Thursday, 19 November 2015

HIV/AIDS STILL DESERVES THE FUNDING IT GETS!

What does a disease deserve?
  1. Jocelyn Kaiser
Pressure from AIDS groups such as ACT UP, protesting at the White House in 1987, propelled Congress to begin earmarking research funding for HIV/AIDS. 
PHOTO: © BETTMANN/CORBIS
 
In the early 1990s, as the deadly HIV/AIDS epidemic marched across the United States and the world, lawmakers in Congress and top officials at the National Institutes of Health (NIH) reached an unusual understanding: Roughly 10% of the NIH budget would be dedicated to fighting the devastating disease. Since then, the steady flow of research cash—some $3 billion this year—has helped transform HIV infection from a death sentence to a manageable disease for many people, and some researchers believe they are getting closer to developing a vaccine that could halt new infections.
That special arrangement is now under fire. Health policy experts, lawmakers, and even NIH officials have wondered why, 2 decades after AIDS death rates began dropping dramatically in the United States, the disease still gets a lion's share of NIH resources. As questions have arisen about how HIV/AIDS funds are spent, NIH has also resolved to refocus AIDS money on ending the epidemic. Some voice a broader critique: that NIH's spending on a disease often doesn't align with how much suffering it causes. They note that diseases imposing a relatively small burden on U.S. society, such as AIDS, can get a larger share of NIH funding than those that cause greater harm, such as heart disease (see graph, p. 901). NIH's spending priorities can be “out of whack” says Senator Bill Cassidy (R–LA), a physician who serves on a panel that helps set NIH's budget.
Recently, while responding to pointed questions from Cassidy about the issue, NIH Director Francis Collins said the agency is ready to abandon the 10% set-aside. If Congress follows through on proposals to give NIH a hefty funding boost for 2016, its HIV/AIDS portfolio need not necessarily grow in “lock-step” with the increase as it has in the past, Collins said at a 7 October hearing. At the same time, NIH is taking a broader look at disease spending. Next month officials are expected to release an agency-wide strategic plan that they say will address how disease burden should influence the allocation of research dollars.
The ferment worries AIDS research advocates. “HIV/AIDS research could shrink as a percentage of the total [NIH budget] for the first time” in more than 2 decades, laments Kimberly Miller of the HIV Medicine Association in Arlington, Virginia, which represents health workers who treat HIV-infected patients. Long-time NIH observers also wonder whether the developments signal a re-emergence of the sometimes fierce disease funding wars of the past, when advocates for breast cancer research and other diseases battled for a bigger share of the NIH pie. Already, Cassidy has proposed shifting some AIDS spending to neurodegenerative diseases such as Alzheimer's. 
Some in the biomedical research community, however, welcome these developments. “I'm glad the questioning is happening no matter how annoying it may be to some people,” says Claiborne Johnston, a stroke researcher at the University of Texas, Austin, who has studied disease funding trends. “I hope ultimately that we figure out a way to truly address, through our research and our care, some of these conditions that definitely are neglected.” 
FROM ALMOST THE VERY beginning, NIH's AIDS earmark has created tensions. After activists helped persuade Congress to ramp up HIV/AIDS funding in the 1980s, lawmakers agreed to cap it at 10% of NIH's budget, but keep that proportion year after year. NIH officials argued that AIDS deserved a special allocation because it was a new disease, was still spreading, and had become the leading cause of death for U.S. adults between 25 and 44 years old. Key lawmakers were convinced, and since then AIDS research, which NIH has treated as its own distinct pool of funding, has essentially expanded in sync with the agency's overall budget.
It wasn't long before the deal inspired advocates for breast cancer and several other diseases to publicly argue that those fields, too, deserved large budget increases. Those 1990s campaigns ultimately met with mixed success in Congress. But the so-called disease wars did stir tensions within the large coalition of university, patient, and science groups that advocate for greater biomedical research spending. Those allies traditionally try to present a united front, for fear that internal divisions could fragment and endanger political support for overall NIH spending increases.
Now, that uneasy alliance has again come under pressure as the threat of AIDS has faded domestically. As new drugs made the disease more manageable, the number of deaths directly attributed to HIV plummeted in the United States from 45,000 per year in 1995 to 7000 in 2013. At the same time, some patient groups have recently helped persuade some lawmakers that they should be concerned about the much higher toll of other diseases, such as stroke and diabetes, and the staggering projected costs of caring for Alzheimer's patients. Representative Andy Harris (R–MD), another physician who has taken an interest in NIH policy, noted at a hearing last March that NIH spends 100 times less per U.S. heart disease death than it does per AIDS death. The “stunning” discrepancy “needs to be justified,” he said.
A matter of proportion CREDITS: (GRAPHIC) A. CUADRA/SCIENCE; (DATA) NIH
Many AIDS research advocates and NIH officials continue to defend the earmark, arguing that the global AIDS death rate remains high, and that researchers are making strides toward a vaccine. “I'm looking forward to a time when … we have ended the AIDS epidemic and there won't be any argument about what you want to do with the money, because you won't need the money,” said Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases (NIAID), which oversees about half of NIH's AIDS spending, during a hearing this past April. Robert Eisinger, acting director of the NIH Office of AIDS Research, also notes that the billions spent on AIDS research have produced “numerous crossover benefits” for other diseases—new drugs that treat hepatitis B infection came out of AIDS research, for example.
Yet congressional support for the AIDS set-aside has begun to crack. In a report accompanying the 2015 spending bill for NIH, House of Representatives and Senate appropriators omitted some oft-repeated instructions telling NIH to keep AIDS at 10% of its budget. The omission signaled their desire for NIH to abandon the earmark, says Chris Meekins, a staffer for Harris.
