Drinking Our Own ORS

(This is a reprint of a post I wrote for my Global Health Basics blog, which it turns out I have neither the time nor the technical prowess to maintain.)

In social media, they talk about eating your own dog food. In global health, I think the equivalent would be drinking our own Oral Rehydration Solution (ORS). We need to do a lot of that. It’s important to think about what we ask of people because it gives us a much clearer sense of why we get ignored. Here’s the starter list for how to drink your own ORS:

1. Drink an entire glass of ORS from a packet every time you get the runs, not the tastier homemade kind. Don’t take Imodium.

2. Boil and cool all your water before drinking it.

3. Never spend a single cent on a treatment or cure that hasn’t been proven to work. No vitamin C for a hangover, no Preparation H, no Neosporin on your cuts.

4. No antibiotics when they aren’t strictly necessary. That means nothing for your bronchitis or your child’s ear infection.

5. Use a condom every single time you have sex, even with your spouse, even if your spouse doesn’t want to.

6. Take your child to the doctor immediately if she is showing any of the IMCI warning signs, but don’t take her if she is less sick than that.

7. Breastfeed exclusively until six months, and continue breastfeeding until at least age 2. If you have to work, then express milk by hand into a jar and store it in a cool place. But never feed your child with a bottle. Use a cup and spoon.

8. Choose your food on the basis of what is cheapest and most nutritious, without regard for flavor or cultural tradition.

9. Don’t see the doctor you are most comfortable with; instead, see the doctor that your government recommends.

10. When caring for your sick child, don’t follow the advice of your mother or mother-in-law. Instead, follow advice from a government doctor you may only have met once.


(No antibiotics for her! photo credit: rabble)

Arguing against innovation

Well, I didn’t win the CSIS Smart Global Health Essay Contest, possibly because I argued against innovation in a contest that was explicitly looking for new ideas. I liked my essay, though, so I am sharing it here. CSIS was asking how the US government should spend their money on global health, and specifically looking for new and exciting ideas.

An Argument Against Innovation

Now is not the time for programming innovation. Instead, we should focus the next fifteen years on expanding the programs that work. Innovation is aimed at system-changing efforts that will lead to huge success or major failure; that’s not what we need right now. US government resources are not limitless, and we have a deep body of research in what works in global health. We have highly effective programs that are begging for funding; that is where our money should go. The government is well suited for the role of supporting boring but effective health interventions.

Global health research is full of solid, evidence evidence-based interventions that have been proven to improve health. These include increasing access to contraception, increasing vaccination coverage, home visits by nurses or community health workers, and strengthening primary health care and training health care providers in Integrated Management of Childhood Illness (IMCI). These are many effective pilot projects – proven to work – that have not been broadly implemented. Three examples:

Incorporate IMCI into physician and nurse education in every developing country. IMCI prevents stunting, promotes breastfeeding, and gets mothers to support child development by talking to their children more. It provides inexpensive, effective care for children. We know how train health care works in the strategy, and we know how to include it in medical education. The only thing stopping global adoption is money.

Meet the unmet demand for contraception. Studies have shown that giving couples access to contraception reduces child mortality rates, maternal mortality rates, and deaths from unsafe abortion. Letting women control their fertility also helps to promote gender equality and improve a family’s income. And contraception can be provided by trained health workers; a physician is not needed.

Put more resources into tropical diseases. Onchocerciasis control is a demonstrated success story, but 18 million people are still infected with the nematode that causes it. The African Programme for Onchocerciasis Control seeks to control the illness through universal treatment by 2010, but it will require financial support to keep providing the necessary drugs.

If we want to innovate, we should innovate with our funding models. The United States should start a fund that is devoted to supporting pilot projects that want to expand their reach. That would be an effective counterpoint to the many funding programs that provide “venture capital” for innovative efforts. Governments, NGOs, or UN agencies could apply for funding to scale up pilot programs with a certain number of years of experience, and a certain level of proven effectiveness.

Individuals and foundations love to fund innovative ideas; exciting new programs are easily marketed to foundations and philanthropic individuals. The Gates Foundation, for example, has a clear focus on innovation. In contrast, there is an important role for the US government in supporting the interventions that have been proven to succeed.

The American government doesn’t need to sell its ideas to fickle donors or get intensive publicity for the work it does. Instead, it can commit to the slow and steady underpinnings of global health. It’s good for global health efforts to have reliable donors supporting programs that work, and it’s good for American taxpayers to know that their money is going to projects that will definitely have an impact in improving global health.


photo credit: LaniElberts

Looking for a few good questions

Based on a couple of emails I’ve received recently, I want to start a Q & A feature on this blog. I’ll answer readers’ questions about international development, both theory and practice. If you’ve ever wondered exactly what IMCI stands for, or why it’s a good strategy, now is your chance to ask. What’s the difference between a PSC and a PCV? What is “do no harm”? I’m at your disposal. If I can’t answer your question, I’ll find someone who can and make them write a guest post.
Just post in the comments on this entry or drop me an email at alanna.shaikhNOSPAM@gmail.com. (For the uninitiated – take that NOSPAM out of the address.)