USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Malaria is a Marathon, Not a 50-yard Dash

Each year, World Malaria Day (April 25) commemorates the global fight toward zero malaria deaths and mobilizes action to combat malaria. This year’s theme is “Invest in the Future: Defeat Malaria.”

I used to call them “disease du jour” bills. As a staffer on the U.S. Senate committee with jurisdiction over public health issues, every time a Senator’s nephew or cousin or college roommate’s daughter got a terrible diagnosis, it was my job to explain why passing a one-time bill wasn’t the answer for every disease. Washington’s attention span tends to wane after the galas end, the celebrities leave town, and the surge of early funding and enthusiasm dries up.  Without unglamorous vigilance, the disease remains after the politicians and paparazzi move on to the next disease du jour. Global health was no different.  After working on malaria policy for several years, I noticed the buzz starting to shift to tuberculosis. Malaria control was just so… 2006.

For children under five, malaria mortality rates have fallen dramatically with scale-up of malaria control efforts. Photo credit: USAID

Surely the private sector wouldn’t be so fickle, right? I joined MosquitoZone International, a U.S.-based firm that offers malaria prevention services to companies with operations in endemic areas. How exciting to work with clients who were absolutely committed to keeping their workers and communities safe from malaria! It turns out, of course, that companies can sometimes be a lot like governments. They invest in controlling malaria and they make so much progress that pressure builds to redirect scarce resources into one of the other health and safety threats facing their workers and their bottom line. But malaria doesn’t go quietly into the night.

One of our clients started off doing everything right. They committed to eliminating malaria at a sub-Saharan African project site. They hired us to run a comprehensive vector control program and we don’t play around. Our entomologists knew every mosquito on that jobsite by name and killed it. By 2011, our client had zero new cases among non-immune expatriate workers and zero complicated cases among semi-immune local workers. They bragged about their success on the company web site. Problem solved.

Inevitably, the urgency of the need for investment in sophisticated entomology was questioned. After all, there were plenty of other problems clamoring for their health and safety resources. Unfortunately, when you stop putting experienced entomological eyeballs on surveillance data, the bugs get the upper hand. After we left, the company failed to respond to entomological data suggesting a major spike in the mosquito population that should have prompted a five-alarm investigation. The company recognized the problem, recommitted to entomological excellence and their success continues with MosquitoZone’s entomologists driving their prevention program today.

Time and again, we see the same predictable cycle in public and private sector programs all over the world. Success turns the volume down on the alarm bells that drive the investments that produced that success in the first place, and when that happens, only failure raises the alarm again. But failure isn’t just a technical abstraction about budget line-items or resistance data. Failure means babies dying, workers downed, and human productivity and potential plummeting.

When it comes to the wily mosquito, every day has to be World Malaria Day.

Katy French is the Vice President for Corporate Affairs at MosquitoZone International.

Photo of the Week: Invest in the Future: Defeat Malaria

Malaria kills more than 650,000 people each year; the majority of those deaths occurring on the African continent. Each year, World Malaria Day (April 25) commemorates the global fight toward zero malaria deaths and mobilizes action to combat malaria. This year’s theme is “Invest in the Future: Defeat Malaria.” On this occasion, the President’s Malaria Initiative (PMI), led by the U.S. Agency for International Development and implemented together with the U.S. Centers for Disease Control and Prevention (CDC), will release its Seventh Annual Report to Congress, which describes the U.S. Government’s contributions to the global fight against malaria. Photo is from Jaclyn Wong, CDC.

USAID’s Global Health Bureau is working with United States Africa Command and partners all day on April 25 for a Twitter relay.  Join @USAfricaCommand from 6 – 10 a.m. EDT, then join @USAIDGH and partners starting at 9:30 a.m. EDT.  Medical experts and malaria prevention specialists will be standing by live to answer your questions. Additionally, Admiral Timothy Ziemer, U.S. Global Malaria Coordinator and leader of the U.S. President’s Malaria Initiative (PMI), will join the chat from 9:30 – 10 a.m. EDT. View the full schedule.

Join the conversation with #malariabuzz on Twitter.

Learn more about World Malaria Day.

