According to a report on drug pricing of ARVs, middle-income countries like Brazil, India and China, with high populations of HIV+ individuals, will no longer receive preferential pricing of anti-retroviral drugs. Many of the big pharmaceutical companies including Merck, Pfizer and GSK have reduced or eliminated their preferential pricing, and are now focused on reducing the prices for countries that are low-income.

For someone like me whose focus is sub-Saharan Africa, this hardly changes the picture, as a majority of the countries fall in the “developing” category and a great many are “low income countries” according to the World Bank.

But I suggest you refrain from rejoicing in poverty. There is something drastically wrong and disillusioning about an idea that punishes countries for improving their economic rating. If a low-income sub-Saharan nation is able to raise its rating to upper-middle-class, they stand a chance to lose their benefits to medicines. At the same times, it stands that an increase in the rating indicates an increase in the purchasing power of the nation, which should cushion the hike in prices.

However, it is rarely as clean cut as that and impossible for an increase in lending rating to equal an increase in the financial situation of every household in a nation. The pharmaceutical companies make an exceptional point: “drug company discount programs were not a long-term solution, and governments would have to start using trade-related aspects of intellectual property rights (TRIPS) measures to override patents”.

So here is the dilemma: being rich is certainly good and being poor is certainly bad. But being a rich country is certainly not best for the individual (ex: Britain and USA) and being a poor country is also just as certainly not best for the individual. But which is the lesser of two evils? I would argue that actions that try to enrich a “country” while not necessarily doomed to failure, only serve a small population. You can certainly have a rich country where 1% of its population are multi-billionaires and the remaining 99% paupers. I argue that moves to enrich the population, and not the country are best because they are the best bet for a slight guarantee of an equally rich population. Not a society where everyone earns the same, but one where the increases in GDP can be felt from the CEOs of companies to the factory workers that affect production. Only then would increases from “low-income” to “middle-income” become things to celebrate and not look upon with foreboding.

References:

http://www.guardian.co.uk/global-development/2011/jul/22/hiv-aids-antiretroviral-drugs-pricing

http://data.worldbank.org/about/country-classifications/country-and-lending-groups

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http://socialnetworking.procon.org/

http://techcrunch.com/2009/02/24/why-social-networks-are-good-for-the-kids/

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http://socialnetworking.procon.org/

http://www.web-strategist.com/blog/2009/01/11/a-collection-of-soical-network-stats-for-2009/

http://techcrunch.com/2010/02/01/facebook-coo-sheryl-sandberg-world-economic-forum-davos/

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The article was an interview of Dr. Francis Omaswa, the executive director of the African Center of Global Health and Social Transformation. When he was asked about the strategy for working with the health systems in Uganda and Kenya, he said:

What we are all doing in all these countries is what is called ‘sector-wide approaches’. This is a way of planning and delivering health services that involves sitting together with all the stakeholders and agreeing on one plan, and then the plan is implemented by the government of the country. But you also have one mechanism of monitoring and you monitor together.

If you’ve read any of my older articles, this is basically the solution to many problems in other countries that I previously wrote about. But the problem lies in the implementation of these problems—but he is doing it.

When he was asked what the lacking problem in the health system was, and the impediment to achieving the Millennium Development Goals, he said:

The biggest impediment is the resource envelope we talked about. We are spending too little money on health. The second is we need to close the implementation gap, which is the things we know we want to do, have decided to do, and coming around to actually doing them. And that brings us back to capacity building and strengthening of health systems.

So basically, really obvious solutions, but no one is able to actually implement them. The obviousness of the solutions is actually the most terrifying part—its so easy that I could come up with the same basic problems and solutions that a Doctor working decades in global health has come up with, but no one has really been able to do it, even in the great America.

But he also talked about something that I had never considered before. Outsiders often view Africa as this continent that seems to survive off international aid. But I rarely thought about the processes that determine this dependence on aid, beyond governmental and uni-national problems. Dr. Omaswa, when asked about Africa’s role in global health, said:

After attending meetings at the United Nations and the World Health Assembly, it became very clear that Africa was getting a raw deal. We were not prepared for the debates as well as we should be prepared…Sometimes decisions were made which we didn’t support, but we did not come with evidence to combat the other side of the debate…You go to the World Health Assembly or to the Global Fund meeting and the U.S government will come with a delegation of maybe 30-40 people and Uganda will go with a delegation of two people. The developed world comes to these meetings with very clear positions.

