USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Partnerships Put “Action” into the Global Action Plan for the Prevention and Control Pneumonia and Diarrhoea

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 11-17, we will be featuring the important role of mothers and partnerships in Global Health.

The global health sector sounds vast – after all, it has the word “global” in it – when in reality, it is a relatively small number of people with a noble mission that requires a ton of work. None of us can do it alone. As a result, government and nonprofit groups of all shapes and sizes emphasize the importance of partnership.

But what does partnership really mean? Like advocacy, integration, and other important yet nebulous buzz words of international development, it is best illustrated by example. For us, one of the most exciting partnership activities was the recent global NGO response to the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD).

As the first-ever action plan to simultaneously tackle the two leading killer diseases of children less than five years old, the plan itself is a blueprint for practical partnership in action (or, to use another one of our favorite words, for integration). After all, child health does not exist in a vacuum; while there are distinct solutions for each illness, there are also overlapping protective interventions, so it makes sense for our community to tackle pneumonia and diarrhea at the same time.

More than 100 NGOs with diverse focus areas and geographies supported this integrated approach by signing onto a community statement and more than 40 global leaders and experts in the field lent their voices to the effort. Partners rallied around the #MindTheGAPPD conversation to make it a success on social media (a special shout out to @USAIDGH, the top user of the hashtag!). Each group’s focus area – WASH, vaccines, indoor air pollution, etc. – brought unique perspectives to the larger conversation without taking away from any one group’s mission. By putting it into the larger context, it strengthened our messages on a scale impossible to achieve on our own and brought the global health sector one step closer toward a common goal: to ensure that every child gets to celebrate a fifth birthday.

For the Global Action Plan to truly be actionable, partnership efforts must cascade to the local level. That’s why PATH and World Vision developed a toolkit to enhance the efforts of our colleagues advocating for change at the national, subnational, and community levels. From conception to implementation, partnerships are taking the movement forward.

Will you join us?

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

Photo of the Week: Celebrating Mothers Everywhere

During the month of May, we have been highlighting USAID’s work in Global Health. Global health plays a critical role in ending extreme poverty — with a particular focus on ending preventable child and maternal deaths, and creating an AIDS-free generation. The first part of the month, from May 1-10, we focused on the role that science, technology and innovation plays in global health. In celebration of mothers everywhere, we will be featuring the important role of mothers and partnerships in Global Health during May 11-17. Future highlights include AIDS-Free Generation (May 18-27), Family Planning (May 27-June 2), Nutrition (June 3-8). Photo is from PATH/Satvir Malhotra.

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

From Haiti to Kenya – Honoring the Wisdom & Contributions of Moms

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 11-17, we will be featuring the important role of mothers and partnerships in Global Health.

While visiting Haiti last month, I met with a group of farmers to discuss how they were using micro-loans from a local cooperative association. During the conversation, a woman mango grower spoke about using credit to pay her kids’ school fees prior to harvest and then using profits from the sale of her fruit to pay off the loan. It reminded me of a conversation with Maasai women during a trip to Kenya where they recounted the use of proceeds from their cattle fattening business to pay school fees for kids in their community. Both exchanges brought to life the critical role that mothers—and women generally—play in promoting development around the world.

A woman and her baby. Photo Credit: Adriane Ohanesian

Mother’s Day provides a special opportunity for us to reflect on the role moms play in our lives and in the lives of people around the world. In the home, mothers are often the primary caregivers. They are important in ensuring that children receive the food, health care and education needed to grow into healthy, productive adults. They are educators, teaching children skills that will last a lifetime. The American Sociology Association estimates that moms spend 10 more hours a week multitasking than fathers, mainly doing housework and taking care of kids. At the same time, they are often also generating income for the family. That income is critical to kids’ well-being because girls and women have been found to spend 90 percent of their earned income on their families, while men only spend between 30-40 percent that way. Given their multiple, critical roles, we need to think about how we can support moms and leverage their contributions. Invest in mothers and we can grow economies, alleviate poverty and create the foundation for sustainable growth and development.

