since the outbreak of COVID-19.

In Iran, the dominant cultural view states that an Iranian woman enter her husband’s house in a white wedding dress, and can only leave in the same white dress. These social and cultural norms can often lead to Iranian women enduring violence and not reporting cases due to related stigma. During the first and second wave of the pandemic and during times of lockdown, evidence and studies showed that the prevalence of experienced domestic violence among Iranian women has increased.

Domestic violence against women in Ireland, like in most other countries, is something not openly discussed. It brings with it feelings of shame with impact on women’s ability to seek help for their situation.  In contrast to Iran divorce is easier in Ireland. The prohibition of divorce was removed from the Constitution and was signed into law in 1996. Historically, the Catholic Church  had  a strong influence on Irish society, and its views on divorce, as well as the use of contraceptives greatly influenced  women’s ability to seek help for domestic violence.

In Ireland evidence suggests that domestic violence has risen since the outbreak of COVID-19. There was a 6 per cent increase in criminal charges for breaches of Domestic Violence Act Orders in 2021 based on 2020 figures. According to Safe Ireland (2021), when the country was at the height of its second Level 5 lockdown, more than 2,180 women and 602 children availed of support from a domestic violence service.

We need urgent action, increased political and social will, and a commitment to sound policy and resource/information infrastructure to address the rising rates of domestic violence in both Ireland and Iran, as well as other countries around the world. It is promising to see Ireland’s recent approach to help protect women against domestic violence, in passing legislation making coercive control a criminal offense.

Burnout among health care workers and the rising mental health burden among women

Burnout has a substantial impact on not only staff, most which are women, but also on the health care system itself.  Iran and Ireland are different according to health system infrastructure and human resources. Iran is under serious economic sanction. Sanction leads to drug and medical devices shortage in Iran. Health workforce shortage, maldistribution and migration of health workforce are among the top problems in the Iranian health system, and these have been exacerbated and with more serious consequences since the nuclear sanctions. Due to a lack of appropriate budgetary resources, the government has not been able to invest in growing, nurturing or developing a new workforce, and the stress of the health system falls on the pre-existing (and burnout) few. The World Bank estimated in 2018, that Iran had approximately 2.1 nurses and midwives per 1000 population. In contrast, the United States had 15.7, Ireland had 13.0, and Canada had 11.8. Even among the Arab World, Iran fared poorly, with the United Arab Emirates having 5.7 nurses and midwives per 1000 population, Saudi Arabia with 5.8, and Kuwait with 7.4.  Studies looking at the context in Iran have shown significant burnout and emotional exhaustion among health care providers, which especially affect women who make up.

Ireland, on the other hand, has a strong health system, with an approximately adequate health workforce (13 nurses and midwives per 1000 population). However evidence shows that both health systems suffer from workforce burnout during pandemic. There is limited literature addressing burnout from an Irish context during the COVID-19 pandemic, however one such study reported psychological distress to be prevalent among health care workers. It seems that,  high workload,  fear, prolonged involvement with COVID-19  and hopelessness  are among the predisposing factors for health workforce burnout. Burnout results in increased absenteeism, increased medical errors and as a consequence negatively impacts patient care.

Both countries have reported increases in rates of anxiety and depression among women. Anxiety and depression among women have been reported to be higher than in men, although factors like social stigma and gender norms may affect reporting.  This is of particular significance when looking at the impact of mental health disorders during pregnancy. The treatment of depression and anxiety during pregnancy and postpartum period is critical for the health of mother and baby. Interestingly,  in both Iran and Ireland data shows a decrease in preterm birth rates, as well low birth weights  during the first and second wave of pandemic. This may be due to improved hygiene practices, changes in work environment and lifestyle. It’s estimated that a number of health promoting behaviors have been disrupted completely or partially within the lock down period. They include regular exercises in indoor places, routine medical follow- up, annual screening tests like mammography, pap smear, blood tests etc. Fear of getting infections, as well as lockdown policies are among the top cited causes of postponing such healthy behaviors. These further affect consequences among women, and lead to negative impacts on their health and well-being.

 The impact of COVID-19 is universal, affecting both developed and developing countries. Health system resilience is therefore a very crucial factor in the level of involvement between countries. Regardless of the level of development in each country, women are among the most vulnerable population.  It is, therefore, imperative that governments and the global society consider appropriate strategies in order to mitigate the risks and results of the COVID-19 pandemic on vulnerable populations.

