USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Public, Private, and Civil Society Partnerships in Action

This post originally appeared on the Save the Children Blog.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How many die each year?

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

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

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

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

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Strong Families Equal Strong Nations

Kathleen Strottman is the Executive Director at the Congressional Coalition on Adoption Institute. Photo Credit: CCAI.

Business giant, Lee Lacocca once said, “The only rock that stays steady, the only institution that works is the family.” This simple, yet profound, principle is one that has not only withstood the test of time but is also the foundation of emerging brain science.

Here is what we know: We know that strong families are the building blocks of strong communities, and strong communities are the building blocks of strong nations. Thanks to leaders like Dr. Jack Shonkoff, we know that relationships with other human beings are not a luxury for children, but an absolute necessity.  But you do not need to be a Nobel Prize-winning economist or a world-renowned neurologist at Harvard to be able to recognize that children do best when raised by loving and protective parents.  For many of us, we need only to reflect on our own life experience to understand the impact that a loving embrace or encouraging words have in times of stress.

Despite these certainties, millions of children in the world are growing up without the care of a protective and permanent family. These children live in institutions or on the streets; they have been torn from their families because of war or disaster; or they have been bought and sold for sex or labor. And worst yet, the number of children who suffer such fates is rising. For this to change, governments of the world need to not only recognize that children have a basic human right to a family; they must also establish and enforce laws and systems to protect this right. It is for this reason that the Congressional Coalition on Adoption Institute (CCAI) is proud to support the U.S. Government’s Action Plan on Children in Adversity.

Under the plan’s tenets, the millions of children outside of family care will have the opportunity to benefit from programs that prevent them from being separated from their families and quickly reunify them when separation proves inevitable. The Plan also makes the commitment to pursue adoption, foster care, kinship and guardianship for children whose biological families are unable or unwilling to care for them. This is a major step forward and holds promise not only for the futures of children, but the future of nations.

Kathleen Strottman is the Executive Director of the Congressional Coalition on Adoption Institute (CCAI). Prior to working at CCAI, Kathleen served for nearly eight years as a trusted advisor to Senator Mary Landrieu and then as an associate at Patton Boggs, LLC. As the Senator’s Legislative Director, Kathleen worked to pass legislation such as the No Child Left Behind Act, The Medicare Modernization Act, The Inter-Country Adoption Act, The Child Citizenship Act of 2000, The Adoption Tax Credit and the Family Court Act. Throughout her career, Kathleen has worked to increase the opportunity for positive dialogue and the exchange of best practices between the United States and countries such as China, Romania, Russia, Guatemala, Honduras, El Salvador, Ethiopia and India. Kathleen regularly presents at national and international child welfare conferences and has appeared on CNN, FOX News, CBS, NBC, C-SPAN, PBS and numerous other media outlets. She is also a regular contributor to Adoption Today magazine.

A Reflection on the Human Spirit on International Human Rights Day

Jonathan Hale is deputy assistant administrator for Europe and Eurasia. Photo Credit: USAID.

The 20th century was marked by dark episodes of violence, repression and mass killing around world especially in Europe. Hitler killed between 11 to 14 million Jews and other minorities, and Stalin was responsible for the death of more than 20 million Soviet citizens. The exact numbers may never be known and the depth of individual suffering is also incomprehensible. Beyond what happened in wars, regimes themselves were responsible for massive human rights violations against their own people.  Rule by fear was the order of the day.

On this 2012 International Human Rights Day, the final day of our 16 Days of Activism Against Gender Violence, the countries of the former Soviet Union and Eastern Europe continue to deal with the legacy of that history and continue to come to terms with it. Over the last several years, I have spoken with many USAID Foreign Service Nationals who have told me their stories of what happened to their grandparents or their parents or in some cases in Bosnia harrowing stories of their own families’ ordeals. They pointed out that 20 years ago we never would have been able to have such a conversation.  Sadly, at the same time there are still far too many reports of human rights abuses in the region – of those who speak out against corruption, who speak up for their rights and whose political views still sometimes face peril – incarceration, beatings, or even death.

