Reader’s Note: This blog post will begin with dismal, shocking, dramatic, etc. facts about HIV/AIDS and its effects on the world. About 33 milllion people are living with HIV globally, and almost 7,500 new infections are reported every single day. One-third of people living with HIV are young people ages 13-29. And, in 2009, only 35% of young people between the ages of 18-35 reported being tested for HIV. Now that those gloomy facts are on the table we must ask the question: What can we do about it?

World AIDS Day 2010 is coming up this Wednesday, December 1^st. According to the official World AIDS Day website, “World AIDS Day is an opportunity to bring people together to raise awareness of HIV. By organising or attending an event you can help raise awareness of HIV and get people talking.” It is indisputable that awareness and education are fundamental components of social movements and important forces of change and action. With that fact established, will World AIDS Day 2010 really make an impact on the lives of people living with HIV/AIDS or the people who will inevitably contract the disease?

The United Nations News Wire, one of the most widely read newsletters asked their readers, “Which HIV/AIDS-fighting campaigns are you most familiar with?” The UN Wire gives 5 options to answer this question: UNAIDS, The Global Fund to Fight AIDS, Tuberculosis and Malaria, AIDS Healthcare Foundation, (RED), and World AIDS Campaign. Many believe that the (RED) Campaign, The Global Fund, and UNAIDS, among others, are far from the most effective and affective organizations and campaigns to fight HIV/AIDS. For example, The (RED) Campaign is widely known as a publicity stunt and ingenious advertising campaign for multi-national corporations such as GAP and Apple.

The UN endorses these highly popular campaigns that oftentimes produce little effects on the fight against HIV/AIDS. However, people shouldn’t forget the original goal of World AIDS Day: to raise awareness and fight HIV/AIDS. What will you be doing this Wednesday for World AIDS Day? How will you make a difference?

The growing resistance to the most effective malaria treatment on the market, Artemisinin therapy is a grave concern in Southeast Asia. Resistance to the drug has spread across most of Asia, and has the potential of spreading in a significant way to Africa. This is especially detrimental because African countries are the most affected by malaria and this resistance to treatment could put millions of lives at risk.

According to the World Health Organization (WHO), nearly half of the world’s population is at risk of contracting malaria and one million people die each year from the disease.  In African countries, 1 out of 5 childhood deaths are malaria-related.  If resistance to Artemisinin treatment for malaria becomes a reality in African countries, like it has throughout Asia, what does that mean for efforts to promote African health and welfare, and efforts to reduce childhood mortality?

As of 2007, resistance to Artemisinin therapy in 55 countries worldwide was below 5%. WHO has called for a broad and up-to-date study of the efficacy of malarial treatment throughout Africa.  According to one report, health experts in African nations believe that the problem doesn’t lie with the efficacy of Artemisinin therapy but poor manufacturing and use of “fake drugs and substances,” replacing and mixing with the drug components in Artemisinin.

One Zambian public health official said, ‘We have to try to find other drugs and new regimens to avoid a catastrophe.” Overall, resistance to a drug that has made strides in reducing malarial rates throughout the world, especially African countries, is not a death sentence. There are alternatives to Artemisinin therapy. With research, cooperation and utilization of resources the growing resistance to malaria treatments is a solvable problem.

Across the African continent health systems are greatly impacted by the burden of neglected disease, endemic malaria, HIV/AIDS, and other environmental difficulties. Very often these health crises are exacerbated by the lack of enough trained health workers to administer treatments, provide care, and build the capacity of health systems. Africa Health Placements is one such organization that brings in foreign and local health workers to fill the gaps. Placements are long-term and the needs are real. In 2009, I finished an academic paper titled “Why there is No Doctor” about the lack of health infrastructure, doctors, and the impacts of HIV/AIDS in South Africa.

South Africa has pioneered some of the most advanced medical procedures in the world. In 1967, Christiaan Barnard preformed the first human-to-human heart transplant, but still the majority of the South African population is without adequate health care. Cosmetic and plastic surgery has grown a “medical tourism” industry in South Africa while rural populations wait for doctors.

With 15 million people living in Lagos, Nigeria sanitation and health problems that arise from lack of toilets has been a growing issue in the past few years. When Nigerians leave their homes and work there is no place for them to use a bathroom.  Nigerian entrepreneur, Otunba Gaddaffi started a growing and successful business providing toilets, showers and other sanitation necessities around the city.For a small fee, people can use the bathroom, take a shower, or brush their teeth in convenient places throughout Lagos. His sanitation stations provide regularly cleaned, air-conditioned toilets and showers for the people of Lagos.