In the past twenty years, mothers have been instrumental in helping reduce the mortality rate for children under five years old by almost fifty percent. Unfortunately, today, every two minutes, a mother dies during childbirth. A staggering 80 percent of those deaths could be prevented by providing access to basic health services. Similarly, almost 19,000 children under five still die daily from preventable causes. Sub-Saharan Africa and South Asia bear 75 percent of the global disease burden, and mothers and children continue to suffer disproportionately from these illnesses borne of poverty. USAID is working hard, in partnership with country governments and non-governmental organizations globally, to reduce these preventable deaths.

Through continuous improvements to monitoring and evaluation, we are  directing resources toward increasing services for underserved populations; concentrating on the primary causes of child deaths in the hardest hit countries.  We are being strategic with taxpayer dollars by investing in programs that yield the greatest results. Our development efforts are increasingly focused on educating girls, empowering women, and promoting inclusive economic growth. That’s because we know that educated mothers are less likely to die in childbirth, more likely to send their kids to school, and provide better nutrition and health care at home. In fact, data suggests that each additional year of schooling reduces the likelihood that a mother’s child will die as an infant by 10 percent.

At USAID, we are supporting mothers worldwide. Since June 2012, the agency has been helping lead the U.S. Government’s push to renew the global effort to end preventable child death. We are committed to utilizing resources, technology, and expertise to achieve the A Promise Renewed for Child Survival goal of reducing the under five-mortality rate to below 20 deaths per 1000 live births by the year 2035. Reaching this target is a team effort by governments, civil society, the private sector, innovators, and the global health and faith-based community. Workings together, the international community can help ensure a promising future for all women and their children.

We know the statistics and we know what we need to do. We know that investing in mothers pays dividends for children, families, communities and nations. The data is clear but it’s the stories from the women in Haiti, Kenya, and around the world that bring those numbers to life. This Mother’s Day, let’s honor their wisdom and their contributions.

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

 

Malian Midwife Champions Respectful Care for Pregnant Women and their Families

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 11-17, we will be featuring the important role of mothers and partnerships in Global Health.

The man brings his pregnant wife into the health center and is confronted by the irritated midwife who raises her voice: “I’m too busy, what do you want? Go outside, this is no place for a man!” Later, the man returns for news about his wife’s condition and is promptly told to “go back and sit there.”

This role play session about abuse and disrespect in maternity care was part of a training in Burkina Faso sponsored by MCHIP. Through role play, MCHIP trainers demonstrated to doctors and midwives what not to do when attending to their patients, as disrespectful treatment of pregnant women and their families is all too common in health facilities around the world. This is especially true in developing countries, where doctors and midwives often lack basic infrastructure, supplies, manpower, or even awareness about patients’ rights to be treated with dignity during birth.

Pregnant woman with companion at the renovated maternity ward in Bobo Dioulasso, Burkina Faso. Photo credit: USAID

Training participant Haoua Ba had never heard about respectful care until this MCHIP training, even after 22 years as a midwife in Mali. Haoua and about 30 other midwives, pediatricians and obstetricians are known as Africa “Champions” (or advocates) for improving maternal and newborn health by promoting up-to-date knowledge, practices and attitudes in their countries and region. Mali is one of 10 key African countries—along with Benin, Guinea, Kenya, Liberia, Madagascar, Senegal, South Sudan, Uganda and Zambia—where the MCHIP Africa Champions Program is being implemented over two years (2011-2013).

MCHIP maternal and newborn health trainings have always emphasized “women friendly care,” for example by introducing skills checklists with which providers are evaluated on their ability to provide respectful care. However, given the prevalence of disrespect and abuse—in Africa in particular—and the lack of knowledge about this issue, Africa Champion trainers developed an entire training module devoted to this topic. In this 1.5 hour session, a facilitator helps training participants understand during group discussion that there is evidence that key components of respectful care, such as involving a woman in her care, will make the birth experience go more smoothly for both the woman and the health care provider.

