Geneva Health Forum Archive

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Alternative Approaches to New Drug Development: Two R&D Initiatives

Author(s): Philippe Desjeux1, Bernard Pécoul2
Affiliation(s): 1Senior Programme Officer for Disease Control, iOWH, San Francisco, CA, USA, 2Executive Director, Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
Summary (max 100 words): Philippe Desjeux: The illnesses of invisible people usually stay invisible. This statement is reflective of the limited attempts to develop new treatment regimens for neglected diseases. Most of these diseases are preventable or curable, but often strike poor and marginalized people living in remote rural areas. Development of effective, safe and affordable drugs for neglected diseases is an urgent need. Many of the available drugs are not adequate: they are either toxic, difficult to administer or too expensive. Therefore, investment in drug research and development for neglected diseases is crucial to bridge the gap between the pharmaceutical R&D model and the unique requirements of the global health field, where the traditional market system does not work. Meeting the challenge: The Institute for OneWorld Health (iOWH) is the first non-profit pharmaceutical company in the USA, formed to address the 10/90 gap in health R&D. Our mission is to develop safe, effective and affordable new medicines for people with infectious diseases in the developing world. OneWorld Health’s core competencies lie in pharmaceutical product development. Our in-house teams identify development leads through partnerships with industry and universities. Together, iOWH works to optimize existing drug candidates, complete preclinical and clinical investigation needs, secure quality manufacturing of developed products, and obtain the necessary regulatory approvals to bring the product to the beneficiaries. Concurrently, iOWH collaborates to devise product delivery and access strategies with relevant stakeholders, which include governments, donors, and international NGOs. These Public-Private Partnerships (PPPs) allow for a more rapid development of new drugs by utilizing complementary skills and resources. iOWH’s current pipeline includes programmes for visceral leishmaniasis (VL), malaria, and diarrheal disease. Paromomycin, for the treatment of VL, is currently the most advanced pharmaceutical product for iOWH. After the completion of a Phase III clinical trial in Bihar, India, for paromomycin, iOWH has submitted the dossier for regulatory approval in India. iOWH’s product selection criteria is designed to meet the needs of the poor in the developing world. In addition to customary selection criteria such as scientific merit, probability of success, clinical and regulatory developmental path, iOWH examines the unmet medical needs in the developing world, cost-of-goods, and mechanisms of delivery, including the endemic country’s infrastructure. These criteria allow us to devise products that will be both appropriate for communities with high disease burden and affordable and accessible to the population in a manner which is sustainable. Conclusions: iOWH strives to provide a flexible and innovative vehicle to engage both the pharmaceutical and biotech industries, as well as public health organizations in global health product development. Through partnerships and collaborations, by adhering to the highest ethical standards for clinical research, and by utilizing the scientific and manufacturing capacity of the developing world, OneWorld Health can deliver affordable and effective new medicines where they are needed most.Bernard Pécoul: The majority world shoulders a disproportionate burden of disease and has few drugs with which to respond to this challenge. In 2005, Africa, Asia (excluding China)- Pacific, and Latin America, which housed 63 per cent of the world?s population, had a mere 11.7 per cent share of the world's $602 billion pharmaceutical market. This stark disparity is echoed in the dearth of research funding dedicated to the diseases prevalent in developing regions. Over the past 30 years, only 21 of the 1,556 new chemical entities marketed between 1975 and 2004 were for tropical diseases and tuberculosis. Millions continue to suffer from diseases such as tuberculosis, malaria, leishmaniasis, sleeping sickness, and Chagas disease. Regrettably, these diseases target impoverished populations with immune systems already weakened by hunger and other diseases. If patients are to have any hope of survival they urgently need new, more effective treatments for these diseases, as the few available drugs are compromised by poor efficacy, toxicity, long courses of treatment, parenteral administration and resistance to the parasite.
Meeting challenges: The Drugs for Neglected Diseases Initiative (DNDi), a not-for-profit drug R&D initiative, is seeking to research and develop new drugs for these neglected diseases. Existing treatments for these diseases are often inadequate and ineffective and patients need new medicines urgently. Founded by a group of 5 renowned medical research organizations including the Indian Council for Medical Research, the Oswaldo Cruz Foundation from Brazil, the Kenya Medical Research Institute, the Ministry of Health of Malaysia, and the Pasteur Institute, as well as the WHO’s Special Programme for Research and Training in Tropical Diseases, and Médecins sans Frontières (MSF), DNDi presents an alternative approach to drug development. It facilitates north-south and south-south collaboration, capacity building, and knowledge sharing among researchers, scientists, industry, and governments.
Conclusion (max 400 words): DNDi's current portfolio of 20 projects focuses on discovery and development projects for malaria, leishmaniasis, sleeping sickness, and Chagas disease. Its alternative approach will make new drugs available for the treatment of neglected diseases within the next decade. It is already on the road to success with its two fixed-dose artesunate-based combination therapies scheduled to be delivered to patients by the end of 2006.

