USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Mass Media’s Role in Malaria Control

This originally appeared on the Malaria No More Blog.

As researchers and policymakers gather in Washington, D.C. this week to evaluate how population-level behavior change communications (BCC) can dramatically improve child survival, Malaria No More is working to keep up the momentum of BCC for malaria control in Africa.

Infographic for Knock Out Malaria In Cameroon campaign. Photo credit: Malaria No More

Though it is hard to measure the impact of our mass media communication campaigns, there is already evidence that they are helping to change the culture of malaria control in places like Cameroon. Through a combination of nightly reminders via SMS, radio and television ads, plus a hit song about malaria by the country’s biggest pop stars, the Cameroon campaign produced a 6.6 percentage point increase in nightly mosquito net use among adults and a 12 percentage point increase in net use among their children under 5. That’s over half a million people now sleeping under nets that otherwise wouldn’t have been because of the knowledge, motivation, and/or timely reminder provided by the campaign.

The NightWatch program – Malaria No More’s model of multimedia, national-scale BCC for malaria – was supported by ExxonMobil and COTCO, and embedded in a national campaign with strong support from the Cameroonian government (Ministry of Health and National Malaria Control Program), health partners UNICEF, Plan International, IRESCO, CHAI, CCAM, ACMS-PSI, Lalela Project and United Against Malaria, and corporate partners such as MTN. NightWatch has also been rolled out within national campaigns in Chad, Senegal, and Tanzania.

Findings

The results of a program evaluation were published earlier this year in the peer-reviewed Malaria Journal. The evaluation was based on national survey results from 2011 and 2012, and estimated the impact of NightWatch malaria communications that were part of Cameroon’s national K.O. Palu campaign. Using a propensity score matching model, the analysis estimated that among Cameroonians with at least one net at  home, exposure to NightWatch was associated with a 6.6 percentage point increase in last-night net use among adults (65.7% vs 59.1%) and a 12.0 percentage point increase in last-night net use among their children under five (79.6% vs 67.6%).

The program cost less than $0.16 per adult reached, and less than $1.62 per additional person protected by a net. The results suggest a strong role for mass media communication interventions in support of investments in malaria control commodities such as LLINs.

To read the study in full, click here.

 

MCHIP’s Respectful Maternity Care Toolkit Promotes Positive Attitudes in the Care of Women and Newborns

Abuse and disrespect during maternity care has been documented and observed globally. In response, USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) is launching the Respectful Maternity Care (RMC) Toolkit. This package of materials is designed to provide clinicians, trainers, managers and other stakeholders involved in the provision of maternity care with the tools necessary to begin implementing RMC in their area of work or influence. This toolkit contains program learning documents, such as: surveys and briefs on country experiences; training materials; tools to assess and improve RMC within programs and services; job aids; and a resource list.

Women who chose to give birth at home without a skilled health care provider, as well as their newborns, are more likely to suffer complications and die. In less developed countries, there may be many reasons women chose not to give birth in a health facility, such as distance, and lack of transport or money to pay for health services. However, all too often a lack of respectful care from frontline health workers—such as doctors and midwives—cause women and their families to distrust the health care system and opt for more risky homebirths, with unskilled traditional birth attendants (TBAs). Women often choose to deliver with TBAs not only because their services cost less, but also because they provide RMC and follow up care, and are trusted and known within their communities.

Mozambican mother holds her newborn. Photo credit: Jhpiego

Multiple factors may contribute to disrespect and abuse within healthcare services. Health systems may be underequipped, and healthcare workers may be overwhelmed due to inadequate pay, lack of infrastructure, or insufficient staff and supplies. An attitude of disrespect for clients and patients may permeate the healthcare system, and healthcare workers may not receive any guidance or supportive supervision related to RMC or their work in general.

The goal of this toolkit is to empower frontline health workers to provide RMC, allowing women and their families to experience better maternity care and to choose to deliver with a skilled provider at home or, preferably, in a health facility. The ultimate impact of more women using skilled birth services during child birth will be reduced newborn and maternal deaths.

RMC in Mozambique                                    
 ”Giving birth is such a special time for a woman, but it is also filled with stress and fear,” said MCHIP Senior Technical Advisor Veronica Reis. She often wondered during her more than 20 years of clinical practice in Brazil why ensuring women’s comfort and preferences during childbirth was almost never discussed at medical school: “Most of the training in medical school was technically focused, about diagnostic treatment and clinical procedures.”

