A Global Health Revolution: Expanding Access to Basic Care

Posted by on August 22nd, 2014

A Global Health Revolution: Expanding Access to Basic Care, Pt. 1–
The need for essential surgery to ensure healthy and vibrant communities worldwide

By: Myra Donnelley; @EniwareMyra
Company: Eniware; @Eniware

“Surgery is the neglected stepchild of global health.” ¹
 - Paul Farmer, Chairman of the Harvard Medical School Department of Global Health and Social Medicine and co-founder of Partners in Health

Essential Surgery

What is “essential surgery”?

Essential surgery refers to simple procedures that produce a big “bang for the buck” in regards to the death and disability that can be avoided without a large drain on limited resources. Generally, four basic types of surgeries are considered “essential”: 4

(a) injury care for lacerations/cuts, burns and broken bones to save lives and prevent disability

(b) emergency childbirth care including C-sections and repair of birth-related injuries to preserve maternal health and reduce maternal/neonatal mortality

(c) treatment of life-threatening abdominal conditions such as hernias and appendicitis

(d) procedures to correct or prevent disability including repair of birth defects such as cleft palate and clubfoot, removal of tumors and growths, and simple eye and ear surgeries to prevent blindness and deafness²

Surgery as a global public health “solution”

Access to basic surgical care is a human right and an economic necessity. Somewhere between 11 and 25% of the global burden of disease– more than twice the burden of HIV/Aids, Malaria and TB combined – is addressable by these simple, essential procedures. Likewise, “estimates of the disease burden addressable by vaccination are coincidentally similar to current estimates for surgery.”⁴ But while billions of dollars have been spent and laudable gains have been made in the field of global disease prevention through vaccination efforts, global support for surgical treatment of injury and disease has lagged far behind. Now, largely because of successful public health interventions, the global burden of infectious disease is shrinking and the burden of non-communicable disease (NCD) is growing. With surgical conditions comprising a significant proportion of NCDs and the global burden of NCDs growing year by year, access to basic surgical care is now more urgently “essential” than ever.

Access to essential surgery is Extremely Far Behind

In the 2008 Lancet article, “An Estimation of the Global Volume of Surgery”, the authors estimated that 234 million surgeries were performed annually. Of these 73.6% (more than 172 million procedures) were performed for the benefit of the richest third of the world’s population. Only 3.5% were estimated to benefit the poorest third of the world’s people. ³

But isn’t surgery expensive?

Recent studies have helped explode the widely-held, but mistaken belief that surgery is too expensive to be an effective global health strategy. A 2014 review of 26 studies measuring cost-effectiveness for seven categories of basic surgical interventions found that, “nearly all studies showed the same result: surgical interventions are cost-effective or very cost-effective.” For example, the cost-effectiveness of surgical circumcision (for HIV prevention) was similar to that of standard vaccinations and of bed-nets for malaria prevention, both widely regarded as low-cost, high return interventions. Likewise, the C-sections were found to be more cost-effective than multi-drug anti-retroviral treatment of HIV, a similarly well-regarded, public health intervention seen as money well-spent. The article concludes that “data from these studies lend support to the conclusion that a subset of surgical interventions compares very favourably (sic) to accepted health interventions in low-income and middle-income settings.”⁶

How can we make essential surgery more widely available?

Thank you for asking. We will answer that question in Part 2 of our blog under the SOCAP community discussion “Healthcare Innovators”: see “Eniware’s portable, power-free sterilization for medical instruments and other disruptive healthcare solutions igniting healthy and vibrant communities worldwide”

https://www.youtube.com/watch?v=P7P6ecl9N7c

1.http://news.harvard.edu/gazette/story/2010/11/where-surgery-is-lacking/
2.http://www.ncbi.nlm.nih.gov/books/NBK11719/ Debas, Haile T. , Richard Gosselin, Colin McCord, and Amardeep Thindin, “Chapter 67 – Surgery”, Disease Control Priorities in Developing Countries. 2nd edition, Jamison DT, Breman JG, Measham AR, et al., editors. Washington (DC): World Bank; 2006.
3.http://www.thelancet.com/journals/lancet/article/PIIS0140673608608788/abstract Although published in 2008, global surgery figures are for 2004. In 2013, The Centers for Disease Control reported that 51.4 million inpatient surgeries were performed in the US alone. http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm This does not include outpatient, or ambulatory, surgeries; in 2006, the most recent statistical year available, there were reported to be 24.7 million of these outpatient procedures in the US. http://www.cdc.gov/media/pressrel/2009/r090128.htm
4.http://www.who.int/bulletin/volumes/86/8/07-050435/en/ Other experts estimate the global burden of disease treatable by surgery to be as high as 25%, making surgical conditions more than twice as economically and medically impactful globally as HIV/Aids, Malaria and TB combined. (see citation #6)
5.http://www.givewell.org/international/charities/vaccination-organizations
6.http://www.globalsurgery.info/wp-content/uploads/2014/01/Cost-Effectiveness.pdf

