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Archives for Health

Can Private Financing Answer Uganda’s Health Care Woes?

Early this year, the U.S. and Swedish ambassadors went on a joint site visit to Rhona Medical Center, a medium-sized health clinic in Kampala. Site visits by the U.S. ambassador are not uncommon in Uganda where the health sector makes up the lion’s share of the aid budget. But this joint visit was unusual because it was to a private health facility that a year ago had received a loan co-guaranteed by USAID and the Swedish International Development Agency (SIDA).

Uganda’s adoption of the Anti-Homosexuality Act in February this year and the Ugandan president’s dismissal of the value of the U.S. Government’s development assistance to the country has prompted a review of our 50-year-long efforts in Uganda. In his February 24 speech, after signing the anti-homosexuality bill into law, Uganda’s President Yoweri Museveni stressed, “Uganda is a rich country that does not need aid, because aid is in itself a problem…”

Indeed, Uganda has made much smaller gains in key health indicators than its neighbors despite receiving larger aid inflows per capita, amounting to three quarters of all public health spending. I have spent some of my last three years at post pondering how we might be effective in improving the health of Ugandans when, despite the critical support provided by USAID and our implementing partners, the government fails to adequately enforce accountability and performance in the public health system. Uganda has had nominally free health care since 2001, yet a recent World Bank survey found that 51 percent of public sector health workers were absent from their posts and drug stock-outs also remain a problem.

An obvious answer to me was to invest in the emerging private sector, rather than continuing to unsustainably prop-up the public system. While USAID continues to support the public sector to ensure that the poorest Ugandans continue to access vital health care services, we can also ensure that people have additional health service options outside of the public sector, even when those options require payment. By distributing our aid across the public and private sectors, we hoped to continue to reach the poorest Ugandans while also helping increase the quality of health services through private sector development.

A nurse works in southwest Uganda's Kabwohe Clinical Research Center, a facility that received a $35,000 loan guaranteed through USAID's Development Credit Authority, and was able to hire more staff and provide life saving AIDS treatment to 4600 patients as a result. / USAID, Morgana Wingard

A nurse works in southwest Uganda’s Kabwohe Clinical Research Center, a facility that received a $35,000 loan guaranteed through USAID’s Development Credit Authority, and was able to hire more staff and provide life saving AIDS treatment to 4600 patients as a result. / USAID, Morgana Wingard

Over the last three years, with invaluable support from USAID’s Development Credit Authority, USAID/Uganda has built a portfolio of risk-sharing guarantees with local banks to open $10 million in private lending for Uganda’s health sector, at a cost of only $315,000 to USAID. The financing was made available for everything in the health sector from small drug shops to hospitals in Kampala, with an emphasis on facilities that serve rural areas – a segment that banks previously considered too high-risk to qualify for commercial loans.

Thanks to the risk-mitigating guarantees, private clinics can now access commercial loans to purchase medical equipment and expand their facilities to serve more clients. The results so far are impressive – Centenary Bank has utilized 50 percent of a five-year guarantee in a little over a year, reflecting the pent-up demand for credit. One of its loans – of around $25,000 – went to Rhona Medical Center and was used to purchase a dental x-ray, a scanning machine, a clinical chemistry machine, a hematology analyzer and six desktop computers.

Accompanying the U.S. and Swedish ambassadors on this site visit, Rhona’s director, Dr. Edward Bemera, shared with us that the clinic was able to get much better terms on its loan thanks to the USAID guarantee facility.

Along with the new medical equipment, he used his loan to hire additional nurses and to make renovations to the facility. As a result, the Medical Center’s revenues more than doubled, and the number of clients receiving better services quadrupled.

Dr. Bemera explains Amb. DeLisi, Amb. Andersson and the rest of the team about how he used the loan to scale up activities at his clinic.

Dr. Bemera explains to Amb. DeLisi, Amb. Andersson and the rest of the team about how he used the USAID-backed loan to scale up activities at his clinic. / USAID, Roberta Rossi

The contribution of the private health sector will grow significantly in years to come as banks realize that this segment is credit-worthy. This is evidenced by the fact that there have been no defaults to date under the guarantee. Increased competition will gradually reduce prices for patients, making private health care more affordable and of better quality.

USAID/Uganda has embraced the value of this private partnerships approach in other areas of our work. For example, since girls’ secondary enrollment is a strong predictor of improved maternal and child health outcomes, we are about to launch a new loan guarantee for girls’ school fee loans, that will be managed as part of our Orphans and Vulnerable Children program.

For me, to be given the opportunity to champion innovative approaches to development, and to see those translated into tangible results is a dream come true.

 

ABOUT THE AUTHOR

Daryl Martyris is a Health Development Officer in USAID Uganda’s Office of Health, HIV/AIDS and Education.

If You ‘Let Girls Learn,’ You Save Lives Too

letgirlslearn_rev2

Oppression and prejudice toil in a cage of ignorance and cruelty.  Before the U.S. Civil Rights movement altered the course of history, Jim Crow laws and terror imposed segregation and licensed discrimination, casting a pall of shame over America.

Today, the inhumane degradation and culturally sanctioned abuse of girls in many parts of the world is a shockingly similar shame. Denied the most basic universal human rights, girls have limited access to health care, nutrition, education and job skills training, as well as productive resources, such as water, land and credit.

The kidnapping of 300 Nigerian girls by the extremist group Boko Haram focused global attention, issuing a clarion call that girls’ education and health are civil rights worth fighting for, leading to benefits, not only for girls, but for entire communities and nations. In low income countries, mothers who have completed primary school are more likely to seek appropriate health care for their children. A child born to a literate mother is 50 percent more likely to survive past the age of 5.

  • In low income countries, mothers who have completed primary school are more likely to seek appropriate health care for their children.
  • A child born to a literate mother is 50 percent more likely to survive past the age of 5.
  • Women with some formal education are more likely to seek medical care and ensure their children are immunized.
  • Women with some formal education are more likely to be better informed about their children’s nutritional requirements, and practice better sanitation.
  • An educated girl is three times less likely to contract HIV.

