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Archives for Global Health

Reliable Family Planning Supply Chain Delivers Better Health and Prosperity to Ethiopian Families

“I started using contraceptives after I gave birth to my second child,” said Birtukan Bezabih, a 25-year-old married mother of three in southern Ethiopia. “I did not know that I was pregnant with my second child until [he] started moving inside my womb.  It was just a few months after I gave birth to my first child…so my first child didn’t get proper care and he was not well breast fed.”

Nurse Haileshet Bekele at Tulla Health Center counsels Birtukan Bezabih, a mother of three. Photo Credit: USAID

Access to family planning empowers couples, like Birtukan and her husband, to plan and maintain healthier families. After the challenge of breastfeeding her first child and carrying her second at the same time, Birtukan turned to family planning methods to choose the right time to bring a third child into her life.

In Ethiopia, the Ministry of Health is committed to improving access to family planning through programs that have benefitted countless women and families to date. During the past six years, Ethiopia has seen a rapid increase in contraceptive use and a decline in the average number of births per woman. From 2005 to 2011, the percent of reproductive-age women using contraceptives in Ethiopia nearly doubled, from 15 to 29 percent. In the same period, the average number of children born to Ethiopian women declined from 5.4 to 4.8. By having fewer children by choice and ensuring children are spaced a healthy distance apart, mothers in Ethiopia are able to care better for the children they have, helping more children reach their fifth birthdays.

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Community Mobilization

I accompanied our Mission Director on a field trip to northeastern Madagascar in January 2012, where a USAID partner, Santenet2, is implementing a mother and child health and family planning program.

One of the villages that we visited was Amboanio, where poverty is rampant after the closing of a cement factory that used to provide jobs to the local people.  Amboanio is in a remote, poor rural area where access to health care is more than inadequate: the nearest health center is 5km away, and the main hospital another 40km from there.

Marie-Ange and her son Bertrand Photo Credit: Bruno Rasamoel, USAID/Madagascar

In 2010, the USAID-funded Santenet2 program launched a community-based system that helps to identify danger signs in pregnant women and newborn children. It also arranges for their medical evacuation in case of an emergency.

One of the first beneficiaries of this system in the village was Marie-Ange, a fisherman’s wife, who was pregnant in 2010 and started having labor pains when she was in her eighth month of pregnancy. “In March 2010, I was pregnant again with my child—this one, Bertrand. I had a miscarriage two years ago. My water broke but then labor stopped.  The community health worker took me to the local health center—it’s a one-hour walk—where the chief physician recommended that I go to the hospital. My father and the Mayor arranged for transportation up to the central hospital,” she said. Marie-Ange was evacuated to the main hospital, using a rural bus paid by the community through a social solidarity fund. She went straight into the operating room, and her life and her baby’s was saved.

This community-based emergency medical evacuation plan, established under USAID/Santenet2’s “obstetrical and neonatal care” program, works through a Solidarity Fund that is run by a Social Development Committee (SDC). Participating village residents contribute a small amount on a monthly basis. The Fund pays for necessary medical evacuations, using rural taxis called taxi-brousse. One member of the SDC, Samsoudine Ben Said, said: “I’m the Deputy Mayor of Amboanio, and at the same time a member of the Social Development Committee (SDC) that is comprised of representatives of the community at all levels, I mean villages, churches, transporters, local dignitaries. I want to make it clear that referring a patient to the hospital is a decision to be made solely by the physician at the health center. There’s no fixed amount for financial contributions to the solidarity fund. Those who have more money contribute more, and those with less money contribute less.” The SDC enters into an agreement with local transporters that provide regular transportation services between the commune and the main town. Fuel is paid out of the solidarity fund, and the patient reimburses after she is healed.

It is very simple: Marie-Ange’s life was saved thanks to community mobilization. The entire community is now much more aware of the need for emergency services and advance planning.

USAID’s FrontLines – June/July 2012

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Esther Ouma with her son, Barrack, in the Busia district of western Kenya. After losing her first two babies, Ouma successfully delivered Barrack after a visit from a community health worker who provided a link to health services and support groups available to expectant mothers in some Kenyan communities. “I will forever be grateful,” says Ouma, who attributes her good health and that of her child to the health worker’s intervention.  Photo credit: Bibianne Situma, AMREF

Read the latest edition of USAID’s premier publication, FrontLines, to learn more about the Agency’s work on issues surrounding child survival and its portfolio of projects in Ethiopia. Some highlights:

  • Efforts to end preventable child deaths are in their last lap and on a sure path to victory, says USAID’s top doc in the Bureau for Global Health.
  • The Swaziland parents who decide to have their newborn baby boys circumcised are part of a worldwide effort to achieve an HIV-free generation sooner rather than later.
  • UNICEF Chief Anthony Lake has seen firsthand the resourcefulness of this planet’s youngest citizens in the midst some of its worst disasters.
  • Find out why, despite one of the region’s worst droughts last year, the perpetually battered country of Ethiopia escaped the season with no famine.
  • A truce between four groups of people from Ethiopia’s Somali and Oromiya regional states who held longstanding grievances appears to have ushered in an unprecedented period of peace and an end to violent – and sometimes deadly – clashes.
  • Though Earth Day celebrations ended in April, USAID’s work to protect the environment continues 365 days a year. See that work through photos that won the 2012 environment photo contest put on by FrontLines and the Bureau for Economic Growth, Education and Environment as well as those that came in as runners-up.

