Happy Holidays/ Joyeuses fêtes

 

CSIH Board Members Colleen Cash, Barb Astle, Janet Hatcher Roberts  (Executive Director), Karam Ramatar, Anne Fanning (Lifetime Award Winner) and Anne McCarthy

CSIH Board Members Colleen Cash, Barb Astle, Janet Hatcher Roberts (Executive Director), Karam Ramotar, Anne Fanning (Lifetime Award Winner) and Anne McCarthy

Le français est ci-dessous                                                          

A year in review…

This last year CSIH has focused on three main areas:  a strategic planning review and implementation of those priorities; the efficient delivery of our projects in Kazakhstan and Tanzania, with the assistance of many experts both here in Canada and Europe and consistent and significant proposals for new projects.

CSIH staff and many dedicated Canadian and European consultants have been working to implement the three large World Bank projects in Kazakhstan as part of their overall health reform and in Tanzania as part of CIDA’s commitment to maternal child health. We are sub contracted by World Vision to provide technical capacity for planning, resource allocation and human resource development.  These projects support our goal of Project Implementation and Technical Assistance. 

We have also been successfully implementing through the support of the Public Health Agency of Canada, a Global Network for Viral Hepatitis.  The funding we have secured supports a global network, knowledge bank and World Hepatitis Day for the next two years.

The 2012 Conference was a great success attended by almost 500 people! We were happy to welcome many new faces as well and hope to continue to grow CSIH membership. The 2013 Conference theme has been decided: Global Health 2013: Are We Making an Impact? It will be held at the Westin Hotel in Ottawa on October 27-29th – so mark your calendars!

We look forward to your involvement and new commitments for our public engagement and social media activities as well as working to engage more members. We are also starting up the planning committee for the conference and need committed members to help plan and organize the program.  We hope you will consider giving some time and thought to the work of the Society.

Janet Hatcher Roberts
Executive Director

Aperçu de l’année écoulée…

Au cours de l’année qui se termine, nous nous sommes principalement penchés sur trois questions : la révision du plan stratégique et l’application des priorités, la prestation efficiente de nos projets au Kazakhstan et en Tanzanie avec l’aide de nombreux experts, ici au Canada et en Europe, et la formulation de propositions cohérentes et significatives pour de nouveaux projets.

Le personnel de la SCSI et plusieurs experts canadiens et européens dévoués ont travaillé ensemble en vue de mettre mettre en œuvre trois grands projets de la Banque mondiale au Kazakhstan, dans le cadre de sa réforme globale de la santé, et en Tanzanie dans le cadre de l’engagement de l’ACDI envers la santé maternelle et infantile. Vision mondiale nous a choisis pour la sous-traitance des capacités techniques de planification, d’allocation des ressources et de développement des ressources humaines. Ces projets concordent avec notre objectif d’application de projets et d’aide technique.

Nous avons également mis sur pied avec succès, grâce à l’aide de l’Agence de la santé publique du Canada, un Réseau mondial de lutte contre l’hépatite virale. Le financement que nous avons obtenu appuie un réseau mondial, une banque de données et la Journée mondiale de l’hépatite pour les deux prochaines années.

Avec ses plus de 500 participants, le congrès 2012 a remporté un grand succès! Nous avons été heureux d’accueillir de nombreux nouveaux visages et nous espérons continuer de recruter des membres au sein de la SCSI. Le thème du congrès de 2013 a été choisi : Santé internationale 2013 : Exerçons-nous un impact? Ce congrès aura lieu à l’Hôtel Westin d’Ottawa, du 27 au 29 octobre – à noter à vos calendriers!

Nous attendons impatiemment des nouvelles de votre participation et de votre implication vis-à-vis de notre engagement public, de nos activités sur les médias sociaux et du recrutement des membres. De plus, nous mettons actuellement sur pied le comité de planification du prochain Congrès et il nous faut des membres dévoués pour nous aider à planifier et à organiser le programme. Nous espérons que vous envisagerez de donner du temps et que vous contribuerez ainsi aux réalisations de la Société. Au nom de la direction et du personnel de la SCSI, nous vous souhaitons ce qu’il y a de mieux pour 2013.

