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Ending Extreme Poverty in Asia through Universal Health Coverage

A woman in the Philippines receives a tetanus shot during a pre-natal visit. / HealthPRO

A woman in the Philippines receives a tetanus shot during a pre-natal visit. / HealthPRO

The 2010 World Health Report on Health Systems Financing and the unanimous endorsement of Universal Health Coverage (UHC) by the United Nations in 2012 have paved the way for rich and poor countries alike to take a closer, more critical look at how raise resources and improve access to health services, particularly for the poor. Asia is home to 3.9 billion people and accounts for a third of the global economy. Despite the region’s robust economic growth, almost two thirds of those in extreme poverty still live in Asia.

While there are many paths that a country can choose to get out of poverty, mobilizing domestic resources towards the health sector – in the form of Universal Health Coverage policies that seek to increase access to services especially for the poor – is a sound and sustainable investment that can lead to great economic returns. These reforms that empower the poor are critical because poor health and health shocks are leading causes of chronic poverty and impoverishment.

An Indonesian patient awaits further instructions during a check-up. / USAID

An Indonesian patient awaits further instructions during a check-up. / USAID

Rapidly growing Asian countries, Bangladesh, Indonesia, Thailand, and Vietnam have shown that improving health indicators and reducing extreme poverty are clearly linked. Declines in infant and child mortality rates in these countries preceded periods of strong and sustained economic growth.

Clearly, an agenda to end extreme poverty must include UHC goals.

Ill health prevents the poor from climbing out of poverty and can impoverish the near poor. When a household member falls ill, this can mean diminished labor productivity. In addition, households often make catastrophic financial outlays paid for by selling their assets, reducing their consumption, dipping into their savings, or borrowing at high interest rates for seeking health care.

High rates of out-of-pocket spending, a highly regressive way of financing health systems, create financial barriers to accessing health care., This financing represents 36 percent and 61 percent of the total health spending in developing East Asia and Pacific and South Asia regions, respectively.

Pupils in Vietnam's Bac Giang Province take part in a USAID deworming project . /  Richard Nyberg, USAID)

Pupils in Vietnam’s Bac Giang Province take part in a USAID deworming project . / Richard Nyberg, USAID)

UHC reforms come in different shapes and sizes. Some common characteristics include improving revenue collection mechanisms so that they are fair and affordable;, helping people move away from paying for health services out of pocket and toward prepayment and risk pooling; improving value for money with strategic purchasing;, and targeting the poor through subsidies.

Many of these reforms across Asia have increased access and utilization of health care, provided financial protection, as well as improved health care outcomes.

Countries such as China and Bangladesh successfully piloted schemes. In Bangladesh, the pilot voucher program to improve maternal and child health successfully increased pre-and post-natal care and facility-based deliveries, while reducing out-of-pocket spending and the costs of these services, and decreasing neonatal mortality rates by a third to almost half in home-based interventions. Bangladesh has adopted UHC as a national policy goal and USAID is providing assistance to support implementation of their health financing strategy.

Vietnam and Indonesia have reached partial coverage of their populations by around two thirds, and have recently taken additional steps to expand their coverage.

Analysis of various UHC schemes in Vietnam (public voluntary health insurance, social insurance and the health care fund for the poor) showed that they had improved financial protection – significantly decreasing spending for the beneficiary insured and providing evidence of positive impacts on their nutrition indicators. And in January of this year, Indonesia set out on the path towards UHC with the goal of covering its entire population of 250 million people by 2019.

The dynamic economic environment in fast-growing Asia means that the role of donors like USAID and the development assistance architecture will need to evolve as well.

Individual countries and the region at large will need to grapple with growing migrant populations and the need for portable schemes that ensure access for migrant labor populations across porous borders. A large and growing informal sector, individuals not covered by the labor and social security provisions, will continue to test how countries communicate expanded coverage to remote and often marginalized communities. Equally as important will be the question of how to finance and address the changing mix of population health needs arising from demographic trends and the emergence of non-communicable diseases.

As many of the developing countries in Asia continue to grow, they will have sufficient resources to afford a basic package of health services for their entire population; however, governments tend to under-invest in their health sector relative to their economic potential.

As a result, oftentimes as countries grow wealthier, public health systems fall further behind.

In Asia and globally, growing domestic resources represent a critical window of opportunity where countries must have the vision and courage to strategically direct this increased wealth towards the health sector so that development dollars are crowded out.

By financing policies that focus on increasing equity and access to quality essential health services – the aim of universal health coverage – countries will be taking concrete steps towards the bold vision of ending extreme poverty.

ABOUT THE AUTHOR

Kristina Yarrow is a Senior Health Technical Specialist in the Asia Bureau, backstopping technical areas specific to health systems strengthening and research such as health financing, UHC, and implementation research.

Caroline Ly is a Health Economist in the Bureau for Global Health’s Office of Health Systems.

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Breaking Invisible Barriers in the West Bank and Gaza

USAID supports girls’ education in the West Bank. The Agency built the new Nahalin Secondary Girls' School in the Bethlehem Governorate  / Credit Alaa Badarneh

USAID supports girls’ education in the West Bank. The Agency built the new Nahalin Secondary Girls’ School in the Bethlehem Governorate / Alaa Badarneh

It’s nearly impossible to watch the news or read a newspaper without hearing about the West Bank and Gaza. It seems every week there’s a breaking story of violence and destruction. And yet when I visited USAID’s West Bank and Gaza Mission in November, the message I consistently heard was one of hope.

I went to see first-hand how USAID’s diverse programs are helping to ensure women and girls have the tools and capacity to realize their rights. From the justice system to small business, it was inspiring to witness the positive impact of USAID’s work.

