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Archives for Global Health

A Deciding Moment for Women, Girls, and HIV

For the past two weeks, the buzz in Washington, DC and at the White House, is all about women and girls.

Yesterday, to mark National Women and Girls HIV/AIDS Awareness Day, the Administration announced a new initiative to help local communities and grassroots organizations fight HIV/AIDS and gender-based violence.

U.S. Global AIDS Coordinator for the President’s Emergency Plan for AIDS Relief (PEPFAR), Ambassador Eric Goosby, and Ambassador-at-Large for Global Women’s Issues, Melanne Verveer, highlighted how $4.65 million in small grants to civil society organizations will help promote gender equality and prevent HIV among women and girls in local communities.

With women accounting for over 64 percent of HIV-positive people worldwide, addressing the needs of women and girls living with HIV and AIDS worldwide is essential. Equally important is improving our response to gender-based violence, given that violence against women and girls increases their vulnerability to HIV.

Partnerships between US agencies, civil society, private corporations, and international institutions, are key to tackling these issues.

For its part, USAID is working to integrate gender-based violence into all of our HIV/AIDS programs. According to Carla Koppell, Senior Coordinator for Gender Equality and Women’s Empowerment at USAID, the intersection between domestic and international HIV/AIDS and gender-based violence programs is crucial.

USAID-supported projects like the Go Girls! Initiative, which worked in several countries, including Botswana, Malawi, and Mozambique, have made significant gains in this area. By helping to prevent HIV infection in adolescent girls through the development of youth-focused materials, Go Girls! made gender a central issue to tackling HIV/AIDS.

Private companies are also helping to fight gender-based violence and HIV/AIDS. Yesterday we heard from the MAC AIDS Fund, one of several partners teaming up with national governments to fight poverty and promote HIV prevention around the world.

In South Africa, I’ve seen first-hand how successful these types of partnerships can be.

A recent collaboration between the South African government, USAID, MAC AIDS Fund, and other partners provides support for Thuthuzela Care Centres, which offer important counseling and health services for women and girls to combat sexual violence and HIV. More engagement from partners and private corporations will go a long way in turning the tide against both gender-based violence and HIV/AIDS.

While the events over the last few weeks have done much to highlight women and girls, our work to improve their wellbeing in the context of HIV/AIDS and gender-based violence is only just beginning. To truly tackle these issues, we must continue to work together with all of our partners to create a generation free of HIV and improve the lives of women and girls around the world.

Video: Health Research and Development in Kenya

USAID’s  health research strategy (PDF) includes assessing health conditions in developing countries and developing, testing, adapting, and introducing appropriate products and interventions within the context of strengthening local health systems.

See that strategy in action in this new video from Global Health Technologies Coalition about our health research and development work in Kenya.

Watch this video on YouTube.

Fighting newborn infections: New evidence leads the way

As published on HNN

USAID is proud to be a partner of this research and is already supporting the first national scale-up of chlorhexidine in Nepal.

A newborn baby. Photo: Bangladesh, by Shafiqul Alam Kiron / Save the Children

Exciting new evidence has bolstered our fight against one of the top three causes of newborn deaths around the world. Each year approximately 1 million newborn babies lose their lives to largely preventable severe infections, accounting for nearly one third of the total burden of newborn deaths.  Most of these lives could be saved by improving hygiene and reducing exposure to life-threatening bacterial infections particularly in the first week of life, and by making antibiotics available to newborns who become sick.

Research published this week in The Lancet confirms that a simple solution can prevent newborn infections and dramatically reduce newborn deaths. Findings from studies done in Bangladesh andPakistan show that when chlorhexidine, an inexpensive and widely available antiseptic, is applied to the newborn’s umbilical cord at home and soon after birth, neonatal mortality can be significantly reduced.  The two studies support earlier findings from a field trial in Nepal which showed a 24% reduction in newborn mortality when community health workers applied chlorhexidine to the cord during home visits.

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FY13 Budget: Making Smart Investments

The Fiscal Year 2013 International Affairs budget, which was released on February 13, showcases President Obama’s commitment to making smart, efficient investments to help those in the greatest need while helping to create economic opportunity and safeguarding American security.

