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Archives for Global Health

Invest in Health Workers to End AIDS

A nurse in the perinatology unit at the Jaime Moto Regional Hospital in Barahona attends to a newborn after receiving training in preventing mother to child transmission of HIV. The training was conducted through CapacityPlus, a USAID-funded project to strengthen the health work force in the Dominican Republic. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

A nurse in the perinatology unit at the Jaime Moto Regional Hospital in Barahona attends to a newborn after receiving training in preventing mother to child transmission of HIV. The training was conducted through CapacityPlus, a USAID-funded project to strengthen the health work force in the Dominican Republic. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

The recent focus on Ebola in West Africa has reminded us of the need for strong and resilient health systems. Behind every quality health system is an army of available and accessible health workers. However, in facilities and communities across the globe, health worker vacancies and weak support systems hamper achievement of health goals and threaten overall preparedness for future infectious diseases.

In most countries with a high HIV burden, health work force shortages are commonplace and create significant barriers to combating the epidemic.

Much has been accomplished. USAID is incredibly proud of its significant contributions to PEPFAR’s (the U.S. President’s Emergency Plan for AIDS Relief) achievements in strengthening the health work force to deliver quality HIV services. On World AIDS Day, Secretary Kerry announced that PEPFAR has exceeded the target of 140,000 new health care workers, which was mandated by Congress in 2008.  This is a great milestone not only for PEPFAR, but also for the broader global health work force agenda.

A strong health work force composed of both facility- and community-based workers is essential for achieving an AIDS-free generation. Health workers are key to making sure that people living with HIV access the appropriate services at the right time, ensuring effective linkages across HIV services and clients’ continuum of care. Health workers also play a critical role in providing HIV services to vulnerable populations, including children, adolescents and other key populations.

USAID has an extensive history in training and educating health workers. For the last decade, the Agency has been at the forefront of advocating for a growing focus on the health work force in the global health agenda. USAID has also supported a breadth of innovative program models that have made immense contributions to the health worker target.

A physician and nurse examine a young patient at a clinic in Mbarara, Uganda, one of 11 main service centers and clinics managed by The AIDS Support Organization (TASO), a large local NGO receiving USAID funding to provide care and support for orphans and vulnerable children. / USAID/Tash McCarroll

A physician and nurse examine a young patient at a clinic in Mbarara, Uganda, one of 11 main service centers and clinics managed by The AIDS Support Organization (TASO), a large local NGO receiving USAID funding to provide care and support for orphans and vulnerable children. / USAID, Tash McCarroll

For example, USAID and the Touch Foundation created a PEPFAR-supported public-private partnership in Tanzania to expand training of health workers and strengthen management capacities of the Catholic University of Health and Allied Sciences and Bugando Medical Center. Through this partnership, student enrollment has jumped from 277 students to over 1,800 across 14 different health worker cadres—a sixfold increase since 2004. Enrollment of medical students alone increased from 10 to 750 students over the last 10 years.

The program has also focused on strengthening deployment of graduates to underserved rural areas with the highest prevalence of infant and maternal mortality, HIV and malaria. With 96 percent of medical doctors trained in the program still employed in the Tanzanian health system, the program has become a model for achieving high graduate placement and retention rates.

However, there is still work to be done. Significant health work force shortages remain and systemic challenges continue to impact the support needed to enable and sustain health workers’ delivery of HIV services.

The new PEPFAR Human Resources for Health (HRH) strategy  highlights the need to overcome these barriers. USAID continues to contribute to PEPFAR’s health work force investments by building upon and leveraging past contributions and advancements that span beyond training and include health worker deployment, retention and management.

The strategy’s five objectives outline a common roadmap for ensuring adequate supply and quality of the health work force to expand and sustain HIV and AIDS services:

  1. Assess HRH capacity needs to deliver HIV/AIDS services.
  2. Support adequate supply and appropriate skills mix of health workers to deliver HIV/AIDS services.
  3. Establish recruitment, deployment and retention strategies to ensure a consistent and sustainable supply of trained health workers.
  4. Establish sustainable financing for health workers, which ensures adequate local financing for health workers that provide HIV/AIDS services and sustained capacity for sites where PEPFAR salary support has been transitioned.
  5. Improve health worker performance for service quality.

We often, and rightly so, think about our impact from the perspective of the clients we serve. But it is also important to see through the lens of the health workers who have devoted their lives to serving others and have worked tirelessly in mediocre conditions. What is preventing them from doing their jobs effectively? What additional support do they need? That perspective may help us get one step closer to achieving an AIDS-free generation.

ABOUT THE AUTHOR

Diana Frymus is the Health Systems Strengthening Advisor in the Office of HIV/AIDS

Disruptive Innovations Bringing Nepal Closer to Ending Extreme Poverty

Nurses apply chlorhexidine to the umbilical cord of a newborn at Nepalganj Medical College & Teaching Hospital. USAID is helping Nepal bring the life-saving antiseptic gel to villages, communities and health centers across the country. / Thomas Cristofoletti for USAID

Nurses apply chlorhexidine to the umbilical cord of a newborn at Nepalganj Medical College & Teaching Hospital. USAID is helping Nepal bring the life-saving antiseptic gel to villages, communities and health centers across the country. / Thomas Cristofoletti for USAID

In the maternity ward of a USAID-supported hospital in Dhulikhel, a town on the eastern rim of the Kathmandu Valley in Nepal, I watched a nurse apply a disinfectant gel to the umbilical cord of a newborn baby. That tube of the antiseptic chlorhexidine — worth under 15 cents — has been shown in a randomized control trial, to reduce neonatal mortality by a remarkable 34 percent in Nepal.