Mass grave in Guba, Azerbaijan - alleged victims of mass killings of Azerbaijani, Jewish, Lezgi by Bolsheviks in March 1918. Photo Credit: Jonathan Hale.

During the darkest times of the Soviet period, people still found a way to express dissent whether openly or through literature, art, and music. The same is true today – people will not be silenced, the human spirit is too strong. This morning I met activists from Belarus to discuss ongoing challenges. In Belarus, the government arbitrarily arrests and imprisons citizens for criticizing officials, for participating in demonstrations and for other political reasons. There are hundreds of politically motivated imprisonments and no accountability for past politically motivated disappearances. And yet brave Belarusians like those I just met continue to seek a way to press for protection of their rights and to improve the lives of their families.

A cadre of human rights activists across the former Soviet Union who devote their lives to bringing human rights protections to every individual remain active. As the Belorussian activists expressed concerns about the conditions of confinement of fellow activists in Belarus, it was clear that even today this is still a perilous endeavor to demand protections for the most fundamental rights. We admire the efforts of these individuals and are reminded of the special place that the U.S. possess in the hearts and minds of the human rights defenders from around the world.

The American people have long stood with repressed people in Europe and Eurasia and around the world. In the 21st Century, we will continue to support those who speak out for universal human rights, freedom and dignity.

Book Review: “No Time to Lose: A Life in Pursuit of Deadly Viruses” by Peter Piot; Reviewed by Jennifer Albertini, USAID Africa

Jennifer (Jenny) Albertini is Senior HIV/AIDS Technical Advisor for USAID Africa's Health Team where she focuses on policy, program and technical guidance for the Agency's HIV/AIDS programs in Africa. Jenny has worked with PEPFAR since its inception, including spending seven years in Zambia and Swaziland implementing and managing HIV/AIDS programs there.

Synopsis

For many, childhood is a time of wonder and ambitious dreams to travel to foreign lands and work on issues of social justice.

Often times, such dreams remain unfulfilled – but, not for Peter Piot. As he details in “No Time to Lose: A Life in Pursuit of Deadly Viruses,” more than half of Piot’s life has been spent chasing viruses and politicians around the globe in his effort to understand and mitigate the impact and devastation of infectious diseases.

What started as a mysterious virus delivered to his laboratory in Belgium in 1976 led to his first trip to Africa to pursue what later became known as Ebola. Before he knew it, Piot was partnering with scientists in Africa to investigate other infectious diseases, including sexually transmitted infections, positioning him well for when AIDS began chipping away at the continent in the early 1980’s. He was at the forefront of efforts to unravel what quickly became the newest and fastest growing pandemic. Translating his scientific prowess into bureaucratic-ease, a decade later, Piot helped bring together 10 United Nations agencies to form UNAIDS, the Joint United Nations Programme on HIV/AIDS. UNAIDS was the first UN agency dedicated solely to working on fighting one disease. He led the agency for 14 years (1994-2008).

No Time to Lose…” isn’t just about the laboratories and boardrooms that Piot was able to grace during his career. As he describes, his relationship with truck drivers and heads of state, physicians and patients, and commercial sex workers and advocates is what pushed him to keep fighting, learning, fundraising, and advocating for those affected with infectious diseases for more than thirty years. These relationships still drive him, and this book is as much a reflection of his career in global health as it is an expression of his respect for the people who have been most affected around the world.

