Highlights from the 2006 Global Health Mini-University

October 27, 2006, was "back to school" day for the more than 600 global health students and professionals who attended the 2006 Global Health Mini-University at the George Washington University School of Public Health and Health Services. (Click here to see photos from the 2006 Mini-University.)

This year's Mini-University featured nearly 60 sessions and about 90 presenters who highlighted evidence-based best practices and state-of-the-art information from a variety of technical areas across the Global Heatlh field: Cross Cutting Issues, Family Planning and Reproductive Health, HIV/AIDS, Infectious Diseases, and Maternal and Child Health. In addition, two exciting brown bag sessions were offered during the lunch break: Malaria Control and the President's Malaria Initiative and Global Health: A View from the Hill. For the second year, Continuing Education Units (CEUs) were offered at the Mini-University so that participants could earn up to 0.5 CEUs from the American College of Nurse Midwives. (Click here to view or download the 2006 Mini-University presentations.)

Knowledge Extravaganza

The day culminated with a Knowledge Extravaganza opened by Kent Hill, Assistant Administrator for the Bureau for Global Health at USAID, and Dean Ruth Katz of the George Washington University School of Public Health and Health Services. Jim Shelton of USAID presented the annual MAQie Awards. This year's award for Field-based Leadership was given to Dr. Binta Keita; the award for Global Technical Leadership went to Dr. Roberto Rivera. (Click here for details about the 2006 MAQie Awards.)

During the N'Lightening Round, key messages from Mini-U sessions were presented before a panel of judges, and prizes were awarded for the top take-home messages (also known as "pearls").

 

The panel of judges included:

• Dean Ruth Katz of the George Washington University School of Public Health and Health Services
• Margaret Neuse, Director Emeritus of the Office of Population and Reproductive Health at USAID
• Richard Greene, Director of the Office of Health, Infectious Diseases, and Nutrition at USAID
• Ken Yamashita, Director of the Office of HIV/AIDS at USAID

Pearls were judged on several criteria including:

• Brevity
• Clarity
• Practical
• Realistic
• Useful
• Innovative
• Interesting
• All around impact to make the world a better place

AND THE 2006 WINNING PEARLS ARE. . .

Honorable Mentions

1. We know what to do – point-of-use (POU) water treatment, handwashing, sanitation – now we are working on innovative programs to actually do it.
2. POU partnerships w/PSI and others are going to scale.
3. Focus on important, doable actions – à la chlorination at the household level. 

Third Place

Where Have All the Workers Gone?: The Extent of the Global Health Care Worker Shortage, Why Workers Are Leaving and Some Strategies for Addressing the Crisis
Lois Schaefer and Pam McQuide

R I G H T

Workers Skills Place Time

→ REQUIRES     →

R

Reliable information Recruitment Relevant training Realignment (postings and tasks) Resource management (human) Retention

 Second Place 

1. Contraception: It is required IF planning your family size is desired.
2. Contraception: So what’s new? Male Hormonals, YES it’s true!
3. Contraception: What’s effective? The “I” methods are your best selections.
4. Contraception: Who can use it? There’s a method for everyone – you only need to choose it!

WINNER! First Place

1. Type of cut does NOT MATTER. They all have negative health consequences. Soooooo…
2. Cut your grass, not your women!!

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Pearls from Other Sessions

1. Need to listen to the community (community empowerment is necessary).
2. The full model of services (FP counseling) needs to occur for women having D+C and MVA.
3. Decentralization is working (cases in communities are up and cases in hospitals, down).

1. Vaccine preventable diseases are under-represented in current and future estimates of causes of child mortality. Take another look!
2. Having a vaccine in the program is just half the battle; the harder half is getting it to those who need it, in good quality.
   
   
   

1. Why the foreskin? "Trojan Horse" phenomenon
2. For roll out of MC services, apply lessons from USC and other programmatic principles.