All around the country, more than 50,000 female community health volunteers  are sharing this innovation and saving thousands of lives in the process.

Thanks to simultaneous advances in health, education, nutrition and access to energy, Nepal stands at the edge of its prosperity. On the path to overcoming the remnants of internal conflict and transitioning to democracy, the Nepalese have cut extreme poverty by 50 percentage points in the last two decades.

Gita, a female community health worker, visits a pregnant woman and her family to show them how to use the chlorhexidine antiseptic gel and how to apply it to the umbilical cords of newborns.   / Thomas Cristofoletti for USAID

Gita, a female community health worker, visits a pregnant woman and her family to show them how to use the chlorhexidine antiseptic gel and how to apply it to the umbilical cords of newborns. / Thomas Cristofoletti for USAID

Innovative programming like chlorhexidine application is growing more common in Nepal and around the world. USAID is also supporting creative community-based approaches to countering human trafficking, including a novel effort to criminalize organ sales that has won landmark court cases, setting new precedent in Nepalese law for holding traffickers accountable.

Suaahara, a comprehensive nutrition program  that translates to “good nutrition,” teaches skills for nutrient-rich backyard vegetable farming, raising poultry, improving sanitation and hygiene, and controlling pests through demonstration farms and new mothers’ discussion groups.

A focused effort to improve early-grade reading is supporting the Ministry of Education’s School Sector Reform Plan by strengthening curricula and training teachers, school committee members, parents and technical support staff in more than 27,000 Early Childhood Education Development centers across the country. Just a 10 percent increase in the share of students with basic literacy skills can boost a country’s economic growth by 0.3 percentage points, while laying the foundation for their later learning.

We need these kinds of disruptive innovations to help bend the curve toward increased child survival, better access to justice, lower malnutrition, greater literacy and skills, and, ultimately, the end of extreme poverty. Solutions like these will drive broader development progress and elevate our efforts to realize transformative change, and now, 2015, is the time to do it.

This year will be a pivotal year for international development. In Addis Ababa this summer, leaders will come together at the third Financing for Development conference to agree on a new compact for global partnership.

In the fall at the U.N. General Assembly in New York, heads of states will ratify a post-2015 development agenda, a universal, more comprehensive, more ambitious follow-on to the Millennium Development Goals, outlining a vision for the next 15 years of development progress. And in Paris next December, member states will adopt a new agreement to combat global warming at the 21st Conference of Parties to the U.N. Framework Convention on Climate Change.

Substantial challenges lie ahead for Nepal. Tensions from the recent conflict remain, simmering below the surface. The government has set a January 2015 deadline to approve a constitution – after a failed attempt in 2012 – to be followed by local elections, which haven’t been held in 16 years. And a quarter of Nepal’s population still lives on less than $1.25 a day.

Based on current projections, Nepal is likely to eradicate extreme poverty before 2030. If Nepal can navigate the pitfalls ahead, it is well-positioned to see long-term, sustainable growth by developing its immense hydropower potential, exploiting its unparalleled tourist draw, and producing goods and services for the growing middle class on its doorstep – the belt from eastern Pakistan through northern India to Bangladesh that constitutes the most densely populated area on earth.

A worker for Lomus Pharmaceutical packs tubes of a chlorhexidine antiseptic gel that is one of Nepal’s great innovations and success stories in global health. The gel, when applied to the cut umbilical cord stumps of newborns, instead of traditional substances like oil, curry powder or ash, can reduce the risk of infant death by up to a third.  / Thomas Cristofoletti for USAID

A worker for Lomus Pharmaceutical packs tubes of a chlorhexidine antiseptic gel that is one of Nepal’s great innovations and success stories in global health. The gel, when applied to the cut umbilical cord stumps of newborns, instead of traditional substances like oil, curry powder or ash, can reduce the risk of infant death by up to a third. / Thomas Cristofoletti for USAID

While the solution to a vexing challenge like neonatal mortality may seem as simple as applying a bit of antiseptic ointment at the right time, this breakthrough came only after a dedicated and concerted effort to hammer away at the problem. USAID worked in partnership with academic researchers, government service providers, community extension workers, private-sector drug manufacturers and others to rigorously pilot, test and scale the Chlorhexidine project.

One particular obstacle, for instance, was that in much of Nepal mothers traditionally rub substances like cooking oil, ash, or even cow dung, on their babies’ umbilical stumps. For widespread adoption to be viable, USAID and its partners had to develop a gel that could be applied similarly to traditional salves, and spend as much effort on behavior change and institutional strengthening as on the technology.

By focusing our efforts on disruptive innovations such as Nepal’s successful chlorhexidine project and using the U.S. Global Development Lab to design, test and scale similar interventions around the world, USAID will help bend the curve towards the end of extreme poverty.

ABOUT THE AUTHOR

Alex Thier is the Assistant to the Administrator in the Bureau for Policy, Planning and Learning. He tweets from @Thieristan

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Saving Korto and Josephine

This post originally appeared December 31, 2014 on the International Medical Corps website. It has been reposted here with permission.

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Photo courtesy of International Medical Corps

Bong County, Liberia – Korto was admitted to International Medical Corps’ Ebola Treatment Unit (ETU) in late November, while her four-month old daughter Josephine, who tested negative for Ebola, was cared for nearby. Although deeply saddened by being separated from her young baby, Korto maintained such positivity during her treatment. The whole medical team couldn’t help but believe she was going to make it and see her daughter again.

