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The Story Behind the Headline: Investments in Implementation Science Tackle HIV Prevention in Swaziland

The incidence of HIV in Swaziland has stabilized, but the country continues to have the world’s highest estimated prevalence rate of HIV-infected adults. According to the Centers for Disease Control and Prevention (CDC), 26 percent of adults aged 15 to 49-years old in Swaziland are HIV-positive. USAID, through PEPFAR, is partnering with ICAP, a global health center at Columbia University, to evaluate an innovative approach to HIV prevention in countries like Swaziland. The study is one of three pilots in the country described in The Lancet article “HIV prevention: new pilots for beleaguered Swaziland,” published on January 12.

The article describes Swaziland’s efforts to answer a critical HIV prevention question: How can the high efficacy of antiretroviral-based prevention found in clinical trials be translated into effective programs? In other words, how can we turn science into practice? By evaluating different approaches to providing HIV treatment for HIV+ women, USAID’s partnership with ICAP will help answer this question for one of the groups made most vulnerable by the epidemic: pregnant women living with HIV.

The story behind the headline? USAID’s partnership with ICAP is part of an over $20 million investment in implementation science made by the Agency and as part of outgoing Secretary of State Hillary Clinton’s vision for an AIDS-free generation. Through the Annual Program Statement (APS) “Implementation Science Research to Support Programs under PEPFAR,” USAID supports eight studies in eight of the African countries hardest hit by HIV/AIDS. In addition to addressing the critical HIV prevention question posed in The Lancet article, the scope of the APS provides a unique opportunity to fund cutting-edge research in a wide range of HIV-specific program areas. These studies aim to improve programs across the prevention, care, and treatment continuum. Data gathered will support efforts to prevent new infections and save lives.

As stated in the recent PEPFAR Blueprint (PDF), “Science must continue to guide our efforts” and “it is science that will underpin all our efforts to achieve the goal [of an AIDS-free generation] and save even more lives.” USAID’s commitment and investments in implementation science are a driving force in these efforts.

Learn more about USAID’s investments in implementation science in the Issue Brief “Implementation Science Research to Support Programs under PEPFAR.”

Contribute to the search for innovations to address key implementation science questions. The second round of the APS solicitation is public and the deadline for concept paper submissions is January 30, 2013. USAID anticipates awarding up to an additional $11 million of funding through the second round, with the maximum for a single application set at $1.8 million over three years.

Video of the Week: Administrator Shah’s Address to African Leadership on Child Survival Meeting

In an effort to catalyze global action for child survival, the Governments of Ethiopia, India, and the United States together with UNICEF convened the ‘Child Survival Call to Action’ in Washington, D.C. in June 2012. . Under the banner of ‘Committing to Child Survival: A Promise Renewed‘, more than 160 governments signed a pledge to renew their commitment to child survival, to eliminate all preventable child mortality in two decades.

A United Africa Under a Child Survival Revolution

Peter Salama, Unicef Representative to Ethiopia, makes closing remarks at “African Leadership for Child Survival” held in Addis Ababa, Ethiopia on January 18,  2013. Photo credit: UNICEF

Last Friday, it was a real honor for me to take part in the closing ceremony of the African Leadership on Child Survival – A Promise Renewed (ALCS/APR), together with H. E. Kesetebirhan Admasu, Minister of Health in Ethiopia, my esteemed colleague Dennis Weller, USAID mission director to Ethiopia, and my African colleagues in health and development.

In June 2012, during the first Call to Action – Promise Renewed meeting in Washington D.C., Dr. Tedros had committed that Ethiopia would host an African Leadership for Child Survival Conference that was linked to the AU summit. That promise is now fulfilled and I wish to thank Dr. Tedros and Dr. Kesete and all of the colleagues at the Ministry of Health for making this all African meeting a reality and a success.

The pledge signed by the African countries present and the consensus reached by the conference are both significant and historic. The event has marked a new era for the African continent in which it is no longer acceptable for any child to die an untimely and preventable death.