Segenet Wendawork was 5 years old when her mother died. After her father moved away, she bounced around, living with her grandmother for a while, then an aunt who kept her home from school to help with chores.  Thanks to a USAID scholarship program, Segenet was able to return to school in Ethiopia and complete her education. “Before the scholarship, I was unable to dream about the future,” she said.

Sixty-two million girls are not in school, and are also unable to dream about their future. And millions more are fighting to stay in school. The U.S. Government invests $1 billion each year through USAID in low-income countries to ensure equitable treatment of boys and girls, to create safe school environments, and to engage communities in support for girls’ education.

According to the Working Group on Girls (WGG), a coalition of over 80 national and international non-governmental organizations, schoolgirls of all ages report sexual harassment and assault, ranging from gender discrimination to rape, exploitation and physical and psychological intimidation in school.

Last week, a new effort was launched by the U.S. Government, and led by USAID, to provide the public with meaningful ways to help all girls get a quality education. Let Girls Learn aims to elevate a conversation about the need to support all girls in their pursuit of a quality education. In support of the effort, USAID also announced over $230 million for new programs to support education around the world.

Thomas Staal, a senior leader with USAID, said education is essential to fight poverty and all its corollaries: hunger, disease, resource degradation, exploitation and despair. “Women are the caretakers and economic catalysts in our communities. No country can afford to ignore their potential.”

Since education level has the greatest effect on the age at which a woman has her first birth, and adolescent mothers are more likely to die in childbirth, education both empowers young people directly and affects family planning choices and labor force participation.

 “Education is essential to fight poverty and all its corollaries.” In this photo, school children in Haiti. / Devon McLorg, USAID

“Education is essential to fight poverty and all its corollaries.” In this photo, school children in Haiti. / Devon McLorg, USAID

Conversely, a healthy start in life and good nutrition are essential for children to thrive, develop and spend more time in school. Last month, USAID launched a new global nutrition strategy  aimed at reducing the number of chronically malnourished or stunted children by at least 2 million over the next five years. Every year, under-nutrition contributes to 3.1 million child deaths—45 percent of the worldwide total.

In the strategy, USAID is prioritizing the prevention of malnutrition given the irreversible consequences of chronic under-nutrition early in life. Under-nutrition inhibits the body’s immune system from fighting disease and impedes cognitive, social-emotional and motor development.

In addition to focusing on good nutrition in the first 1,000 days for mother and child, USAID is also saving newborns from severe infections, protecting young children from the risks of diarrhea, pneumonia and malaria, and helping women space the births of their children to protect their health and that of their children.

This week, USAID, the governments of Ethiopia and India, in collaboration with UNICEF, the Bill & Melinda Gates Foundation, and others will hold a high level forum to take stock of recent efforts aimed at reducing child and maternal deaths and plot a new course that will ensure progress continues.

USAID will refocus the majority of our maternal and child health resources toward specific, life-saving tools in 24 countries where the need is greatest and empower our partner countries to lead with robust action plans and evidence-based report cards to save an unprecedented number of lives by 2020.

USAID Assistant Administrator Ariel Pablos-Mendez said by coupling family planning investments with policies supporting child survival, girls’ education and job creation – especially those targeting women – countries can be positioned to realize substantial economic growth that lifts everyone out of poverty.

Doing so will allow girls and boys to follow their wildest hopes and dreams and live productive lives.

ABOUT THE AUTHOR

Chris Thomas is a communications advisor in the Bureau for Global Health. Read more from the author in the latest FrontLines, which features articles about the Agency’s work in maternal and child health: In Health Research Fueled by USAID Is Fielding Innovative Solutions, he writes about innovative, cost-effective and life-saving health care solutions whose research and development were aided by USAID; and in Your Voice: Frontline Health Workers are the Unsung Heroes of Global Health Progress, he describes just how essential community health workers are to rural and other underserved communities in developing nations.

Global Leadership, Collaboration Aligned in the Fight Against Tuberculosis

Tuberculosis preys on the urban poor. ​​In the photo, the family of Rehmat Shek deals with the disease in Rafik Nagar slum in India. Global leaders in the fight against TB hope to end the epidemic by 2035.

Tuberculosis preys on the urban poor. ​​In the photo, the family of Rehmat Shek deals with the disease in Rafik Nagar slum in India. Global leaders in the fight against TB hope to end the epidemic by 2035. David Rochkind / WHO

With approval of the post-2015 global tuberculosis strategy by the World Health Assembly, the global community stands united as we work toward ambitious new targets for 2025 and 2035 to end the global TB epidemic. As we look to the future, it is important to evaluate the current global response to the epidemic so we may develop an effective and coordinated approach going forward. Major investments in TB by high-burden countries, the U.S. Government, the Global Fund (GF), the World Health Organization (WHO) and others have led to impressive progress and shown the potential for future impact. Promising new tools are now finally available, with others in the pipeline, and governments, donors and partners are allied around a new strategy with refocused resources.

Where are we succeeding?

TB kills three people a minute, is a security threat to the world, and puts health care personnel and poor and marginalized populations at risk around the globe. Yet, TB treatment is one of the best buys in global health – the disease is almost always curable (unless resistant to major drugs) with inexpensive medications and low-cost delivery approaches, and has been considered in various assessments as one of the most cost-effective public health interventions. New and cheaper models to diagnose and treat multidrug-resistant TB are being scaled up in many high-burden countries and the cost of second line drug treatment regimens to cure TB have decreased by 32 percent, thanks to efforts by the Global Drug Facility (GDF).

In the space of 17 years since the implementation of a new standard approach to control TB, 56 million people across the globe have been successfully diagnosed, treated and cared for, and WHO estimates that 22 million lives have been saved by using comprehensive and proven approaches to TB care[U1] , compared to what would have occurred if previous standards continued. These milestones reflect the ongoing commitment of governments and the global community to transform the fight against TB and work toward elimination of this major public health problem and global threat. Since 1990, TB deaths have declined by 45 percent and TB prevalence has declined by 37 percent globally. The world is now on track to meet the MDG target of 50 percent reduction in mortality by 2015.

