USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Ask the Expert: Administrator Shah on the AIDS fight

Dr. Rajiv Shah serves as the 16th Administrator of USAID and leads the efforts of more than 8,000 professionals in 80 missions around the world.

Dr. Rajiv Shah serves as the 16th Administrator of USAID and leads the efforts of more than 8,000 professionals in 80 missions around the world.

Originally published at Global Pulse, by John Donnelly and Charles M. Sennott.

Q: Secretary of State Hillary Clinton announced this week that the administration would be put together a blueprint in five months for an “AIDS-free generation.” She first announced this vision eight months ago. Why does it take 13 months to put together a plan?

A: Let’s start with the goal. We were all very committed to create an AIDS-free generation. … We want to take a very honest and rigorous approach. We know it will require resources. We know it requires a great deal of local knowledge and development insights to say which communities are transmitting the most, how are we going to reach them, how do you reach people who are not as symptomatic? And what are the implementation strategies that are going to allow us to target and maximize outcomes against this goal?

We are trying to step through that in a very rigorous way. We are not holding anything up by doing that analysis. We’re embarking on an aggressive scale up of treatment, of prevention, of country ownership, of investing in country systems, even as we craft a blueprint that completely guides this country and our global partners for sometime in the immediate future.

Q: Is there a need for a blueprint, and is there wisdom in waiting for the results from the HIV combination prevention trials, which will test different approaches to reduce infections all at once?

A: The HIV combination prevention trial in Tanzania is particularly important because that’s probably the largest scale among them. It’s going to add a great deal of knowledge and data. But the reality is the pathway that defines success is going to look different based on the unique characteristics of the pandemic in countries and in communities. We need to do those trials and learn from them. We also are moving ahead with the aggressive presumption that combination prevention, including treatment as prevention, can be an effective strategy to get to an AIDS-free generation.

Q: Regarding male circumcision, you’ve had some problems in creating demand, such as what you’ve seen in Swaziland. What approach do you use now?

A: We need to apply more local insight, partnership with local institutions, better understanding of local behaviors and cultural preferences in how we scale up male circumcision programs. It is a medical intervention that has lots of data to substantiate its efficacy, but it is also a very personal and very significant cultural statement that we even in the United States in parts of our country debate and struggle with.

The big lesson learned is to take a little bit of time to be consultative with local partners who really know and are from the cultures in which we hope to scale up access to the intervention. I think we are working in the context of an aggressive scale up of male circumcision.

Q: The closing of the Global Health Initiative office ended the original dream of moving GHI to USAID. Are you disappointed that the dream didn’t materialize?

A: I kind of focus on what works and what doesn’t work, and what’s necessary to achieve our goals at a particular time. Our administration has set three critical health goals for our work: an AIDS-free generation; child survival call to action and eliminating preventable childhood death; and the virtual elimination or significant reduction of mothers who die in childbirth.

But what we learned in order to achieve them, we can’t have the current situation, where the US is keeping its funding constant in a tough global economy, but others are doing a little bit less. We know we need to have more focus and a more integrated approach. In the call to action we bring together malaria, preventing infections from mother to child, nutrition during the first 1000 days, GAVI and other immunization, and therapy for pneumonia and diarrhea. Let’s think of these as a combination approach to achieve the results of saving 5.5 million kids.

I know from my conversations with the president and the secretary that that’s their expectation — we are delivering on that. So, you know, the organizational structuring of it evolved in order to take on these goals and to address these challenges that were in our midst. Remember, GHI was launched before funding challenges existed both for US and abroad, and I think this is responsive to the reality of what’s needed.

Q: But GHI was perceived as the signature global health program of the Obama administration.

A: Just because we don’t have a Global Health Initiative coordinator at the State Department anymore doesn’t mean we don’t have a Global Health Initiative. We believe this structural approach will be more effective in delivering the kind of integration across services that we think is at the crux of getting health outcomes for the same resources, which is what GHI is about. It is true: We had a structure, we didn’t think it was the right structure to deal with the challenges going forward. We made changes to that, but we are absolutely committed to the GHI, to the goals we’ve established and to the concept of integrating service delivery to drive better results.