Janet Hatcher Roberts

Day 1 summary from Joseph Ana

Joseph Ana, Nigeria

Date: Mon, 22 Oct 2012 08:06:16
To: HIFA2015 – Healthcare Information For All by 2015<HIFA2015@dgroups.org>
Subject: [HIFA2015] Day 1 from Canadian Global Health Conference in Ottawa

Dear All,

Day 1 at the Canadian Global Health conference delivered all that was expected from such a mega meeting: loads of learning points to fill gaps in my PIN (Practitioner Information Needs). The format as three plenary sessions and two breakout periods with concurrent sessions for participants to choose from. Both sessions are separated by tea breaks and lunch.

The opening plenary, 8.45 am to 10 am, was for ‘Setting the stage: Global Health in the Shifting World Economy’. The speakers Professor of Global Health, Washington University, Dean Jamison and Professor of Sociology, Columbia University, Saskia Sassen wetted our appetite for what lay ahead. That led me to choose to attend the concurrent symposium on ‘whither Global health in a shifting World Economy’ so as to continue on the subject of ‘health and economy’ (the other two were ‘Global health Research’ and ‘Global Health Education’). I chose health & economy, because in my country, the 2013 federal budget has just been submitted to the national assembly, and unfortunately for health sector it is bad news. Inspite of the comatose state of the health sector, and all the human resource, equipment and infrastructure waiting and calling for ’emergency resuscitation’ to save Nigerians, the allocation to health is about 6% (we know that the actual release will eventually be below 2%). I still don’t understand the budget planners in Nigeria!. Sorry, I must not deviate!

At the meeting there was a lecture titled ‘Sex, Death and Money’,  but the speaker Prabhat Jha, Chair of Disease Control, University of Toronto spoke only on ‘Death’ (at the end of his lecture, I think I heard murmurings of disappointment) with examples from India where poverty is still a major obstacle to improving that countries Health outcomes, even though the GDP has been enviable in recent years. No wonder India and Nigeria (and South Africa) share someting on the prevalence of AIDS. Nigeria like India is touted to be enjoying high GDPs but you only have to visit the rural areas in either country to ask, ‘Is the Economy stupid or is Health mad?’ Which one?.

During Q & A, I joined the cue to ask Prof Jamison who characterised USA health policy as ‘pro poor’ and that of Europe as ‘pro- Universal care’. I understood that the description of Health Policy in Europe but wanted him to throw more light on how USA health can be described as pro-poor’ and there are many millions of Americans without access to care (which I think is what Obamacare wants to correct). Well I could not ask my question because the session ran out of time. I may yet have time to ask him my question one-on-one before he conference closes.

My next session was the Peoples Health Movement (PHM) because I wanted to learn about it. My summary is that PHM is an activist group of lay and professional volunteers that arose from 2000 to fight for ‘health as a human right’, when Alma Atta declaration failed to deliver ‘Health for All’ in that year. It has succeeded in gaining reognition such that every year it hs representation at the World Health Assembly that follows the UN General Assembly. It sensitises the world on the impact that human activities (mining, politics, culture, religion, social changes, gender, abuse, aging & elderly, environment, etc) have on health of the people. From its meeting in Ecuador in 2009 started the ‘International Peoples Health University’ (IHPUs). Don’t be carried away these are not aceademic universities as we know them. IHPUs are 10-day intensive, live-in experiences that are case study oriented in various regions of the world. The Latin American region one discusses ‘mining and health’ because it has huge relevance in that region.