As we have seen at this meeting, in many ways the progress made in the health sector in Ethiopia, as well as many other African countries, has become a  powerful global symbol of what can be achieved in resource-constrained environments and has given many international partners renewed faith in the development enterprise.

To accelerate progress we need to do some things differently. Dramatic reductions in preventable child deaths can be achieved through concerted action in five critical areas, outlined in the global roadmap: geographical focus, high burden populations, high impact solutions, gender equality, and mutual accountability and financing.

The theme of equity, in all its dimensions, has come out very strongly through the conference conclusions on geography, gender equality and high burden populations. We know that as much as we have made global progress on child survival in recent decades so too have we seen an increasing concentration of child deaths in Africa which now accounts for around half of all the world’s child mortality.

During the three days, we have also seen that the highest rates of death are now overwhelming in fragile states and conflict-affected countries and regions. This demands that our attention also be placed on governance issues and on human security. There is a major role here, not only for the United Nations but also for regional institutions, and is why the role of the AU will be even more paramount as we move forward on this initiative. Indeed we are very hopeful that with the Ethiopia government taking over the chair of the AU in 2013, maternal and child survival will be seen as not only a health and development issue but as a peace and security issue. It seems auspicious that the African Leadership on Child Survival has taken place right before the AU heads of state meeting next week. I sincerely hope that the recommendations of this conference are shared with the AU leadership and head of states for their endorsement.

We have seen the strong leadership of African governments in this process. This is not an initiative led by UNICEF or USAID or any other partner, and it is very refreshing to see that this initiative and the commitments being made are home-grown. All countries have existing strategies and plans for improving maternal, newborn and child health. Integration of the ALSC/APR initiative with local processes, rather than setting up vertical mechanisms, will be important. Government should also coordinate efforts of various partners and the different initiatives and synthesize them into a coherent whole at the country level.

One of the most exciting aspects of the meeting and the overall process for me is to have seen the peer to peer dynamic in action. I know the lesson learning and sharing of good practices from country to country will continue over the coming months and that many countries are planning study visits to other African countries. We should nurture this dynamic at all costs. I believe the seeds of success and of sustainability for us in African have been planted by all at this meeting. By working hand in hand, we can and we will end all preventable maternal, newborn and child deaths, and thus complete the work begun under the child survival revolution.

Under Five Child Survival Under Microscope at Summit

This post originally appeared on Mom Bloggers for Social Good.

This week child survival is under critical review in Addis Ababa, Ethiopia during the African Leadership for Child Survival – A Promise Renewed summit. This meeting, held at the African Union headquarters and convened by the Ethiopian government along with UNICEF and USAID brought together African Ministers of Health to enter into discussions about markedly improving child survival rates. The summit ends Friday.

Between 1990-2011 child mortality has decreased 39% in sub-Saharan Africa. Photo credit: Mom Bloggers for Social Good

Between 1990-2011 child mortality has decreased 39% in sub-Saharan AfricaAccording to UNICEF, 1 in 8 children in sub-Saharan Africa die before their fifth birthday from five leading causes: pneumonia, pre-term birth complications, diarrhea, intrapartum-related complications, newborn infection and malaria…continued

Read more to learn which key tweets and infographics are emerging from the summit at the#promise4children hashtag.

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USAID’s Youth in Development Policy: Investing in Young People’s Sexual and Reproductive Rights and Health

Disclaimer: The views expressed are those of the Youth Health and Rights Coalition. They do not necessarily represent the views of the U.S. Agency for International Development nor of the U.S. federal government.

It is often said that young people are our future. But young people aren’t just assets for development tomorrow – they are agents of change today. The first-ever USAID Youth in Development Policy (PDF) clearly recognizes this reality and provides important opportunities to involve global youth in shaping our development agenda and advancing their health and rights.

Young people in Kenya. Photo credit: USAID.

