submitted by Jonathan Hale
Earlier this week, I flew four hours from Moscow to Sarajevo. Bosnia and Herzegovina is mountainous and very green in the spring. While it is a post-conflict country, people here are still in many ways searching for the path towards sustainable peace and prosperity. Divisions still run deep. Life remains segregated by ethnic community. There are separate schools within the same buildings. Multiple layers of segregated government and politics. There are even segregated telephone systems! Speaking with our very talented local foreign national staff, it is clear that there are still deep and painful memories of war here, even though it ended more than a decade ago. It’s striking to note that, according to the UNDP, a considerable proportion of Bosnians (up to 19% per UNDP figures), which enjoyed a relatively high living standard before the war now live at or below the poverty line.
I spent Wednesday and Thursday on the road. We drove around the country from Sarajevo to Mostar, Grude, Jajce, and Banja Luka in the Republika Srpska, and back. Along the way, I saw some hope along with the challenges. In Grude, I met with a mayor that is pressing for reforms to make government more responsive to the needs of the people. I understand there are a handful of other mayors and local officials like him throughout Bosnia-Herzegovina. I had the privilege of participating in a community event
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By developing and implementing high-impact, evidence-based interventions, delivered at low cost, USAID programs reduced newborn mortality by 16 to 42 percent in 11 these countries. With USAID support, counties as diverse as Nepal, Cambodia, Ethiopia, Madagascar, Tanzania, and Afghanistan have reduced under-five mortality by 25 percent in 5 to 7 years.
Death rates in children under 5 are dropping in many countries at an accelerated pace, according to a new report in ‘The Lancet’ based on data from 187 countries from 1970 to 2010. Worldwide, 7.7 million children are expected to die this year down from the 1990 figure of 11.9 million.
Global child survival programs have focused on reaching increased numbers of children with basic health interventions, which scientific research and field programs have demonstrated to reduce the susceptibility of children to serious illnesses. Vaccines, vitamin A supplements, better treatment of diarrhea, pneumonia and malaria, insecticide-treated bed nets to prevent malaria, more education for women, reduced numbers of high risk and closely spaced births, and AIDS medicines in high-HIV prevalence countries are among the factors that have helped lower death rates. USAID has supported much of the research that identified and proved the effectiveness of high-impact interventions, from Oral Rehydration Therapy and vitamin A to community treatment of pneumonia and essential newborn care.
USAID’s work with developing country governments alongside UNICEF, the World Health Organization, World Bank, other donors, NGOs and private sector partners has contributed to successes at an unprecedented global scale. When the U.S. Child Survival program began in the early 1980s, it was estimated that almost 15 million children died each year in the developing world. Without reduced rates of mortality, the number of deaths today would be about 17 million each year. However, The Lancet report notes that, despite significant progress, the rate of decline in infant and child mortality is still not fast enough to meet the 2015 MDG target. This underscores the importance of the Global Health Initiative’s increased focus on maternal and child health.
On May 19th, ‘The Lancet’ released a special series on tuberculosis, which includes a series of papers and comments highlighting the need for new tools, the threat posed by drug-resistant strains, results of current control efforts and other issues about TB worldwide http://www.thelancet.com/series/tuberculosis. While treatment strategies saved six million lives and 36 million cases of the disease were successfully treated between 1995 and 2008, TB remains a severe global public health threat. TB remains second only to HIV among infectious killers worldwide today and is the third leading cause of death among women aged 15-44.
The Lancet series also focused on the broader issues that contribute to the spread of the disease. The majority of TB cases and deaths occur in developing countries. TB proliferates in close spaces, and it perpetuates poverty by striking the poorest and most vulnerable groups. Large numbers of TB cases go undetected and untreated, fueling new cases and deaths. Making matters worse, new forms of the disease have emerged that are resistant to existing drugs. According to the report, without significant investments in new technology and prevention and treatment tools, drug-resistant strains of TB could become the “dominant” form of TB over the coming decades. In addition, new approaches to diagnose TB, coupled with improved health delivery systems and stronger community awareness, are critical to earlier detection and treatment. Urgent actions are also needed to scale up effective and integrated services for TB and HIV at the country level.
