There are exciting new developments in the fight against malaria. More attention must be paid to mental illness around the world. Finally, a community-based program out of Senegal is stamping out female genital cutting, and the model should be developed to be scalable and replicable for areas where the practice endures.
Malaria Developments: As fellow Foreign Policy Association blogger Cassandra Clifford writes, a new malaria vaccine in phase three trials from GlaxoSmithKline has shown promising results. The vaccine, currently named RTS,S, provides 47% protection against severe malaria in children. Although this is not a slam-dunk, it is heartening news. The WHO and PATH have also released a report (PDF) projecting that one-third of countries with endemic malaria will eliminate the disease within ten years. Reuters has the short version. Of course, there is more to be done. An editorial in The Economist points out that “eliminating malaria in a stable country is dramatically easier than doing so in a turbulent one.” Unfortunately, endemic malaria and unstable regions sometimes go hand-in-hand. Furthermore, the editorial reminds us that this discovery comes at a time “when global health programmes must compete fiercely for cash.” On the bright side, anti-malaria efforts have the support of the Bill and Melinda Gates Foundation, the largest private foundation in the world.
In The Huffington Post, Ms. Gates discusses the importance of social media and new technologies in fighting malaria. She writes that social media has helped raise awareness in donor countries about malaria and that community-based efforts have helped curb the epidemic. Ms. Gates cites the Lalela Project’s Night Watch campaign as a positive example. Night Watch releases 30-second nightly reminders on television, radio, and by SMS to sleep under treated bed nets in Cameroon and Senegal (with programs opening soon in Tanzania and Chad). The reminders are read by local celebrities. Although it seems unclear from the website how much of an effect the reminders are having (I suspect it might be difficult to measure such an impact), this is a cheap, simple, locally-based innovation that has the potential to be replicated and scaled broadly. All-in-all, it’s nice to report on something hopeful in the global health community for once.
Global Mental Health: In 2007, The Lancet published a series of papers on global mental health. Now, the journal has pulled together a follow-up series. The UN’s humanitarian news agency, IRIN, has a good overview. Although mental illness makes up almost 14% of the global disease burden (see here), in high-income countries only a third of people with mental illnesses receive treatment. In low- and middle-income countries, that rate can be as low as one in fifty, or 2%. The former rate is unacceptable and the large gap represented by the latter rate is unconscionable. As Dr. Julian Eaton et al. discuss in their paper, there are significant barriers to implementing and scaling up successful mental health programs, including little reporting and baseline data, lack of political will and funding, and social stigma. They suggest that decentralizing mental health services and decreasing the focus on institutionalization of people with mental illnesses would be better solutions than large mental health hospitals in major urban areas (which is supported by medical evidence). They also point out that mental health professionals are scarce, but their suggestions for task-shifting and decentralization do not address the problem of overburdened and overworked health care professionals across the board in many lower-income countries. Unfortunately, as always, the call comes for more funding.
In a commentary in the series, Giuseppe Raviola et al. suggest that the successes in HIV/AIDS care can be adapted for mental health. Many people living with HIV/AIDS have a chronic, if now manageable, illness and have had to face social stigma, functional impairment, and lack of health knowledge. Raviola et al. argue that people with mental illnesses confront a parallel set of issues: a chronic, impairing disease that is stigmatized and about which the public knows little. They assert that mental health programs should borrow from successful HIV/AIDS interventions and build upon existing health structures. This argument holds a bit more water, since it looks to enhance and strengthen efforts that are already underway, instead of constructing entirely new programs. With hope, global mental health can find a funding champion like the Gates Foundation, and the gap in services can be remedied.
Female Genital Cutting in Senegal: The New York Times published an article last Sunday on female genital cutting (FGC) or mutilation (FGM) and efforts to abandon the practice in Senegal. Tostan, a community education program started in Senegal and now operating in ten African countries, implements a health and human rights curriculum at the village level and relies on support from community leaders. At the center of its efforts, Tostan encourages neighboring villages whose youth intermarry to mutually abandon FGC. So far, over five thousand villages in Senegal have committed to ending the practice. As the Times article details, FGC has been an ineffable subject until recently, and efforts to eradicate the practice have been underfunded.
FGC/FGM is a difficult topic. It can be stomach-churning to read about: check out the UNFPA’s fact page if you want to learn more. Understandable vehemence from mostly Western-based women’s rights groups have led to an underground continuance of the practice. It is hard to argue for more measured words (the shift from “female genital mutilation” to “cutting” is a controversial one) in the face of such a practice, which is a clear human rights violation and increases risk to maternal and infant health. Without considered, community-based approaches, however, it will be impossible to end FGC. In my own experience living in Senegal, it was clear that while a village in which I was staying said it was not practicing FGC, the government ban (which is ten years old) was resented, and the practice continued anyway. In the Times article, it is pointed out that the practice is “a convention parents [follow] out of love for their daughters” and due to religious stipulation. Without women and men from local communities speaking out and parents pledging to protect their daughters, FGC will endure in spite of legislation. Tostan’s technique is the right one. Unfortunately, it is also expensive, costing around $21,000 per village for its 2-3 year program. For a successful end to FGC, we will need–you guessed it–more funding and support to replicate Tostan’s program or to develop similar approaches that cost less. For now, however, I hope that Tostan continues to do the work that is needed to eradicate FGC, one village at a time.
Header photo available here, by Pratham Books, CC BY 2.0.
