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Global Leadership, Collaboration Aligned in the Fight Against Tuberculosis

Tuberculosis preys on the urban poor. ​​In the photo, the family of Rehmat Shek deals with the disease in Rafik Nagar slum in India. Global leaders in the fight against TB hope to end the epidemic by 2035.

Tuberculosis preys on the urban poor. ​​In the photo, the family of Rehmat Shek deals with the disease in Rafik Nagar slum in India. Global leaders in the fight against TB hope to end the epidemic by 2035. David Rochkind / WHO

With approval of the post-2015 global tuberculosis strategy by the World Health Assembly, the global community stands united as we work toward ambitious new targets for 2025 and 2035 to end the global TB epidemic. As we look to the future, it is important to evaluate the current global response to the epidemic so we may develop an effective and coordinated approach going forward. Major investments in TB by high-burden countries, the U.S. Government, the Global Fund (GF), the World Health Organization (WHO) and others have led to impressive progress and shown the potential for future impact. Promising new tools are now finally available, with others in the pipeline, and governments, donors and partners are allied around a new strategy with refocused resources.

Where are we succeeding?

TB kills three people a minute, is a security threat to the world, and puts health care personnel and poor and marginalized populations at risk around the globe. Yet, TB treatment is one of the best buys in global health – the disease is almost always curable (unless resistant to major drugs) with inexpensive medications and low-cost delivery approaches, and has been considered in various assessments as one of the most cost-effective public health interventions. New and cheaper models to diagnose and treat multidrug-resistant TB are being scaled up in many high-burden countries and the cost of second line drug treatment regimens to cure TB have decreased by 32 percent, thanks to efforts by the Global Drug Facility (GDF).

In the space of 17 years since the implementation of a new standard approach to control TB, 56 million people across the globe have been successfully diagnosed, treated and cared for, and WHO estimates that 22 million lives have been saved by using comprehensive and proven approaches to TB care[U1] , compared to what would have occurred if previous standards continued. These milestones reflect the ongoing commitment of governments and the global community to transform the fight against TB and work toward elimination of this major public health problem and global threat. Since 1990, TB deaths have declined by 45 percent and TB prevalence has declined by 37 percent globally. The world is now on track to meet the MDG target of 50 percent reduction in mortality by 2015.

Key ingredients to success and readiness to face challenges:

1.  Proven strategies, collaboration and leadership. Coordination and harmonization of efforts were the key to high effectiveness and success. The national programs take the lead in establishing policies aligned with international best practice and ensuring their implementation within primary care services. A clearly budgeted national strategic plan is fundamental to optimizing the use of resources and identifying gaps. Technical partners and financiers support the plan in a uniform manner. Supporting this model, the U.S. Government is the largest bilateral donor for TB and USAID serves as the lead agency for international TB control. Without this current systematic response, we will miss out on opportunities with endemic country partners and governments. Most importantly, progress in saving lives will be slowed.

 2.  Boots on the ground.  The U.S. bilateral program works directly with local governments and ministries of health to develop country-owned approaches and build national capacity so countries can successfully implement their TB care and treatment programs. This close collaboration with ministries of health has resulted in faster detection and treatment of TB; scaled-up prevention and treatment of multi-drug resistant TB (MDR-TB); expanded coverage for interventions for TB/HIV; and improvements in the health system. This approach also improves the strategic use of GF and domestic resources as well as the quality of TB programs.

3.  Resource Allocation and Realignment. The Global Fund and the United States both recently realigned their resources to further strengthen the next phase of TB response and focus where the need is greatest to sustain value and resolve outstanding challenges. Among the concerns faced by countries are ability to match external financing, coverage of services, and the MDR-TB and TB/HIV burdens. Since 2009, the U.S. Government has allocated almost $3.3 billion towards implementation of TB programs in high-burden countries with over $600 million in FY13 (see table below). The U.S. bilateral program, led by USAID, is focused on countries with the greatest TB burden and need. The current 27 USAID-supported countries carry almost 70 percent of the world’s annual TB cases, not including China. Through its new funding model, the GF has also redefined support for TB.  Twenty-four of the eligible countries account for 79 percent of the world’s annual TB cases (not including China) and have been allocated almost 60 percent of the total of TB funds. The GF has increased TB resources from 16 percent to 18 percent of all funds for 2014-2017.

