The Secret Behind Rwanda’s Successful Vaccination Scores: When Poverty Can’t Stop You

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THE best medical treatment option in the world can’t save a single patient unless it is delivered at the proper time, with the proper plans and processes in place.
Thats why implementation science for health matters. It can best be described as a collection of principles that, if applied, will ensure the best possible health care is delivered to a specific community. It involves using evidence-based research to identify the obstacles to delivering health services, and the best ways to overcome them. The research must take into account things like geographical limitations, the social and economic make up of a community as well as cultural practices. Once established for one community, the methodology can be reused in others.
Through my own experience as an academic and as former health minister of Rwanda I am convinced that unless we adopt this approach we won’t be able to achieve universal health coverage and other United Nations Sustainable Development Goals. This is particularly true for Africa where health services are stretched because of a lack of resources.
If we incorporate efficient, evidence-based practices into our service delivery models in Africa well save millions of lives, as well as millions of dollars.
A vaccination programme rolled out in Rwanda illustrates what I mean.

THE RWANDAN EXAMPLE
In 2011 Rwanda began a vaccination programme for human papillomavirus (HPV) the most common sexually transmitted disease in the world. 33 countries had rolled out vaccination programmes, but few of them were in developing countries and none were in Africa.
In 2010, when we were preparing our first campaign, Rwanda seemed an improbable candidate for achieving near-universal HPV vaccination coverage. After all, we were ranked the 15th poorest nation in the world. International skeptics argued that developing countries couldn’t manage because of their weak scientific base, poor infrastructure, economic difficulties and overemphasis on curative, rather than preventative, medicine.
At the time even the developed world had achieved only moderate coverage of HPV vaccinations. The US had less than 35% of its adolescent female population fully vaccinated, and France also had a low coverage. If countries like this couldn’t realize HPV universal vaccination roll-outs, how could low and medium income countries manage?
But we weren’t deterred. We convinced HPV vaccine producers to ignore the global disapproval by presenting our evidence-based strategy of how we would roll-out a programme across the country. They listened, and then signed a public private partnership agreement, which funded the programme.
Despite the seemingly impossible odds, Rwanda achieved 93% HPV vaccination coverage within a year of initiating the campaign. The coverage level has been maintained ever since.
What is the secret to Rwandas success? The answer is simple. We put our trust in implementation science.
IMPLEMENTATION SCIENCE IN ACTION
For the rollout we collected evidence, adapted distribution methods to our setting and set clear targets and outcomes.
Every step of HPV distribution was evidence-based. To analyse the cultural implications of our programme, the Ministry of Health conducted a series of interviews and discussions with community members. We set up a task force which included all stakeholders – religious, educational, political, parliamentary, and community leaders – and designed a strategy of nationwide community education to spread awareness of cervical cancer, the benefits of the vaccine, and the proper time to receive it. Since almost all types of cervical cancer are caused by the human papillomavirus, it was important first to explain the link with cancer.
Using the same focus groups, we developed a method of defining and reaching the target population. Since HPV is a sexually transmitted disease, we wanted to vaccinate girls before they became sexually active. The task force researched the proper age bracket for this. Its conclusion was that a school-based vaccination scheme of 12-year-old girls would be most effective. Over 97% of female Rwandan pre-teens are enrolled in primary school and few have sexual intercourse at that age.
Another research component was on the cold chain management. We needed to know how much vaccine to procure, how much storage space and money this would require, how many transport vehicles we would have to mobilise and where to send them. We also drew from our experience in rolling out other vaccination programs to create a rotating decentralized storage system.
Once all the evidence had been evaluated, we put a detailed delivery plan in place. We organised a distribution system to transport the vaccine from the cargo plane, to Kanombe International Airport, to the national warehouse, to the 30 district hospitals, to the 436 health centres at that time, to the primary schools.
We also collaborated with Rwanda’s 45,000 community health workers and all the teachers concerned. They identified girls who were absent from school on the day of vaccination to make sure they were covered too. And teachers were taught how to monitor students in the days after the vaccination so that they could report any adverse side-effects and be a key pillar of the HPV vaccine pharmacovigilance system.
The principles of implementation sciences applied for the success of the HPV vaccination roll-out have been used in other vaccination campaigns. Today in Rwanda we have more than 90% of all children fully vaccinated for 11 vaccines, with an additional HPV vaccine for all girls.