Today’s generation of young people is the largest in history; nearly half of the world’s population—some three billion people—is under the age of 25. Given that this large demographic of young people presents the world with an unprecedented opportunity to accelerate economic development and reduce poverty, the policy is particularly timely and critical. It rightly acknowledges that in order for young people to realize their potential and contribute to the development of countries, they must be able to access information and services that protect their rights and promote their sexual and reproductive health throughout their life span. Advocates, implementers, young people and government partners can help achieve that vision by ensuring that the following important policy provisions are translated into action:

Start early in life

Young people bear a significant burden of poor sexual and reproductive health outcomes, including unmet need for family planning, early marriage and childbearing, maternal death, gender-based violence and HIV. However, when families, communities and nations protect and advance adolescent and youth reproductive rights, young people are empowered to stay healthy and take advantage of education and economic opportunities throughout their lives. We know when these investments happen early in life as well as throughout the life course, they help foster more gender equitable and healthier attitudes and behaviors. So why wait? Let’s embrace the tenets of the policy and invest in young people’s health and rights today.

More money, more tracking

The Youth in Development policy clearly calls for the implementation of evidence-based programs and interventions. The Youth Health and Rights Coalition (PDF) looks forward to supporting this effort with the range of tools and resources developed to effectively implement evidence-based sexual and reproductive health interventions. But we need more than guidance to truly protect and promote the well-being of young people. Advancing youth development will require more funding, better data collection to track investments and outcomes, robust partnerships across sectors, and strong commitment across the agency. It’s a challenge, but one worth taking.

“Nothing about us, without us!”

Many of the young people who are members and partners of the Youth Health and Rights Coalition often call upon this phrase to express the importance of meaningful and ongoing youth engagement, something which is still too often missing in development today. The policy puts the importance of youth participation and engagement front and center of the USAID programming process and emphasizes the need to support more meaningful and equal partnerships with young people while building capacity of local youth-led and youth-serving organizations. USAID’s dedication to civil society consultations to inform the development of the policy was an important first step to put words into action. So let’s keep it up and continue to engage young people as we move forward with the implementation of the policy.

We applaud USAID for recognizing how critical it is to meaningfully engage youth across the diverse countries where the Agency works and look forward to future collaborations. Only together can we succeed in meeting the sexual and reproductive rights and health of all young people and work with them to fulfill their full potential.

The Youth Health and Rights Coalition (PDF) is comprised of advocacy and implementing organizations who, in collaboration with young people and adult allies, are working to advance the sexual and reproductive rights and health of adolescents and youth around the world. The YHRC advocates with key decision makers to prioritize funding and support for comprehensive adolescent and youth sexual and reproductive rights and health policies and practices. Their goal is to ensure young people in the developing world have the sexual and reproductive rights and health information, tools, commodities, and quality services necessary to make healthy and informed choices about their own lives.

Member organizations of the coalition include: Advocates for Youth, American Jewish World Service, Americans for Informed Democracy, CARE, Center for Health and Gender Equity (CHANGE), Family Care International, FHI 360, Georgetown University-Institute for Reproductive Health, Global Youth Coalition on HIV/AIDS, Guttmacher Institute, International Center for Research on Women, International Planned Parenthood Federation/Western Hemisphere Region, International Women’s Health Coalition, Ipas, John Snow, Inc., Marie Stopes International-US, PATH, Pathfinder International, Plan International USA, Planned Parenthood Federation of America, Population Action International, Population Reference Bureau, Population Services International, Public Health Institute, Save the Children, and Women Deliver.

Ethiopia Hosts African Leaders to Accelerate Gains in Child Survival

Today it was an honor for me to join African colleagues in health and development at the opening of the African Leadership for Child Survival – A Promise Renewed. Minister of Foreign Affairs Tedros Adhanom, Minister of Health Kesetebirhan Admasu, and the rest of the Ethiopian Government should be congratulated for hosting this meeting to accelerate the reduction of Africa’s child mortality rates.