Haoua described how this training session taught her to respect pregnant women and their families by greeting them politely and continually informing them in a soothing voice about everything she is doing. And since the training last year, Haoua has seen a big difference after putting into practice these new skills.

“When you show respect, it really facilitates things,” she said. “If you calmly tell the woman what to do and explain things her, it comforts her. And word gets around so women know who is going to treat them well and they request that midwife when they come into the hospital.”

After participating in three Africa Champions maternal and newborn health trainings on innovative, lifesaving practices, Haoua is uniquely positioned to transfer these lessons learned. She plans to do so with both staff and student interns at the busy Referral Health Center in Bamako, Mali, where she also works as a midwife with 22 other midwives and three gynecologists. In fact, one of her primary goals as a Champion is to help strengthen the health center team by promoting evidence-based care. She described how she and one of the doctors will organize trainings about twice a month on a particular theme and have attendees practice on mannequins under their supervision to ensure they are correctly using their newly acquired skills and knowledge.

Importantly, Haoua has taught her colleagues that a woman should be allowed to have a companion by her side during the birth, which is a central tenant of respectful care. Having a loved one present provides women with essential comfort and support during the birth process, especially when the health center staff are busy or overworked. Evidence supports this practice as one that can help to shorten labor and increase normal outcomes.

A pregnant woman who must give birth without the company of a loved one or who must lie on the floor because there are not enough tables, without the privacy of a curtain, is not receiving respectful care. But even in the worst conditions, said Haoua, “if you have the will to do things well, you can help women.”

She is a perfect example of how the USAID-funded Africa Champions program is helping to prevent the untold suffering of women during one of the most vulnerable but extraordinary times in their lives.

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

Saving & Empowering Lives through Clean Cooking Innovation

During the month of May, IMPACT will be highlighting USAID’s work in Global Health.

A major study published in December cited high blood pressure, alcohol, and tobacco as the top three health risks in the world. Could you guess the fourth? You probably did it last night.

The seemingly simple act of cooking a meal is responsible for 4 million deaths each year.

That’s because nearly 3 billion people burn solid fuels such as wood, charcoal, coal, and other fuels to cook every day. When burned in open fires and basic stoves, solid fuels emit a harmful smoke that causes a range of cancers, heart and lung diseases, developmental and neurological impacts, cataracts, and more.

Example of a pine needle powered cook stove. Photo credit: USAID

Inefficient and dangerous cooking practices are also a major cause of burns, and the acts of collecting and burning fuelwood lead to deforestation and the release of climate-changing gases, respectively.

Women and children have the primary responsibility for cooking and fuel collection in developing countries, and are therefore most at risk from the side effects: smoke inhalation, crippling burns, time lost for schooling or work, human or animal attacks during fuel collection, and myriad others.

But, you’re probably asking, how can technological innovation change such a seemingly intractable and global challenge? Enter the Global Alliance for Clean Cookstoves.

Launched by then-Secretary of State Hillary Rodham Clinton in 2010 with 19 founding partners under the leadership of the UN Foundation, today, the Alliance is comprised of more than 650 partners across 6 continents. They’ve joined the Alliance to save lives, improve livelihoods, empower women, and protect the environment by creating a market for clean, safe, efficient, and affordable cooking solutions. Our goal is for 100 million households to adopt clean cookstoves and fuels by the year 2020.