NEED FOR RESEARCH AND EDUCATION

As Vice Chancellor of the University of Global Health Equity in Rwanda we are introducing researchers to implementation science.
Like any science, it requires research. At the moment, the global focus (and therefore global funding) is on clinical research and fundamental sciences. Last year less than 2% of all research grants offered by the National Institute of Health, the largest funder of health research in the world, have been dedicated to implementation science.
But to improve health care we must also invest in implementation research to improve service delivery. Sure, we need basic science to create cheaper, more effective technology. But we also need implementation science to provide cost-effective ways of delivering and promoting universal health coverage.

-This article was originally published on The Conversation.

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Ghana coach Avram Grant: We had to be ‘faultless’ to beat DR Congo

 

 

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Ghana coach Avram Grant says his side had to cut out all mistakes from their previous matches to dislodge 

The Black Stars posted a 2-1 win over the Leopards at the Stade d’Oyem to secure a semi-final berth.

It was an improved performance after losing 1-0 to Egypt last Wednesday in the final Group D match.

“We corrected mistakes we made and in the second period it was totally different,” Grant told reporters after the DR Congo game.

“We played good football. The two goals we scored were fantastic. And when we fell asleep, they (DR Congo) also scored a fantastic goal.”

For more Ghana football news visit www.ghanasoccernet.com

Handing over to Akufo-Addo-led government starts today

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The outgoing John Mahama-led administration will Wednesday morning present its handing over notes containing details about the state of the nation to the incoming New Patriotic Party (NPP) government.

The Transition Team, jointly inaugurated by President Mahama and president-elect, Nana Akufo-Addo, is expected to sit for six weeks from Wednesday.

The meeting will afford the incoming government the opportunity to enquire about matters of national interest from the Mahama administration.

The transition team will meet at 10 a.m. Wednesday at the International Conference Centre to set up the Transitional Committee comprising those of the incoming and outgoing teams.

There would also be the transitional sub-committee on finance, energy, infrastructure, social services, the presidency, etc, presenting their handing over notes to representatives of the incoming administration.

The spokesperson for president-elect Nana Akufo-Addo, Mustapha Hamid, said Tuesday once his team gets the notes they would scrutinise it and ask further questions for clarity as this would be the basis for proceeding on anything.

“Certainly there would be questions that we would need clarifications on, and those questions would be the basis for meetings…we already have a lot of information from various ministries and government agencies and we hope that the notes that we would be given would be consistent with some of the things that we know. Where there are inconsistencies we would ask questions,” he said.

Mr Hamid does not expect any hiccups past transitions have experienced if the teams work with honesty, openness and transparency as said Nana Akufo-Addo said.

He stressed that past traditions did not have a law governing them, unlike the current system where there is a law governing the process adding he has “no doubt this would be arguably the smoothest transition process we are likely to have.”

Story by Ghana | Myjoyonline.com | GN

Donald Trump and Barack Obama to meet at White House

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President Obama is to welcome his successor Donald Trump to the White House for talks aimed at smoothing over the transition of power.

It could prove a difficult meeting with Mr Trump having questioned Mr Obama’s US citizenship and promising to dismantle some of his key policies.

Mr Obama though has said he is “rooting” for Mr Trump after his shock defeat of Hillary Clinton.

Thousands have taken to the streets of major US cities denouncing Mr Trump.

Mr Obama – who for his part had branded Mr Trump “unfit” for office and campaigned against him – urged all Americans to accept the result of Tuesday’s election.