 

Multilingual Leadership: Cracking the Code

Posted by on August 22nd, 2014

By Cathy Clark, Jed Emerson and Ben Thornley

Screenshot 2014-08-22 16.08.59Last year at SOCAP, we had the privilege of sharing the high-level findings from our Impact Investing 2.0 research project, which included a dozen case studies of outstanding funds and the core elements that enabled them to succeed.

Those elements included the critical role of “Catalytic Capital” (i.e., investors who use their capital to spur others to action), the relatively consistent approach of funds to developing a strong “investment thesis of change” as a top priority before focusing on financial discipline in deployment and tracking impact rigorously throughout (something we called “Mission First and Last”), and the deep engagement of all funds in public policy, which we called “Policy Symbiosis.”

These are all essential ingredients in impact investing; however each and every one of them hinges on our fourth core element – “Multilingual Leadership.” It isn’t enough to deeply understand the needs of people with no access to water in Africa, and it isn’t enough to be a hotshot asset manager with 20 years of Wall Street success, or a connected policymaker who understands how to get things done in Washington. The core practices that lead to success in impact investing are inherently cross-sector and complex. Notwithstanding the many other well-documented barriers to scale in impact investing, like the lack of deal-flow, data, proven performance, intermediation, or market infrastructure, we have come to believe the single biggest barrier to the growth of successful social finance is that we, as people, need to catch up. Our educational systems are siloed and our career paths are as well. To succeed as an impact investor, an innovative entrepreneur or a builder in the new impact economy, you must be a multilingual leader, period.

So, what is Multilingual Leadership and how do you master it?

Multilingual Leadership is the science of concurrently approaching investment (or social entrepreneurship or government for that matter) from a business, non-profit/philanthropic, and public policy perspective at all times, and implementing systems to ensure this is not just an individual but an institutional practice. It is awe-inspiring to witness what is so clearly the way of the future when impact organizations such as Accion Texas, Aavishkaar, Bridges Ventures, Calvert Foundation, Elevar, Microvest, RSF, SEAF and many others seamlessly talk about their work as being unremittingly financially-driven (business speak), but with a clear logic model moving the needle on specific social/environmental challenges (non-profit/philanthropy speak), while addressing systemic market failures (public policy speak).

The individuals who run these funds often have uniquely multilingual experiences. For example, Gil Crawford, the CEO at MicroVest, was trained at Chase Manhattan Bank after working for the Red Cross and the US State Department, founded Seed Capital Development Fund, a US-based nonprofit that created financial instruments and attracted funds to capitalize microfinance institutions, and worked for the Latin American financial markets division at the International Finance Corporation (IFC). These are the four main industry competencies we found again and again in our research: finance; non-profit; government; and international development.

But Multilingual Leadership extends beyond simply individuals to institutions as well. Bridges Ventures in the UK is majority owned by its senior management team, but with the nonprofit Bridges Charitable Trust holding a substantial minority ownership interest, with control over any change to the firm’s founding commitment to raise only funds with both financial and social goals. The Bridges team also donates 10 percent of their own profits to the trust’s philanthropic activities, which are targeted at financial support for social issues that cannot be resolved by market-type investment capital.

It’s one thing to document Multilingual Leadership, however, and another thing entirely to develop and cultivate it – which is the shift in emphasis for the three of us at SOCAP this year.

In our Peer Workshop late Thursday morning, “Becoming a Multilingual Leader,” we will experiment with a live training, with most of our time spent in small group discussions facilitated by a group of expert “coaches”, such as Tina Castro from Avivar Capital (formerly director of mission-related investing at The California Endowment), and Christine Looney, a senior program investment officer from Ford Foundation.

Based on a pre-conference survey of people joining the session, we will assign participants into small groups that illustrate and test the different types of approaches inherent in multilingual leadership, drawing out the need for a reinvigorated emphasis in impact investing on education, stakeholder alignment, communication, and field building. And while our workshop will ask participants to take the point of view of an investor, we are certain that the lessons of Multilingual Leadership will be just as relevant for entrepreneurs, journalists, and others trying to crack the code of impact investing to achieve their ends.