Public Responsibility in Research and Development Partnerships

Author(s): Bernard Pécoul1
Affiliation(s): 1Executive Director, Drugs for Neglected Diseases Initiative, Geneva, Switzerland
Key issues: A fatal imbalance exists in the investment in new drugs for neglected diseases, such as sleeping sickness and leishmaniasis, versus diseases prevalent in wealthy countries. From 1975 to 2004, of the 1,556 new drugs marketed only 21 just over one percent were for infectious tropical diseases and tuberculosis, in spite of the huge need. So, not only are the poor in developing countries disproportionately suffering from curable diseases, but their needs are woefully unmet by the existing model of drug development.
Meeting challenges: This disparity is now widely acknowledged and is being addressed by new research as well as new initiatives. Several research initiatives have been set up in the last 5 years to address this issue, e.g., the Drugs for Neglected Diseases Initiative (DNDi), Medicines for Malaria Venture, and TB Alliance. The challenge here lies in procuring full financial and political support from governments so that the initiatives can achieve their goals of developing and delivering desperately needed, new, effective, needs-oriented medicines to neglected patients. Currently, only 16% of funding for these initiatives comes from governments, while almost 80% comes from philanthropic organisations. This is unsustainable. The importance of public responsibility in providing equitable access to these health tools is an essential part of DNDi’s message as a not-for-profit research organisation that works in close collaboration with public and private partners in both developing and developed countries. The need for increased public support of essential innovation for neglected diseases is a growing global concern. Governments are being urged to lose no more time in supporting new funding mechanisms for neglected disease research and development and to create a favourable environment to stimulate R&D. A handful of Innovative Developing Countries such as India, South Africa, Brazil, etc. are becoming more proactive in the field of drug R&D. Yet innovation in drug discovery for neglected diseases remains a critical gap.
Conclusion (max 400 words): This message has recently gained ground at the WHA 2006, which voted to adopt a resolution to establish a global strategy and a plan of action directed at public health, innovation and essential health research. These are positive steps towards addressing the greater problem of R&D for neglected diseases. Much more remains to be done.

Strengthening Health Systems through Formal Links with Storekeepers, Volunteers and Community Health Committees in Urban Settings: Extending Services to Communities Project

Author(s):

B. M. Nhlema Simwaka*1, P. Nkhonjera1, A. Willetts2, F. M. L. Salaniponi3, R. Malmborg4, S. R. Theobald2, B. S. Squire2

Affiliation(s):

1Research for Equity And Community Health Trust, Lilongwe, Malawi, 2Liverpool School of Tropical Medicine, Liverpool, United Kingdom, 3National TB Control Programme, Ministry of Health, Lilongwe, Malawi, 4Norwegian Health and Lung Patient Association, Oslo, Norway

Keywords: Health system, informal health providers, referral, tuberculosis
Background:

This abstract highlights finding of an intervention research called Extending Services to Communities. The aim of the study was to document the impact of improving the advisory, referral and health promotion skills of storekeepers, volunteers, and community health committee in improving early care seeking for tuberculosis. The intervention package included a capacity building, referral system between the community and health facilities and health promotion on tuberculosis and chronic cough.

Summary/Objectives:

The objectives of the study were: (1) To develop and implement the Extending Services intervention package. (2) To analyse the acceptability of the intervention by the different stakeholders involved in implementation. (3) To explore, through gender and poverty analysis, the community perspectives of the impact of the intervention. (4) To quantify the extent of the impact of the intervention on TB control indicators. (5) To make recommendations for approaches for implementing and evaluating similar community based health interventions.
The research was conducted in Malawi by Research for Equity and Community Health Trust, in three resource-poor settings of urban Lilongwe in collaboration with the National TB Control Programme, Lilongwe District Health Office and City Assembly. The first intervention area was Ngwenya and second area was Kauma. Kauma was used to test replicability of the intervention. Chinsapo was used as a control area. The multi-method approach was used to develop and implement the intervention and to evaluate its impact and acceptability from social and biomedical perspectives.

