The Blue Dye Innovation that Makes Disinfecting Health Facilities More Effective and More Visible

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by Jason Kang, Co-founder and CEO, Kinnos

In 2014, I co-founded Kinnos in response to the West Africa Ebola crisis. At the time, one of the biggest problems contributing to high rates of infection was ineffective surface decontamination caused by human error and gaps in training.

Disinfectants like bleach are transparent, making it easy to miss spots; hydrophobic, making it bead up and roll off the surfaces it’s meant to disinfect; and only effective if used for a specific contact time, meaning healthcare workers must ideally wait for a certain period for pathogens to be inactivated. These problems are universal to disinfection in facilities outside the scope of epidemic outbreaks.

Highlight, our patented additive, colorizes the disinfectant so that users can easily see where it has been applied. Highlight modifies the liquid properties to eliminate droplet formation and improve adherence to surfaces. The color fades as the contact time needed for the disinfectant to work passes, indicating when decontamination is done.

To put this into context, our time at the Ebola Treatment Unit in Ganta, Liberia, was particularly memorable – I remember the intense heat and how incredible it was that staff were wearing layers of stuffy, personal protective equipment for 4 to 6 hours at a time. However, this also meant that they were only too eager to remove their protective gowns and coveralls, often not waiting the requisite contact time for the disinfectant sprayed on their protective garments to work.

Combined with the inherent difficulties of achieving full coverage with bleach, we quickly understood why health staff were up to 32 times more likely to be infected with Ebola than the average person.

When healthcare workers started telling us that Highlight was making them feel more confident in their own safety and easing their stress in such high-risk situations, we realized that our technology was tapping into an invaluable resource: peace of mind. Interacting with the healthcare workers who had volunteered to put themselves directly in danger to help others was humbling and inspiring, and doing our part to make their lives even a little bit better was incredibly motivating.

The breakthrough that Highlight represents – the ability to overcome training and language barriers to empower health workers and those who clean facilities with a feeling of confidence through disinfection they can see – can have a profound impact in reducing healthcare-associated infections globally as part of the BASICS solution. In our mission to prevent infections and improve patient safety, we have not forgotten about the people who are tasked with the important step of disinfection.

In addition to our humanitarian focus in low- and middle-income countries, Kinnos is working to radically reduce healthcare-associated infections and the prevalence of antimicrobial resistance within the U.S. healthcare system.

We’ve partnered with leading medical organizations to pilot our technology in hospitals, ambulatory surgical centers and other facilities. It’s a sober reminder that infections affect society at large and are an urgent global problem that require a concerted effort to solve.

The fact that someone today can receive a life-threatening infection from a place where they expect medical care and treatment is unacceptable, and we are motivated to make this a problem of the past.

Historically, so many resources have been devoted to diagnosis and treatment, even though it’s recognized that prevention is key to sustainable healthcare. We always knew that surface disinfection was only one key part of the larger infection prevention ecosystem, so having the opportunity to enact a system-wide program with the rest of the BASICS team is extremely exciting to me.

The world has been waiting too long for an initiative like BASICS to set the standard of infection prevention.

The Beauty of a Community Coming Together at the Border: An Emergency Responder Shares Her Story

Save the Children and GSK have been global partners since 2013 and have worked together in the U.S. since 2015. Together, our two organizations are helping children, with GSK providing corporate and employee donations to directly aid children. Angie is a GlaxoSmithKline (GSK) employee who, as part of a partnership between Save the Children and GSK, was recently deployed to Las Cruces, New Mexico where Save the Children is running child-friendly spaces in transit shelters for children and families released by U.S. Customs & Border Patrol. Here is her story.

 

The Beauty of a Community Coming Together at the Border
Written by Angie, GSK

In early August, I was incredibly honored to have been selected for 6-month program that would allow me to take a leave of absence from my full-time job at GSK and work with Save the Children. My specific placement with Save the Children is with the DC-based U.S. Domestic Emergencies team.