On December 3, a delegation from the U.S. government was visiting the ETU. This happened to be the same day Korto finally received her negative Ebola test, clearing her for discharge. Korto left the patient ward giggling, laughing, and soaking in the cheers from the delegation and ETU staff, and she was finally reunited with Josephine that day.

Korto noticed late that evening that Josephine had diarrhea, as well as a cough and fever. The next morning, Korto was back at the ETU, and our whole team sighed with the saddest disappointment. Seeing mother and baby back in the patient ward was difficult, but our doctors, nurses, and psychosocial support staff encouraged Korto to keep breastfeeding, which provides the best source of nutrition for an infant.

For more than two weeks, Josephine’s condition fluctuated. She would become very sick one day, then a bit stronger the next day, and then very feverish the next. Because Josephine was so small, the only way to give her the additional fluids she needed was through an intravenous drip placed in a vein on her head. There were several days when we held our breath, hoping to see Josephine alive as we began each shift. Eventually she gained strength. Her eyes were no longer puffy and tired but became bright and attentive. She held her little head, now shaved for the IV, higher and higher each day.

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Photo courtesy of International Medical Corps

Finally on December 22, our colleague from the U.S. Navy lab, brought in to expedite Ebola testing in the area, could not hide the excitement in his voice when he relayed the news to the team. Josephine had tested negative for Ebola. Many tears of joy flowed from all of our staff and about everyone else who heard the news. Korto, of course, started dancing and clapping, smiling big with her grin we all love. And for the first time in weeks, Josephine let a small smile peek through.

We have all seen so much devastation working on this outbreak in West Africa. In our ETU, we’ve lost several young patients, but bright moments like seeing Korto and Josephine together and well spur our team to continue the fight against Ebola alongside our partners and the people of Liberia.

To date, International Medical Corps’ Ebola Treatment Unit in Bong County, Liberia, has discharged 74 survivors, including Korto and Josephine. International Medical Corps is operating an additional ETU in Margibi County, Liberia, and has trained over 150 health care and other workers in Liberia to date, including senior management and experts from the Liberian Ministry of Public Works, Ministry of Health and Social Welfare, and the Ministry of Defense. In addition, International Medical Corps teams are also working to fight Ebola in Sierra Leone and Mali.

A Look into the Hot Zone of Sierra Leone’s New Ebola Clinic

“Death is always difficult,” said Elizabeth Stevens, a nurse from Freetown, Sierra Leone.
At her new job, Stevens is forced to confront this stark reality every day, and in a way that she never has before.

“The first day, when I entered the [medical] ward, I was frightened,” said Stevens.  “But now it’s getting better.”

It’s been just a week since a new Ebola treatment unit (ETU) opened on December 1 in the town of Lunsar in Sierra Leone’s Port Loko district—an area with one of the highest rates of Ebola in the country. On its first day of operation, four patients were admitted to the facility being run by International Medical Corps (IMC) with USAID support. USAID provided more than $5 million for the staffing and management of the 50-bed ETU.

According to the ETU’s medical director, some of the facility’s 150 staff members were nervous to start caring for Ebola patients in spite of all the training they received. But by day three, things started coming together.

“For the first two days, you could see people’s anxiety…more of the fear of it being real,” said IMC medical director Vanessa Wolfman. “But we have a great psychosocial team to talk to staff about their fears.  Now we’re getting into a routine. Everyone’s much more comfortable and can rely on each other.”

This reliance and teamwork is evident even before the first patient is seen.  On one end of the medical complex, there’s a small group of people around emergency room nurse Lisa Woods, helping her get into the protective suit, gloves, apron, boots, and goggles that will keep her safe while treating Ebola patients.

“You don’t have any touch with the patients,” said Woods, her voice slightly muffled from the mask covering half her face; giant red goggles cover the other half. “I think that’s the hardest part, not being able to connect with my patients in a human way. Like right now there’s a 14-year-old in there, and boy, that’s hard.”

On the other end of the treatment complex, groups of men and women are washing hundreds of articles of clothing, boots, goggles, and gloves by hand. Right next to them, several people are hooking up a washing machine that was recently delivered—just in time to speed up the laundering process before more patients arrive and the ETU gets busier.

“We are really sympathetic with the patients,” said Idrissa Kamara, a nurse at the ETU. “These people are our people.  So we take great care of them because we don’t want to see them missing.”

Just then, the medical director announces that another ambulance is on its way with a confirmed Ebola patient. Idrissa and the other nurses walk out of the staff rest area, to suit up and take care of another one of their own.


12.4.14-IMC-Lunsar-ETU-one-of-few-places-where-food,-water-could-be-passed-from-safe-zone-to-hot-zone.-photo-Carol-Han-USAID-OFDA

A look into the hot zone: This is one of the few places where water and food could be passed from the safe zone to the patient areas. Orange fencing indicates the areas where staff must be wearing protective clothing. / Carol Han, USAID


12.4.14-Ambulance-delivers-new-patient-to-Lunsar-ETU.-Photo-Carol-Han-USAID-OFDA

An ambulance brings a patient to the newly opened Ebola treatment unit (ETU) in Sierra Leone’s Port Loko district, one of the areas hardest hit by the epidemic. / Carol Han, USAID


12.4.14-Look-inside-PPE-donning-area-at-USAID-supported-Lunsar-ETU-2-photo-Carol-Han-USAID-OFDA

