Who Are the Health Eight (or H8)?

And why should we care?

The Nieman Global Health Fellows had lunch with Bill Hsiao last Thursday for a wide-ranging talk about global health. Our journalists' ears perked up when he said that eight big global health groups have organized themselves into something akin to the G-8 alliance of world's biggest economies. Hsiao is a favorite amongst the Global Health Fellows because he speaks forthrightly, clearly and on the record.

Here's what the Norwegian Foreign Ministry has to say about the H-8:

Health 8 (H8) is an informal group of eight health-related organisations, WHO, UNICEF, UNFPA, UNAIDS, GFATM, GAVI, Bill and Melinda Gates Foundation, and the World Bank created in mid-2007 to stimulate a global sense of urgency for reaching the health-related MDGs. It focuses on better ways of working, particularly within institutions, which can lead to the MDGs being achieved more quickly. And it has a remit to ensure systematic and robust knowledge management and learning around the MDGs, and to seize opportunities presented by renewed interest in health systems.

That last part--about health systems--turns out to be key. Hsiao says that there's an ongoing tussle in the global health community over whether to emphasize the shortage of health care workers or the need to strengthen the health systems those doctors, nurses and others should be working in. This is not merely an academic exercise, Hsiao says. It could well determine what health strategies the real G-8 takes on at their next meeting in Tokyo in July.

And as anyone who has covered global health for at least half a minute knows, once a grand strategy gets adopted, whatever money there is often gets diverted in that direction.

Related blog posts:
How Big a Problem is the Brain Drain?

Related external links:
Why Japan sees global health as a good foreign relations initiative
Preparing for the G-8 summit in Tokyo
The health experts of the G-8 meet the H-8

Rwanda: From Genocide to Malaria Progress

Congrats to Jeb Sharp, whose Rwanda series won a Sigma Delta Chi award for feature reporting from the Society for Professional Journalists. Listen to Jeb's piece about the heartbreaking aftermath of the genocide and then marvel at Rwanda's recent successes in improving the health of its citizens. The combination of bed nets and artemisinin-based anti-malaria drugs has cut the country's death rate from malaria in half, according to the World Health Organization. Now Rwanda is expanding its anti-malaria campaign to rural areas.

Oh yeah, and happy World Malaria Day.

Related posts:
Rwanda's Agnes Binagwaho on Brain Drain

Can Malaria Be Eradicated?

Agnes Binagwaho on Brain Drain

Every time I meet Agnes Binagwaho, I am struck by her lightness of spirit. There’s usually a hint of mischief in her voice—even when she’s addressing an overflow crowd at Harvard’s School of Public Health, as she did yesterday afternoon.

That’s quite a contrast with her life’s work, which is fighting HIV in Rwanda. Dr. Binagwaho is the head of Rwanda’s national AIDS program. But when she returned to the small African country in 1996, just two years after the genocide, she told us she nearly packed her bags to go back to France. The drugs to treat AIDS were too expensive. Women died in childbirth for “entirely stupid reasons” Binagwaho recalled. “The first week I was back in Rwanda was the worst year of my life,” she continued. “I saw more deaths in one week than I had seen in five years as a pediatrician in France. I nearly packed my bags to go back. There were no resources. Everyone was dying.”

I can’t imagine what would have happened if Binagwaho had turned back. Neither apparently, could a young woman in the audience, a nurse from Rwanda who is now living in the US. It was an extraordinarily poignant moment when this young woman took the microphone and thanked Binagwaho for staying in Rwanda, for helping to bring anti-retroviral medicine to that country and for helping to insure that they are distributed and used properly. Binagwaho was quick to say that she hadn’t done it alone, that many people in Rwanda have worked to make the national AIDS program a success. And that they were now tackling other health issues.

For me, though, it was another illustration of the complexity of the brain drain issue. Binagwaho returned to Rwanda—and is helping to create the conditions that will allow more doctors and nurses to stay. But there was no recrimination for the young nurse who had left. Binagwaho understood far too well why someone might feel compelled to leave.

Related post:
Lament From a Public Hospital in Malawi

Related External Link (updated):
Health Care and Economic Development in Rwanda

Nurses in Malawi, Botswana and Kenya

Several articles from allAfrica.com about nurses and other health workers in Malawi, Botswana and Kenya have caught my eye this morning. They underscore how often the human element is overlooked in global health in favor of inexpensive drugs or technological solutions. Dealing with people may be harder but you cannot avoid it.