So perhaps it is not just the problem of bad government, but then again bad government funding is the reason why only 2 overworked delegates can go to important and vital meetings that determine the futures of millions.

The solutions are obvious but the problems themselves are barriers to the solutions. How then can this circular problem be solved? I have no idea (I am only a 3rd year Biology major with no experience in Health systems) ask me in maybe 5 years? I hope this does not depress you too much, but gives you even stronger motivation (as it has given me) to learn more about an issue (only one, after all a jack of all trades always drops at least one ball) and try to implement a solution.

References:

http://allafrica.com/stories/201106240043.html

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I’ve always heard integrity defined as the good decisions you make both in public and when no one is watching, when it seems like no one would even care what you did. Well, it does matter. Take the Casey Anthony trial for example. Had Casey been practically blameless in her public life (not going out every night and partying even though her child was missing) and had she not made incriminating searches on her computer that she thought no one could see, this trial might be a lot harder for the prosecution than it has been. The fact of the matter is that Casey hasn’t shown any integrity at all, in any part of her life.

Representative Weiner is another example, among the endless line of politicians who have been found to be unfaithful toward their wives (Clinton, Schwarzenegger, etc). His lack of integrity in a moment of weakness led to the loss of his job and ultimately his reputation. Yes, integrity is a powerful thing. Useful, and built through healthy, specific habits.

I taught this morning with the hope that the girls were inspired to make hard choices. Sure, they could cheat on a test, and no one could find out, but what is the cost in the long run? Guilt, a strong possibility that would cheat again, and if anyone did find out, they could be in big trouble. Gossip may seem like a small thing – something everyone does and no one thinks twice about. But it’s a big deal, and resisting the urge to talk about people behind their backs leads to a reputation of integrity, one where people can be found faultless when under scrutiny.

Daniel is a great example in the Bible. In Daniel chapter 6, satraps of the kingdom of Babylon were jealous of him and tried to impeach him before the king. It didn’t work because Daniel’s strong work ethic and infallible reputation left the satraps with no case. His integrity shined out in everything he did.

Integrity is essential for non-profits because people have to know that their donations and their time and their passion are going towards something that is honest. It’s a terrible feeling when you learn about an organization which was led by someone who embezzled funds or lied about the purpose of the organization. Having honesty and integrity in the workplace and among non-profits is necessary to build trust among people dedicated to humanitarian issues.

Jenny Combs

Team 2: Servant Scholars

Grade 12

Alabaster, AL

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So it was with this attitude that I considered most charities: well-meaning but clueless about the communities they so wanted to help. I recently read an article in Time magazine called “Race Relations: Ghana’s Foreign Chiefs”, and I was surprised to see that some Ghanaian kingdoms often crowned foreign chiefs with titles for the good work they had done. The article highlighted the crowning of a new chief (who is actually Humphrey Barclay of Barclays Bank), in a kingdom called Kwahu-Tafo in Ghana. He was crowned thus because he was able to mediate an argument between two women in the village, and the chief recognized his abilities. He was anointed by the chief to become the “Head of Development”. And this was a title he took seriously, opening charities to create schools, libraries, cleaner water, and other such tasks. And his situation is not unique.

While I was aware of many Nigerian villages, especially in the oil-rich areas, crowning foreign chiefs, it was often for money’s sake, and rarely for development. But this is a successful story that combats the fact that most charities are actually disabling: they foster a crippling dependency for the recipients, and are rarely sustainable, hence the oft asked question: “What happens when the aid workers leave?”. But this story is different, because Mr. Barclay was considered part of the community, and his projects, while funded by charities he started, all came from requests by the community and he is seen as part of the community—he cannot simply “leave”.

This idea has been so successful that Kofi Annan (the former U.N. Secretary-General) proposes a council of foreign chiefs to spread the word.

It is rare that I feel tempted to donate to a charity that aims to do “good work in Africa” but this is one of those occasions that I actually would be convinced to donate: work is been done for the community by the community to improve their way of life. And this work does not ignore the previously recognized challenges of aid work, but actually finds novel ways to remove those challenges.

Perhaps this will become a successful model for aid work—not of course foreign chiefs in every village—a model that utilizes the community’s skills and trains rather than gives. I would rather give a book and a scholarship, than give a grand check to a faceless organization to help faceless people with tasks they may not actually need.