Funding Stream

2009 (USD M)

2010 (USD M)

2011 (USD M)

2012 (USD M)

2013 (USD M)

2014 (USD M)

USAID TB Bilateral[1]

176

249

238

256

232

244

PEPFAR TB/HIV[2]

150

137

152

132

132*

132*

USG Portion of GF TB Grants**[3]

129

172

145

166

242

213

Total TB funding for Country Implementation

455

558

535

554

606

589

*Assumed flat-line budget numbers based on the public FY12 figures.

**This represents 1/3 of the total TB allocations to countries in each year. It is the actually disbursement of TB funds for in this year. Note, the increase in 2013 is due to a large increase in distribution of funds for India.

 4.  Research and Innovation. After decades of using outdated tools that limited achievements, the TB community now has newer rapid molecular diagnostics, modernized approaches and new medicines already available for the treatment of MDR-TB. With the introduction of an innovative diagnostic test, Xpert, countries can implement faster and better detection of TB and drug resistant TB.  Further, the price buy-down of this new technology by the U.S. Government, the Bill & Melinda Gates Foundation and UNITAID has ensured rapid adoption and implementation of Xpert by over 100 low- and middle-income countries. In addition, new TB treatment regimens that use novel drugs and will bring renewed hope for TB patients are under study, including the expanded STREAM study (a 9 month MDR-TB regimen with a new drug) and the PaMZ study that is evaluating the efficacy, safety and tolerability of a treatment regimen for both drug susceptible and drug-resistant TB. Lastly, the work of the Global Drug Facility, supported by the U.S. Government, has ensured that quality, affordable second line drugs are available as countries scale-up MDR-TB treatment. USAID has collaborated with the Global Drug Facility and other partners to support over 40 manufacturers to improve the quality and availability of second-line drugs and make MDR-TB treatment more affordable.

A doctor visits a patient at the Group of TB Hospitals in Mumbai during the daily rounds. / David Rochkind, WHO

A doctor visits a patient at the Group of TB Hospitals in Mumbai during the daily rounds. / David Rochkind, WHO

Future Strategic direction: 

The post-2015 Global TB Strategy approved at the World Health Assembly in May 2014 focuses on three pillars including: patient centered care and prevention; bold policies and supportive systems; and intensified research and innovation. The U.S. Government  is developing a new long-term strategy that will align with the recently approved WHO post-2015 strategy to Reach, Cure, and Prevent.  The U.S. Government commits to Reach every person with TB, Cure those in need of treatment and Prevent new infections and spread of the disease. To reach these goals, the different U.S. agencies involved in TB treatment and control will need to leverage their collective strengths and continue to collaborate through existing processes such as a common strategy and joint projects, defined roles, joint reporting and regular coordination.

Filling the Funding Gap – Despite recent wins and progress against TB, the current funding gap of $2 billion per year remains a fundamental challenge to face. The availability of this funding would result in major benefits for a huge number of people. As mentioned in the recent February Lancet commentary, domestic resources should continue to be mobilized for long-term and effective TB care and treatment. The international community must continue to bolster national efforts as well as support the development of global, common goods such as research, affordable and quality TB commodities, and support for innovations and new research. Global partners should help mobilize resources to fill gaps in TB care, including crowding in partner country financing and identifying new partners.