The company slogan, “Shit Business is Serious Business” is a perfect representation of his company’s goal for the future of Lagos sanitation standards.   Gaddaffi, explains that people would use bushes when they were away from home or work, causing increasing sanitation problems along with the increasing population. Gaddaffi’s innovation is not only a huge sanitation and health improvement in the highly populated city, but also an example of a grassroots Nigerian-born solution to a major health problem.

CNN correspondent, Christian Purefoy speaks with the entrepreneur himself in this VIDEO.

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Our key stakeholders in the United States are young people and students at universities. More often than not, business leaders, non-profit directors, politicians, and other “experts” don’t think that young people have much to contribute in the way of new ideas of skills to improve or make a difference on global health issues. This video was chosen today because it is an excellent example of how young people are entering into development projects with an open mind, understanding of community control over projects, and the limitations of their work. These students from Harvard present an excellent idea adapted from a Western development project to improve the health and nutrition of people in Kibera slum of Nairobi, Kenya.

The video is very quiet, turn up the volume and listen closely.

When you think about Facebook, Twitter, and other social networks, questions of health care, rural African villages, and humanitarian aid are not the first things that pop up in your mind.  Although, social networking sites are oftentimes used for social purposes, they have one prevailing positive attribute: the ability to “spread the word” to hundreds of millions of people around the globe. Whether it be Facebook groups asking users to “like” actress, Megan Fox, or sites like YouTube that turn a 14-year old kid with a web cam into Justin Beiber, social networking sites certainly get the message across.

And its relevance to provision of basic health care to people in African countries? Assuming that the average American has no idea about the current state of health care systems in rural African villages, a simple Tweet, Facebook post, or blog can spread the experiences and needs of rural health systems to a person with a computer or smart phone in New York, London, Beijing, Cape Town, and even small town America. Social media (through the internet) is a relatively new phenomenon with capabilities beyond that which any kind of campaign or social movement has ever experienced.

As the m-Health conference concluded, one of the biggest headlines was the expectation of 500 million mobile health devices being used on the African continent in the next 5 years. If 500 million is the number of mobile health devices (typically cell phones) used on the African continent, internet and cell phone use among people in African countries must be enormously higher. Thus, the potential for a strong, direct connection between people living and working in African countries with people living and working in Iowa, Florida, and Michigan is incredible.

According to a study done by the Society for New Communications Research, the nonprofit world uses social media more than any other social institution. The opportunity for global connection and cooperation are endless when social media is employed to its fullest.  Despite trivial, superficial and admittedly negative effects of the ever growing social media movement, do you think social media should be considered as a useful force in providing health access, care and development to African countries? What are some of the downsides of this new social media revolution?

This week in the African health world the conclusion of the m-Health Summit in Washington D.C. garnered a lot of attention concerning the future of African health efforts. With the highly publicized polio and cholera outbreaks throughout the world and the African continent, the UN and aid agencies are asking for support from the developed world to contain and eradicate the outbreaks and diseases.

As the m-Health craze comes to a close in Washington D.C. there were two main headlines attached to the summit. One number thrown around the summit was 500 million. That’s the number of mobile health applications expected to be in use by 2015, according to the Global Mobile Health Market Report released after the close of the summit. Bill Gates even made a comment about the issues associated with the next highlight of this post, recent outbreaks of preventable diseases.  During his keynote address at the summit Gates said, “Diagnosis of malaria and TB will likely be the first ones you can assign a number to and say without this mobile phone app these people would have died.” Whether or not m-Health really is the savior everyone says it will be is to be determined. However, the m-Health movement and its supporters are definitely trying to make a mark on health in the developing world.

This week big agencies like the United Nations have called for an increase in support of containing and thus eradicating these diseases. It has been reported that Tuberculosis (TB) killed almost 2 million people in Africa and Asia in the last year.  UNICEF and WHO are trying to contain the Polio outbreak in the Democratic Republic of Congo. In three different provinces in the DRC there have been approximately 30 cases of Polio in the last year. Hopefully, the United Nations (including UNICEF) and WHO along with local support within the countries can tame the sudden outbreak of multiple preventable diseases.

Follow the Polio outbreak in real time with HealthMap

Smallpox has been globally eradicated since 1980, so why is the eradication of Polio so much more difficult? The World Health Organization (WHO) recently released that the Global Polio Eradication Initiative (GPEI) would be conducting a new targeted 15 country effort to vaccinate 72 million children in Africa. The new campaign follows numerous failed efforts of the past and reemerging outbreaks. Why does the African continent remain prone to Polio outbreaks that spread rapidly? Why did the organized campaign to eradicate Smallpox take only 21 years while Polio is going on almost 40 years?