Therefore, Dr. Reis was pleased to hear about a movement known as Humanization of Childbirth, which centers on putting women and their families at the center of care, especially during childbirth. This movement began in Brazil and has increasingly gained prominence in Latin America and elsewhere. Grounded in respect for human rights, this movement has evolved into what is known as Respectful Maternity Care, which promotes the idea of the client as a person with values and expectations that should be respected during the provision of health care.

Therefore, when asked in 2003 to help promote RMC at the Ministry of Health’s National Maternal Health Program in Brazil, Veronica jumped at the chance, convinced this was a worthwhile initiative that was long overdue. There she learned that the presence of a companion at birth, usually a family member or loved one, is an important part of RMC. She was amazed that in all the hospitals where she had worked, policies never permitted family members to accompany the woman in labor; they were always forced to stay outside and/or not be present. Nor did policies allow women to make many other choices in their care, including the right to choose their birth position.

Importantly, Veronica was able to take the skills and knowledge she developed in RMC and successfully help apply them in Mozambique, where she supported USAID’s Jhpiego-led maternal and newborn health program (ACCESS) starting in 2006.  At a large stakeholders meeting in 2007, attendees learned that one important reason women were not giving birth in hospitals—and therefore more often suffering from complications of and dying in childbirth—was fear of not being treated well.  ”Women were afraid of being treated badly and dying alone in the hospital,” Veronica explained.

With continued advocacy by Veronica and her colleagues, the Minister began to prioritize RMC through on-going health programs, most notably through MCHIP’s Model Maternity Initiative (MMI), starting in 2009.  This initiative, carried out in the largest 34 hospitals in the country, supports birthing practices that recognize women’s preferences and needs.  Not only are these hospitals continually evaluated on the quality of care they provide, but also on their ability to provide RMC. Some RMC behaviors include: respect for beliefs, traditions and culture; the right to information and privacy; the choice of a companion during birth; freedom of movement and position; keeping mother and baby together after birth; and the prevention of violence and disrespectful care.

Thanks in large part to strong commitment from the country’s key decision makers and local communities, and with financial backing from USAID through MCHIP, RMC is becoming more widespread in Mozambique. The influence of RMC can be seen increasingly in training institutions, professional associations, and civil society. In fact, the MOH, with the support of USAID and other partners, has now scaled up RMC to more than 80 facilities, and is working to scale up the MMI to more than 122 health facilities by 2014. Significantly, this figure covers about half of all facility births in the country. The MOH and its partners are taking action so that women won’t have to fear that they will be treated poorly during one of the most beautiful—and challenging—times of their lives.

The Toolkit includes:

  • “RMC: Country Experiences” survey offering an RMC overview from 19 countries
  • RMC Program Review Instrument to be used for country-level RMC self-assessment
  • “RMC: General Concepts and Considerations” presentation for guidance on the promotion of RMC
  • Learning Resource Package for RMC with all materials needed to conduct a one-day RMC workshop for clinicians
  • Operational Standards for RMC for antenatal care, childbirth care and postnatal care, which establish objective guidance to gauge health care workers’ clinical performance promoting RMC
  • Resource List for RMC with related references and links
  • Program Briefs detailing examples of RMC being implemented at the field level
  • Monitoring Indicators for RMC to measure the success of RMC interventions
  • Job Aids to serve as on-the-job reminders of the importance of maintaining RMC

Follow USAID Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Photo of the Week: Nutrient-Rich Crops for Kenyan Children

During the first week of June, IMPACT will be highlighting the role of nutrition in Global Health

In Kenya, the U.S. Government, through Feed the Future, is working with whole families to improve food security and childhood nutrition by helping farmers introduce nutrient-rich crops to their farms and teaching families new recipes full of vitamins and minerals needed to ensure healthy growth. Photo Credit: Fintrac Inc.

Learn more about USAID’s efforts to improve nutrition.

Follow USAID (@USAID) on Twitter and use #GHMatters to join in the conversation about global health issues including nutrition.

Proof that the U.S. Government, NGOs and Activists are Working Together on Nutrition

During the first week of June, IMPACT will be highlighting the role of nutrition in Global Health

This originally appeared on the ONE Campaign blog

This morning, USAID Administrator Raj Shah joined a Google+ Hangout – a group video chat – with ONE’s U.S. Executive Director Tom Hart and a group of ONE members and agriculture policy experts from Feed the Future, GAIN, Thousand Days and Future Fortified.