With our partners, including founding partner USAID, we are taking an all-of-the-above approach to ensure that as hundreds of millions of people enter the global middle class, they no longer cook as their ancestors have done since the beginning of human history:

  • Research: We are commissioning research with cookstove and fuel interventions that will help us better understand how to achieve the cleanliness and efficiency markers essential to save and improve lives and the environment, and to underscore once and for all that this is a major global development challenge that deserves awareness and funding on par with similar crises.
  • Standards: International standards to define cookstove cleanliness, safety, and efficiency had never existed until the Alliance and the Partnership for Clean Indoor Air began working with the International Organization for Standardization (ISO). The interim system that has been adopted is now in the process of being translated into permanent standards. A tiered system through the ISO will create global norms and strengthen a market for clean cooking solutions.
  • Testing centers: To carry out those standards and further propel local manufacturing and testing, the Alliance is supporting the enhancement or creation of testing centers in 12 countries worldwide. Previously, most stoves had to be sent to North America or Europe to be tested, proving very costly for manufacturers and impeding local growth of markets.
  • SPARK and Pilot Innovation Funds: The SPARK and the Pilot Innovation Funds are part of our plan to increase the level of resources, grants, and investment in the clean cooking sector. Each year, we will support entrepreneurs and innovation through at least $2.25 million. This year’s Pilot awardees were recently announced, and we look forward to announcing the SPARK recipients later this month.
  • Input from consumers: Each of the above steps will be fruitless if we aren’t engaged in dialogue with consumers at each step along the value chain: food taste; cooking style; stove design, weight and color; manufacturing; distribution; purchasing; and adoption. The Alliance and its partners have strong relationships with community associations, women’s groups, and others to ensure we hear directly from consumers about their economic, health, and standard of living aspirations, and then translate that information into action.

The Alliance and its partners strongly believe that cooking shouldn’t kill, and because you are reading this blog during USAID’s Global Health Month+ series, I suspect that you do, too. Find out about all of our market-enabling activities and join us at www.cleancookstoves.org.

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

The Power of Mobile Technology to Save Lives

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

The development field has been exploring for years ways to harness the power of technology to benefit those in need, especially mobile technology, which can reach people in remote areas who need food, health, education, and other assistance quickly and well.

A health worker refers to her mobile phone for information while making a house visit. Photo credit: World Vision

Health is an area in which the benefits of mobile technology are obvious. One initiative World Vision is especially proud of is our mobile health (mHealth) projects  in 13 countries. Our mHealth projects leverage the ubiquity of mobile phones to deliver information to, and receive information from, patients and caregivers and can address a broad range of scenarios, including announcements, targeted messages, appointment reminders, medical records for patients, treatment reminders, training and tools for front line health workers and volunteers. Key mHealth principles that have been integrated into current and planned projects include: 1. Align closely with Ministries of Health and their partners; 2. Work in partnership with other funders, developers, and implementers to build on and add to global learning; 3. Design to meet the needs of local users but also provide the basis for maturing the evidence base; 4. Be initially affordable yet based on sustainable costing models and scalable technology; 5. Be respectful of data governance issues; 6. Utilize and strengthen government and partner information systems; 7. Emphasize coherence and quality of approach and program/project management; and 8. Favor open source solutions and emerging global standards.

To support mHealth, World Vision has strategically partnered with the Bill & Melinda Gates Foundation, Grameen Foundation, and Dimagi to create and deploy a World Vision version of the Gates-funded MOTECH Suite (MTS), a sustainable, scalable, open source mobile solution. MTS provides a set of capabilities encompassing five key functional mHealth areas: Behavior Change & Demand Generation, Managing Patient Data, Improving Worker Performance, Last-Mile Supply Chain, and Patient Adherence. This partnership allows World Vision’s funded mHealth projects to utilize a common, yet customizable, field-tested mHealth tool.

MTS was piloted in World Vision’s Afghanistan mHealth project (USAID-funded Child Survival Health program 2008-2013), and the evaluation results are encouraging:

  • significant improvement between intervention and control groups in any antenatal attendance (20 percent),
  • skilled delivery at a health facility (22.3 percent),
  • having a birth plan that included improved coordination with the health facility (12.6 percent),
  • saved money and arranged transport (12.9 percent)
  • knowledge of two or more pregnancy danger signs (12.9 percent).

