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Archives for Global Health

U.S. Investments in Foreign Aid Provide a Healthy Return

Ariel Pablos-Mendez (left), Assistant Administrator for Global Health and Pape Gaye, President and CEO, IntraHealth International. Photo credit: USAID and IntraHealth.

What if you could take a fraction of a penny and use it to help build a health system?  Believe it.  It takes only a fraction of a single penny per American taxpayer dollar to train a global health workforce—a workforce that will reach millions through treatment, prevention and counseling services.

Just ask midwife Teddy Tiberimbwaku, who had the opportunity to meet Uganda’s vice president Thursday.

Last year, Uganda’s Ministry of Health, operating with only one doctor and 13 nurses to serve every 10,000 people, was told by the Ministry of Public Service that not only could it not create any new positions, but also any unfilled positions—some 42 percent of them—would be lost.

Yet Thursday, Ugandan Vice President Edward Ssekandi, on behalf of President Yoweri Museveni, celebrated and honored the work of Teddy and other health workers at the “Celebrating Health Workers in Uganda” event. Other awardees honored for their inspiring work included Prof. Francis Omaswa, Dr. Yasur Mubarak and Dennis Tabula.

Dennis Tabula, Senior Clinical Officer, Frontline Health Worker Award. Photo credit: USAID

In addition to highlighting the contributions of individual health workers who have worked tirelessly to save the lives of their country’s most vulnerable and strengthen the overall health system, the event marked a new $19.8 million investment by the Ugandan government to fill critical health workforce positions throughout the country—a true show of in-country leadership and ownership. Just how the Ugandan Parliament approved such a significant amount of money from its limited budget exemplifies why the United States invests in global health.

Furthering the bipartisan legacy of American leadership in global health has helped slash child mortality around the world by 70 percent over the last 50 years, end smallpox, and put polio on the brink of eradication, President Obama and members of Congress from both parties have laid out a bold, yet achievable, vision to put an end to preventable child and maternal deaths, and create an AIDS-free generation.

Teddy Tiberimbwaku, Enrolled Midwife, Frontline Health Worker Award. Photo credit: USAID

The United States Agency for International Development (USAID) and its non-profit partners, like IntraHealth International, recognize that a major barrier to realizing this vision is a severe lack of trained and supported health workers, especially those on the frontlines of care. The World Health Organization estimates that 1 billion people have little or no access to essential health services, and that at least 1 million more frontline health workers are needed to deliver these services in developing countries. Global supply of antiretroviral drugs or vaccines cannot suffice without the health workers to deliver them to those in need – they are the backbone of any health system.

Such a crisis cannot be solved by the United States alone. We must work closely with our developing country partners to help them develop sustainable solutions that work in their own local context. This is why we are truly heartened by the commitment of the Government of Uganda to solving its health workforce crisis.

Dr. Nasur Mabarak, Yumbe District Hospital Team, Health Innovator Award. Photo credit: USAID

IntraHealth’s Uganda Capacity Program, supported by USAID, works with the Ugandan Ministry of Health on health worker staff audits for three years. The program keeps tabs on how many health workers are employed throughout the country, where they are, how many positions are vacant, and other key data that many developing country governments lack.

So when the Uganda’s planning ministry proposed the hiring freeze for the health sector, Uganda’s Ministry of Health and supporters of health workers across the country literally had the data at their fingertips to illustrate just how disastrous the freeze would be to the country, which has one of the highest maternal mortality rates globally, and the tenth highest HIV/AIDS prevalence rate in the world, according to UNAIDS.

Ugandans pushed their agenda forward using the power of evidence, which led to a budget passed in September 2012 that set aside almost $20 million to increase financial incentives for doctors who serve rural areas and created more than 6,000 jobs for new health workers who will improve the health and wellbeing of hundreds of thousands of Ugandans.

Professor Francis Omaswa, Pauline Muhuhu Award. Photo credit: USAID

The Ministry of Health and the Uganda Capacity Program are now working on a sustainable, data-driven allocation plan for these in-country investments in health workers. Meanwhile, USAID and IntraHealth are working together through mechanisms such as the Frontline Health Workers Coalition to amplify our collective belief that trained and supported health workers are crucial to giving millions access to health care, and in turn, creating a healthier, safer, and more prosperous world.

Dr. Ariel Pablos-Méndez is Assistant Administrator for Global Health at the United States Agency for International Development (USAID) and Pape A. Gaye is President and CEO of IntraHealth International.

 

 

 

 

 

 

 

 

Success in India Paramount to Ending Preventable Child Deaths Globally

Ariel Pablos-Mendez, PhD, is the Assistant Administrator for Global Health

I just returned from India‘s “Call to Action Summit for Child Survival and Development“, which took place in Mahabalipuram, Tamil Nadu.

India accounts for the largest number of deaths of children under five: nearly 1.5 million per year. This number is staggering, but there is good news. There has been a steady rate of decline in child mortality — even ahead of the global rate of reduction. As I told DevEx during the Summit, “success in India is paramount to see the global success and vision of ending preventable child deaths in this generation.”

Led by India’s Ministry of Health and Family Welfare, the Summit called for an accelerated response to decrease child mortality across the country. This event was a direct outcome of the Call to Action held in Washington, DC last year — where India joined Ethiopia and the United States with UNICEF to launch a global roadmap to end preventable child deaths globally. About 300 policymakers, public health practitioners, private sector, civil society and media representatives attended India’s Summit, including 27 international and 35 national experts. Notably 20 State delegations were present. U.S. Ambassador Nancy Powell, a stalwart advocate for child survival, addressed the opening plenary on behalf of the United States.

The Summit had several main themes related to child survival and development: quality of newborn care, interventions for preventing diarrhea and pneumonia, social determinants of child survival, nutrition, strengthening health systems, improving accountability, communication for child survival, partnerships for improved maternal and child health, and leadership dialogue. The complete agenda and speakers can be found on the Summit’s website.

There was a rich discussion at the Summit along with solid deliverables. The Government of India launched the Reproductive Maternal Neonatal Child Health Adolescent health strategy (RMNCH+A), which serves as a roadmap for the States. Also released were several guidance documents including implementation of newborn care as well as management of pneumonia and diarrhea.  A National Child Survival Scorecard was showcased, and States were encouraged to develop their own scorecards and to monitor progress.

India’s Call to Action is the beginning of a national movement. Attendees demonstrated a passionate commitment to mobilize on behalf of India’s children — and to hold each other to account. India’s leadership and programmatic success will help galvanize the global response. USAID will continue to be a steadfast partner of “A Promise Renewed”, the sustained effort led by UNICEF to reach our global goal. Working together, ending preventable child deaths will be one of the greatest moral victories of our time.

Video of the Week: “Partnering for Progress: Eliminating Neglected Tropical Diseases Globally”

USAID-funded projects End in Africa and End in Asia have partnered with global organizations to work towards eliminating neglected tropical diseases. Leaders in the field talk about the progress that has been made and their hopes for the future.

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.

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