“We are now all rooting for his success in uniting and leading the country,” he said.

The defeated Mrs Clinton also told supporters Mr Trump had to be given a “chance to lead”.

In his victory speech in the early hours of Wednesday, Mr Trump vowed to “bind the wounds of division”, after an acrimonious election contest, and to be “president for all Americans”.

White House spokesman Josh Earnest has insisted Mr Obama will be sincere about ensuring a smooth handover when he meets Mr Trump, although he added: “I’m not saying it’s going to be an easy meeting.”

With the Republicans holding a majority in both chambers of the US Congress Mr Trump has an easier path to pass his laws and scrap key Obama initiatives like his healthcare reforms.

The president-elect will be accompanied to the White House on Thursday morning (1600 GMT) by his wife, Melania, who will have a meeting with First Lady Michelle Obama.

Source: BBC

School ban on pregnant teens divides Equatorial Guinea

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“Pregnancy is neither a crime nor a mental illness,” insists Imelda Bosuala, a 15-year-old who was turned away by her school in Equatorial Guinea after falling pregnant.

When the school term began last month, the government had put in place a new rule — in order to enrol, all teenage girls must take a pregnancy test.

And a positive test means no more education.

Speaking on state television, deputy education minister Maria-Jesus Nkara said the tough new measure sought to encourage schoolgirls to protect themselves against unwanted pregnancies.

A month into the new term, it is still too early to tell how many girls have been affected by the ban in a country where teenage girls come under heavy pressure to start a family.

World Bank figures show that in 2014, the birth rate among Equatorial Guinean adolescents aged 15-19 was 110 in 1,000.

The figure is substantially higher than the global average of 44 per 1,000, but lower than in other African nations such as Niger (204), Mali (175) and Angola (167).

Rights organisations have criticised the authorities for violating the right to education, slamming the measure as another example of repression in this tiny oil-rich nation whose president, Teodoro Obiang Nguema, has ruled with an iron fist since seizing power in a 1979 coup.

Illegal abortion fears

But opinions within the country are divided.

“This is a good decision,” said 13-year-old Sabina in the playground of Bioko Norte high school in the capital, Malabo.

“Coming to class while you’re pregnant shows a lack of respect.”

Even Bosuala herself is in two minds. “Pregnancy is also not a good example to set in the school environment,” she admits.

But French teacher Gerardo Ndong believes the decision was “foolish”.

And Trifonia Melibea, a sociologist and teacher at the National University of Equatorial Guinea, was also dismayed by the decision.

“These adolescents are being deprived of the fundamental right to education. That’s an insult,” she said.

She also warned that the measure could push teenagers into seeking abortions in “inhuman conditions”.

In the former Spanish colony of 800,000 people, pregnancies can be legally terminated only if there is a threat to the health of the mother and with the authorisation of the spouse or parents.

Daughters as ‘trade items’

Efua, whose 14-year-old daughter is expecting a baby, believes the government should open a dedicated school “especially for young pregnant girls” so they can keep up their studies.

Early pregnancies are most common in poor families, where adults might even consider sending a daughter out as a sexual offering.

“Some parents use their daughters as items of trade, asking them to go out with rich men to help the family survive,” said 19-year-old Ana Rita.

Sociologist Martin Ela pointed to increasing pressures from consumerism since oil production began in the 1990s.

“These little girls go out with someone who is able to give them a smartphone because they want to be on Facebook or WhatsApp,” Ela said.

Melibea said teenage girls were particularly vulnerable to pressure.

“In Equatorial Guinea, if a girl reaches the age of 18 without having a child, everybody starts saying she’s barren,” she said.

The high number of teen pregnancies can also be linked to the absence of legislative protection for minors against sexual harassment, meaning abusive men can operate with impunity.

‘Devastating consequences’

Sierra Leone introduced a similar ban on pregnant teens last year, prompting a sharp reaction from Amnesty International.