Since 1796, when cowpox was used to protect humans from Smallpox, eradication efforts have taken place. It wasn’t until the WHO intensified the eradication of smallpox in 1967 that efforts were coordinated around the world. The Smallpox Eradication Program (SEP) was jointly run by the WHO, CDC, and National Ministries of Health in various countries. Doctors and epidemiologists from the US volunteered to help with the efforts. In many instances US volunteers were overbearing and controlling of their local counterparts. A report by Paul Greenough documented the use of intimidation and coercion in the final stages of the SEP. Foreign volunteers were sent to kick down doors (literally), force vaccination of those who refused, and fix the mistakes of local staff members (1995). These coercive tactics evoked resistance from local communities, but the SEP prevailed. The SEP was run in a structured, militant fashion, where individual human rights were overridden for the global public good. Similar issues with resistance have been seen in Polio eradication efforts, but responses to resistance have not been as militant. Could this be why Polio has continued to resurface?

The earliest documented case of Polio in Africa is traced back to 1580 B.C. in Egypt and still the virus continues to spread across the continent. The eradication of Polio relies heavily on National Immunization Days (NIDs), but these events are ineffective because they aren’t comprehensive vaccination efforts, positive cases are missed and some children aren’t vaccinated causing continued Polio outbreaks. Organized Polio eradication efforts began when the World Health Assembly launched the Expanded Programme on Immunization (EPI) in 1974, a program implemented through the NIDs . In 1988, the World Health Assembly said that by the year 2000 Polio would be eradicated and they launched the Global Polio Eradication Initiative (GPEI) to make it happen. Many prominent people and organizations put their support behind the program including Rotary International and Nelson Mandela, who in 1996 launched the “Kick Polio Out of Africa” campaign which vaccinated 420 million children. In the 90s, the UN Secretary General negotiated peace treaties to vaccinate in war-torn Liberia and Sierra Leone. Most recently in 2004, 23 African countries coordinated NIDs focused on Polio vaccination.

After all these efforts, Africa remains the only continent where Polio remains alive and well in multiple countries. A series of studies completed across West Africa showed that due to misconceptions about the vaccine, lack of adequate funding and corruption at the local level, and ineffective immunization campaigns, Polio has persisted on the African continent (Melissa Leach & James Fairhead, 2007). The year 2007 marked an outbreak of 25 cases in Angola which spread to 28 cases in the Democratic Republic of the Congo (DRC). In 2008, after an outbreak in northern Nigeria, where there have been vaccination conspiracy theories, spread to a dozen other countries, the WHO made Polio eradication their “top operational priority.”

Armed with a “more effective” version of the oral vaccine, the new GPEI organized effort across 15 countries hopes to eradicate Polio for good. However, just yesterday the New York Times wrote that the WHO reported 104 deaths and 201 cases of paralysis from Polio in the DRC. Is the renewed GPEI effort, launched Oct. 28, 2010, even working? Is eradication even a desirable goal at all, if past experience with Smallpox Eradication Program requires militancy?

Crossposted from the Americans for Informed Democracy Blog where I am writing as a Global Health Analyst.



Marci Baranski is a PhD student at Arizona State University in “Biology and Society,” an interdisciplinary degree.  Her research focuses on the human and social dimensions of climate change adaptation in agriculture.

Climate change is now globally recognized as a threat to food security and human well-being.  Countries that are highly dependent on agriculture and with poor political and technological infrastructures are particularly vulnerable to the impacts of climate change [1]. Sub-Saharan Africa hosts 12 out of 25 of the most climate-vulnerable countries, according to a recent report. This post will focus mostly on climate change adaptation, which is defined by the IPCC as “adjustment in natural or human systems in response to actual or expected climatic stimuli or their effects” [2]. Droughts, increased pests, and flooding all threaten food security in Africa, and women and smallholder farmers will bear a disproportionate cost of adapting to these impacts [3]. Yet the focus on fear and vulnerability has led to a new regime of climate change research, policy and initiatives that are leading Africa in the wrong direction.

Half a century ago, the “Green Revolution” increased the yields of staple crops across Central America and South Asia. Time has shown the negative consequences of these new crops and the advent of industrial monocropping. The first Green Revolution never took hold in Africa, but calls for a “second Green Revolution”- this time in Africa- grow louder. Many donors cling to the idea that Africa just needs more food. I argue that instead we should turn to better food that is appropriate for the local social and environmental systems. Significant investments from donors like the Gates Foundation are driving the “Alliance for a Green Revolution in Africa,” which hopes that new research and technology can feed Africa. In the face of ecological problems such as climate change, limited access to freshwater, and nutrient depletion, the threats are real, but the solutions are not so simple.

