Monday, 22 August 2011

Harkness Health Care Fellowships - Sept 12th deadline

Harkness Fellowships in Health Care Policy and Practice

The Commonwealth Fund's Harkness Fellowships in Health Care Policy and Practice provide a unique opportunity for mid-career health services researchers and practitioners from Australia, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom to spend up to 12 months in the United States, conducting original research and working with leading U.S. health policy experts.

The deadline for applications from Australia, New Zealand, Norway, Switzerland, and the United Kingdom is September 12, 2011. The deadline for applications from Germany, the Netherlands, and Sweden is December 2, 2011.

Also see their other fellowships

Sunday, 14 August 2011

India - Annual Health Survey of 9 states with worst ill health

Ministry of Health and Family Welfare 10-August, 2011 17:37 IST
Results of Annual Health Survey Conducted in Nine States

Bageshwar in Uttarakhand has reported minimum Crude Birth Rate (CBR) of 14.7 while Dhemaji in Assam has reported the Minimum Crude Death Rate (CDR) of 4.5 as per the findings of the Annual Health Survey (AHS) in 284 districts of nine states. The survey results were released by Secretary, Health & Family Welfare Shri K. Chandramouli at a press conference in New Delhi today in the presence of Registrar General of India Shri C. Chandramouli. The CBR which is measure of live births per 1000 population was maximum at 40.9 in Shrawasti in Uttar Pradesh. CBR in rural areas of districts is generally higher than that in urban areas. CDR which denotes number of deaths per 1000 population was also maximum in Shrawasti at 12.6. Further, rural death rate in districts is significantly higher than the corresponding urban death rate. Low female death rates have also been observed as compared to male death rates.

Infant Mortality Rate (IMR) which denotes the number of infant deaths (age below one year) per 1000 live births has been reported to be minimum at 19 in Rudraprayag in Uttarkhand while in Shrawasti in Uttar Pradesh it was maximum at103 exhibiting a variation of 5 times. Six districts namely Purbi Singhbhum & Dhanbad (Jharkhand) and Chamoli, Rudraprayag, Pithoragarh & Almora (Uttarakhand) have already achieved the UN Millennium Development Goal (MDG)-4 National target of 28 by 2015. Another 4 districts viz. Bokaro & Ranchi (Jharkhand) and Bageshwar & Nainital (Uttarakhand) are in closer vicinity. Female infants in districts experience a higher mortality than male infants. IMR in rural areas of districts is significantly higher than that in urban areas.

Neo-Natal Mortality Rate (NNMR) measures the number of infant deaths (age below 29 days) per 1,000 live births. Rudraprayag in Uttarkhand has reported the minimum NNMR at 11 while Balangir in Orissa, the maximum at75 showing a variability of 7 times. Out of every 10 infant deaths 6 -7 pertain to Neo Natal Deaths. Rural NNMR in districts is significantly higher than the urban.

Under Five Mortality Rate (U5MR) which denotes the number of children who died before reaching their fifth birthday per 1,000 live births has been reported in Pithoragarh district of Uttarakhand as minimum at 24 and maximum in Kandhmal district of Orissa at 145. More number of females in districts die before reaching age 5 years as compared to their counterparts. In all, 7 districts viz. Pithoragarh, Almora, Rudraprayag, Chamoli, Nainital & Bagheswar (Uttarakhand) and Purbi Singhbhum (Jharkhand) have already achieved the MDG -4 National target of 42 by 2015. Another 10 districts viz. Dhanbad, Bokaro, Kodarma, Hazaribagh & Giridih (Jharkhand) and Kota (Rajasthan) and Champawat, Udham Singh Nagar, Dehradun & Uttarkashi (Uttarakhand) are in closer vicinity. Rural U5MR in districts is significantly higher than the urban.

In order to facilitate direct intervention, the Maternal Mortality Ratio (MMR) measuring the proportion of maternal deaths per 1,00,000 live births has been published for a group of districts. The grouping of districts has been done on the basis of existing administrative divisions (Commissionraits) in the respective AHS States. In all, there are 62 such divisions across 9 AHS States. Among these divisions, the minimum MMR of 183 has been reported for Kumaon HQ in Uttarakhand and the maximum 451 in Faizabad Mandal in UP.