USAID’s Office of U.S. Foreign Disaster Assistance provided $5 million dollars to staff and manage the ETU. USAID partner International Medical Corps (IMC) is running the facility. / Carol Han, USAID


12.4.14-IMC-Dr.-Lisa-Woods-at-Lunsar-ETU-in-middle-of-6-hour-shift-Photo-Carol-Han-USAID-OFDA

Lisa Woods is an emergency room nurse from San Francisco who came to Sierra Leone to work at the USAID-supported ETU.  “To give to somebody, what greater gift is that?” said Woods. Photo credit: / Carol Han, USAID


12.4.14-IMC-Lunsar-nurse-group-hero-shot-1-Photo-Carol-Han-USAID-OFDA

Most of the 150 people working at the ETU are Sierra Leonean. “All of us are working in unity,” said nurse Elizabeth Stevens (far left). / Carol Han, USAID


12.4.14-IMC-Lunsar-ETU-laundry-area-were-goggles-are-washed-1-photo-Carol-Han-USAID-OFDA

Hundreds of articles of clothing, goggles, boots, and gloves are washed every single day by hand. A newly installed washing machine will speed up the laundering process. / Carol Han, USAID


12.4.14-IMC-medical-dream-team-suits-up-for-another-round-in-clinical-ward.-photo-Carol-Han-USAID-OFDA

Dream Team: A group of nurses suit up to go into the patient ward during their six-hour shift. It takes teamwork not only to work with patients, but to get dressed for duty. “It’s really been a great experience,” said Lisa Woods (right). / Carol Han, USAID


12.4.14-IMC-Nurse-Idrissa-2-photo-Carol-Han-USAID-OFDA

“These people are our people,” said Idrissa Kamara, a nurse at the ETU. “So we take great care of them because we don’t want to see them missing.” / Carol Han, USAID

ABOUT THE AUTHORS

The Ebola Disaster Assistance Response Team (DART) is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the U.S. Government, including USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), the U.S. Centers for Disease Control and Prevention (CDC), and the Departments of Defense and Health and Human Services.

The Intersection of HIV/AIDS and Gender-Based Violence: A Critical Connection

A mother plays with her child while waiting for services at Jose Maria Cabral y Baez Hospital in Santiago, Dominican Republic. Health workers and supervisors from this hospital participated in a workshop and supportive site supervision system designed and delivered by the Directorate of STI/HIV/AIDS (DIGECITSS), the health services network (REDES), and CapacityPlus to improve the quality of services to eliminate mother-to-child transmission of HIV and congenital syphilis. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

A mother plays with her child while waiting for services at Jose Maria Cabral y Baez Hospital in Santiago, Dominican Republic. Health workers and supervisors from this hospital participated in a workshop to improve the quality of services to eliminate mother-to-child transmission of HIV. / Wendy Tactuk, courtesy of CapacityPlus and IntraHealth International

This week we mark World AIDS Day. Appropriately, it occurs during the Sixteen Days of Activism Against Gender-Based Violence. Why so appropriate? Because we know that gender-based violence (GBV) prevention and response are critical to effectively treating and reducing the spread of HIV. Though not always self-evident, the connection is clear.

For me, the linkages were driven home during recent conversations I had with health experts in Ghana. While discussing our health programs, I casually asked how important attention to GBV was within efforts to treat and stem the spread of the HIV.  As soon as I asked the question, the room’s atmosphere changed palpably. Everyone sat up and leaned in. People began speaking all at once, tripping over one another to respond. The passion was tangible and the analysis compelling. It was all the more persuasive because it is backed up by research.

In Ghana, the HIV rate is low and declining, though the rate is 15 – 20 times higher for key populations at risk of contracting HIV, which include female sex workers (FSWs) and men who have sex with men.

GBV is particularly common among female sex workers (FSWs), 24 – 37 percent of whom are HIV-positive. How do GBV and HIV rates correlate and relate, and how do we bear that in mind in our work to prevent and treat the infected?

A traditional leader discusses multiple concurrent partnerships, a key driver of HIV in Zambia, during a November 2013 training on HIV/AIDS leadership messaging in Kanyembo Chiefdom in Luapula Province / JSI/SHARe II

A traditional leader discusses multiple concurrent partnerships, a key driver of HIV in Zambia, during a November 2013 training on HIV/AIDS leadership messaging in Kanyembo Chiefdom, Luapula Province. / JSI/SHARe II

Many of my conversations in Accra focused on how to help people change behavior to decrease the risk of transmitting the virus and to increase the likelihood of seeking testing and treatment. The experts discussed how much more difficult it is for a woman or a man to negotiate condom use with an abusive partner.

The victim is less likely to try to persuade the abuser to use protection. The perpetrator is less likely to listen. The practitioners also talked about how victims of gender-based violence have less self-esteem and a lowered sense of self-worth. As a result, victims of abuse don’t believe they have the “right” to receive health services. It is much harder to coax people who face GBV or who fear violence or abandonment to seek services, test for HIV, or to successfully access or adhere to treatment.

A 2010 study of FSWs in Karnataka state, south India, confirmed what the Ghanaians explained to me; fear of partner violence prevented women and girls from seeking health services and from asking their partners to use condoms. The study found that condom use was some 20 percent lower those who had been beaten or raped within the last year compared with those who had not faced such violence.

The experts I spoke with also mentioned how gender-based violence cements relationships in which one partner is clearly dominant; they discussed how that feeling of dominance can give the abusive partner a sense of invincibility, reducing his or her willingness to practice prevention.