1. "Marketing" LAPM requires supportive behavior change and promoting services, not just selling a product.
2. No access, no equipment, no trained provider, no product → no services → no program

1. Read the Institute of Medicine report on drug use.
2. Involve sex workers, MSM, and IDU in program development. 
     

1. A cost-effective means to a better end
2. An approach to target the whole family

1. Community-based health insurance (CBHI) has been shown to reduce financial barriers to access for key primary health care services in West Africa.
2. CHBI can be scaled up successfully as in Ghana and Rwanda.

1. Food fortification is an efficacious and efficient way to increase micronutrient intake, when they are needed, IF based on formal industries. Otherwise, keep trying with dietary supplements, including those mixed with meds ("home fortification").
2. Food fortification, under mass-approach, is cost-effective if price increment is low, amounts of added nutrients are small, and fortificants do not segregate or change the sensory properties of the food vehicle.

1. The private sector is an important source of health care at all levels.
2. Quality Improvement experience in the public sector needs to be adapted to special issues of the private sector.
3. Even in the absence of formal training and supervisory structures, quality can be improved.

INITIATE

1. If I had a magic bullet…it would be the Microbicide (Bill Gates, 2006) is now a widely held view favoring an HIV prevention method that can be used by women.
2. Women are already taking 'cides to prevent HIV transmission, at least in clinical trials, with results in 2007-2008.
3. Ensuring ACCESS to the best products now and in the future will require continued research and funding for production and introduction.
   
   
   
   
   Maternal Anemia
   Phil Harvey
   
   
   1. Anemia in the moderate and mild range is an important risk factor for maternal mortality. Universal iron/folic acid supplementation for pregnant women is an effective program approach. It may be the one exception to the rule that "one size does not fit all."
   2. In developing and evaluating maternal anemia programs, it is essential to distinguish between anemia and iron deficiency anemia. Approaches to reduce iron deficiency such as iron fortification and iron/folic acid supplementation will reduce only the anemia that results from iron deficiency – that is, about half of all anemia.
      
      
    
   Revitalizing Child Survival
   Diana Silimperi
   
   
   1. The interventions to drastically improve child health exist and are known – a core set of six intervention combinations.
   2. Assure that child-focus is not lost in vertically funded or delivered programs.
      
      
      
    
   Against All Odds: Surviving the First Month of Life
   Lily Kak and Indira Narayanan
   
   
   1. All newborns need essential newborn care.
   2. Kangaroo MotherCare is for humans, too!
      
      
    
   Another Poster? How to Program Effective Behavior Change Communications (BCC)
   Elizabeth Younger, Lisa Sherburne
   
   
   1. BCC requires partnership between technical experts who know what will make a difference and participant groups who know what is possible and realistic.
   2. Counseling needs to be reshaped so that the counselor and client have a discussion about what is realistic for the client to do, rather than the ideal that the counselor wants the client to attain.
      
      
    
   The Killer in the Kitchen: The Risks of Indoor Smoke and What We Can Do About It
   John Borrazzo
   
   
   (Smoke from cooking)
   1. Indoor air pollution kills twice as many people as outdoor air pollution = ~1,500,000.
   2. Social/cultural context is critical: health is not always the prime motivator to change behavior/stove fuel.
   3. Scaling up requires a commercialization strategy (under development).
      
      
   
   New Evidence Ensuring Strategic Use of M&E Data
   Charles Teller, Edward Abel, Shannon Salentine, Scott Moreland, Nicole Judice
   PD&L (a.k.a. M&E)
   
   
   1. ENGAGE and EMPOWER champions to demand USEFUL M&E data.
   2. VISIBILITY on BANG for BUCK starts with M&E in program design.
      