WITHIN NIH, top officials are also scrutinizing AIDS spending, about half of which is doled out by institutes and centers that don't focus primarily on infectious disease. Last year, Collins ordered a sweeping review of the AIDS portfolio. One pilot analysis by NIH staff found a surprise: 15% of grants did not have HIV/AIDS in the title or abstract, suggesting they were only remotely connected to AIDS. That finding added to existing concerns, both within and outside of NIH, that requiring institute directors to spend their dedicated AIDS money can encourage them to look far afield for projects to fund, or force them to lower their standards. At NIH's National Heart, Lung, and Blood Institute, for example, 42% of AIDS grant proposals received funding in 2012, compared with just 18% for non-AIDS projects, Cassidy noted at the October Senate hearing. “They're getting too much money for HIV/AIDS,” Cassidy said. “Can we move money out of that area?”
NIH's new AIDS research priorities
High priority
Vaccines, new therapies, cure strategies, HIV-associated diseases, related basic research
Medium priority
Basic research and projects on health and social issues that “meaningfully” include HIV/AIDS and “will advance HIV treatment or prevention” 
Low priority
Epidemiology of diseases that occur with HIV/AIDS and basic studies on copathogens that are not in the context of HIV infection, behavioral studies where HIV/AIDS is only one outcome 
This past August, in a bid to tighten controls on AIDS spending, Collins announced a revised set of research priorities (see box, right). Vaccines and potential cures are at the top; at the bottom are studies of diseases that sometimes co-occur with AIDS, such as malaria, and basic virology and immunology work that doesn't necessarily include HIV. Also at risk of losing new AIDS funding, the memo suggests, is behavioral research that doesn't focus specifically on AIDS, such as studies of risky sexual behaviors and drug abuse. Although exactly how the new priorities will influence NIH's funding decisions is uncertain, many behavioral researchers are “very nervous,” says epidemiologist David Celentano of Johns Hopkins University in Baltimore, Maryland.
At some NIH institutes, directors have found that disbursing the AIDS money is a distraction from their main mission. Thomas Insel, who stepped down last month as director of the National Institute of Mental Health (NIMH), says he was surprised to realize 3 years ago that the $180 million his institute was spending on AIDS research (12% of NIMH's budget) nearly matched its spending on disorders such as anxiety and schizophrenia. Insel shifted some of the AIDS grants and his HIV/AIDS program staff to NIAID, to ensure better coordination with that institute's bigger AIDS program.
In Congress, some lawmakers are taking direct aim at the earmark. This past summer, during a Senate spending panel debate on NIH's 2016 appropriation, Cassidy proposed taking $235 million out of NIAID's AIDS budget and giving it to other institutes studying neurodegenerative diseases.
The proposal dovetailed with a major push by patient groups to increase NIH funding for Alzheimer's disease, which has helped produce a 30% funding leap for Alzheimer's over the past 4 years. But Robert Egge, chief public policy officer for the Alzheimer's Association, and George Vradenburg, chair of the influential group UsAgainstAlzheimer's, say their organizations did not ask Cassidy to offer his Alzheimer's proposal. 
In the end, Cassidy's measure failed. Still, the move shook the AIDS research community. “To find more money for Alzheimer's you have to cut HIV/AIDS, [that] makes no sense,” says Miller, who is part of a coalition of AIDS groups now lobbying to preserve AIDS funding.
THE DEBATE over how much NIH's spending priorities should reflect disease burden goes back to at least the late 1990s, when The New England Journal of Medicine published an analysis suggesting that NIH wasn't spending enough on certain high-burden conditions, such as peptic ulcers and pneumonia. In a 2011 study revisiting the issue in PLOS ONE, Johnston and co-authors found that diseases with strong advocates (breast cancer, for example) enjoy relatively robust funding, whereas spending lags on those that carry a stigma, such as depression, alcoholism, and lung cancer, despite the higher burden they impose on society. Although “you can't expect a perfect correlation” with funding, says Johnston, “the clearest take-home message is: Some conditions below the line are those where we blame the victim.”
This past summer, for the first time, NIH published its own comparison of health burden and spending. It confirmed that AIDS and cancer receive relatively generous funding, whereas others, such as migraine and chronic obstructive pulmonary disease, receive disproportionately little. An agency official commented on a blog that “we're looking forward to using these analyses as a jumping off point for a larger conversation about priority setting.” And Collins has said in hearings that a new NIH-wide strategic plan due out in December will address disease burden.
Some observers are skeptical that the new plan will have much influence, given the many factors that influence spending, from tight budgets to the power of certain disease groups. And NIH officials caution that, in the end, disease burden data, which have limitations, can't alone be the basis for funding allocations. Institutes must consider the scientific quality of proposals, as well as the need to balance basic and clinical research. They note that it makes sense to spend relatively more on rare diseases that otherwise would be neglected, because they can shed light on common diseases. And infectious diseases can't be funded strictly based on the number of U.S. cases, because it's not possible to predict when viruses such as Ebola and severe acute respiratory syndrome—which have had little impact in the United States—might flare up and cross borders. At the same time, pouring new money into a disease just because it imposes a high social cost can be misguided, NIH insiders say. If the field lacks a critical mass of researchers, or promising research avenues, the money could be wasted.
Johnston and others who call for more attention to disease burden don't buy that. “It's a circular argument,” he says. “Scientific promise happens when you have investments in an area. … If you fund the science, there will be more promise in that area.”
Insel agrees, to a point. He says that when he did a disease burden analysis of NIMH and NIH spending on mental illnesses compared with other diseases, he was struck by how every mental illness was “under the line,” or appeared to get short shrift. This year he shored up funding for the two areas that lagged the most—suicide prevention and eating disorders—in order to stimulate fresh approaches. A decision NIMH made a few years ago to ramp up autism research—amid a push from activists—had convinced him that doing so wouldn't be a waste of dollars where there is “scientific traction.” After the infusion of new funding into autism, he says, “we saw better proposals.” 
Whether that kind of redistribution catches on across NIH remains to be seen. But some AIDS researchers are already resigned to losing their special status, whether the initiative comes from Congress or NIH itself. “For a long time we were the golden child. … We had a 30-year run,” Celentano says. But now, “I think we need to justify better why we should be at the table.”