The trip was also a powerful reminder that gender relations in the West Bank and Gaza are unique and complex but also obscured by the ongoing conflict. The main challenge Palestinians face is occupation, being both physically and socially restricted in everyday life that we take for granted.

Susan Markham meets with USAID staff, beneficiaries, and partners to promote the importance of gender equitable structures, institutions, and infrastructure in Palestinian society. USAID/West Bank/Gaza

Susan Markham meets with USAID staff, beneficiaries, and partners to promote the importance of gender equitable structures, institutions, and infrastructure in Palestinian society. / USAID/West Bank/Gaza

While the physical roadblocks inhibit movement, there are also invisible barriers that Palestinian women face. Despite a commitment to girl’s education, and a long tradition of women’s engagement in political life, separate social structures and a male dominated culture endure. However, instead of being demoralized, what really shone through was the enthusiasm and determination of both women and men to fully engage on equal terms.

I was energized to meet Maysa, a 26-year-old entrepreneur breaking ground within the tourism industry. By organizing photography tours throughout the West Bank, running her own YouTube channel, and designing original souvenirs, she is staying at the forefront of tourism and opening doors to women who wish to work in the industry.

I spoke with inspiring women entrepreneurs who are breaking barriers within their communities and launching successful businesses in information and communication technology (ICT), marketing, tourism and international training and certification. Thanks to assistance from USAID, many of these women are already planning to start a second business.

Through USAID’s Local Government and Infrastructure Program, I was able to hear from young women participating in and leading Youth Local Councils across the West Bank where women and men work together to advance community driven ideas around education, health, infrastructure and governance.

Perhaps nowhere was progress in gender equality so evident than at the Youth Development and Resource Center in Hebron. There I met Omar whose parents forbid him to go to the center as a boy because there would be girls there. Today, he runs the center, providing skills training, work experience, and a dynamic example of what’s possible when men and women work together.

From the teachers fighting for improved training for their students to the women working in cutting edge technology fields, there was optimism for a brighter future and a fierce resolve to get there.Vera Baboun, the mayor of Bethlehem, summed up the experience best when she quoted poet Mohja Kahf to me:

All women speak two languages:
the language of men
and the language of silent suffering.
Some women speak a third,
the language of queens.
They are marvelous
and they are my friends.

 

ABOUT THE AUTHOR

Susan Markham is the USAID Senior Coordinator for Gender Equality & Women’s Empowerment. Follow her @msmarkham

South Sudan: The Threat of Worsening Hunger

Residents of Bor County receive sorghum, oil, and lentils in exchange for road construction work they completed as part of the Catholic Relief Services led Jonglei Food Security Program, in Jonglei, South Sudan.  / CRS

Residents of Bor County receive sorghum, oil, and lentils in exchange for road construction work they completed as part of the Catholic Relief Services led Jonglei Food Security Program, in Jonglei, South Sudan. / CRS

A few weeks ago, my office instructed a vessel carrying 21,000 tons of American-grown sorghum destined to serve hungry people in South Sudan to divert from its Djibouti destination and discharge its cargo in Port Sudan instead. That vessel arrived and offloaded last week.

While the food was originally destined to travel for weeks by road from Djibouti to Gambella, Ethiopia, and then be airlifted or air-dropped into remote areas of South Sudan, a recent agreement between Sudan and South Sudan brings the possibility of a more hopeful scenario.

After almost a year of negotiation, the U.N. World Food Program secured agreement from both governments, as well as opposition groups in South Sudan, to facilitate safe passage of this grain to hungry people in South Sudan.  Saving both time and expense, it will be trucked or shipped by barge across the border from Sudan to South Sudan to meet immediate food needs and be pre-positioned in remote areas for use in the coming months.  If the two governments follow through on their commitments, the opening of this corridor will help to stave off hunger in a new country, whose hopes for growth and prosperity were dashed by ruinous fighting between the government and armed opposition groups one year ago.

Mary Ngok, 31, a farmer in Bor County receives sorghum, oil, and lentils in exchange for road construction work they completed as part of the Catholic Relief Services led Jonglei Food Security Program, JFSP, in Jonglei, South Sudan. / Sara A. Fajardo/Catholic Relief Services

Mary Ngok, 31, a farmer in Bor County receives sorghum, oil, and lentils in exchange for road construction work they completed as part of the Catholic Relief Services led Jonglei Food Security Program, JFSP, in Jonglei, South Sudan. / Sara A. Fajardo/Catholic Relief Services

South Sudan is the most food-insecure place in the world. Six months ago, after visiting, I laid out five key actions that USAID was taking to avert hunger and famine in South Sudan. One of them was to draw on the Bill Emerson Humanitarian Trust (BEHT), a seldom-used fund that USAID taps when unanticipated global needs outstrip food aid budgets, to procure additional food for South Sudan. Thanks to this trust, 50,000 tons of U.S. food – including the 21,000 tons recently offloaded in Port Sudan, are being used to respond to the hunger crisis in South Sudan.

The scale-up has enabled emergency care for more than 76,000 children suffering from severe acute malnutrition, and humanitarian workers have reached roughly 3.5 million vulnerable and displaced people with aid since January. Throughout 2014, conflict and bad weather forced the international community to rely on expensive airlift operations to move food and other supplies into remote areas of the country – operations that are roughly 8 times more costly than serving people by road. While extraordinarily costly in terms of expense, lifesaving aid has helped avert famine – for now.

The question is, what happens next?