 

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Dr. Sevil Hakimi is associate professor of Midwifery in Iran. With more than 15 years, she is experienced in clinical working and volunteer working in the refugee camps as well as in the research. Since 2013 she has worked as an academic member in the department of midwifery in Tabriz University of Medical Science. She is teaching undergraduate and postgraduate students. She has been supervisor for more than 30 master and doctorate thesis and has published several papers in peer review journals. She is editorial board member of European Journal of Midwifery.   Her main research areas are in maternal and preterm newborns` health and health system strengthening on maternal care. Dr. Hakimi has served as consultant for WHO, UNICEF and was visiting professor in Turkey for 4 years. By Dr. Hakimi recently on PEAH: Beyond the Waives: Indirect Effects of Covid-19 on Mothers in Low and Middle-Income Countries  

Laura Neenan BSc, MA; is university tutor in the School of Education at the University of Limerick, where she teaches on modules that focus on the psychology of education with a specific focus on inclusivity. She serves as a member of the European region of the International Working Group for Health Systems Strengthening (IWG) and her research interests include suicide prevention, health literacy and mental health promotion. She is a registered nurse and a SafeTALK trainer, whereby she delivers suicide prevention training workshops to a range of community groups on behalf of the National Office for Suicide Prevention.

 

News Flash 487: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Mauve Stinger jellyfish (Pelagia Noctiluca)

News Flash 487

Weekly Snapshot of Public Health Challenges

 

PHM Course Application Form- September 2022 -The Struggle for Health and Access to COVID-19 Medical Products

Webinar registration: The Three COVID crises and Multistakeholderism : Impacts on the Global South. Jul 28, 2022 02:00 PM in Amsterdam

[ISSUE PAPER] CHANGING POLITICAL ECONOMY OF PHARMACEUTICAL PRODUCTION IN POST-COVID-19 ERA AND CIVIL SOCIETY MOVEMENT STRATEGY IN SOUTH KOREA

The Movement for a Global Pandemic Treaty

A pandemic treaty for equitable global access to medical countermeasures: seven recommendations for sharing intellectual property, know-how and technology

An Effective Pandemic Response Must Be Truly Global

Who Gets To Sit At The Table in Pandemic Treaty Negotiations? Debate Opens Pandora’s Box of Vested Interests

WHO: Intergovernmental Negotiating Body 18-22 July 2022

Future Pandemic Treaty Will be ‘Legally Binding’, Member States Resolve During ‘Honeymoon’ Negotiations

The radical plan for vaccine equity

KEI review of 62 COVID 19 contracts reveals 59 authorizations for non-voluntary use of third party patents under 28 USC 1498

EMA: Safety of COVID-19 vaccines

Big Pharma Offers to Reserve Pandemic Products for Poorer Countries in Future – Albeit With Prerequisites

HOW IS COVID-19 AFFECTING AFRICA?

WHO Issues Stiff Warnings as COVID Cases Double and Monkeypox Expands Reach

New vaccines and old can curb drug resistance – WHO

CSO letter to ViiV calling for access to HIV PrEP drug CAB-LA

Scientists urge close monitoring of cholera variants

DNDi 2021 Annual Report

MSF International Activity Report 2021

MSF: Ten years in dire conditions perpetuates severe mental health problems for Rohingya

Sustainable Development Goals can be reached ‘despite our grim times’: ECOSOC President

Cybercrime convention could help and harm victims

Invest in development as an effective antidote for future crisis

Tackling Barriers to Africa’s Scientific Innovation – From Lack of Skills to Afro-pessimism

Women and Water in Uganda: A One Health Social Science Approach by Aisha Nankanja, Monica Agena, and Laura C. Streichert, PhD, MPH

Globalization and Health: Looking Backward, Looking Forward by Ted Schrecker

One Health Needs More Soft Power

Human Rights Reader 638 THERE ARE TWO WAYS OF DEMEANING HISTORY; ONE IS TO FALSIFY IT; THE OTHER IS TO DIMINISH AND OBLITERATE IT.