Building a multi-sectoral response – Tuberculosis provides a perfect example of how health security is intimately linked to social and economic development. Ending extreme poverty is critical to global progress on TB as are overarching efforts to achieve universal health coverage. A person’s health status is intimately entwined with underlying poverty, political and social stability, economic growth, food security, education and gender equality.  Development agencies such as USAID, along with U.N. agencies, NGOs and civil society, need to play their part in building cross-sectoral links. Together, we must work in harmony to reduce the social determinants of TB and to reach and serve the poorest and most vulnerable.

Research – The post-2015 goals will be difficult to achieve without a more robust research pipeline. This will require additional funding for research to ensure that the top priorities for innovation are a point-of-care diagnostic, better and shorter regimens and a new vaccine.  New tools for improving approaches at the country level will be necessary to optimize results.

The global fight against TB remains fragile, given resource constraints. Yet, promising new tools are now available, with others in the pipeline, and donors and partners are allied around a new strategy with refocused resources. We are now at a crossroads between ending the TB epidemic by 2035 and witnessing millions more TB deaths. But with continued consultation, coordination and leadership, we believe we will end the epidemic.

 


[1] USAID CBJ budget figures for each year

[2]  PEPFAR FY13 CBJ: http://www.pepfar.gov/documents/organization/222642.pdf

[3] GF website: http://portfolio.theglobalfund.org/en/Home/Index

[U1]Footnote that this is WHO data.

 

ABOUT THE AUTHOR

Dr. Ariel Pablos-Mendez is the Assistant Administrator for Global Health at USAID
Dr. Mario Raviglione is the Director of Global TB Programme for WHO
Dr. Dyah Erti Mustikawati is the NTP Manager at MOH/Indonesia
Mr. Lerole David Mametja is the Chief Director for TB Control and Management at MOH/South Africa

 

10 Reasons Vaccines are the Best Protector of Human Life

A young boy receives an oral polio vaccination at a USAID -funded medical clinic on July 13, 2010 in Petionville, Haiti.  In 2011 in Haiti, the U.S. Government  vaccinated nearly 157,000 children under the age of one for routine childhood diseases and provided more than 350,000 antenatal care visits and more than 131,000 post-partum/newborn care visits.  The United States is providing access to health services for 50 percent of the people of Haiti.  Kendra Helmer/USAID

A young boy receives an oral polio vaccination at a USAID-funded medical clinic on July 13, 2010 in Petionville, Haiti. In 2011 in Haiti, the U.S. Government vaccinated nearly 157,000 children under the age of 1 for routine childhood diseases. / Kendra Helmer, USAID

Immunization is one of the most powerful health interventions ever introduced. Every year, the World Health Organization estimates, vaccines save between 2 and 3 million children from killers such as polio, measles, pneumonia, and rotavirus diarrhea.

To mark World Immunization Week, USAID partner PATH is reporting on the lifesaving potential of vaccines against four illnesses that kill more than 2 million young children a year: malaria, pneumonia, rotavirus, and Japanese encephalitis. Here, Dr. John Boslego, director of PATH’s Vaccine Development Program, lists the top 10 ways vaccines make a difference for children and for global health. This post originally appeared on PATH.

No. 10: Vaccines lower the risk of getting other diseases.

Contracting some diseases can make getting other ones easier. For example, being sick with influenza can make you more vulnerable to pneumonia caused by other organisms. The best way to avoid coinfections is to prevent the initial infection through vaccination.

Here a Nepalese boy demonstrates the water flow of a USAID-built electric tube well used for irrigation in the Terai region of Nepal. Patrick D Smith/USAID

A Nepalese boy demonstrates the water flow of a USAID-built electric tube well used for irrigation in the Terai region of Nepal. / Patrick D Smith, USAID

No. 9: They keep people healthier longer.

Some vaccines protect people for a limited time and require booster doses; others protect for a lifetime. Either way, vaccinated people are much safer from many serious diseases than people who haven’t been vaccinated, both in the short and long term.