We all have much to learn and should rally to that opportunity if we are to capture the full potential before us—whether we work on the ground, or mobilize and deploy capital, to enable greater impact in the communities and world we each care so much about!

 

Check out the  “Becoming a Multilingual Leader” panel at SOCAP14! 

Remembering Priya Haji

Posted by on July 16th, 2014

priya-haji

 

The SOCAP community is deeply saddened by the passing of entrepreneur Priya Haji. Priya was CEO & co-founder of both SaveUp and World of Good, an online wholesaler of sustainable goods. She was a respected voice in social impact and we have been honored to work with Priya since the first SOCAP conference in 2008.

We know Priya’s great work will continue through the countless lives she touched. A fund has been started by Future of Fish Founder Cheryl Dahle for Priya’s two young children.

 

 

 

 

Health Intervention in Public Schools

Posted by on June 24th, 2014

By: Stephanie A. Whyte MD, MBA; Chief Health Officer, Chicago Public Schools

Prompt: Given your role in the Chicago Public Schools, the SOCAP community will most benefit from learning about the challenges that face the public school system, and its direct relationship to the health of the students. Specifically, we hope to learn from the successes (and failures, if relevant) of implementing health-based initiatives. 

In 2012, Chicago Public Schools (CPS) in collaboration with the Chicago Department of Public Heath hired the district’s first ever-Chief Heath Officer.  The primary charge was to build the infrastructure to remove health-related barriers to learning.  Research shows and most people will agree “Healthy students are better learners.” But how does one promote and prioritize health and wellness in a system whose main objective is to educate students?

From the onset, it is necessary to make the connection between student health and academic success.  For example, students who are more fit perform better academically (Grissom, 2005); students miss 51 million hours of school annually due to dental problems (Surgeon General’s Report 2000); and experts agree that 80% of what children learn is processed through the visual system. Quite simply, if little “Johnny” cannot see the blackboard (or smart board as the case may be) he will certainly struggle with reading and literacy.

Whyte

The state of Illinois mandates vision and hearing screenings for select grades of students annually as well as a comprehensive vision exam for kindergarten students.  Over 30,000 Chicago Public School students failed their vision screening last year.  Once a child fails a screening, it is the responsibility of the parent to seek further evaluation. One of the systems of support that Chicago Public Schools has in place is a comprehensive vision exam program in which schools have the option to visit a year-round CPS partner-ran vision clinic or receive school-based services at their school.  With the school-based option, optometrists arrive with all equipment in tow to provide services to students’ thereby creating access to care and removing vision as a health obstacle to learning.

The impact of this program on student achievement is heralded in the true story of little “Johnny” (not his actual name) below:

A Chicago Public School opted into the school-based vision exam program and its school nursetargeted students who failed the vision screening, were kindergarten students and/or were recommended by the teacher for evaluation.  A visit to the school from a vision service provider ensued and little “Johnny” a kindergartener received his state mandated exam.   Prior to this exam, “Johnny” had an individualized education plan (IEP) with a diagnosis of borderline autism.  During his comprehensive exam, it was noted that “Johnny” had rapid intermittent eye movements, he was referred for specialty care where it was also noted that he had headaches due to light sensitivity and problems with visual processing and tracking.

whyte 3

“Johnny” was prescribed tinted eyeglasses that “slanted” his world and a visor.  The change was almost immediate!  After receiving the eyeglasses, “Johnny” performed much better in school.  He no longer required an individualized education plan and was perceived to be a completely different student by his teacher.  “Johnny” progressed so well that he was subsequently tested for and enrolled into one of the district’s regional gifted centers.

Whereas, the impact of this story is profound; it reinforces that “healthy students are better learners.”  Health can be a barrier to learning but once identified and treated, unexpected gains and results can ensue.  Of note, the Mayor of Chicago has since expanded this school-based vision model, which is expected to serve 45,000 Chicago Public School students in 2014.

Whyte 2

For those of us in the trenches, it is a serves a wonderful reminder that we must treat and teach the entire child and leverage all of resources to ensure their success.  As we respect the role of the school as the hub of the community, we must strengthen the relationships and engagement of all stakeholders.  And in this age of innovation, we must consider those who are not traditionally seated at the table for inclusion in the discussion.


Tune into conversations with Dr. Whyte at the SOCAP Health Conference, June 25 + 26.
Checkout the free conference livestream sponsored by the CDC. 

Best Addressed by a New Yorker

Posted by on June 24th, 2014

By: Marla E. Salmon, ScD, RN, FAAN; Professor at University of Washington

I received an invitation from Divya Chandran to contribute to the SOCAP Health blog. It read: Given your expertise on the practical and sociopolitical aspects of nursing, the SOCAP community will most benefit from learning about why nurses are a necessary, powerful voice in discussions surrounding health solutions….”