Key ingredients to success and readiness to face challenges:

1.  Proven strategies, collaboration and leadership. Coordination and harmonization of efforts were the key to high effectiveness and success. The national programs take the lead in establishing policies aligned with international best practice and ensuring their implementation within primary care services. A clearly budgeted national strategic plan is fundamental to optimizing the use of resources and identifying gaps. Technical partners and financiers support the plan in a uniform manner. Supporting this model, the U.S. Government is the largest bilateral donor for TB and USAID serves as the lead agency for international TB control. Without this current systematic response, we will miss out on opportunities with endemic country partners and governments. Most importantly, progress in saving lives will be slowed.

 2.  Boots on the ground.  The U.S. bilateral program works directly with local governments and ministries of health to develop country-owned approaches and build national capacity so countries can successfully implement their TB care and treatment programs. This close collaboration with ministries of health has resulted in faster detection and treatment of TB; scaled-up prevention and treatment of multi-drug resistant TB (MDR-TB); expanded coverage for interventions for TB/HIV; and improvements in the health system. This approach also improves the strategic use of GF and domestic resources as well as the quality of TB programs.

3.  Resource Allocation and Realignment. The Global Fund and the United States both recently realigned their resources to further strengthen the next phase of TB response and focus where the need is greatest to sustain value and resolve outstanding challenges. Among the concerns faced by countries are ability to match external financing, coverage of services, and the MDR-TB and TB/HIV burdens. Since 2009, the U.S. Government has allocated almost $3.3 billion towards implementation of TB programs in high-burden countries with over $600 million in FY13 (see table below). The U.S. bilateral program, led by USAID, is focused on countries with the greatest TB burden and need. The current 27 USAID-supported countries carry almost 70 percent of the world’s annual TB cases, not including China. Through its new funding model, the GF has also redefined support for TB.  Twenty-four of the eligible countries account for 79 percent of the world’s annual TB cases (not including China) and have been allocated almost 60 percent of the total of TB funds. The GF has increased TB resources from 16 percent to 18 percent of all funds for 2014-2017.

Funding Stream

2009 (USD M)

2010 (USD M)

2011 (USD M)

2012 (USD M)

2013 (USD M)

2014 (USD M)

USAID TB Bilateral[1]

176

249

238

256

232

244

PEPFAR TB/HIV[2]

150

137

152

132

132*

132*

USG Portion of GF TB Grants**[3]

129

172

145

166

242

213

Total TB funding for Country Implementation

455

558

535

554

606

589

*Assumed flat-line budget numbers based on the public FY12 figures.

**This represents 1/3 of the total TB allocations to countries in each year. It is the actually disbursement of TB funds for in this year. Note, the increase in 2013 is due to a large increase in distribution of funds for India.

 4.  Research and Innovation. After decades of using outdated tools that limited achievements, the TB community now has newer rapid molecular diagnostics, modernized approaches and new medicines already available for the treatment of MDR-TB. With the introduction of an innovative diagnostic test, Xpert, countries can implement faster and better detection of TB and drug resistant TB.  Further, the price buy-down of this new technology by the U.S. Government, the Bill & Melinda Gates Foundation and UNITAID has ensured rapid adoption and implementation of Xpert by over 100 low- and middle-income countries. In addition, new TB treatment regimens that use novel drugs and will bring renewed hope for TB patients are under study, including the expanded STREAM study (a 9 month MDR-TB regimen with a new drug) and the PaMZ study that is evaluating the efficacy, safety and tolerability of a treatment regimen for both drug susceptible and drug-resistant TB. Lastly, the work of the Global Drug Facility, supported by the U.S. Government, has ensured that quality, affordable second line drugs are available as countries scale-up MDR-TB treatment. USAID has collaborated with the Global Drug Facility and other partners to support over 40 manufacturers to improve the quality and availability of second-line drugs and make MDR-TB treatment more affordable.

A doctor visits a patient at the Group of TB Hospitals in Mumbai during the daily rounds. / David Rochkind, WHO

A doctor visits a patient at the Group of TB Hospitals in Mumbai during the daily rounds. / David Rochkind, WHO

Future Strategic direction: 

The post-2015 Global TB Strategy approved at the World Health Assembly in May 2014 focuses on three pillars including: patient centered care and prevention; bold policies and supportive systems; and intensified research and innovation. The U.S. Government  is developing a new long-term strategy that will align with the recently approved WHO post-2015 strategy to Reach, Cure, and Prevent.  The U.S. Government commits to Reach every person with TB, Cure those in need of treatment and Prevent new infections and spread of the disease. To reach these goals, the different U.S. agencies involved in TB treatment and control will need to leverage their collective strengths and continue to collaborate through existing processes such as a common strategy and joint projects, defined roles, joint reporting and regular coordination.

Filling the Funding Gap – Despite recent wins and progress against TB, the current funding gap of $2 billion per year remains a fundamental challenge to face. The availability of this funding would result in major benefits for a huge number of people. As mentioned in the recent February Lancet commentary, domestic resources should continue to be mobilized for long-term and effective TB care and treatment. The international community must continue to bolster national efforts as well as support the development of global, common goods such as research, affordable and quality TB commodities, and support for innovations and new research. Global partners should help mobilize resources to fill gaps in TB care, including crowding in partner country financing and identifying new partners.

Building a multi-sectoral response – Tuberculosis provides a perfect example of how health security is intimately linked to social and economic development. Ending extreme poverty is critical to global progress on TB as are overarching efforts to achieve universal health coverage. A person’s health status is intimately entwined with underlying poverty, political and social stability, economic growth, food security, education and gender equality.  Development agencies such as USAID, along with U.N. agencies, NGOs and civil society, need to play their part in building cross-sectoral links. Together, we must work in harmony to reduce the social determinants of TB and to reach and serve the poorest and most vulnerable.