A volunteer health worker refers to her mobile phone for information while making a house visit. Photo credit: World Vision

In World Vision’s Mozambique mHealth project (Gates-funded Grand Challenges 2010-2012), MTS research results indicated that pregnant women in the project’s intervention area had a higher likelihood of accessing antenatal care, prepare better for birth, and have their births assisted by a skilled provider. They were also more likely than those in the control group to know about signs of pregnancy complications and to seek care at a facility for that complication.

The advantages of the shared framework of MTS are numerous, from minimizing software development, operations, and support costs, to making available the source code, best practices, learning, and other assets to the global community to avoid duplication, and ultimately, save more lives. As World Vision rolls out MTS in additional countries and regions, we’ll analyze the complexity and economics of this versus other models, the interface with national Ministries of Health systems, impact, and sustainability.

Deployments of WV’s global version of MTS have begun in Sierra Leone, Uganda, and Zambia, with others to follow in Tanzania, Sri Lanka and India by this August. World Vision aims to increase geographical mHealth reach within these countries while enhancing MTS functionality at the community level. The focus is on creation of a solution that is globally deployable, meeting at least 80 percent of functionality needs for each project, and further customizable for each context. A key characteristic of this effort is collaboration with Ministries of Health and intentional efforts to forge public-private partnership agreements with mobile network operators and other potential private sector partners. This model has already effected notable reductions in duplication of effort and overall costs at the global level, as well as for each project.

Initiatives like MTS are the way forward for NGOs to impact the global health field, including reducing incidence of malaria, improving maternal and child health, and improving child nutrition. Read more about World Vision’s mHealth projects.

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

Using Technology For STH Control

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

This originally appeared on the InterAction Blog.

I consider myself extremely fortunate and even spoiled in this 21st century with smart phones and so much mobile technology available. If I ever feel there is a need to make my life more convenient with technology, chances are I can go to the app store to download some utility that will help. And, even if it’s not 100% satisfactory, by virtue of having asked the question or conducted the search for this app, some techie out there is likely monitoring the query and I can probably be assured that in weeks, if not days, something better will be created.

So as I wrangle with the question of how the Neglected Tropical Disease (NTD) community can more effectively and efficiently manage our disease control and elimination programs around the world, I hark back to how we can leverage the fact that almost 75% of the world have access to cell phones. The NTD sector should be paying close attention to the opportunities presented by the proliferation of mobile technology.

There has been interesting progress in the use of mobile technology, like this smart phone, in the fight against NTDs. Photo credit: InterAction

In April 2012, attendees of the Ninth Global Health and Innovation Conference overwhelmingly agreed that a key to transforming global health is to push the development of social enterprises toward mobile technology. The reach of mobile phones into even the poorest and most remote parts of the world has shown these devices to be the tool of choice for civil and social transformation.

Those working in the HIV sector were some of the first to leverage the utility of mobile phones to check on people living with HIV. As a substitute for home visits, which are expensive, time-intensive, and far from discreet, mobile technology became a key factor in dealing with the stigma of HIV. Mobile phones have also been used to send reminders to patients and caretakers to improve adherence to antiretroviral treatment regimens. Another Johnson & Johnson supported mHealth program, MAMA, is bringing health information to pregnant women in more than 40 countries.

Considering that more than two billion people worldwide are affected by NTDs, the development and use of mobile technology for preventing and controlling NTDs has lagged. However, one bright spot for the NTD sector is the development of mobile technology tools to report on the global prevalence of trachoma. Using data collected through surveys leveraging smart phones and SMS, comprehensive prevalence maps of the disease have been developed, which will greatly improve the tracking and treatment of individuals infected with NTDs. As noted by Dr. Simon Brooker of the London Center for Neglected Tropical Disease Research in The Guardian earlier in the year, “maps are important to the control and elimination of NTDs … [and] only now are we starting to develop this blueprint.”