Wednesday, 18 November 2015

Aligning USAID Funding Targeting Adolescent girls and Young Women; Cues For Local Government Councils In Uganda


SUMMARY:

Local government officials can present over 25 performance indicators below following the use of USAID funds:

1) focus on the poor; 2) improve engagement of the private-for-profit sector; 3) enhance efficiency; 4) strengthen stakeholder coordination; 5) improve service quality; 6) stimulate consumer-based advocacy for better health;  7) programming in maternal; 8) newborn and child health; 9) immunization; 10) family planning and reproductive health; 11) nutrition; 12) health systems strengthening; 13) water/sanitation/hygiene; 14) malaria; breaking cycle of transmission of HIV; 15) pediatric HIV care and treatment; 16) increase in numbers of women attending at least one antenatal care visit with a health care provider; 17) Opportunities for women to deliver their babies with a skilled attendant present will increase; 18) planning meetings on targeted health themes;  19)  identify key persons to contact as far as HIV/AIDS, Adolescent girls and Young Women issues go; 20) develop a community health information management system with vital statistics, targets for treatment, prevention and anti-discrimination; 21) lists of partnerships such as schools, villages, faith-based organizations and traditional healers involved in promoting health;  22) existence of strategic plans at different levels of governance reflecting needs of communities;  23) realizable PEPFAR engagement and an expanded capacity to use Ambassador’s Small Grant Program for advocacy, community mobilization;  24) generating disaggregated statistics giving insight into population demographics and;  25) lists or action plans by Village Health Teams.


