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Accelerating Innovation and Impact in Global Health

This originally appeared on the Stanford Social Innovation Review.

Sad examples abound of inexpensive, lifesaving health solutions failing to reach the most vulnerable in the developing world. Whether it is amoxicillin treatment that is out of reach for the 1.3 million children under five who die each year from childhood pneumonia, or a simple and effective $0.50 oral rehydration salts or Zinc treatment inaccessible to the 1.5 million kids dying each year from dehydration stemming from diarrhea, it is clear that new solutions and approaches are needed. Given this reality, global health practitioners are recognizing the need to look beyond their traditional operating models and seek new solutions to reach the world’s most vulnerable.

At the same time, the private sector, faced with slowing economies in the US and Europe, is increasing investment and experimentation in the more challenging emerging markets as a source for new growth. These firms—whether they are medical device, pharmaceutical, or consumer-packaged goods companies—stand to learn much from global health and development practitioners who have operated at the bottom of the pyramid for years. Similarly, global health practitioners can learn much from these private sector efforts by, for example, better leveraging the rigor and well-defined processes involved in designing, introducing, and scaling products. Given the increasingly aligned incentives, the time is right for more effective and consistent collaboration between these two groups.

A child peers around the corner in the waiting room of the HIV Comprehensive Care Clinic of Meru District Hospital in Kenya’s Eastern province as two pediatricians stand in the background. Photo credit: Mia Collis, Elizabeth Glaser Pediatric AIDS Foundation

The Center for Accelerating Innovation and Impact in USAID’s Global Health Bureau launched last year with these shared incentives in mind; it aims to promote and reinforce innovative, business-minded approaches to bottlenecks in global health. An important piece of this strategy is bringing together thought leaders and frontline practitioners from both the public and private sectors to share proven and tested practices, and then collaboratively develop new global health models.

IDEO’s work developing products and services in India and Africa, for example, has demonstrated an important relevant learning for the global health community and private sector alike: innovation needs to be holistic and strategic. It’s about evaluating and targeting specific gaps in the surrounding ecosystem, with a square focus on empathizing with all stakeholders. While new technologies and products are needed, often times re-evaluating (or evaluating for the first time) the true bottlenecks in the health ecosystem can uncover new opportunities for innovation in training and education, operating/business model design, demand generation, behavior change, and other areas.

An example: In Africa, IDEO worked on a project to develop a low-cost toilet but quickly realized that developing the toilet itself wasn’t enough. To be practical and to succeed, it had to be designed for the unique constraints that existed there, including the lack of centralized plumbing. As such, IDEO designed a system with a separate container to trap the waste. Most importantly, though, the toilets, instead of being sold directly to customers, are instead sold to franchisees that then rent the toilets to customers. The rental fee covers not only the toilet but also a fee to collect and dispose of the waste properly. This way everyone wins. Customers pay a lower amount per month rather than an expensive, one-time, fixed fee. Franchisees earn an attractive return on their investment, and the system ensures that waste is removed and disposed of properly—not on some street corner where it becomes a public nuisance and health hazard. Above all, the incentives are aligned to make the system sustainable.

Another often cited yet supremely relevant example is Jaipur Foot in India. Founded in 1975, Jaipur Foot has fitted more than 40,000 Indians with leg prostheses. To reach such massive numbers, in addition to innovating on a low-cost “product” (in this case, a $45 artificial lower limb), the organization developed an entirely new operating model. It has flipped the traditional healthcare service model on its head, and it now takes diagnoses and treatment to the patient. The organization regularly organizes health camps outside of its centers in more rural locations—where most Indians live—to help patients who have financial and physical difficulty traveling to larger cities. Jaipur Foot sends everything required for treatment to the camps, including doctors, assistants, and equipment. They can even fabricate, fit, and deliver limbs on the spot.

These are just two of a growing number of examples that both global health and private sector practitioners can learn from and collaboratively put into practice. USAID’s new Center for Accelerating Innovation and Impact hopes to enable this best practice sharing as one avenue to more efficiently and effectively deliver healthcare to those at the bottom of the pyramid.

Dheeraj Batra is head of business design at IDEO Mumbai. Over the last three years, Dheeraj has worked extensively in the medical device industry in India having spent the majority of that time incubating businesses and piloting new initiatives for some of the largest companies in the sector. He was a key architect and led the on-the-ground implementation for Healthy Heart for All, a nationwide initiative by Medtronic in India.