Review

Piot’s book is not just a clinical review of infectious diseases – in fact, in the context of his narrative, Ebola or HIV & AIDS could have gone by any other name. What matters – and where Piot devotes much of his prose – is the impact that these diseases have had on the fabric of societies, and how the themes of poverty, family and governance radiate throughout all of their (and our) lives. He was able to connect the science uncovered in the laboratories with the faces of the patients he saw in clinics from Brussels to Kinshasa – and throughout the world. Perhaps most importantly, his book brings these stories to the world leaders he lobbied for so many years to do more to advance efforts to fight HIV & AIDS in their countries. He was not always successful at moving them towards action, but he always tried. And, his persistence is palpable through the pages.

I first saw Peter Piot in a nightclub in Rio during the International AIDS Society conference of 2005. As a self-proclaimed “public health nerd,” it was practically a celebrity sighting to see such an esteemed man dancing with the rest of us mere mortals. The results of a successful male circumcision trial in South Africa had been released that day and there was buzz in the air about this highly efficacious prevention intervention. It felt good to take a deep breath and celebrate a win for once.

One of my favorite quotes from Piot, as he describes AIDS, is, “This time, I knew, we were looking at the worst epidemic I could imagine, the greatest assailant I would ever face, something that would absorb all the energy that I could throw at it, and far more. In my mother tongue, Dutch, I wrote in my notebook:  Incredible. A catastrophe for Africa. This is what I want to work on. It will change everything.”

A lot of progress has been made since that catastrophe first started 30 years ago. We are now – hopefully – on a path towards creating an AIDS-free generation. As we commemorate World AIDS Day this year, a review of Piot’s book seems most timely. It allows us to reflect on where we have been and how far we have come, but it also serves as an impetus to keep moving towards our goal with a sense that there is ‘no time to lose.’

Discussion Questions

  1. Although Piot lobbied South African President Mbeki repeatedly to change his way of addressing HIV/AIDS in his country, years went by before real change happened as the epidemic grew worse. Was there anything Piot could have done differently to have moved Mbeki into action earlier?
  2. Certain African leaders (like Festus Mogae of Botswana) have been outspoken champions on HIV/AIDS. What are the characteristics or drivers which have made them positive leaders and what would it take for more of their peers to also take on these efforts?
  3. Did the creation of UNAIDS serve (one of) its intended purpose of focusing UN efforts around a single disease to achieve maximum impact, or would they have made more of an impact utilizing their existing platforms?
  4. Several recent articles have focused on balancing career and family, like Anne-Marie Slaughter’s piece “Why Women Still Can’t Have It all.” Piot mentions his family rarely in this book, although the birth of his children coincided with the beginning of the initial Ebola and AIDS outbreaks and he speaks volumes about his incessant travelling, late nights at work, etc. What are the differences that would have been experienced by a woman taking on Piot’s role at the time he worked on these issues?  What, if anything, would be different now?

Book Review: “Tinderbox” by Daniel Halperin & Craig Timberg; Reviewed by Roxana Rogers, Paul Mahanna, David Stanton, Office of HIV/AIDS

Roxana Rogers, Director of the Office of HIV/AIDS, has a lifetime of experience working for USAID, previously supporting health offices in Zimbabwe and Burkina Faso. She has also worked as the Health & PEPFAR Office Chief at the USAID mission in South Africa.

Synopsis

Daniel Halperin, a medical anthropologist with a peripatetic background, including work with USAID, and Craig Timberg, a Washington Post journalist, combined impressive talent in this book, which details the unintended consequences of colonialization as it created the ideal situation for an explosive AIDS epidemic.

For centuries, or even millennia, SIV (simian immunodeficiency virus) had been carried by monkeys, and probably jumped from monkey to man many times as men killed and cut up monkeys to eat as bush meat. But, until the time of colonial ransacking, the virus fell on wet moss, infecting households occasionally but travelling no further. The brutal intrusion of colonial Europeans seeking fast wealth and power destroyed ancient social norms, tore apart families and created a “tinderbox” ignited by the spark that turned into a raging epidemic.