Local governments in Uganda can design systems that promote the health and life of adolescent girls and young women (5-24 years). A mental, sexual and reproductive health plan targeting adolescent girls and young women, can be effective if it is integrated with other activities. At a three percent (3%) population growth by 2025, a young population and a high total fertility rate, Uganda’s high population rate will continue to drive health expenditures upwards. Local Governments in Uganda are entities that can mobilize for action through planning and partnerships. This is captured in the Health Sub-District concept bringing essential health services-especially basic surgical and obstetric care closer to the communities. The attendant staffing, infrastructure, equipment and operating costs become resources for promotion of health. A  comprehensive WHO review of Uganda’s Health System conducted in 2011, found that whereas significant efforts are being implemented to qualitatively and quantitatively improve health in Uganda, more needs to be done to a) focus on the poor; b) improve engagement of the private-for-profit sector; c) enhance efficiency; d) strengthen stakeholder coordination; e) improve service quality; and f) stimulate consumer-based advocacy for better health. At local government level there are opportunities to conduct local health assessment and devise community health improvement plans. These local government entities are in a better position to tap into, say, the USAID funding if a focus on quality of care, service integration, and equity are to become a reality. The generated mechanisms and resources at an initial phase may be costly but these costs are reimbursed under the inbuilt cost of doing the U.S. government’s PEPFAR Business (CODB). The critical fiscal space thus created is an opportunity to increase government expenditure on health.  This will in turn create a standardized service delivery across all local government regions. Uganda has a Maternal mortality ratio of 435/100,000 live births. By end of 2015, Uganda needs to reduce that figure to 131/100,000. Poor access to quality maternal care services, is a significant barrier to improving maternal mortality in Uganda. “HIV/AIDS, malaria and respiratory infections are the top three causes of overall disease burden in terms of Disability-Adjusted-Life-years (DALYs) lost,” (Fiscal Space For Health In Uganda).


There are two documents I hope local government planners can use. One is the Country operational plan guidance document provided by USAID, with focus on eradicating HIV/AIDS. It is a comprehensive tool that local council members in Uganda can find useful as they try to utilize PEPFAR funds in a bid to align money in prevention investments. At the local government level, planned and costed investments are called votes, e.g., providing insecticide-treated mosquito nets to a given number of households. In a bottom-up planning, promoted by decentralization, it is possible to harmonize targets for treatment, prevention and anti-discrimination at Local Council I, II, III, IV, V, Town Council, Municipality, Division and district. There are two outcomes that come to mind. One, it will strengthen an existing local public system that ensures health promotion and prevention of diseases. Two, it will critical forces of change at community level with health promotion and prevention of diseases at the planning core.


The second document is the:The Maternal and Child Survival Program (MCSP). MCSP supports programming in maternal, newborn and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. The Program places greater emphasis on key cross-cutting issues such as innovation, e/mHealth, equity, quality, gender, public-private partnerships, and involvement of civil society, community approaches and behavior change interventions. While maintaining focus on the technical high impact interventions, MCSP works toward sustainable scale up to include strengthening the health systems that deliver these interventions. (http://www.mcsprogram.org/). “It is at the heart of improving maternal-newborn health services globally: ensuring care is patient-focused; integrating programs to better serve the needs of mothers and babies; and extending innovative health services to the poorest and most socially vulnerable mothers and babies,” (Bliss, K. 2015). This USAID funding will help local governments mobilize for action through planning and partnerships where a woman in Uganda can seek appropriate counseling and maternal care services in any facility. There will be an increase in number of women attending at least one antenatal care visit with a health care provider. Opportunities for women to deliver their babies with a skilled attendant present will increase.


The health sector at the district and sub district level in Uganda is governed by a district health management team (DHMT). The DHMT is led by the District Health Officer (DHO) and consists of managers of various health departments in the district. The heads of health sub districts (HC IV managers) are included on the DHMT. The DHMT oversees implementation of health services in the district, ensuring coherence with national policies. A Health Unit Management Committee (HUMC) composed of health staff, civil society and community leaders is charged with linking health facility governance with community needs (http://gov.ug/ministry/ministry-health).