Ethiopia’s Minister of Foreign Affairs Dr. Tedros Adhanom opens the African Leadership for Child Survival meeting in Addis Ababa, Ethiopia. Photo credit: UNICEF

Ethiopia has made great progress in tackling child survival and strengthening their health sector. Since the development of Ethiopia’s first national health policy in the mid-1990s, Ethiopia and the United States Government have partnered to increase and expand access of quality health services to Ethiopians nationwide. The United States is proud to have a long-standing health program in Ethiopia with many of our agencies working in the health sector: CDC, DOD, Peace Corps and my agency, USAID.

Last June, Ethiopia joined India and the United States in cooperation with UNICEF to host a Child Survival Call to Action in Washington. More than 700 global leaders came together and challenged each other to reduce child mortality to 20 deaths per 1,000 births, or lower, in every country around the world by 2035. Assuming countries already making progress continue at their current trends, achieving this rate will save an additional 5.6 million children’s lives every year.

In the last two decades, Sub-Saharan Africa has experienced a 39 percent decline in the under-five mortality rate, a tremendous achievement that has been called part of the “the best story in development.” But despite this progress, we know that some countries are doing better than others. By joining together to share best practices, we can create a strong coalition to help each other’s children live to see their fifth birthdays.

An investment in Africa’s children is an investment in Africa’s future. I am pleased USAID is supporting the African Leadership on Child Survival meeting – and we are committed to being Africa’s partner in this effort for years to come.

Photo of the Week: Call to Action for Child Survival In Ethiopia

School children gathered in Ethiopia. Photo Credit: Nicole Schiegg/USAID

Since 1990, the number of child deaths in sub-Saharan Africa has dropped by 39%. Many African countries are within reach of the 2015 millennium development goal to reduce the under-five mortality rate by two thirds. Yet even with the availability of proven, inexpensive, high-impact interventions for maternal, newborn, and child health, their adoption is slow and high rates of childhood illness and death persist in a number of countries. In sub-Saharan Africa 1 in 8 children die before they reach their fifth birthday.

In an effort to catalyze global action for child survival, the Governments of Ethiopia, India, and the United States together with UNICEF convened the ‘Child Survival Call to Action’ in Washington, D.C. in June 2012. Under the banner of ‘Committing to Child Survival: A Promise Renewed‘, more than 160 governments signed a pledge to renew their commitment to child survival, to eliminate all preventable child mortality in two decades.

To maintain this momentum, the Government of Ethiopia, and former Minister of Health Tedros Adhanom, whose leadership raised Ethiopia’s profile in child survival in the continent, committed to convene the ‘African Leadership for Child Survival—A Promise Renewed’ Meeting January 16-18, 2013, in Addis Ababa, the seat of the African Union.

Ministers of Health from 54 African countries have been invited to come together with peers and global experts to ensure child survival is at the forefront of the social development agendas across the continent and renew the focus of African leaders to head their own country’s efforts and sustain the gains made over the last two decades.

Ethiopia Shares Best Practice for Maternal and Child Survival

In advance of tomorrow’s African Leadership on Child Survival meeting in Addis Ababa, Ethiopia, the Ministry of Health organized a media site-visit to showcase their community health extension program and its impact on the country’s tremendous reductions in child mortality.

I was taken away from the hustle and bustle of Addis to the Aleltu district, which is north in the Oromia region. The visit began at a health center, then a health post and finally I visited households in a kebele (village). I saw firsthand how the health extension workers along with the voluntary community health promoters, called the “women health development army,” are key to Ethiopia’s health infrastructure. Health extension workers have finished secondary school, or grade 10, and have been through one-year of training that covered 16 components under four categories: family health; disease prevention and control; sanitation and hygiene; and health education. This is called the health extension worker package.

Members of the press interview women at a health center in Mikawa, Ethiopia. Photo credit: Nicole Schiegg

At the health center in Mikawa, the capital of Aleltu, I observed kids getting immunized and women accessing prenatal care. Two women with their newborns in the waiting area agreed to be interviewed by the press. Both commented on how they learned about family planning from the center and how birth spacing leads to healthier children. They planned to wait three years before their next child by using family planning methods offered by the center, which is funded by USAID as part of an Integrated Family Health Program through JSI and Pathfinder International.