Research – The post-2015 goals will be difficult to achieve without a more robust research pipeline. This will require additional funding for research to ensure that the top priorities for innovation are a point-of-care diagnostic, better and shorter regimens and a new vaccine.  New tools for improving approaches at the country level will be necessary to optimize results.

The global fight against TB remains fragile, given resource constraints. Yet, promising new tools are now available, with others in the pipeline, and donors and partners are allied around a new strategy with refocused resources. We are now at a crossroads between ending the TB epidemic by 2035 and witnessing millions more TB deaths. But with continued consultation, coordination and leadership, we believe we will end the epidemic.

 


[1] USAID CBJ budget figures for each year

[2]  PEPFAR FY13 CBJ: http://www.pepfar.gov/documents/organization/222642.pdf

[3] GF website: http://portfolio.theglobalfund.org/en/Home/Index

[U1]Footnote that this is WHO data.

 

ABOUT THE AUTHOR

Dr. Ariel Pablos-Mendez is the Assistant Administrator for Global Health at USAID
Dr. Mario Raviglione is the Director of Global TB Programme for WHO
Dr. Dyah Erti Mustikawati is the NTP Manager at MOH/Indonesia
Mr. Lerole David Mametja is the Chief Director for TB Control and Management at MOH/South Africa

 

10 Reasons Vaccines are the Best Protector of Human Life

A young boy receives an oral polio vaccination at a USAID -funded medical clinic on July 13, 2010 in Petionville, Haiti.  In 2011 in Haiti, the U.S. Government  vaccinated nearly 157,000 children under the age of one for routine childhood diseases and provided more than 350,000 antenatal care visits and more than 131,000 post-partum/newborn care visits.  The United States is providing access to health services for 50 percent of the people of Haiti.  Kendra Helmer/USAID

A young boy receives an oral polio vaccination at a USAID-funded medical clinic on July 13, 2010 in Petionville, Haiti. In 2011 in Haiti, the U.S. Government vaccinated nearly 157,000 children under the age of 1 for routine childhood diseases. / Kendra Helmer, USAID

Immunization is one of the most powerful health interventions ever introduced. Every year, the World Health Organization estimates, vaccines save between 2 and 3 million children from killers such as polio, measles, pneumonia, and rotavirus diarrhea.

To mark World Immunization Week, USAID partner PATH is reporting on the lifesaving potential of vaccines against four illnesses that kill more than 2 million young children a year: malaria, pneumonia, rotavirus, and Japanese encephalitis. Here, Dr. John Boslego, director of PATH’s Vaccine Development Program, lists the top 10 ways vaccines make a difference for children and for global health. This post originally appeared on PATH.

No. 10: Vaccines lower the risk of getting other diseases.

Contracting some diseases can make getting other ones easier. For example, being sick with influenza can make you more vulnerable to pneumonia caused by other organisms. The best way to avoid coinfections is to prevent the initial infection through vaccination.

Here a Nepalese boy demonstrates the water flow of a USAID-built electric tube well used for irrigation in the Terai region of Nepal. Patrick D Smith/USAID

A Nepalese boy demonstrates the water flow of a USAID-built electric tube well used for irrigation in the Terai region of Nepal. / Patrick D Smith, USAID

No. 9: They keep people healthier longer.

Some vaccines protect people for a limited time and require booster doses; others protect for a lifetime. Either way, vaccinated people are much safer from many serious diseases than people who haven’t been vaccinated, both in the short and long term.

As part of a USAID-supported polio initiative, a vaccinator in the Democratic Republic of Congo (DRC) administers the oral polio vaccine March 23 in the Commune of Ndjili, Kinshasa. On that day, Minister of Health, Victor Makwenge Kaput officially launched a vaccination campaign against the wild polio virus in the capital city. USAID/A. Mukeba

As part of a USAID-supported polio initiative, a vaccinator in the Democratic Republic of Congo administers the oral polio vaccine in the Commune of Ndjili, Kinshasa. / USAID, A. Mukeba

No. 8: They are relatively easy to deliver.

Through national immunization programs and mass vaccination campaigns, vaccines can be delivered quickly to large numbers of people, providing widespread protection. Thanks to creative strategies, delivery in even the remotest parts of the world is becoming easier.

USAID and the Medical Relief International Charity (Merlin) support cholera treatment centers in Goma, Democratic Republic of Congo.  Pictured is a young child suffering from cholera and receiving food aid from the Agency.  /  Frederic Courbet

USAID and the Medical Relief International Charity (Merlin) support cholera treatment centers in Goma, Democratic Republic of Congo. Pictured is a young child suffering from cholera and receiving food aid from the Agency. / Frederic Courbet

No. 7: They prevent disease where medical care isn’t an option.

Too many children die because high-quality care is unavailable. When a child in poverty gets sick, medical care could be inadequate or several days’ travel away. Stopping disease before it starts could be that child’s only lifeline.

Solar lights funded by OTI in Cap Haitien and en route to Caracol, Haiti, on Oct. 19, 2012.. / Kendra Helmer/USAID

Solar lights funded by USAID help children read at night in Cap Haitien. Haiti, on Oct. 19, 2012. / Kendra Helmer, USAID

No. 6: They play well with other interventions.

Vaccines complement other global health tools. We’re seeing this with the integrated strategy to protect, prevent, and treat pneumonia and diarrhea through basic sanitation, safe drinking water, hand-washing, nutrition, antibiotics, breastfeeding, clean cook stoves, antibiotics, zinc, oral rehydration solution, and vaccines. Leveraging these tools across diseases could save the lives of over 2 million children by 2015.