As for why my family never used mosquito nets on our beds? We had screens on our windows, and every other night, we simply used insecticide and made sure our screens were always closed. Have I seen those nets? Yes, but often being sold in the markets and never offered freely as marketed by these charities. The only place I saw these nets used were in hospitals and boarding school—but these were always purchased nets. If someone had asked these questions, or asked what we needed, perhaps there wouldn’t be piles of mosquito nets lying unused and unneeded in some well-meaning person’s warehouse.

References:

http://www.time.com/time/magazine/article/0,9171,2062486,00.html

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70% of the world’s 5-billion Mobile phone users live in low- and middle-income countries, and Global health stake holders are looking for a way to utilize this fact to help improve health. Just last week, the first African Mobile Health summit was held in Cape Town, South Africa (http://www.mhealthafricasummit.com/index.php).

This summit was a collaboration between mobile network owners, and global health professionals, looking for a way to create a successful business model through mHealth (mobile Health), while achieving the public health goals that the mobile health initiatives are hoping to reach.

Some existing mHealth interventions include using phones to connect patients in their communities with hospital infrastructure. A new program called MAMA (mobile alliance for maternal action) relies on the use of SMS (text-messaging) to communicate due dates with clinics and send information to promote a health pregnancy and post-natal information to mothers regarding vaccinations and check-ups.

But like all potential breakthroughs, there are a few points to keep in mind—points that were also brought up in articles about this program. The first main point is that the mHealth solution simply cannot be enough. A simple text-message, while helpful as a reminder, cannot replace the work and knowledge of actual trained human professionals on the ground addressing other issues like water and sanitation that are as much a part of good public health, as meeting health appointments.

Another point raised, was that these such programs are only in the “pilot” or “idea” stages, and these pilots address targeted issues, while the goal of mHealth is to be wide-encompassing project. Aside from that, the success of these services are not being assessed—in fact, only 12% of such pilots have been assessed. Thus mHealth cannot and should not become a reality until a fully encompassing and assessed trial has been run.

As noted above, an important part of mHealth is that it brings in good revenue for the owners of mobile carriers. There is little to no regulation of the mobile industry in Africa, which can lead to pharmaceutical companies taking advantage of the mHealth system, should it be launched and successful. And as always, the issues of cyber-security would become critical and needs to be considered strongly.

However, in my opinion, a simple text-message cannot suffice. Reminding someone to go to an appointment in the city when this someone has no means of transportation, or cannot pay for the bus to the hospital is a completely ineffective means of improving health. mHealth needs to work closely with already existing community health programs that understand the needs of separate communities, and can customize mHealth based on the different communities it serves. What mHealth does in a big city like Cape Town or Lagos, will be very different from what it does in little villages far from the highway. mHealth cannot simply be mobile and “in the air”, it has to be very grounded before it can take off as a success. The steps outlined in the picture above are what mHealth should be, but in just reading it, it is quite clear that this would be a daunting process.

References:

http://allafrica.com/stories/201106091184.html

http://allafrica.com/stories/201106050001.html

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But, I am going to start with a story about numbers.

You often hear stories like “__ million children die of malaria each year”, “__ country has __ number of HIV/AIDS infected individuals” and in relation to this article, “__ individuals currently have TB in __ country”. Many of the countries often related to these statistics are often poor, ‘underdeveloped’ and ‘developing’ countries. One quality that people often forget when reading these numbers is the fact that: this is a poor country, how (and why) on earth would they find the resources to diagnose and report all these numbers?

As I’ve learned more about Global Health and Aid given to poor countries, I’ve come to realize it is sometimes reduced to a numbers game: how poor are you (if your country is not poor enough…too bad), how many sick people do you have (not enough people are dying in your country, call us back when you’ve reached pandemic numbers), and other such fascinating (and completely disheartening facts). But often, the most important number often has this sign ($) in front of it. However, as I have also come to learn, the number after the $ sign is often affected by the numbers previously stated (how poor are you, etc.). So this creates a conflict of interest for these countries: how poor should are we? how much help do we really need?…How poor are we?

And then of course there is the number that determines survival: how long after which treatment becomes useless, how many minutes to get a diagnosis to even begin treatment. Healthcare in general. For higher risk situations that are often the focus of Global Health efforts, these numbers are even more important.