Sex Ratio at Birth (SRB) defined as the number of female live births per 1,000 male live births has been reported the lowest at 764 in Pithoragarh district of Uttarakhand and the maximum 1030 in Moradabad district of Uttar Pradesh. SRB in rural areas of districts is generally higher than in urban areas.

The survey has been implemented by the Office of Registrar General, India in all the 284 districts in eight Empowered Action Group States which include Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Orissa and Rajasthan and in Assam for a three year period of XI Five Year Plan. It has been designed to yield benchmarks of core vital and health indicators at the district level on fertility and mortality; prevalence of disabilities, injuries, acute and chronic illness and access to health care for these morbidities; and access to maternal, child health and family planning services. The objective is to monitor the performance and outcome of various health interventions of the Government including those under National Rural Health Mission (NRHM) at closer intervals through benchmark indicators.

These nine States, which account for about 48 percent of the total population in the country, are the high focus States in view of their relatively higher fertility and mortality indicators. A representative sample of 18 million population and 3.6 million households is to be covered in 20,694 statistically selected PSUs (Census Enumeration Blocks in case of urban areas and villages or a segment thereof in case of villages in rural areas) in these 9 AHS States every year. Even with the present coverage, the AHS is the largest demographic survey in the world and is two and half times that of the Sample Registration System.

The fieldwork for Baseline Survey was carried out during July, 2010 to March, 2011. The first set of data was released today in the form of a State-wise bulletin. These indicators would provide requisite inputs for better planning of health programmes and pave the way for evidence based intervention strategies.

Wednesday, 10 August 2011

Tanzania study shows one in three girls sexually abused

Nearly one third of Tanzanian girls experience sexual violence before they turn 18, a Unicef survey has found.

The figure among boys is 13.4%, says the UN children's agency.

The most common form of abuse is sexual touching, followed by attempted intercourse, it says.

Unicef official Andy Brooks said the survey was the most comprehensive carried out on this issue in any country and showed the government was prepared to tackle the problem.

"Tanzania is the first country with the courage to expose the full extent of child abuse among boys and girls," he told the BBC's Focus on Africa programme.

The survey also found that of those who had sex before they turned 18, 29.1% of females and 17.5% of males reported that their first encounter was unwilling.

This meant they were forced or coerced to engage in sexual intercourse, Unicef said.

Tanzania's Education Minister Shukuru Kawambwa said the government was determined to end sexual abuse.

It would set up reporting mechanisms for abuse victims and would urge teachers to take care of vulnerable children, he said.

Mr Brooks said similar surveys would be carried out in Kenya, Rwanda, Malawi, Zimbabwe and South Africa.

Tanzanian girls risking rape for an education

Friday, 5 August 2011

Ethiopia 'using aid as weapon of oppression'

A joint undercover investigation by BBC Newsnight and the Bureau of Investigative Journalism has uncovered evidence that the Ethiopian government is using billions of dollars of development aid as a tool for political oppression.

Posing as tourists the team of journalists travelled to the southern region of Ethiopia.

We are just waiting on the crop, if we have one meal a day we will survive until the harvest, beyond that there is no hope for us
Villager in southern Ethiopia

There they found villages where whole communities are starving, having allegedly been denied basic food, seed and fertiliser for failing to support Prime Minister Meles Zenawi.

The investigation has also gathered evidence of mass detentions, the widespread use of torture and extra-judicial killings by Ethiopian government forces.

Yet Western donors including Britain - which is the third largest donor to Ethiopia - stand accused of turning a blind eye by continuing to provide aid money despite being warned about the abuses.

The aid in question is long-term development aid, not the emergency aid provided in response to the current drought in Ethiopia and its neighbours in the Horn of Africa.

Government response

Ambassador Abdirashid Dulane, the Deputy Head of Ethiopia's UK Mission, has rejected the allegations saying that the Newsnight/Bureau report "lacked objectivity, even-handedness".

Starving villagers in southern Ethiopia
The team found villagers eating leaves in order to survive

"The sole source of the story was opponents of Ethiopia who have been rejected by the electorate, and time and again it has been shown that their allegations are unfounded".