This photo took third place in the FrontLines photo contest. Maamohelang  Hlaha tenderly kisses her young son Rebone. An HIV-positive mother of four, Hlaha’s  village is inaccessible by vehicles and a three-hour hike from the nearest health clinic.  She receives HIV treatment through the Riders for Health program, which is funded  by USAID and run by the Elizabeth Glaser Pediatric AIDS Foundation. As part of the  program, pony riders and motorcycle riders transport blood tests, drugs and supplies to  Lesotho’s remote mountain health clinics. The system allows people to receive HIV test  results sooner, access life-saving drugs and ensure an uninterrupted supply of medication.  Rebone, whose name means “we have witnessed,” was born HIV-free in August 2008. / Reverie Zurba, USAID/South Africa

A mother of four who receives HIV treatment through a USAID-funded program tenderly kisses her young son in South Africa. Thanks to the treatment, her son was born HIV-free in August 2008. / Reverie Zurba, USAID

No. 5: They continue to evolve.

Tackling unmet health needs requires us to continue to pursue the next generation of better and more affordable vaccines. Candidates like RTS,S for malaria and ROTAVAC® for the leading cause of severe diarrhea—rotavirus—are two examples of innovative technologies on the horizon that give families and communities more cause for hope.

This photo was chosen as a finalist in the FrontLines photo contest. These schoolchildren in Aqaba, Jordan, are beneficiaries of the Jordan Schools Program and  Education Reform Support Program. Both of these projects are funded by USAID to  support the Jordanian Ministry of Education’s reform efforts in improving the quality of education in the country. March 2011. / Jill Meeks, Creative Associates International

These schoolchildren in Aqaba, Jordan, are beneficiaries the Jordan Schools Program and Education Reform Support Program. Both  are funded by USAID to support Jordan’s efforts to improve the quality of education in the country.  / Jill Meeks, Creative Associates International

No. 4:  They indirectly protect loved ones and communities.

For many diseases, immunizing a significant portion of a population can break the chain of transmission and actually protect unvaccinated people—a bonus effect called herd immunity. The trick is immunizing enough people to ensure that transmission can’t gather momentum.

A little girl in Tajikistan eats mashed potatoes with greens, which her mother prepared for her. Over 5,000 Tajik children under 5 years old tasted new foods such as pancakes ("blini") with cottage cheese and vegetable salads that their mothers prepared for them after a training. / USAID

A little girl in Tajikistan eats mashed potatoes with greens, which her mother prepared for her. Over 5,000 Tajik children under 5 years old tasted new foods such as pancakes (“blini”) with cottage cheese and vegetable salads that their mothers prepared for them after a USAID-supported nutrition training. / USAID

No 3: They are safe and effective.

Vaccines are among the safest products in medicine and undergo rigorous testing to ensure they work and are safe. Their benefits far outweigh their risks (which are minimal), especially when compared to the dire consequences of the diseases they prevent. Vaccines can take some pretty terrible diseases entirely or nearly out of the picture, too. That’s the case with smallpox and polio, and others will follow.

School girls in Sana’a gather for their lesson. Since many girls in Yemen do not attend primary school or graduate from it, recent USAID-backed measures have ensured all girls a right to attend school and increase literacy. / Malak Shaher, USAID/YMEP

School girls in Sana’a gather for their lesson. Since many girls in Yemen do not attend primary school or graduate from it, recent USAID-backed measures have ensured all girls a right to attend school and increase literacy. / Clinton Doggett, USAID

No. 2:  They are a public health best buy.

Preventing disease is less expensive than treating severe illness, and vaccines are the most cost-effective prevention option out there. Less disease frees up health care resources and saves on medical expenditures. Healthier children also do better developmentally, especially in school, and give parents more time to be productive at home and at work.

This image captured top honors in the FrontLines photo contest. These rural schoolchildren participate in the USAID-funded Southern Sudan Interactive Radio Instruction project, which uses radio to broadcast interactive student lessons. The lessons, based on Southern Sudan’s primary school syllabus, complement classroom instruction in literacy, English, mathematics, and life skills for grades one through four. July 2010. / Karl Grobl, Education Development Center Inc.

These rural schoolchildren participate in the USAID-funded Southern Sudan Interactive Radio Instruction project, which uses radio to broadcast interactive student lessons. The lessons, based on Southern Sudan’s primary school syllabus, complement classroom instruction in literacy, English, mathematics, and life skills for grades one through four. July 2010. / Karl Grobl, Education Development Center Inc.

No. 1:  They save children’s lives.

Roughly 2 to 3 million per year, in fact. In short, vaccines enable more children to see their 5th birthdays, let alone adulthood. That’s reason enough to top my list.

Video: Ghanaian Town Takes on Malaria

A couple in Ghana sits with an insecticide spray technician. / Erin Schiavone, Abt Associates

A couple in Ghana sits with an insecticide spray technician. / Erin Schiavone, Abt Associates

When it’s a buggy summer day, Americans may dust off the old bottle of Off, or light a citronella candle. Here, a mosquito bite is a nuisance. In many parts of the world, it’s a deadly killer.

 In 2012, there were still 207 million cases of malaria and over 600,000 deaths –  three quarters were children under 5. Approximately half of the world’s population is still at risk of malaria.

What choices do people in malarial zones have to protect themselves from this flying terror? And what are we doing to help?

 One of the most effective methods being supported by the U.S. President’s Malaria Initiative (PMI) around the world is spraying homes in the areas where the mosquitos live with an insecticide.

According to the World Health Organization an estimated 3.3 million lives were saved as a result of the scale-up of malaria control interventions over the last decade. Over the same period, malaria mortality rates in African children were reduced by more than half.

This delivers a massive, concerted blow to the mosquito population. In order to have an impact, indoor residual spraying, as it is called, must be carried out in least 80 percent of the homes in malaria-prone areas, use an effective insecticide and be executed by a well-trained workforce.

In Ghana, the entire population of 25 million is at risk for malaria; indoor residual spraying is helping protect families from this deadly disease. But it doesn’t happen on its own. A network of “social mobilizers” help communities realize the benefits of spraying, and encourage other health-improving behavior as well.

