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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!

16 Day Challenge: Let’s Eliminate Gender Violence

Carla Koppell serves as Senior Coordinator for Gender Equality and Women’s Empowerment at USAID

Today we launch our 16 Days of Activism Against Gender Violence.

One young rape survivor in a camp for the internally displaced in Goma, a city in the eastern Democratic Republic of Congo (DRC), is one of the strongest people I have met since joining USAID as Senior Coordinator. She survived a vicious gang rape while collecting fuelwood in the surrounding forest. She only saw a doctor after receiving contributions to pay for treatment from fellow impoverished camp residents. She survives by selling dung briquettes—though she earns less than she did from fuelwood— because she is too afraid for her safety to go back to the forest for wood. She is still recovering.

Yet, she came to tell her painful story to me and other strangers. Why? Because she hopes that by talking with us, others might be kept safe. She is a victim and leader at the same time; she represents and speaks for millions of women and girls around the world who face abuse, discrimination and violence when they are beaten, married as children, circumcised, attacked with acid, or sold like cattle.

This week we launch the 16 Days of Activism for the Elimination of Gender Violence, which runs from November 25 to December 10. We must use this time to recognize the magnitude of the challenge. In the DRC, for example, a 2011 study in the American Journal of Public Health estimates that some 1,150 women are raped every day. And one USAID-supported study found that Bangladesh sacrifices over 2 percent of GDP annually as a result of gender-based violence (GBV). The health care and legal costs, lost income and lost productivity are enormous. Yet even as we contemplate the numbers, we must not forget the individuals, the victims of violence, as well as the incredible male and female leaders—some of whom are survivors—that lead the campaign to end the epidemic.

USAID has greatly increased our focus to combating gender-based violence. This need is front and center in the Agency’s new Gender Equality and Female Empowerment policy (PDF). Additionally this past summer, the United States released its first ever Strategy for Preventing and Responding to Gender-Based Violence Globally (PDF), which incorporates action plans for our Agency as well as the State Department. USAID followed-up with a vision for ending child marriage and meeting the needs of married youth. At the same time, the U.S. National Action Plan on Women, Peace and Security and accompanying USAID implementation plan include a more extensive focus on sexual violence in situations of state fragility triggered by conflict, humanitarian disaster, or political transition. USAID now truly has a comprehensive strategic vision and frame for addressing the many forms of GBV around the world.

While I am proud of the commitment implicit in the new policy frame, I am even more gratified to see expanded efforts on the ground. For example, a new commitment to combat child marriage was announced by our mission in Bangladesh in October; our mission in Pakistan incorporates GBV prevention efforts into education programs; our programs in the Democratic Republic of Congo have ramped up their focus on GBV prevention as part of several sector efforts; and in Afghanistan, USAID is focused on consolidating gains for women’s rights and opportunity. These efforts are emblematic of how our commitment to end gender violence is translating into action.

As our policies and strategies gain traction and implementation gains speed, we recognize a collective responsibility to ensure our mission translates into results around the world. I recognize a personal obligation to make sure that one woman’s story in the DRC was not told in vain.

Hope Springs in Burma for Maternal and Child Health

Ariel Pablos-Mendez is the Assistant Administrator for Global Health

With an economy of more than $80 billion, growing at over 5 percent annually, Burma presents unique challenges and opportunities for development as it transitions to an open society. Inequality, ethnic strife and migrants in border areas, as well as authoritarian vestiges of the military regime and crony capitalism, are some of the challenges. While women are relatively empowered thanks to low fertility, Buddhism underpins a rich culture, and a socialist past left reportedly high levels of literacy and very low crime rates.

Under the leadership and vision of President U. Thein Sein, his partners in government, and an energized Parliament that notably includes Daw Aung San Suu Kyi, the reform agenda moves forward.

This month, Robert Clay joined me on a visit to Burma – the first of its sort for global health. We were generously hosted by ThuVan Dinh, our new health advisor in Rangoon, and Dr. Aye Aye Thwin, the health office chief from the regional mission in Thailand, with great support from USAID Mission Director Chris Milligan and U.S. Ambassador to Burma Derek Mitchell.

Health statistics are mostly unreliable – the result of poor health information systems and no census since the late 1980s. Add regions in conflict, and a central bureaucracy and peripheral culture that demanded positive reports, challenges seem aplenty. But at least in Rangoon and nearby townships, things look better than in many low-income countries and are ripe for smart development. Hope springs anew for a transformative era of peace, prosperity and development for a country that’s just emerging from isolation from the international community.

