Launched in 2023, Strengthening Health Systems to Reduce Lead Exposure is a partnership between Pure Earth and the Ministries of Health in Colombia, Indonesia, Kyrgyzstan, Maharashtra, India, and Peru to strengthen each country’s national healthcare system to better prevent, identify, and treat lead poisoning.
A new video highlights the progress made since the project began toward expanding blood lead level surveillance in these 5 countries, which is crucial to understanding prevalence and severity of childhood lead exposure.
In addition, during an International Lead Poisoning Prevention Week 2024 webinar, Briefing on the Progress of Blood Lead Level Surveillance in 5 Countries, project leaders discussed progress in establishing blood lead level surveillance, collaborations with government partners, and the future impact of the data collected on national policies to combat lead exposure.
Panelists included:
Drew McCartor, Executive Director, Pure Earth
Lizeth Olaya, Country Director, Pure Earth Colombia
Indira Zhakipova, Director, Ecois Bishkek, Kyrgyzstan
Budi Susilorini, Director, Yayasan Pure Earth Indonesia
Rodrigo Velarde, Country Director, Pure Earth Peru
Debanjana Choudhuri, Country Director, Pure Earth India
Yi Lu, Senior Program Manager, Vital Strategies
Yatin Pimplé, Technical Advisor, Environmental Health Surveillance, Vital Strategies
To analyze the capacity of the healthcare system of the Kyrgyz Republic to monitor the concentrations of lead and other heavy metals in blood, urine and other media and existing regulatory legal acts as well as to provide recommendations for changes. The study was conducted in coordination with international project experts and using questionnaires developed by them.
Analysis of the capacity of the healthcare system of the Kyrgyz Republic to monitor lead concentrations (Desk review report) was prepared for the project Strengthening Health Systems to Reduce Lead Exposure. This report serves to justify the project and to inform decision-makers about the subsequent implementation of monitoring lead levels in children’s blood and determining priority actions to establish a sustainable monitoring, prevention, and treatment system for heavy metal poisoning, including lead.
Lead is a toxic element that even in small concentrations can have serious negative effects on human health, especially vulnerable groups such as children. Research indicates that exposure to lead can lead to developmental delays, reduced cognitive abilities, behavioral problems, and other adverse health outcomes (Lanphear et al., 2005; Canfield et al., 2003). However, despite the well-known risks associated with lead, many countries, including Kyrgyzstan, lack comprehensive monitoring and prevention programs for lead poisoning, particularly among children. This is due to insufficient data on the scale of the problem at the national level and a lack of awareness among the population and decision-makers about the importance and urgency of this issue.
Conducting this study will help fill the gaps in knowledge regarding current levels of lead in children’s blood in Kyrgyzstan and identify the main sources and pathways of lead exposure in children. The data obtained will serve as a basis for developing targeted public health programs aimed at reducing lead exposure and preventing its negative health consequences for children. This, in turn, will contribute to improving quality of life, reducing healthcare costs, and enhancing public well-being.
To conduct monitoring of lead and other heavy metals concentrations in blood, urine, and other mediums, and to determine priority actions and effectively utilize existing resources, a situational analysis of the healthcare system’s potential in the Kyrgyz Republic was conducted.
Acknowledgements
We are grateful to the Ministry of Health, the Ministry of Natural Resources, Ecology, and Technical Supervision of the Kyrgyz Republic, as well as to the staff of centers and laboratories, including private ones, for their active support in conducting the assessment of the healthcare system’s potential in the Kyrgyz Republic for monitoring the concentration of lead and other heavy metals in blood.
The funder had no role in the capacity inventory design, data collection, analysis, and report preparation.
AUTHORS
Ainash Sharshenova, Doctor of Medical Sciences, Professor, International School of
Medicine, International University of Kyrgyzstan
Indira Zhakipova, Civil Society Association ECOIS-BISHKEK
Kubanych Almerekov, Civil Society Association ECOIS-BISHKEK
“The Strengthening Health System to Reduce Lead Exposure” Program in Indonesia
For non-profit organizations, collaboration is crucial in reaching organizational goals and creating a positive impact on the communities. In addition, synergy can make combined efforts accomplish more. Pure Earth has been partnering with governments, communities and industry leaders to identify and implement solutions in order to stop toxic exposures, protect health, and restore environments. The organization – collaborating with various global and local stakeholders – also specifically works to sustainably address the root causes of lead and mercury pollution.
In regards to health surveillance, conducting baseline Blood Lead Level (BLL) testing and analysis is crucial to understand prevalence, severity and sources of lead exposure. In 2023, with a grant from Takeda Pharmaceutical Limited (Takeda), Pure Earth launched “Strengthening Health Systems to Reduce Lead Exposure” program, a partnership between Pure Earth, Vital Strategies, and the Ministries of Health in Colombia, Indonesia, Kyrgyzstan, Maharashtra, India, and Peru to strengthen each country’s national healthcare system to better prevent, identify, and treat lead exposure.
