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Global Health: 11 to Follow in 2011

Family planning: Happy Birthday, Pill!

In 2010, “the pill” turned 50, providing the opportunity to reflect on the history and importance of family planning. Birth Control Pill Turns 50: 7 Ways It Changed Lives, in US News and World Report, acknowledged that “the pill opened the door for other hormonal birth control methods,” including Depo Provera injectable, the progesterone-releasing intrauterine device, skin patches and vaginal rings, and leads to lower rates of unplanned pregnancies and abortions[1].

When the pill was “born” in 1960, only about 10 percent of couples used contraception; today, about 63 percent do. However, worldwide, 215 million women want to use contraceptives but don’t, for a multitude of reasons, including lack of information and lack of access to services.

We are encouraged that the Global Health Initiative highlights family planning goals, which are: “Prevent 54 million unintended pregnancies by meeting unmet need for modern contraception. Contraceptive prevalence is expected to rise to 35 percent across assisted countries, reflecting an average 2 percentage point increase annually. First births by women under 18 should decline to 20 percent.”

How will the U.S achieve these goals without proportionate funding? In 2010, the U.S. government appropriated $648.5 million for family planning[2]—and $5.7 billion for HIV/AIDS, which doesn’t include contributions to the Global Fund. US bilateral funding for international family planning assistance has declined by about $100 million since 1995. We hope that, in 2011, the GHI will start to make good on its promises to invest significantly in family planning, and prioritize it among its maternal and child health goals.

Malaria: quality care means more attention to diagnosis

More good news in health this past year: the World Malaria Report 2010 shows that in 11 African countries, the malaria burden has dropped by more than 50% since 2000. The under-reported part of the story, it seems, is that the decrease in incidence rates means that how we respond to and treat malaria needs to change rapidly.

Initial community-level successes in treating malaria, like IntraHealth’s work in Rwanda and Senegal, were based on presumptive treatment, or assuming that every child with a fever who did not have other symptoms was presumed to have malaria, and treated with antimalarials. The 2010 malaria report declared, for the first time, that “everyone with suspected malaria has a right to a confirmatory diagnostic test.” The report says that fever can no longer be equated with malaria, and that “inexpensive, quality-assured rapid diagnostic tests . . . can be used all the way down to the community level.”

The use of rapid diagnostics can not only save the unneeded use of hundreds of thousands of antimalarials, but also allow for better surveillance. National malaria control programs, donors and implementers need to respond quickly to ensure that rapid diagnostic tests are in the hands of those who need them, and that the frontline workers have the skills to use these tests.

Workforce development: making medical schools more socially accountable

In many countries—including the US—medical schools have traditionally been seen, and treated, as part of the education system, with no real responsibility to serve the greater good of the communities in which they operate or society at large. Often housed within ministries of education, schools have produced doctors, but not always doctors who are ready to meet the needs of the communities they serve.

Perhaps one of the most under-reported global health stories in 2010 was the Global Consensus of Social Accountability of Medical Schools. The Consensus focuses on the responsibility of medical schools—and, by extension, nursing schools and other health professional schools—to improve the health of the most vulnerable. The document has ten strategic directions for schools to become more socially accountable, highlighting improvements needed to respond to current and future health needs and challenges in society, reorienting their education, research, and service priorities accordingly.

As IntraHealth’s Kate Tulenko, who participated in the development of the Consensus, wrote last year in Foreign Policy (Countries without Doctors), medical and nursing schools in the US also need to change. Medical and nursing schools in the US are “turning away tens of thousands of qualified applicants for lack of places and funding to accept and train them.” Reversing this trend in the US would “take years of building new medical schools, particularly in areas where there is already a shortage of doctors.”

» Next 9–11: Non-communicable diseases: a new MDG? | Country ownership: let’s get real | Americans supportive of global health

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[1] According to a 2009 Guttmacher Institute study

[2] Including a $55 million contribution to UNFPA