This group is responsible for managing and implementing Save the Children’s emergency responses – simply put, the team deploys into communities so that families and caregivers can meet the unique needs of affected children.  My assignment is to identify and improve the operational efficiencies of the current model so that teams of people can deploy within 24-72 hours after an emergency strikes.  Additionally, I also deploy with the team to emergency response sites. Just three short days into my assignment, I was asked to do just that and support Save the Children’s efforts at the U.S.-Mexico border. Of course, my answer was yes. 

To be honest, I had no idea what I was getting into, but knew that help was needed. On July 19, I landed in El Paso and headed out to Las Cruces to meet a team of incredibly dedicated Save the Children staff and volunteers.  Thus began my work at the southern border.

The most common question from my family and friends is, “How are things at the border?” We see things in the media, and the purpose of this story is to give you my answer. Yes, there are stories and things I have seen that will leave a lasting impression and take some time to process and understand. Then there are the stories that we should all hear and embrace.

Save the Children and GSK have been global partners since 2013 and have worked together in the U.S. since 2015. Together, our two organizations are helping children, with GSK providing corporate and employee donations to directly aid children. Angie is a GlaxoSmithKline (GSK) employee who, as part of a partnership between Save the Children and GSK, was recently deployed to Las Cruces, New Mexico where Save the Children is running child-friendly spaces in transit shelters for children and families released by U.S. Customs & Border Patrol. Here is her story.

The Save the Children crew on the ground is the epitome of what working with a team should be.  They received me with open arms and got me quickly up to speed. We would brief and debrief at the beginning and end of each day and ensured we looked after each other’s health, security and well-being.  Some of my best memories of deployment were cooking dinner for the team and chatting about our lives and everything in between, or travelling to a destination playing trivia and discovering new songs to listen to.  We laughed and helped each other out on our tough days by simply listening to each other.

We had many tasks, but the most important was to set up child-friendly play spaces in two shelter locations for children of families transiting onto their next destination after clearing detention. We did this every day and welcomed kids and parents open arms.  The thing is, based on my time in New Mexico, our work is a brief moment in someone else’s story. A child’s story. A child’s life. The children come into our child-friendly spaces and in the matter of a few seconds, they feel safe. They feel like they are children again. They just want to play and be kids. We created gardens, undersea magical kingdoms, and made it snow in the heat of a New Mexico summer using our imagination and some art supplies. We played soccer, football and endless games of Jenga. Every day, I saw new faces and smiles, and heard the laughter of children who had faced harrowing journeys. Despite different languages, we found a way to communicate, and more importantly, connect. 

I met a mom and her daughter who traveled for days with little or no food to get to the border. Upon reaching our space, the mom finally got to breathe and relax with her 2-year-old daughter. This beautiful mama sat in a rocking chair with a blissful smile on her face, while I played with her precocious daughter. She smiled, knowing she was about to give birth to her second child. She smiled, despite being separated from her husband and not knowing when she might see him again.  She smiled, moving into an uncertain future with a relative she had not seen in 6 years. 

I met another family who were waiting at the transit shelter for another family member to pick them up. That family member dropped everything and hopped into a car to drive 15 hours to pick up his sister and nephew. While they were waiting, the son very sweetly took care of his mom and all of the little ones around him. He played games, read to kids and colored. There was a kindness and curiosity about him that was infectious. We spent the latter part of the day looking at a map so he could understand where he came from and where he was heading. His curiosity shone brightly and by the end of the afternoon, a large group of us were standing around the map telling our stories. There were at least four different languages among us and yet we all understood.

After three weeks in the field, I now have an answer for those who ask about what’s happening at the border. I have met people with the courage, vulnerability and compassion to place humanity and common decency at the core of everything they do. I have seen the beauty of a community coming together to help people and children know that all is not lost and to inspire them to keep moving on their journey. I have seen the brilliant smiles of parents and children and heard their laughter. The work that team is undertaking at the border is quite possibly the first positive interaction some of these kids have had while heading towards their new homes. And yes, a brief moment in their lives, but hopefully a lasting memory that kindness, empathy and compassion can triumph over adversity. 