On March 24th, the U.S. Government, through USAID, released its Global Tuberculosis Strategy – our blueprint for expanded TB treatment and control over the next five years. To meet our targets, we will invest in country-led plans, scale up country level programs, increase our impact by leveraging our efforts with the Global Fund and mobilize additional resources from the private sector. We will also promote research and innovation. Our investments focus on new diagnostics that will allow us to detect TB more easily, including drug resistant TB, and new drugs that will reduce the duration of TB treatment. Assisting countries to introduce these new tools into programs is also a priority.
by Jonathan Hale
Energy and environmental issues have been a key focus of my visit to Russia this week. I had the great opportunity to meet with officials at the Ministry of Energy, which is responsible for improving energy efficiency in Russia, as well as with civic leaders from environmental groups and the Institute for Sustainable Development of the Public Chamber, an entity that serves as an intermediary between Russian citizens and the government. Across the board, my Russian counterparts expressed a strong interest in collaborating with the U.S. to improve energy efficiency and protect the environment.
Two American wildlife experts examine the health of a female Far Eastern leopard in Primorskiy Krai, Russia. With a population of only 30-40 confined to a thin stretch of forest along the Russian-Chinese border, this leopard is one of the world’s rarest and most endangered cats. USAID is supporting a joint US-Russian effort to better understand their ecology and protect their habitat. (Photo by Andrew Harrington, Wildlife Conservation Society)
President Medvedev has identified inefficient use of energy – and its impact on the country’s economy and environment – as an issue of critical importance and has called for reducing the energy intensity of the Russian economy by half by 2020. Today, Russian energy losses due to inefficiency are equal to the annual energy consumption in France! But it’s estimated that Russia could save 45% of consumed energy through innovation and modern technology, which will also help Russia better address climate change. In my meetings here this week, we discussed the challenges of improving energy efficiency in Russia and the substantial impact USAID programs have had in other countries.
At the Public Chamber, I was especially pleased to meet some of the Russian scientists and activists who are a driving force behind environmental protection here. Organizations like the World Wildlife Fund (WWF) Russia and Greenpeace Russia are led by impressive Russian experts – such as Dr. Ivan Blokov, who also serves as the interim Head of Greenpeace International’s Research Unit. I heard their concerns about pollution and its impact on human health. They also offered their insight on how USAID can continue to partner with Russia to improve the stewardship of its forests – the largest in the world. Together, we can ensure that Russian forests continue to serve as one of the world’s most important carbon sinks and as home to unique ecosystems that include amazing animals like the Amur tiger, the Far Eastern leopard, and the Baikal seal. We also spoke about the Arctic.
Why should this matter to Americans? Russia’s forests and ecosystems make up 22% of the world’s territory so protection in Russia is essential to maintaining a balanced biosphere worldwide. The passion that I have seen this week has energized me even more to find new and exciting ways for USAID to partner and cooperate with Russia on energy efficiency and the environment.
Dr. Rajiv Shah, USAID Administrator, speaks at the Bangladesh Food Security Investment Forum in Dhaka on May 26, 2010
I’m in Bangladesh today to participate in the Food Security Investment Forum. What a crowd! The Prime Minister, Her Excellency Sheikh Hasina, who has shown a strong commitment to food security, spoke this morning, as well as luminaries such as Dr. David Nabarro, Dr. Shenggen Fan, and Dr. John Mellor.
We’ve all come together in Bangladesh because this country represents a situation that we need to address now. The rising population, decreasing availability of land for agricultural production, and the growing adverse consequences due to climate change means we need to think dramatically differently about what it takes to feed the future generations in this country.
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This marks my first trip to Russia since I took on the role of Deputy Assistant Administrator for USAID’s Europe and Eurasia Bureau. I’m very pleased to be back here, at a time when there is a lot of optimism about the “reset” in U.S.-Russia relations.
Today I met with Russian experts and NGOs that are partnering with USAID to reduce maternal and infant mortality, improve reproductive health, and reduce the number of children living in orphanages and on the streets. These are priorities for both Russia and the U.S., and an important area of collaboration under the Bilateral Presidential Commission established by Presidents Obama and Medvedev last July.
I was impressed by the leading role that Russian organizations such as
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Young people are watching a play about adults being encouraged to get tested for HIV as part of participating in a clinical trial for a novel HIV vaccine at YRG Care, a premiere HIV referral center in Chennai, Tamil Nadu, India.
Administrator Shah recently said that “humanity demands an AIDS vaccine” when describing USAID’s approach to high impact development. USAID and its partners continue to support the quest for a safe vaccine that could effectively prevent HIV — a search that is commemorated each year on May 18th, HIV Vaccine Awareness Day. This work is essential since notable progress in providing life-saving treatment to those who need it cannot keep up with the number of new HIV infections. For every two people living with HIV who begin taking antiretroviral therapy, five additional people become newly infected. Each day, there are at least 7,400 new infections.
Our current efforts are outlined in a vaccine brief.
USAID’s Senior Technical Advisor for HIV Vaccines was featured in a recent issue of Frontlines [PDF].