The authors provocatively argue that Westerners, and even USAID, have failed to appreciate the unique risk factors in this tinderbox. HIV spreads in very different ways in different parts of the world, yet we used (and still tend to use) the same approach to fighting the epidemic everywhere. While acknowledging the importance of treatment and other interventions, the book argues that in Africa the major intervention for HIV should be prevention aimed directly at the main cause of its spread: sexual behavior. They also argue that local solutions work best.

Review

We found this a fascinating, very readable book that draws on science, social history, anthropology and personal stories to tell the evolution of the disease and recommend solutions.

The book traces HIV’s spread over the last century, starting from chimpanzees in isolated West African rainforests to the boomtown, Leopoldville, and from there to the rest of Africa and the world. It tells the unlikely story of how an American Rhodes scholar who had bicycled across Africa, paired up with a venerable evolutionary British biologist and traced the genetic history of the virus by analyzing samples of blood and tissues that had remarkably been preserved for 40 or 50 years. And, how Californian scientists studied monkey feces in remote sections of Cameroon to determine the exact area where the virus leaped from monkey to man.

It tells compelling stories about Africans infected early, before drugs were available, struggling to warn people to change behavior despite the stigma associated with AIDS; people like the famous Zairian singer Franco, who died in 1989; and, the popular Ugandan singer Philly Lutaaya who spent his last days singing messages of prevention and hope. And, how President Museveni in the earlier days of his presidency, recognized the threat posed by HIV and preached “zero grazing.”  Under the influence of this early leadership, behavior changed dramatically in Uganda and prevalence fell rapidly.

The authors also take aim with certain aspects of the U.S. Government’s President’s Emergency Plan for AIDS Relief (PEPFAR), which they say has taken an approach to fighting HIV that is expensive, not adapted or locally designed, and too dependent on technology. In its initial days, they say PEPFAR was too focused on A, for ‘abstinence’ when the focus should have been on B, for ‘be faithful’ – also known as partner reduction. They point out that condoms have a role to play where key populations – such as gay populations and sex workers – drive the epidemic, but not where the epidemic is generalized and affects all populations indiscriminately. USAID promoted condoms as one key strategy to fighting AIDS because they played a significant role in driving down the epidemic in the U.S., and because they were easy to count and report as indicators, claim the authors. Dr. Halperin, who was an outspoken advocate of circumcision to prevent HIV long before the World Health Organization (WHO) had endorsed it based on the outcome of three clinical trials, laments that had we promoted circumcision years earlier, much transmission would have been prevented.

Today, the United States is looking to eliminate AIDS as a disease of consequence. The tipping point, when the infection rate falls below the rate of new people on treatment, is in sight. In November, one year ago, Secretary of State Hillary Clinton announced that the U.S. Government is on the road to an AIDS-Free generation; then on World AIDS Day last year, President Obama announced that the United States, through PEFPAR, would scale up treatment, circumcision and prevention of mother to child transmission interventions, with the dual goal of saving lives and preventing new infections.

The contributions of the United States to fighting HIV & AIDS and improving health in Africa have been outstanding. Indeed, it is now hard to remember what Southern and Eastern Africa looked in 2003. AIDS affected every aspect of life. Hospitals were overwhelmed. I remember visiting a hospital where two people shared the same bed and a third laid on the floor. Coffin-making was a growing business and funerals were almost a daily event. This has turned around dramatically, with much credit to PEPFAR and USAID. Almost 8 million in the world are receiving treatment, and more than half of those receive some support from PEPFAR.

Indeed through PEPFAR, USAID has changed the world. Some coffin makers are going out of business. Yet, it would be a mistake to ignore the lessons from this book. We know that sustaining the response will be challenging over the long term. The findings of many studies confirm what we already know — that adherence is a challenge. Risk perception is low. Uganda, the early success story, is now experiencing an increase in prevalence as the commitment of local leadership has waned. Unless there is fundamental behavior change that accompanies the scaled up efforts around treatment, our remarkable success to date may be short lived.

