Malaria, a life threatening mosquito-borne infectious disease, poses a risk to approximately 3.3 billion people, approximately half of the world’s population. Most malaria cases occur in Sub-Saharan Africa, but they also occur in Asia, Latin America, and to a lesser extent the Middle East and parts of Europe. In 2010, malaria was found in 106 countries and territories, with an estimated 216 million cases and nearly 0.7 million deaths – mostly among children living in Africa. In addition to its health toll, malaria places a heavy economic burden on many countries with high disease rates, with estimates of as much as a 1.3 percent reduction in GDP in those countries.
As our sturdy Land Cruiser inched its way down a precipitous dirt track, trying to descend from a high ridge into the Rift Valley, I wondered what might happen if we had an accident here in the heart of Kenya’s remote Samburu County. Mobile signals had faded soon after we left the town of Maralal several hours before. We could have tried to walk back, but would have been very unlikely to make it before nightfall. Luckily, after a few mishaps and some serious jolting, we arrived at our destination in the valley—lonely Suyan manyata, whose distant circular outline we had seen from the ridge.
Talking to some of the women in the manyata, I realized that the ground that we had covered to get to them was nothing. We had done it in good health in a vehicle built for difficult terrain. As they told us what life was like in their village, my heart quailed at the thought of enduring a bumpy ride in a run-down van if one were pregnant or in labor with complications—if at all transport could be obtained. Just a few days ago, a child had died here of malaria, the women said. How did they usually get help, I asked. “We send our fastest runner 18 kilometers to the nearest dispensary,” said Ma Toraeli, a grandmother in the village. “From there someone comes to help us”. Health workers also visited the village from time to time, she said, to immunize babies and perform other routine checks.
Immunization seemed high on people’s minds in Samburu. Later that day, we visited Barsaloi, a larger village with its own government dispensary and another run by Catholic nuns. The two stood side by side, with a well-worn path between them. There I met another grandmother, Agnes, who had brought an infant girl, Salini, to be immunized, although her record showed that she was early and didn’t need this service yet. But while Stephen, the clinical officer at the government dispensary, was examining the baby and we were on the subject of immunization, the district head nurse showed us how vaccines were stored at the required temperature in the two-room government dispensary without power supply.
In my post “Should you trust a medical journal?” I think I might have been a bit unfair. Not on The Lancet, which I have since discovered, via comments on David Roodman’s blog, has something of a track record of publishing sensational but not exactly evidence-based social science articles, but rather on Ernst Spaan et al. for challenging the systematicness of their systematic review of health insurance impacts in developing countries. It’s not that I now think Spaan et al. did a wonderful job. It’s just that I think they probably shouldn’t have been singled out in the way they were.
While we non-physicians may feel a bit peeved when we hear “Trust me, I’m a doctor”, our medical friends do seem to have evidence on their side. GfK, apparently one of the world’s leading market research companies, have developed a GfK Trust Index, and yes they found that doctors are one of the most trusted professions, behind postal workers, teachers and the fire service. World Bank managers might like to know that bankers and (top) managers come close to the bottom, just above advertising professionals and politicians.
Given the trust doctors enjoy, the recent brouhaha over allegations of low quality among some of the social science articles published in medical journals must be a trifle embarrassing to the profession. Here’s the tale so far, plus a cautionary note about a recent ‘systematic review’.
UNITED NATIONS | It has been a week of inspiring ideas and action plans at the United Nations General Assembly in New York. I met with a number of world leaders, including Liberian President Ellen Johnson Sirleaf. We talked about the importance of creating jobs for ex-combatants, the pressing need for more energy sources, and more. You can hear my thoughts on our meeting in the video below.
Today, World Bank Group President Jim Yong Kim announced a special funding mechanism to enable donors to scale up their funding to meet the urgent needs related to Millennium Development Goals 4 and 5, leveraging the International Development Association (IDA), the World Bank's fund for the poorest.
Dr. Kim announced the special funding mechanism during his remarks at the Every Woman, Every Child event at the UN General Assembly.
His remarks, as prepared for delivery, are available on the World Bank's website (http://www.worldbank.org/en/news/2012/09/25/world-bank-president-kim-every-woman-every-child-un-general-assembly).
While much of the health focus in sub-Saharan Africa has been directed toward communicable diseases, particularly HIV/AIDS, there has been less acknowledgement that non-communicable diseases (NCDs) are a growing problem. These diseases already account for about 30% of deaths and are expected to become the leading cause of ill health and death by 2030 (see chart).
In case you hadn’t noticed, there’s a growing clamor for a global commitment to universal health coverage (UHC). You might have seen the recent special issue of the Lancet on “the struggle for UHC”. Inevitably, accompanying this clamor, there’s been a lot of wracking of brains on how to measure progress toward UHC. With the excitement of a new political agenda, there’s understandably a desire to carve out a new measurement agenda too. While not wanting dampen people’s enthusiasm for the UHC cause, I would like us to reflect whether on the measurement agenda we’re building enough on what’s been done before.