Bertha Moisob a passionate public health advocate working on a PMI-funded program in Ghana says this:

“My hope for the future is to see that reduced malaria burden.. Children are healthy, pregnant women delivery safely…”

Watch this video on how Bertha and her community are mobilizing against malaria

Full Speed Ahead on Malaria

 

Rear Admiral Tim Ziemer / Platon

Rear Admiral Tim Ziemer / Platon

Today, the greatest success story in global health is anchored by a continent once known mostly for famine and war. Many countries in sub-Saharan Africa are making unprecedented gains in child survival and reducing the devastating burden of malaria—a disease carried by mosquitoes and a major killer of children.

According to the World Health Organization an estimated 3.3 million lives were saved as a result of the scale-up of malaria control interventions over the last decade. Over the same period, malaria mortality rates in African children were reduced by an estimated 54 percent.

Most Americans are unaware of the devastating impact of malaria. But the insidious disease, a root cause and consequence of poverty, conspire against young children and pregnant women. The anopheles mosquito is a serial killer — a flying syringe that injects parasites during nightly blood meals.

Just a decade ago, the malaria story was one of despair across wide swathes of the African continent, killing more than 1 million people, and burdening health systems — up to 45 percent of all hospital admissions were caused by malaria.

A mother and child under a malaria-fighting bednet. /  Maggie Hallahan

A mother and child under a malaria-fighting bednet. / Maggie Hallahan

I was raised in Asia, and was infected by malaria as a child. Although malaria no longer threatens boys and girls in the United States, across Africa and in parts of Asia, it is still a frightening and literally gut-wrenching fact of life. Each case can be a struggle for survival.

Because malaria remains one of the foremost health problems on the African continent it is vital to test all children with fever and treat those who test positive for malaria as well as provide appropriate treatment to those with non-malaria fevers. With many people living great distances from or lacking transport to health facilities, community health workers are often the first and only link to providing health services essential to child and maternal health.

Community health works, like these in Madagascar, are often the front lines of defense against malaria. Photo Credit: Maggie Hallahan

Community health works, like these in Madagascar, are often the front lines of defense against malaria. / Maggie Hallahan

Thanks in part to American investments made through the U.S. President’s Malaria Initiative (PMI), led by the U.S. Agency for International Development (USAID) and implemented together with the Centers for Disease Control and Prevention (CDC), 61,000 front-line health workers were trained on how to treat malaria cases. Many were also trained to diagnose and treat the other main causes of childhood illness, diarrhea and pneumonia.

In the past year, Americans, through PMI, protected over 45 million people with a prevention measure (insecticide-treated nets and/or indoor residual spraying), as well as procured more than 48 million antimalarial treatments and more than 51 million rapid diagnostic tests.

In Madagascar, people line up to receive insecticide-treated bednets and treatment. Photo Credit: Maggie Hallahan

In Madagascar, people line up to receive insecticide-treated bednets and treatment. / Maggie Hallahan

Success is a triumph of partnership – the initiative was launched by President George W. Bush, and expanded under President Barack Obama. We have benefited from strong bipartisan support in the Senate and House. And with host country government leadership, donors, partners like the Peace Corps, and countless groups like Lutheran World Relief, Catholic Relief Services, Malaria No More and Nothing But Nets – we are taking malaria and other public health interventions the last critical mile, to communities in the most remote parts of malaria endemic Africa.

Commemorating World Health Day

In his State of the Union address, President Obama called upon our nation to join with the world in ending extreme poverty in the next two decades. Today, we have new tools that enable us to achieve a goal that was simply unimaginable in the past: the eradication of extreme poverty and its most devastating corollaries, including widespread hunger and preventable child and maternal death.

Preventing and controlling vector-borne diseases, diseases carried by insects, ticks and small animals, is central to achieving President Obama’s vision of ending extreme poverty. On World Health Day, commemorated each year on April 7, the World Health Organization (WHO) highlights actions we can all take to protect ourselves from the serious diseases that these “vectors” can cause.

Children wash their hands in Ghana, where USAID supports prevention and treatment of trachoma, a blinding eye disease.  International Trachoma Initiative (ITI) ..

Children wash their hands in Ghana, where USAID supports prevention and treatment of trachoma, a blinding eye disease.
International Trachoma Initiative (ITI) ..

More than half of the world’s population is at risk from vector-borne diseases, such as malaria, dengue fever and neglected tropical diseases. The most commonly known vectors include mosquitoes, sandflies, bugs, ticks and snails, which are responsible for transmitting a wide range of parasites and pathogens contributing to deadly diseases.

Senegal: Demonstrating the proper use of ITNs in Senegal. Photo Credit: Maggie Hallahan

Senegal: Demonstrating the proper use of ITNs in Senegal. Photo Credit: Maggie Hallahan

Below, we highlight solutions to combat extreme poverty and vector-borne diseases.

Solutions

  • In this scene-setter, USAID Administrator Rajiv Shah explains how USAID and its partners have embraced the challenge of creating a world without extreme poverty.
  • In “A Call to Action to End Extreme Poverty,” Alex Thier and Ilyse Stempler discuss how USAID and its partners are adopting an integrated, holistic approach that capitalizes on their collective expertise. They share past successes in addressing extreme poverty and introduce some new ideas to finish the job.
  • In “Your Voice,” a continuing FrontLines feature, Adm. Tim Ziemer, U.S. Global Malaria Coordinator, shares his perspective on leading a major presidential initiative to end deaths from malaria
  • Katherine Sanchez profiles Ghana’s efforts to become the first country in sub-Saharan Africa to eliminate trachoma, the world’s leading cause of preventable blindness.
  • A Yumbe survey team learns how to use electronic tablets to collect data on trachoma.  Christine Ninsiima

    A Yumbe survey team learns how to use electronic tablets to collect data on trachoma.
    Christine Ninsiima

    And in “Trachoma vs. Technology,” Phil Downs and Scott Torres uncover efforts to capture and analyze data quickly on mobile electronic tablets in rural Uganda. This approach is transforming the battle against an ancient eye disease, for which timely treatment can prevent blindness.