Will the United States’ BEHT food make it safely to its intended destination, as planned? Will people already worn down by a year of war be reached with lifesaving aid and recovery support? Or will renewed fighting move South Sudan into a deeper downward spiral?

Sadly, the dry season, which typically lasts from December to April, is not only a time for recovery but has in past years also been a time for renewed conflict. Already we have reports that fighting has begun anew, adding to the suffering experienced by the nearly 1.9 million displaced people.

The international community is already overstretched due to the scale and gravity of the crisis and other humanitarian emergencies worldwide. The United States has provided more than $720 million in response to the crisis, including more than $339 million for food and nutrition assistance alone.

The future of South Sudan is in the hands of the combatants. This humanitarian crisis is man-made, as will be its resolution. The best way to avert a future famine is for the combatants to stop fighting, so that ordinary South Sudanese people can plant crops, markets can reopen and communities can begin to recover.

ABOUT THE AUTHOR

Dina Esposito is the Director of USAID’s Office of Food for Peace

A ‘Daily’ Struggle for Human Rights

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Today, in honor of International Human Rights Day and the 66th anniversary of the Universal Declaration of Human Rights, USAID joins the world  in standing with all those who struggle for the realization and protection of their human rights. We believe that promoting human rights is closely linked to advancing long-term, sustainable development, and that these rights are instrumental to attaining other goals such as economic growth and democracy and addressing underlying grievances that cause instability and conflict.

While USAID’s global mission is to end extreme poverty and promote resilient, democratic societies, inextricably linked to this mission, is the protection and promotion of universally accepted human rights for all persons where we work.

Following the Rwanda genocide in 1994, issues of reconciliation remain a concern for maintaining peace into the future. USAID's Reconciliation and Reintegration programs provided trauma counseling and space for dialogue that allowed Elaine to forgive Alexis (both pictured) for killing her family members. They now have rebuilt their lives in the same community.  / Carol Storey

Following the Rwanda genocide in 1994, issues of reconciliation remain a concern for maintaining peace into the future. USAID’s Reconciliation and Reintegration programs provided trauma counseling and space for dialogue that allowed Elaine to forgive Alexis (both pictured) for killing her family members. They now have rebuilt their lives in the same community. / Carol Storey

Ending poverty is not feasible if people are denied the right to work, or are not paid fairly for their labor or are unable to secure housing, land, and property or lack access to health care.  Building well-functioning democratic societies requires respect for fundamental rights and freedoms of assembly, association, expression, information, political participation, and a fair trial.

Everyone should have the right to non-discrimination and protection against arbitrary arrest and detention, torture and inhumane treatment, and forced labor and slavery.

USAID’s human rights programming is grounded not only in core democratic principles and values of the United States of America, including the four freedoms articulated by President Franklin D. Roosevelt in 1941 (of speech, of worship, from want, and from fear), but also in the clear and timeless framework of the United Nations Declaration of Human Rights.   This includes:

  • Article 2.  Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.  In countries and regions such as Cameroon, Nicaragua, Bosnia, South East Asia, Kazakhstan, Vietnam, Zambia, and Jordan, USAID is supporting the education, advocacy and sensitization work of local activists and human rights organizations who are breaking down the barriers of many forms of discrimination. USAID’s recently launched Lesbian, Gay, Bisexual, and Transgender (LGBT) Vision for Action specifically highlights our commitment to promoting and protecting the rights of sexual and gender minorities.
Training of Human Rights Monitors, part of USAID’s Human Rights in Action Program, Chernihiv, Ukraine. / USAID/Ukraine

Training of Human Rights Monitors, part of USAID’s Human Rights in Action Program, Chernihiv, Ukraine. / USAID/Ukraine

  • Article 3. Everyone has the right to life, liberty and security of person.  USAID is assisting human rights defenders and national human rights institutions in Ukraine, Burundi, Zimbabwe, and Mali, among many other countries, to document, investigate, and report on the severest forms of violations of this internationally enshrined right to life. USAID also supports the protection of human rights defenders  and the victims and survivors of human rights violations.
Youth from the municipality of Caucasia (Bajo Cauca Antioqueño), Colombia, participating in the first intercollegiate human rights competition “Human Rights: A Strategy to Educate.” This initiative, carried out by Corporación Jurídica Colombia Humana with USAID’s Human Rights Program support, sought to promote a human rights culture at schools through a human rights competition that evaluates knowledge acquired during the project duration. Photo Credit: Jairo  Martínez, Corporación para el Desarrollo Social del Bajo Cauca, partner with USAID’s Human Rights Program

Youth from the municipality of Caucasia (Bajo Cauca Antioqueño), Colombia, participating in the first intercollegiate human rights competition “Human Rights: A Strategy to Educate.” This initiative, carried out by Corporación Jurídica Colombia Humana with USAID’s Human Rights Program support, sought to promote a human rights culture at schools through a human rights competition that evaluates knowledge acquired during the project duration. / Jairo Martínez, Corporación para el Desarrollo Social del Bajo Cauca, partner with USAID’s Human Rights Program

  • Article 4. No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms. As millions of people around the world continue to be exploited in the modern day slave trade or human trafficking, USAID set forth a new vision to counter-trafficking in persons (C-TIP) through an agency-wide C-TIP Policy with key programming objectives that include integrating C-TIP activities in development projects across sectors from health to economic growth.  USAID is responding to human trafficking trends in Bangladesh, Cambodia, and Nepal by supporting programs that foster legal labor recruitment practices and safe migration. We also work to ensure that its own employees, partners, and procurement practices are not in any way facilitating human trafficking, by diligently enforcing the agency’s C-TIP Code of Conduct. New partnerships are being cultivated with the private sector since ending human trafficking is everyone’s business.
Nusrat Bibi, an acid burn survivor, takes photographs during a field trip for the photography workshop in Pakistan. Nusrat received photography training from Acid Survivors Foundation (ASF) under the USAID Gender Equity Program, which supports women’s rights as human rights and works to empower women, especially those who are survivors of gender-based violence. As part of a rehabilitation process that includes developing new skills, ASF trained nine acid attack survivors. The photographic work of these survivors was featured in three different exhibitions in Islamabad. / Diego Sanchez.

