Hyderabad: after a 6 month break

Motivated by more consistent (this is basically any) abroad bloggers, am back on the blog to try and keep updating on work with the Clinton Foundation and life in Zambia.

Biggest recent update: I got a car!

Giddily celebrated the acquisition of mobility (and independence!) by cruising yesterday with Megumi. And realized that you can never underestimate the joy of driving around while listening to sweet joyride music (Always be my baby, thank you very much).

Already can see road trips galore in the future... Malawi? Namibia? Botswana? No African borders can hold me back - I have 4WD! Have high hopes for, hopefully, lots of vacation time in the year to come and lots of bonding hours spend trundling my new wheels through the bush.

So earlier I had this thought of having this be sort of educational and informative, since even 10 months after the fact, I feel like I moved pretty abruptly. Life here is great - I just got in from lying out by the pool (and it's winter!) - but work is the real driving force behind time here, and despite some initial reservations of "Crap. I may be working for the man... as an office monkey." work with the Clinton Foundation has turned out to be pretty amazing and less office monkey (though still this sometimes) than feeling like I have no experience but an still trusted to be involved in planning at the Ministry of Health.

Some background on CHAI. Started in 2003, the CHAI's is one of several initiatives under the umbrella of the Clinton Foundation. CHAI's first work was driven by volunteers from private sector backgrounds and centered around bringing down the prices of antiretrovirals; at the time, most of the developing countries which needed ARVs the most weren't able to afford them - hella expensive. Why? They are expensive to produce, especially if manufacturers can't predict the demand and have to produce based on intermittent, small volumes. To make up for the cost of production, profit margins had to be huge, making the drugs expensive to purchase... which means that poor countries couldn't order large quantities and would purchase intermittently when they could afford it which meant that price of production - Can see how this was a vicious cycle.

So CHAI went into a bunch of poor countries with high HIV prevalence and linked up the demand and the supply. Coordinating and providing TA for demand forecasts in these countries countries, CHAI got national governments to agree to buy the drugs - if the prices came down. On the supply side, CHAI worked with manufacturers to agree to slim down their profit margins if global order volumes came way up (economies of scale!) and CHAI could help ensure accurate forecasts were provided. And - voila! - generic prices have come down over 50% for 31 formulations and the annual cost of drugs dropped to $130 for adults and $60 for children.

Pretty cool, huh?

CHAI is still working on this at the global level, focusing on diagnostics and adult second-line and pediatric ARVs, which are the smaller-volume and higher-cost products now. CHAI has 25 partner countries where there is also program support provided to national governments. Clinton, being a former president (and not so apparently nuts in 2003 than he's been these days), was about supporting existing systems and strengthening central leadership. Thus, the big programs now are the pediatric HIV program, procurement (of ARVs for countries funded by a French government donor source called UNITAID), and lab support - and bringing a bunch of ex-ibankers and ex-consultants from the private sector to improve systems management and planning at ministries of health.

It's growing pretty fast though, and differently in every country, which is cool because (duh) countries are all different and it's great that CHAI is flexible (sometime this actually means disorganized, but that another post) enough to be responsive to that.

Ok, lots of text, not so many pictures. But so far then have covered Zambia, CHAI, and next then is I guess CHAI in Zambia. And then me in Zambia. That should only take another year, at the rate I'm going.

Crowd-pleasing photos. So to leave you with some pictures which are more interesting than text, here are some snaps from Lake Kariba, where I went 2 weekends ago with co-worker Megumi, random friend Danielle (weirdly doppelgangers in photos despite looking totally different in real life), peace corps Pat, and Zambian rose-farmer Liam. Conclusion: Liam has a boat, and large bodies of water are glorious.