If you don’t believe you are vulnerable to harm or disease, there is no need to protect yourself. A 2014 study in South Africa supported this contention. The study, which considered women and girls attending four health centers in Soweto, found that abusive relationships with high levels of male control were “associated with HIV seropositivity.” In relationships where men had a great deal of power or where violence was frequent, researchers found that females were less likely to request condom use and had about a 12 percent greater likelihood of being HIV-positive.

Sometimes, the statistics were actually pretty astonishing.  A 2012 study in Moscow, Russia found that FSWs were more than 20 percent more likely to be HIV-positive or to carry a sexually transmitted infection (STI) if they experienced client violence. In addition, over forty percent of FSWs who were coerced into sex with the police were STI/HIV infected. Researchers concluded that reducing the risk of infection would require decreasing client, pimp and police abuse and coercive behavior.

A 2013 WHO systematic global review and analysis of studies across different HIV epidemic settings underscored the association between GBV and HIV, finding that intimate partner violence increases the risk for HIV infection among women and girls by more than 50 percent, and in some instances up to four-fold.

There are two bottom lines to the research and experiential data. First, reducing and responding to gender-based violence should be a key tool in efforts to prevent the spread of HIV. Second, additional research is needed to understand those violence-reducing interventions that best reinforce HIV prevention and treatment.

USAID has seen important dividends from integrating GBV prevention and response into HIV and AIDS programs in collaboration with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). In Tanzania, USAID has supported development of National Management Guidelines for Health Response and Prevention to GBV, which provide a framework to guide comprehensive management of GBV survivors.

The Guidelines have led to training of health care providers and roll-out of a GBV register at health facilities across the country. In Zambia, USAID with PEPFAR funding, is collaborating with the British Department for International Development (DFID) and six government ministries to strengthen the response to GBV; this includes doubling the number of one-stop centers in several provinces, reaching 5 million adults and children with preventive messages, assisting 47,000 survivors, and training 200 police and justice sector personnel through 2018.

All told, USAID has contributed significantly to important results under PEPFAR; in FY2013, 2.5 million people in 12 countries were reached by efforts to address GBV and coercion, and an additional 800 health facilities began offering GBV screening, assessment and/or referrals to service providers.

The connection between gender-based violence and HIV infection is unambiguous. The data combined with the experience and perspectives of field experts make it clear. As we renew our commitments this week both to combat the spread of AIDS and to prevent GBV, let’s recognize and ensure that programs address the intersection. It could make the difference between the success and failure of efforts around the world.

ABOUT THE AUTHOR

Carla Koppell is USAID’s Chief Strategy Officer. She was formerly the Agency’s Senior Coordinator for Gender Equality and Women’s Empowerment. You can follow her @CarlaKoppell

U.S. Opens New Ebola Clinic in Liberia

Liberia is in the midst of a building boom to help control the spread of Ebola. In support of the Liberian Government’s Ebola response strategy, the United States is in the process of constructing 15 Ebola treatment units (ETUs) in this hard-hit nation. Across the country, teams of workers are busy moving dirt, laying concrete, trucking in construction materials, and erecting large white tents.

The first ETU to be built and staffed by the U.S.—in the city of Tubmanburg—started receiving patients on November 18. Now, a second ETU supported by the United States is operational in the city of Kakata, about 45 miles northeast of Monrovia. Built by the organization Save the Children with support from USAID, the ETU is being run by International Medical Corps (IMC), which is also managing another ETU in Bong County, Liberia.

Members of USAID’s Ebola Disaster Assistance Response Team (DART) visited the site on November 22, joining a Liberian delegation that included the Assistant Minister of Health and county health officials. Below is an inside look at the USAID-supported ETU, including those areas that are currently off limits to cameras now that the facility is open to Ebola patients.

11.22.14-Kakata-ETU-sign-photo-credit-Justin-Pendarvis-USAID-OFDA About an hour’s drive northeast of Monrovia, in the heart of Liberia’s rubber cultivation belt, the second Ebola treatment unit (ETU) in Liberia to be constructed and staffed with U.S. Government assistance is now receiving patients. / Justin Pendarvis, USAID/OFDA


The facility was built by Save the Children with USAID providing construction materials, gravel, cots for patients, generators to power the ETU, and other support.  The red fencing separates public areas from Ebola “hot zones.” Photo courtesy: Justin Pendarvis, USAID/OFDA The facility was built by Save the Children with USAID providing construction materials, gravel, cots for patients, generators to power the ETU, and other support. The red fencing separates public areas from Ebola “hot zones.” / Justin Pendarvis, USAID/OFDA


USAID is funding International Medical Corps (IMC) to operate the ETU in Kakata. Here, USAID Disaster Assistance Response Team (DART) Deputy Justin Pendarvis (left) gets a tour from IMC Emergency Response Team Director Sean Casey (right). / Alisha McMichael, USAID/OFDA USAID is funding International Medical Corps (IMC) to operate the ETU in Kakata. Here, USAID Disaster Assistance Response Team (DART) Deputy Justin Pendarvis (left) gets a tour from IMC Emergency Response Team Director Sean Casey (right). / Alisha McMichael, USAID/OFDA


More than 160 people—mostly Liberian national staff—work at the ETU. For the past two weeks, IMC’s medical team received rigorous training on Ebola patient care, safety protocols, and ETU management. Photo courtesy: Alisha McMichael, USAID/OFDA More than 160 people—mostly Liberian national staff—work at the ETU. For the past two weeks, IMC’s medical team received rigorous training on Ebola patient care, safety protocols, and ETU management. / Alisha McMichael, USAID/OFDA