At the Wogiti Dera health post, where they focus on maternal and child health in collaboration with the Mikawa health center, I met a 25-year old health extension worker named Mandarin. She showed me charts depicting data from the progress in her village. Practicing what she teaches, Mandarin is one of the women in the village who delivered her baby at the health center. When asked if she aspired to be a doctor, Mandarin replied, “Of course, anything is possible.”

Finally, I visited a household in the Wogiti Dera village, designated a “model household” because it successfully completed a checklist of 16 good behaviors consistent with the 16 components in the health extension worker package. Examples of good behaviors in the package include: women delivering their babies with a skilled birth attendant, children being vaccinated, and the household practicing good sanitation and hygiene.

What was consistent throughout the visit was an emphasis on data to measure impact and performance. This information feeds up to the regional and national level to populate a scorecard to measure Ethiopia’s progress in reducing maternal and child mortality in the region. The community health extension program is one of many best practices that will be shared at this week’s African Leadership on Child Survival meeting.

Public, Private, and Civil Society Partnerships in Action

This post originally appeared on the Save the Children Blog.

We like to think of development as a team sport requiring all players to work together toward the same goal. The game gets particularly exciting when you add new players to the team at half time.

Save the Children has served children and families in Nicaragua for almost 80 years. Three years ago, we began partnering with Green Mountain Coffee Roasters Inc. (GMCR), based in Vermont, on a project to increase the income and food security for families of workers on coffee farms. By helping families to diversify their crops, improve storage techniques, and bring crops to market, they can better withstand periods of food scarcity during the months between coffee harvests.

The United States Agency for International Development (USAID) joined the partnership two years ago, adding an ambitious health component through their regional “4th Sector Health” project. Implemented by Abt Associates, 4thSector Health develops public-private partnerships and supports exchanges between countries to advance development through health in Latin America and the Caribbean. In Nicaragua, 4th Sector Health is working with Save the Children and GMCR, along with local civil society partners, to boost maternal and child health and nutrition for the same coffee-growing communities.

USAID’s 4th Sector Health also recently funded an experience sharing trip for Save the Children staff from five Latin American countries, who were involved in implementing GMCR-funded projects. The participants learned from each other’s experiences and are replicating best practices in their own programs, serving to increase their impact and sustainability.

Save the Children visits neighborhoods in Nicaragua to monitor child health and nutrition, and treat sick children. Photo credit: Gerardo Aráuz

The alliance between USAID, Save the Children, and GMCR is intended to maximize the use of resources and help identify new solutions to challenges affecting these communities. Sometimes the alliance organizations face challenges of their own — coordinating work plans, reporting on technical outcomes, and carrying out their separate missions.

Public-private partnerships, otherwise known as the “Golden Triangle,” are a hot topic in the field of international development. Donors like USAID have invested millions of dollars in partnerships with the private sector, yet some development experts have questioned the development impact of such partnerships in achieving real benefits for the poor and marginalized in developing countries.

As part of its recent reform efforts, USAID has put more attention towards improving its public-private partnership model. For one, USAID is including technical experts in health and nutrition such as Save the Children in some partnerships, recognizing that U.S. civil society groups lend valuable expertise in maternal-child health and other technical areas. Moreover, USAID is steering the private sector towards achievement of concrete development targets through their partnerships, as well as ensuring that companies are held to certain standards, such as respect for workers and environmental stewardship.

From my perspective, this alliance between Save the Children Nicaragua, USAID, and GMCR, is having a transformative impact on the communities in which it operates.