  • Students prepare to take part in a mapping survey at Pav Primary School in Rattanakiri.  Credit: Chan Vitharin ..

    Students prepare to take part in a mapping survey at Pav Primary School in Rattanakiri.
    Credit: Chan Vitharin ..

    In “Wiping Snail Fever Off Cambodia’s Map – by Drawing It On,” Sokhon Sea delves into an effort to enlist many, including school children, on a mission to wipe out the infection that can lead to debilitating illness and malnutrition and cognitive difficulties in children.

  • Finally, Ann Varghese and Chris Glass explore a unique drug-shoe combination that could stomp out two debilitating diseases endemic to Haiti and how wearing new sneakers kicks up that protection even more by creating a barrier between parasites and kids’ feet.

 

Texts Connect Midwives to Mothers in Timor-Leste

Health posts in rural Timor-Leste are often several hours' walk from remote communities. / Henrique Bere, HAI

Health posts in rural Timor-Leste are often several hours’ walk from remote communities. / Henrique Bere, HAI

‘A pregnant woman has one foot in the grave.’ This common saying reflects the reality in many developing countries: bearing a child is one of the main risks to a woman’s life. In the poor countries of the world, giving birth is both one of the most significant days in a woman’s life but also a time when she is closest to losing it.

In Timor-Leste, a tiny country just north of Australia, progress against maternal deaths has been slow. Since independence from Indonesia in 2002, the country has made great efforts to provide trained midwives for pregnant women who seek them, but a wide gap remains. The rural population is widely dispersed in mountainous terrain and often far from health facilities. More than half of all babies in Timor-Leste are born at home with help only from family members. As a result, many women and babies die in those first few hours and days after birth.

USAID has been working with Timor-Leste’s Health Ministry since 2004 to help find solutions to this terrible problem. In 2011, U.S.-based NGO Health Alliance International (HAI) won a USAID Child Survival and Health Grant to try a new approach.

“We realized that one basic reason that many women didn’t give birth with professional help was that their contact with midwives was so brief that they weren’t able to develop a sense of trust and confidence,” said Susan Thompson, HAI’s Program Director, based in Seattle. “There also was a lot that women could do to have a healthy baby that they didn’t know about, and it couldn’t be conveyed in the usual two or three short prenatal care visits.”

Midwife Justa Pereira and mother-to-be Rosalia Juela test the project's SMS messages. / Catalpa International

Midwife Justa Pereira and mother-to-be Rosalia Juela test the project’s SMS messages. / Catalpa International

How could HAI help the Ministry bridge that gap between women and their midwives? Noting the dramatic increases in mobile phone use throughout the country, HAI proposed the first use of this technology as a permanent behavior-change tool. The focus for this new use of mobile phone technology is in Manufahi District, where cell phone ownership is fairly high at just over half, but, at 19 percent, use of skilled birth attendants is well below the national average of about 30 percent. Ministry statistics estimate that the district has about 11,000 women of reproductive age, and expected 2,200 pregnancies in 2013, the first year of the project.

The project is called “Mobile Moms” or Liga Inan (“connecting mothers”) in the local language of Tetun. The project team matched the technological opportunity to the needs of the Ministry and developed a dual approach to making use of the widespread availability of mobile phones.

First, working with Catalpa International, a software development group in Timor-Leste, the project team created an internet-based program to send SMS maternal health messages twice a week to pregnant women in Tetun, the language most widely spoken. The messages detail important actions that the women can take to safeguard their pregnancies, and include advice on postpartum and newborn care for the first six weeks after delivery.

Second, the project facilitates phone conversations between midwives and the expectant mothers at critical times. Women can send SMS messages very cheaply to ask for information or assistance, and midwives can call them back at the project’s expense.

Health Ministry officials in rural Manufahi District have been supportive and intensely involved since the beginning. Director of District Health Services Teofilho Tilman said that they have “seen … a significant increase in the number of women receiving antenatal care and delivering at the health facility” since the project began. Over the past year in Same Subdistrict, where the project started its work in February 2013, the number of women coming to a birthing facility, using a skilled birth attendant or making four or more antenatal care visits has doubled.

In a recent study on the impacts of this project on health professionals, midwives consistently reported that they liked the service because they can better follow the progress of their patients and meet their needs. In her response, one midwife said:

For me, it helps… because before Liga Inan we didn’t know the condition of the mothers. Through Liga Inan, we have their number and we know their due date. So for example, in November we know which mothers will give birth. We match that info with the data here to check, and if they didn’t come to the health facility, we call to find out how they are.

Amalia Martins Calapes is a new mother in Same, the capital of Manufahi District. Project SMS messages have encouraged her to visit her midwife regularly. / Marisa Harrison, HAI

Amalia Martins Calapes is a new mother in Same, the capital of Manufahi District. Project SMS messages have encouraged her to visit her midwife regularly. / Marisa Harrison, HAI


In the first year of the project, Same Subdistrict midwives enrolled more than 1,000 women in the project. Nearly 600 women have completed their pregnancies and received the special postpartum SMS messages to help them give their babies a healthy start in life.

Women participating in Liga Inan provide the project with valuable input about project impact and success. Amalia Martins Calapes from the town of Same did not participate in the program through her first two pregnancies. During her third, she did. And it helps her stay motivated to seek care.

Sometimes I feel too lazy to go to the clinic… but on Mondays and Thursdays I read the SMS that comes to my phone, and think, ‘Today, I must make myself go to the clinic.’

An important goal of the program is to increase community understanding of better ways to assure a healthy pregnancy. Encouraging women to share the SMS messages is one way that can happen. According to Amalia:

When the messages arrive, the first person that I share them with is my husband. He knows and then the household knows, and then I can share information with my girlfriends. I can tell them that the Liga Inan program sent me messages about this, and this, and this. So when they need something, they can contact this number or go directly to the clinic.

Today, Amalia agrees with Timor-Leste’s new saying for mothers:

‘Healthy mothers and healthy babies give us a strong nation.’