 

Non-hormonal Methods of Contraception Meet Need in DRC

More than 26 percent of married women in the Democratic Republic of the Congo (DRC) want to avoid pregnancy but aren’t using a modern method of family planning. Furthermore, meeting this demand for family planning is not an easy task in the DRC, where deep-seated traditional and religious views exist around family size, gender roles and the use of contraception.

USAID programs have worked to meet the needs of women in the DRC by expanding access to a wide range of family planning choices from short term to long acting reversible contraceptives and permanent methods. USAID has also identified the need to increase access to non-hormonal methods to increase options for women and couples. Since 2003, USAID and its partners have worked to incorporate fertility awareness-based methods into the DRC context, in particular, the Standard Days Method “SDM” (PDF), developed by the Institute for Reproductive Health with funding from USAID. Using SDM, women track their menstrual cycles with CycleBeads in order to avoid unprotected intercourse during their fertile days and by doing so can prevent pregnancy. Based on World Health Organization analyses (PDF), with perfect use, the SDM is effective 95% of the time, and 88% of the time with average use.

Christopher Hook with members of Maman An’Sar. Photo credit: USAID

CycleBeads have a particularly strong acceptance in the DRC’s religious communities. I recently visited the capital city of Kinshasa and was lucky enough to attend a community training of young women on use of CycleBeads. A local Catholic organization, La Conduite de la Fecondité, conducts these trainings twice per week in thirteen integrated maternal and child health clinics all across Kinshasa. It was a moving experience for me as a development professional (even though I did not speak a word of Lingale!). The training incorporated singing, dancing and call-and-response, which created a fun atmosphere where learning could happen.

Later that day I also met with representatives from Maman An’Sar, a Muslim organization who advocates to local Imams to incorporate family planning messages (PDF) into their weekly sermons. Following a sermon, Maman sends out teams of community health workers who follow up with individuals and couples from the congregations to talk about what they heard. Faith-based organizations like Maman and religious leaders have significant potential to influence positive behavior change within communities and disseminate reproductive health messages.

The use of CycleBeads continues to grow in the DRC. Today, SDM has been scaled-up in 278 of 515 health zones, and CycleBeads are available in more than 1800 sites with trained providers ready to assist potential users. Moreover, SDM has been included in all Ministry of Health norms and protocol documents, ensuring long-term host government support of fertility awareness-based contraception as a key component of the contraceptive method mix.

Access to family planning information and services is only one health challenge in the DRC, but it’s an important one. The DRC has one of the highest rates of child mortality in the world, and enabling couples to determine whether, when and how often to have children is vital to safe motherhood and child survival. Research has shown improving access to family planning and reproductive health services could prevent up to 40 percent of maternal deaths across the world, and save the lives of 1.6 million children (PDF) under the age of five annually. Increasing access not only to hormonal methods of family planning, but also to fertility awareness methods is one way in which USAID and its partners are seeking to meet unmet need in the DRC and across the world.

If you or someone else you know may be interested in using the SDM, please follow this link for the web-based service, and this for the iCycleBead smartphone app.

The Final 1,000 Days of the MDGs: Accelerating Progress and Working to End Extreme Poverty

Today we  mark an important milestone: 1,000 days left until the end date of the Millennium Development Goals (MDGs). The MDGs, agreed to at the UN in 2000, constitute the world’s first global development agenda. Together, world leaders committed to tangible, ambitious targets for reducing poverty and hunger, expanding primary education, ensuring gender equality, improving the health of mothers and children, halting the spread of infectious diseases, promoting environmental sustainability, and coming together in partnership to achieve these important goals.

The MDGs and the broader development agenda are a work in progress, for sure—but it’s important to recognize what they have achieved so far, and remember these critical commitments we made.

The United States is committed to the MDGs and, broadly, to improving wellbeing, promoting prosperity, and tackling some of the world’s gravest challenges, like poverty, hunger, morbidity, and inequality. In 2010, President Obama announced the U.S. Global Development Policy, the first of its kind by any administration. The policy outlined key development objectives—broad-based economic growth, democratic governance, game-changing innovations, and sustainable systems for meeting basic human needs—that feed directly into the MDGs. This year, in his State of the Union address, President Obama reiterated the U.S.’s commitment to a core tenet of the MDGs: poverty reduction. We are now in a position, the President said, to eradicate extreme poverty within a generation. USAID and its partners are working towards this important end—by connecting people to the global economy, empowering women, saving children from preventable death, ending the scourge of AIDS, and helping communities to feed, power, and educate themselves.