Results:

A participatory process promoted ownership of the intervention and improved the referral and health promotion skills of storekeepers, volunteers and community health committees. Health workers used the referral letters as a screening tool for tuberculosis. The major limitations were coverage of health promotion activities and the participation of men in these activities. The community members explained that the intervention had greater impact on the poor men and women than the poorest because of the nature of their livelihood activities. In the intervention areas there was a significant increase between 2003 and 2006 in the proportion of chronic coughers seeking care within two weeks of symptom onset (Kauma from 23.4% to 68.8%, [p=0.001]; Ngwenya from 9.3% to 30.8 %, [p=0.042]) compared with the control area where the change did not reach statistical significance (Chinsapo from 36.9% to 15.4%, [p=0.0142]). In addition the proportion of Lilongwe city’s total annual notifications of smear positive TB arising from the intervention areas rose significantly (Kauma from 0.2% to 1.3%, [p=0.002], Ngwenya from 1.4% to 3.2%, [p=0.004]) while the proportion reported from the control area did not rise significantly (Chinsapo from 2.7% to 3.3%[p=0.44]).

Lessons learned:

The multi-method approach helped to understand the impact of the intervention on access to services from different perspectives and in framing different research outputs for different audiences. It was also clear that integration of the informal health providers to the formal health system depended on building on their existing roles as early entry points into the health system for poor men and women and was not intended as a way of replacing the role of the health workers. The Extending Services to Communities Model is one way of strengthening the health system to increase access to elements of the Essential Health Package. Meaningful integration calls for embracing of both biomedical and social models of health.

Analytical Study of WEB Pages from India

Author(s): D. Srivastava1
Affiliation(s): 1Division of Publication and Information, Indian Council of Medical Research Hqrs, New Delhi, India
Keywords: Geriatrics, web analysis, health problems
Background:

India is said to be ‘greying’ The population aged 60 plus in India clearly indicates a doubling and is expected to go up to 9.87 by 2021.Dream to live long is the legitimate right of every citizen, the social and the economic implications and the humanitarian issues are causing serious concern and require immediate attention from the government and social organizations. A proper solution would be an integrated approach, involving information providers, financiers and providers of healthcare, public and private to deliver ‘quality healthcare’ to people. In the age of the Internet, if the elderly population is provided with adequate information required by them, on this medium, it will be of great help to them. Early diagnosis of diseases is difficult among the elderly people, because they mostly ignore symptoms considering signs as ageing. It is often too late when a disease is diagnosed.

Summary/Objectives:

Recent studies conducted among the old people show that 35 % of them in the urban areas are living alone. In rural areas they constitute 32%. IT heralded a major change in dissemination of health information, with the promise of transferring knowledge from health professionals to the general public. Studies show that in India more and more people (2002-1.6% and 3.7% during 2007) have access to the Internet, and the majority of Internet users seek health information The three main ways of accessing online health information are: (i) searching;(ii) participating in support groups; and (iii) interacting with professionals. Elderly people constitute a growing group of computer users and information seekers on the Internet. One of the top favourites for the elderly is to access health information .With this background in the present study, attempt has been made to analyse the hits on topics associated to health problems of elderly population from the web pages from India. The study has been done for two year(s) (2002 & 2007).The content analysis of few web pages from India has also been done to ensure the topics covered. To execute this, efforts are made to explore the availability of information on ‘health problem’ in the field of geriatrics. Going through the literature, it has been established that there is no concentrated effort, to take a stock of available health related information specifically oriented towards our elderly population by Indian web servers

Results:

Search on Health Problems of elderly by Google, on world wide web revealed that the hits were for the year 2002 was 1400000 while for 2007 it was 5390000 .Hits for pages from India, revealed 1720 hits (2002) to 95000 hits in 2007. Disease based search revealed that general well being of elderly population, in both the years was most favoured, along with issue related to HIV/AIDS. Other areas in context of world wide web were Neurological Problems & Alzheimer’s, Nutrition, Skin care. Pages dealing with Tuberculosis also showed an increasing trend. HIV/AIDS, Nutrition, General well being, Diabetes, Health & Hygiene, Alzheimers and Hypertension were the top most areas during the 2 years together. Pages from India revealed that they are concentrating upon few select problem areas like nutrition, Rural population & health, diabetes, Population policy and old age, Hypertension and General well being. Some of the important areas like Neurological Problems, Urinary incontinence or Musculosleeletal issues have not been addressed adequately.