David Milestone is senior advisor at USAID, Center for Accelerating Innovation and Impact. In this role, David leads the Market Access team in the development and implementation of market-based strategies to accelerate the adoption of priority health solutions. Prior to joining USAID, David held various strategic marketing roles at Stryker, including innovation and strategy initiatives in India.

India’s Leadership Furthers Global Child Survival Movement

At the forefront of the fight against child mortality and morbidity, India is leading the global community in placing a renewed emphasis on this important mission. India’s Call to Action demonstrates leadership and commitment to both the global community and the children of India.  India has an opportunity to make great gains on child survival with increased commitment and funding for the most effective life-saving practices. Moreover, India’s unique culture of social entrepreneurship, innovation, and technological advances present a historic opportunity to accelerate progress in reducing childhood illness and death.

William Hammink speaks at opening press conference for India’s Call to Action on February 3, 2013. Photo credit: U.S. Embassy

India is a regional leader and can guide and support other countries in several ways.  We commend the progress India is making in tackling child survival and strengthening India’s health sector.  India is one of the countries to have significantly reduced the incidence of HIV – from 0.41 percent in 2002 to 0.27 percent in 2011.  India has reduced its maternal mortality by more than 50 percent – from 570 in 1990 to 212 in 2009 per hundred thousand live births – and child mortality by 45 percent from 119 in 1992 to 59 per thousand live births in 2012.

The United States has been a longstanding partner of the Government of India, and our relationship dates back more than six decades. The U.S. Government through its agencies including the United States Agency for International Development, and the Centers for Disease Control and Prevention has been actively engaged in working alongside the Government of India as it endeavors towards ending preventable child deaths within a generation. In recent years, USAID has made significant investments in the area of reproductive, maternal, newborn, and child health, nationally and in key Empowered Action Group States.

USAID is currently developing its five-year Country Development Cooperation Strategy, while continuing to provide targeted assistance to support flagship national health programs, it will increasingly adopt methods focused on innovation and partnerships: more directly engaging local partners; leveraging co-financing instead of fully funding agreements; and developing platforms and alliances to generate development outcomes that encompass multiple organizations.

The U.S. Government is proud to be a part of this initiative and to give our unwavering support to India’s Call to Action. In the coming months, USAID will look at opportunities for newer partnerships with multi-stakeholder engagement including the government, private sector, entrepreneurs, and civil society to identify, and scale up solutions to address the challenges in accelerating child survival efforts.

As USAID Administrator Raj Shah said in his welcome letter to Summit participants: “An investment in India’s children is an investment in India’s future.” We stand ready to be part of India’s tomorrow.

Photo of the Week: Saving Children in India

Did you know that almost 7 million children under five died in 2011 from largely preventable diseases? In India, 1.7 million children under five died in 2011. February 7 marks the start of the the National Summit on “Call to Action for Child Survival and Development“, to be held in Mahabalipuram, Tamil Nadu.

Organized in partnership with UNICEF and USAID, the Summit is a critical platform that will strategically engage over 200 delegates including 27 international and 35 national experts, key policy makers, planners and implementers from the health sector representing all states of India, representatives and heads of UN and development agencies, global health experts and practitioners, civil society members and private sector, to discuss and debate on child survival and development in India. The Summit will be an opportunity for sharing experiences and challenges; celebrate successes in maternal, newborn, child survival & development programmes; and pledge to meet India’s child survival and development goals. Photo is from UNICEF.

 

International Day of Zero Tolerance to Female Genital Mutilation/Cutting

February 6th marks the tenth observance of the International Day of Zero Tolerance to Female Genital Mutilation/Cutting (FGM/C), an internationally recognized day to foster awareness of the devastating effects of FGM/C and renew the call for the abandonment of this harmful traditional practice. FGM/C is a practice that ranges from nicking to total removal of the external female genitalia. Some 140 million women around the world have undergone this brutal procedure and three million girls are at risk every year.

This 10thanniversary, I’d like to take a look back over progress achieved in the past decade. Significant efforts have been made at the community, national, and international levels to address the issue of FGM/C. Studies have looked at the physical, emotional and mental impacts of FGM/C. Research has deepened our understanding of the diverse reasons for the continuation of the practice, providing a frame for theories about the origins and social dynamics that lead to its continuation. Reflecting the work of dedicated advocates, today most practicing countries have passed laws banning the practice, and prevalence is beginning to decline in some countries.