Q: At a panel at the Kaiser Family Foundation, Mike McCurry called on the Obama administration to articulate one clear global health goal – not three or five. But one. What do you think of that?

A: Mike was dead right. We got to this point by focusing on immunization, focusing on getting malaria bed nets to kids, focusing on HIV/AIDS. We still need to do that. But going forward, as Mike suggested, we need integrating concepts, concepts that people can be inspired by, that are operational and real, but that bring things together so that we are not competing with each other and instead grow enthusiasm for the overall effort.

That’s what the call to action for childhood survival was all about. You see 80 countries show up in the Washington meeting, co-hosted by India, Ethiopia and the United States. Fifty-six countries signed a pledge to eliminate preventable childhood deaths. Probably 20 some have already published scorecards to demonstrate how they are going to measure that. The US agencies and others have all agree to highlight the annual rate of reduction in childhood deaths as an operational metric to focus on across all of our grants. That’s the kind of coming together around something big, inspiring, and very genuinely country driven that I think will define success in the next decade for global health.

Q: Why did the call to action work then?

A: I don’t know the analysis, I just know the answer to the question. It’s somehow the energy is coming from the countries. We had a mid-level delegation from Yemen come to the Washington meeting, and they were so inspired that when they got back, when I got to Yemen the next week, the president of Yemen and deputy health minister both approached me and said, ‘We want to be part of this call to action. We looked to our statistics, we feel we can do better.’ When that happens, and that’s the demand signal we’re getting, that to me is what this should all be about, as opposed to our trying to construct something that then we ask others to respond.

Q: The phrase ‘turning point’ is used a lot when it comes to the AIDS epidemic. Do you use that phrase, and if so, why is it a turning point?

A: Well, the pandemic, the turning point, my understanding, the way I use it, is to refer to a specific moment when the number of global new infections is lower than the number of people added to treatment. Every year after that, you are reducing the number of people with the disease. We are not there. We are still in situation where the aggregate number of people with the disease is growing, so the turning point is a very important concept because once you hit that point you are on the decline and you can legitimately say we’re working statistically downhill toward zero. But the drivers of the turning point are what’s critical. That’s where you see that expanding prevention in a focused way that reaches the most transmitting populations is critical to achieving the turning point. And expanding efforts that effectively reduce risky behaviors so that you don’t have another turning point, and go back up again, are all critical to solve AIDS over the long term. So I think it’s a very viable concept.

A Vaccine to Help End the AIDS Pandemic

A new energy animates the hallways of the Washington Convention Center this week, as leaders and advocates commit to a goal once thought impossible: ending the AIDS pandemic.

Indonesian volunteers light candles during a ceremony to mark World AIDS Day in Jakarta. Photo Credit: Adek Berry/AFP

Attendees at the AIDS 2012 Conference here in Washington, and at conference hubs from Nairobi to Chennai, are telling the world that we can end the AIDS pandemic. Among the astonishing accomplishments in our battles against other infectious diseases that allow us to believe this bold claim, is the long-sought eradication of polio. The world learned in January that one of the last holdouts of this viral disease – India – has not recorded a single new case of natural polio infection for more than one year.  Polio still needs to be defeated in a small number of countries, but one of its most stubborn reservoirs of the virus is clearly being drained. That is no small feat.

How was this extraordinary feat accomplished?

In short: through massive immunization campaigns and people working together around the world to end a common threat.

HIV is, admittedly, a far more challenging foe. The virus attacks our body’s immune cells, changes its appearance ceaselessly and incorporates itself into our DNA, where it cannot be extinguished. The deviousness of HIV has long challenged the brightest minds of science. But it is nonetheless a challenge that can be overcome—if, that is, we commit ourselves to supporting research and building on the progress scientists have made so far.