We met the Minister of Health and officials in other ministries in Naypyitaw, the brand new capital city as well as with several other governmental institutions in Rangoon and nearby townships, and partners (implementing NGOs, U.N. agencies, bilateral donors, private sector organizations, etc.) Our calling card was the integrated and joint priority of reducing child mortality by 30 percent in five years. And while maternal and child health, HIV/AIDS, TB and malaria are obvious targets for investment, there was a strong emphasis on the importance of strengthening health systems and stemming the growing problem of chronic diseases and injuries: of the approximately 500,000 annual deaths, 40 percent are due to chronic conditions and 30 percent to injuries according to estimates.

Pablos-Mendez talks with health workers in Burma. Photo credit: Leek Deng.

New commitments in health hold promise for the Burmese people. Soon, health officials plan to roll out the pentavalent vaccine – a combination of five vaccines in one: diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenza type b (the bacteria that causes meningitis, pneumonia and otitis) for children in the country under the age of 1. Leadership has pledged to hire as many midwives as needed, and efforts are underway with Parliament to raise a meager health budget.

Add possibilities of new U.S. investment in Burma’s first Demographic Health Survey, a public private partnership to increase neonatal survival by offering evidence-based training and high quality affordable resuscitation devices to birth attendants to Help Babies Breath, and technical assistance on financing reform towards Universal Health Care (UHC), there is great momentum and transitions afoot.

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Reflections on Burma

Reflective lakes, green mountains, golden pagodas, and friendly people.  These are some of the lasting images from my first visit to Burma, also known as Myanmar, this past month.  Clearly, Burma is a country on the move, making up for lost time when it was largely isolated from the rest of the world.  While there to determine how USAID could best work with the national government and the local partners on health priorities, people wanted to know about our “window to the world” at every stop.  Top requests—training and insights on how to improve the quality of information.  Despite Burma’s long isolation from the West, Rangoon was very developed much to my surprise, clearly showing its connection to the southeast “Tiger countries,” particularly their next door neighbor—Thailand.

Robert Clay and Ariel Pablos-Mendes, Assistant Administrator for Global Health, on their recent trip to Burma, also known as Myanmar Photo Credit: Leek Deng, USAID

But I had a nagging feeling this did not reflect the true Burma, so the next time I visit, I’d really like to see what is beyond the city.

With that said, it proved to be an incredibly productive trip.  I traveled with the Assistant Administrator for USAID’s Global Health Bureau, Dr. Ariel Pablos-Mendez, and we spent most of our time meeting with government officials, technical experts, local civil society organizations, and other donors to hear from them about their experiences and thoughts for continuing to move Burma forward.  It quickly became clear to me that there is a great need in health, but Burma also has the potential to use donor assistance to build their country programs.  Our visit to a local township hospital and private clinics pointed out the need to improve decentralization, especially decision-making and data quality.

A few highlights

A visit to the Shwedegon Pagoda after a long day of meetings ended being one of my favorite highlights of Rangoon.  Imagine a village of temples, crowded with people celebrating the Buddhist Festival of Lights holiday, and the amount of excitement filling the streets.  Truly an experience I will not soon forget.
We also spent a day in the new capital city, Naypyitaw, meeting with the Minister of Health and his staff.  They were very gracious with their time and it was clear that USAID already enjoyed a good partnership.  The capital is quite a contrast to Rangoon.  The government built it just 7 years ago for a much larger population than what exists today, for example 12 lane roads without many cars.  And the flight up and back from Rangoon gave us some idea of the lush landscape of the rural area.

Finally, my most impressionable moment came while looking out my hotel room window over a beautiful lake and political activist, Aung San Suu Kyi’s, house.  It is hard to believe she was held there under house arrest for almost 15 years.  The world must look quite different for her, as she works tirelessly to help shape democracy for her country.  My hope is that our assistance will help Burma have both a vibrant democracy and a healthy society.

Video of the Week: Voices of TB

This moving three-minute video features the powerful voices of TB survivors from around the world.

Handwashing Partnership Turns Five

Guest authors Katie Carroll and Patricia Mantey from the Global Public-Private Partnership for Handwashing.