The ecological effects of climate change cannot be separated from the social context of agriculture. For example, women grow more than half of Africa’s food, but are often overlooked by traditional research and extension programs. I saw this first hand when, in 2008, I spent three months in Bangladesh in the aftermath of a devastating cyclone. Agricultural rehabilitation efforts were almost exclusively focused on male farmers, and created dependency by giving farmers free high-cost inputs like hybrid seeds and fertilizer. Once the crisis is over, these farmers are just as vulnerable to climate change impacts, but now they have higher capital investments every season as well as higher risk. This is the Green Revolution in its prime.

Climate change both challenges and drives agricultural innovation. Talk of “climate-smart” farming and “climate-ready” crops dominate the international discourse and command international funding. In the previous century, the perceived “population bomb” drove agricultural research that led to the Green Revolution. Yet we know today that the population problem was a neo-Malthusian blame game. Nature magazine’s food issue read, “”It’s not about the bomb … Even as population has risen, the overall availability of calories per person has increased, not decreased” [4].

In contrast to last century’s misguided population nightmare, we are already seeing the impacts of climate change on African agriculture and water resources [5]. We look to science for answers, but the issue of climate change is complex and difficult to predict the local impacts. There are lessons we can learn from the Green Revolution, as well as new forms of technological exploitation such as the commoditization of genetic diversity and corporate control of genetically modified crops. The previous Green Revolution should teach us that broad, technological fixes will not solve world hunger- especially in Africa.

During the Green Revolution research institutions like the Consultative Group on International Agricultural Research (CGIAR) developed higher-yielding crops to ameliorate the perceived population bomb in countries like India and Mexico. Yet food policy experts question the capacity of the CGIAR to address new challenges in global food production such as climate change [6]. The CGIAR has historically invested in plant breeding, which, along with increased fertilizer application, was the main method of increasing crop yields in the Green Revolution. However, global climate change is predicted to have highly uneven and locally contextualized impacts; impacts that higher yielding crops alone cannot address. How long have we been waiting for the promised results of biotechnology, and how much longer will we wait on promises of drought resistant crops? In the meantime, we must focus on local, sustainable solutions.

Sweeping global policies and research investments are not the solution to climate change adaptation in agriculture. Investing in infrastructure, addressing government corruption, and increasing social capital are adaptations that are necessary even outside of climate change. Africa faces shocks in the climate system that we simply cannot predict, but these investments are poised to improve human well-being and improve Africa’s capacity for climate adaptation. We also must recognize the connections between local health and food security, such as the impact of HIV/AIDS on food production and vice versa [7]. Local efforts like Gardens for Health address both human and environmental sustainability. Ultimately, strategies to alleviate the impacts of climate change on agriculture must go beyond classifying vulnerable groups and prescribing technological solutions– instead we must empower them as agents of change. Developed countries, largely responsible for anthropogenic climate change, have a moral responsibility support these grassroots solutions.

Footnotes:

[1] http://www.maplecroft.com/about/news/ccvi.html

[2] Intergovernmental Panel on Climate Change (IPCC) 2001. Third Assessment Report Glossary. P. 365.

[3] IPCC. Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Cambridge, UK, 273-313.

[4] “Food: The Growing Problem.” 29 July 2010. Nature 466, 546-547.

[5] http://e360.yale.edu/feature/when_the_water_ends_africas_climate_conflicts/2331/

[6] Von Braun, J. 2010. Strategic body needed to beat food crises. Nature 465:548-549.

[7] http://www.ifpri.org/publication/exploring-linkages-between-agriculture-and-hivaids

Other sources and further reading:

http://www.ifpri.org/publication/impact-climate-change-agriculture-factsheet-sub-saharan-africa

http://e360.yale.edu/content/feature.msp?id=2261

http://www.economist.com/node/14447171?story_id=14447171

http://allafrica.com/stories/201010270185.html

http://allafrica.com/stories/201010160010.html

http://iatp.typepad.com/thinkforward/

http://www.afcconference.com/

This week and last we’ve been talking a lot about mobile health (mhealth) and how it impacts communities in developing African countries. As the mHealth Summit 2010 takes place in Washington DC, I can’t help wondering if this represents a lack of perspective on developing traditional health infrastructure. Mobile is hip, easy, quick, and exciting however how do we measure its success. A recent article on MobileActive.org  asks if mobile technologies are “really impacting the poor?” As we sit in our nice homes, co-working spaces, conferences and offices we must not forget accountability and scale. Many during the mHealth Summit 2010 have noted that success comes through capacity building with locally based organizations. This could not be more true. Community-based initiatives that seriously invest in people will succeed.

“The most effective forms of organization are based on partly autonomous and contextually rooted local units linked by connective structures, and coordinated by formal organizations.” (Tarrow, 137)

This week I’d like to share a video from Josh Nesbit (co-founder SMS:Medic) demonstrating the successes of FrontlineSMS: Medic in scaling its work and staying accountable to the communities they support through local capacity building.