It is important to remember that these numbers represent lives around the world that can be supported and saved through our smart investments in agriculture, health, and access to clean water, among other programs.  And these investments come at an incredibly small fraction of our national budget—in the case of development assistance, less than one percent.

Similar investments we made last year demonstrated a number of important results. Thanks to our investments in humanitarian assistance, we were able to save tens of thousands of lives in the Horn of Africa after a devastating drought led to famine and threw over 13 million people into crisis. U.S.  support helped provide lifesaving AIDS drugs to nearly 4 million people, protect 200,000 infants from HIV infection and keep millions of children throughout Africa safe from malaria. And our  agricultural investments are  supporting the goal of lifting 18 million people from a state of hunger and poverty.

Despite those results, we’ve had to make difficult choices this year, consolidating some programs and eliminating others. Our 2013 budget shows a willingness to focus on countries and programs where we believe we can make the greatest impact.

Global health is a key part of our investment in economic and human security.  Our request goes to cost-effective, proven global health interventions delivered through President Obama’s Global Health Initiative. These investments will help achieve a number of the President’s ambitious global health goals, including saving the lives of five million children by the year 2015, and expanding HIV/AIDS treatment. Thanks to the falling costs of health commodities, including contraceptives, malaria bednets and antiretroviral drugs, and increased investments by partner governments, we can now save more lives.

$1 billion of our FY 2013 request is devoted to Feed the Future, President Obama’s landmark food security initiative. These investments will help countries develop their own agricultural economies and  grow their way out of hunger and poverty, rather than relying on humanitarian food aid that costs us seven times as much to deliver. We’ve also designed a results framework so we can transparently measure and demonstrate the impact our investments have made in fighting poverty, hunger and malnutrition.

Our budget request maintains robust funding for our humanitarian accounts. Efficiencies in our use of these resources will ensure we have the necessary means to continue U.S. leadership in responding to natural and man-made disasters, just as we did last year after a devastating drought in the Horn of Africa. In addition, we continue to increase our focus on preventing future crises through disaster risk reduction activities and funding for greater resilience against food shocks through Feed the Future.

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Turning the Corner on HIV and Tuberculosis Co-infection in Brazil

AIDSTAR-One is funded by USAID’s Office of HIV/AIDS. The project provides technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs.

A patient at the CECAP Clinic in São Paulo receives his TB medication from his doctor. Photo Credit: Ed Scholl, JSI

HIV and tuberculosis (TB) affect millions of people worldwide every year. Eighty percent of the world’s cases of HIV are concentrated in the 22 countries—including Brazil—with the largest TB epidemics. Without precise and sustained treatment, HIV and TB can become a deadly combination for men, women, and children.

Adolescents like 17-year old Silvia (name has been changed) from São Paulo need access to medical services to treat both TB and HIV. I met Silvia last November, when she came to a clinic to seek medical care for multi-drug resistant tuberculosis (MDR TB)—a dangerous form of TB that requires special medical care and treatment.

With funding from the U.S. Agency for International Development (USAID), which provides support to medical clinics throughout Brazil for TB and HIV services, Silvia is receiving the care she needs to lead a full, healthy life.

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Empowering Communities to Help Eliminate Female Genital Mutilation

Today is the International Day of Zero Tolerance for Female Genital Mutilation and Cutting (FGM/C). Worldwide, 100 to 145 million women have been subjected to this practice, which can range from nicking the skin to a total removal of the external female genitalia. Every day, 6,000 girls are at risk.

In Guinea, a woman receives training in problem-solving skills as part of USAID-supported efforts to encourage communities to abandon female genital mutilation. Photo Credit: Elizabeth Fakan, USAID

Zero Tolerance Day is an opportunity to raise awareness about the harmful effects of FGM/C and unite communities around the world in calling for an end to the practice. FGM/C is practiced across cultures and religions—though notably, major religious doctrines do not mandate the practice. It is most common in Africa, the Middle East, and some countries in Asia. However, it also can be found in the United States, Europe, and other places where migrants bring their cultural traditions with them. Parents and communities practice FGM/C based on cultural beliefs about health, hygiene, and women’s sexuality. In many cases, it is considered a traditional rite of passage.