The Pocket-Sized Solution

WHO report shows poorer health outcomes for many vulnerable refugees and migrants

It’s Getting Harder for Forests to Recover from Disasters

Threatened environmentalists have a new protector

Zimbabwe Turns to Boreholes Amid Groundwater Level Concerns

 

 

 

 

 

 

 

 

 

 

 

 

Women and Water in Uganda: A One Health Social Science Approach

This forward-looking article tells us how grassroots efforts to improve water access in Uganda have been operationalized by the Rural Water Initiative for Climate Action (RWICA), as a Uganda-based nonprofit aimed at empowering ‘communities to meet their water needs and build resilience to climate change by applying a One Health perspective’, whereby community engagement is at the core of all activities

 

By Aisha Nankanja, Monica Agena, and Laura C. Streichert, PhD, MPH

Rural Water Initiative for Climate Action (RWICA), Uganda

 

For more information, contact:

Aisha Nankanja, ashafaith16@gmail.com

Monica Agena, agenamonica@gmail.com

Laura Streichert, PhD, MPH, lstreichert@gmail.com

Women and Water in Uganda: A One Health Social Science Approach

Any actions done for-- and not with -- a community are destined for failure

 

Throughout rural Uganda, access to affordable clean water is a major challenge, especially for marginalized and underserved populations. Multi-pronged approaches are needed to address this complex problem. An integrated One Health strategy that considers the linkages between human, animal, and environmental health is relevant because it addresses the multiple causes and impacts of water scarcity.

To be sustainable, solutions must also consider the role of social science disciplines, such as sociology, psychology, economics, and communications. A One Health Social Science (OHSS) approach adds the social context to technical water system problems.

Access to clean water is a right denied to many

Women and children bear the burden of collecting and managing water for household functions.

A woman and her children collect contaminated water in a river affected by drought in Mpigi, Uganda. Photo credit: Aisha Nankanja

 

Gender equity, therefore, is an important component of the water dialogue. Women-led businesses, including hair salons, small vegetable farms, gardens, and restaurants rely on the availability of affordable water. Disruptions cause imbalances in daily routines with more time dedicated to finding water. Piped water, when available, is expensive and out of reach for many in rural areas. For many Ugandan women, tackling with the need for clean water is daily and urgent.

COVID-19 has made water matters worse

The loss of casual labor jobs and income as a result of the ongoing COVID-19 pandemic and economic slowdowns have left many unable to purchase water. As a result, people turn to natural, open water sources that are often further than 1 km away, unprotected, and contaminated by animal and plastic waste. Women face personal safety issues when collecting water in remote places. Children carry heavy jerricans, often missing school to fetch water. With water so precious, compliance with COVID-19 recommendations for healthy behaviors, such as hand-washing, has been nearly impossible.

The negative health consequences of contaminated water are significant. The high prevalence of diarrhea, typhoid, bilharzia, and other waterborne diseases cause widespread suffering, especially among children. Although the water from natural sources may be free of charge, there are addition costs for charcoal to boil it. This also leads to deforestation of local areas for firewood. Targeted education, training, and capacity-building are needed to address low health literacy and to empower women as earners and decision makers.

One Health approaches offer simple solutions with immediate impact

To operationalize grassroots efforts to improve water access, we created the Rural Water Initiative for Climate Action (RWICA), a Uganda-based nonprofit, “to empower communities to meet their water needs and build resilience to climate change by applying a One Health perspective.”

The transdisciplinary RWICA team joins expertise in sociology, population health, forestry, community organizing, OHSS, and public policy. Community engagement is at the core of all activities. The RWICA tagline frames OHSS in a way that resonates with Uganda communities: Rethinking how we live with nature (www.rwica.org).

Community engagement is key to project success and sustainability

RWICA’s programs in community capacity building, ecosystem conservation, water system solutions, and gender equity are all conducted in partnership with local stakeholders.

Activities with direct community impact have included:

  • Ecosystem restoration with tree planting and environmental education
  • Installation of a new rainwater harvesting tank at a primary school
  • Community Water Education Days with One Health lessons translated into the local Luganda language (onehealthlessons.com)
  • “Waste to Wealth” trainings for women to create and market objects from repurposed plastic; and
  • Distribution of over 200 jerricans.

These are simple, low-resource interventions with broad community support catalyzed by a local youth-led organization.

RWICA is a model for youth leadership and OHSS in action

To date, RWICA’s grassroots OHSS approach has impacted over 2,500 people, primarily women and youth. Our goal is to amplify our impact by expanding the rain harvesting tanks, Waste to Wealth trainings, and other activities to other sites within Mpigi district. Installing a rainwater harvesting tank at one school underscored the need for implementing this simple solution at other nearby schools and health centers. Policies, education,  and interventions to assist under-served populations are needed to transform community mindsets and to achieve system level changes. These actions should be grounded in research using social science techniques to understand water use practices and to align water solutions with community priorities and needs. Any actions done for– and not with — a community are destined for failure.