USAID funding into a local government budget plan will cause: 1) planning meetings on targeted health themes including national and district indicators (UBOS, 2010)  2)  identify key persons to contact as far as HIV/AIDS, Adolescent girls and Young Women issues 3) develop a community health information management system with vital statistics, targets for treatment, prevention and anti-discrimination 4) lists of partnerships such as schools, villages, faith-based organizations and traditional healers involved in promoting health 5) existence of strategic plans at different levels of governance reflecting needs of communities 6) realizable PEPFAR engagement and an expanded capacity to use Ambassador’s Small Grant Program for advocacy, community mobilization 7) generating disaggregated statistics giving insight into population demographics and 8) lists or action plans by Village Health Teams as a continuum of response who bridge the gap and increase equity in access to health services ( http://www.pathfinder.org/). With the above it is more likely to have information on: voluntary medical male circumcision (VMMC), Test and treat, Viral load, TB/HIV, virology suppression, children health, pregnant women receiving B+, adults on life-saving anti-retro viral treatment, health needs of groups that are higher risk than total population, identified community resources  that support the public health system in promoting health and improving quality of life. A list of themes would be developed, which in turn could be used to assess community health status and community themes. 


Form a team amongst you and check with the US Embassy to see how your local government entity qualifies. A devolved institutionalized public health service is possible in Uganda. Turnock (2015) in “Essentials of Public Health” lists outcomes of deliberate community health improvement plans. I have chosen some points from the long list that I feel would be further outcomes of using USAID funds at a local government level. These are some of the further outcomes: 1) working with policy-makers, promote partnerships, educate, inform, develop policies and plans that support individual and community health efforts and plans 2) Social-community level activity plans 3) Social marketing and targeted media public 4) joint health education programs with schools, churches, Faith-based Organizations, cultural organizations and other entities 5) undertaking health improvement planning e.g., preventive screening, rehabilitation and support programs 6) building coalitions drawing from a wider range of potential human/material resources to improve community health.

REFERENCES:

1. Bliss Katherine (2015). http://www.smartglobalhealth.org/
2. Fiscal Space For Health in Uganda. World Bank Working Paper No. 186 Africa Human Development Series 
3. Government of Uganda, Ministry of Health. http://gov.ug/ministry/ministry-health
4. National Village Health Teams (VHT) Assessment In Uganda. 2015. http://www.pathfinder.org/
5. Statistical Abstract. Ministry of Health. 2010. http://www.ubos.org/
6. Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett.
7. USAID (2015). Country Operational Plan Guidance 2016 – Draft
8. USAID (2015). http://www.mcsprogram.org/our-work/ 

Sunday, 15 November 2015

Important Public Health Pre-occupations in the 21st Century USA

The main role of public health in the 21st Century will be to protect us from various diseases or life threatening conditions deriving from: climate change; emerging diseases; bioterrorism; racism; stigma; prejudice; and political dilemmas. Public health practitioners of the 21st Century must be in position to understand the complexities of cultural diversity, e.g.,different generational, economic, professional, ethnic, religious, linguistic background, gender, gender identity, sexual orientation, stereotypes, prejudices, physical status, conscious bias, unconscious bias, structural bias, enjoyment of access to resources, access to opportunities, access to options, safety from violence,  affordability of housing, civil rights, access to food, access to jobs, opportunities for job trainings, access to recreation and readiness to be  a compassionate provider. Many clients and communities face bias and discrimination when they attempt to access health and social services and , as a result, receive fewer services and services of poorer quality (Berthold, T. 2009). In order to provide public health services, government has concrete plans such as enacting laws, enforce laws, provide financial support and oversight to ensure promotion of health, prevention of diseases and instituting a preparedness mechanism.The most important new or expanded roles for public health occupations in the 21st century will include:

1. Strengthening the public health activities framework that is interlinked by a network of federal, state and local public health agencies with emphasis on referral mechanisms and oversight processes.

2. Ensure a reporting mechanism that dovetails into the overarching design where: the contribution of USA to international health-related interventions continues; the legal foundation gives gives primacy for health concerns to states; allows the federal government to promote consistency and minimum standards across the 50 diverse states; and a practical foundation of LHDs serving as the point of contact between communities and the three-tiered government.

3. Shifting mobilization tasks to advocacy entities at community level as a means of having a pulse on changing needs, resource needs and meeting public expectations.