Joytara, one of the women whose life has been changed for the better through Bangladesh’s “Jita” Rural Sales Programme, which generates income and employment opportunities for the rural poor. The program is one of the ways USAID is meeting MDG 1 to end extreme poverty and hunger. Photo credit: Kathryn Richards, CARE

Working together, we have made substantial progress (PDF) since the Millennium Declaration was signed 13 years ago. For the first time since we’ve measured world poverty, the number of people living on less than $1.25/day is falling in every developing region—including sub-Saharan Africa. In 1990, more than 43% of people in developing countries lived in extreme poverty; as of 2008, this proportion had dropped to 23%. Estimates suggest that the MDG 1 target to halve extreme poverty was met in 2010. During this period, more than 600 million people have risen above the $1.25/day line.

We have made important gains on other MDGs, as well. The enrollment ratio of girls to boys in primary school rose, from 91% in 1990 to 97% by 2010—that’s within the margin of error of complete parity, the target for MDG 3. The incidence of tuberculosis has fallen since 2002, and, since 2006, this decline has outpaced global population growth—achieving part of the MDG 6 target to reverse the spread of infectious disease. And more than 200 million people living in urban slums gained access to improved water sources, sanitation facilities, and housing, more than doubling the MDG 7 target.

Elsewhere, though, we have more work to do. Today, 1.2 billion people still live in extreme poverty, and 870 million people suffer from hunger—we expect the proportion of undernourished to drop to 12.5% by 2015. This, however, falls short of MDG 1 target of 11.6% (half of the 1990 level). Globally, primary enrollment is at 90%, up from 82% in 1999. But that remains below the MDG 2 target for universal primary education. While we’re within the margin of error for gender parity in primary schools, progress on secondary education has been slower. Although we cut under-five mortality by more than a third, we are still only halfway to the MDG 4 target of a two-thirds reduction. And although maternal mortality has been halved since 1990, this is far from the MDG 5 target of a three-quarters reduction. The number of AIDS-related deaths fell to 1.7 million in 2011, a decline of 24% from the peak in 2005—but this lower mortality also means that, today, more people than ever are living with HIV/AIDS.

The MDGs touch on issues across the development spectrum. USAID’s programs reflect this broad array of efforts—and others as well, like promoting human rights and democratic governance, managing and mitigating conflict, investing in renewable energy and infrastructure, building resilience to recurrent crisis, combating climate change, and more. USAID Forward (for which the 2013 Progress Report, PDF, was just released) and the USAID Policy Framework (2011 – 2015) (PDF) outline this comprehensive approach to development.

In recent years, USAID and its partners have made substantial contributions towards MDG achievements. In these final 1,000 days, though, there is much more we can accomplish—and USAID is looking to accelerate progress as we near the finish line. Through Feed the Future and the New Alliance for Food Security and Nutrition, for instance, we are catalyzing private sector investment and expanding our reach to smallholder farmers, to help them increase productivity, adopt modern technologies, connect to wider markets, and access financial services and products. Together, these initiatives can help lift 50 million people out of poverty in the next 10 years. And in cooperation with UNICEF and the governments of India and Ethiopia, we are spearheading a global effort to reduce under-five mortality to less than 20/1,000 births in every country by 2035.

USAID is also looking towards the future of development—and towards finding new ways to address some of our most intractable challenges, such as helping fragile states realize peace, stability, and long-term prosperity. We also recently released policies and strategies to address some of the most pressing issues we face, like building resilience to recurrent crisis (PDF), the development response to violent extremism and insurgency (PDF), promoting gender equality and female empowerment (PDF), engaging and empowering youth in development (PDF), and adapting to and mitigating climate change (PDF).