USAID Administrator Raj Shah with ONE’s U.S. Executive Director Tom Hart. Photo credit: ONE.org

Tom gave Administrator Shah a fat stack of 100,336 petition signatures from ONE members across the US. Their ask? End chronic malnutrition for 25 million children by 2016. Administrator Shah heard them loud and clear, with two ONE members, George Houk and Vanessa Avila, as witnesses and representatives of our U.S. membership.

One of the highlights of the Hangout was hearing Administrator Shah talk about how global food security is in fact in America’s best interest.

“We know that this [nutrition] is an issue that touches on the economic prospects of countries that will be our trading partners in the future, it touches on our national security in places ranging from Afghanistan to Somalia, where far too many children die of core underlying malnutrition, and most importantly, we know it just touches on our moral consciouness because we cannot live in 2013 knowing that hundreds of millions of children go hungry and that that hunger prevents them from learning in school, from fighting disease, from surviving a simple bout of diarrhea or pneumonia and of building a better future for themselves,” he said.

After handing off the petition signatures, the conversation turned to our agriculture policy experts, Tjada McKenna, Deputy Coordinator for Development at Feed the Future, and Lucy Sullivan, Executive Director of 1,000 Days, and guest foodie activist, Chef Candice Kumai, a nutrition champion for Future Fortified. Adrianna Logalbo from GAIN moderated a lively discussion on the importance of agriculture, some of the successes and progress the world has made on nutrition, and how everyday citizens can get more involved.

Watch the full Google+ Hangout here:

Administrator Shah will be off to the pre-G8 Summit event, Nutrition for Growth, next week, with your petition signatures in hand. Stay tuned to ONE.org for updates on this important and critical event.

Learn more about USAID’s work on improving nutrition

Follow USAID (@USAID) on Twitter and use #GHMatters to join in the conversation.

Video of the Week: The Powerful Women of Kenya Fortified

During the first week of June, IMPACT will be highlighting the role of nutrition in Global Health

In 2012, as East Africa recovered from record drought, we called on the Future Fortified community to help invest in good nutrition in Kenya. And thanks to them, we achieved our goal and right now we are reaching over 20,000 children in southern Kenya with home nutrition packets – small packets filled with the essential nutrients children need to live, grow and learn.

Kenya Fortified is possible because of an incredible network of powerful, local women — community leaders, health workers and mothers — working together to help nourish the future.

Follow USAID (@USAID) on Twitter and use #GHMatters to join in the conversation.

This is not an endorsement of Future Fortified and individuals must make their own choices. 

Women Deliver: Bold Visions for Women’s and Girls’ Health and Rights

Robert Clay serves as deputy assistant to the administrator for Global Health. Photo credit: Robert Clay

I’ve just returned from an inspiring and thought-provoking week in Kuala Lumpur, Malaysia where leaders and advocates from 149 countries gathered for the Women Deliver 2013 conference. My USAID colleagues and I were proud to participate in one of the decade’s largest conferences on the health and rights of girls and women.

One of the most memorable parts of the week for me was speaking on a panel at the Ministerial Forum with Yemurai Nyoni, a youth representative from Zimbabwe. He was a strong and articulate voice for youth and urged that young people be included in program design and implementation of youth-focused programs. It’s people like Yemurai that give us hope for the future. And with 1.8 billion youth in the world today, it is vital that we listen and include them in our development work.

Women Deliver served as a pivotal opportunity to renew commitment to meeting the needs of girls and women across the globe. USAID places women and girls at the center of our global health programs because we know improving women’s and girl’s health is critically important to almost every area of human development and progress. We’re helping countries acquire the resources they need to improve health outcomes through strengthened health systems and integrated services. This week in Kuala Lumpur I discussed the bold visions we have for our future to end preventable child and maternal deaths and create an AIDS Free Generation. Bold visions inspire action, and action paves the way for progress.

Over the past decade, we’ve seen wonderful success in reductions of maternal and child deaths and improved access to family planning. But despite all the good we have done, millions around the globe still do not receive the reproductive, maternal, newborn, and child health services they need. Every year 6.9 million children die of preventable causes and 287,000 women lose their life in pregnancy or childbirth. Some 222 million women who want to avoid pregnancy are not using a modern method of family planning.  Closing this access gap to family planning information and services would reduce maternal deaths by 30 percent and could save the lives of 1.6 million children annually (PDF).

After a week of renewed commitments, sharing lessons learned, and listening to those pioneering the way forward on women’s health and rights, I feel inspired to do my part in leading USAID to achieve our global health goals and improve women’s and girl’s health and rights across the globe.