In the last three years alone, clinical studies have demonstrated that preventive HIV vaccines and microbicides are possible. Other research has shown that antiretroviral therapies can be used in various ways to prevent HIV transmission as well. Meanwhile, voluntary medical male circumcision is increasingly being used to reduce the risk of HIV infection.

Each and every one of these strategies must be added to the existing toolkit for HIV prevention—and used together as a tour de force—if we are to end the AIDS pandemic.

New impact modeling, conducted jointly by the Futures Institute and IAVI, suggests that the full implementation of the UNAIDS Investment Framework by 2015 could help turn the tide of this pandemic. The subsequent development and deployment of a broadly effective AIDS vaccine could then further bend the curve and bring us closer to truly ending the AIDS pandemic.

Recent advances have fueled optimism and lent a new momentum to the field of HIV vaccine R&D. This momentum must be sustained. IAVI and its many partners around the world are racing to build on this progress. We invite you to join us in our efforts.

A Shared Vision of Improving Lives

Three decades ago, when AIDS was ravaging communities around the world, some said it would be impossible to provide treatment in resource-poor countries. Others said it was impossible to stop the transmission of HIV from mother to child. And most said it was unimaginable to see the end to AIDS.

Those days are in the past. In this video, Roxanna Rogers, the director of the office of HIV/AIDS at USAID, describes the progress we have made in the battle against HIV/AIDS. “We haven’t ever been at a point in time where we can talk about a future where AIDS has virtually disappeared. Our vision is to make that happen,” she says.

That is a powerful vision, and one that can now be realistically considered in large part because of partnerships.

From the earliest years of the HIV epidemic, partnerships between donor agencies, health ministries, nongovernmental organizations and communities have resulted in HIV research, prevention and treatment programs that have brought us closer to the vision Ms. Rogers describes.

Partnerships provide a framework for building on gained knowledge. Partnerships allow people with different perspectives to work together, and partnerships have allowed us to make this vision of an end to AIDS a realistic goal.

One of FHI 360’s longest-standing partners has been USAID. For three decades, we have been working together as part of a larger effort in the fight against HIV/AIDS. Together we other organizations, we have contributed toward turning the tide on a devastating global epidemic.

Our collaboration has focused on access to HIV/AIDS services, capacity building in resource poor settings and effective HIV prevention technologies. The approach is comprehensive and driven by research, evidence and a long track record of engaging directly with the communities around the world that have been hit the hardest.

FHI 360 is committed to bringing every critical voice to the table to work together for lasting solutions. Our efforts succeed only when we have strong partnerships with governments, civil society organizations, the private sector and the communities we serve.

We invite you to view our video titled “A Shared Vision of Improving Lives.” It shows what a vision — and partnerships — can do.

African Leaders Call for Scale up Voluntary Medical Male Circumcision in East and Southern Africa

Dr. Emmanuel Njeuhmeli is the Senior Biomedical Prevention Advisor with USAID and Co-Chair of PEPFAR’s Male Circumcision Technical Working Group.

Scientific advances in the treatment and prevention of HIV infection over the past years have created unprecedented optimism that the fight against the HIV/AIDS. Voluntary Medical Male Circumcision (VMMC) for HIV prevention is one such intervention that has enormous potential to alter the course of the epidemic.

Three clinical trials have definitively demonstrated that VMMC can reduce female to male transmission of HIV by approximately 60%.  This means that if brought to scale to achieve a coverage of 80% of adolescents and men, VMMC could prevent 3.4 million new HIV infections and save countries in East and Southern Africa US$16.5 billion in care and treatment costs between now and 2025.

With tens of thousands of people who work in the field of HIV in Washington, D.C. —political leaders, public health experts, activists, people living with HIV—all equally committed to achieving a future free of AIDS, the time is now to examine possibilities to rapidly scale up comprehensive VMMC services. Key African political and traditional leaders from some of the hardest hit countries of East and Southern Africa will participate in a satellite session tonight to discuss challenges and solutions to accelerating VMMC scale up in 14 priority countries.