References

Buregyeya E, Atusingwize E, Nsamba P, Musoke D, Naigaga I, Kabasa JD, Amuguni H, Bazeyo W. Operationalizing the One Health Approach in Uganda: Challenges and Opportunities. J Epidemiol Glob Health. 2020 Dec;10(4):250-257. doi: 10.2991/jegh.k.200825.001. Epub 2020 Aug 28. PMID: 33009732; PMCID: PMC7758849.

Lapinski MK, Funk JA, Moccia LT. Recommendations for the role of social science research in One Health. Soc Sci Med. 2015 Mar;129:51–60.

Michalon J. Accounting for One Health: Insights from the social sciences. Parasite. 2020;27:56. doi: 10.1051/parasite/2020056. Epub 2020 Nov 3. PMID: 33141659; PMCID: PMC7608981.

 

Globalization and Health: Looking Backward, Looking Forward

A lucid synthesis here, also in the light of recent events, of what globalisation and the so-called neoliberal policies have meant for health and health inequalities on human, animal and plant embedded ecosystems. As such, while climate-related phenomena are concerned, and Covid-19 pandemic can be identified as a ‘neoliberal disease’, much more can be pulled out for future research from Professor Schrecker’s reflections below

By Ted Schrecker

Professor of Global Health Policy, Newcastle University

Globalization and Health: Looking Backward, Looking Forward

 

Much of my academic work over the past 20-plus years has focussed on the processes of globalization and what they mean for population health.  One of the early (2007) major products of that work, co-written with long-time colleague Ronald Labonté, came out of analysis done for the WHO Commission on Social Determinants of health.  It took the form of a three-part series in the journal Globalization and Health, discussing in turn historical context and methodological background; the role of the global marketplace; and prospects for promoting health equity in global governance.  (The later work on globalization that informed the WHO Commission appeared in book form in 2009.)   In view of the cataclysmic world events of the last 30 months (at this writing) and my pending retirement from salaried academic life, I thought it useful to look back on some of our analysis to see what it got right, what it neglected, and how future research should learn from such reflections.

The work focussed, quite rightly in my view, on how the emergence of a global marketplace and the associated worldwide spread of neoliberal economic ideas and institutions transformed opportunities to lead a healthy life and the options for public policy to reduce health inequalities.  Indeed, we perhaps did not focus intensively enough on neoliberalization and its transformative impact, about which I have written elsewhere.  The figure below shows (in blue) the seven interacting ‘clusters of pathways’ that we identified in Globalization and Health, and (in red) how I think this analysis needs to be modified and added to in light of recent events.  The rest of this post concentrates on three areas, obviously in insufficient detail.

The first of these relates to the consequences of global environmental change, now observable in daily headlines about such climate-related phenomena as shrinking polar ice cover, heat waves, megadroughts and wildfires.  As conspicuous as these impacts are, they reflect only one dimension of what is now widely described as the Anthropocene Epoch – a new era of geologic time marked by the scale and extent of human-induced changes in the natural environment, exemplified by (for example) the prospect of the transformation of the Amazon rainforest into savannah as a result of continuing deforestation.  A key concept in the Anthropocene literature is the Great Acceleration, a multidimensional speeding up of economic activity and the associated biophysical transformations beginning, on many reckonings, around 1950 with the post-World War II period of economic growth.  Until recently, that growth was concentrated in the (mostly high-income) OECD group of countries.  Formidable questions of global justice are raised by the implausibility of sustainable growth within planetary boundaries if the rest of the world were to continue pursuing anything like the standard of living taken for granted within the OECD.  Anthropologist Jason Hickel has been one of the most vocal and articulate proponents of ‘degrowth’ in this context; whether intentional degrowth is feasible under any kind of democratic political arrangements is a question yet to be resolved.