For the fifth consecutive year, on October 15, 2012, hundreds of millions of people around the world will celebrate Global Handwashing Day. This year we have much to celebrate. In 2011, 600,000 fewer children under five died than in 2008, the first year Global Handwashing Day was celebrated. In 2012, Global Handwashing Day will share its fifth birthday with more than 121 million children who are also turning five this year.
Thanks to the support of USAID and other public and private partners, Global Handwashing Day has grown from a one-day celebration in a few cities to a worldwide movement for handwashing with soap. The Global Public-Private Partnership for Handwashing (PPPHW) and its partners encourage everyone to join in our fifth birthday celebration to promote handwashing with soap.

Every day, USAID promotes handwashing with soap through its Water, Sanitation and Hygiene (WASH) or WASHplus program.  The project, operated by FHI 360, CARE and Winrock International, aims to increase access to and lower the cost of water and sanitation services, and improve personal hygiene habits.  The “plus” represents the project’s efforts to combat pneumonia and other respiratory illnesses caused by indoor air pollution from inefficient or misused cooking stoves

In Zambia, a new school program called SPLASH focuses its efforts on boosting child education as it relates to good hygiene practices. They do this by working with schools to improve both access to better hygiene facilities, such as latrines and hand washing stations, and by teaching students and staff how important good hygiene practices are in making them healthier, like washing hands with soap at key times (after using a latrine or before eating). By reducing the number of days students and teachers miss school due to diarrheal diseases caused by poor sanitation, unsafe water, or the inability to wash their hands with water and soap, they have more opportunities to learn.

In Madagascar, USAID is working with communities in urban areas to provide public-private solutions that provide more options for households who can’t afford or aren’t able to build their own latrines and hand washing stations.  A growing number of communities run WASH blocks that provide latrines with sinks and soap for handwashing, as well as showers and in some cases laundry areas for anyone to use for a small fee.  Some of these blocks get as many as 200 users per day. Claudine, who is the chair of the WASH committee in her neighborhood, welcomed the construction of a WASH block for her community. “Our neighborhood is poor and our living environment is dirty, and we do not have enough water,” she said. “So the WASH block was something that the community really needed.”

Because of their weakened immune systems, people living with HIV and AIDS have an especially high need for clean water to wash their hands and safely drink, as well as access to a clean and safe latrine.  In Kenya, USAID is training partners on the ground to train their community health workers on ways that people living with HIV and their families can improve water, sanitation, and hygiene practices, including hand washing with soap to reduce their chances of getting diarrhea.  Community health workers use pictoral cards (available in both English and Kswahili) to show HIV positive clients and their caregivers or family members how to wash hands correctly, build a water saving device called a tippy tap to wash hands, and other healthy hygiene practices.

There are many examples of how Global Public-Private Partnership for Handwashing has progressed with its mission of encouraging proper handwashing.  But the more people we can get to the spread the message, the fewer people will get sick or die from diarrheal disease.

Hands Up If You Agree: Handwashing is Hands-down Essential

Guest author Joshua Briembergis a WaterAid Country Representative in Nicaragua.

Handwashing is a habit, or at least it should be if we hope to positively impact the health and well-being of the impoverished populations of Nicaragua.  Those of us who work in the water, sanitation and hygiene (WASH) sector read studies that repeatedly demonstrate the link between correct handwashing and the reduction of diarrhea, one of the leading causes of under-five preventable child deaths.  We then go further, to make the link between a reduction in diarrhea and the benefits this brings: more schooling, less malnourishment, savings on medical treatment and more productive lives, and greater happiness.

Still, during a forum of WASH professionals to discuss progress in sanitation a year ago, a secret survey of the participants as they left the toilet facilities showed that less than 60 percent of both men and women practiced handwashing at this critical moment.  These are alarming results, especially since the participants had access to a clean hotel washroom with amenities in a capital city.  Not long after, at a meeting at the Ministry of Health headquarters precisely to discuss a handwashing campaign, one participant noted that there was no soap to enable proper handwashing practice in the washroom facilities.

In the villages and poor urban slums where WaterAid focuses its attention, most of the general public who we work with on a daily basis is able to identify handwashing as a good hygiene habit.  But there is a big difference between knowledge and practice, and this is the challenge WaterAid’s hygiene promotion programs seek to address.

According to the Nicaragua Ministry of Health, acute diarrhea illness in 2008 affected 572.1 of every 10,000 inhabitants (or 5.7% of the population) with a death rate of 4.3 per 100,000 inhabitants (total population), and 20.8 per 100,000 inhabitants in children under age five.