“Excluding pregnant girls from mainstream schools and banning them from sitting crucial exams is discriminatory and will have devastating consequences,” the London-based rights group said in a study released in November 2015.

“Education is a right and not something for governments to arbitrarily take away as a punishment.”

The report said the prohibition, which was sometimes enforced through “humiliating physical checks”, was likely to affect an estimated 10,000 young girls and risked destroying their future life opportunities.

The ban has yet to be lifted.

Source:Malabo (Equatorial Guinea) (AFP)

I haven’t endorsed NPP – Kwaw Kese

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Ghanaian rapper Kwaw Kese has debunked reports that he has declared his support for the Presidential Candidate of the NPP, Nana Addo Dankwah Akufo-Addo.

Debunking the reports on his facebook page, he told his fans to disregard such publication.

“There is news going around that I have said I’ll vote for a particular political party.

Pls ignore that in the name of God.

I have never said that anywhere and don’t even take part in any voting. This is false news and my team and I are working to sue any blogger or media house reporting these lies.

Get the detailed story via:

http://www.berniceblog.com/2016/09/i-havent-endorsed-npp-kwaw-kese.html?m=1

Visit berniceblog for latest entertainment stories, fashion, music and many more

KENYAN ACTOR PHILIP MUCHIRI SIGNS AS NABA LIFE FOUNDATION AMBASSADOR

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Philip ‘Mentor’ Muchiri, an ambitious, energetic and career minded film producer cum actor who strives to excel in the role he is assigned to, has signed as the Kenyan Ambassador for NABA LIFE FOUNDATION, a registered non-governmental organisation in Ghana.

“I am happy to join NABA Life Foundation as they are implementing great initiatives to help the less privileged in Ghana. I want to be part and will do my best to support an organization that seeks to help the under privileged in the society”, he stated.

Apart from the acting career, Philip Muchiri has developed the passion in giving back to his people, creating a hope for a better today and an even better tomorrow for people especially children.

He said “I will use my influence in Filmmaking to show together we can rise for the better and together we can change the world in our own small deeds of helping each other and caring for the less privileged in our society”.

Philip Muchiri has passion in acting and was involved in script writing, directing, editing and playing lead roles. He also studied digital editing as well and has experience in production and holds a brown belt in Karate.

He has featured in movies like GICAGI, Mtaani, Street Game, The Blessed Child and Boda Boda, among others. He has won several awards including Best Cinematography in Gicagi Film 2014, Best Lead Actor in Boda Boda, Riverwood Academy Award 2015, etc.

MISS WHITNEY TAI IS NABA LIFE FOUNDATION AMBASSADOR

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Whitney Tai, an emerging singer, songwriter, entertainer and designer from New York City has signed as the ambassador for NABA LIFE FOUNDATION, a registered non-governmental organisation in Ghana.

Whitney is an artist looking to give back to the community and help people from around the world gain inspiration and motivation to achieve their deepest, most personal goals.

In January 2014, Tai released her first pop single in collaboration with Sunfreakz, “To Be Loved,” and a remix by Adrian Buster shortly after. The song received Hot Shot of the week on two FM stations in the country of Holland gaining her recognition from DJ’s and producers worldwide.

In April 2015, Whitney dropped her first debut pop alternative album, “Metamorphosis,” written and co­-produced with Billboard chart topping composer, Sunfreakz.

Whitney Tai has been working extensively to give out the best in the music career to her fans all over the world. Her newest EP of 2016, “Forever”, was produced by Billboard producer Spencer Garn, engineered by Morgan Ray Garcia of Upstairs Records.

The entire Board and Management of the foundation wish to say “Ayekoo” to Miss Whitney for joining the team to promote a good cause in helping young people in the country and beyond.

Source: NABA LIFE FOUNDATION

 

Early HIV vaccine results lead to major trial: researchers

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Durban (South Africa) (AFP) – Promising results from an early safety trial with a potential HIV vaccine have paved the way for a major new study, researchers announced at the International AIDS Conference in Durban on Tuesday.