The second area of neglect relates to the continued, indeed enhanced danger of transnationally dispersed pandemics.  With 20-20 hindsight, there was little reason for this.  Journalist Laurie Garrett had been warning of the prospect since 1994, and in 2019 – just a few months before the start of the Covid-19 pandemic – published a prescient article warning that: ‘The world knows an apocalyptic pandemic is coming … But nobody is interested in doing anything about it’.  This problem does not appear at first directly connected with the global marketplace, but in fact it is.  Public health infrastructure is one of the key prerequisites of societal survival that the so-called free market cannot and will not provide; it is one of the few truly public goods for health.  The neoliberal turn in public policy is thus implicated in the neglect of public health infrastructure to the extent that Matthew Sparke and Owain Williams recently (and correctly in my view) identified Covid-19 as a ‘neoliberal disease’.  Incredibly, if predictably given the current UK government’s tenuous hold on reality, it  has not learnt from the pandemic: in April 2022 the government announced staff reductions of 40 percent at the Health Security Agency, responsible for pandemic planning and response, at the finance ministry’s insistence.  In the same month, again predictably, a scientifically illiterate US Congress refused to continue Agency for International Development funding for vaccine delivery in low-income countries.

Third and finally, researchers like myself took too seriously and literally the idea of a ‘Borderless World’ put forward by Japanese economist Kenichi Ohmae.  The book in question, originally published in 1990, remains an iconic paean to a world in which governments have become largely irrelevant; ‘if a corporation does not like its government, it can move its headquarters to other, more hospitable places’; and the future resembles nothing so much as a global duty-free shop.  Many elements of this vision, notably its focus on the footloose corporation and its tacit acceptance of rising inequality, remain accurate if dispiriting descriptions of the world economy.  At the same time, nationalism and geopolitics continue to render the world anything but borderless, and political institutions anything but irrelevant, in many respects.  In 2016, UK voters narrowly supported leaving the European Union and its single market, an act of economic self-harm that will have consequences for decades, most of them magnifying existing inequalities and their destructive effects on health.  And several European countries, Germany most particularly, appear to have believed that the world really was borderless for purposes of energy policy.  This catastrophic inattention to geopolitics led directly to today’s vulnerabilities associated with reliance on Russian natural gas supplies and may yet pave the way to deep recession, widespread social unrest, and domestic political pressure to accept Ukraine’s dismemberment.  Much of this could have been avoided through careful attention to a long list of books drawing attention to Russia’s internal political transformation, going back at least to the late Anna Politkovskaya’s 2004 Putin’s Russia. (She was murdered shortly after its publication.)

Much more can and should be said on all these matters, and others.  For example, global health researchers have not yet come to grips with the implications of a widespread retreat from democracy and drift into autocracy in which, according to the respected Varieties of Democracy Institute, ‘the last 30 years of democratic advances following the end of the Cold War have been eradicated’.   As historical sociologist Margaret Somers points out in the US context, this trend is not unrelated to the hegemony of neoliberalism, although the connections are likely to vary among country cases.   Faced with such complexity, many researchers will be tempted to retreat into the familiar territory of health systems design and what might be called global medicine.  This tendency should be resisted, not least because – as Martin McKee notes in an important recent article – ‘politics is at the heart of public health’.  This is even more true in the global frame of reference than at the national level about which he was writing.

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By the same Author on PEAH

New Year, New Lockdown in the United Kingdom: ‘The Great Deception’

No Exit? The United Kingdom’s Probable Russian Future

Whistling Past the Graveyard of Dreams: Hard Truths About the Likely Post-Pandemic World

Plague and Depression in the Just-In-Time World

Why No Talk of an Inequality Emergency?

Revelation! The International Monetary Fund Discovers Tax Avoidance and Capital Flight

‘Lifestyle Drift’, Air Pollution and the World Health Organization

Public Finance and Public Health

What Public Health Policy Can Learn from the Murders of Nicole Brown Simpson and Ron Goldman

On Health Inequalities, Davos, and Deadly Neoliberalism

Environment and Health in the Anthropocene

Brexit can be Hazardous to our Health

‘Neoliberal Epidemics’ in Global Context

News Flash 486: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Image: Barracuda (Sphyraena viridensis)

News Flash 486

Weekly Snapshot of Public Health Challenges

 

TDR Newsletter July 2022

UN Human Rights Council’s Resolution on Access to Medicines and Vaccines Welcomed by Civil Society

Why patients cannot access to medicines they need in Europe

Fairer access to medicines: what needs to change in the revised EU pharma legislation

WHO: Statement on the twelfth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic

ECDC and EMA update recommendations on additional booster doses of mRNA COVID-19 vaccines

WHO: COVID-19 Global Health Emergency Continuing; Monkeypox Cases Increase by 50%