Subscribe to FrontLines for an email reminder when the latest issue is posted online.

Caryl Stern: Join us to help every child achieve a fifth birthday

This originally appeared on UNICEF’s Field Notes.

A child’s fifth birthday is a joyful moment for most parents, a milestone marking the passage out of early childhood into the world of pre-K and grade school and upward and onward.

Caryl M. Stern, President & Chief Executive Officer, U.S. Fund for UNICEF, at age 5. Photo Credit: UNICEF

It signifies the end of a wonderful period, though sometimes a tough one. After the candles are blown out and all the presents opened, more than a few parents have taken a deep breath, looked each other in the eyes, and said,” Wow, we survived.”

Of course, in much of the world, the fifth birthday marks a different kind of milestone — one sometimes greeted with an entirely different sentiment: “my child survived.” That’s because in so many places, for so many beautiful children, just reaching age five alive is a battle, a battle that many don’t win — 21,000 every day, more than 7 million every year.

Raising awareness about these children is a key to reaching the day when zero children die from preventable causes. That’s why we’ve partnered with USAID for a new social media campaign: “Every Child Deserves a 5th Birthday.” The idea: post a photo of yourself or your kids at age five. Share it. Friends can do the same and find out about the millions of children who never get a chance to celebrate being five.

Please join the campaign by taking a moment to upload a personal fifth birthday photo. And don’t be embarrassed about sharing that photo. If I did it, you can too!

You’ll be hearing more from us about the 5th Birthday campaign in the lead up to an exciting  event in June. More to come!

Saving Children’s Lives, Closer to the Home

My most vivid early childhood memory is waking up to excruciating pain in my throat, and seeing the goldfish swimming in the aquarium of the pediatric surgical ward. Although penicillin had been discovered 30 years earlier, doctors had not learned yet that treating “strep throats” with penicillin was better than operating. I didn’t need the tonsillectomy. But, I was lucky to receive quality care in a health facility, close to my home.

Jonathan D. Quick when he was five years old. Photo Credit: MSH

Millions of children today are not so lucky. Over 7 million children under the age of 5 die each year; 70 percent of child deaths occur in sub-Saharan Africa and South-East Asia. The vast majority — over two-thirds — are entirely avoidable with existing safe, effective, low-cost prevention and treatment.

We’ve come a long way: reducing child mortality by nearly 70 percent in 50 years. But a child born in a low-income country is still about 18 times more likely to die before the age of five than a child born in a wealthy country. We know how to prevent most child deaths through low-cost, high-impact, close to home interventions such as community-case management and increasing access to quality medicines. We can and must do more to end preventable child deaths.

Every Child Deserves a 5th Birthday,” a new child survival initiative, launched by USAID Administrator Dr. Rajiv Shah, is building this awareness across the country and the world. Join the global campaign to end preventable child deaths.

Prevention, treatment and care close to the home are keys to saving children’s lives

Improving access to quality, essential children’s medicines reduces preventable child deaths. Where do you take your child if they have a fever or diarrhea and the closest doctor is a day’s walk away? If you live in rural Tanzania or other low-income countries, it most likely is a community health shop, hours closer and much more convenient than the nearest health facility or pharmacy. Previously, these shops were staffed by unlicensed, untrained dispensers who sold medicines of questionable quality.

In response, MSH worked with the Tanzania Food and Drugs Authority to develop an accredited drug dispensing outlet (ADDO) program, with funding from The Bill & Melinda Gates Foundation. Through the ADDO program, nearly 10,500 dispensers have been trained and certified and over 3,800 shops accredited across 15 regions of Tanzania. The licensed dispensers at these accredited shops provide, for example, oral rehydration salts & zinc for diarrhea, and bednets & treatment for malaria; and they know the screening questions to provide appropriate medicines for treatment of acute-respiratory infection among children or, if necessary, make a referral to a clinic. The ADDOs are a sustainable enterprise, bringing life-saving prevention, treatment, and care for children closer to home. The ADDO program also empowers women, as nearly 40 % of shop owners and over 90% of trained dispensers are women.