Lessons learned:

This may not be the absolute true picture of the web in Indian context, but definitely the study has indicated that potential of web information provision has not been exploited by Indian content developers. This calls for immediate attention of all concerned, as health projections of concerned ministries and census data (Health Status of India) have shown that a large population is of ≥ 60 years of age and number of patients in the areas of Alzheimer, Neurological, Muscoloskeletal and Psychological problem is going to increase.

Unhealthy Conditions and Lack of Care in Detention Centres for Migrants in Malta

Author(s): L. Schockaert*1, G. de Molla2, M. Philips1
Affiliation(s): 1Analysis and Advocacy Unit, Medecins sans frontieres, BRUSSELS, Belgium, 2coordination, Medecins sans frontieres, Rome, Italy
Keywords: Migrant health, detention centres, health status, mental health, disease control
Background:

Over the last years thousands of migrants tried to reach Europe over the Mediterranean Sea. In 2008 Malta has registered 2704 new arrivals, a significant increase compared to previous years. People arriving without documents are systematically put in government detention centres. Since August 2008 MSF provided health and psychological care in three Maltese detention centres, but the continued unacceptably poor conditions led to suspension of MSF’s intervention in February 2009.

Methods:

Analysis of medical data collection based on 3192 consultations by MSF between Aug 2008 and Feb 2009, interviews with key informants, including patients, migrants, health and administrative staff in the detention centres. Additional specific documentation of living conditions in these centres.

Results/Conclusions:

For almost 60% of arrivals the country of origin was in conflict or with widespread human rights abuse - 47% came from Somalia. Numbers of new arrivals are increasing, with Among arriving migrants in malta detention centres, 7% were women and children. Almost 70% reported illness problems at arrival, mainly linked to the travel.
Conditions in detention centres showed overcrowding with in some cases less than 3 m² per person, very few functioning showers and toilet amenities. Shelter and nutrition were under-standard. Basic care and hygiene measures for infectious diseases were insufficient or absent, this in presence of outbreaks of chicken pox, gastro-enteritis and tuberculosis. Isolation measures were applied randomly, including for non-ill persons.
Deterioration of health status among detained people was documented, with 65 episodes of infectious disease among 60 people that previously were examined and found healthy at arrival. A high frequency of respiratory, skin and gastro-intestinal infections was documented.
The journey and the detention have a serious impact on mental health, without adequate care for these problems. 21 % reported to have suffered physical abuse prior to arrival and many report witnessing deaths of family members or co-travellers.
The intention to deter migrants from entering Malta seems ineffective in view of increasing numbers of arrivals. The overall term ‘Migrants’ can be misleading as the majority of people arrive from countries with major refugee streams, fleeing conflict and violence. Several people arrive with health problems, but most get ill as a consequence of bad hygienic and nutrition conditions during detention. Some documented detention centres would even fall short of international minimal standard conditions for refugee camps in Sub Saharan Africa. Measures to provide care and to control infectious diseases are insufficient, psychologic and physical health damage is caused by conditions of detention.

The Global Fund’s Fight against Corruption

Author(s): B. P. O’Donnell1
Affiliation(s): 1The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
Background: The vulnerability of the health sector to corruption is an issue that has driven the Global Fund to recruit a large team of specialist auditors and investigators in the Office of the Inspector General (OIG). This risk has driven significant changes to our approach in identifying fraud and corruption, and in dealing with such cases when the risk becomes ‘actual’.
The Global Fund is a unique global public/private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria. Since its creation, the Global Fund has become the main source of finance for programs to fight these diseases, with approved funding of around US$20 billion for more than five hundred programs in 144 countries. It provides a quarter of all financing for AIDS globally, two-thirds for tuberculosis and three quarters for malaria. Global Fund financing is also enabling countries to strengthen health systems by making improvements to infrastructure and providing training to those who deliver services. So far, the world-wide programs supported by the Global Fund have averted more than four and a half million deaths. The Global Fund does not implement programs directly, relying instead on a broad network of partnerships. The challenges in this model are clear – primarily, the need to strike a balance between encouraging country ownership, while at the same time ensuring accountability, efficiency and effective anti-corruption measures.
Methods:

The OIG uses a number of strategies to fulfill its mandate. Some of the key strategies include:
1. The OIG has developed methods of making a report that are industry best;
2. By mandating reporting by all key partners;
3. Through detailed, risk-based audits;
4. By undertaking ‘on the ground’ investigations and by working with national authorities to ensure that cases are criminally prosecuted where appropriate and providing specialist assistance where necessary;
5. By insisting on the full recovery of funds and publicly announcing to the world what has happened;
6. By working with the Secretariat to ensure further funding is subject to appropriate action being taken in-country and remedial action being taken to mitigate further risk; and
7. Through the development of a Supplier Code of Conduct and a Sanctions and debarment process.

Results/Conclusions:

All large-scale finance programs face the very real risk of fraud and corruption, but often these issues are not pursued as vigorously as they could be by all agencies that fund health and development programs because finding fraud can be viewed as a ‘bad news story’. The Global Fund has taken a very active approach to finding and vigorously pursuing fraud and corruption. The OIG ‘follows the money’ to conduct investigations whenever and wherever fraud and corruption are suspected. When we establish that fraud and corruption has occurred, we demand our money back and work with the Secretariat to tie future grants to repayment and remedial measures. We also work closely with national law enforcement and prosecutorial agencies to see that those responsible are criminally prosecuted.

Establishing and Supporting Partnerships between Community and basic health Units for Tuberculosis (Tb) Prevention and Control: A Case of a Union Council, Pakistan

Author(s): S. Bhanbhro1
Affiliation(s): 1Community Health Sciences, Aga Khan University, Karachi, Pakistan
Keywords: Community, Partnership, Tuberculosis, Basic Health Units and Appreciative Inquiry
Background:

An established seamless framework is required to strengthen the link between community and local health units for sustainable improvement in preventing and controlling TB. Minimising risk of TB is the responsibility of everyone. It requires all who are involved knowing their roles, ways to communicate effectively, and how to reduce the TB cases. The aim of this study was to map out existing resources on TB prevention and control, to build a holistic framework and a care pathway to embed effective prevention and control into everyday practice. The main objectives were: to review existing resources; to identify gaps in practice and communication; to build a partnership across range of stakeholders including community, diagnostic laboratories, basic health units, hospitals and schools and to establish a safe and effective patient pathway in order to map out a clear journey for patients and to improve practice.

Methods:

Semi-structured and Appreciative Inquiry (AI) interviews were conducted with representatives of different organisations, community and groups who are working on TB control, including Basic Health Units staff, Community representatives, members of local council, representatives of community organisations and people with TB. Interviews were guided by a list of questions, concerned to explore information about existing resources on TB prevention and control, role of interviewees and their organisation or group, seeking their perspectives on preventing and controlling TB, identification of blockages and problems in services, management, and communication.

Results/Conclusions:

Findings show lack of clarity about the patient journey and lack of communication between Basic Health Units and Community. However, it is identified that there is lack of a collaborative system, which provides information on a patient’s status and journey between hospitals and community. It is found that little attention has been paid at community level, where TB originates. It was also reported that BHU staff are not always providing full information to minimise risks. It was acknowledged there are no formal links and an established communication system among different institutions and groups who are working in field of TB control. The second phase of study will address the communication and practical issues between service providers and community. From the interviews it has been recognised that a participatory sessions are planned to seek the views, perceptions and expectation about TB from different stakeholders including community, labortoary staff and hospitals. Literature shows that behaviour change and short campaigns are not enough, for sustainable improvement in TB prevention and control, a system based holistic approach needed, which embed best practice and drives cultural change (HOMIP, 2008). Hence, strength based action research methodology Appreciative Inquiry (AI) has been identified to undertake further phases of the project to identify solutions, improve practice, and build a link between the BHUs and a range of stakeholders and to establish a system to provide information on a patient’s TB status and a complete route from hospital to home.

Providing HIV Treatment and Care Services at Rural Health Centres in Zambia – Its Impact and Implications for Health System Strengthening

Author(s): I. Naoko1
Affiliation(s): 1Bureau of International Cooperation, International Medical Center of Japan, Tokyo, Japan
Keywords: AIDS, HIV, Zambia
Background:

There has been a growing debate on disease-specific initiatives and their impact on health systems. In Zambia, where these initiatives such as the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have been playing significant roles in scale-up of HIV treatment and care, it has been argued that these initiatives are undermining existing health systems and other critical health services including maternal, newborn, and child health. However, these arguments are often anecdotal, otherwise theoretical, and evidence from the field is limited, which failed to effectively inform operational strategies and actions for the future.