Mobile technology can be used in many other facets of the control and elimination of NTDs, for example, informing communities when and where treatments will be distributed, sharing messages about the causes of infection and how to prevent them, and collecting and reporting treatment data to health centers.

Recently, there has been even more interesting progress in the use of mobile technology in the fight against NTDs. Isaac Bogoch and other researchers innovated a way to turn the lens of an iPhone camera into a field microscope to detect intestinal worms in childrens’ stool samples. This is particularly timely because the global health community is ramping up the administration of medicines donated to treat infection with intestinal worms, also known as soil-transmitted helminthes (STH).

The increase of treatments globally will mean a greater need for diagnostic testing to monitor the impact and effectiveness of the programs. This concept of converting a phone to a field microscope would reduce the cost of the testing by eliminating the need for desk top light microscopes. It will also allow for images to be saved for enhanced analysis later or sent to a central repository for batch analysis almost instantaneously. In addition, as the increased use of anti-parasitic medicines will result in an overall decrease in the number of STH in the infected populations, a more sensitive and robust diagnostic tool is needed. The authors noted that this is, indeed, the first generation of the mobile phone microscope for resource constrained settings, but that newer technologies are certain to come along to improve its sensitivity and specificity.

These recent developments in mapping and diagnostics reassure us that mobile technology for control of NTDs is gaining traction. With two billion people on our planet at risk of NTDs, there is a market for mobile technology to eliminate or control the NTDs. There is clearly still much to be done. The NTD community must encourage and leverage this potential to maximize the health and development gains that can be made using this technology in all aspects of our work. The possibilities are limited only by our imaginations.

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

Adding Vaccines to Intensify the Assault on Malaria

David Kaslow, MD, serves as Director of the PATH Malaria Vaccine Initiative. Photo credit: David Kaslow

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

At the turn of the last century, the call to action to bring to bear tools such as insecticide-treated bed nets, malaria rapid diagnostic tests and artemisinin-based combination therapies, was heard. Governments, foundations, non-profit groups, and the commercial sector mobilized to stem the tide against an ancient scourge—the result has been an estimated 274 million malaria cases and 1.1 million deaths averted between 2001 and 2010.

And yet, the fight against malaria is far from over and new tools will be needed to continue to build on these initial impressive gains.

Given these gains the World Health Organization (WHO) has undertaken an update of the 2006 Malaria Vaccine Technology Roadmap—a document developed through a consultative process to align the malaria vaccine development community toward common goals. In 2006, the Roadmap set a shorter-term goal—by 2015, develop and license a first-generation malaria vaccine that has a protective efficacy of more than 50% against severe disease and death and lasts longer than one year—which is expected not to change. However, the long-term goal will be updated to better reflect the global health community’s desire to eradicate malaria altogether and targets vaccines that interrupt malaria transmission (VIMTs) and that support the elimination/eradication agenda, including transmission-blocking vaccines (TBV). TBVs are designed to break the cycle of transmission, preventing the malaria parasite from passing from humans to mosquitoes. When used in conjunction with other technologies, a transmission-blocking vaccine could help a country push across the threshold from control to elimination and ultimately help achieve global eradication.

Although there is not an approved malaria vaccine today, several lines of evidence indicate that it is biologically feasible to develop one. A recent update by the WHO of the global malaria vaccine pipeline identified more than two dozen active vaccine candidates in clinical development. This list includes the most clinically advanced candidate, GlaxoSmithKline’s RTS,S, which is in the midst of late-stage Phase 3 trials in Africa. Results to date show that RTS,S cuts cases of malaria in half in toddlers and by one-third in infants, on top of the protection provided by bed nets.