However, research has consistently shown that all forms of the practice harm women’s health. It causes serious pain, trauma, and frequently severe physical complications such as bleeding, infections, or even death. In the long term, it can also lead to recurrent infections, infertility, and difficult or dangerous childbirth that threatens the lives of both mother and infant.

Since the early 1990s, USAID has supported FGM/C abandonment efforts. In September 2000, the Agency officially established the elimination of FGM/C as part of its development agenda, and issued an official policy and strategy on the topic. The single most important aspect of ending this practice is involving the community. USAID focuses on enabling and empowering communities to make their own collective choice to abandon FGM/C.

For example, in West Africa, USAID has provided support to the Tostan project that incorporates health and rights information about FGM/C into a basic education curriculum that also teaches problem solving, math, and reading. As a result, thousands of villages in eight African countries in both West and East Africa have publicly abandoned FGM/C and other harmful traditional practices over the past 15 years. Another program in Senegal, called the Grandmother Project, has focused on empowering grandmothers and other elderly women to lead community discussions and call for change.

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Dispelling Family Planning Myths in the DRC

“Are family planning methods safe?” wondered Mutombo, a community health worker at the Kawama Village health center, in the Democratic Republic of Congo’s Katanga Province.  “Don’t they contain a poison?” he added, directing his question to Isaac Chishesa, a community mobilization specialist with USAID’s Democratic Republic of Congo-Integrated Health Project (DRC-IHP).

Isaac facilitates a group session on FP with health workers at Kawama Village Health Center. Photo Credit: MSH

Tough question!  One Isaac was not expecting, at least not within a discussion among trained community health workers.  An experienced community health professional, Isaac responded with a smile and said, “Thank you, my friend, for sharing your concern,” affirming the participants’ right to ask questions.  “Family planning methods are safe,” he then reassured the group.  “Based on international quality standards, each method is required to go through extensive testing before it is made available to the public.”

The faces of Mutombo and his peers lit up.  They sighed, a collective sigh of relief, and burst out laughing to relieve some of the tension.  They all recognized that even though they were dedicated to bringing about improvements in health behaviors, they, like most of their fellow community members, harbored misconceptions and rumors about family planning.

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Tackling Tuberculosis in Migrant Populations

On December 19, 2011, the day after International Migrants Day, I found myself on a plane from Almaty, Kazakhstan to Dushanbe, Tajikistan, for a business trip.  I was surrounded by Tajik laborers returning home to celebrate the New Year. Other than my three colleagues and I, the seats were filled with Tajiks bearing electronics, toys, and other gifts for their families.  Had it not been for my ignorance of Tajik or Farsi, I would have struck up a conversation with my neighbor to find out what life was like being separated from one’s family for work.  Instead, I reflected on my own family, descendants of immigrants not unlike my fellow passengers.

Migrants and medical officers discuss the TB situation in the region. Photo credit: Abt Associates,Tajikistan

On December 23, 1909, my 26-year-old great-grandmother, Auyoung Yee Lau, emigrated from China to Hawaii to join my great-grandfather, who had opened a successful shop in Honolulu.  Prior to his wife’s arrival, my great-grandfather sent home $45 each month to feed five adult family members.  I wonder what went through Auyoung Yee’s mind as she boarded the boat from Hong Kong to what she called “the land of the Golden Mountain.”  I would guess that her thoughts were on the unknown country she was about to make her life in and the three children that she had lost in recent years, two of whom died of preventable childhood diseases before the age of 3.

After my great-grandmother’s journey to America, her tragedy was overcome with the subsequent births of five boys, four girls, and finally, my grandfather, whose Chinese name translated into “Happiness Complete.”  Had my great-grandmother and her family been denied access to health care services in Hawaii due to their migration status, I wonder if my grandfather and his siblings would have suffered the same fate as Auyoung Yee’s first three children?  Would my great-grandmother’s happiness have been complete?