Methods:

In Zambia, some districts have started to provide HIV treatment and care services at rural health centres with support from district health management team. It was recognized as a successful case to provide HIV services within existing health systems with limited capacities. However, some negative impacts on other health services provided at these rural health centres were also reported. This study explored the field level impact of HIV/AIDS initiatives on basic healthcare service delivery at rural health centres in Zambia in order to examine its realities in the field and to recommend strategies to address challenges and to further promote synergies between HIV services and other health services so as to strengthen existing health systems. Health services provided at the rural health centres were observed and key informant interviews and focus group discussions targeting healthcare providers were organized.

Results/Conclusions:

It was found that HIV service provision at rural health centres was facing several challenges including limited human resources and capacities on its own. It was also found that other basic health care services were often affected due to the overwhelmed tasks related to HIV services. However, the potential for possible improvement including enhancing collaborations and synergies between HIV services and other services were identified and future recommendations were made.

Working Together for Mental health: the Nouadhibou Pilot Experience

Author(s): A. Ould Hamady1, D. A. Gérard*2
Affiliation(s): 1Neuropsychiatric Hospital, Nouakchott, Mauritania, 2Sanofi-aventis, Access to Medicines department, Gentilly, France
Keywords:

Developing countries; mental health; community care; access to medicines; Mauritania; schizophrenia; treatment gap; awareness campaign; advocacy

Background:

Mental disorders are emerging as a major contributor to the Global Burden of Disease in developing countries. Nevertheless in Mauritania, as in most low-income-countries, access to mental healthcare remains neglected. Psychotic patients suffer from stigmatization, paucity of qualified health professionals, and difficulties to get medicines. In 2005, an international conference held in Nouakchott underlined that improving mental health care in Mauritania, as in other low-income-countries, will require: changing legislation and policies; setting up services; getting funding; training healthcare professionals and making medicines accessible. According to its Corporate Social Responsibility policy sanofi-aventis has launched initiatives to improve access to medicines in six areas that constitute serious public healthcare concerns in emerging and developing countries and in which the group has some expertise (Malaria, Tuberculosis, Leishmaniasis, Sleeping Sickness, Epilepsy and Mental Health). In mental health, the Program is focused on schizophrenia and consists in both the development of adapted Information - Education - Communication tools and the implementation of a preferential pricing policy for sanofi-aventis antipsychotic medicines.

Methods:

The Nouadhibou Pilot Experience is a Public-private partnership between the Mauritanian Ministry of Health and sanofi-aventis. It is a demonstration project which objective is to prove that access to care of schizophrenic patients could be improved drastically by simple, assessable and adaptable programs. The program is located in Nouadhibou, the Mauritania’s second largest city. It will last 3 years. It combines:
- Advocacy efforts towards political and administrative decision makers;
- Awareness campaigns about mental disorders;
- The development of psychiatric facilities in community care;
- An encouragement to the enlargement of local NGOs dedicated to mental health;
- A sustainable supply of high quality antipsychotic drugs ;
- A strict assessment of the impact of the program: epidemiological survey at baseline, then patient’s follow-up kept in a registry.

Results/Conclusions:

The program was set up in October 2008 in Nouadhibou through an awareness meeting opened by the Minister of Health at the National Assembly; key achievements include:
- Radio broadcasts and  articles in national newspapers;
- More than 500 attendees at advocacy meetings;
- Creation of specific Information-Education-Communication tools: flip chart, posters, booklets;
- Expansion of the local association of patients’ families;
- Organization of a sustainable supply of high quality antipsychotics with a preferential pricing policy from sanofi-aventis;
- Training of 37 health professionals (MDs and nurses) to diagnose and treat psychotic disorders under the supervision of specialists from the Nouakchott Neuropsychiatric Center;
- Mental health facilities opened in 6 centers (May 2009) in the city and its neighborhood, under the supervision of specialists from the Nouakchott Neuropsychiatric Center;
- One hundred and seventy patients with schizophrenia followed up within the program (first three quarters);
- Treatment gap decreased by 18% (93% to 76%).
This program is a model of public/private partnership serving the “Make Mental Health a Global Priority» objective at the country level. Lessons drawn from the “Nouadhibou Pilot Experience” may enable potential partners to consider lending its support to the expansion of such approaches to other locations and to the scaling-up of the project to the other provinces of Mauritania.