The final set of data from the Phase 3 efficacy trial is expected in 2014, and will provide decision-makers with important information about RTS,S, including vaccine effect in different malaria endemic settings and the impact of a booster dose. And anticipated modeling outputs will illustrate how the vaccine candidate’s efficacy may translate into public health impact—another important input for decisions about the possible role of RTS,S in the future. Experience from vaccines to combat other diseases, such as rotavirus, has shown that the relationship between vaccine efficacy and public health impact is not always straight forward. Rotavirus vaccine efficacy is higher in South Africa than in Malawi (77 percent versus 49 percent – 60 percent greater in South Africa), but the vaccine’s impact in terms of cases averted is actually 60 percent greater in Malawi.

Building on the key learnings from RTS,S, and using unique tools, such as the malaria “human challenge model”, revolutionary new ways to accelerate vaccine development are being used to hunt for additional vaccine targets. The US Government, through multiple cross-sector collaborations, is at the center of much of this research. Initial breakthroughs in malaria vaccine science came from the Department of Defense and the National Institutes of Health—often with the support of USAID. And key elements of the global malaria vaccine pipeline are supported by USAID’s Malaria Vaccine Development Program, which, along with the President’s Malaria Initiative, has been integral to the successes made to date in the fight against malaria. Indeed, it is only through strong partnerships that the overall battle against this disease will be won.

The international community has made phenomenal progress against malaria, but the gains are fragile. More than 650,000 people still die from malaria each year, almost all of them young African children, and history tells us that when support for control programs wanes, the parasite resurges with a vengeance. Over the years, malaria vaccine development has progressed from a pipe dream to a pipeline, and adding a vaccine to the arsenal is more important than ever to vanquish this parasite. At the turn of the next century, malaria should exist only in the annals of eradicated infectious diseases.

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

The Power of Mobile to Improve Women’s Health

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

Last month, I had the chance to visit a clinic in Nigeria just outside of the Federal Capital Territory where approximately 70 pregnant women were waiting to receive prenatal care. Being a big fan of impromptu focus groups, I asked the women to raise their hands if they had a cell phone. Hands shot up around the outdoor meeting space, many of them proudly clutching mobiles phones of all shapes, sizes and varieties. This was an exciting moment for me, a clear representation of just how ubiquitous mobile technology has become in low-income countries. The GSM Association estimates that the mobile penetration rate in developing countries is now 89%.

There is no doubt that the pervasiveness of mobile technology has made possible innovative new ways to deliver health information and services. mHealth projects throughout  the world are harnessing the power of mobile to do everything from registering births to supporting health workers to raising awareness about disease prevention (and a great deal in between!). Mobile phones have also become valuable tools for empowering women: more than 1 billion women have access to a mobile phone in developing countries, and 9 out of 10 women who use mobile phones say they feel safer and more connected with friends and family.

With a mobile phone, this mother has access to health information and services. Photo credit: VillageReach

Women, as mothers and health workers, are commonly the beneficiaries of mHealth projects. But even as we acknowledge the potential power of mobile phones to improve their health and wellbeing, it’s important to recognize that they are rarely equal participants in the development of these interventions or the policies that govern access and use.

I believe firmly that mHealth projects, especially those related to reproductive, maternal, newborn and child health, must take into account social, cultural and gender norms in order to produce improved health outcomes. This belief led me to work with my colleague, Madhu Deshmukh, who is seconded to the mHealth Alliance from CARE – a leader in the movement to promote the empowerment of women and girls – to develop a Gender Analytical Framework (PDF). Through this framework, mHealth implementers can better understand the nuances and implications of gender issues, and then design or modify their projects accordingly.

When developing the framework, we interviewed a number of organizations working on mHealth projects, including VillageReach, one of our grantees bringing a toll-free maternal health hotline to scale in Malawi. What VillageReach told us is that they have experienced first-hand the challenges of taking gender into account when designing mHealth programs, for instance when they realized men were calling into the service on behalf of their families. By creating this framework, the mHealth Alliance is providing mHealth implementers like VillageReach with a powerful tool that will help ensure women and men not only have access to mobile technology but that it is being harnessed in a way that truly benefits the health of pregnant women and their families, as well as the male and female health workers that serve them.