HIFA2015 members can join PHM at http://groups.google.com/group/mps-phm-canada or at phmovement.org

At these mega global meetings ,one is fortunate to meet heroes and heroines of the yester-years of ‘Health in Nigeria’ especially during the peri-indepence period which was truncated by the milatary and the concomittant Biafra Civil War. At the second plenary in Ottawa Professor Brian M. Greenwood, Canada Gairdner Global Health Award winner, and emeritus of the University of Ibadan and Ahmadu Bello University, Zaria, and formerly of MRC, The Gambia delivered an eponymous Gaidner lecture titled: ‘Pnuemonia: A Neglected Problem in African Children’. In summary – Pneumonia kills more children than malaria but it has not received anywhere near the attention that its deadly cousins AIDS, Malaria and Tuberculosis (AMT). The Global Fund has done a lot to tackle AMT but not so pneumonia. He mentioned his experience in Nigeria and mentioned several of his contemporaries that gave Nigeria its golden years in Health, yet: Eldryd Parry, Late David Morley and Pearson. One of them, Professor John Owen as present and asked questions. I acknowledge the achievements of these expatriates to Nigeria’s health and topped it with a question on ‘what is being done to bring down the price of the vaccines as was done for antiretroviral drugs and ACTs?’. Apparently that is under discussion!. In my experience, as with AIDS and Malaria a significant reduction in pnuemococcal vaccine price will deal the same blow to killer pneumonia, alonside other measures like improved cooking stoves, preventing passive smoking (hopefully children don’t smoke), increased micronutrients in nutrition for children (zinc, vit A & D), training Community Health workers on rational antibiotics use, etc, etc. The lecturer acknowledged that the pionering work on the huge impact of pneumonia started in Papua New Guinea many years before the MRC in the Gambia. Prof Greenwood did an excellent job in taking the audience along his line of advocacy, judging by the ovation that followed his lecture.

Before Greenwoods lecture, I attended a concurrent symposium where several groups described their various interventions, mostly in Africa (Ghana, Ethiopia, Mlawi, Zimbabwe, Maozambique, Mali) but also in Asia (Pakistan, Bangladesh) supported by CIDA.

The day ended with a cocktail reception but before it we networked according to the subregions of choice. I joined the west africa group and met many colleagues in Global Health. We have exchanged notes on our activities in our countries and hope to follow up when we return.

If Day 1 was like this, top class in every conference evaluation parameter, I can’t wait for Day-2.

Joseph Ana, Nigeria

Day 2 Summary from Joseph Ana

Date: Tue, 23 Oct 2012 07:53:37
To: HIFA2015 – Healthcare Information For All by 2015<HIFA2015@dgroups.org>

Dear all,

This update is delayed because, surprise, surprise the internet ‘failed’ to connect during most of Day 2 in the hotel. I wondered if I brought the gremlin with me. but as you can see it has been sorted and we are back to broadband again.

Day 2 at the Canadian Global Health conference was as action-packed as the first day and as instructive and exciting. The organisation and all other evaluation parameters remain excellent. Thanks to the organisers: Julia Sanchez, Sarah Brown, and many others whose names I may not know yet. The co-Chairs of the Conference LOC, Janet Hatcher Roberts and Shree Mulay deserve special mention too. Of course there cannot be a conference without the multitude of participants, volunteers, speakers and poster presenters, including the key note plenary speakers. The arrangement is such that going from one event to the other, on different floors, in this magnificent hotel, Delta City Centre, is seamless and smooth.

Day 2 started with a formal opening speech by Hon Julian Fantino, minister of International Cooperation who re-emphasised Canada’s commitment to Global Health especially by supporting Public Private Initiatives in Health; strengthening Health systems; supporting measures to sustaining the drop in maternal and child mortality; etc.

The first Plenary which followed his speech was chaired by Julia Sanchez and there were five keynote lectures:

 – Jon Kim Andrus of PAHO on ‘From Declaration to multi-stakeholder Action: PAHO’s perspective on partnerships- he described the structure of PAHO and the formation of Pan American Forum for Action on NCDs.