Our reporters visited one village in southern Ethiopia with a population of about 1,700 adults.

Despite being surrounded by other communities which are well fed and prosperous, this village, which cannot be named for fear of reprisals, is starving. We were told that in the two weeks prior to our team's arrival five adults and 10 children had died.

Lying on the floor, too exhausted to stand, and flanked by her three-year-old son whose stomach is bloated by malnutrition, one woman described how her family had not eaten for four days.

"We are living day to day on the grace of God," she said.

Another three-year-old boy lay in his grandmother's lap, listless and barely moving as he stared into space.

"We are just waiting on the crop, if we have one meal a day we will survive until the harvest, beyond that there is no hope for us," the grandmother said.


In another village 30 km (19 miles) away it was a similar story.

Almost all of the aid goes through the government channels... in terms of relief food supply and some of the safety net provisions, they simply don't get to the needy of an equitably basis
Professor Beyene Petros, opposition politician

There our team met Yenee, a widow who along with her seven children is surviving by begging, eating leaves and scavenging scraps from the bins in the nearest town.

"The situation is desperate," she said. "We have been abandoned... It is a matter of chance if we live or die."

The two villages sit just 15km (9 miles) either side of a major town, surrounded by other communities where the populations are well fed and healthy. They are in desperate need, but no-one is helping.

According to local opposition members they are being punished for failing to vote for the ruling party, the Ethiopian Peoples' Revolutionary Democratic Front (EPRDF), which Mr Meles leads.

Further north a group of farmers alienated by Mr Meles' government met the BBC/Bureau team at a secret location on the edge of a remote village.

One farmer described how he had been ostracised for failing to support EPRDF: "Because of our political views we face great intimidation. We are denied the right to fertiliser and seeds because of political ideology," he said.

'Buying support'

The Ethiopian federal and regional governments control the distribution of aid in Ethiopia.

Professor Beyene Petros, the current vice-chairman of the Ethiopian Federal Democratic Forum, an alliance of eight opposition parties known as Medrek, told our reporters that aid is not distributed according to need, but according to support for the EPRDF:

Meles Zenawi
Ethiopian Prime Minister Meles Zenawi took power in 1991

"Almost all of the aid goes through the government channels... in terms of relief food supply and some of the safety net provisions, they simply don't get to the needy of an equitably basis.

"There is a great deal of political differentiation. People who support the ruling party, the EPRDF, and our members are treated differently. The motivation is buying support, that is how they recruit support, holding the population hostage," he said.

Mr Beyene said that the international community, including the British government, is well aware of the problem and that he has personally presented them with evidence:

"The position of the donor communities is dismissive... they always want to dismiss it as an isolated incident when we present them with some proof. And we challenge them to go down and check it out for themselves, but they don't do it."


The UK International Development Minister Stephen O'Brien issued a statement in response to the allegations raised by the investigation, saying:

"We take all allegations of human rights abuses extremely seriously and raise them immediately with the relevant authorities including the Ethiopian Government, with whom we have a candid relationship. Where there is evidence, we take firm and decisive action.

They raped me in a room, one of them was standing on my mouth, and one tied my hand, they were taking turns, I fainted during this
Ethiopian woman from the Ogaden

"The British aid programme helps the people of Ethiopia, 30 million of whom live in extreme poverty. We demand full accountability and maximum impact on the ground for support from the British taxpayer."

The Bureau of Investigative Journalism and Newsnight also gathered evidence of a crackdown and human rights abuses in Ethiopia's Somali region, the area bordering Somalia and Kenya, also know as the Ogaden region.

Ethnic Somali rebels from the outlawed Ogaden National Liberation Front (ONLF) and Ethiopian government forces have been fighting for control of Ogaden since the 1970s.

The media and most aid agencies are banned from the region.

Ethiopia, one of the poorest countries of the world, is currently suffering from horrific drought.

Many of those fleeing the ensuing humanitarian crisis have headed to Dadaab refugee camp in northern Kenya.

It is the largest refugee camp in the world, and the vast majority of the 400,000 people there are from Somalia, but among them are an increasing number of Ethiopians from the Ogaden.