Nusrat Bibi, an acid burn survivor, takes photographs during a field trip for the photography workshop in Pakistan. Nusrat received photography training from Acid Survivors Foundation (ASF) under the USAID Gender Equity Program, which supports women’s rights as human rights and works to empower women, especially those who are survivors of gender-based violence. As part of a rehabilitation process that includes developing new skills, ASF trained nine acid attack survivors. The photographic work of these survivors was featured in three different exhibitions in Islamabad. / Diego Sanchez.

  • Article 10.  Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal in the determination of his [or her] rights and obligations and of any criminal charge against him [or her]. USAID provides Rule of Law assistance to more than 40 countries around the world, including Bosnia, Burma, Cote d’Ivoire, and Indonesia in order to strengthen the administration of justice and promote independent, accountable, and efficient judicial systems.
Vu Lieu, LGBT Advocate, participated in the Vietnam National Dialogue as part of the “Being LGBT in Asia” Initiative.  The dialogue convened LGBT persons from around Vietnam to share lived experiences and discuss legal and socio-economical challenges they face and propose solutions. / Information Communication and Sharing, Vietnam

Vu Lieu, LGBT Advocate, participated in the Vietnam National Dialogue as part of the “Being LGBT in Asia” Initiative. The dialogue convened LGBT persons from around Vietnam to share lived experiences and discuss legal and socio-economical challenges they face and propose solutions. / Information Communication and Sharing, Vietnam

  • Article 19. Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers. In Central African Republic, USAID is supporting local journalists, radio and press outlets to ensure critical and accurate information and peacebuilding programming is reaching those communities severely affected by the crisis.
  • Article 25.1. Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.  In Angola, USAID has empowered communities affected and threatened by forced evictions and demolitions through capacity strengthening activities and legal assistance and assisting the government in compiling a database of those in need of housing.

Today, we support the global efforts to expand human rights and the fundamental liberties contained in the Universal Declaration of Human Rights, which reminds us that “the inherent dignity and…the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.” It is equally a foundation of development.

ABOUT THE AUTHOR

Nicole Widdersheim is Human Rights Advisor for USAID’s Center for Democracy, Human Rights and Governance

The Intersection of HIV/AIDS and Gender-Based Violence: A Critical Connection

A mother plays with her child while waiting for services at Jose Maria Cabral y Baez Hospital in Santiago, Dominican Republic. Health workers and supervisors from this hospital participated in a workshop and supportive site supervision system designed and delivered by the Directorate of STI/HIV/AIDS (DIGECITSS), the health services network (REDES), and CapacityPlus to improve the quality of services to eliminate mother-to-child transmission of HIV and congenital syphilis. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

A mother plays with her child while waiting for services at Jose Maria Cabral y Baez Hospital in Santiago, Dominican Republic. Health workers and supervisors from this hospital participated in a workshop to improve the quality of services to eliminate mother-to-child transmission of HIV. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

This week we mark World AIDS Day. Appropriately, it occurs during the Sixteen Days of Activism Against Gender-Based Violence. Why so appropriate? Because we know that gender-based violence (GBV) prevention and response are critical to effectively treating and reducing the spread of HIV. Though not always self-evident, the connection is clear.

For me, the linkages were driven home during recent conversations I had with health experts in Ghana. While discussing our health programs, I casually asked how important attention to GBV was within efforts to treat and stem the spread of the HIV.  As soon as I asked the question, the room’s atmosphere changed palpably. Everyone sat up and leaned in. People began speaking all at once, tripping over one another to respond. The passion was tangible and the analysis compelling. It was all the more persuasive because it is backed up by research.

In Ghana, the HIV rate is low and declining, though the rate is 15 – 20 times higher for key populations at risk of contracting HIV, which include female sex workers (FSWs) and men who have sex with men.

GBV is particularly common among female sex workers (FSWs), 24 – 37 percent of whom are HIV-positive. How do GBV and HIV rates correlate and relate, and how do we bear that in mind in our work to prevent and treat the infected?

A traditional leader discusses multiple concurrent partnerships, a key driver of HIV in Zambia, during a November 2013 training on HIV/AIDS leadership messaging in Kanyembo Chiefdom in Luapula Province / JSI/SHARe II

A traditional leader discusses multiple concurrent partnerships, a key driver of HIV in Zambia, during a November 2013 training on HIV/AIDS leadership messaging in Kanyembo Chiefdom, Luapula Province. / JSI/SHARe II

Many of my conversations in Accra focused on how to help people change behavior to decrease the risk of transmitting the virus and to increase the likelihood of seeking testing and treatment. The experts discussed how much more difficult it is for a woman or a man to negotiate condom use with an abusive partner.

The victim is less likely to try to persuade the abuser to use protection. The perpetrator is less likely to listen. The practitioners also talked about how victims of gender-based violence have less self-esteem and a lowered sense of self-worth. As a result, victims of abuse don’t believe they have the “right” to receive health services. It is much harder to coax people who face GBV or who fear violence or abandonment to seek services, test for HIV, or to successfully access or adhere to treatment.