WHO: Urgent call for better use of existing vaccines and development of new vaccines to tackle AMR

Global regulators agree on key principles on adapting vaccines to tackle virus variants

An Update on Omicron Subvariants

EU designates AMR top priority as WHO calls for vaccine development

Monopolies Are Getting in the Way of mRNA Vaccines

Audio Interview: Covid-19 Vaccines and the FDA

The Medicines Patent Pool welcomes collaboration between Afrigen and NIH on mRNA vaccine research

Some 1.1 Billion COVID-19 Vaccine Doses Likely Wasted Since Rollout Began

Managing community engagement in research in Uganda: insights from practices in HIV/AIDS research

Why world’s first malaria shot won’t reach millions of children who need it

Swastha Mahila Swastha Goa: A Demonstration of Implementation Science by Sumedha Kushwaha

Reflections on Promoting Sustainable Healthcare and Pharmaceutical Trade between India and Africa, including from a recent roundtable in Hyderabad

How to Get to High-Impact Health Benefits Packages: Challenges and Solutions from the iDSI Network

Could Person-Centered Care Be The Secret To Achieving The Triple Aim?

FAO, IFAD, UNICEF, WFP and WHO. 2022. In Brief to The State of Food Security and Nutrition in the World 2022. Repurposing food and agricultural policies to make healthy diets more affordable. Rome, FAO

Food Security: We Are Still Going Backwards

‘Use wild species sustainably’ to meet world food needs

Understanding cyclone behaviour in a changing climate

Can planting trees mitigate climate change?

Environment, Part of One Health, Is Often Missing in Action

Innovation Fund: EU invests €1.8 billion in clean tech projects

Eyes wide shut, EU industry faces energy efficiency reckoning

People’s health Dispatch Bulletin #29: Violence against health workers and rights persists

Promoting health beyond prison walls

How Covid-19 Mitigation Measures Disproportionately Impacted Women and Girls

Human Rights Reader 636 CONFRONTING INEQUALITIES IN THE ‘DONOR’-‘RECIPIENT’ RELATIONSHIP

Global humanitarian need worse than UN estimates, report suggests

 

 

 

 

 

Swastha Mahila Swastha Goa: Implementation Science Demonstration

A snapshot here of the structural design and current results of ‘Swastha Mahila Swastha Goa’ (SMSG) as a forward-looking, scalable and replicable project developed by the Yuvraj Singh Foundation (YSF) to conduct population level breast cancer screening of 100,000 age-eligible asymptomatic women across the state of Goa in India within two years. The uniqueness of the project lies in close looped implementation with partners to successfully develop a sustainable ‘Continuum of Care’ model from screening to treatment for breast cancer at national level

By Dr. Sumedha Kushwaha

Global Head- Strategy and Partnerships, Yuvraj Singh Foundation

Temerty Faculty of Medicine, Institute of Medical Sciences, University of Toronto

Swastha Mahila Swastha Goa: A Demonstration of Implementation Science

 

‘Swastha Mahila Swastha Goa’ (SMSG) literally translates to ‘Healthy Women Healthy Goa’. Amongst Indian states, Goa is smallest in terms of area; situated on the southwestern coast. According to 2011 Census, it has a population of 1.459 million people, with 62.17% of the population living in urban areas. The sex ratio is 973 females to 1,000 males.


Image credit: Wikipedia

 

Breast Cancer is the most prevalent cancer among women. 1 in 8 women in India contract the disease. Around 1,62,000 new cases are detected, every year which bring about 87,000 deaths every year. Unfortunately, 70% patients are detected at a late stage.

SMSG initiative was launched by the Yuvraj Singh Foundation (YSF) in partnership with SBI Foundation, Indian Institute of Banking and Finance, and the State Government of Goa. This program, was launched to provide free breast cancer screening facilities to 100,000 age eligible women in Goa with the help of iBreastExam (iBE). Developed by an Indo-US company UE LifeSciences, it is a low cost, battery powered, hand held, rapid diagnostic device for identification of breast abnormalities and early detection of breast cancer in a radiation free and non-invasive way.

YSF developed this unique project to conduct population level breast cancer screening of 100,000 age-eligible asymptomatic women across the state of Goa in India within two years. This project is a beautiful demonstration of understanding the ‘Positivity Rate’ for benign and malignant cases detected by iBE at a population level. It uses the principles of ‘Implementation Science’ to understand the dynamics involved in successful implementation of a health tech innovation at a mass level.