Started in April 2024 until present, Yayasan Pure Earth Indonesia (PE Indonesia) and Vital Strategies (VS) have been in discussion with the Ministry of Health (MOH) of the Republic of Indonesia in designing and implementing the new national program to identify, monitor and reduce lead exposure. The working plan is still being developed together by the working team. Quite many inputs came up from the members of the working team, which consists of members from various institutions, including PE Indonesia, VS and directorates (Dit) under MOH, such as Environmental Health as the Coordinator, Public Health Governance (Takelkesmas), Center for Health Development Policy (BKPK), Data and Information Center (Pusdatin), as well as cross-sectoral government agencies, i.e. Central Bureau of Statistics (BPS) and many more. The last technical coordination meeting was just held on June 24, 2024, where small group meetings will be carried out to finalize and agree on the working plan.
Surveillance as one of the instruments in public health has a role in producing information from the data collected, hence stakeholders can determine effective and efficient policies (Groseclose, 2017). BLL Surveillance (SKTD) is expected to be a tool in monitoring children’s BLL nationally in Indonesia, so that policies in controlling lead exposure can be established effectively.
In the context of the implementation of the “Strengthening Health System to Reduce Lead Exposure” program, SKTD piloting activities will be carried out to obtain data on the prevalence of BLL in Indonesian children as reference material in efforts to strengthen the health system in Indonesia. The piloting activity will be carried out in two stages, the first phase of which is planned to be carried out in the second semester of 2024 with the aim of monitoring BLL in children in Indonesia and understanding the increasing prevalence of BLL in children, evaluating the capacity of existing resources, and testing the feasibility of implementing national BLL. Meanwhile, the second phase is planned to be implemented in 2026 with the aim of initiating the integration of SKTD into periodic active surveillance.
As an essential step toward establishing such a system at the state level in Maharashtra, we conducted a capacity assessment to evaluate existing laboratory capacity and health system structure and provide recommendations for capacity strengthening and surveillance options best suited for Maharashtra. This capacity assessment report evaluated the policy landscape, public health infrastructure laboratory capacity to initiate and support a statewide childhood lead surveillance system, which will be fulfilled in close collaboration with the Public Health Department (PHD), Government of Maharashtra.
Preventing exposure to lead (Pb) is particularly important for health, because neurological and behavioral impacts caused by lead exposure among children are generally irreversible. Blood lead surveillance is a critical component of a comprehensive lead poisoning prevention program, as effective and comprehensive prevention begins with information obtained from surveillance. Unfortunately, at present, very few countries in Asia have established blood lead surveillance due to a lack of awareness and resources.
In India, a recent National Institution for Transforming India (NITI) Aayog—Council of Scientific and Industrial Research (CSIR) report has highlighted the importance of establishing blood lead surveillance that can generate high-quality local data to help understand lead exposure and health burden among Indian children. This may be implemented effectively at the state level, starting in states including Maharashtra, where there is demonstrated government commitment to addressing environmental health issues. Statewide childhood blood lead surveillance typically involves monitoring blood lead levels (BLLs) among children and collecting other information that may indicate risks and sources of lead exposure.
Acknowledgements
Vital Strategies and Pure Earth gratefully acknowledge the support of the Public Health Department of the Government of Maharashtra in this assessment. Commissioner of Health Services cum Mission Director National Health Mission gave his input and connected us with concerned senior health officials. We thank the officials from the State Family Welfare Bureau, State Health Systems Resource Centre, State Surveillance Unit, and State Public Health Laboratory for providing us with valuable insights who work under the leadership of the Director of Health Services. The assessment was made possible by the generous support received from Takeda Pharmaceuticals.
Contributors:
Yatin Pimplé, Vital Strategies
Yi Lu, Vital Strategies
Sumi Mehta, Vital Strategies
Dan Kass, Vital Strategies
Lavanya Nambiar, Pure Earth
Debanjana Choudhari, Pure Earth
The views expressed in this report are those of the contributors and do not necessarily reflect those of the funders or the Public Health Department of the Government of Maharashtra.
October 2023. Lima, Peru. The National Center for Epidemiology, Prevention and Disease Control (CDC Peru) of the Ministry of Health (Minsa) joins Pure Earth and Vital Strategies in a joint effort to strengthen epidemiological surveillance of lead exposure in Peru. By signing a “Memorandum of Understanding” on September 22 in Lima, these three entities seek to strengthen information systems, train health professionals, and generate evidence for public policies. This collaboration represents an important step towards preventing lead exposure in children and improving public health in Peru as part of the Strengthening Health Systems to Reduce Lead Exposure project.