Community case management saves children’s lives. In rural, low-income countries, health centers can be inaccessible to most of the population. Over half of the deaths of children under the age of five occur in the home. Training community health workers empowers the community, including the mothers, on prevention and treatment of basic needs for children under the age of five, such as malaria, diarrhea, pneumonia, and malnutrition.

The USAID-funded BASICS program in Benin, led by MSH, has helped local leaders implement a community-based, integrated management system for child health. Over a six-month duration, community health workers treated 27,060 cases of child illness, referred 1,043 cases to health centers, and made 14,822 home visits to increase awareness of child illness, immunization, and nutrition. Now, over 1,000 community health workers provide case management at the community level for child illness, covering over 200,000 children under the age of five in five health zones in Benin.

Empowering mothers, through community health workers, improves care for children’s common illnesses. In Afghanistan, under-five mortality and infant mortality rates have dropped dramatically, due in part to a combination of close-to-home interventions targeting mothers in the home. Over 20,000 trained community health workers serve nearly 45 percent of the country’s sick children, with health facilities serving 55 percent. Community health workers visit villages and households, teaching mothers, like Taj Bibi, how to care for common child illnesses, such as treating diarrhea with oral rehydration salts and zinc.

Together, we can, and must, reduce preventable child deaths.

Expanding access to quality health care closer to the home will improve child survival in low-income countries. Training and certifying rural medicine dispensers at a national scale, and providing community-based care by community health workers, will help empower rural communities and improve the health of children in these resource-poor areas. Through these cost-effective, high-impact interventions closer to the home, we can accelerate the reduction in child mortality and save millions of lives.

I joined the 5th Birthday campaign by posting my 5th birthday photo and wish. Please join me and the 5th Birthday campaign by posting your 5th birthday photo with a wish for children globally.

Every child deserves a 5th birthday.

Related

Jonathan D. Quick, MD, MPH, is president and chief executive officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.

A Mother’s Fight

The following is a guest blog post from Florence-Ngobeni Allen. She is an HIV/AIDS educator and counselor, and a long-time Ambassador for The Elizabeth Glaser Pediatric Aids Foundation. She lives in Johannesburg, South Africa.

Fighting a mother’s fight against HIV has been a very significant part of my life.

Florence-Ngobeni Allen and her baby. Photo Credit: A Mother's Fight

I have worked as an HIV educator for more than a decade, counseling thousands of women in South Africa who have struggled with loss, stigma, and illness because of this epidemic.

As an Ambassador for the Elizabeth Glaser Pediatric AIDS Foundation, I have fought for mothers around the world to have access to the tools and support they need to keep their children healthy and HIV-free.

And I have fought my own, personal battle with HIV for more than 15 years.

I first worked as a counselor at Chris Hani Baragwanath Hospital in Soweto, South Africa, helping new mothers who tested positive for HIV. I discovered that my story was not that different from the women I met there.

A lot of the mothers could not afford HIV medicines and services for themselves or their babies. Some would report that they had not eaten for days. Others talked about feeling scared to disclose their HIV status to their partners for fear of violence. Too many of these women came to our clinic with bruises on their arms, their backs, and their hearts.

Every day, I was surrounded by the cries of babies who were fighting the effects of HIV, and mothers who were trying to care for them and keep them alive.

These experiences were so traumatizing for me. To get through the toughest moments, I would lock myself in the bathroom and cry. At that time, there were no treatment options available for HIV-positive mothers or their babies in South Africa.

I knew what was next for them. I knew that their babies were going to die.

The reason I knew is that I had experienced the same thing. I lost my beautiful baby girl, Nomthunzi, to AIDS when she was only five months old.

Nomthunzi was born with no complications to her proud parents. She was just a few weeks old when my husband grew ill. He passed away three months later.

Shortly after, Nomthunzi got sick as well. I brought her in for HIV testing, where I received the worst news a mother can hear. I learned that I was HIV-positive, and I had unknowingly passed the virus on to my baby. Nomthunzi passed away just a few weeks later.

When I became an HIV counselor, I knew the pain these new mothers were experiencing. The pain of losing a child is unbearable. But the pain of realizing that there is nothing you can do to save your child is equally intolerable.

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Putting Orphans and Vulnerable Children First on the Path to an AIDS-Free Generation

Today marks the 10th anniversary of World AIDS Orphan Day – and an important opportunity to highlight stories of children affected by HIV and AIDS.

Despite many gains in the fight against AIDS, children still lag far behind adults in access to important medical services, including HIV prevention, care, and treatment.

At the end of 2010, approximately 16.6 million children lost one or both parents to AIDS – 14.9 million of whom live in sub-Saharan Africa.

And the number of children who are orphaned or made vulnerable by AIDS continues to rise.

Children like Ashley from Zimbabwe are living proof of how orphans and vulnerable children can thrive if given the opportunity.

Ashley is six years old and lost her parents to AIDS several years ago. She currently lives with her siblings and cousins under the care of her grandmother, Juliana, who struggles to maintain all 13 children in her care.