The global community has also begun a discussion about “post-2015″.  What will the next set of MDGs look like?  USAID has been deeply involved in this dialogue. The UN Secretary General’s High-level Panel and the Open Working Group on Sustainable Development Goals, for instance, will both issue recommendations in the coming months. We are grateful for the leadership of these two bodies and the many contributions from a diversity of voices around the world—and are looking forward to continuing the conversation.

While we work to accelerate progress in these final 1,000 days, we also hope these interlinked and collaborative efforts will produce a new development agenda, for beyond 2015, that builds on the impressive and historic successes of the MDGs.

Learn more about how USAID is working towards achieving the MDGs.

FrontLines Releases March/April 2013 Issue

Read the latest edition of USAID’s FrontLines to learn how the Agency is working to provide safe water to the millions who live without this vital resource, and how unique approaches to wipe out neglected tropical diseases are faring. Some highlights:

Three young boys having some fun while they use a public standpipe in Bauchi town, Nigeria. This is one of the sites where town residents retrieve water since few have water taps at their homes. In December 2011, USAID’s Sustainable Water and Sanitation in Africa project signed an agreement with town officials to help them expand and improve services to residents. Photo credit: Emily Mutai, SUWASA

  • When a family of 12 fled violence in Syria, the Jordanian relative who took them in was not too concerned about providing everyone with adequate water – a scarce resource in this region of the world – thanks to a USAID project that helped build cisterns to harvest and store rainwater.
  • water ATM? Similar technology that meters public water sources is a welcome development for some urban Kenyans who would otherwise face the high cost and inconvenience of procuring water for cooking, washing, cleaning and everything else.
  • Cambodia is enlisting a variety of players – including school children – on its mission to wipe out snail fever, an infection that can lead to debilitating illness, and, in children, malnutrition and cognitive difficulties.
  • Delivering medications efficiently could stomp out two debilitating diseases endemic to Haiti; wearing new sneakers kicks up that protection even more by creating a barrier between parasites and kids’ feet.
If you want an e-mail reminder in your inbox when the latest issue of FrontLines has been posted online, subscribe here.

Video of the Week: Help a Child Reach 5

For the first time in history, we have the available knowledge and technologies to reach the world’s most marginalized children with life-saving interventions. Now is a time for action, to deliver on our long-standing commitment to end preventable child deaths. By working together with renewed determination, we can accelerate declines in child and maternal mortality, enabling more countries to achieve Millennium Development Goals (MDGs) 4 and 5 by 2015 and sustaining the momentum well into the future. Learn about A Promise Renewed.

Latin America’s Slums and TB

In the slums of Latin America, 117 million people live in poverty. The region’s megacities, including Mexico City, Sao Paulo, Bogota, Rio de Janeiro, and Lima, generate over-crowded living conditions without access to clean water or electricity, poor nutritional status, and often lack of basic health services.  These marginalized populations are made up of the poor, the homeless, and vulnerable indigenous groups that have migrated to the city in search of a better life; they are the urban poor of Latin America.

The combination of these social determinants generates a breeding ground for tuberculosis (TB).

A woman and child receive TB treatment. Photo credit: USAID

Around the world, tuberculosis rates are often high in urban areas and in the Americas it is no exception. Twenty-five percent of Peru’s urban poor live in Lima-Callao, which reports 60% of the tuberculosis cases for the entire country and 85% of drug-resistant tuberculosis cases which is difficult and costly to treat.

As populations continue to explode throughout the region, health conditions will continue to worsen if they are not addressed, particularly in slums.  In 2011, 30,000 people died of tuberculosis in the Americas and there were 268,000 new reported cases. Worldwide, 1.4 million lost their fight against the disease. Tuberculosis, once thought an old disease, is the new emerging problem for the most vulnerable.

Tuberculosis has been used as a prime example of a “social disease” because it finds its nest among the poor and marginalized. The control of tuberculosis in cities requires social, economic, and environmental interventions to improve living conditions and increase access to health services. USAID has funded the Pan American Health Organization (PAHO) to tackle this concentrated epidemic in key cities across the Americas.

PAHO currently works with municipalities in Sao Paulo, Brazil; Bogota, Colombia; and Lima, Peru to improve their tuberculosis programs that service the urban poor. The successes from these cities will be shared with Mexico City, Guayaquil, and other megacities in Latin America and around the world.