Sure, the minimal conditions are often lacking: running water, soap, hand towels, and adequate provision for wastewater drainage.  Schools, kitchens and toilets are often built without handwashing facilities and when they are, the handwashing facilities are typically not conveniently located, which is important to the process of teaching good habits.

As these problems are addressed by WaterAid with low-cost provision of handwashing facilities next to toilets, within classrooms, and near to areas for food preparation and eating, leading by example remains a powerful tool. During all of our vocational and professional development training sessions with municipal WASH technicians, community water user association operators, teachers and health workers, the rules of order go beyond those of mutual respect, punctuality, and other common meeting ground-rules, to include good hygiene practices. Handwashing before eating and after using the toilet is at the top of the list.

As we saw at the sanitation conference, old habits often die hard.  No matter what facilities are available it can take time and plenty of reinforcement for the habit of handwashing to become ingrained, so repetition of hygiene promotion messaging is vital.

Children tend to be the most receptive audience for handwashing promotion.  Without a lifetime of habits to unlearn, they are generally a lot more amenable to new ideas.  In Nicaragua and around the world, WaterAid works with schools to develop fun hygiene promotion programs, which help kids to understand the health benefits of handwashing and untap their potential to act as ambassadors of good hygiene within their families and the wider community.

But you too can be a handwashing ambassador.  Global Handwashing Day is October 15—on this day and every day, remember to wash your hands, and model healthy behaviors that will last a lifetime!

Results, Results, Results

Originally posted at 1,000 Days

Last week at the High-Level Meeting on Scaling Up Nutrition in New York City, United Nations Secretary-General Ban Ki-moon commended the progress being made by the 30 countries that have committed to putting nutrition at the heart of their approach to development.  The 30 SUN countries are home to 56 million children suffering from stunted growth due to chronic malnutrition, representing more than one-quarter of the world’s stunted children.

Secretary General Ban Ki-moon addresses the 2nd Annual High-level Meeting on Scaling Up Nutrition. Photo credit: John Gillespie UNIC

Putting nutrition front and center

The Secretary General stressed the importance of boosting global efforts to end “the hidden disgrace of stunting.” His comments were echoed by Anthony Lake, Chairman of the SUN Lead Group and Executive Director of UNICEF, who noted that stunting is one of the most under-recognized and under-attended issues in the world today, yet it can be prevented for approximately $15 per child.

Over the past year, countries in the SUN movement have set themselves clear targets, scaled up programs targeting women and children, and put into place the necessary resources to begin to tackle to problem of malnutrition.  At the meeting, several leaders highlighted new or intensified commitments to scale up nutrition, including:

  • Peru’s First Lady, Nadine Heredia, who indicated that tackling child malnutrition is a critical pathway to breaking the cycle of poverty between generations in Peru and highlighted that the Peruvian President has signed a commitment to protect a $1 billion budget allocation for fighting child malnutrition.
  • Tamar Manuelyan Atinc, World Bank Vice President for Human Development, announced that the World Bank committed to increase investments in nutrition from $100 million per year to $560 million over the next two years which would expand the Bank’s reach into 36 countries, where 70 percent of the world’s stunted children live.
  • Dr. Rajiv Shah, USAID Administrator, committed to decrease stunting by 20% over five years in 14 of the 30 SUN countries:  Bangladesh, Ethiopia, Ghana, Guatemala, Haiti, Malawi, Mali, Mozambique, Nepal, Rwanda, Senegal, Tanzania, Uganda and Zambia.  He also highlighted results achieved with U.S. funds to date.  In Uganda, U.S. funding has meant that 50 million children received vitamin A supplementation last year, along with a 90% increase in the use of cooking fortified with Vitamin A.  Collective efforts in Tanzania have encouraged the government to hire more than 100 district nutrition officers, leading teams that have the potential to reach more than 20 million people.  An initiative with the Government of Bangladesh, CARE and 44 local organizations has created a 30 percent reduction in stunting for children under age five.

While progress at country-level to scale up nutrition has indeed accelerated since the SUN movement was born in 2010, the focus is now on results, results, results.  From now until 2015—the next critical benchmark for the SUN movement and the year the world takes stock of its progress against the Millennium Development Goals (MDGs)—success will depend on the ability to translate political will into tangible and lasting improvements in rates of malnutrition.  The road ahead will likely be a challenging one as global economic problems persist, and food price crises and climactic shocks continue to threaten progress toward curbing chronic malnutrition.  This is precisely why now, more than ever, the global community must rally to mobilize unprecedented resources behind ending the “hidden disgrace” of chronic malnutrition.

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