The 88-bed ETU, which opened on November 22, has received a number of patients. Some were discharged after testing negative for Ebola. Photo courtesy: Alisha McMichael, USAID/OFD The 88-bed ETU, which opened on November 22, has received a number of patients. Some were discharged after testing negative for Ebola. / Alisha McMichael, USAID/OFD


NO DETAIL OVERLOOKED: Inside the clinical care areas are electrical outlets where patients can play music or charge their cell phones to keep in touch with their loved ones. USAID provided generators to power the ETU. / IMC NO DETAIL OVERLOOKED: Inside the clinical care areas are electrical outlets where patients can play music or charge their cell phones to keep in touch with their loved ones. USAID provided generators to power the ETU. / IMC

ABOUT THE AUTHOR

The Ebola Disaster Assistance Response Team (DART) is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the U.S. Government, including USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), the U.S. Centers for Disease Control and Prevention (CDC), and the Departments of Defense and Health and Human Services.

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Key Populations Essential to Realize AIDS-Free Generation

Sex worker working on the Phnom Penh riverside. /  Ian Taylor

Sex worker working on the Phnom Penh riverside. / Ian Taylor

As we commemorate World AIDS Day this year, let’s take a moment to remember how far we’ve come, and where we must go. There are currently 35 million people living with HIV worldwide, and 13.6 million of those people are receiving antiretroviral therapy. New HIV infections continue to decline each year, with 2.1 million in 2013, which was 38 percent lower than in 2001. However, over 4,000 people continue to die from AIDS each and every day.

In accordance with the immense toll that HIV and AIDS have taken on the world, the U.S. Government established the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 as the single largest commitment by any nation to combat a single disease. Since then, working closely with many partners, PEPFAR has supported lifesaving antiretroviral therapy for more than 6.7 million men, women and children. As a key implementing agency of PEPFAR, USAID has made significant contributions to this remarkable progress. But, together, we have more work to do to finish the job.

UNAIDS has identified the 90-90-90 targets by 2020. These milestones aim to have 90 percent of people living with HIV know their status, 90 percent of people who know their status receive treatment, and 90 percent of people on HIV treatment having a suppressed viral load so their immune system remains strong and they are no longer infectious. In order to achieve these goals and have a lasting response to this epidemic, we must examine what is required to sustain HIV treatment for decades to come.

India World AIDS Day 2008 / AFP/Narinder Nanu/Getty Images

India World AIDS Day 2008 / AFP/Narinder Nanu/Getty Images

The vision for the next phase of PEPFAR is partnering to deliver an AIDS-free generation with sustainable results.However, a sustainable response to this epidemic requires intensified action to address major ongoing challenges such as health care financing, health systems and new technologies for treatment and prevention. And there is a special need for increased attention to the human rights of key affected populations. These include sex workers, men who have sex with men, transgender persons and persons who inject drugs.

The high vulnerability of key populations to HIV is disturbing. Compared to the general population, sex workers are 14 times more likely to be infected with HIV; men who have sex with men are 19 times more likely to be infected; and the limited data we have on transgender women suggest that they are 49 times more likely to be infected with HIV. Equally unsettling are the global estimates that the number of people living with HIV who inject drugs range from over 1 million to slightly less than 4 million people.

Barriers to essential services prohibit these figures from coming down. Stigma and discrimination, violence, criminalization, bad or ineffective policies, and opposition to civil society engagement present real challenges. One of the most egregious barriers is the lack of acknowledgement by governments and other leaders that key populations even exist and/or are underserved. As I have observed over the years, the most insidious form of oppression is to ignore a people.

Fortunately, that pessimistic view is tempered by the knowledge that these barriers can be overcome. We know from experience that effective programs can reach key populations with high quality, effective services, and that key populations infected with HIV can be linked to the care and treatment services that they desperately need. On Thursday, Dec. 4, we will highlight the importance of key populations in the HIV epidemic at the D.C. launch of USAID’s PEPFAR-funded LINKAGES project.

The U.S. Government’s official theme for World AIDS 2014 is Focus, Partner, Achieve: An AIDS-free Generation. This theme captures the core elements of what is needed to reach this goal, which is outlined in the PEPFAR Blueprint. We must deliver the right thing, in the right place and at the right time. This means focusing on the highest impact interventions, bringing them to scale in key geographic areas and among the most vulnerable populations, including men who have sex with men, sex workers, injecting drug users, and transgender persons.

On this World AIDS Day, nearly 35 years into the epidemic, I am extremely proud of our collective progress. But, while an AIDS-free generation is within our reach, we must not stop until it becomes our reality.

ABOUT THE AUTHOR

David Stanton is the Director of USAID’s Office of HIV/AIDS

Building Ebola Treatment Units to Foster Hope, Healing in Liberia

Liberian Vice President Joseph Boakai, middle, gets a tour of the U.S.-built Tubmanburg Ebola treatment unit from USAID partner International Organization for Migration, which will be running the facility / Carol Han, USAID/OFDA

Liberian Vice President Joseph Boakai, middle, gets a tour of the U.S.-built Tubmanburg Ebola treatment unit from USAID partner International Organization for Migration, which will be running the facility / Carol Han, USAID/OFDA

In the Bomi Hills northwest of Monrovia, in an area that used to be the region’s iron and diamond mining center, it’s hard to miss the new “precious resource” that has become critical to Liberia’s fight against Ebola.

