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The Last Mile, at Last?

Onno Ruhl's picture

Onno visiting a medical dispensary in Okhla, Delhi, IndiaIt looked like an ordinary little drugstore. A reasonable supply of medication on the right, and man behind a small desk in the middle.

But what was on the desk was not ordinary: a netbook laptop and a fingerprint scanner. And on the left were boxes, all the same medication, with names written on them. “Try it,” Neema said. “Scan your finger.” I did and the screen turned yellow. “You have never been here yet” said Neema, “I cannot give you any medication.”  

What Sparks Change? How Can We End Poverty?

Jim Yong Kim's picture

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What will it take to end poverty?What inspires change? What has impact on policy? What really motivates us to do social good?

Here’s one story from my past that I’ll never forget.

In 1987, Dr. Paul Farmer and I and a few others helped start a group called Partners in Health to provide access to quality health care to the poor. In the beginning, the majority of our work was centered in Haiti. Seven years later, in 1994, we set up a program in Carabayllo, a settlement on the outskirts of Lima, Peru.

We began our program in Peru because a good friend of ours -- Father Jack Roussin – said we must. He said the area needed a much stronger primary health system, and so we helped build a cadre of community health workers. Our organization there, Socios en Salud, worked to improve the health care of people in the community, employed 20 local young people, built a pharmacy, and then conducted a health assessment for the town.

Then Father Jack became ill. He started losing weight. I urged him to return to his home in Boston. When he finally did, tests revealed that his lungs were full of tuberculosis (TB). And it wasn’t any TB. It was multi drug-resistant TB (MDR-TB). His disease was resistant to the four major drugs used to treat TB. Soon after, Father Jack died.

We went back to Carabayllo and investigated. Why did he have drug-resistant TB? We found an alarming number of cases of MDR-TB. We did two things: First, we immediately started looking for supplies of the drugs that could treat TB cases we discovered. We gave those to patients, and to our great relief we were able to cure most of them. Second, we started to push for a global program to treat poor people everywhere suffering from drug-resistant TB.

A Great Day in South Africa for a Development Junkie

Jim Yong Kim's picture

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PRETORIA, South Africa - I have to admit it. I’m a bit of a development junkie. For most of my adult life, I’ve been reading thick tomes describing the success or failure of projects. I talk to friends over dinner about development theory. And I can’t stop thinking about what I believe is the biggest development question of all: How do we most effectively deliver on our promises to the poor?

So you can imagine how excited I was to have a day full of meetings with South Africa’s foremost experts on development: the country's ministers of finance, economic development, health, basic education, water and environmental affairs, and rural development and land reform - and then with President Jacob Zuma.

I chose to travel to South Africa as part of my first overseas trip as president of the World Bank Group because of the country’s great importance to the region, continent, and the world. It is the economic engine of Africa, and its story of reconciliation after apartheid is one of the historic achievements of our time.

Circumcision and smoking bans: Can policies nudge people toward healthy behaviors?

Patricio V. Marquez's picture

Walking through river. Mali. Photo: © Curt Carnemark / World Bank

The scaling up of voluntary medical male circumcision, particularly in high HIV prevalence settings, is a highly cost-effective intervention to fight the epidemic—randomized controlled trials have found a 60% protective effect against HIV for men who became circumcised.

But, the supply of this medical service is just one part of the picture. Without active involvement from individuals and communities to deal with social and cultural factors that influence service acceptability, the demand for this common surgical procedure will be low.

Indeed, on a recent visit to Botswana, a country with high HIV prevalence and low levels of male circumcision, my World Bank colleagues and I had a good discussion with the National HIV/AIDS Commission about ways to address the low uptake of voluntary, safe male circumcision services in spite of a well-funded program by the government.  It was obvious to all that if the demand for, and uptake of, this service were not strengthened through creative mechanisms that foster acceptance, ownership, and active participation of individuals and community organizations, the program would not help control the spread of HIV through increased funding of facilities, equipment, and staff alone.

So, what do we need to do to ensure that need, demand, utilization, and supply of services are fully aligned to improve health conditions?

En Afrique australe, la tuberculose migre avec les mineurs

Patrick Osewe's picture

Il y a quelque temps, je suis parti en mission visiter un nouvel hôpital au Lesotho. Je savais que cet établissement était destiné à accueillir des patients atteints de tuberculose multi-résistante et je sais aussi le lourd tribut que la co-infection VIH-tuberculose fait payer au pays. Je m’attendais donc à ce que les caractéristiques démographiques des patients correspondent à celle du VIH : essentiellement des patients jeunes, et de plus en plus de femmes.

Mais je n’étais pas préparé à voir deux familles entières, jeunes et vieux, hommes, femmes et enfants, confinées ensemble pour un certain temps, sous la surveillance de professionnels de santé veillant à ce que tous prennent bien leurs doses quotidiennes de médicaments.