As urbanization rates continue to increase, so are the chances of tuberculosis among the urban poor. Tuberculosis is contagious but also curable; acting now while the epidemic is concentrated will help avoid astronomical costs for treatment and keep the region healthy.

Improving Tuberculosis Treatment for Children

David Greeley, Senior Vice President at TB Alliance. Photo credit: TB Alliance

World TB Day is Sunday, March 24. 

Fighting tuberculosis (TB) is extremely tough on any patient. Treatment consists of multiple pills each day over the course of at least six months. The medicines often have significant side effects and adhering to treatment often infringes on a patient’s ability to work and interact with his/her family. As prolonged and harsh as it sounds, that is actually the best case scenario for a TB patient. Those who contract or develop TB that is resistant to “first-line” treatments (the most commonly prescribed TB medicines) will be prescribed a still harsher combination of thousands of pills and shots—a draining course of treatment with greater side effects that can last as long as two years. And even then, a clean bill of health is far from guaranteed.

As grueling and debilitating as TB treatment may be for an adult, a child who is infected with TB will face an even rougher road. Treatments for children with TB are the same for children as they are for adults, but the recommended dosages are different. However, pediatric-appropriate versions of TB treatment remain absent from the marketplace. In 2010, WHO issued new guidelines for pediatric TB treatments, however, in the years since, child-friendly TB treatments in the correct dosages have not been produced. Parents or caregivers are left to split or crush adult pills for children, estimating the proper amount of medicine. If they guess wrong, children can be undertreated, resulting in poor outcomes and the development of drug-resistant forms of TB.

Furthermore, because treatments are designed for adults, none of the medicines used to treat children come in formulations that are easy for children to take. This means every dose becomes an adventure for the little ones and their caregivers—a struggle lasting as long as two years in attempt to cure the disease.

As a parent, I find it hard to understand how children with TB can be so neglected. Even among TB patients, who are underserved as a whole, children are particularly vulnerable and face the toughest road to cure when sick. But we’re going to change that! USAID is teaming up with TB Alliance, which is dedicated to the research and development of better TB drugs, to change course, help our children, and brighten the future prospects for the youngest TB patients.

In this new partnership, efforts will promote new understanding of the problem that can help lead to the sustainable supply of new TB drug formulations for children. And a stronger emphasis on patient care will help the world’s youngest TB patients comfortably and confidently survive one of the most persistent diseases ever known.

The Growing Movement to End Preventable Child Deaths

Yesterday at an event hosted by AEI and the Center for American Progress, USAID Administrator Raj Shah spoke about President Obama’s vision to end extreme poverty through innovation and partnership. His remarks mentioned an important corollary goal – the end of preventable child deaths. The first audience question commended the visionary Child Survival Call to Action held in Washington last year and asked about progress at country-level. Administrator Shah responded that the movement to end preventable child deaths is nothing short of extraordinary.

Administrator Raj Shah earlier this month in India at their Child Survival Summit. Photo Credit: USAID/India

Since the Call to Action, 172 countries have now signed A Promise Renewed pledge to accelerate declines in child deaths.  More than 400 civil society and faith-based organizations as well as over 2,000 individuals have also pledged support. Each signature represents a renewed commitment to give every child the best possible start in life.  Governments are leading the effort to convene policymakers, technical experts, and development partners in a concerted effort to scale-up high-impact strategies for maternal, newborn and child survival. Below are a few highlights of countries leading and how USAID is supporting this important work.
Bangladesh

USAID and other donors are supporting the Ministry of Health to develop an action plan to end preventable child deaths in Bangladesh, particularly at district level.  This plan will identify priority actions and benchmarks to reach the goal of no more than 20 deaths/1,000 live births by 2035, or earlier.  A technical advisory group has been convened to discuss evidence-based interventions that can be deployed in Bangladesh to bend the curve. This includes programs to address Pneumoccocal and Rotavirus vaccines, corticosteroids, clean cord care, child drowning and Kangaroo Mother Care, among others.  Given the fact that 60% of child deaths in Bangladesh occur within in the first 28 days of life, there is a huge need for post-natal monitoring to reduce stubborn neonatal mortality rates.