A 2010 study of FSWs in Karnataka state, south India, confirmed what the Ghanaians explained to me; fear of partner violence prevented women and girls from seeking health services and from asking their partners to use condoms. The study found that condom use was some 20 percent lower those who had been beaten or raped within the last year compared with those who had not faced such violence.

The experts I spoke with also mentioned how gender-based violence cements relationships in which one partner is clearly dominant; they discussed how that feeling of dominance can give the abusive partner a sense of invincibility, reducing his or her willingness to practice prevention.

If you don’t believe you are vulnerable to harm or disease, there is no need to protect yourself. A 2014 study in South Africa supported this contention. The study, which considered women and girls attending four health centers in Soweto, found that abusive relationships with high levels of male control were “associated with HIV seropositivity.” In relationships where men had a great deal of power or where violence was frequent, researchers found that females were less likely to request condom use and had about a 12 percent greater likelihood of being HIV-positive.

Sometimes, the statistics were actually pretty astonishing.  A 2012 study in Moscow, Russia found that FSWs were more than 20 percent more likely to be HIV-positive or to carry a sexually transmitted infection (STI) if they experienced client violence. In addition, over forty percent of FSWs who were coerced into sex with the police were STI/HIV infected. Researchers concluded that reducing the risk of infection would require decreasing client, pimp and police abuse and coercive behavior.

A 2013 WHO systematic global review and analysis of studies across different HIV epidemic settings underscored the association between GBV and HIV, finding that intimate partner violence increases the risk for HIV infection among women and girls by more than 50 percent, and in some instances up to four-fold.

There are two bottom lines to the research and experiential data. First, reducing and responding to gender-based violence should be a key tool in efforts to prevent the spread of HIV. Second, additional research is needed to understand those violence-reducing interventions that best reinforce HIV prevention and treatment.

USAID has seen important dividends from integrating GBV prevention and response into HIV and AIDS programs in collaboration with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). In Tanzania, USAID has supported development of National Management Guidelines for Health Response and Prevention to GBV, which provide a framework to guide comprehensive management of GBV survivors.

The Guidelines have led to training of health care providers and roll-out of a GBV register at health facilities across the country. In Zambia, USAID with PEPFAR funding, is collaborating with the British Department for International Development (DFID) and six government ministries to strengthen the response to GBV; this includes doubling the number of one-stop centers in several provinces, reaching 5 million adults and children with preventive messages, assisting 47,000 survivors, and training 200 police and justice sector personnel through 2018.

All told, USAID has contributed significantly to important results under PEPFAR; in FY2013, 2.5 million people in 12 countries were reached by efforts to address GBV and coercion, and an additional 800 health facilities began offering GBV screening, assessment and/or referrals to service providers.

The connection between gender-based violence and HIV infection is unambiguous. The data combined with the experience and perspectives of field experts make it clear. As we renew our commitments this week both to combat the spread of AIDS and to prevent GBV, let’s recognize and ensure that programs address the intersection. It could make the difference between the success and failure of efforts around the world.

ABOUT THE AUTHOR

Carla Koppell is USAID’s Chief Strategy Officer. She was formerly the Agency’s Senior Coordinator for Gender Equality and Women’s Empowerment. You can follow her @CarlaKoppell

3 U.S. Events to Watch at U.N. Climate Talks in Lima

The 2014 U.N. climate conference has kicked off in Lima, Peru, and negotiators are working hard to reach agreement on global climate targets. But this world gathering is also a chance for governments, non-government organizations and companies to showcase innovative work they are doing to address climate change.

Here are three key events to watch at the U.S. Center, run by the State Department, to show off some of the ground-breaking work U.S. government agencies are doing on climate change. All three will be streamed live at: YouTube.com/TheUSCenter

Thursday, December 4, 5:30p.m. EST:  Private financing for REDD+ projects: New approaches in 2014

Crops like cacao can help forest-dependent people earn more using less land, improving livelihoods and conserving forests. / Hanz Rippe

Crops like cacao can help forest-dependent people earn more using less land, improving livelihoods and conserving forests. / Hanz Rippe

REDD+ is a policy approach to compensate forest countries and communities for reducing carbon dioxide emissions from deforestation and forest degradation. The idea is, governments and communities should be rewarded for preserving forests. Cutting down forests currently causes more than 10 percent of all heat-trapping emissions.

The question is, how do we come up with the money or incentives to reward forest communities for conservation, so that the whole world can reap the health and ecosystem benefits they provide?

The best source of financing is the private sector – and quite a few REDD+ projects today are showing how it can work.

Anyone who loves forests – and especially the Amazon – should tune in Thursday at 5:30 to hear Peru’s Environment Minister Manuel Pulgar-Vidal and Indonesia’s REDD+ lead Heru Prasetyo, talk with three large Amazon REDD+ programs – and one very innovative investment fund  – about how they are changing the economics of forest conservation. The fund, Althelia, has more than $130 million to invest in the carbon benefits and other benefits of forest conservation and sustainable land use projects all over the world.

Friday, Dec 5, 1:30 EST: Game-Time: Using Climate Information to Make Critical Decisions

Climate science and decision making tools such as SERVIR provide data on climate indicators such as storms, precipitation, floods, and temperatures. / SERVIR.net

Climate science and decision making tools such as SERVIR provide data on climate indicators such as storms, precipitation, floods, and temperatures. / SERVIR.net

Imagine it’s your job to sift through reams of data about how climate change is affecting your country or city. What information is essential, and how do you apply it to protect your coastlines, infrastructure and, above all, your people? Or, imagine you are a poor farmer deciding whether to spend last year’s small profit to plant 10 percent more this year – or use it to buy insurance so your family won’t go hungry if this year brings drought. Where do you go to find a science-based forecast for your area with clear guidance specific to the current season?