So please remember these stories – these are the stories that matter. 

 

 

Why I’m Passionate About Reducing Infections in Health Care Facilities

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by Alison Macintyre, Health Technical Lead – WaterAid

Having spent a lot of my childhood in and out of hospitals, I believed that hospitals were a place where you go to get better, get well; where you leave feeling more positive and healthier than when you arrived. And, I still do.

As I embarked on my career in the field of water, sanitation and hygiene (WASH), I realized for most of the world, that isn’t true. We, the global health community, are currently failing to achieve the absolute basics. Right now, we can’t ensure we are, at an absolute minimum, doing no harm to the millions of people who use health care systems every day. Too many health care facilities operate without water, without toilets that everyone can use, and without water and soap to stop the spread of infection.

This failure is what motivates me. We will only see dramatic, sustained changes in health if we get the basics right. 

Early in my WASH career I was in Papua New Guinea, undertaking a study on the role of WASH during childbirth for women. Most of the women I interviewed were unable to reach a facility to give birth and had to deliver their babies, often alone, on coffee plantations, in pig pens or on the side of the road.

As part of the study, we also visited health facilities. I had hoped that they would provide a potential solution for improving maternal and newborn mortality in these remote communities. One facility has always stuck in my mind.

Despite the newness of the facility (it was only five-years old), water, sanitation and hygiene were not available. A refrigerated, fully stocked drug cabinet was present, but gloves and soap were not. There was a sophisticated rainwater collection system, but the pump to distribute the water to the facility was broken and they weren’t able to fix it. There were two modern toilets, but they were locked and reserved for staff – patients had to go out to a hole dug in the back of the facility, passing an open waste pit on the way, to relieve themselves.

The lack of water also meant women were turned away if they arrived in labour. The next hospital was 2 hours away on a treacherous road.

How did a hospital have sophistical equipment, but couldn’t fix a water supply and women weren’t able to deliver their babies? How were antibiotics kept cold-chain with a reliable supply, yet soap and gloves were not available?

I left the facility angry, wondering how health systems neglected WASH in so many ways.

This visit made me realize that when statistics show us that health care facilities do not have basic WASH services, it doesn’t always mean the infrastructure is completely absent. Often, it may not suitable (for instance in the case of toilets not being accessible to people of limited mobility) or it is not functioning, or basic commodities like soap are not part of general supply lists.

I also realized that it is the system that’s broken, not just the infrastructure. Health systems that have monitoring and budgets for WASH, trained operation and maintenance staff, in-service and pre-service training on hygiene and cleaning, WASH standards and accountability mechanisms, are uncommon. This should be the norm.

That’s why I’m excited about the prospect of leading the WASH element of BASICS (Bold Action to Stop Infections in Clinical Settings), on behalf of WaterAid. Through the work I’ve done, I have learned the importance of integrating basic WASH into broader patient safety and infection prevention control programes. Without such integration, a system-wide approach is not possible and WASH will never become part of the day-to-day routine of health center operations.

BASICS brings together NGOs, researchers and the private sector to support health systems to sustainably address WASH and patient safety. The BASICS team has a wealth of expertise on health, WASH and evidence-based behavior change. This combination is essential for improving patient safety, health and the quality of health care facilities for all.

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.

Data Snapshot: How Do Donors Support Citizen Engagement in Tax Policy?

Written by Andrew Wainer, Director, Policy Research

This summer’s Addis Tax Initiative (ATI) conference in Berlin demonstrated that the ATI is increasingly open to civil society participation. It was a forum where donors and revenue authorities discussed how to better harness tax for development, but local and global NGOs also asserted the importance of accountability and equity in tax policy and administration.