El desafío de la TB de África meridional emigra con los minero

Patrick Osewe's picture

Hace un tiempo, formé parte de una misión que debía visitar un nuevo hospital en Lesotho. Me advirtieron de antemano que el propósito de estas instalaciones era atender a las personas que sufren de tuberculosis (TB) multirresistente a los medicamentos, y conociendo la inmensa carga de coinfecciones de VIH y TB en el país, esperaba que el perfil demográfico de los pacientes fuera similar al del VIH: en su mayoría jóvenes y cada vez más mujeres.

Para lo que no estaba preparado era para encontrarme con dos familias enteras —jóvenes y viejos, hombres, mujeres y niños— confinados juntos en el futuro inmediato para ser observados por trabajadores de la salud mientras toman sus medicamentos diariamente.

Southern Africa's TB challenge migrates with miners

Patrick Osewe's picture

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A while ago, I was part of a mission to visit a new hospital in Lesotho. Warned in advance that this facility was intended to treat people with multi-drug resistant tuberculosis (TB)– and knowing the huge burden of HIV-TB co-infection in the country—I was expecting the patients’ demographic to match the profile of HIV: largely young and increasingly female.

What I wasn’t prepared for was the sight of two entire families—young and old, men, women and children—all confined together for the foreseeable future, to be monitored by health workers as they take their daily drugs.

Drug-Resistant TB – A Battle India Must Win

Patrick Mullen's picture

Ten year old Vibha Kumari looks like any Delhi school girl. Except that a clean but well- worn old handkerchief masks her young face. For Vibha has multi-drug resistant TB - or MDR-TB - caused by a strain of bacteria that has developed resistance to the first line of antibiotics.

Vibha’s is a classic case of drug-resistant TB. Two years ago, when she had a terrible cough that just wouldn’t go away, she was treated by a village doctor at home in Bihar. When she didn’t get any better even after eight months of treatment, the family moved to Delhi where her father sold drinking water on the teeming streets of the city.

Moving into a one-room tenement in an overcrowded urban slum – where large families share small badly-ventilated rooms in conditions that are ripe for the infection to spread –Vibha was tested for TB. When MDR TB was found, probably as a result of inappropriate treatment in the village, she was put on the second line of drugs for a two-year course of treatment.

A Story of hope from Kangemi

Miriam Schneidman's picture

“Tuberculosis was a silent killer a few years ago,” says Rogers, a community health worker at the Kangemi Health Center, which assists people living with TB to receive effective treatment in a sprawling settlement on the outskirts of Nairobi.

Peninah, a mother of four, in Kangemi, KenyaCommunity health workers like Rogers are a vital link between patients and medical providers and are well respected and trusted. They educate, enlighten, and empower patients and people in the wider community. They work with the local area chiefs in mobilizing communities in the fight against TB.  Rogers proudly notes that he actively identifies TB cases, provides home-based care, and traces people defaulting on treatment, all critical elements in managing TB at the community level.

Detection and management of TB are critical in Africa, where roughly a quarter million TB deaths were reported in 2010. The continent accounts for about one-quarter of the global TB burden and is facing challenges in meeting the Millennium Development Goal of reducing 1990 TB mortality rates by half by 2015. However, there is also reason for hope on TB control in Africa, as seen in communities like Kangemi. In Kenya, with support from government and partners, including the World Bank (Health Sector Support Project, Total War Against HIV/AIDS Project, East Africa Public Health Laboratory Networking Project), activities are underway to strengthen the availability of drugs, channel funds directly to lower level health centers , and improve access to the latest diagnostic tools for detecting TB.  “The state-of-the-art diagnostics will go a long way to turn the tide on this pandemic,” notes Lucy Chesire, Executive Director of the TB Action Group in Nairobi.  “Patients will no longer wait months to get results.”

The clock is ticking: attaining the HIV/TB MDG targets in the former Soviet Union countries

Patricio V. Marquez's picture

Some countries of the former Soviet Union, the so-called CIS countries, are facing difficult challenges to achieve the HIV/tuberculosis-related Millennium Development Goal (MDG 6) by 2015. The continuing growth of new HIV cases, insufficient access to prevention services and treatment for people living with HIV, combined with the severity of region’s tuberculosis (TB) epidemic (particularly multi-drug resistant TB) are major challenges.

On October 10-12, 2011, the Russian government, along with UNAIDS, the Global Fund, and the World Bank, is hosting in Moscow a high-level forum to discuss these challenges and ways to reach MDG 6 in the CIS. (Click here for a video, a presentation, and more from the forum.)

Unless concerted action is taken, sustained political commitment mobilized, new public/private and civil society partnerships established, and a sharp improvement in the effectiveness of HIV and TB programs realized, MDG 6 risks not being achieved. So, what to do?


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