On Friday, Red Cross/Red Crescent hosts an interactive game at the U.S. Center, where  audience members take the role of poor farmers and harried government officials trying to make critical decisions with limited information. All sorts of weather and climate information is out there, but how do you get hold of the specific data you need in a useable format, whether you are planting rice or building seawalls?

For game participants, it can be shocking how quickly these become life-or-death decisions. Fortunately, speakers from Red Cross and USAID are there to provide comfort after the game by discussing new climate-smart tools and approaches that can help farmers, governments and development practitioners make climate-savvy smarter decisions.

Thursday, Dec. 11, 1:30 p.m. EST:  U.S. Commitments on International Resilience

Climate change induced degradation of land could be the inheritance of inaction regarding climate change.  / George Safonov

Climate change induced degradation of land could be the inheritance of inaction regarding climate change. / George Safonov

President Obama announced a set of new initiatives in September to strengthen global resilience to climate change – including a new Public-Private Partnership on Climate Data for Resilient Development. The idea is that USAID, with NOAA, NASA, USGS and other agencies, will harness, create and share climate data, information, tools, which developing countries need to build climate resilience and curb greenhouse gas emissions.

The partnership will make existing climate data, science, outlooks, tools, and services easier to access and better tailored for making decisions. It will also link climate data with development efforts, identify gaps and develop new products to support decision-making in climate-vulnerable areas. Just two weeks ago, USAID sent out a public request for information seeking input.

For anyone working with USAID, this emerging initiative could have implications. Thursday’s event will shed light, as White House science lead John Holdren beams in via Skype to chat about what’s coming with Kelly Gallagher, White House Office of Science and Technology, and Kit Batten, USAID’s global climate change lead.

ABOUT THE AUTHOR

Andrea Welsh is USAID’s communications lead at the U.S. Center for U.N. climate talks . Follow @USAIDenviro and @US_Center

Nutrition’s New Frontier: The Science of Scaling Up

A young girl has access to healthy, nutritious foods – thanks in large part to interventions being taken to scale across Africa. /  Sight and Life.

A young girl has access to healthy, nutritious foods – thanks in large part to interventions being taken to scale across Africa. / Sight and Life.

We are in a new era for global nutrition.

The political will is here: 54 countries have committed to the Scaling Up Nutrition (SUN) Movement. The 1,000 Days partnership has created champions across business, government and civil society to promote action and investment in early nutrition. Governments, donors and businesses pledged $4.15 billion to support nutrition interventions around the globe at last year’s Nutrition for Growth Summit. And more than 170 governments and nutrition and development leaders met in Rome last week at the Second International Conference on Nutrition (ICN2) and agreed upon a framework for action to accelerate progress on nutrition.

The evidence is in: good nutrition improves health, saves lives and builds prosperity.

The landmark 2008 Lancet Series on Maternal and Child Undernutrition identified optimal nutrition during the critical 1,000 days between pregnancy and a child’s second birthday as key for both human and economic development. The 2013 Lancet Series on Maternal and Child Nutrition identified a package of nutrition interventions that could save 900,000 lives in 34 high-burden countries, equipping nutrition advocates and policymakers with the evidence and recommendations to create impact in the world’s poorest countries.

We know what to do, but we don’t yet know how to do it at scale. There are bottlenecks to scaling up any effort, and nutrition is no exception. The transition from efficacy trials to real-world settings has been slow, and global health research to date has not examined the relationship between demand for services and their delivery.

Implementation science in nutrition helps ensure optimal interventions reach vulnerable children at a young age, giving them adequate nutrients to grow and thrive. / Sight and Life.

Implementation science in nutrition helps ensure optimal interventions reach vulnerable children at a young age, giving them adequate nutrients to grow and thrive. / Sight and Life.

Systematic research is needed to understand and resolve the challenges of scaling up nutrition—research into every stage along the continuum of a nutrition program, from program development to delivery to uptake to adherence.

Consider the twice-yearly administration of vitamin A capsules to children ages 6-59 months, recommended to improve immune systems and reduce death. Although policymakers can chart a course of action, it is the regional directors of services and program managers who are responsible for implementing.

But how?

Should they tack this intervention onto child vaccination days? Well-child visits? Other opportunities?

It is this process of adopting an evidence-based practice into existing services—or creating new pathways—and the appropriate utilization of the services that must be informed by science to deliver a public health nutrition impact.

Implementation science is nascent, especially in nutrition, but progress is being made. In 2012, the New York Academy of Sciences convened a working group on delivery science in nutrition. Since 2009, the USAID-funded TRAction project has supported implementation and delivery science related to maternal, newborn and child health.

And the recently-formed International Society for Implementation Science in Nutrition works to empower the “doers,” those professionals and practitioners who propose implementation plans, gather evidence for informed decision making and improve programs. As a convener of scientists, policy leaders and practitioners, the Society works alongside other global efforts and organizations to advance research on the delivery of nutrition interventions worldwide.

The global nutrition community needs donors, NGOs and governments to prioritize implementation science when funding program implementation on the ground because it is this type of science that places service delivery, capacity building and local context at the heart of global nutrition efforts.

For a woman in India, service delivery influences whether she has access to prenatal micronutrients that help her deliver a healthy baby. Adequate training of health workers can influence whether a mother in Cambodia feeds her newborn with infant formula, or knows to exclusively breastfeed for the first six months.