Malawi. Low pay isn't the only issue contributing to the emigration of nurses from poor countries to rich ones. "There are just too many patients, too few nurses, too few hands," writes Dorothy Ngoma of the National Organization of Nurses and Midwives of Malawi. "You get frustrated, you don't have enough drugs, protective wear, even things like health insurance for the nurses and health care workers. It is all those things that are pushing the nurses out." (See also this two-minute video of Ngoma talking about the view from Malawi.)

Botswana. The government has started paying more money to civil servants with scarce skills but has decided nurses don't fit that category. The Nurses Association of Botswana has called an emergency meeting to see what they can do to change the Botswana government's decision.

Kenya. There's plenty of blame to go around, says Dr. Peter Ngatia, in this brief opinion piece on how to address the global shortage of health care workers. In the case of sub-Saharan Africa, Ngatia singles out not just the donor community but also national governments for not spending more money to train, absorb and retain health care workers.

Related blog posts:
Shifting Focus on Malawi's Nurses

How Big a Problem is the Brain Drain?

Spinning Avian Flu, Climate Change

Despite the blogosphere's reputation for ill-considered punditry, some sites do in fact provide the long view on subjects like climate change and avian flu.

Health and climate change. The Pump Handle concludes that "pathogens may not even be the biggest health problem climate change brings . . . Farming will become harder due to hotter, drier conditions . . . so we’ll probably see more widespread hunger and malnutrition."

Spinning Avian Flu. "The most unsettling thing to us is when 'experts' tell us to 'remain calm.' " Revere wishes the international health community would stop worrying about panic over the newly confirmed case of human-to human transmission of H5N1 in China and just give us the facts.

Related stories:
Editing the CDC on climate change
Bird Flu: How Much Fear is Healthy? (an article I wrote for TIME)

Jeb Sharp Looks at War and Sexual Violence

Jeb Sharp, a radio journalist at The World, is now blogging about two topics: how wars end and sexual violence in conflict. Sharp writes she became interested in the latter topic "after meeting rape survivors from Darfur in the refugee camps in Chad last August."

Along with my fellow Nieman fellow Walter Ray Watson, Jeb has given me some great tips on audio reporting. (Walter is also teaching a journalism class at Harvard's extension school this summer.)

I'm eager to try my hand at all this while in Malawi on my nurses' project. Of course, if I mess up, it's most assuredly NOT Walter's and Jeb's fault. There's a lot to learn and, most of all, practice.



Related stories:
Amy O'Leary Teaches the NYTimes about Sound
Do-It-Yourself Journalism

Abortion and Database Censorship

Score one for list-serv journalism. Looks like the folks over at SLA-DBIO and MEDLIB-L uncovered a major case of censorship. The Popline database, which Johns Hopkins University maintains for the U.S. government, was reconfigured some time in the past few weeks so that searches of the term "abortion" yielded no results.

The official explanation from the database managers: "We recently made all abortion terms stop words. As a federally funded project, we decided this was best for now."

The news quickly swirled around the blogosophere and then on to the traditional media, which is still how most of us learned about it, I bet.

In response, Johns Hopkins decided to reinstate "abortion" as a search term in the Popline database. Very 1984.

Gorman to Speak at Weatherhead Seminar

Adil Najam, Phil Hilts and I will be co-panelists on Tuesday, April 8 from 4-6 pm at Harvard's Weatherhead Center. Our topic is "Rethinking the United States Behavior in the World: The Role of Global Health." The address is 1737 Cambridge Street, Room N-262.

Najam is an associate professor of international negotiation and diplomacy at Tufts.

Hilts is the incoming director of the Knight Science Journalism Fellowships at MIT.

Here's the official Weatherhead post about the seminar.

Gapminder, Worker Safety, Pandemic Absenteeism

Visualize This! The INFO Project notes that Gapminder is now available through Google Spreadsheets.

Workplace Safety. Over at the Pump Handle, Celeste Monforton is "ready to start a petition drive to bring Jerry Scannell back as the head of OSHA in the next (D) or (R) Administration!"

No-shows. Revere looks at new laws that would penalize health care workers who refuse to show up at work during a pandemic.

Cell Phone Journalism in Zimbabwe

Another example of how cell phones and text messaging are transforming public discourse and civic engagement.

AfricaFocus reports that "a late change in [Zimbabwe's] electoral law had resulted in the public posting of results in constituencies around the country, and that this had made it possible for unofficial counts to speed around the country by text message, email, and mobile phones."

And now the New York Times is reporting that Mugabe may be on his way out.

Related stories:
How Not to Repair Zimbabwe's Health Care System
Radio Plus Cell Phones Beat Low-Cost Laptops