An estimated 140 million girls and women worldwide have undergone female genital mutilation/cutting. Photo credit: Panos

In September 2000, USAID officially incorporated elimination of FGM/C into its development agenda and created the official U.S. Government policy toward FGM/C.  In 2002, the Donors Working Group on Female Genital Mutilation/Cutting was formed to bring together key international actors, including representatives from USAID, U.N. agencies, European donors and private funders.

In February 2003, the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children held its landmark conference in Addis Ababa, Ethiopia. Many first ladies of Africa, led by the first lady of Nigeria, officially declared “Zero Tolerance to FGM” to be commemorated every year on February 6th. Drawing from this energy, UNICEF’s Innocenti Research Center organized a consultation in 2004, resulting in a seminal publication, “Changing A Harmful Social Convention: Female Genital Mutilation/Cutting.”

In 2008, the Donors Working Group ultimately produced A Platform for Action Toward the Abandonment of FGM/C (PDF).  That same year, UNFPA and UNICEF formed a strategic partnership known as the UNFPA-UNICEF Joint Programme on FGM/C’s “Accelerating Change“. They have been working together, in headquarters and field offices, to develop, fund, and implement policies and programs to accelerate abandonment of FGM/C. The result of this program should inform the work of programs and governments for years to come.

In December 2012, the 67th session of the United Nation’s General Assembly passed a wide-reaching resolution urging States to condemn all harmful practices that affect women and girls, in particular Female Genital Mutilation/Cutting.

While we have made tremendous progress over the past decade, work still lies ahead.  We must all work together – men, women, grandfathers, grandmothers, community and religious leaders, government, civil society, and multilateral organizations – to overturn deeply entrenched social norms that are not only harmful to women and girls, but to our communities and societies.

Join us on February 6th at 9:30am EST for a live webchat discussion at the State Department. The event will include a panel of experts and practitioners, as well as a discussion on programs and solutions to address this issue. Follow @USAIDGH on Twitter and join the conversation using the hashtag #EndFGM/C.

Germany’s Renewed Support: Another Leap Forward for the Global Fund

Germany’s Minister for Economic Cooperation and Development, Dirk Niebel, announced at a World Economic Forum news conference in Davos, Switzerland on January 24 that Germany will contribute 1 billion euros ($1.35 billion USD) to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for the period of 2012 to 2016. As the third largest donor to the Global Fund, Germany has contributed $1.785 billion since the Global Fund’s creation in 2002, with approximately $259 million contributed in 2012. Another leap forward for the Global Fund, the Federal Republic of Germany’s commitment and renewed support will allow the organization to continue to further its mission to halt the spread of these highly infectious diseases.

The Global Fund employs an innovative approach to prevent and treat HIV and AIDS, tuberculosis and malaria. Based on country ownership and performance-based funding, the Global Fund’s model provides resources to developing countries so that they can implement their own programs. Through more than 1,000 programs in 151 countries, Global Fund support has provided 4.2 million people with antiretroviral treatment, detected and treated 9.7 million new cases of infectious tuberculosis, and distributed 310 million insecticide-treated nets to protect families from malaria transmission.

The Global Fund’s Executive Director Mark Dybul, Bill Gates, and German Minister of Economic Cooperation and Development Dirk Niebel announce Germany’s EUR 1 billion commitment to the Global Fund at the World Economic Forum in Davos. Photo credit: The Global Fund

USAID, through PEPFAR, and alongside many donor countries such as Germany, has been a strong supporter of the Global Fund since its inception. Having endured a period of structural transformation and leadership transition, it is more and more apparent that the Global Fund will continue to enact the necessary changes to ensure that grant processes reduce risk and enable countries with the greatest need to access the critical funds they need to continue the fight.

In particular, USAID appreciates the close collaboration with its German Government counterparts in improving Global Fund grant implementation through technical assistance efforts. Since 2007, USAID has provided urgent solutions to countries experiencing bottlenecks in their Global Fund grants through the Grant Management Solutions (GMS) project. GMS has established an effective relationship with the German BACKUP Initiative—Deutsche Gesellschaft fur Internationale Zusammenarbeit. Through the Office of HIV/AIDS, USAID regularly coordinates technical assistance efforts with the German GIZ-BACKUP program to reduce overlap and improve global reach of technical support to the Global Fund. We welcome the opportunity to expand this important collaboration in the months ahead.

Given the positive steps that the Global Fund has taken and is expected to take under Executive Director Mark Dybul’s leadership, we encourage all countries to honor their pledges to the Global Fund, especially during this time of transition to the new funding model.

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.

Follow USAID Global Health on Facebook and Twitter.

 

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.

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