Faculty Perspectives: Jeffrey Moe

Jeffrey Moe

Jeffrey Moe, PhD, Professor of the Practice, Duke Global Health Institute

Bass Connections Project Team: Chlorhexidine for Umbilical Cord Care

Professor Moe is leading a project team focused on identifying strategies to accelerate the introduction of chlorhexidine for umbilical cord care. A baby’s newly cut umbilical cord can be an entry point for bacteria, which can lead to infection and potentially life-threatening sepsis. Chlorhexidine is a low-cost, efficacious and safe intervention to reduce neonatal mortality, but there are significant gaps in manufacturing, distribution and adoption by mothers that are barriers to its widespread use. For less than fifty cents a dose, chlorhexidine could save an estimated 422,000 babies’ lives over the next five years. Two trips to Bangladesh were important parts of the team’s work.

We asked him a few questions about his Bass Connections experience; below are excerpts from our conversation.

A good idea, a lot of barriers

CHX launch Our team is conducting a global value chain analysis of the launch of chlorhexidine (CHX) for umbilical cord care in Bangladesh. We’re not just looking at the supply chain, but more broadly looking at all the factors surrounding the production, distribution and adoption of CHX by health care workers and mothers. With the value chain mapped, we can ask, Are there ways we can anticipate this newly created CHX market will change and evolve? How can key decision-makers make choices that will shape the market in sustainable directions? That proved to be a good way to think of it.

Our work is not going to give you a short-term solution to resolve, say, a bottleneck or complete stoppage to the flow of CHX through the supply chain. The way we approach the problem is looking for medium- to long-term solutions to develop a sustainable supply at the lowest cost with the highest quality of CHX over many years.

We looked at everything from sourcing active pharmaceutical ingredients to health disparities which create barriers to accessing CHX for mothers. It’s important to realize that seventy percent of the births in Bangladesh are home births.

The students got to see the variety of barriers to a low-cost antiseptic being introduced and actually being applied to every umbilical cord cut during the 3.2 million annual births.

An unexpectedly wonderful experience

We needed students from many disciplines. We were fortunate to have advanced students like Courtney Caiola, a nursing doctoral candidate with experience nursing in the developing world. We drew three students from the business school; undergraduate students in majors like biomedical engineering and women’s studies. One thing was true of them all: they had pluck!

CHX participantsSeveral of the students are coming back this year and we’ve received a no-cost extension to our Bass Connections grant. We may be back in Bangladesh [later this year].

We went to Dhaka twice. Danny Hamrick and I took roughly half the team in March and the remaining half in May. It was an unexpectedly wonderful experience where we worked hard and also had time to discover a little of Dhaka.

New collaborations

Nimmi Ramanujam is a biomedical engineer with important work in cervical cancer. She was curious about the value chain analysis: how we applied that perspective using an interdisciplinary team. Global value chain has application to her cancer work. We knew each other only by reputation and mutual friends and colleagues. Through our Bass team we’ve become friends. I’m hoping to contribute to her cervical cancer work going forward. A new faculty friendship and an additional opportunity to contribute to the reduction of a global health disparity, available and accurate cervical cancer screening, was a wonderful side benefit.

One of the guys I recruited to the team, Danny Hamrick, is an NC State doctoral candidate who is a researcher at Duke’s Center on Globalization, Governance and Competitiveness. We’re writing two papers now. One is our global value chain analysis of CHX in Bangladesh. The other compares “bottleneck analysis” with the approach we used in Bangladesh that focuses on “leverage points.” We’re excited to share the team’s work with a broader audience and offer the lessons learned in Bangladesh to help other CHX introductions in Africa and Asia.

Bass Connections was extremely gratifying. I loved my team. Many things happened, some predictable and others completely unexpected!

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