These leaders understand very well the urgency of bringing this intervention to scale.  Mr. Blessing Chebundo, a member of Zimbabwe’s Parliament, was publicly tested and circumcised last month in an amazing show of leadership. I was fortunate enough to be in Zimbabwe that day and witness 44 members of Parliament in a makeshift tent at Parliament House stepping up to inspire other men in their country to do their part for HIV prevention. It was a moment I will never forget.

We know that with strong leadership, commitment and coordination this is doable. We’ve seen Kenya’s successful VMMC program where more than 400,000 voluntary medical male circumcisions have been administered since 2008. Government leadership and program flexibility have been key.  In Iringa, Tanzania, local leaders and officials, with PEPFAR support, overcame human resource and infrastructure constraints and managed to exceed their targets, performing more than 100,000 VMMC since 2010. Thirty-one thousand circumcisions were performed during an eight-week campaign. Based on modeling estimates, they’ve already prevented over 14,000 new HIV infections. Surely other countries can do this too.

Preventable HIV infections occur every day among uncircumcised men in the countries of East and Southern Africa. Each day that this proven prevention method is not brought to scale represents a lost opportunity to change the course of the epidemic.

There is no time to waste, now, it’s time to act.

The Journey of Life for Children Living with HIV – From Diagnosis to Adulthood

Not long ago, it was expected that children living with HIV would not survive to adulthood.  Today, children living with HIV are thriving through adolescence into adulthood, and doing so in large numbers.

Though effective antiretroviral treatment is allowing many to live long and healthy lives, living with HIV remains a complex burden for these age groups. Treatment, care and support needs are challenging and ever-changing.  Focusing on clinical services alone is insufficient.  Children and adolescents living with HIV have a range of other essential needs that must be supported.  They require psychosocial support, sexual and reproductive health education, alcohol and substance use counseling, and information on voluntary and safe disclosure, loss, grief, and bereavement.   Children and adolescents are often confronted with a multitude of emotions, questions, and concerns regarding the complexities of disclosure, their health, and their future.

PEPFAR, WHO, UNICEF, national governments, NGOs, organizations of people living with HIV, and others are working to support children living with HIV as they transition from childhood to adolescence and adulthood.

One of USAID’s foremost concerns is how best to support and address the unique health, psychological, and social needs of adolescents living with HIV as they transition into adulthood and into adult care environments.  Only an estimated 15% of HIV-exposed infants are identified and in southern Africa less than 12% those between 15 and 24 years of age have been tested and know their HIV status results.   USAID acknowledges the urgent need for age-appropriate HIV testing and counseling for children and youth to identify those that remain undiagnosed. 

With the participation of children and adolescents living with HIV in USAID programs, we continue to better understand how best to reach adolescents with the services they need.   For one, HIV remains highly stigmatized.  Children and adolescents living with HIV are confronted with complex challenges regarding disclosure with their peers and even family members.   They are in need of support to practice voluntary and safe disclosure, maintain treatment literacy and adherence, and have healthy relationships.

This is a historic moment in human history. We know what works in the effort to combat major killers of children and we are in a unique position to further reduce childhood all-cause mortality and virtually eliminate new pediatric HIV infections while keeping mothers healthy.

The focus on adolescents living with HIV is important to USAID and part of a greater initiative to meet the health needs of children.  For fifty years, USAID has been committed to improving child health.

In June, the Child Survival Call to Action challenged the world to reduce child mortality to 20 or fewer child deaths per 1,000 live births in every country by 2035.  Reaching this historic target will save an additional 45 million children’s lives by 2035.

Fifty-six governments and over 100 civil society partners committed to sharpening national plans for child survival, monitoring results, and focusing greater attention on the most disadvantaged and vulnerable children.

For children and adolescents living with HIV, we must manage their care with the desire and actions that show their self-worth including treatment and clinic adherence.  And let’s continue to prioritize meeting essential needs so children and adolescents can make a healthy transition into adulthood and a fruitful, productive life thereafter.