Discussion Questions

  1. The authors present some unorthodox views on the long-term approaches to ending the AIDS epidemic. To what extent do you agree or disagree with their case for “how the world can finally overcome AIDS”?
  2. A number of countries are now experiencing declines in HIV prevalence. What, if any, are the roles of interventions that address changes in behavior as other more aggressive interventions, such as treatment for prevention and circumcision, are rapidly being scaled up in Africa?
  3. The AIDS epidemic in Africa is a tragic example of the negative consequences of both colonialization of Africa and the increased mobility and inequity that accompanied economic development. But, was it inevitable?  What are the lessons learned from the history of HIV in Africa and around the world?
  4. The book outlines the importance of local leadership in affecting social change. If this is true, what is the role of an international development agency in affecting sustainable long-term change?
  5. What most surprised you in the book?  Has your view of the HIV epidemic changed after reading this book and how?

Implementation Science in Action: Turning HIV Research Into an AIDS-free Reality

I began work in USAID’s Office of HIV/AIDS this past August – and, what an exciting time it’s been! With the agency-wide shift towards program efficiency, capacity building, country ownership and sustainability, a new term has risen to prominence: implementation science.

The implementation science framework aims to increase the sustainability, cost-effectiveness and impact of global health programs in areas hardest hit by HIV & AIDS. It translates and implements research findings into routine and common practice. As we come together this week to commemorate World AIDS Day 2012, it’s important to remember the vital role and impact implementation science has in helping us achieve an AIDS-free generation.

In August 2011, USAID announced the Annual Program Statement (APS), “Implementation Science Research to Support Programs under PEPFAR.” Under the first round of the APS, USAID and PEPFAR awarded more than $21 million for eight studies in eight countries. I’ve had the privilege to provide support to each of these eight studies. While implementation has only just begun, I am confident that the impact of these studies will be powerful.

These eight studies will answer critical questions such as:

  • How can we shorten the time between an HIV positive diagnosis and entry into care?
  • What are the most cost effective and feasible measures to significantly reduce MTCT?
  • How do we translate the high efficacy of antiretroviral-based prevention found in clinical trials to programmatic delivery?

Hopefully, by now, you are as excited about implementation science as I am, because this is your chance to channel your excitement into action! The second round of the APS “Implementation Science Research to Support Programs under PEPFAR” is underway. The APS solicitation is public and the deadline for concept paper submissions is January 31, 2013.  USAID anticipates awarding up to 10 awards, with maximum funding available for a single application set at $1.8 million over three years.

The scope of the APS provides a unique opportunity to fund cutting-edge research in HIV-specific program areas, improving the integration of programs across the prevention, care and treatment continuum.  Data gathered will support efforts to prevent new infections and save lives.

Have a great idea? Apply! Know a local organization with research capacity expertise? Share the solicitation!  I’m excited for the innovative ideas that will be evaluated in Round 2!

Shared Responsibility: The Catalyst for Long-Term Success in HIV & AIDS

Ariel Pablos-Mendez is the Assistant Administrator for Global Health

This post originally appeared on AIDS.gov.

This is a remarkable time to be in Global Health. The successes we are seeing now would not have been achieved without the shared responsibility and partnerships that have been forged over the years – most important of which are those with our implementing partners. Our implementing partners – in collaboration with civil society, the private sector, communities of faith, host governments, NGOs and many others local institutions – have been at the forefront of and catalyst for these shifts and transitions. And as we near World AIDS Day, we celebrate this collective effort as we get closer and closer to an AIDS-free generation.

But to make an AIDS-free generation a reality, we must continue to come together inclusively – understanding our strengths, contributions and the roles we each play in the response. This is about each player owning their part and sharing in the responsibility of reaching this goal– one that requires partnerships and long-term commitments, including collaborations with organizations like the Global Fund Against AIDS, TB & Malaria.