Understanding cultural and societal factors is necessary to ensure that our messages motivate mothers in Kenya to feed their daughters colorful fruits and vegetables to provide the nutrients the child needs.  If we want people to demand good nutrition, we must deliver good nutrition.

We have the tools and the knowledge to change the future through the power of good nutrition. We know the interventions that work. Implementation science will help create a world where the effective nutrition interventions are affordable, accessible and adequately used.

A world where every child can grow to their full potential. A world free of malnutrition.

It’s time to invest in implementation science.

ABOUT THE AUTHOR

Dr. Eva Monterrosa is Senior Scientific Manager of the nutrition think tank Sight and Life that works toward a world free of malnutrition.

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USAID and Special Olympics: Advancing Human Dignity Worldwide through Sport

The inclusive volleyball team from Krusevac, Serbia, formed as part of the USAID/Special Olympics "Inclusion for All" project. / Special Olympics

The inclusive volleyball team from Krusevac, Serbia, formed as part of the USAID/Special Olympics “Inclusion for All” project. / Special Olympics

It remains one of the most marginalized populations in the world. It is a disability subset that has consistently witnessed widespread discrimination and stigma, hindering its ability to advance. It is a group that has been largely misunderstood and misrepresented. This population — individuals with intellectual and developmental disabilities (ID) — still exists very much on the margins of both developed and developing nations. Through focused, country-level partnerships, Special Olympics is working together with USAID missions to create inclusive development strategies and programs to support individuals with ID.

The innovation that these partnerships offer to the development community, foreign governments and civil society alike is the methodology used: the unifying power of sport.

Despite significant gains made across the world in critical development areas like poverty eradication, gender equality, and global health, individuals with ID experience some of the lowest access rates, across sector, of any subset globally. Estimates from leading development agencies, such as the World Health Organization and UNICEF, demonstrate that individuals with ID experience a poverty of access to basic services that plunge them, and their extended families, into a repeated cycle of exclusion and isolation. This isolation can be felt in every aspect of life.

Special Olympics and USAID are working together to change that.

As part of the USAID-Special Olympics partnership initiative in Serbia and Montenegro, launched in September 2012, seminars increased public awareness of intellectual disability and what strategies could be employed to achieve greater social inclusion.

The seminars’ results speak to a strong response. From the 17 seminars organized throughout Serbia and Montenegro, 34 Unified Sports (inclusive) teams were created with over 350 participants and led to more than 200 local competitions. Special Olympics Serbia athletes reported that 81 percent felt more accepted by their peers since joining Unified Sports programs, and all participants were eager to continue the team trainings and competitions. The success of this program emphasizes the need for sustained access to sport to achieve key development indicators, and the important role sport.

Most recently, Special Olympics and USAID have joined forces to offer increased capacity in development-through-sports services in rural Cambodia. The project will increase participation of people with ID in rural Cambodia through the provision of local sports programming, coaches training, and orientation on public awareness on intellectual disability.

The project, initiated in 2014, will formally recruit over 1,000 new Special Olympics Cambodia athletes, 250 families and over 100 new coaches in various sports modules. This simple model of engaging individuals with and without disabilities through sport has underscored the viability of a key tool in the quest for inclusive and sustainable development.

As the world pauses today to recognize the International Day of Persons with Disabilities, Special Olympics is proud of our joint efforts with USAID which hold increased promise that all individuals, including those with ID, will share in the benefits of a new round of development goals. This promise is not only a cause for celebration, but of increased action across all sectors to bring this vision of human dignity to all communities under the banner of perhaps the most active foreign aid agency in the world in support of marginalized groups.

ABOUT THE AUTHOR

David Evangelista is Vice President, Global Development and Government Relations for Special Olympics. Follow Special Olympics @SpecialOlympics

U.S. Opens New Ebola Clinic in Liberia

Liberia is in the midst of a building boom to help control the spread of Ebola. In support of the Liberian Government’s Ebola response strategy, the United States is in the process of constructing 15 Ebola treatment units (ETUs) in this hard-hit nation. Across the country, teams of workers are busy moving dirt, laying concrete, trucking in construction materials, and erecting large white tents.

The first ETU to be built and staffed by the U.S.—in the city of Tubmanburg—started receiving patients on November 18. Now, a second ETU supported by the United States is operational in the city of Kakata, about 45 miles northeast of Monrovia. Built by the organization Save the Children with support from USAID, the ETU is being run by International Medical Corps (IMC), which is also managing another ETU in Bong County, Liberia.

Members of USAID’s Ebola Disaster Assistance Response Team (DART) visited the site on November 22, joining a Liberian delegation that included the Assistant Minister of Health and county health officials. Below is an inside look at the USAID-supported ETU, including those areas that are currently off limits to cameras now that the facility is open to Ebola patients.

11.22.14-Kakata-ETU-sign-photo-credit-Justin-Pendarvis-USAID-OFDA About an hour’s drive northeast of Monrovia, in the heart of Liberia’s rubber cultivation belt, the second Ebola treatment unit (ETU) in Liberia to be constructed and staffed with U.S. Government assistance is now receiving patients. / Justin Pendarvis, USAID/OFDA


The facility was built by Save the Children with USAID providing construction materials, gravel, cots for patients, generators to power the ETU, and other support.  The red fencing separates public areas from Ebola “hot zones.” Photo courtesy: Justin Pendarvis, USAID/OFDA The facility was built by Save the Children with USAID providing construction materials, gravel, cots for patients, generators to power the ETU, and other support. The red fencing separates public areas from Ebola “hot zones.” / Justin Pendarvis, USAID/OFDA