A multi-component strategy has to be employed when an innovation is tested not only for its clinical efficacy but also for its successful implementation, which involve a host of local and national factors are in-charge. The description, implementation and sustenance of such projects depends on the ‘Political Will’ to take up such an initiative, ‘Ease of use of Technology and its efficacy’, the ‘Adoption of technology and Skill Development’ of health workers and health professionals, ‘Acceptance and Motivation’ of patients to get themselves screened, and ‘Infrastructure and Facilities’ of the healthcare system. A major unseen factor is the management and administrative capabilities of the implementing agency like YSF in this case. Ancillary factors include adaptation of the program to local requirements, fidelity towards the project, cost effectiveness, penetration at population level, and mitigating challenges and barriers.

This project demonstrates the capabilities to strengthen existing infrastructure and manpower and through Capacity Building and Skill Development of Primary Health Care Workers. The uniqueness of the project lies in close looped implementation with partners to successfully develop a sustainable ‘Continuum of Care’ model from screening to treatment for breast cancer at national level. The data generated from this project can employ principles of ‘Knowledge Translation’ to recommend implementation of policy for a ‘National Breast Cancer Screening Program’ using iBE for women across the country.

The Indian state Goa, where this project is implemented is divided into North and South Goa districts. As a part of the project, staff nurses at Primary Health Centers (PHC) and Community Health Centers (CHC) across the state were trained to use the iBE device. Additionally, for successful implementation, 11 staff members were employed by the YSF.

Implementation science actually requires academic knowledge being translated into a research used for practical purposes. It is also a clear and unique style of project management which ensures success.

The staff in the project includes one ‘Project Lead’, an individual who overlooks at the entire project and coordinates with the Government, Funding Partners, Public and Private Organizations, Not for Profit Organizations, and the Foundation. Main duties involve being able to lead & motivate the project team to work towards achieving the organizational & project goals, take daily reporting from the Project Managers, ensure Daily/Weekly/Monthly scan targets met by the YWC Team & PHC/CHCs, and ensure all the project related assets are safe and secure. Technical Activities include troubleshooting device related queries for staff during screenings, organizing training for healthcare professionals at health centers on using iBE, maintaining inventory of the balance scan numbers in each device of your allocated region, and management of iBreastExam devices allocated under your assigned region

Under the Project Lead are two Project Managers, these are individuals responsible for each district separately- North and South Goa respectively. They are responsible for actively reaching out to Private Companies, NGOs, Government Organizations & other prospective partners and schedule Screening Camp keeping in mind the approximate number of beneficiaries. They would be responsible for assigning daily & weekly tasks and roles to Cluster Coordinators for the allocated Region and take Daily Reporting of the Cluster Coordinator of the allocated region, follow up with iBreastExam suspected cases, contact and collect the medical updates and reports of the suspected cases, contacting, counseling and handholding of the positive cases and maintaining their medical records.

Under these project managers are Cluster Coordinators, eight in number, four in each district, these staff members are always on the ground- responsible for conducting awareness sessions on Breast Cancer Screening followed by Question & Answer round, distributing the Information, Education and Communications material to the beneficiaries, conducting breast cancer screening following all COVID-19 precautions and protocols, ensuring proper usage of iBE devices, reports being mailed to Reporting Manager and to collecting all consent forms & data collection forms.

Through the collaborative effort of the Honorable Health Minister’s Office, ample support of the doctors working in the Ministry of Health and Family Welfare at State level, Government Hospitals, Medical Colleges, PHC doctors and staff nurses and the YSF Team- Within six months of its launch, a total of 14,316 scans have been conducted by a staff of 9 health workers at 35 Health Centers and at more than 120 outreach camps.  54 patients have been detected of benign lesions, 9 patients were positive for malignancies, undergoing treatment. iBE Suspected cases are referred to the Community Health Centres or Government Medical College, Goa for further investigation like a Breast Sonography or Mammography, as suggested by doctors free of cost. If the patient is found positive for a benign lesion they are advised prescribed conservative medical treatment. If a patient is diagnosed of a malignancy, they undergo surgical intervention and chemotherapy as prescribed by the Oncologist; both free of cost.

Such projects are examples of sustainable, scalable and replicable models which can be used across the nation; even countries for delivering a high level national breast cancer screening program at the population level.

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