Malaria Control - Staying Focused on Local Communities

As I consider what impact the upcoming Malaria 2012: Saving lives in the Asia-Pacific will have on communities within our region, I am in the process of organizing a month’s worth of anti-malarial drugs for an upcoming trip, one of the few luxuries afforded to me that I would not consider going without. 

Malaria is one of the world’s oldest diseases yet continues to be a major global disease burden with enormous impact on the health and development of almost half the world’s population. Though in general, cases result in uncomplicated disease with a low case fatality rate, it can lead to severe complications, particularly for pregnant women and children. Demonstratively, across the Asia-Pacific there are 36 million cases of malaria every year, with 42,000 fatalities. Despite this significant impact on morbidity and mortality, the real tragedy of malaria is the burden placed on families and the economic growth of developing countries through losses in productivity, education, and the associated health care costs. 

RESULTS' Aldo King (left) and Maree Nutt (right) with the "African Princess" and Roll Back Malaria Ambassador Yvonne Chaka Chaka in Parliament House, Canberra to meet with MPs and Senators on Malaria and other issues.

This is a disease of poverty, mostly affecting countries with limited infrastructure and resources available for malaria control. In endemic countries malaria is a part of everyday life, you do not have to look far to discover the constant impact it has on communities. Some families can spend over a quarter of their income on malaria prevention and treatment. Therefore, aside from the modest goal of saving lives, a real benefit of controlling and eliminating malaria will be a significant improvement to the livelihoods of hundreds of millions of people. 

The good news is that malaria could be controlled for less than one-tenth of the economic losses suffered as a result of death and illness. Malaria control, costing between US $2-24 per disability adjusted life year (DALY) saved, is one of the most cost-effective health interventions. It is also considered one of the most effective strategies for reducing poverty and childhood mortality. So… if malaria is easily treatable and preventable, why does it continue to be a leading cause of morbidity and mortality across the majority world?
Infectious diseases do not respect borders, therefore, a regional approach must be a collaborative long term commitment. Developing countries have by far the largest global disease burden, but also both the lowest incomes and global health expenditure, tackling malaria has to be a responsibility for the entire international community. In the past a combination of political factors and shifting global priorities has meant we have failed to deliver a sustained and collaborative commitment.  Unless we see programs through to the end with necessary scope and coverage, the disease will resurge and all our efforts thus far will be waisted or worse, deadly, demonstrated by the emergence of increasing drug resistance. 

What we often neglect in the struggle to identify global priorities is what malaria control means at the local community level. The reality is that for many communities living in poverty, malaria prevention might not be the highest priority when faced with daily struggles to survive. Reflecting upon my own experiences in malaria endemic regions, and the fact that often effective and readily available interventions such as bed nets can be underutilized, we need to ensure that our efforts within the region combine resources and support with adequate education and awareness activities. 

Malaria 2012 therefore, brings me cautious hope. The increasing priority placed on malaria control globally is very exciting, and for our neighbours in the Asia-Pacific this could mean great things for both their health and economic development. It is pleasing to see Australia take leadership and place importance on this significant disease. At the same time, we need to ensure that recent and ongoing efforts to tackle malaria are sustained and comprehensive, staying focused on the very communities we hope to impact. The goal of saving lives by controlling and eliminating malaria will ultimately benefit us all. 

by Sandra Opoku, RESULTS Melbourne Group

The global TB situation

The newest Global Tuberculosis Report, which was released on 17 October 2012 and is the seventeenth report on tuberculosis (TB), reveals both bright and dark sides of the global TB situation. It is clearly great that we are on track and likely to reach the Millennium Development Goal (MDG) of reducing by half the TB epidemic by 2015. 

Yet the numbers of people infected by TB are still high. Last year 8.7 million people worldwide became ill with TB, and 1.4 million people died because of the disease. The highest numbers of TB cases are found in the South East Asia and Western Pacific regions, where about 60 % of the world's TB cases are located. Additionally, although the numbers globally are going down, seen regionally Africa and Europe are not on track to reach the MDG before its set date of 2015.

AIDS, TB and malaria are the three most deadly infectious diseases in the world today. However, funding for TB is lacking behind compared to the other two diseases. Consequently, the epidemic is becoming increasingly resistant to the few medicines available to fight the disease. 

This critical lack of sufficient funding for TB care and control, is one reason for the high numbers of TB cases, when there are not enough medicines or vaccines provided to the people in need. Also, research and development are held back because of insufficient funding, although there has been progress in developing new medicines and vaccines. 

The Global Fund is a major sponsor of fighting TB, malaria and AIDS, and 90 % of global funding for TB comes from this financing institution, which is one of RESULTS International's partner organisations. 