Four stark white tents gleam in the sun, the most prominent part of the new Ebola treatment unit (ETU) in Tubmanburg, which is the first ETU to be built and staffed by the United States in Liberia.

Liberian Army Capt. Glee Dilliard Dada led a team of Liberian soldiers who worked closely with the U.S. military to build the facility. Despite the rain, heat and construction setbacks, the Ebola treatment unit was built in 35 days / Carol Han, USAID/OFDA

Liberian Army Capt. Glee Dilliard Dada led a team of Liberian soldiers who worked closely with the U.S. military to build the facility. Despite the rain, heat and construction setbacks, the Ebola treatment unit was built in 35 days / Carol Han, USAID/OFDA

Construction on the 2-acre site was overseen by the U.S. Defense Department in close partnership with the Armed Forces of Liberia. More than 60 people had to overcome the rain, heat, poor roads and supply shortages to build the site in 35 days, completing the ETU earlier this month.

“Especially in this time of national crisis, it has been rewarding to be out here and assisting,” said Armed Forces of Liberia Capt. Glee Dilliard Dada, who supervised the Liberian military construction crew. “I am very overwhelmed with a lot of pride. In a month’s time we did all of this.”

The Ebola treatment unit (ETU) in Tubmanburg is the first ETU to be built and staffed by the United States in Liberia / Carol Han, USAID/OFDA

The Ebola treatment unit (ETU) in Tubmanburg is the first ETU to be built and staffed by the United States in Liberia / Carol Han, USAID/OFDA

USAID Disaster Assistance Response Team leader Bill Berger called the ETU an extraordinary effort, saying, “It took strong partnership to build this ETU. It will also take strong partnership to provide care to patients.”

USAID partner the International Organization of Migration, or IOM, has stepped forward to manage the ETU under the leadership of the Liberian Ministry of Health and Social Welfare. For the past two weeks, IOM’s medical team—made up of local and international health care workers—received rigorous training on Ebola patient care, safety protocols and ETU management.

Within the 2-acre site is a changing area where local and international staff with the International Organization for Migration will be donning googles and other protective equipment to care for patients. / Carol Han, USAID/OFDA

Within the 2-acre site is a changing area where local and international staff with the International Organization for Migration will be donning goggles and other protective equipment to care for patients. / Carol Han, USAID/OFDA

More than 120 members of IOM’s team are now prepared to care for patients. Tejanie Golafaley, a local resident and Ebola survivor, is especially eager to speak to patients at the ETU about his experience beating the disease.

“When I got Ebola, people didn’t want to come around me. I was stigmatized by Ebola,” Golafaley said. “The best thing I can do is talk to [patients] …. I’m going to tell them I’m a survivor. I want to give them hope.”

Tejanie Golafaley, an Ebola survivor, saw it as his personal mission to work at the USAID-supported Ebola treatment unit in Tubmanburg. “I want to explain my story to patients [so that] they can start to take courage.” / Carol Han, USAID/OFDA

Tejanie Golafaley, an Ebola survivor, saw it as his personal mission to work at the USAID-supported Ebola treatment unit in Tubmanburg. “I want to explain my story to patients [so that] they can start to take courage.” / Carol Han, USAID/OFDA

ABOUT THE AUTHOR

Carol Han is the Press Officer for USAID’s Ebola Disaster Assistance Response Team [DART], which is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the government, including USAID’s Office of U.S. Foreign Disaster Assistance, the U.S. Centers for Disease Control and Prevention, and the Departments of Defense and Health and Human Services.

Recapturing Growth in Ebola-Stricken West Africa

With funding and support from USAID, construction crews work quickly to build a new Ebola treatment unit in Monrovia, Liberia, in front of the former Ministry of Defense building, Oct. 1, 2014

With funding and support from USAID, construction crews work quickly to build a new Ebola treatment unit in Monrovia, Liberia, in front of the former Ministry of Defense building, Oct. 1, 2014 / Morgana Wingard

Unlike a civil war or natural disaster, an epidemic does not destroy property. But it sharply increases the cost of doing business, with powerful effects on employment and investment.

This is happening in Guinea, Liberia and Sierra Leone where the secondary impacts of the Ebola crisis have been seen in terms of shuttered businesses and closed schools. But just as economies can stall during an epidemic, we also know what expedites their recovery—a robust business climate that encourages private sector investment.

New Ebola cases continue to be recorded in Guinea, Liberia and Sierra Leone, but as health workers have begun to contain the epidemic, we are already turning our attention, in partnership with host governments, to the task of restoring business activity in these countries. Liberia and Sierra Leone had been growing strongly before the crisis, driven largely by foreign direct investment in the mining sector; Guinea’s growth was weaker but had been expected to increase in 2014. All three economies have contracted sharply in the latter half of 2014, with full-year gross domestic products now expected to be at or below 2013 levels.

A first look at a 25-bed critical care hospital—staffed by U.S. medical professionals—in Harbel, Liberia, that will treat all Ebola health care workers in the country, Oct. 15, 2014

A first look at a 25-bed critical care hospital—staffed by U.S. medical professionals—in Harbel, Liberia, that will treat all Ebola health care workers in the country, Oct. 15, 2014 / Morgana Wingard

Public and private investment plans have been scaled back, suggesting that slow growth will linger through 2015 even if the epidemic is contained early in the year. This is actually not driven primarily by the loss of labor to sickness and health care, but rather by what economic epidemiologists call “social distancing”—when people avoid interacting with each other in order to avoid a perceived risk of viral transmission.