Join the USAID-sponsored International AIDS Society satellite:  Journey of Life for Children Living with HIV – From Diagnosis to Adulthood Sunday, July 22, 2012 from 9:00-11:00.

From Evidence to Action: What Works for Women and Girls

In the coming days, thousands of political leaders, public health experts, activists, people living with HIV and other delegates from around the world will gather in Washington D.C. to debate, discuss, reflect upon, and celebrate the achievements that have been made in the fight against HIV/AIDS.

But in Lesotho, and other southern African countries, the epidemic remains a painful reality.

During my recent trip to the Mountain Kingdom, a tiny country surrounded on all sides by South Africa, conversations about the epidemic inevitably turned to the fact that women and girls are a much greater risk for HIV due to a combination of biological, structural, and cultural conditions. In many ways, Lesotho clearly illustrates the nature of the epidemic in sub-Saharan Africa, where 60% of those living with HIV are women. In the nine countries in southern Africa most affected by HIV, prevalence among young women aged 15-24 years is on average about three times higher than among men of the same age.

In Lesotho, where women and girls have much higher rates HIV than men, our U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Country Team and implementing partners are acutely aware of the realities facing women and girls and are continuously seeking ways to ensure that programs and services use the most up-to-date evidence to meet their needs.

Fortunately, the evidence of what works for women and girls is just a click away.

What Works for Women and Girls: Evidence for HIV/AIDS Interventions

First launched at the International AIDS Conference in Vienna in 2010, this groundbreaking resource is a comprehensive website documenting the evidence for effective HIV interventions. Spanning more than 2,000 articles and reports with data from more than 90 countries, What Works for Women and Girls contains—in one centralized, searchable location—the evidence of successful gender-specific programming from global programs and studies, with a focus on the Global South.

Having the evidence of what works is crucial for organizations working on the front line of the HIV/AIDS response. In Kenya, for example, the evidence has been essential for crafting national policies on gender-based violence and HIV prevention for women.

From Evidence to Action

As we celebrate the rich evidence base in What Works for Women and Girls, we must now focus on what this means for the implementation and scaling up of the HIV/AIDS response. How can we ensure that the evidence is applied correctly and consistently to ensure quality programs at scale? Are our programs and services addressing the underlying gender inequities that not only put women and girls at risk for HIV, but men and boys too? How will we use the evidence to inform sound public health policies and priorities?

Most importantly, how can we ensure that the available evidence helps us to maximize the benefits so that we can, finally, turn the tide against HIV/AIDS?

For the women and girls of Lesotho, and across the southern Africa, there is not a moment to lose.

The Right to a Nationality: Women and Children

Anne C. Richard serves as Assistant Secretary of State for Population, Refugees, and Migration. This article was originally posted to DipNote, the  U.S. Department of State official blog

On July 11, leaders from around the world are meeting in London at the Family Planning Summit to express support for a fundamental component of reproductive rights — the right of every woman to decide freely and responsibly whether, when, and how many children she will have. This is a right most women in the United States have had the luxury of taking for granted in recent generations, unlike women in developing countries where 99 percent of all maternal deaths occur. The statistics are staggering — every two minutes a woman dies of pregnancy-related complications. For many, limited access to voluntary, safe, and effective modern contraception, information, and services becomes a matter of life and death.

More than 200 million women and girls in developing countries who want to use family planning to delay or avoid becoming pregnant do not have access to modern contraception. Addressing this human rights issue and health inequity has been a priority for the Obama Administration, because we understand the linkages between family planning and women’s health and a wide range of development issues including poverty reduction, girl’s education, maternal and child health, gender equality, and environmental sustainability. For over 40 years the U.S. government, through the work of the U.S. Agency for International Development (USAID), has been committed to supporting effective and sustainable family planning programs. In this fiscal year the U.S. contributed over $640 million through USAID for bilateral family planning and reproductive health programs, and $35 million to the UN Population Fund (UNFPA), which is a world leader in providing life-saving family planning and reproductive health information and services.