The annually Global Tuberculosis Report gives a comprehensive and up-to-date assessment of the TB epidemic, and analyses the progress in implementing and financing TB prevention, care and control at global, regional and national levels. This report is helpful for the future work on TB, and important in our struggle to reach the MDGs globally, regionally as well as nationally.

Important days for the future

The International Day for the Eradication of Poverty was marked on the 17th October.  This day is a part of the Anti-Poverty week 2012, running from 14th to 20th October. This is a day than the United Nations General Assembly has designated to promote awareness of the need to eradicate poverty and destitution in all countries. 

This year's Day for the Eradication of Poverty was the twentieth ever, and the focus of the day in the country was on Australia's aid program towards the important Millennium Development Goal (MDG) number one - eradicate extreme poverty and hunger. The aim is to cut by half the global number of the people living under such conditions. 

The theme for this year's day was 'Working together out of poverty', which highlights the need for a truly global anti-poverty alliance. There are different ways of lifting people out of extreme poverty. Some examples are to train farmers in more efficient agriculture, microfinance and financial services to secure poor families' income, provide health services to poor communities, and provide primary education to more children worldwide. 

For Anti-Poverty Week, and the International Day for the Eradication of Poverty our lovely RESULTS supporters at Elanora Heights Public School Ella, Sienna (pictured) and Edita celebrated by educating their school friends about poverty and getting all pupils in year six and many teachers performing a fabulous flashmob dance to a cheering school crowd. They also managed to raise over $700 for RESULTS' ongoing education and advocacy work. Fantastic effort girls, we are so proud of you!

The importance of education was also being emphasised on the International Day of the Girl Child, of which the very first was marked on Thursday 11 October 2012. This day, that is to be celebrated every year on 11 October, is a day to recognise the importance of girls globally, and focus on their rights. The focus of this day's first celebration was to end child marriage.

Child marriage is a fundamental human rights violation in itself. In addition, many more rights are ignored and violated when girls are forced to marry at a young age. Consequently, she is denied a childhood, and her education is most likely disrupted, which limits her opportunities in life, and prevents her in reaching her full potential.  Conversely, girls with little or no education are more likely to be married early.

Early and unwanted pregnancies also very often follow child marriage. This poses life-threatening risks for girls, especially considering that pregnancy-related complications are the leading cause of death for girls in developing countries aged 15-19. Child marriage is a major obstacle for reaching the MDGs, such as improved maternal health, universal education, promoted gender equality, as well as eradicate extreme poverty.

When looking at the age group 20-24, on a global basis today, every third girl was first married before her 18th birthday. The connection between child marriage and education is vital. In developing countries one in four girls does not attend school at all. Also, the drop-out rate of primary school is quite high. There are various reasons for this in addition to child marriage, for example that the family cannot afford to pay the tuition fees, or the family prioritises the boys over the girls. Some girls are taken out of school by their parents because the schools do not have separate toilets for boys and girls.

When a girl receives education of seven years (or more), she will marry four years later and have two less children, than in the case of no education or if she is dropping out during primary schooling. If she receives secondary schooling, she is up to six times less likely to be married before the age of 18.

As the problems of child marriage have so many solutions in education, as well as education has so many repercussions, it is important to continue to focus on primary education in the struggle to reach the MDGs. 

In addition to emphasising the importance of education, there are other focus areas that has proven effective to better and prolong the lives of girls and women. It is vital to continue and expand the work of immunisation of children worldwide. GAVI is doing remarkable work in this area, as the organisation is providing a great part of vaccines to children at risk in developing countries.

Microfinance has also proven to be an effective way of protecting girls and women. But also for this a certain level of schooling is necessary, to learn how to manage a business and money, and to secure work and income. When a mother's income increases, it will have impacts on the whole family. For example, her daughters (as well as boys) will most likely stay in school longer, develop their potential further, and be more responsible. This will also benefit the society, not only the people directly involved. 

It is important to remind the world and state leaders about the unfair inequalities and problems that exist in the world today. Occasions like the Day for the Eradication of poverty and the International Day of the Girl Child are great opportunities for this, and important in the fight of poverty and protection of girls' rights, which are closely related. 

Have a look these fantastic animations - great for kids and adults.

The Girl Effect                                 The Clock is Ticking

Drug resistant TB levels described as alarming by new international study

A large, international study published in The Lancet reveals alarming levels of tuberculosis (TB) that are resistant to both first-line and second-line drugs.

The findings show high prevalence of resistance to at least one second-line drug (43.7%) among multidrug-resistant (MDR) TB patients from eight countries in Africa, Asia, Europe, and Latin America. Worse still, the study found higher than expected overall levels of extensively drug-resistant (XDR) TB.