I am not a fan of the caps placed on resources given to countries that need them, however it follows that if your (true) numbers are low (in income) and high (in incidence of particular disease), then you need the resources more.

But there is also another side of the story: those who are sick but because of the conditions of their society, they are unable to even get a diagnosis. And once again this affects the all important numbers game.

But there is some heartening news, at least for some diseases. The CDC recently approved a set of rapid malaria diagnosing equipment (do more research). And the WHO recently approved a new rapid test for Tuberculosis (TB) and drug resistant TB that should be both affordable, and also give results available within 100 minutes (not the previous 48-hour wait).

So here’s some more hope that the numbers we see reflect an even more accurate image of the country they are written about, and are not warped images designed to gain more resources. I would like to hear of any similar (and affordable) breakthroughs that we are aware of, because I am also interested in seeing where exactly these resources are available.

-Onome U. Chicago IL, International Health Team, College Sophomore.

References

http://allafrica.com/stories/201012090136.html

http://www.cdc.gov/malaria/diagnosis_treatment/rdt.html

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Chanapa Tantibanchachai
Team 1: Education
Barrett, The Honors College at Arizona State University

Source: Technology and Society: Building Our Sociotechnical Future
                 Johnson, Deborah G. and Westmore, Jameson M.
                 2009 The MIT Press

Photo credit: http://www.studiosixtyseven.co.uk/blog/?p=75

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Now that I am into the eighteenth month of my service projects, I have another challenge that pops up.  As a junior, I am reminded daily by the seniors at school that for them this is the time to apply to college, submit scholarship applications, get recommendations, and the list goes on.  So a question that keeps on gnawing me is: What will happen to my two community service projects when I go away to college?

How can I achieve sustainability?  What is the use of my projects if they are short-lived?  What good are my projects if they dwindle to nothing when I leave my hometown?  That is quite a challenge for a teenager who has started tow community service projects…  How do I sustain my efforts, making sure that the good vibes will continue?

Let me tell you what I have started to do.  For my Hum-N-Play project at the Waters Edge Lodge, I have started to train my younger brothers to take on more responsibilities.  From ten minutes of intermission entertainment, they are preparing two more songs each week so that they can entertain the seniors for fifteen minutes when we go to the senior residence on Sundays.  By summer, I hope they can take over half 30 of the 90 minutes of entertainment.

While Spencer and Justin perform more songs during the music-sharing sessions, I get to mingle more with my senior friends, leading them in the sing-along.  This way, I will have a chance to bond with my audience, and by the time I leave for college, my younger brothers will definitely be able to take over the music performance project.  I am hoping to set an example so that they will, when their time comes, prepare another performer or two to play at Waters Edge Lodge.  This will then become a wonderful tradition of having teenagers perform for the elderly at Waters Edge Lodge.

As for my Alameda County Community Food Bank Fundraiser, sustainability is even a bigger challenge.  That was why I started my own club, wrote the constitution and was able to make sure that this club aims to do community service.  The Youth Reaching Out Club is my hope of keeping the fundraiser alive.  Currently, we are looking into ways to raise money during school events, and all proceeds will go to ACCFB.

In addition to the usual fundraisers, we are discussing how we can use the model of my personal fundraiser, which has already raised over $10,000, to help in future fundraisers for our club.  Using my Hum-N-Play project as a springboard to my ACCFB fundraiser, I have recruited sponsors to donate to the Alameda County Community Food Bank.  My philosophy is that I do what I can to help the community.  So I play the piano to entertain the elderly because that is what I know how to do.  In return I ask my sponsors to do what they can, and that is donate to the food bank.  So far, I have raised over $10,000 for the food bank, which translates into $50,000 because ACCFB can stretch one dollar to five dollars in its efforts to buy groceries for the hungry.

Using my personal fundraiser as a model, the members of Youth Reaching Out Club are coming up with other ideas of how they too can do something for the community first and then ask for support for their efforts from their sponsors by donating to the Alameda County Community Food Bank.  We are currently designing a donation form so that we can explain to our sponsors our philosophy of how we do something, and then they do something for the good of the community.  With a school club willing to take on the challenge, then my ACCFB fundraiser will have a chance at sustainability, perhaps the biggest challenge of any teenager’s community service project.

Brian Wong

Alameda, CA

January 19, 2011

Team 4: Global Justice

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