4. Investing in early warning mechanisms for threats from fires to bio-terrorism. There will be need to have a contingency for fire hazards now that the globe is getting warmer. This will mean wildfire-prone geographical zones like Mid-Western and California will have more established fire departments. The quarantine points at border entry points, airports and ports need to be strengthened now that there is more likelihood for bio-terrorisms, hostility and acts of sabotage against the U.S. or any other nation by terrorists and enemies (www.nytimes.com). 

5. Public health practitioners reaching out to the indigent or marginalized. This will rely on the work of local health agencies. These will in turn report to second tier government levels and different organizations that form the backbone through which the power to protect the public’s health is possible.

6. Providing training and promoting competencies for public health professionals in the 21st century mostly in these areas: conducting essential public health services; legislation; regulation; policies; and the ability to negotiate,  justify public funding for many public health initiatives. For public health to be perceived, such essential services as are relevant: monitoring the health status of the population; diagnosing and investigating problems deemed hazardous to the public’s health; educating the population on health issues; mobilizing communities to act on their own health issues; developing policies; enforcing laws and regulations that protect the public; linking people to health services; ensuring a competent healthcare workforce; evaluating the effectiveness, access and quality of health services and researching to continue progress and innovation in healthcare (Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett).

7. Use of Technology, which will enable complex research to be translated into action in a faster and flexible way. Technology can be used in many other forms as well. One way is establishing a centralized health management information templates that can be used to report for instance compliances to the Healthy 2020 vision and mission. Events in which equity and equality are addressed can be captured at local, state, regional and federal levels. Racial biases are shown to be a part of the social structure of medical practices at both macro and micro levels (Centre for excellence in health care journalism). Use of web-based platforms to share information can help improve on coverage of what works and who is served. Public health will be a means for America to deal with the hot topics that focus on: race, culture, ethnicity, lifestyle, health status and health care in America. This might be the great quest of technology as well. Through technology it will be possible to level the health care playing field. Socioeconomics, individual racism, and institutional racism that represent the three predominant pathways to differential treatment for diseases will be targeted and redress provided. Reporting mechanisms will provide common indicators used to gauge quality of life for women and men irrespective of their gender, sexuality, race and social status.  Compiling reports into a format that can be disseminated to all concerned is another good use of  print technology and the world-wide web. In this format the media can be relied upon to make information available or the applicability of the information by society in form of case reports/studies or any format that is reliable for dissemination. However, newsprint, radio and TV tend to tap into our anxieties focusing on trivia. “The CDC has had to contend with bogus reports of imported banana carrying flesh-eating bacteria, drug addicts placing HIV-infected needles in pay coin-return boxes, virus soaked sponges arriving with the mail,” (Drexler, M. 2010). 

8. Understanding the need for post trauma stress counseling and care arising from the link between terrorism, massacres and resultant traumas. A global nightmare envelopes the world every time wars, genocides and terrorist attacks occur anywhere in the world. The rallying call that brings together nations ready to do rescue activities is to profess solidarity with the suffering nations. Rescue efforts are made by nations. This was seen after September 11, 2001, in UK, in Uganda, in Tanzania, in Kenya and most recently in the 10th district of Paris where the most recent attacks have occurred. The San Francisco editorial has this to say, “France’s loss is our loss. Its grief is our grief. And its fight to counter the forces of inhumanity is our fight”  (San Francisco Chronicle, Editorial, November 14th, 2015). 

9. The effects of political pronouncements such as the recent debate on mass deportations sends trauma shocks to those who are  not documented yet they many have lived in USA all their life and some are employed. These people may end up not attending social services for fear of being hounded and put on hot lists.

 10. Establishing a structure of international partnership to deal with climate change, neglect, poverty and famine  at a global level which in turn make humans and in some cases livestock vulnerable to influenza, Legionnaires’ disease, Lyme disease, toxic shock syndrome, E. Coli 0157:H7, STDs, Ebola virus, AIDS, severe acute respiratory syndrome (SARS), H1N1 influenza (Drexler, M. 2010). 

11. Understanding the increasing relation of chronic low-level inflammation, wide range of common debilitating disorders, stealth infections, deadly sepsis, how to balance use of antibiotics and inflammatory-quashing steroids. Research findings recommend Mediterranean style diet for those suffering from inflammatory disorders (Sachs J.S., 2007).

In the 21st Century, stigma discrimination, bias and prejudice will be the issues that need addressing. This in turn will clear the way for addressing neglect, poverty and famine. In situations where equality, respect and dignity are promoted, proper protection of life and ensuring individual well-being will be achievable.