Martha Lorena Diaz is one of many enterprising women working with us,whose partner, Jose Manuel Benavidez, is a coffee farmer on a cooperative that sells to GMCR. Martha was initially given five hens and now keeps 40 in her small business, earning about one dollar a day from selling the eggs and chickens. Save the Children project training sessions have helped Martha to identify nutritious sources of food for her three children, particularly during the lean months when she struggles to provide enough food for them. Martha now makes a corn flour drink to boost her childrens’ daily vitamin intake. Moreover, health promoters, trained by Save the Children, visit her neighborhood and others to monitor child health and nutrition and treat sick children in their communities, which are often far from the closest health center.

Successful partnerships, such as the one between USAID, GMCR, and Save the Children Nicaragua, are critical to achieving lasting results in the communities that we all serve. With an increase in USAID’s partnerships with private sector and NGO players, who are committed to making a real difference in the lives of families in Nicaragua and elsewhere, I believe our team will prevail.

FrontLines Year in Review: Children’s Saviors on the Front Lines

This is part of our FrontLines Year in Review series. This originally appeared in FrontLines May/June 2012 issue as a special section.

Front-line health workers are the first and often the only link to health care for millions of children in the developing world. They are the most immediate and cost-effective way to save lives, and foster a healthier, safer and more prosperous world. The developing world has experienced remarkable declines in maternal, child and infant mortality in recent decades, thanks in large part to the contributions of those who bring the most basic health services and education into the communities of the world’s underserved.

Millions of people are alive today because a midwife was by their side when they gave birth, or they were vaccinated as infants by a nurse, or because their families learned from a community health worker to adopt healthy behaviors like breastfeeding, hand washing, birth spacing and sleeping under a mosquito net.

While progress is being made thanks to the training and deployment of health workers in many countries, there are still too few health workers to reach the millions of families who urgently need care. Millions of children still die every year from preventable causes. The World Health Organization estimates a shortage of at least 1 million front-line health workers, particularly in Africa and parts of Asia.

Community health worker Rosalina Casimiro meets with children in Nampula province, Mozambique, to demonstrate how to purify water prior to drinking. Photo credit: Luisa Chadreque, Pathfinder Nampula

A million more health workers could save many millions more if they had proper training and support.

Many of the interventions that have proven most effective in saving lives require health workers with some kind of training to deliver them. Front-line health workers do not need to be highly educated to be successful. Experience in many countries has shown that health workers with basic schooling plus several weeks of well-designed training, followed by on-the-job supervision, can master the skills needed to diagnose and treat common illnesses, promote lifesaving health practices, and counsel families about family planning, nutrition and hygiene.

Some front-line health workers are midwives, nurses or private providers such as drug-shop dispensers. Many are community health workers who are selected by—and working in—their own communities. To ensure acceptance of these health workers by their communities, they must respond to local norms and customs. Some front-line workers are compensated for their work, either through the formal health system or by the communities they serve; others are volunteers motivated by non-monetary incentives, including flashlights and bicycles, as well as a sense of pride in their work, and increased status in their communities. Many female front-line health workers, in particular, note that their role has helped increase the respect they get from their families, friends and neighbors.

Major killers of children such as diarrhea, pneumonia, malaria and newborn complications can often be prevented or treated close to home by a well-trained health worker who is armed with basic tools and skills, and is part of a functioning health system.

How many die each year?

  • 7.6 million children under 5 die every year, 3.1 million of them during their first month of life.
  • Major causes of death among children are pneumonia, which causes 1.6 million 1.4 million deaths each year, and diarrhea, which causes 1.3 million 800,000 deaths each year. Malnutrition is estimated to contribute to more than one-third of deaths among children.

“For more than 40 years, USAID has helped children throughout the world grow into healthy, productive adults. Progress in child survival has long been, and remains among the Agency’s major accomplishments,” said USAID’s Deputy Assistant Administrator for Global Health Robert Clay.

USAID-funded initiatives save the lives of approximately 6 million children under 5 each year. The stories from Madagascar, Kenya, Zambia, Mozambique, Bangladesh and Timor-Leste highlight some of the health workers who are saving lives in their communities, and individuals whose lives have been touched—through USAID support—by these saviors on the front lines.

Members of the Frontline Health Workers Coalition contributed to this article.

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