As part of a USAID-supported polio initiative, a vaccinator in the Democratic Republic of Congo (DRC) administers the oral polio vaccine March 23 in the Commune of Ndjili, Kinshasa. On that day, Minister of Health, Victor Makwenge Kaput officially launched a vaccination campaign against the wild polio virus in the capital city. USAID/A. Mukeba

As part of a USAID-supported polio initiative, a vaccinator in the Democratic Republic of Congo administers the oral polio vaccine in the Commune of Ndjili, Kinshasa. / USAID, A. Mukeba

No. 8: They are relatively easy to deliver.

Through national immunization programs and mass vaccination campaigns, vaccines can be delivered quickly to large numbers of people, providing widespread protection. Thanks to creative strategies, delivery in even the remotest parts of the world is becoming easier.

USAID and the Medical Relief International Charity (Merlin) support cholera treatment centers in Goma, Democratic Republic of Congo.  Pictured is a young child suffering from cholera and receiving food aid from the Agency.  /  Frederic Courbet

USAID and the Medical Relief International Charity (Merlin) support cholera treatment centers in Goma, Democratic Republic of Congo. Pictured is a young child suffering from cholera and receiving food aid from the Agency. / Frederic Courbet

No. 7: They prevent disease where medical care isn’t an option.

Too many children die because high-quality care is unavailable. When a child in poverty gets sick, medical care could be inadequate or several days’ travel away. Stopping disease before it starts could be that child’s only lifeline.

Solar lights funded by OTI in Cap Haitien and en route to Caracol, Haiti, on Oct. 19, 2012.. / Kendra Helmer/USAID

Solar lights funded by USAID help children read at night in Cap Haitien. Haiti, on Oct. 19, 2012. / Kendra Helmer, USAID

No. 6: They play well with other interventions.

Vaccines complement other global health tools. We’re seeing this with the integrated strategy to protect, prevent, and treat pneumonia and diarrhea through basic sanitation, safe drinking water, hand-washing, nutrition, antibiotics, breastfeeding, clean cook stoves, antibiotics, zinc, oral rehydration solution, and vaccines. Leveraging these tools across diseases could save the lives of over 2 million children by 2015.

This photo took third place in the FrontLines photo contest. Maamohelang  Hlaha tenderly kisses her young son Rebone. An HIV-positive mother of four, Hlaha’s  village is inaccessible by vehicles and a three-hour hike from the nearest health clinic.  She receives HIV treatment through the Riders for Health program, which is funded  by USAID and run by the Elizabeth Glaser Pediatric AIDS Foundation. As part of the  program, pony riders and motorcycle riders transport blood tests, drugs and supplies to  Lesotho’s remote mountain health clinics. The system allows people to receive HIV test  results sooner, access life-saving drugs and ensure an uninterrupted supply of medication.  Rebone, whose name means “we have witnessed,” was born HIV-free in August 2008. / Reverie Zurba, USAID/South Africa

A mother of four who receives HIV treatment through a USAID-funded program tenderly kisses her young son in South Africa. Thanks to the treatment, her son was born HIV-free in August 2008. / Reverie Zurba, USAID

No. 5: They continue to evolve.

Tackling unmet health needs requires us to continue to pursue the next generation of better and more affordable vaccines. Candidates like RTS,S for malaria and ROTAVAC® for the leading cause of severe diarrhea—rotavirus—are two examples of innovative technologies on the horizon that give families and communities more cause for hope.

This photo was chosen as a finalist in the FrontLines photo contest. These schoolchildren in Aqaba, Jordan, are beneficiaries of the Jordan Schools Program and  Education Reform Support Program. Both of these projects are funded by USAID to  support the Jordanian Ministry of Education’s reform efforts in improving the quality of education in the country. March 2011. / Jill Meeks, Creative Associates International

These schoolchildren in Aqaba, Jordan, are beneficiaries the Jordan Schools Program and Education Reform Support Program. Both  are funded by USAID to support Jordan’s efforts to improve the quality of education in the country.  / Jill Meeks, Creative Associates International

No. 4:  They indirectly protect loved ones and communities.