– Irene Klinger of PAHO on ‘Harnessing multi-stakeholder action to combat chronic disease in the Americas- described the participation of PAHA at the UN High Level Meeting on NCD in Sept 2011. She [said] that smoking continues to be a major challenge for NCD action because 35% of teenage girls in Chile for instance smoke cigarette, and this is inspite of high cost and ugly packaging!

– Alex Palacios of GAVI Alliance on ‘Saving Lives and Improving health through partnership and Innovation’- said that UNICEF had just released the good news that Under-5 mortality has just dropped below 7 million per year for the first time!. New targets have been set e.g. 80% access to vaccines by 2025. But the bad news is that up to 20% of children are still vulnerable to preventable diseases.

– Celina Gore of Global Alliance on Chronic disease on ‘Innovative Partnerships for Global Health Research’- described the work of Global Alliance for Chronic Disease (GACD) based in London, advocated that the research community need to work with Private sector to achieve the NCD objectives.

 – Mark Fryars of Micronutrient Initiative on ‘The role of SUN movement in increasing multi stakeholder efforts to improve nutrition’- described what the SUN movement is and what it has been doing to improve nutrition especially micronutients – zinc, vit A & D , iodised salt, etc. He advocated a multi sectoral approach to the issue of nutrition.

The first breakout session that I attended continued with the theme of NCDs and the speakers emphasised the points made during the plenary. Essentially, NCDs (non communicable diseases) have overtaken infectious diseases and injury as the major killer worldwide. But for me, right from 2010, when Richard Smith, former BMJ Editor higlighted this fact at a BMJ West Africa Workshop in Abuja, Nigeria, I have wondered why that is the case in LICs. In LICS the life expectancy is dropping not increasing; obesity is not as common as in HICs because of malnutrition and other factors; smoking is not as common as in the west; alcohol is over consumed by a small part of the population.These are all common causes of NCDs in the West unlike in the poor countries. The indigenous communities in Canada and the aborigines in Australia have these factors as to suffer NCDs but what about the LICs ? We are told that poverty is the cause but that does not expalin it? I welcome any clarification on this conundrum.

The second breakout session was on Access to to healthcare and we listened to six short reports on what is being done in various countries on this: Ghana, DEnmark, (using sms to convey advice to NCD patients in Gabon); Social health insurance in Ghana and its challenges; Access to emergency obstetric care and its catsatrophic effect on the poor; Disfunctional pharmacy services in failing health systems.

The third breakout session was on ‘retention of health workers in subsaharan africa: reform to inform policy’. There were four speakers from research in Malawi, Zambia, Burkina Faso and Mali. Their reports generated very exciting discussion and suggestion to ‘take Home’.

The Day came to an end with a buffet dinner with background music (Paul Simon’s Graceland album!).

 Our appetite is surely wetted for Day 3.

Joseph Ana, Nigeria

Scholarship, Activism, Politics and Economics

Scholarship, Activism, Politics and Economics: Intersecting Global Health Themes 

Tuesday, October 23rd, 2012

This session was chaired by Genevieve Dubois-Flynn, Manager and Senior Advisor, Ethics Office, Canadian Institute of Health Research.

Susan George (Transnational Institute, Honorary President, Association for Taxation of Financial Transactions to Aid Citizens) joined the session by Skype for Paris, France.  She highlighted several areas of “good news” and “bad news”, including:

  • In the area of hunger, the number of seriously malnourished children is down by about 35 percent since 1990. However, 36% of all African children and 27% of all Asian children are severely malnourished. Also, while the number of underweight children is down in the South, childhood obesity is an increasingly serious problem.
  • The scarcity of clean drinking water worldwide is a major cause of illness and disease. Although it is feasible to get clean water to everyone that lacks it, we are not making the expenditures necessary to achieve this.
  • The airline tax collected by UNITAID is making inroads in the area of HIV/AIDS, malaria and tuberculosis.
  • Structural adjustment programs continue to have a lasting impact in Africa. The global financial crisis in European countries – including Spain, Portugal and Greece – is now fueling a health crisis.
  • Climate change is having an impact on health. Diseases that we consider “tropical” are moving north.