Extensively drug-resistant tuberculosis (XDR-TB) is a form of tuberculosis caused by bacteria that are resistant to some of the most effective anti-TB drugs.

In the Preserving Effective TB Treatment Study (PETTS), Tracy Dalton, the study’s lead author from the US Centers for Disease Control and Prevention (CDC), says that XDR-TB has been reported in 77 countries worldwide, but the exact prevalence remains unclear.

“Drug-resistant TB is more difficult and costly to treat, and more often fatal," Tracy Dalton explained. 

"Internationally, it is particularly worrisome in areas with fewer resources and less access to effective therapies.  As more individuals are diagnosed with, and treated for, drug-resistant TB, more resistance to second-line drugs is expected to emerge,” Tracy added. 

According to the study, XDR TB was detected in 6.7% patients overall, with prevalence in South Korea (15.2%) and Russia (11.3%) more than twice World Health Organisation's global estimates for the same time period (5.4%).

"There needs to be more investment in research and development for new vaccines, diagnostics and treatments for TB (and MDR-TB)," said RESULTS National Advocacy Director Kate Finch.

"After all, MDR-TB was originally caused by inappropriate or incomplete TB  diagnosis & treatment," Ms Finch added.

Among the study’s other key findings were that risk of XDR disease was more than quadrupled in previously treated patients, and previous treatment with second-line drugs was consistently the strongest risk factor for resistance to these drugs.

Further analysis also found unemployment, a history of imprisonment, alcohol abuse, and smoking as factors associated with resistance to second-line injectable drugs.

"The more cases of MDR-TB that are diagnosed and treated, the more resistance will occur to second-line drugs. This then leads to higher cases of XDR-TB, which is practically impossible to treat," continued Ms Finch.

Recently RESULTS has submitted advice on AusAID's new Medical Research Strategy, which is aimed to help poor countries increase access to health technologies that work, and emphasised the rates of MDR-TB in the Asian region.

"One of the first priorities for the strategy is investing in public-private partnerships for TB R&D," continued Ms Finch.

"This investment will need to be long term and sustained if new products are really to make it through the whole development cycle and to those most at risk.

"It is really encouraging to see AusAID invest in R&D with a focus on poverty-related disease at a time when other governments are pulling back," said Ms Finch.

Significant roundtable meeting on The Global Fund attended by RESULTS

On August 22 our National Manager,  Maree Nutt,  attended a roundtable meeting hosted by Bill Bowtell AO, Executive Director of Pacific Friends of the Global Fund and Andrew Hewett, Executive Director of Oxfam Australia.  Attending the meeting were Global Fund representatives Gabriel Jaramillo, General Manager, Dr Mphu Ramatlapeng, Vice Chair (and former Health Minister in Lesotho) and Dr Christoph Benn, Director, Resource Mobilization and Donor Relations of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Sr Jaramillo, Dr Ramatlapeng and Dr Benn visited Australia to meet with Senator Bob Carr, Minister for Foreign Affairs, other  Ministers and Members of Parliament, bureaucrats, research institutions, the community sector and business leaders to brief them on the Global Fund’s contribution towards preventing and treating HIV & AIDS, tuberculosis and malaria.  

On the Solomon Islands, newly qualified nurse Rose visits a family of 13, where one daughter died of tuberculosis, and three others received treatment and survived. Rose was trained in TB detection, testing and treatment as part of a national strategy to further reduce the TB burden in the Solomon Islands, with support from the Global Fund. Photo: The Global Fund / John Rae.

The Global Fund is a unique, public-private partnership and international financing institution dedicated to attracting and disbursing additional resources to prevent and treat HIV and AIDS, Tuberculosis and Malaria. This partnership between governments, civil society, the private sector and affected communities represents an innovative approach to international health financing. 

Since its creation in 2002, the Global Fund has become the main financier of programs to fight AIDS, Tuberculosis and Malaria, with approved funding of US$ 22.9 billion for more than 1,000 programs in 151 countries. To date, programs supported by the Global Fund have provided AIDS treatment for 3.6 million people, anti-Tuberculosis treatment for 9.3 million people and 270 million insecticide-treated nets for the prevention of Malaria. The Global Fund works in close collaboration with other bilateral and multilateral organisations to supplement existing efforts in dealing with the three diseases.

The roundtable meeting was an opportunity for Australian stakeholders to discuss the work of the Global Fund and what it means for Australia and the Pacific region.

Please click here for a full-report on the Global Fund's regional results report (2011)

Approximately a third of Australia’s total foreign aid funding goes to support multilateral organisations.  The effectiveness of these organisations were reviewed recently in the Australian Multilateral Assessment and though the Global Fund scored highly in the “Results and relevance” category there was room for improvement in “Organisational behaviour”.