Learn more about USAID’s work at Women Deliver and share with us your thoughts below.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Healthy People, Healthy Environment: Family Planning and Integrated Development in Tanzania

Filmed in the northern coastal region of Tanzania, the short documentary “Healthy People, Healthy Environment showcases an innovative approach to development that combines efforts to conserve natural resources with reproductive health services and sustainable economic opportunities, such as clean cook stoves and seaweed farming.

In the film, three women from the Pangani and Bagamoyo districts – Rukia, Mahija, and Fidea – show how integrated population, health, and environment (PHE) projects empower them to help their families, their communities, and their environment.  Family planning and women’s empowerment are key to this long-term, holistic approach to the problems of environmental degradation and food insecurity.

“When you have a large number of children, there are two consequences: children can get malnutrition as a result of inadequate nutrition in their diet because the family is large. Second, when there are many children, the environment can be affected because it might be necessary for you to cut down trees in order to feed the children,” says Fidea Dastani Haule, a peer educator in Pangani district of Tanzania. “Therefore, the main thing we encourage is that a family plans their number of children so that you can adequately feed, clothe, and educate them.”

Watch Healthy People, Healthy Environment: Integrated Development in Tanzania here.

About the Film

“Healthy People, Healthy Environment” was produced by the Woodrow Wilson Center’s Environmental Change and Security Program with support from USAID’s Office of Population and Reproductive Health. To request a screening, please contact Sean Peoples at sean.peoples@wilsoncenter.org

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

DRC Making Great Strides in Child Survival

This week, the Congolese Government’s National Steering Committee for Health  is meeting to officially launch the National A Promised Renewed (APR)’s acceleration framework to reduce infant and maternal mortality in the Democratic Republic of the Congo (DRC).  Following the Minister of Health’s participation in the Child Survival Call to Action in Washington June 2012 and at the African Leadership for Child Survival in Addis Ababa in January 2013, the DRC Government has made great strides in developing a strategic country-specific plan to move towards accelerated reduction of maternal and child deaths. This Action Framework aims to reduce under-five mortality by 48 percent and maternal mortality by 31 percent, saving the lives of 430,000 children and 7,900 mothers by 2015.

Part of the action framework includes a national scorecard which will serve as a monitoring tool to better track successes at the provincial level.

"Birth - Growth - Progress" for every woman and child. Photo Credit: UNICEF

USAID’s current health portfolio directly aligns with the objectives of the Ministry of Health’s APR plan and efforts to intensify the reduction of maternal and child deaths. USAID has worked with the DRC to improve access, availability and quality of health services in 80 health zones through the Integrated Health Project, led by Management Sciences for Health. This $144 million five-year project spans the spectrum of essential health services and provides support to the government’s Health Systems Strengthening Strategy (SRSS) and the National Health Development Plan (PNDS).

In support of A Promise Renewed, USAID and UNICEF are collaborating to promote essential maternal and child health services through a package of high impact interventions in 27 health zones, where access to health centers faces the greatest barriers and the risk of child mortality is highest. A thorough LiST (Lives Saved Tool) analysis identified these interventions, which will target children under five and pregnant women with vouchers that subsidize care. Some of the key activities will focus on pre-packaged family kits that will be distributed to prevent, diagnose and treat malaria, diarrhea, and respiratory infections and to provide basic emergency obstetrical and neonatal care in health centers. If this approach is successful, there are plans to scale it up nationwide, impacting those most at risk throughout the DRC.

This is an exciting time for the DRC, and the USAID Mission here in Kinshasa is committed to working closely with UNICEF to support the DRC Ministry of Health on implementing the country plan to drastically improve child survival.

The injection advantage: Reaching more women with an effective and convenient family planning method

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. This week we are focusing on family planning. 

The women are about 25 to 30 years old. They’re married with two, or as many as nine, children. They’re tired. They may have miscarried, more than once. They want a break.

This is how community health workers in Senegal describe the women who visit village health huts for family planning. “Some are educated and some are not,” one health worker said, “but they are smart. They worry about the health consequences of multiple pregnancies.”

Small, light, and easy to use, Sayana Press is well-suited for community health workers. Credit: PATH/Patrick McKern

These women know what they want: the chance to choose an effective family planning method that meets the reality of their lives.

When convenience and privacy are important

For many women, injectable contraceptives have tremendous advantages: one shot of the popular Depo-Provera® protects for three months. It is safe and effective, with almost no risk of unintended pregnancy.