Hosted by the U.K. government and the Bill & Melinda Gates Foundation with support from UNFPA, the Family Planning Summit will build on this solid foundation. The Summit will seek financial and political support to provide access to contraceptives, information, and services for an additional 120 million women in the poorest countries. The goal is that by 2020 a total of 380 million women and girls in developing countries will be able to plan the number, timing, and spacing of their children. By meeting this need for contraception, maternal mortality would be reduced by one third and deaths of children under five reduced by one quarter. Reducing unintended pregnancies would also lead to fewer girls dropping out of school — and the longer children stay in school the higher their lifetime earnings will be, enabling them to lift themselves out of poverty. Families become healthier, wealthier, and better educated as the benefits pass to the next generation because mothers who have had an education are more than twice as likely to send their own children to school as mothers with no education.

Every woman and girl deserves the opportunity to determine her own future — it’s what we all want and work hard to achieve for our own children. We’ve long since come to expect that most mothers in the United States will live through the process of giving birth, to love and nurture their children, to contribute to the health and well being of their families, and to play a meaningful role in their communities and the prosperity of our country. We should expect and accept no less for all women and girls — regardless of income, education, and geography. We all deserve the opportunity for healthy, happy, and productive lives.

Protecting the Lives of Women and Girls: London Summit on Family Planning

Today I joined leaders from around the world at the London Summit on Family Planning to commit to the goal of providing 120 million women in the world’s poorest countries with lifesaving contraceptives, information, and services by 2020. This Summit comes at a crucial time, following up to last month’s Child Survival Call to Action. Convened by the governments of the United States, Ethiopia and India, the Call to Action brought over 1,000 representatives from around the world to Washington, DC to rally behind the goal of ending preventable child death. We know that this effort begins even before a child is born. By enabling mothers and families to time and space the birth of their children, family planning could save the lives of more than 1.6 million children under five annually.

To support the aspirations of the London Summit, the United States commits the power of its voice and example, as well as resources, technical support and leadership that will lead to new and innovative ways of substantively reducing unmet need for family planning. Over the course of several decades, the U.S. has provided roughly 50 percent of total donor funding in family planning.

In the last four years alone—during the Obama Administration—we’ve increased our commitments 40 percent, going from $470 million in 2008 to $640 million today.This past year, we reached more than 84 million women—helping to prevent 15,000 maternal deaths and save the lives of more than 230,000 infants.
I recently took a trip to Yemen where I saw the great challenges the nation faces in terms of both high rates of fertility and mortality. In Yemen, seventy-five percent of the population is younger than 30. Driven by a fertility rate of about 5.5 children per woman—nearly twice the regional average—each new generation is larger than the last. At best, these demographic challenges pose a roadblock for economic growth and global health gains. At worst, they interrupt the stability of societies—putting regional security and prosperity at risk. We need to make strategic investments today to get ahead of the curve and seize unprecedented opportunities in development. One of the biggest opportunities comes when you couple family planning with real reductions in child mortality—leading to an important shift in population that, with appropriate investments in education and job creation, can fuel as much as two percentage points of GDP growth for years.

Today, we’re building on our legacy of research and development to create a new generation of contraceptive methods that are easier to provide, easier to use, and more affordable. For example, we’re partnering with DFID, the Bill and Melinda Gates Foundation, and others to expand access to the popular “depo-in-uniject” contraceptive in five to six countries.  Packing an all-in-one, single dose, this innovative contraceptive can be provided right in the home.

USAID currently runs the largest and most effective global supply chain system in family planning commodities. But we need to work closely with our private sector partners and country governments to drive even greater efficiencies so we can avoid stock-outs and reach particularly vulnerable women in rural and urban settings. And we need to strengthen our partnerships, working closely with local actors, private firms and faith based organizations to fully integrate family planning services into HIV and maternal and child health programs.

Over the next eight years, our work to support more than 84 million women annually across 42 countries will provide for 675 million user-years of coverage. This is in addition to all the extraordinary commitments made at the Summit today. But combining our efforts, our support will ensure that, in 2020, 380 million women in the poorest countries of the world will have the power to determine the size of their families. By 2020, our work together will be helping prevent the deaths of 1.3 million children under the age of five—more than 15 percent of all preventable child deaths.