'Revenge killings'

Abdifatah Arab Olad, an Ogaden community leader, told our reporters that up to 100 refugees are arriving every month with tales of killings and the burning of villages by government troops.

Dadaab refugee camp
Ethiopians from the Ogaden are fleeing to Dadaab refugee camp

"Whenever fighting has taken place between the rebels and the army, for each army member that is killed, the military go to the nearest town and they start killing people," he said. "For each army member killed it equals to 10 civilians losses."

In the corner of a makeshift shack in the camp, an old woman who had arrived from Ogaden three weeks earlier described being arrested along with 100 others in her village.

She said they were taken to a jail where they were locked up in a shipping container, and picked out on a nightly basis to be tortured:

"They beat me then started to rape me; I screamed and fought with them... I tried to bite them... they tied me this way," she said, gesturing to her legs.

"They raped me in a room, one of them was standing on my mouth, and one tied my hand, they were taking turns, I fainted during this... I can't say how many, but they were many in the army," she said.

'Assaulted when pregnant'

Other women in the camp also said they had been arrested and accused of being members of the OLNF.

They included one who said that she was eight months pregnant when she was detained and raped by eight soldiers:

"They were beating me while I was being raped, I was bleeding," she said, describing how one soldier stamped on her stomach and beat her with the stock of his rifle:

"I fell unconscious when I saw my baby... a man jumping on your stomach, you can imagine what happened to the child, very big kicks blows with the back of a gun. As a consequence of that the child died."

We cannot substantiate these individual allegations. But other credible sources have reported similar stories of the widespread use of rape by Ethiopian security forces against women in the Ogaden.

Speaking on Newsnight, Ethiopia's Ambassador Abdirashid Dulane said that the claims of rape and torture were a "rehash" of old allegations that the Ethiopian government had answered time and again.

"The Ethiopian government is governed by the rule of law, and human rights and democratic rights are enshrined in the Ethiopian constitution," he said.

The Hindu : Getting for the poor their due in private hospitals


31 July 2011

The recent direction of the Supreme Court of India to government hospitals in Delhi to refer poor patients to private hospitals gains significance not only as one more pro-poor judicial pronouncement but also because it highlights one of the major contradictions in India's health care service: even as there has been a mushrooming of huge, well-equipped, multi-discipline hospitals in big cities serving the rich, thousands of rural India's poor patients have to go without even a semblance of medical care when they desperately need it.

A two-member bench of the apex court comprising Justice R.V. Raveendran and A.K. Patnayak said that private hospitals would provide the patients from the crowded government hospitals necessary treatment free of cost, pending the preparation of a scheme that would involve private hospitals in treating the poor. It is perhaps to find out how far the private hospitals are right in claiming that if they provide total free treatment to the poor they would become bankrupt. When one of the counsels of the private hospitals told the court that nobody was occupying the beds allotted for the poor, the Bench responded stating, “It means you are not welcoming anybody.”

The Bench was hearing an appeal filed by private hospitals against a 2007 judgment of the Delhi High Court, which directed the private hospitals to ensure free treatment to 10 per cent of in-patients and 25 per cent of outpatients. The High Court ruling made it mandatory for private hospitals on the ground that they had received subsidised land after giving an undertaking that the hospitals they built would provide free treatment to the economically weaker sections of the people.

The Supreme Court directed the Delhi government and the private hospitals to draw the necessary modalities for the purpose. During an earlier hearing of the appeal, the court came down heavily on the private hospitals. Stating that they behaved like “star hotels,” they were highly critical of these hospitals for collecting abnormal charges from the poor. They also took strong objection to their failure to honour their word and violation of the condition that the poor be given free treatment.

The Supreme Court's bold initiative should enthuse social activists, political parties, and the media to carry the message that there is an urgent need to strengthen the public health security system in the country so that deprived sections of the people could have greater access to medical assistance in time. Only recently Nobel laureate Amartya Sen warned that gigantic inequalities in access to healthcare would lead to poor health in general. Commending the splendid work done by human rights activist, Dr. Binayak Sen among tribal people, he said that inequality in access to healthcare was not only bad distribution of the overall health benefits; it also reduced the overall health benefit.