Since 2018, CDC Peru has taken steps to strengthen public health epidemiological surveillance of risk factors for lead exposure. In this context, the Technical Unit of Epidemiological Surveillance of Environmental Risk of the CDC has considered the need to continue strengthening epidemiological surveillance for lead exposure with an inter-institutional and inter-sectoral approach to address surveillance and response at the level of the regions for equipment and strengthen competencies in a comprehensive manner.
This Memorandum of Understanding proposes the following objectives: • Strengthen public health epidemiological surveillance and health intelligence information systems in relation to lead exposure. • Strengthen public health epidemiological surveillance of risk factors for lead exposure. • Strengthen the capacity of health professionals for epidemiological surveillance in public health for the prevention of lead exposure. • Strengthen epidemiological research applied to lead exposure risks in order to generate evidence that contributes to the formulation of public policies. • Initiate dialogue between the technical offices involved to promote coordination and collaboration in the continuity and implementation of activities related to epidemiological surveillance for lead exposure, and then sign a new cooperation agreement.
“At Pure Earth we collaborate with the national government, communities, industry leaders and specialized agencies to identify and apply solutions that stop exposure to toxic contaminants, protect health and restore the environment. Lead exposure is a far greater threat to children’s health than previously thought. We are committed and ready with all our capabilities to address lead contamination in Peruvian children, supporting our communities to have a future free of contamination,” says Rodrigo Velarde, Country Manager of Pure Earth Peru.
In this way, this document represents a fundamental step forward and will promote important advances in the prevention of children with lead exposure and strengthen epidemiological surveillance in public health in Peru.
Strategic Alliance to Prevent Lead Exposure
Protecting children from lead exposure is important for their lifelong health. There is no safe level of lead in children’s blood. Even low levels of blood lead have been shown to affect learning, attention span, and academic performance. To avoid further exposure and reduce damage to your children’s health. The most important step parents and caregivers, health care professionals, and public health professionals can take is to prevent lead exposure before it occurs.
“People can be exposed to lead from contaminated soil, adulterated foods, cookware, paint and smelting operations, yet many countries lack the technical capacity to collect, analyze and use childhood lead data to identify their leading sources of exposure. We look forward to this opportunity to strengthen our active partnership with Pure Earth, and we will build upon our work with governments to establish systems of monitoring blood lead levels in children, including helping to develop clinical guidelines and national environmental health monitoring plans,” said Dan Kass, Senior Vice President, Environmental, Climate and Urban Health, Vital Strategies.
A Global Initiative
Currently, 1 in 3 children have enough lead in their blood to cause permanent brain damage. These actions are part of a broader Pure Earth initiative to strengthen the knowledge of national health systems to prevent, identify, and treat lead exposure in 5 countries. An estimated 292 million of these children with high lead levels live in Colombia, India (Maharashtra), Indonesia, Kyrgyzstan, and Peru. Pure Earth’s 5-year global project will help these 5 countries overcome key technical and clinical barriers to effectively identify, treat, and prevent childhood lead exposure, and implement effective national measures to monitor and reduce the risks of lead exposure.
Pure Earth prioritizes local knowledge and solutions. Pure Earth is working to address lead poisoning in these focal countries under the Global Lead Program: Bangladesh, Colombia, Georgia, Ghana, India, Indonesia, Kyrgyzstan, Mexico, Peru, and the Philippines.
Priority countries on a “watch list” due to high levels of lead poisoning are Zambia, Zimbabwe, Egypt, Pakistan, and Nigeria. These remain a priority for program expansion if and when additional resources are secured.
Pure Earth Is A Global Leader In Addressing Lead Poisoning, Reducing Children’s Exposures
Pure Earth has been acknowledged as a leading organization addressing global childhood lead poisoning. In their Global Lead Exposure report, think tank Rethink Priorities evaluated the impact of Pure Earth’s work and confirmed the effectiveness of our approach and programs.
Global Lead Program: Pure Earth’s 5-Phase Approach to Solving Lead Poisoning
Our goal is to measurably and sustainably reduce lead pollution and poisoning where we work and to encourage and enable increased action by other stakeholders in the global health and development sphere.
Pure Earth’s Global Lead Program strategy is designed around a framework consisting of five core elements that apply in all countries. This 5-phase approach was informed by our years of experience implementing over 50 projects in multiple countries to mitigate lead exposure.
Health Surveillance: Conduct baseline blood lead level (BLL) testing and analysis to understand prevalence, severity and location of exposure.
Source Analyses: Measure likely sources in homes where people have elevated lead levels, to determine the most significant sources of exposure.
Source-specific Interventions: Design and implement a range of interventions to reduce exposures and the use or release of lead in products and industrial processes.
Communications: Disseminate findings and recommendations to inform and build support with governments and funders for action.
Institutional Strengthening: Enhance the capabilities of government institutions to plan, implement, and sustain effective public health programs to reduce lead poisoning.