For many diseases, immunizing a significant portion of a population can break the chain of transmission and actually protect unvaccinated people—a bonus effect called herd immunity. The trick is immunizing enough people to ensure that transmission can’t gather momentum.

A little girl in Tajikistan eats mashed potatoes with greens, which her mother prepared for her. Over 5,000 Tajik children under 5 years old tasted new foods such as pancakes ("blini") with cottage cheese and vegetable salads that their mothers prepared for them after a training. / USAID

A little girl in Tajikistan eats mashed potatoes with greens, which her mother prepared for her. Over 5,000 Tajik children under 5 years old tasted new foods such as pancakes (“blini”) with cottage cheese and vegetable salads that their mothers prepared for them after a USAID-supported nutrition training. / USAID

No 3: They are safe and effective.

Vaccines are among the safest products in medicine and undergo rigorous testing to ensure they work and are safe. Their benefits far outweigh their risks (which are minimal), especially when compared to the dire consequences of the diseases they prevent. Vaccines can take some pretty terrible diseases entirely or nearly out of the picture, too. That’s the case with smallpox and polio, and others will follow.

School girls in Sana’a gather for their lesson. Since many girls in Yemen do not attend primary school or graduate from it, recent USAID-backed measures have ensured all girls a right to attend school and increase literacy. / Malak Shaher, USAID/YMEP

School girls in Sana’a gather for their lesson. Since many girls in Yemen do not attend primary school or graduate from it, recent USAID-backed measures have ensured all girls a right to attend school and increase literacy. / Clinton Doggett, USAID

No. 2:  They are a public health best buy.

Preventing disease is less expensive than treating severe illness, and vaccines are the most cost-effective prevention option out there. Less disease frees up health care resources and saves on medical expenditures. Healthier children also do better developmentally, especially in school, and give parents more time to be productive at home and at work.

This image captured top honors in the FrontLines photo contest. These rural schoolchildren participate in the USAID-funded Southern Sudan Interactive Radio Instruction project, which uses radio to broadcast interactive student lessons. The lessons, based on Southern Sudan’s primary school syllabus, complement classroom instruction in literacy, English, mathematics, and life skills for grades one through four. July 2010. / Karl Grobl, Education Development Center Inc.

These rural schoolchildren participate in the USAID-funded Southern Sudan Interactive Radio Instruction project, which uses radio to broadcast interactive student lessons. The lessons, based on Southern Sudan’s primary school syllabus, complement classroom instruction in literacy, English, mathematics, and life skills for grades one through four. July 2010. / Karl Grobl, Education Development Center Inc.

No. 1:  They save children’s lives.

Roughly 2 to 3 million per year, in fact. In short, vaccines enable more children to see their 5th birthdays, let alone adulthood. That’s reason enough to top my list.

Video: Ghanaian Town Takes on Malaria

A couple in Ghana sits with an insecticide spray technician. / Erin Schiavone, Abt Associates

A couple in Ghana sits with an insecticide spray technician. / Erin Schiavone, Abt Associates

When it’s a buggy summer day, Americans may dust off the old bottle of Off, or light a citronella candle. Here, a mosquito bite is a nuisance. In many parts of the world, it’s a deadly killer.

 In 2012, there were still 207 million cases of malaria and over 600,000 deaths –  three quarters were children under 5. Approximately half of the world’s population is still at risk of malaria.

What choices do people in malarial zones have to protect themselves from this flying terror? And what are we doing to help?

 One of the most effective methods being supported by the U.S. President’s Malaria Initiative (PMI) around the world is spraying homes in the areas where the mosquitos live with an insecticide.

According to the World Health Organization an estimated 3.3 million lives were saved as a result of the scale-up of malaria control interventions over the last decade. Over the same period, malaria mortality rates in African children were reduced by more than half.

This delivers a massive, concerted blow to the mosquito population. In order to have an impact, indoor residual spraying, as it is called, must be carried out in least 80 percent of the homes in malaria-prone areas, use an effective insecticide and be executed by a well-trained workforce.