Dr Susan Horton (Associate Provost, Graduate Studies and GICI Chair in Global Health Economics, University of Waterloo) spoke about the extent to which economic growth has a positive effect on global health and shared some “good news”/”bad news” stories:

  • She explained that height is a sensitive indicator of nutritional status and economic growth has a positive effect on height. For instance, the proportion of children that are stunted is going down around the world – however, the least benefit can be seen in Africa.
  • Also, the number of child deaths under age 5 has declined globally since 1960, but the same decline can not bee seen in sub-Saharan Africa.
  • Life expectancy is increasing globally, but is lower in sub-Saharan Africa. HIV/AIDS, state failure, war, and genocide reversed some gains. But now that more and more resources have been directed to HIV/AIDS, the adverse trend is now being reversed, and life expectancy is starting to increase again.

In addition to economic growth, a large infusion of funding into global health – particularly HIV/AIDS, and the Global Fund for AIDS, tuberculosis and malaria – has played an essential role in improving global health. The US is the largest donor in the area of global health. Other initiatives, including the UNITAID airline tax, funding from the private sector (e.g., Gates Foundation), funding for innovations, such as Grand Challenges, have also been helpful. Dr. Horton explained that she has been involved in initiatives to increase global funding for nutrition.

Dr. Salimah Valiani (Policy Analyst and Economist of the Ontario Nurses’ Association; Associate Researcher with the Centre for the Study of Education and Work, University of Toronto)discussed the undervaluing of caring labour, the export of nursing labour and the implications for human development. The movement of nurses (for example, from the global south to the north) has implications for human development.  The United States is the largest net receiver of internationally trained nurses. Canada and Australia also receive many internationally educated nurses (but are also losing nurses). Nurses migrate for various reasons including better wages, better working conditions, and also because of the persistent undervaluing of nursing and other care in labour. There is a significant loss of health labour from the African continent and from other parts of the global south. This results in severe shortfalls of health professionals. Governments in the global south often support the export of their nurses because they are interested in the remittances that are sent home. Remittances have increased dramatically over the last decade and are a new form of development for some countries (e.g., the Philippines). In the Philippines, there is even a legal requirement for those leaving for temporary work to remit.

A lively discussion took place following the presentations. The importance of scholars linking their work to activism was discussed. Activism needs to be supported by scholarship. The importance of programs/funding to encourage social innovations was also discussed.

Prepared by Jennifer Kitts

Mentorship in Global Health Research

Tuesday

Mentorship in Global Health Research: Experience of university-based Canadian Coalition for Global Health Research Pilot Program – Vic Neufeld, Jennifer Hatfield, Sheila Harms, Donald Cole

I was happy to learn about the global health research mentorship pilot coordinated by the Canadian Coalition for Global Health Research. Three Canadian universities (McMaster University, University of Toronto and University of Calgary) were part of this pilot, using different approaches to execute a mentorship program for post-doctoral students and junior faculty within their institutions. As described in the session, the program was initiated to overcome some of the challenges experienced by individuals starting a research career in global health. Because global health research is a relatively new field, funding and career tracks can be a bit uncertain. In addition, this area of study requires a board understanding of research and access to networks that can be difficult to tap into.

It was interesting to see that the three schools were so varied in their respective approach to their programs. Both the University of Toronto and McMaster University used different group mentorship strategies, whereas the University of Calgary did some one-on-one mentoring which facilitated student mentoring networks. I really liked the concept of student mentoring. Global health is such an interdisciplinary field of research, so it is conceivable that students may be overwhelmed with decisions for classes, research projects, internships, etc. Having the opportunity to learn from someone with similar interests and aspirations who has gone through the process would be a valuable experience. I’ve found mentors to be strong motivators and can help validate academic/career goals and direction. Furthermore, providing students with the opportunity to develop their leadership skills as student-mentors is an asset for their own career development. 