The benefits to workers, firms and farms to restoring normal economic activity can provide a powerful counterbalance to the effects of social distancing, suggesting that capacity utilization, employment and income will rebound as the epidemic is contained.  But tomorrow’s economy depends on today’s investment. The pace of economic recovery will therefore depend crucially on how private-sector firms view the evolving business environment.

Containing the outbreak will do much to restore that environment, but firms across the size spectrum—including potential new entrants—will be wary of their exposure to health-related losses even as the overall health system is strengthened. Reforms that enhance the quality of regulation and reduce the costs of doing business are therefore crucial components of the recovery effort.

Pick-up trucks-turned-ambulances drive hours through dirt roads in Bong County, Liberia, to collect patients, Oct. 9, 2014

Pick-up trucks-turned-ambulances drive hours through dirt roads in Bong County, Liberia, to collect patients, Oct. 9, 2014 / Morgana Wingard

The World Bank’s newly released business-climate survey of 189 economies—Doing Business 2015:Going Beyond Efficiency—highlighted sub-Saharan Africa as home to five of the 10 top reformers, four of which are in West Africa. “Doing business” reforms are changes in the procedure, time or cost of conducting business in a country, such as reducing the time it takes to get a construction permit or the number of approvals required to open a business. USAID has supported the Doing Business project since its inception in 2004.

Several of the highlighted business reforms from this year’s top reformers in West Africa (Benin, Cote d’Ivoire, Senegal and Togo) were the result of coordinated harmonization efforts led by the Council of Ministers of the Organization for Harmonization of Business Law in Africa. These efforts encouraged  business-friendly innovations throughout the region such as one-stop shops for registering a business, easier land registry and transfer processes, and improved credit information systems—including in the countries most affected by the outbreak.

Liberia and Sierra Leone took the impressive step of establishing public credit registries in the past year, making it easier to get credit in these countries. The resolve demonstrated by member governments in setting a regional reform agenda and implementing meaningful changes for business also bodes well for increased regional trade, which USAID supports through its regional Trade Hubs in West, East and Southern Africa.

USAID has been working with many of the reformers highlighted in this year’s report and will continue to partner with governments in the region as they tackle both the immediate challenges and the secondary effects of Ebola. Better regulatory environments, supported by governments taking the right steps to attract both domestic and foreign investment, will help these countries recover and prosper in the future.

ABOUT THE AUTHOR

Stephen O’Connell is the Chief Economist for USAID

You Can’t Save Lives if you Don’t Fight Pneumonia

MCHIP immunization work in India.

MCHIP immunization work in India / JSI

For many problems in global health, we struggle to know the solutions.

Pneumonia is not one of them.

Since passing the 500 day countdown in August, the global public health community has talked a lot about what it will take to meet the ambitious Millennium Development Goals (MDGs). And one thing is clear: achieving MDG 4 – to reduce child mortality by two-thirds by 2015 – will not be realized without better addressing pneumonia, the leading killer in children under 5.

The good news is that pneumonia is preventable—and that safe, effective and affordable tools are helping to avoid and treat the disease.

Nepali village health worker counting the respirations of a sick infant

Nepali village health worker counting the respirations of a sick infant / JSI/Nepal Family Health Initiative

Pneumonia can be prevented by feeding children micronutrient rich foods, ensuring proper hygiene, including frequent hand-washing, and improving indoor air quality through well-ventilated cooking areas.

Most of all, the disease can be prevented by ensuring all children are vaccinated on schedule and treated promptly and appropriately if signs of pneumonia appear.

Devoted to combating the causes of under-5 morbidity and mortality, USAID’s flagship Maternal and Child Survival Program (MCSP) is celebrating this World Pneumonia Day by working to ensure that every infant in the developing world is fully immunized.

Health worker in Mali assessing the respiratory rate of a sick child

Health worker in Mali assessing the respiratory rate of a sick child / JSI

In 2013, MCSP’s predecessor program—the USAID-funded Maternal and Child Health Integrated Program—joined USAID and more than 100 partner organizations, along with national and global experts, to express support for WHO and UNICEF’s first-ever global action plan to simultaneously tackle the two leading killers of children—pneumonia and diarrhea. Implementation of this plan, linked with ownership by national governments and partners’ involvement, will make these goals a reality.

The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPP-D) calls on all parties to coordinate their approach to fighting pneumonia and diarrhea, for which there are complementary interventions to provide protection, prevention and treatment.

Immunizing in Kenya

Immunizing in Kenya / MCHIP

On this day of reflection and action, let us commemorate the brief lives of the children lost to pneumonia—nearly 1 million every year worldwide—by vowing to support and focus on implementing the Global Action Plan and strengthening countries’ routine health systems in partnership with communities.

The fight against this deadly disease can be won. Children are not dying because effective interventions do not exist; they are dying because these interventions are not readily available for all. To dramatically reduce child mortality, we must achieve high and equitable coverage.

Through effective use of pneumococcal (PCV), Haemophilus influenzae type b (Hib), and rotavirus vaccines, vitamin A, zinc, oral rehydration solution, breastfeeding and other interventions, we can address MDG4.

Collectively around the world, we owe it to the future generation to give them the best start in life and protect them from preventable and treatable diseases like pneumonia.

ABOUT THE AUTHORS

Robert Steinglass is the Immunization Team Leader and Katrin DeCamp is the Senior Communications Specialist for USAID’s Maternal and Child Survival Program.

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