In Ghana, the entire population of 25 million is at risk for malaria; indoor residual spraying is helping protect families from this deadly disease. But it doesn’t happen on its own. A network of “social mobilizers” help communities realize the benefits of spraying, and encourage other health-improving behavior as well.

Bertha Moisob a passionate public health advocate working on a PMI-funded program in Ghana says this:

“My hope for the future is to see that reduced malaria burden.. Children are healthy, pregnant women delivery safely…”

Watch this video on how Bertha and her community are mobilizing against malaria

Full Speed Ahead on Malaria

 

Rear Admiral Tim Ziemer / Platon

Rear Admiral Tim Ziemer / Platon

Today, the greatest success story in global health is anchored by a continent once known mostly for famine and war. Many countries in sub-Saharan Africa are making unprecedented gains in child survival and reducing the devastating burden of malaria—a disease carried by mosquitoes and a major killer of children.

According to the World Health Organization an estimated 3.3 million lives were saved as a result of the scale-up of malaria control interventions over the last decade. Over the same period, malaria mortality rates in African children were reduced by an estimated 54 percent.

Most Americans are unaware of the devastating impact of malaria. But the insidious disease, a root cause and consequence of poverty, conspire against young children and pregnant women. The anopheles mosquito is a serial killer — a flying syringe that injects parasites during nightly blood meals.

Just a decade ago, the malaria story was one of despair across wide swathes of the African continent, killing more than 1 million people, and burdening health systems — up to 45 percent of all hospital admissions were caused by malaria.

A mother and child under a malaria-fighting bednet. /  Maggie Hallahan

A mother and child under a malaria-fighting bednet. / Maggie Hallahan

I was raised in Asia, and was infected by malaria as a child. Although malaria no longer threatens boys and girls in the United States, across Africa and in parts of Asia, it is still a frightening and literally gut-wrenching fact of life. Each case can be a struggle for survival.

Because malaria remains one of the foremost health problems on the African continent it is vital to test all children with fever and treat those who test positive for malaria as well as provide appropriate treatment to those with non-malaria fevers. With many people living great distances from or lacking transport to health facilities, community health workers are often the first and only link to providing health services essential to child and maternal health.

Community health works, like these in Madagascar, are often the front lines of defense against malaria. Photo Credit: Maggie Hallahan

Community health works, like these in Madagascar, are often the front lines of defense against malaria. / Maggie Hallahan

Thanks in part to American investments made through the U.S. President’s Malaria Initiative (PMI), led by the U.S. Agency for International Development (USAID) and implemented together with the Centers for Disease Control and Prevention (CDC), 61,000 front-line health workers were trained on how to treat malaria cases. Many were also trained to diagnose and treat the other main causes of childhood illness, diarrhea and pneumonia.

In the past year, Americans, through PMI, protected over 45 million people with a prevention measure (insecticide-treated nets and/or indoor residual spraying), as well as procured more than 48 million antimalarial treatments and more than 51 million rapid diagnostic tests.

In Madagascar, people line up to receive insecticide-treated bednets and treatment. Photo Credit: Maggie Hallahan

In Madagascar, people line up to receive insecticide-treated bednets and treatment. / Maggie Hallahan

Success is a triumph of partnership – the initiative was launched by President George W. Bush, and expanded under President Barack Obama. We have benefited from strong bipartisan support in the Senate and House. And with host country government leadership, donors, partners like the Peace Corps, and countless groups like Lutheran World Relief, Catholic Relief Services, Malaria No More and Nothing But Nets – we are taking malaria and other public health interventions the last critical mile, to communities in the most remote parts of malaria endemic Africa.

Commemorating World Health Day

In his State of the Union address, President Obama called upon our nation to join with the world in ending extreme poverty in the next two decades. Today, we have new tools that enable us to achieve a goal that was simply unimaginable in the past: the eradication of extreme poverty and its most devastating corollaries, including widespread hunger and preventable child and maternal death.