I feel that mentorship programs are valuable in any capacity and can help prepare students for some of the realities of working in the field of global health. One of the most valuable components of this mentorship program is definitely the networking opportunities available to students and junior faculty. I hope this program will continue beyond the pilot and expand to other universities across the country.

By Megan Duncan

Retention of Health Care Workers in Sub-Saharan Africa

Monday Symposia

Retention of Health Care Workers in Sub-Saharan Africa
Cheick Oumar Bagayoko, Hastings Banda, Fastone Goma, Séni Kouanda, Sumeet Sodhi

The Retention of Health Care Workers in Sub-Saharan Africa session began with acknowledging the overwhelming shortage of human resources for health. To provide some context, there is an average of 2.3 health workers for every 1000 people in Africa and 57 countries in a state of human resources for health crises, with no change in this between 2006 and 2011. The migration of health workers has been devastating for health systems in Sub-Saharan Africa. In response to the overwhelming need for health workers, the panellists discussed the results of their investigations of varying approaches and challenges for retaining health worker in Sub-Saharan Africa. Some of the key questions of these investigations included “What are the changing needs of the people?”, “What are the most pressing health needs?”, “What competencies are needed to meet these needs?”, “What are the systems that need to be in place?” and “Who needs to provide these services?”.

Formal and informal strategies were evaluated for the recruitment and retention of health workers. Methods such as incentive allowances and continuing education were assessed for their ability to retain staff.  The ‘rural hardship allowance’ in Zambia scored favorably among the health workers involved in the study conducted by the University of Zambia. I found it interesting to learn that while financial incentives are a powerful retention strategy, they are not as effective as one would assume. The challenge with allowances is their erosion over time because they aren’t increasing with inflation.

Interestingly, ‘human relationships’ was such a strong factor for staff retention. Important human relationships were those in the work environment, particularly the relationships between workers and their supervisor, and the relationships that workers had with the people in the village. The better the relationships; the more inclined the workers were to stay in the village. This discussion really brought to light for me the importance of good communication between workers and supervisors.

Continuing education also proved to be a valued retention strategy. Some of the results showed that workers were appreciative of opportunities to continue to enhance their level knowledge. Not only can certificates help health workers get promotions, it is also a method for affirming their knowledge, reducing their desire to leave.

One of the more holistic strategies discussed was the need to use a multi-sectorial approach to increasing social amenities in remote villages, primarily information and communication technologies that allow workers to stay connected. I hadn’t considered private telecommunications companies to be key stakeholders in the mission to retain health workers.

By Megan Duncan

Sustainable Development and Health

Monday Symposia

(PDFs of the powerpoints can be found at: http://www.ccgh-csih.ca/csih2012/presentations.php

Sustainable Development and Health – Blake Poland, Nick Previsich, Howard Hu, Donald Cole

I had not planned on attending the session on Sustainable Development and Health, although I was very happy that I did. Four compelling presenters spoke of the benefit and continued need for collaboration across disciplines and sectors to advance and maximize public health and development efforts. Public health approaches such as One Health and EcoHealth set the stage for discussing the harsh realities of environmental health in the developing world. Topics such as climate change, agriculture and mining were at the forefront in the four presentations.

One of the statements that continued to resonate with me after the session came from Blake Poland from the University of Toronto – “There is a growing disconnect between recognizing what’s wrong and being able to do anything about it”. It felt like a shot in the gut. Then the same sentiment was echoed by Howard Hu when discussing the rapid growth of the mining industry. Dr. Hu noted that science cannot keep up with tracking and monitoring exposures. He also made note of the devastating (my word, not his) gap between research and policy. These observations emphasized the growing need to close the gap in the exposure-to-intervention loop. Integrating knowledge and resources across sectors and disciplines will be integral in that in process. These comments also demonstrated the growing need for individuals working the field to be interdisciplinary entities in themselves.

I’m happy to stay the thought provoking session wasn’t all doom and gloom. As Dr. Poland reminded us, “The silver lining is that social change can be as unpredictable and swift as ecological change”.

By Megan Duncan