But thanks to the support of a local organization, J.F. Kapnek Trust, and the US Agency for International Development (USAID), Ashley is now enrolled in a program at a nearby early childhood development center where she receives critical nutrition, health, education, and protection services.

Today, Ashley is healthy, happy, and active. She recently graduated from the ECD program and has started first grade, where she is performing at the top of her class.

We need more success stories like Ashley’s.

Under the President’s Emergency Plan for AIDS Relief (PEPFAR), USAID is working to make children like Ashley, and others who are affected by HIV and AIDS, a priority.

By partnering with national governments, communities, and other organizations, USAID is committed to improving the lives of children orphaned and made vulnerable by AIDS – a critical step in the path to achieving an AIDS-Free generation.

But our work is far from over.

“We are committed to and have a unique opportunity to join together to provide care and support for children affected by HIV and AIDS and ensure that no child has to grow-up with HIV,” said Roxana Rogers, Director of the Office of HIV/AIDS at USAID.

To do that, we need to step-up our early intervention efforts for children under five years old – a time of critical development for young children.

We also need to work with families to help them become more economically stable so they can access essential services and better provide for their children.

By thinking long-term and investing in efforts to strengthen systems of care and support, including social services, we can improve the lives of children around the world.

With a special focus on these strategies, we will achieve President Obama and Secretary Clinton’s goals to turn the tide against HIV and finally see the beginning of the end of AIDS.

Every Birthday Starts with the Golden Minute

Members of the Helping Babies Breathe Global Development Alliance

Every child deserves a fifth birthday. To reach five years, though, a child must take his or her first breath of life in the first minute following birth. The World Health Organization estimates approximately one million babies die each year from birth asphyxia, a condition in which babies who do not breathe on their own immediately following delivery.

Developed by the American Academy of Pediatrics, the Helping Babies BreatheSM (HBB) initiative was designed to equip birth attendants in developing countries with the skills they need to successfully resuscitate babies born without the ability to breathe on their own. At the center of HBB is the concept of The Golden MinuteSM: within one minute of birth, a baby should be breathing well or should be ventilated with a bag and mask.

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Celebrating Success in Saving the Lives of Mothers

Ordinary women make extraordinary contributions as caregivers and caretakers, as breadwinners and bread-makers to families and societies.  And even so, we know that women will not be able to thrive, unless they survive.  On Tuesday, the U.S. Government celebrated remarkable country-level success in saving the lives of women during pregnancy and childbirth.

Health ministers from Afghanistan, Cambodia, Dominican Republic, and the head of maternal and child health from Rwanda took center stage on Capitol Hill. And each told a unique and personal story.

Dr. Suraya Dalil spoke of overcoming illiteracy among Afghan women, a lack of roads and transportation, shortages of female healthcare providers, poor quality health services to tackle the reproductive risk of pregnancy and child birth.   “You need to eliminate child marriage, space child births and provide basic services,” she said.  “Now mothers are surviving and families are thriving.”

Maternal mortality reduction was once viewed as an insurmountable problem. And for two decades after the Safe Motherhood Initiative was launched in Nairobi in 1987, there was no documentation that motherhood was safer, as promised.

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Global Motherhood: Perils And Promise In Ghana

Guest Blogger: Dr. Orin Levine, Department of International Health, Johns Hopkins Bloomberg School of Public Health; Executive Director, International Vaccine Access Center (IVAC).

Originally published to the Huffington Post

Today in Ghana, I had a personal reminder as to why our work to prevent disease is so perilous, and why disease control so promising in Africa. Visiting the storied Princess Marie Louise Children’s Hospital in Accra, I watched as an eight-month-old boy, Isiah, struggled against severe pneumonia. Isiah was receiving supplemental oxygen from a cylinder, yet was still struggling to breathe. Even on oxygen therapy, his saturation was terribly low and his prognosis was poor.

But mostly, I watched Isiah’s father. He shook his son — not roughly, but just enough to keep him from closing his eyes — and he shouted at him with encouragement, urgency and longing, not reproach. I couldn’t understand his language, but as a father of two kids myself, I could not help but put myself in his shoes. I imagined he was imploring his boy to stay alive, to fight a little longer, and to stay strong so he could return home, grow bigger, and live to see another birthday.

In the United States, we can practically start planning our kids’ birthdays from the day they come home from the hospital; deaths in childhood are quite rare. In Ghana, though, you can’t take a child’s fifth birthday for granted. Last year approximately 50,000 young children – nearly seven out of every 100 — died before their fifth birthday.

This fact is unimaginable for those of us lucky enough to have children in the United States. If we in the U.S. had the same rate of child mortality as Ghana, 300,000 children would die annually. That’s the equivalent of half of the children in New York City dying before their fifth birthday every single year.

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