REFERENCES:

1. Berthold, T. 2009. Foundations For Community Health Workers. San Francisco, MA: Jossey-Bass.
Centre For Excellence in Health Care Journalism. 2006.

2. Drexler M., 2010. Emerging Epidemics: The Menace of New Infections: H1N1 Flu, SARS, Anthrax, E.Coli.Penguin Books.

3. http://www.nytimes.com/2015/11/15/world/europe/strategy-shift-for-isis-inflicting-terror-in-distant-lands.html?emc=edit_th_20151115&nl=todaysheadlines&nlid=60949333&_r=0

4. Sachs, J.S. 2007. Good germs,Bad Germs: Health and Survival in a Bacterial World. New York, NY: Hill and Wang.


6. Turnock, B. J. 2016. Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett. 


Saturday, 14 November 2015

Interpreting Health Metrics From a Public Health Perspective; Case of USA and Uganda

All countries have a Public Health Provision Model that combines maximizing individual positive outcomes as well as minimizing adverse collective outcomes. The countries promote population-based activities, monitor health status, investigate health problems and hazards, inform and educate people about health issues, mobilize communities, develop policies and plans, enforce laws and regulations for the wellness of their citizens.

To promote public health practice, medical health practice and long term care practice that in turn ensure quality life, these countries invest money of different amounts. They commit resources which cause health outcomes. However, the social-ecological factors in these countries make it a unique framework within which to provide public health and medical health services. Biologic, environment, behavioral, social, cultural and health services available in a given country in turn affect the well-being of the citizens.  These in turn affect the impact of the strategies or interventions. 

The US has a population total of 320,051,000. Its total expenditure on health as a percentage of GDP for the year 2013 was $ 17.1, a total expenditure on health per capita for 2013 at $ 9,146 and life expectancy of males at 76 and females at 81 (www.who.int/countries/en/).  It has committed over 15 million workers in the Public Health workforce and $ 3.0 trillion in resources. The public health needs presently facing the US include: slowing population goeth rate, and older population, increasing diversity of population, changes in the family structure, a persistent lack of access to needed health services for many Americans and relative prevalence of particular diseases (Turnock, B. J. 2016).

On the other hand, Uganda has a population total of about 37, 579,00, its total expenditure on health as a percentage of GDP for the year 2013 was $ 9.8 a total expenditure on health per capita for 2013 at $ 146 and life expectancy of males at 57 and females at 61 (www.who.int/countries/en/). faced with lukewarm commitment in funding the health sector. The funds keep vacillating below or above $294,117, 000 as in the case of 2011. This amount is far below what the international ceiling ( e.g., Abuja Declaration) calls for.  Uganda still battles parasite infestation e.g., malaria-causing mosquitoes.  Plans to commit to eradicate malaria are half hearted pronouncements made at electoral campaigns most of the time. “The Government also committed itself towards developing and implementing a comprehensive strategy to eradicate malaria and strengthen its prevention, diagnosis and treatment. It also committed itself to reduce morbidity and mortality from the major causes of ill health and premature death,” (www.newvision.co.ug).

In order for public health to be a collective effort that promotes quality health outcomes, countries need to back public health initiatives with a funding commitment and not just lip service. Public Health Provision can be effective if it combines maximizing individual positive outcomes as well as minimizing adverse collective outcomes. 

REFERENCES:

http://www.who.int/countries/en/
Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett.  


Thursday, 12 November 2015

Campaigning and Elections in Uganda November 2015- April 2016

Quick Facts About Uganda Following the On-going Election Campaigns 2015-April 2016



1. Four major candidates have the logistics to move around Uganda: Incumbent/President Yoweri Kaguta Museveni NRM Flag-bearer; Colonel( Ret.) Dr. Kiiza Besigye FDC Flag-bearer; Former Prime Minister, Amama Mbabazi TDA Flag bearer and Dr. Abed Bwanika PDP Flag bearer

2. Four other candidates are still having problems moving around the country: Mr. Mabirizi J.,  Ms. Kyaalya Maureen, Major ( Ret.) Benon Biraro and Professor Barya Venansius.


For more read:

http://www.elections.co.ug/new-vision/election
https://en.wikipedia.org/wiki/Amama_Mbabazi
http://www.elections.co.ug/new-vision/election/1408157/kyalya-left-sh300m-job-contest-presidency

Enjoy!!