Meeting Water, Food and Health Needs in Kenya

On this World Water Day 2014, I am encouraged by how USAID’s water programs around the world contribute to integrated approaches that meet the objectives of the Agency’s Water and Development Strategy, as well as the Feed the Future and the Global Health Presidential Initiatives. During my recent work in Kenya with the USAID team at Kaputir and Kalimngorok, I was able to see first hand the efforts to strengthen Kenya’s resilience to disease, climate change, drought, floods and water shortages.

Across Kenya, USAID’s AIDS, Population, and Health Integrated Assistance Plus (APHIAplus) program is working to strengthen and improve healthcare systems. In Kaputir, the APHIAplus Integrated Marginal Arid Regions Innovative Socialized Health Approach (IMARISHA) project supports a health clinic and a Community-Led Total Sanitation project.

Photo Credit: Martin Mulongo

Photo Credit: Martin Mulongo

As I walked up a slight slope to the village of Kaputir, the first thing I saw was the gigantic masonry water tank that holds 13,000 gallons of water situated next to a one-story, concrete block clinic with maternity, pharmacy, consultation and emergency rooms. The front of the clinic has a small porch on which children and adults sit in a long line, partially shaded from the sun, waiting for their turn to receive basic medical care. The clinic staff proudly showed me their microscope, as well as their solar-powered refrigerator used to store medicines and blood samples.

Photo credit: Martin Mulongo

13,000 gallon water tank in Kaputir (Photo credit: Martin Mulongo)

Also as part of APHIAplus IMARISHA, the nearby community of some 6,000 people is working to achieve “open defecation-free” status. For example, the house right next to the clinic is leading the charge by being the first to add a pit latrine; it has a slab covering the hole, surrounded by a thatched fence and a “tippy-tap” handwashing device with water and soap.

In the same community, another project implemented by the Millennium Water Alliance, through their partner World Vision, supports a large water storage project connected to a nearby borehole. The combined efforts of these programs ensure integrated water, health, sanitation and hygiene services, which in turn reduce the prevalence of diarrhea, a major contributor to childhood mortality.

As we drove into the Kalimngorok area, we looked out at the flat, brown, dry landscape with few bushes and no rivers or streams in sight. At first glance, I wondered how one could grow anything here. In the distance I saw a large water catchment, built to capture and store rainwater for both human and livestock consumption and irrigation. A secondary benefit of the catchment is that water has seeped through the earthen floor, helping to restore groundwater underneath. At the base of the catchment, the community has installed a substantial metal pump on a concrete slab to draw water from the restored aquifer. In the surrounding fields, farmers experiment with different crops resistant to drought, using soil tillage techniques to increase the capture of rainwater when the rains arrive.

WFP Irrigation project in Turkana -Kalemngorok

WFP Irrigation project in Turkana -Kalemngorok (Photo credit: Martin Mulongo)

We also visited USAID’s Turkana Rehabilitation Program in Kalimngorok, implemented by the United Nations World Food Program, which integrates rainwater harvesting technology and food production through a range of water management practices. I walked through the fields observing construction of on-farm contour bunds (embankments) that capture rain as it falls on fields and increases yields, and the building of water pans (shallow retention ponds that store water for irrigation and watering livestock).  The program also promotes improved nutrition by establishing fruit orchards and vegetable gardens, diversifies income through bee keeping, and reduces environmental degradation through establishment of micro-catchments.

At both Kaputir and Kalimngorok, I am left with the sobering firsthand realization of the challenges of assisting thousands of people in this arid environment. But I am also left with a sense of optimism. We saw progress in action in capturing and storing water, providing healthcare, navigating the lack of an electrical grid and producing crops in such an arid environment. USAID/Kenya’s approach of layering, integrating and sequencing its technical interventions and projects brings hope that over time these activities could be expanded and provided at scale, changing the lives of thousands of people for the better.

Bringing Hope to Women in Sri Lanka’s Former Conflict Zones

Like most places that have experienced conflict throughout the world, women were deeply affected by Sri Lanka’s 26-year conflict.  For most women who lived in the Indian Ocean island’s conflict zones, displacement, destruction, violence, harassment and loss were part of their everyday life.  The conflict ended in 2009, leaving many women traumatized and in need of psychosocial care, without belongings or livelihoods, and after the loss of their spouses, as heads of households.  Several USAID initiatives continue to support these women by integrating them into society and bringing normalcy back into their lives.

Thaminy Vedaasingham* is one of the BIZ+ program’s beneficiariesOne such initiative is USAID’s BIZ+ program which helps to increase and enhance equitable economic growth in the former northern and eastern conflict zones.  BIZ+ is partnering with small and medium-sized local businesses to create 5,000 new livelihoods and increase household incomes. The program primarily targets women; including war widows, disabled women and female-headed households.

Thaminy Vedaasingham* is one of the program’s beneficiaries. She is 25 years old and lives in one of the worst conflict-affected northern districts of Sri Lanka.  Having lost a limb during the conflict, Thaminy faced many hardships.  This is when Thaminy heard about the vocational training and production center in her district that provides livelihood assistance to war widows, women abandoned or women separated from their spouses or families. USAID is supporting the center to expand production and marketing of rice flour and spices and provide vulnerable women like Thaminy with new skills and sustainable livelihoods.

“The profit of the business belongs to the vulnerable women who work so diligently in the center. USAID’s assistance and support – in the way of building new hostel and storage facilities, and providing new equipment and transportation – have helped us to overcome any challenges and be successful businesswomen.” says Thaminy.

Thaminy is now economically independent and has the confidence to socialize with others.  “Thaminy is now enjoying life without worrying about the leg she lost. She is happy to work and earn for her family and for herself. As a mother, I am very proud of it”, quips Thaminy’s mother.

The Managing Director of the Vocational Training and Production Centre is happy to see the socio-economic business enterprise model with a vision of improving livelihood of vulnerable women come this far.  But above all, he is happy to see how the project has increased hope in the minds of women who seek empowerment through employment opportunities.

* Name has been changed to protect identity 

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