An 18-month trial with a candidate vaccine dubbed HVTN100 drew on 252 participants at six sites in South Africa, one of the countries hardest-hit by an epidemic that has claimed more than 30 million lives worldwide since the 1980s.

The participants fell within a low-risk category for contracting the sexually-transmitted virus, the researchers said.

The trial cleared a key hurdle in the long, three-phase process to test new drugs. In this early phase, the main point is to assess safety, not efficacy.

“We wanted to see if this vaccine candidate is safe in a South African population and if it is tolerable,” Kathy Mngadi, principal investigator at one of the research sites, explained to AFP.

The team also looked for antibodies signalling that the body’s immune system was responding to the vaccine.

The trial built on the foundations laid by a groundbreaking trial conducted in Thailand in 2009, which yielded the world’s first partially effective vaccine, dubbed RV144.

While hailed as a breakthrough, the effect of the Thai course decreased with time, dropping from 60 percent after one year to 31.2 percent after three-and-a-half years.

“RV144 set us on this journey of hope, but also showed us what we still need to learn and accomplish in this field,” said Fatima Laher, co-chair of the HVTN100 trial.

– Next step –

All the study criteria “were met unequivocally and, in many instances, the HVTN100 outcomes exceeded both our own criteria,” added trial protocol chair Linda-Gail Bekker.

The next phase of the trial, dubbed HVTN702, will kick off in November with the recruitment of 5,400 South African men and women aged between 18 to 25 at high risk of contracting HIV.

People are divided into risk categories through criteria that includes their sexual activity.

“We hope to have results in five years, and it is going to be a very exciting five years for all of us because it is the result of many, many years of hard work,” said Glenda Gray, HVTN Africa programme director.

A fully effective vaccine is still a long way off, she cautioned.

But recent studies have shown that even a partially effective blocker could have a huge impact if rolled out on a large scale.

Some two-and-a-half million people are still becoming infected with HIV every year, according to a new study published on Tuesday, even as drugs have slashed the death rate and virus-carriers live ever longer on anti-retroviral treatment.

While the quest for a cure continues, many view a vaccine as the best hope for stemming new infections.

Larry Corey, principal investigator for the HIV Vaccine Trials Network, a publicly-funded international project, said vaccines were barely mentioned the last time the conference was held in Durban some 16 years ago.

“It’s really gratifying now to see how far we’ve come scientifically,” he said.

Last year, billionaire and philanthropist Bill Gates, who spends millions of dollars on AIDS drug development, said he hoped for an HIV vaccine within a decade, as a cure seems less likely.

Angolan court frees 17 jailed activists

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An Angolan court on Wednesday ordered the conditional release of 17 young activists, including a well-known rapper, three months after they were jailed for rebellion against President Jose Eduardo dos Santos.

Most of group were arrested during a book club meeting in June last year where one of the books on the line-up was about non-violent resistance to repressive regimes.

The activists maintained throughout their trial they were peaceful campaigners for the departure of dos Santos, who has been in power since September, 1979 and rules the oil-rich country with an iron fist.

“Release warrants under house arrest were issued on behalf of 17 applicants to be executed from the present day,” the Supreme Court in Luanda said in a statement.

The ruling overturns sentences ranging from two to eight years in prison, which were handed down at the end of a lengthy trial in March amid complaints about political repression.

One of the accused, rapper Luaty Beirao, went on hunger strike for over a month last year to protest against his detention.

Defence lawyer Francisco Miguel Michel said Wednesday he was “very happy”.

“Any court concerned with the application of justice would have ruled the same,” he said, insisting his clients “committed no crime”.

Human Rights Watch researcher Zenaida Machado told AFP the ruling was “long overdue”.

“The order should have been given immediately after the verdict in March… I am satisfied that the Supreme Court is upholding the law of the country,” she said.

AFP