Burma

Building upon the Child Survival Call to Action, USAID recently launched a public private partnership: Survive and Thrive. This partnership will expand the coverage of quality and high impact maternal newborn services starting with essential newborn care, and link pediatricians, midwives, and obstetricians from American professional associations to peer associations in Burma to build capacity in service delivery. Survive and Thrive will partner with civil society and professional and educational institutions, work within the Ministry of Health’s health system, support the programs of the 3MDG Fund, and maximize synergy with community-based programs of existing partners.

Ethiopia

At the African Leadership on Child Survival meeting hosted by the Government of Ethiopia earlier this year, the consensus reached by over twenty African countries present was both significant and historic. The participating countries declared, in a consensus statement, that they are committed to developing and implementing country-led roadmaps that integrate ongoing efforts to accelerate progress to end preventable deaths among children by 2035, and reduce the mortality rate to below 20 per 1,000 live births in all African nations. Recently, Ethiopia’s Ministry of Health (MOH) signed a Memorandum of Understanding with Namibia. Officials from Namibia are undertaking a study tour to review Ethiopia’s health extension program.

India

At India’s recent Call to Action, the Government of India launched the Reproductive Maternal Neonatal Child Health Adolescent health strategy (RMNCH+A), which serves as a roadmap for the States. India also released 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. USAID’s Maternal and Child Health Integrated Project (“MCHIP”) supported the Ministry of Health and Family Welfare in organizing the recent India National Call to Action for Child Survival and Development, and USAID will continue to provide support in establishing quick response teams for Indian states with the highest child mortality that have committed to accelerating their efforts for child survival.

Indonesia

USAID supported a national newborn conference in Jakarta from Feb 26-March 1. The conference included international experts from India and the U.S. as well as representatives from the Indonesia’s Ministry of Health, key professional associations, academia, and district and provincial health leaders. This was the first such event in Indonesia focusing on newborn survival. Responding to Indonesia’s commitment to A Promise Renewed and the MOH’s call to accelerate progress toward the MDGs, this conference addresses one of the key indicators slowing achievement of MDG goal 4. DHS data from 2012 is now available and demonstrates no progress in newborn mortality since 2007. The rate remains at 19/1000 live births. Partners are committed to reducing this rate by 25% by 2017, in partnership with USAID, UNICEF and WHO, and an exceptionally strong collaborative relationship with the Ministry of Health.

Liberia

The Ministry of Health in Liberia is sharpening its child survival plan using evidence and aligning donors to support the plan.  There is great donor support and commitment to implementing the national plan through the alignment of programs. A launch for A Promise Renewed is being planned by the Government of Liberia. A steering committee led by the Government of Liberia and comprised of representatives from NGOs, house of representatives, representatives from different Ministries has been established and meets regularly to plan the launch event.  An expected key outcome of the launch is greater mobilization of support and resources at the counties, civil society organizations and community leaders around A Promise Renewed.

For more information about A Promise Renewed, please visit: apromiserenewed.org.

Salma Hayek Pinault Presents CHAMPION Project with Award

Actress and Avon Foundation for Women Ambassador, Salma Hayek Pinault, recently presented the USAID-funded CHAMPION project in Tanzania with one of five Avon Communications Awards: Speaking Out about Violence against Women for its outstanding work to bring attention to the need to end violence against women. The CHAMPION Project, implemented by EngenderHealth  with communications support from FHI360, received the award for their work on the Kuwa Mfano wa Kuigwa (Be a Role Model) mass media campaign. The award recognizes outstanding communications campaigns that are helping change communities, policies, institutions, and behaviors to end violence against women.

The CHAMPION Project’s Kuwa Mfano wa Kuigwa campaign is part of a five-year effort to engage men in Tanzania by increasing their involvement in addressing the underlying gender issues and power imbalances in relationships. The campaign, which was launched in Tanzania in collaboration with the Ministry of Community Development, Gender and Children in December 2011, aims to turn men from bystanders to champions with its key message, “Violence is everyone’s problem. Be a role model. Earn respect by standing up to violence.”

Watch a TV spot from the award-winning campaign below and learn more.

 

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