Injectables have other advantages—with no pills to take daily, they are discreet. “This is a small village,” explained another Senegalese health worker. “Everyone knows what everyone else is doing.”

Partnering to reach more women

Depo-Provera is very popular in sub-Saharan Africa and has great potential to reach millions more women. In Senegal, injectables not only account for one-third of contraceptives used—one-third of women who intend to use family planning say they’d prefer injectables, too.

Typically, trained health workers give the injections in clinics, so women in remote villages have to travel long distances to get them. To quote one more health worker: “Sometimes, having to go all the way to the health clinic is enough to discourage women from doing family planning.”

A new initiative announced at the London Summit on Family Planning in 2012 aims to address this gap in access. USAID, the Bill & Melinda Gates Foundation, DFID, UNFPA, and PATH will bring up to 12 million doses of a new form of Depo-Provera, called Sayana® Press, to women in sub-Saharan Africa and South Asia.

A new form of Depo-Provera goes remote

Sayana Press is packaged in the Uniject™ autodisable injection system—each prefilled dose is administered in the abdomen, upper thigh, or upper arm. Small, light, and easy to use, the system is well-suited for community health workers.

USAID, PATH, and our partners are engaging countries interested in piloting the method and learning if and how it could enhance their family planning programs. We’ll be collaborating with ministries of health to introduce Sayana Press, aiming to achieve their goals for increasing access to family planning and meeting women’s needs. We will rigorously evaluate the product’s impact on contraceptive use and costs so that donors and governments have the information they need to make future decisions about use of Sayana Press.

Health worker quotes are from a Sayana Press acceptability study conducted by FHI 360 with support from the USAID PROGRESS project and PATH.

Sayana Press and Depo-Provera are registered trademarks of Pfizer, Inc. Uniject is a trademark of BD.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Contraceptives Save and Improve Lives

Each year an estimated 74.4 million unintended pregnancies occur in the developing world; primarily among women who had an unmet need for effective contraception. Family planning programs, which provide counseling, services and contraceptive supplies, empower couples to make important decisions about the timing and spacing of their children. By choosing the healthiest times for childbirth, mothers give themselves and their children a better chance to live long, healthy lives. This week at the Women Deliver conference, I join public health professionals from around the world who are discussing family planning as one of the core strategies to save women’s lives.

A woman and her children after a family planning consultation at Kalingalinga Clinic in Lusaka, Zambia, 2009. Photo Credit: Arturo Sanabria

When we think about who plays a role in improving access to family planning, we often think of the nurses, doctors and other healthcare workers who administer contraceptives. Warehouse managers and truck drivers, on the other hand, might not immediately spring to mind. However, these individuals play a vital role in ensuring contraceptive security, which exists when every person is able to choose, obtain, and use quality contraceptives and condoms whenever he or she needs them.

On the USAID | DELIVER PROJECT we work alongside USAID and other partners every day to strengthen health programs by improving the supply chains in-country. In our work we often say “No Product. No Program.” What we mean by that is ensuring an adequate supply of contraceptives is critical to the success of family planning programs. These programs are most effective when healthcare providers have commodities on hand for women who want and need them.

In fiscal year 2012, on behalf of USAID, the project supplied a range of contraceptive methods to 45 countries, including over—

  • 751 million male condoms
  • 64.6 million oral contraceptives, and
  • 36.3 million injectables
  • 1.6 million IUD’s
  • 1 million implants

Coupled with comprehensive counseling and services, these commodities prevented an estimated 15,000 maternal deaths and 230,000 infant deaths.

Despite major gains, we know that 222 million women still have an unmet need for family planning, meaning they want to delay or avoid pregnancy but aren’t using a modern method of family planning. Meeting this need for modern contraceptives will save 79,000 mothers and 1.1 million infants. Ensuring and sustaining contraceptive availability at this scale is a substantial task that requires more effective and efficient supply chains, coordination among the public, private and NGO sectors, engagement of civil society organizations, a willingness to go beyond ‘business as usual,’ and leadership and commitment on the part of national and international partners.

Staff load family planning and other health commodities into a truck as part of the Delivery Team Topping Up system in Zimbabwe. 2009. Photo Credit: USAID | DELIVER PROJECT.

While meeting the family planning needs of women around the world happens one woman at a time, making contraceptives available to each of those women requires the concerted and coordinated efforts of individuals and organizations around the world.

View a new infographic by the USAID | DELIVER PROJECT on the important role contraceptives play in saving and improving women’s lives.

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