I accepted, because I think it’s a topic well worth discussing.

My sole regret is that this blog isn’t being written by Lillian D. Wald, a New York social entrepreneur and nurse who understood SOCAP before it was even a concept.  I’ll do my best to channel her, nonetheless.

First, an introduction to Lillian D. Wald, excerpt from the Henry Street Settlement website* (1).

.…In 1893, after witnessing first-hand the poverty and hardship endured by immigrants on the Lower East Side, she founded Henry Street Settlement. She moved into the neighborhood and, living and working among the industrial poor, she and her colleagues offered health care to area residents in their homes on a sliding fee scale. In addition to health care, Henry Street provided social services and instruction in everything from the English language to music. 

Wald quickly came to devote herself to the community full-time. By 1913, the Settlement had expanded to seven buildings on Henry Street and two satellite centers, with 3,000 members in its classes and clubs and 92 nurses making 200,000 visits per year. The Settlement offered an astonishing array of innovative and effective social, recreational and educational services. 

As headworker of Henry Street Settlement until 1933, Wald drew from global intellectual currents of reform — especially networks of women and Progressives — as she integrated her Settlement into powerful political networks for social change. During her 40 years at the helm, she established herself as a courageous national leader in campaigns for social reform, public health and anti-militarism, and as an international crusader for human rights.

…Wald was also an advocate for children, labor, immigrant, civil and women’s rights. She helped institute the National Association for the Advancement of Colored People, the United States Children’s Bureau, the National Child Labor Committee and the National Women’s Trade Union League. A champion of local causes such as Seward Park’s playground and global issues such as bans on child labor and access to health care, Wald encouraged all citizens to act on their own responsibility to all of humanity.”

*The Henry Street website is great to visit– so is going in person to the Henry Street Settlement in NY.

New York Visiting nurse taking a shortcut over tenements, late 1800’s

picture 1

Lillian D. Wald, social entrepreneur and nurse, 1867 – 1940

 picture 2

* * * * *

 

My take on Wald, nursing, and the SOCAP community:

Wald thought being a nurse helped in her work. “…I rejoiced that I had a training in the care of the sick that in itself would give me an organic relationship to the neighborhood (2).  She also knew that being a nurse did not mean going it alone.  Wald inserted herself in a much larger landscape of business, philanthropy, politics, the arts to get her work done.  What Wald added to the community development and health equation is still relevant today.   She demonstrated the value of nurses as:

 

  • Community connectors:   Wald knew that working effectively in and with communities requires knowing and valuing the people who live there.  Nurses are important members of virtually every community – they are the “first to step up” volunteers, and the informal resource and go-to-family member for health information and support.  The trust that nurses inspire, their connections, and their expertise enable them to make connections that are key to effective health-related community development.

 

  • Investment & health improvement opportunities: Nurses bring value to health services innovation through their expertise, flexibility, human connection, and relative cost.  Nurses are involved in innovations that are improving health and wellbeing in communities around the world, reaching underserved communities, addressing health disparities and providing accessible, high quality services to people in need.  Whether functioning as employees or owners/operators in health-related enterprise, nurses are an essential to building healthy communities.

 

  • Partners and collaborators:  Building partnerships in the SOCAP community is not easy – the work is complex, the critical partners have often never worked with one another and often speak different languages (professional and every-day).  It helps to have experts involved who also have the ability to reach across boundaries and make and connections with others.  Relationships are at the core of good partnerships and collaborations.  Nurses do this every day in so many different settings – bringing the human dimension to the table, bridging differences, and building common ground.

 

  • Advocates for social justice and improving the health and wellbeing of others:  It’s probably safe to say that making real differences in the lives of others is a common motivator for people who work in the SOCAP “space”.  Social justice and improving the health and wellbeing of others are closely aligned values and are at the heart of nursing. Individual nurses can make important contributions to advancing these aims as professionals, citizens, and partners. Nursing as a profession brings significant power in number and political voice, which drives  progress at local, state, and national levels.

 

* * * * * *

 

That’s it – the beginning of a conversation and my turn to invite you to add your voice…

Forces impacting the health of children, early 1900’s

 picture 3

 

Tune into conversations with Marla at the SOCAP Health Conference, June 25 + 26.
Checkout the free conference livestream sponsored by the CDC. 


 

  1.  http://www.henrystreet.org/about/history/lillian-wald.html
  2. From Lillian Wald, The House on Henry Street: Henry Holt and Company, Inc, 1915