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Recognizing and Tackling Disrespect and Abuse of Women in Childbirth

A young mother lies with her newborn child. Photo Credit: UNFPA

When I started midwifery training decades ago in the United States, in the hospital where I worked, I first saw evidence of disrespect and abuse of women in labor. Women were separated from families and visitors from admission to discharge four days later and, in the second and third stages of labor, their legs were secured by stirrups and their wrists put in leather restraints.  Soon after, I worked in West Africa in a government maternity and witnessed women being verbally abused — “if you don’t push and your baby is born dead, it will be your fault” – and physically abused by slapping and massive fundal pressure to force delivery. Women were ridiculed for making too much noise in labor — and then were chastised if they were silent and delivered alone.

Fast forward decades later.  As I visit maternity services in a number of countries, I don’t need to look far to see and hear evidence of disrespect and abuse of women in childbirth.  A convulsing woman in labor on the steps of an urban referral hospital turned away from because she cannot pay.  A doctor who derides poor women for not using family planning to control their fertility.  A nurse who tells me that postpartum mothers “sneak in” to see their hospitalized newborns at night, while the families seek to find funds to pay the bills in order to get their newborns discharged.  Unclothed women laboring and giving birth as visitors walk by. A researcher who tells of a postpartum mother being detained for months because she could not pay her bill. The human rights worker who tells me that refugee women are discriminated against in childbirth and that one refugee was forced to keep her stillborn in her bed with her for 24 hours against her will.

I do not cease to be saddened and angered by the number of ways women giving birth are being degraded, abused, and humiliated by healthcare workers, often women themselves.  Abuses continue to occur in all corners of the world, including my own. They are not behaviors that are easy to change.  Some are reinforced by financial incentives and subtle or overt discrimination. For many, the behaviors are learned and reinforced in home, school and society — wherever there are unequal power relationships.

Despite the problems, many of the frontline caregivers at birth – midwives, doctors, nurses and auxiliaries – work diligently, treat women with compassion, and even use their own resources to assist women in referrals in the case of life-threatening emergencies. Their selfless work needs to be recognized, even while the problems of abuse are uncovered.

I am now very encouraged that the issue of abuse is resonating with so many who care for and about childbearing women.  I see there is growing attention to this problem through documentation of the abuses; identification, dissemination and the implementation of the new Universal Rights of Childbearing Women; and implementation research to expand the evidence base on what it takes to tackle this problem effectively.  Many people and organizations are working on this and I am delighted that the United States Agency for International Development is supporting this work in country settings, in partnership with many others, to ensure that all women are treated with the respect and compassion during childbirth that they deserve.

Originally posted at the White Ribbon Alliance blog

 

A Triumph of Coordination: To the Last Case in India and Beyond

Ellyn Ogden delivers a polio vaccine in Kolkata. Photo credit: CORE Group

Ellyn Ogden has coordinated USAID’s polio eradication initiative since 1997 and is a frequent visitor to India.

Western Uttar Pradesh was once seen as the world’s largest reservoir of polio virus. Four districts, namely Moradabad, Bareilly, Rampur and Badaun, were considered the ‘Hot 4’ and for many years, people speculated that the last polio cases would be from these districts. But the skeptics were wrong. The districts pulled together, involved all ministries, not just the health sector, and held everyone accountable for performance. The District Magistrates took charge and became personally involved in solving any obstacles that would crop up. Vacant medical officer positions were filled and progress was monitored closely.

Across India messages travelled the TV and radio airways. Celebrities and sports legends lent their support. Rotarians urged everyone to participate, provided much needed financing, and rolled up their sleeves to help out during the campaigns. CORE and UNICEF Mobilizers spent countless hours answering mothers’ questions, and in some places visited every pregnant woman to sensitize her in advance of the need for immunization. When the baby was born, the mother would then receive a ‘congratulations’ card, an immunization card and education on how to protect the child from a range of diseases. These extraordinary efforts make a difference far beyond polio eradication.

The last polio case in India was in Howarah District of West Bengal. It was not in the ‘Hot 4.’ It was in a child who was never vaccinated against polio in the routine system. It was in an unexpected area, demonstrating the importance of a robust surveillance system. The rapid outbreak response by the West Bengal government has been exceptional. The health team in the area knows how fragile the situation is. Still, far too many families refuse vaccination, there are periodic shortages of the trivalent vaccine used in the routine system, there are vacant medical officer posts, and routine immunization sessions happen once a month rather than the needed once a week in many rural areas.

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