The elevated voice of civil society on tax follows an increase in donor domestic resource mobilization (DRM) assistance to civil society, according to our analysis of OECD data[i].  For example, among ATI donors, the percentage of DRM assistance to civil society rose from 4% ($6 million) in 2015 to 10% ($21 million) in 2017 – an increase of 252%, the largest increase of any category of assistance (see Table 1).

Table 1: Percent Change DRM Disbursements Channel, 2015 to 2017

Channel Change (%)
Public Sector -20
NGOs & Civil Society 252
Public-Private Partnerships (PPP) 186
Multilateral Organizations 42
Teaching Institutions, Research Institutions, Think-Tanks 61
Private Sector Institutions 77*
Other -86

 * OECD CRS values reported only for years 2016 and 2017. Percent change calculated from these two years.

Nevertheless, donor investment in civil society on tax issues remains small within the bigger picture of DRM funding.  And even as the role of civil society in tax policy and administration increases, much more needs to be learned about the impacts of civil society participation

Norway Provides Half Its DRM Assistance to Civil Society
Analysis of the OECD’s Creditor Reporting System data reveals that, for 2017, the top five ATI DRM donors to civil society (by amount of US dollars) provided 95% of total DRM assistance to civil society among all ATI donors (see Table 2 below).

The UK provided the largest amount of funding for civil society – $9 million, or about a quarter of its total $37 million DRM budget for 2017. And the US – while providing the largest total amount of DRM assistance – provided the second largest amount to civil society – $5 million. But Norway is particularly notable for providing fully half of its total DRM budget to civil society – a far larger percentage than any of the other top 5 donors.

Table 2: Top 5 ATI Donors Providing DRM Assistance Channeled Through Civil Society, 2017

ATI Donor Country DRM Assistance to Civil Society (millions of USD)* Total DRM Assistance (millions of USD)* % of Total DRM Assistance Channeled through Civil Society
United Kingdom 9 37 24
United States 5 49 10
Norway 4 8 50
Denmark 1 5 20
EU Institutions 1 14 4

*USD Figures are rounded to the nearest million

 

Assistance Split Between Local and International NGOs
ATI assistance to civil society is clustered among five major donors, but what type of civil society organizations receive this assistance?

As Table 3 demonstrates, it’s split: In 2017, 40% of all ATI DRM assistance to civil society went to developing country-based NGOs, defined as: “An NGO organized at the national level, based and operated in a developing [country].”

While developing country NGOs received a substantial minority of the assistance, the same amount was disbursed to NGOs based in donor countries. These are defined as national-level NGOs based and operated in donor counties. Such organizations would include, for example, Oxfam America and Save the Children USA.

 Finally, almost 20% of this assistance to civil society was delivered to international NGOs, defined as, “an NGO organized on the international level. Some INGOs may act as umbrella organisations with affiliations in several donor and/or recipient countries.” Examples in this category include Doctors Without Borders and the Society for International Development.

Table 3: DRM Civil Society Assistance Delivery Channel, 2017

Delivery Channel Amount (millions of USD)* % of Civil Society DRM Assistance Received Through this Channel
International NGOs 4 19
Donor-county based NGOs 9 40
Developing-country based NGOs 9 40

*USD figures are rounded to the nearest million

 

Africa Receives More Than Half of All DRM Assistance to Civil Society
What part of the world is this donor assistance going to? In 2017, more than half ($11 million) went to Africa (See Table 4). Western Hemisphere nations were the second largest recipients – receiving almost a quarter ($5 million) of all ATI DRM civil society assistance. Asia, Europe, and  Oceana received very small percentages of this type of assistance totaling a combined 6% of all assistance to civil for tax work.