Alongside critical investments in education and economic opportunity for women and girls, voluntary family planning paves the way for peaceful, more prosperous communities. Ultimately, we know that long-term, sustainable development will only be possible when women and girls enjoy equal opportunity to rise to their potential.

I am excited with the level of energy and commitment surrounding this Summit and look forward to working together to lay the foundation for a brighter future.

Learn more about USAID’s work in family planning.

London Summit on Family Planning

Tomorrow, on World Population Day, world leaders will meet in London to discuss expanding access to family planning for millions of women around the world.  Many people have been asking me why the London Summit on Family Planning is important.  This brings me to think back to when my wife and I first thought about having children.  It was an exciting time; much thought went into planning our family.  We decided to have two children, spaced two and a half years apart, as that was the number we thought we could provide enough support, attention, and education.  For more than 40 years USAID has worked to enable millions of couples from around the world to plan their families like my wife and I did.

The London Summit on Family Planning is important because despite all the many advances in family planning, with countries that no longer need assistance in this area, for all the millions of couples who are now using family planning services, there remain millions who want to space or limit their families, but do not have access to the clinics, the commodities, or the services they need to do so.

In fact, the statistics tell the story:

Read the rest of this entry »

Taking Stock of Improvements in South Sudan’s Health Sector

As South Sudan celebrates the first anniversary of its independence on July 9, the new nation is taking stock of what it has accomplished over the past year.

After suffering through civil war for most of its history (since before Sudan’s independence from the United Kingdom in 1956), South Sudan remains one of the world’s least developed nations. Part of this underdevelopment stems from the fact that South Sudan had an informal health system during the war, which was supplemented heavily by relief agencies.  With a lack of skilled health professionals, vast distances between service delivery points, and a dearth of basic health education, the world’s newest country has some of the worst global health indicators, including one of the world’s highest rates of maternal mortality.

Overcoming the vast logistical, technical, political, and social roadblocks to improving health for the population of more than 10 million South Sudanese seems nearly insurmountable.  Deficiencies in infrastructure, human resources, supply chains, pharmaceutical management, education, and health policies produce challenges and delays at every step.

In addition to health and development needs, South Sudan continues to be challenged by conflict, instability, and population movements, including refugees fleeing conflict in Sudan and the return from Sudan of more than 400,000 people of South Sudanese origin since October 2010.  These conditions are taxing an already strained health system and exacerbating the existing deficiencies.

Despite these challenges, progress is being made. South Sudan’s child mortality rate dropped from 135 per 1,000 in 2006 to 106 per 1,000 in 2010. Infant mortality saw a similar decline from 102 per 1,000 in 2006 to 84 per 1,000 in 2010.

To sustain and expand these positive health trends, USAID is funding the Sudan Health Transformation Project, Phase II (SHTP II).  Led by Management Sciences for Health, SHTP II is working closely with South Sudan’s Ministry of Health and local partners to improve access to and demand for health services, while building the skills and knowledge of South Sudanese health workers.  One element of the project is the Leadership Development Program, which focuses on teaching health workers and managers how to identify challenges and seek solutions to overcome barriers to providing health services.  The program teaches teams to look at areas where they are underperforming, and find ways to achieve measureable progress.

At a recent workshop, Marco Agor, who works in the County Health Department in Tonj South, Warrap state, praised the program, saying, “The Leadership Development Program is very important. In my office, we had a lot of organization problems.  Those who had known Thiet in Tonj South before [the program] would say it is a different place. Now, Thiet is the best-run facility.”  The program has been so successful in SHTP II-supported facilities that the Ministry of Health is now assessing its own operational challenges using the Leadership Development Program. The Ministry is also currently working to develop a strategy for training even more of the nation’s health workers in this leadership development program.

Page 21 of 42:« First« 18 19 20 21 22 23 24 »Last »