Under the leadership of General Manager Jamarillo, the Global Fund has subsequently undergone significant reforms in order for it to be even more effective in its activities as it looks ahead to the next 10 years of operation. The Global Fund executives acknowledged the Australian government, the private sector and civil society organisations such as RESULTS for our partnership and ongoing support.

The Global Fund will be looking to Australia for leadership as it plans for the next replenishment meeting to be held in the second half of 2013. As part of our ongoing advocacy around the Global Fund,  RESULTS staff and volunteers will be raising this issue in meetings with Parliamentarians in Canberra on 29 to 30 October 2012. 

If you would like to join us please contact kate@results.org.au

The Grameen Bank, and Professor Muhammad Yunus, are facing a calamitous crisis

Both have been under attack from the Bangladeshi Government for the past 20 months.

Now the Bangladeshi Government has drafted changes to the ‘Grameen Bank Ordinance (Amendment) 2012' Law (the law that created Grameen Bank in 1983), giving the government the power to appoint the GB Chairman, remove both the current women borrower-owner board members as well as Yunus as Managing Director, thus giving the government total control of Grameen Bank.

Professor Yunus responded: “I request my fellow citizens who are as shocked as I am, to try to persuade our government to realise that this is a very wrong step they are taking; they should refrain from proceeding with this …The decision of the government would destroy this well known bank for the poor, the bank that has made the country proud.”

This innovative compassionate man, Yunus rightly won the 2006 Nobel Prize for pioneering the microfinance system. It offered the poorest around the world - especially women – hope in the form of a tiny loan, to generate an income. He is seen as one of the world's leading anti-poverty activists. We cannot let him be discredited.

As final recommendations and law changes will be released in late August 2012, your action – by this Friday, August 17 - is imperative.

Step 1: Sign this petition that will get sent to the Prime Minister of Bangladesh  

Step 2: Share the petition with your friends via email and social media

2012 RESULTS International Conference

THE RESULTS International Conference is held every year in Washington DC for RESULTS national and international delegates. With six of us from Australia, this was our largest delegation ever!

Because the conference also coincided with the biannual International AIDS conference, the speaker list at the conference was most impressive and included spiritual leader and best selling author, Marianne Williamson, Dr. Jeffrey Sachs (arguably the most influential economist in the world), Dr Mphu Rametlapeng (former Health Minister of Lesotho and current Vice Chair of the Global Fund to Fight AID, TB and Malaria)

(Click to view the full-agenda of the conference)

Some of the highlights for our Australian delegates were:

From Angela Cole, Hobart: 

I was totally inspired by Karen Sichinga from Zambia who said of women in Zambia, "Although HIV is her disease, she is plagued by a greater sickness - poverty. It is this which will kill her. Poverty cannot be treated with bandaids".

From David Bailey, Canberra:

How to describe the presentation at the RESULTS International Conference by Dr Jeffrey Sachs arguably the world's most influential economist?

It  was inspirational and dare I say it’s the best Sachs I have ever had!

From Lili Koch, Sydney: 

I was in a session where The Hon. Bob Bennett (a second generation US Senator from Utah, retired) said that 'RESULTS lobbyists are by far the best and most effective lobbyists in our political system'

This was livery nice to hear, especially when the U.S. spend over THREE BILLION DOLLARS every year on lobbyists and RESULT members do it for FREE!

From Mark Rice Brisbane:
"Overall, the Conference provided a reminder of how much respect the RESULTS Internationalpartnership has from development experts and parliamentarians from different countries.  A favourite session was hearing from first-term parliamentarians from the UK and Canada, who are taking advantage of the freedom of a backbench position to take action (which could also be an inspiration for Australian MPs!)"

Rachel Achterstraat, Sydney: 

The opportunity to connect with different people from all over the globe was an amazing thread woven through the entire International Conference and AIDS Conference.

We met with and heard from seasoned advocates, policy-makers and MP's, people affected by TB and HIV, an African pop-princess and world-renowned academics, all who shared our vision to end poverty and beat TB and HIV, together. 

As I hurried from a meeting at the World Bank to a street mobilisation of thousands of passionate community activists, I was reminded of the universality of our goal and that we must all play our unique part in the fight to end poverty. 

From Maree Nutt, Sydney:

It’s always fabulous to connect with the amazing RESULTS volunteers and staff from around the US and the world.  It’s a great reminder that our work here in Australia is so much stronger because we work together with our RESULTS and ACTION partners from places like Canada, Japan, the UK, Mexico, Zambia, France, India, Kenya and the US.

RESULTS advocates in the US