What is the future of epidemiology?

The Lancet 6 August 2011

Raj Bhopal a, Gary J Macfarlane b, William Cairns Smith cEmail Address, Robert West d, on behalf of the Management Executive Committee for the XIX World Congress of Epidemiology

Epidemiology is thriving. The striking features of contemporary epidemiology are diversity, change, and global reach: from society to the molecule, responding to technical advances and changing patterns of disease. The two main challenges are: translating epidemiology into evidence, practice, and ultimately better health; and strengthening epidemiology research capacity, particularly in low-income and middle-income countries.
Epidemiology is confronting old and new threats to human health and wellbeing. Established threats, such as tobacco, alcohol, and tuberculosis, that are controlled in some places are affecting new populations, particularly in low-income and middle-income countries. Further evidence on alcohol consumption and related harms is informing the development of public health policy on alcohol. New threats, such as volcanic ash and Shiga toxin-producing Escherichia coli, are posing new challenges. Re-emerging threats of poliovirus and measles along with neglected tropical diseases1 that affect about a billion people all need to be tackled with epidemiological concepts and methods used in tobacco control. Furthermore, understanding of population change through urbanisation, migration, and ageing, and inequalities arising in modern societies, is critical to epidemiology as a population-based discipline.
Epidemiological methods are evolving through multidisciplinary collaboration with other areas of expertise, including basic sciences, computing, and social sciences. New and improved methods of assessment of exposures, analysis of gene—environment interactions, informatics, biobanking, spatial analysis and graphic presentation, and approaches to mixed qualitative—quantitative methods are emerging from cross-disciplinary working.
Epidemiology is a discipline with a broad international reach where robust evidence can be generated by the application of sound epidemiological methods in a range of different settings using modest resources. Increasing global connectivity has facilitated the development of epidemiology through open access to electronic publication databases, sharing of research tools, and knowledge exchange through interactive websites and discussion lists. Supercourse,2 a dynamic repository of lectures on epidemiology and global health, is an excellent example of this global connectivity.
The International Epidemiology Association's XIX World Congress of Epidemiology3 to be held in Edinburgh on Aug 7—11, hosted by the academic departments of public health in Scotland, has adopted five overarching strategic themes: global problems; chronic diseases; cutting edge methodology; epidemiology and policy; and neglected conditions. Epidemiology and policy is the one theme generating most interest among those attending.
The generation of increasing volumes of evidence by epidemiology is of little consequence unless that knowledge influences policy and practice, in addition to improving our understanding of aetiology and causal pathways. Given that epidemiology needs to be relevant for policy, it needs to be presented in a meaningful way for policy makers. This requires recognition of the different language used by epidemiologists and policy makers, as well as their very different timescales—epidemiologists operate over years if not decades, whereas policy makers make shorter term decisions. Policy makers need to learn more about epidemiological strengths and limitations while epidemiologists need to understand the timescales and cycles in policy making and political processes. Epidemiology also needs to be applied to individual patient care in the assessment of risk at an individual level, tailoring preventive and therapeutic interventions as is increasingly the case in cardiovascular disease.
The second challenge for the future is capacity strengthening. Masters level courses in epidemiology are widely available in all regions through medical schools and universities, often with North—South collaboration. These courses provide an understanding and an appreciation of epidemiological research methods, but it requires doctoral and post-doctoral level programmes to develop advanced and practical research skills in epidemiology. An important challenge for the International Epidemiology Association at both regional and international level is the facilitation of advanced epidemiology training to develop research capacity, particularly in low-income and middle-income countries. The forthcoming XIX World Congress of Epidemiology will be preceded by an advanced course in epidemiological methods. The 1500 Congress delegates will debate the challenges of relevance to policy and practice, and capacity building at a global level.


1 WHO. First WHO report on neglected tropical diseases 2010: working to overcome the global impact of neglected tropical diseases. Geneva: WHO, 2010.
2 WHO Collaborating Center University of Pittsburgh. Supercourse: epidemiology, the internet, and global health.∼super1. (accessed July 18, 2011).
3 International Epidemiology Association XIX World Congress of Epidemiology. (accessed July 18, 2011).