Returning to my unofficial Nigerian focus group, my second question to the women was how many had used their phone to obtain some sort of health information. Remarkably about half of the hands went up. When I probed, many shared that they used their phones to either call a family member or a health worker to seek advice about their pregnancy, though it wasn’t necessarily through a formal service.

In Nigeria, the government has recognized this power of mobile phones to empower citizens, health workers, and the health system through the Saving One Million Lives initiative.  They have also highlighted equity and gender, specifically, as key to ensuring that the full potential of mobile is realized to reach targets for significant reductions in maternal and child deaths and improvement in health and wellbeing.

As more services to provide access to health information are implemented by programs such as VillageReach and the Mobile Alliance for Maternal Action (MAMA), I fully anticipate that more women will be empowered to better care for themselves and their children. On my next visit to Nigeria, I hope to see the number of raised hands rise dramatically, due in no small part to mHealth implementers and designers applying a gender lens to their work.

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

Netbooks Empower Community Health Workers to Improve Health in Bangladesh’s Poorest Communities

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 1-10, we will be featuring the role that Science, Technology & Innovation plays in Global Health.

With a population of 150 million, Bangladesh is a bustling country filled with vibrant people. On a recent trip to Dhaka and Chittagong we experienced first-hand the kindness and welcoming spirit of the country. The goal of our trip was to meet with various USAID implementing partners, and several units within the Ministry of Family Health and Welfareto find out more about their behavior change communication work. Developing high quality, evidence-based communication campaigns that promote healthy behaviors is quite a challenge for Bangladesh with their large population, numerous rural communities, and with so many health issues that need to be addressed. These health areas range from improved antenatal and postnatal care, family planning, nutrition, and child health. USAID implementing partners and the Ministry of Family Health and Welfare are now streamlining their health communications work, making sure their messages are in agreement, effective, and accessible to a range of people of all ages and educational backgrounds.

Community health workers receive training on the new netbooks. Photo credit: Bangladesh Knowledge Management Initiative

A key part in this new effort was the launch of a three-month eHealth pilot program, developed by Johns Hopkins University – Center for Communication Programs in partner with Eminence, the Bangladesh Center for Communication Programs, and the Ministry of Health and Family Welfare, with funding from USAID. The pilot will take place in Sylhet and Chittagong where 300 community health workers have received a netbook computer loaded with several eToolkits that contain a digital library of communication materials in maternal and child health, family planning and nutrition, and eight eLearning courses. The eToolkit includes 116 materials and tools which were selected by a team after a detailed assessment and review. The eToolkit will improve the quality and effectiveness of counseling visits that the community health workers have with their clients, while replacing the heavy materials they previously carried from house to house. The eight eLearning courses on the netbooks are meant to supplement the training that community health workers currently receive. Each course also includes an assessment designed to measure changes in the knowledge and skills of community health workers.

Puspa Rani Paramdar, a community health worker, said she felt empowered with information and knowledge after she received the netbook. Photo credit: Bangladesh Knowledge Management Initiative

The eHealth pilot is one of the first large steps towards achieving a Digital Bangladesh by 2021. The use of digital resources will help extend the reach of key messages for health, population, and nutrition. In early April, colorful balloons and banners welcomed guests to the launch event for the pilot program in Chittagong. Here we witnessed the ceremonially hand-off of ten netbooks to community health workers before an audience of more than100 guests who were excited and engaged, asking interesting technical questions and offering suggestions for future iterations of the project.

On April 20-21, the first 30 community health workers attended an orientation, learned to use the netbook, and navigate the eToolkit and eLearning courses. Facilitators led an interactive orientation to ensure the community health workers felt comfortable operating the netbooks. There was much enthusiasm for the eHealth pilot program from the field workers during the orientation, who shared they felt empowered, informed, and energized to continue their important work.

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