      
      
   Diarrhea: Back to the Future
   Diana Silimperi and Emmanuel Wansi
   
   
   1. Diarrheal disease continues to kill large numbers of children, while use of some of the best known treatment interventions may be declining.
   2. Zinc is an effective adjunct to ORS/ORT. It decreases the duration and severity of diarrheal episodes and confers a preventative effect on diarrhea and pneumonia for two to three months after treatment.
   3. Zinc should be promoted in conjunction with ORS/ORT and should not be delivered as a vertical intervention.
      
      
    
   Update on Obstetric and Traumatic Gynecologic Fistula Programming: Voices from Guinea
   Joseph Ruminjo, Patricia McDonald, Lucy Wilson
   
   
   We talk about fistula as something happening to "women," but each woman is an individual with a story to tell: Mouima, Koumba, and Odia.
   Fistula repair centers bring them together as a community of women, supporting each other, being healed.
   
   
   "Testing" the Limits: HIV Counseling and Testing in Clinics, Communities, and Beyond
   Alison Surdo
    
   Consent
   Confidentiality
   Counseling
   Referrals
   Rapid testing
   
   

    

   Strategies for Building RH/FP Champions: The Role of Private Midwives

   Mary Segall and Meaghan Smith
   
   

   1. Lack of access to credit and lack of business skills is an obstacle for the growth of private midwives' practices.
   2. Improving the quality of private midwives' practices can be done effectively through professional associations, networks, and franchises.
      
      
      

    

   Prescriptions for Development: Health Linkages with Other Development Objectives

   Forest Duncan and Kelly Saldana
   
   

   Better Health: A prescription for:

   • A more productive economy
   • A more democratic society
   • A better governed nation
   • A more peaceful world

   However, we are still searching for the "pharmacies" in which to fill these "prescriptions."

   
   

    
   

   Saving Mothers: Evidence and Issues

   Mary Ellen Stanton and Barbara Deller
   
   

   1. The chance of a woman dying as a result of pregnancy is 150 times greater in Sub-Saharan Africa than in the US. This is the health indicator with the greatest disparity between the developed and developing world.
   2. Postpartum hemorrhage (PPH) is by far the biggest maternal killer, responsible for greater than 30% of maternal deaths in Asia and Africa. PPH is PREVENTABLE!
      
      
      

    

   Billions Available in Health Care – Can Managers Use It Effectively?

   Joseph Dwyer and Sylvia Vriesendorp
   
   

   1. Leaders are NURTURED not BORN.
   2. Physician Heal Thyself: leading and managing begins at home.
      
      
      

    

   Using What Works – Key Best Practices for Family Planning Programs

   Elizabeth Warnick and Jason Smith
   
   

   1. Great technologies and innovations are nothing without field-tested perceptions.
   2. Perception is reality if you want to get practices adopted. People support what they help to create.
      
      
      

    

   Cost-Effective Health Investments: The Biggest Bang for the Buck

   Fariyal Fikree and Ramanan Laxminarayan
   
   

   • CVD is the leading cause of death worldwide, but….
   • Nutrition is THE leading risk factor.
   • You don’t have to be rich to be healthy…
   • Provided you spend wisely and target cost-effective interventions to move forward.
   • Get to FMS and PRSPS?
   • Get B&MG to keep financing.
   • Keep DCP alive and look at the effectiveness of global programs.
   • Produce a “unifying” piece.
      
     
     

    

   Contraception: The Best Kept Secret in HIV Prevention

   Heidi Reynolds and Rose Wilcher
   
   

   1. Remember the number 173,000. (This is the number of HIV+ births that are currently being prevented annually in sub-Saharan Africa by using contraception.)
   2. Who is listening?
   3. M&E needed.
      
      
      

   Preventing Sexual Risk Behaviors among Young People: More Evidence on What Works
   Shanti Conly
   
   

   (Pearls in Verse)

   1. SCALE UP NOW (school-based, mass media, health service) /
      Interventions for youth that WHO says are a “GO!”
   2. Since any one behavioral intervention has effects that are modest in size, /
      LINK these interventions so our impact we can MAXIMIZE