Table 4: DRM Civil Society Assistance to Recipient Regions, 2017

Recipient Region Amount (millions of USD)* % of Civil Society DRM Assistance Received by Region
Africa 11 53
Americas 5 23
Developing Countries, Unspecified 4 18
Europe 1 4
Asia <1 2
Oceania <1 0

 

How is DRM Assistance to Civil Society Used?
As Table 5 demonstrates, almost half of all assistance is directed toward capacity building. Tax advocacy is a complex and contested space, so civil society organizations often need help building the capacity to credibly engage on fiscal issues – particularly at the national level – so this large allocation makes sense. 

Table 5: Civil Society Uses for DRM Assistance, 2017

Function Amount (millions of USD)* % of Total Civil Society ATI DRM Assistance Spent on Function
Transparency 3 14
Technical Assistance and Support 2 10
Research 1 5
Capacity Building 9 43
Other 1 5
Unspecified 5 24

*USD Figures are rounded to the nearest million

 

Taxation and Gender Equity
Ensuring that tax policy and administration is gender-responsive is also an important component of ensuring tax equity. The OECD “tags” foreign assistance for gender equality by assigning activities as ones where gender equality is a “principal objective”, a “significant objective”, or where gender equality is not an objective. As illustrated in Table 6, according to the OECD data, only 13% of civil society DRM assistance in 2017 contained a gender equality component – activities where gender equality were either a principal or significant objective.

Table 6: Support for Gender Equality and Women’s Empowerment for Tax, 2017

DAC Gender Marker Score Amount (millions of USD)* % of Total Civil Society ATI DRM Assistance Dedicated to Gender Equality
(Gender is the principal objective) 0.6 3%
(Gender is a significant objective) 2 10%
Total:   13%

*USD Figures are rounded to the nearest million

 

Based on this analysis of the OECD data, we have a clearer – but still incomplete – picture of how ATI’s increasing DRM assistance to civil society is being used. We have little understanding of the impact of these funds.   

We need to continue to assess the impact of civil society in making tax policy and administration more accountable, participatory, and transparent. Data is key – donors and the OECD must ensure that data on donor assistance to civil society for DRM is reported and labeled accurately and that data is disaggregated, especially by age and sex. The analysis in this blog is a first step to outline the trends and contours of donor assistance for civil society engaging in DRM.  

As the Addis Tax Initiative develops its vision for 2020 and beyond, Save the Children continues to emphasize the role of local citizens in shaping tax policy and administration.  

In coming years, we hope that donor agencies will improve investments in country-based NGOs to strengthen local self-reliance, promote fairer tax allocations, and finance pro-development public expenditure. 

[i] Because the OECD continually updates the historical data in the CRS and these analysis were carried out over a period of months, calculations may vary. Like all large datasets, the CRS may also contain labeling and reporting errors that impact accuracy. Our analysis is based on an analysis of the OECD data as presented.

 

Why I Don’t Want Another Mother to Experience My Health Care Scare

Written by Soha Ellaithy
Senior Director, Strategic Foundation Partnerships and Senior Partnership Director, BASICS

I was born and raised in Egypt, a middle-income country that has a functioning healthcare system and universal healthcare coverage – albeit of often dubious quality.

In 2008, one in 10 Egyptians had chronic Hepatitis C, the highest rate of infection in the world. The direct cause of this catastrophic situation is a mass-treatment campaign conducted by the Egyptian government in the 1970’s and 80’s to eradicate schistosomiasis infection. The repeated use of needles resulted in Hepatitis C, a virus not yet known, being inadvertently spread to millions of people.

When, in 2011, my oldest son went on a school trip to Nepal, he contracted a diarrheal infection and had to be rushed to a local hospital to receive intravenous fluids. He called me and, to my horror, described stepping over pools of blood on the floor to get to a bed with no covering. My heart dropped – and to this day it still does when I think about that moment.

I knew exactly what the implications could be.

I’ve witnessed firsthand the terrible devastation of a healthcare-acquired infection on families and could not bear the thought of my son contracting Hepatitis C or HIV. It took a full three agonizing months of tests to clear my son of any possible infections that he might have picked up from a needle prick in an unclean hospital.