USAID is funding International Medical Corps (IMC) to operate the ETU in Kakata. Here, USAID Disaster Assistance Response Team (DART) Deputy Justin Pendarvis (left) gets a tour from IMC Emergency Response Team Director Sean Casey (right). / Alisha McMichael, USAID/OFDA USAID is funding International Medical Corps (IMC) to operate the ETU in Kakata. Here, USAID Disaster Assistance Response Team (DART) Deputy Justin Pendarvis (left) gets a tour from IMC Emergency Response Team Director Sean Casey (right). / Alisha McMichael, USAID/OFDA


More than 160 people—mostly Liberian national staff—work at the ETU. For the past two weeks, IMC’s medical team received rigorous training on Ebola patient care, safety protocols, and ETU management. Photo courtesy: Alisha McMichael, USAID/OFDA More than 160 people—mostly Liberian national staff—work at the ETU. For the past two weeks, IMC’s medical team received rigorous training on Ebola patient care, safety protocols, and ETU management. / Alisha McMichael, USAID/OFDA


The 88-bed ETU, which opened on November 22, has received a number of patients. Some were discharged after testing negative for Ebola. Photo courtesy: Alisha McMichael, USAID/OFD The 88-bed ETU, which opened on November 22, has received a number of patients. Some were discharged after testing negative for Ebola. / Alisha McMichael, USAID/OFD


NO DETAIL OVERLOOKED: Inside the clinical care areas are electrical outlets where patients can play music or charge their cell phones to keep in touch with their loved ones. USAID provided generators to power the ETU. / IMC NO DETAIL OVERLOOKED: Inside the clinical care areas are electrical outlets where patients can play music or charge their cell phones to keep in touch with their loved ones. USAID provided generators to power the ETU. / IMC

ABOUT THE AUTHOR

The Ebola Disaster Assistance Response Team (DART) is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the U.S. Government, including USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), the U.S. Centers for Disease Control and Prevention (CDC), and the Departments of Defense and Health and Human Services.

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Key Populations Essential to Realize AIDS-Free Generation

Sex worker working on the Phnom Penh riverside. /  Ian Taylor

Sex worker working on the Phnom Penh riverside. / Ian Taylor

As we commemorate World AIDS Day this year, let’s take a moment to remember how far we’ve come, and where we must go. There are currently 35 million people living with HIV worldwide, and 13.6 million of those people are receiving antiretroviral therapy. New HIV infections continue to decline each year, with 2.1 million in 2013, which was 38 percent lower than in 2001. However, over 4,000 people continue to die from AIDS each and every day.

In accordance with the immense toll that HIV and AIDS have taken on the world, the U.S. Government established the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 as the single largest commitment by any nation to combat a single disease. Since then, working closely with many partners, PEPFAR has supported lifesaving antiretroviral therapy for more than 6.7 million men, women and children. As a key implementing agency of PEPFAR, USAID has made significant contributions to this remarkable progress. But, together, we have more work to do to finish the job.

UNAIDS has identified the 90-90-90 targets by 2020. These milestones aim to have 90 percent of people living with HIV know their status, 90 percent of people who know their status receive treatment, and 90 percent of people on HIV treatment having a suppressed viral load so their immune system remains strong and they are no longer infectious. In order to achieve these goals and have a lasting response to this epidemic, we must examine what is required to sustain HIV treatment for decades to come.

India World AIDS Day 2008 / AFP/Narinder Nanu/Getty Images

India World AIDS Day 2008 / AFP/Narinder Nanu/Getty Images

The vision for the next phase of PEPFAR is partnering to deliver an AIDS-free generation with sustainable results.However, a sustainable response to this epidemic requires intensified action to address major ongoing challenges such as health care financing, health systems and new technologies for treatment and prevention. And there is a special need for increased attention to the human rights of key affected populations. These include sex workers, men who have sex with men, transgender persons and persons who inject drugs.

The high vulnerability of key populations to HIV is disturbing. Compared to the general population, sex workers are 14 times more likely to be infected with HIV; men who have sex with men are 19 times more likely to be infected; and the limited data we have on transgender women suggest that they are 49 times more likely to be infected with HIV. Equally unsettling are the global estimates that the number of people living with HIV who inject drugs range from over 1 million to slightly less than 4 million people.

Barriers to essential services prohibit these figures from coming down. Stigma and discrimination, violence, criminalization, bad or ineffective policies, and opposition to civil society engagement present real challenges. One of the most egregious barriers is the lack of acknowledgement by governments and other leaders that key populations even exist and/or are underserved. As I have observed over the years, the most insidious form of oppression is to ignore a people.

Fortunately, that pessimistic view is tempered by the knowledge that these barriers can be overcome. We know from experience that effective programs can reach key populations with high quality, effective services, and that key populations infected with HIV can be linked to the care and treatment services that they desperately need. On Thursday, Dec. 4, we will highlight the importance of key populations in the HIV epidemic at the D.C. launch of USAID’s PEPFAR-funded LINKAGES project.

The U.S. Government’s official theme for World AIDS 2014 is Focus, Partner, Achieve: An AIDS-free Generation. This theme captures the core elements of what is needed to reach this goal, which is outlined in the PEPFAR Blueprint. We must deliver the right thing, in the right place and at the right time. This means focusing on the highest impact interventions, bringing them to scale in key geographic areas and among the most vulnerable populations, including men who have sex with men, sex workers, injecting drug users, and transgender persons.

On this World AIDS Day, nearly 35 years into the epidemic, I am extremely proud of our collective progress. But, while an AIDS-free generation is within our reach, we must not stop until it becomes our reality.

ABOUT THE AUTHOR

David Stanton is the Director of USAID’s Office of HIV/AIDS

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