Impact of Migrant Mobility on Health in Himachal Pradesh – A Paradox

Author(s): N. Sharma*1, A. Panda1
Affiliation(s): 1Health, Himachal Pradesh Voluntary Health Association, Shimla, India
Keywords:

National Population Policy, Under served groups, State Domestic product, Developmental indices, Anemia, skin diseases, fevers, STI, tuberculosis and silicosis, cutaneous leishmaniasis, dichotomy, problem of accessibility, high infant mortality

Background:

The migrant workers and their families face problems in securing shelter, education and health care. It is essential to build up a mechanism for monitoring these changes. In this regard, the National Population Policy, 2000 focuses on Under-Served Population Groups. Little or no access to potable water, sanitation facilities, and health care services has contributed to high infant and child mortality, which in turn perpetuate high TFR and maternal mortality. There is lack of primary health care, including reproductive and child health care, water and sanitation, targeted information, education and communication campaigns. These communities need special attention in terms of basic health, and reproductive and child health services. The special needs of these groups which need to be addressed include the provision of mobile clinics that will be responsive to seasonal variations in the availability of work and income.  Himachal Pradesh is a paradox. This is a policy focus analysis because HP’s developmental indicators are higher than the national average. If we focus on two crucial factors, the IMR is 47 as opposed to 55 in India and the percentage of institutional deliveries is more than 50% of the total number of Ante natal registered cases in the state. The state domestic product has registered a healthy 8% growth in the past years. Industries and service sectors have shown an increase from 1.1% in 1951 to 5.9% in 2001. Industries and mining alone employ about one lakh workers. Today in hydro projects the number of migrant labourers is about two lakhs. In HP there are a total number of 386 slum pockets with a population of 154709. These slums have a population of both migrant and Below Poverty line himachalis. HP has witnessed 90.96% increase in incidence of child labour. All justification and rationale in HP goes baseless because the state’s developmental indices are higher than the national average. The dichotomy is clearly reflected in report of National Commission for the Protection of Child Rights (NCPCR) to Planning Commission, India “Abolition of Child Labour in India”. It states “Surprising is the case of HP which has shown significant increases in school attendance and in literacy levels. However there is a dramatic increase in the percentage of children in the age group of 5-14 years who are classified as workers both main and marginal. In HP the percentage of child workers has gone up from 5.5% in 1991 to 8.6% in 2001. This could be a result of larger numbers of children combining work with schooling or simply better enumeration of children’s unpaid work”.

Methods:

The migrant labourers and slum dwellers face the same type of health related problems. Knowledge with regard to health status and preventive action is rare. Health becomes a concern only when it affects their ability to earn wages. Hygiene conditions in living areas are extremely poor and many live in temporary shacks with no provision of potable water and sanitation. Those who migrate with families have malnutrition among the children. Anemia, skin diseases, fevers, STI, tuberculosis and silicosis (sirmour district) are common diseases and in higher reaches cutaneous leishmaniasis is prevalent (kullu & kinnaur districts). Thus migrants from within the state and outside face critical problem of accessibility to health institutions as the timings of the government hospitals is not suitable and these migrants end up going to private clinics, registration of pregnant women or their follow up is less than 20% complete immunization of children or any kind of follow up is completely lacking, enrolment in formal & non formal schools is minimal and all these are complemented with poor and unhygienic living conditions.

Results/Conclusions:

The migrant labourers and slum dwellers face the same type of health related problems. Knowledge with regard to health status and preventive action is rare. Health becomes a concern only when it affects their ability to earn wages. Hygiene conditions in living areas are extremely poor and many live in temporary shacks with no provision of potable water and sanitation. Those who migrate with families have malnutrition among the children. Anemia, skin diseases, fevers, STI, tuberculosis and silicosis (sirmour district) are common diseases and in higher reaches cutaneous leishmaniasis is prevalent (kullu & kinnaur districts). Thus migrants from within the state and outside face critical problem of accessibility to health institutions as the timings of the government hospitals is not suitable and these migrants end up going to private clinics, registration of pregnant women or their follow up is less than 20% complete immunization of children or any kind of follow up is completely lacking, enrolment in formal & non formal schools is minimal and all these are complemented with poor and unhygienic living conditions.