Photo courtesy of: FACEBOOK PAGE/ SO THAT HE'S NOT SURPRISED
Egypt’s doctors have been anonymously sharing pictures of the conditions they work in – with stray animals and overflowing sewage on display – after the country’s Prime Minister said he was “surprised” at the state of the country’s run-down hospitals. Photo courtesy of FACEBOOK PAGE/ SO THAT HE’S NOT SURPRISED via BBC

Despite a fairly strong medical education system and a tireless and dedicated medical staff, public health care systems in many countries like Egypt, continue to be plagued by poor adherence to proper hygiene standards and the devastating consequences that result.

As the Senior Partnership Director leading the submission to 100 & Change, when my colleagues first discussed with me the idea of eliminating this risk globally, I was immediately engaged. As we fine-tuned our idea in meeting after meeting, I became very excited that in BASICS (Bold Action to Stop Infections in Clinical Settings) we truly have a solution that will change the way healthcare is delivered across the world.

I feel very passionate about this project because it is inconceivable that in this day and age, we are still grappling with a problem whose solution is so simple: wash your hands, clean your working surfaces and be diligent in using sterilized equipment.

BASICS tackles the root causes of the problem and builds a solution that is self-sustaining. Using behavioral science to modify individual behavior so that simple hygiene routines can become “second nature,” we will build the supporting infrastructure and design a national system that ensures this new normal is part of a fully functioning and supportive national health system.

I dream of the day when no mother would ever take her child for a simple procedure only to go home with a child who has a life-threatening disease for absolutely no good reason!

 

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.

Photo credit: Allan Gichigi/ Save the Children, March 2016

A Clean Maternity Ward Is Every Woman’s Right

Written by Janti Soeripto
Chief Operating Officer and President, Save the Children 

Two things never fail to strike me when visiting health facilities as part of my work. First, without exception, is the absolute dedication of healthcare professionals to want to help mothers and children survive and thrive.

Secondly, it’s the incredible frustration of seeing basic gaps in delivery that interrupt that service. From access to clean water, the availability of consistent power sources to affordable referral options and a reliable cold chain to keep drugs safe for use, it must seem a constant game of solving one problem even as another arises for those running health clinics to consistently achieve the outcomes we all want.

Getting to one huge outcome – a sustainable, significant global reduction in healthcare-acquired infections that cause tragic deaths of newborns and mothers and needless pain and suffering – is at the heart of the BASICS partnership. Each partner – Save the Children, WaterAid, the London School of Hygiene & Tropical Medicine and Kinnos – brings a proven approach for tackling one of the factors that contribute to millions of newly acquired infections every year.

Integrating them into one strategy is an elegant solution.

And if we know why infections get passed to mothers and newborns in maternity wards (and to anyone in a health facility, for that matter); if we know what to teach health workers and cleaners to change their behavior and which tools they need; and if we know how to work with governments to set and institutionalize cleanliness standards for facilities; then why wouldn’t we make BASICS one of every partners’ highest health priorities?

The short answer is, we have.

BASICS’ objective of improving health outcomes couldn’t be a more natural fit for each partner’s aspirations, especially for Save the Children, which has been at the fore of maternal and child health programming for decades. Our 2030 ambitions for children include the global breakthrough that no child under age 5 anywhere will die from a preventable cause.

The teams of staff who’ve designed BASICS (Bold Action to Stop Infections in Clinical Settings) are deeply committed to transforming health care to make it safer for everyone … starting with women and newborns but then benefiting anyone who seeks care at a facility.

Each year, 17 million women give birth in facilities where cleanliness is questionable. BASICS will catalyze a simple, low-cost change in practices that can save many of them and their infants from death or illness by infection.

Who is to say these women and babies don’t deserve the same right to a clean maternity ward that I had when my own children were born?

As I step into the role of leading Save the Children, I’m putting the weight of the agency behind BASICS. We’re all eager to begin transforming health care as the recipient of this next 100&Change award.

 

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.