The U.S. is the largest contributor to the Global Fund, investing to date over $7 billion. USAID, through PEPFAR, works directly with the Global Fund by helping with grant oversight and implementation, managing the PEPFAR emergency commodity fund that works to respond to stock-out of drugs and other essential HIV & AIDS medicines and supplies, and working with Global Fund stakeholders to leverage resources in country. PEPFAR and the Global Fund are highly interdependent in supporting countries. Since 2011, the two have supported over 70 percent of all persons on treatment in developing countries worldwide.

Sharing responsibility through partnerships and inclusivity are particularly important for host nations as they move up the economic ladder. Many developing countries around the world are seeing unprecedented growth of their GDP, and half the low-income countries in 2000 will be middle income by 2020.  A growing number of our partner countries will reach total health spending levels per capita that enables them to cover basic health services for the first time in history.  This is a great success in international development and the tax-payers who make it possible deserve credit for this accomplishment.

This transformation is what I refer to as the ‘economic transition of health’. It is critical that efficient and equitable health systems be in place as this transition occurs. Otherwise, the poor may still not have access to quality services and others may be thrown back into poverty by catastrophic health expenditures. This could have significant negative effects on the work we do in HIV & AIDS and under PEPFAR. It could reverse many years of progress, and squash future gains for an AIDS-free generation, an end to preventable child death and maternal mortality. The time to create equitable and sustainable health systems is now.

Last week, I had the privilege of addressing over 42 of USAID’s PEPFAR implementing partner projects at our annual Partner’s Meeting. We talked about transitions in HIV & AIDS at the country level and the challenges and opportunities we face. The most purposeful transitions we are witnessing today is the shift from a U.S. Government to a country-led approach, from direct service delivery to technical assistance models, and from an emergency response to country-led and country-owned HIV & AIDS programs.

Countries want to step up, are proud of their HIV & AIDS programs and want results. Intensive conversations are being initiated and program reviews are being implemented, in particular around anti-retroviral treatment and preventing mother-to-child transmission. Tipping points are occurring in many countries, where the number of new HIV infections is lower than the number of deaths, marking the beginning of the end of AIDS. Shifts and transitions are happening at multiple levels and vary from country to country, and technical area to technical area, increasingly under the stewardship and growing financial support of national governments and local communities. Regardless of where a country or HIV & AIDS program is, our goal has been and will continue to be to move programs toward greater independence and sustainability.

We and our implementing partners have a tremendous opportunity to demonstrate our shared responsibility to making smart transitions and identifying strategic partnerships, while still meeting targets. It will require inclusive planning, growing local capacity and some patience. U.S. investments through PEPFAR have delivered extraordinary results. One year after President Obama announced aggressive targets, PEPFAR is on track to meet its goals. By working together at all these levels, we can foster functioning health systems with country ownership and sustainability, and reach our goal of an AIDS-free generation.

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Debra Messing, Actress and HIV Activist, Promotes HIV Combination Prevention in Zambia

This past May I traveled to Zambia and had the chance to see my taxpayer dollars hard at work – saving and improving lives.

I wanted to see, and learn, how “combination prevention” helps stop the spread of HIV. It’s actually pretty common sense stuff; when multiple interventions are used together, the likelihood of HIV transmission is greatly reduced.

One of my many honors in Zambia was launching a “New Start” counseling and testing center, funded by the U.S. government, with USAID Zambia Mission Director, Dr. Susan Brems, and representatives from the Zambian Ministry of Health.

Debra Messing, Actress and PSI Global Health Ambassador, cuts the ribbon at a US-funded New Start HIV counseling and testing center in Mongu, Zambia. Photo Credit: Zoeann Murphy

The New Start center is located in Mongu, a small, isolated town in Western Province. I was amazed to learn that this was the first center in the area that offered services like voluntary counseling and testing for HIV, male circumcision, STI diagnosis and reproductive health services — all under one roof.

There were nearly 200 people who came from all over the community to be at the launch event. It was a hot muggy day, but still, there were lots of singing and dancing and drama. It was truly a celebration.

Now, the New Start network has nine centers in seven provinces—and reaches more than 14,000 Zambians each month with much needed HIV services. This is incredible to me.

After I cut the ribbon at the New Start center, I had a chance to meet the counselors and nurses who will actually be providing HIV counseling and testing services to the community, and they absolutely beamed with pride. They were excited to walk me through each of the rooms in the clinic—only five in all. I could tell they really wanted me to see and understand what this clinic means to the people in their community.

Seeing their enthusiasm made me so proud to know that the Zambian Government and my government are working in partnership through USAID and PEPFAR, with local organizations like Society for Family Health (SFH), as well as private sector partners— so that residents of Western Province have access to the health services they need.

I now realize that if we are really going to see an AIDS-free generation, we have to work together.  It takes partnerships at all levels – from governments to grassroots to the private sector. Everyone has a role to play.

In Celebration of Men: Stepping up for Male Circumcision

Emmanuel Njeuhmeli serves as Senior Biomedical Prevention Advisor at the Office of HIV/AIDS.

On November 19, the first ever International Men’s Day was celebrated in over 60 countries around the world. It was an occasion to put the spotlight on men’s health, improving gender relations, and recognize positive male role models who make valuable contributions to family, community and society. This year, we recognize and celebrate the hundreds of thousands of men in East and Southern Africa who are stepping up for Voluntary Medical Male Circumcision (VMMC) to protect their own health and that of their families.

We also recognize the political, traditional and community leaders who are leading the charge in their countries and local communities. For many communities, male circumcision has cultural significance representing a rite of passage from childhood to manhood. Ministries of Health are working closely with traditional leaders to ensure that male circumcision is medically safe while still respecting the meaning of the tradition. In 2011, I participated in one such ceremony with the Changaani tribe at an “initiation camp” in a remote area of southern Zimbabwe where adolescent boys learn what it means to be a man. Despite the cultural challenges, the Zimbabwe Ministry of Health and Social Welfare (MOHSW) with support from PEPFAR and USAID, and in collaboration with traditional leaders, was able to provide these boys with safe male circumcision services.

In June 2012, I was again fortunate to witness the kind of male leadership we celebrated on Nov. 19. Mr. Blessing Chebundo, Chairman of Zimbabwe Parliamentarians against AIDS, and a group of fellow Zimbabwe parliamentarians, underwent voluntary medical male circumcision to inspire other men in their country to follow suit. Zimbabwe aims to circumcise 1.2 million men aged 13 to 29 years by 2015 with the potential impact of preventing 750,000 new HIV infections.  It will take leading by example, as demonstrated by Mr. Chebundo, to get this done.

USAID and UNAIDS have estimated that VMMC has the potential to avert more than 3.4 million new HIV infections in 14 countries in Eastern and Southern Africa, and save an estimated $16.5 billion in care and treatment over the next  15 years, freeing up resources for other crucial HIV interventions. It also offers a unique opportunity to not only prevent HIV, but improve men’s overall health. VMMC services present an opportunity to engage men who might otherwise never interact with the health system.

While women are likely to learn their HIV status during prenatal visits, there are simply no comparable programs for reaching men. VMMC programs have the potential to offer millions of men the opportunity to learn their HIV status, along with counseling, condom provision, services around sexually transmitted infections, and the rare chance to discuss their reproductive health.

USAID, with PEPFAR funding, is committed to supporting countries in Eastern and Southern Africa to pave the path for an HIV-Free generation by accelerating scale up of VMMC over the next five years. As we work together to roll out this powerful, life-saving intervention in these 14 countries, let us remember the more than 2 million men who have already made the brave decision to step up and protect their health, their family and their communities by getting circumcised.

I wish all of you brave men a very happy International Men’s Day!

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