Preventing and controlling vector-borne diseases, diseases carried by insects, ticks and small animals, is central to achieving President Obama’s vision of ending extreme poverty. On World Health Day, commemorated each year on April 7, the World Health Organization (WHO) highlights actions we can all take to protect ourselves from the serious diseases that these “vectors” can cause.

Children wash their hands in Ghana, where USAID supports prevention and treatment of trachoma, a blinding eye disease.  International Trachoma Initiative (ITI) ..

Children wash their hands in Ghana, where USAID supports prevention and treatment of trachoma, a blinding eye disease.
International Trachoma Initiative (ITI) ..

More than half of the world’s population is at risk from vector-borne diseases, such as malaria, dengue fever and neglected tropical diseases. The most commonly known vectors include mosquitoes, sandflies, bugs, ticks and snails, which are responsible for transmitting a wide range of parasites and pathogens contributing to deadly diseases.

Senegal: Demonstrating the proper use of ITNs in Senegal. Photo Credit: Maggie Hallahan

Senegal: Demonstrating the proper use of ITNs in Senegal. Photo Credit: Maggie Hallahan

Below, we highlight solutions to combat extreme poverty and vector-borne diseases.

Solutions

  • In this scene-setter, USAID Administrator Rajiv Shah explains how USAID and its partners have embraced the challenge of creating a world without extreme poverty.
  • In “A Call to Action to End Extreme Poverty,” Alex Thier and Ilyse Stempler discuss how USAID and its partners are adopting an integrated, holistic approach that capitalizes on their collective expertise. They share past successes in addressing extreme poverty and introduce some new ideas to finish the job.
  • In “Your Voice,” a continuing FrontLines feature, Adm. Tim Ziemer, U.S. Global Malaria Coordinator, shares his perspective on leading a major presidential initiative to end deaths from malaria
  • Katherine Sanchez profiles Ghana’s efforts to become the first country in sub-Saharan Africa to eliminate trachoma, the world’s leading cause of preventable blindness.
  • A Yumbe survey team learns how to use electronic tablets to collect data on trachoma.  Christine Ninsiima

    A Yumbe survey team learns how to use electronic tablets to collect data on trachoma.
    Christine Ninsiima

    And in “Trachoma vs. Technology,” Phil Downs and Scott Torres uncover efforts to capture and analyze data quickly on mobile electronic tablets in rural Uganda. This approach is transforming the battle against an ancient eye disease, for which timely treatment can prevent blindness.

  • Students prepare to take part in a mapping survey at Pav Primary School in Rattanakiri.  Credit: Chan Vitharin ..

    Students prepare to take part in a mapping survey at Pav Primary School in Rattanakiri.
    Credit: Chan Vitharin ..

    In “Wiping Snail Fever Off Cambodia’s Map – by Drawing It On,” Sokhon Sea delves into an effort to enlist many, including school children, on a mission to wipe out the infection that can lead to debilitating illness and malnutrition and cognitive difficulties in children.

  • Finally, Ann Varghese and Chris Glass explore a unique drug-shoe combination that could stomp out two debilitating diseases endemic to Haiti and how wearing new sneakers kicks up that protection even more by creating a barrier between parasites and kids’ feet.

 

Creating an AIDS-Free Generation through Science and Technology

Last year, the United States government provided testing and counseling for more than 57 million people through the President’s Emergency Plan for AIDS Relief (PEPFAR). The program enrolled more than four million men in voluntary medical circumcision programs and supported more than five million orphans and vulnerable children in countries with some of the highest rates of HIV and AIDS. These are just a few of the remarkable achievements that PEPFAR has made over the past decade—a small testament to the hard work of so many who are committed to and work tirelessly every day to achieve an AIDS-free generation. These great achievements, however, would not be possible without inspiring advances in science and technology.

Women can use this ARV-based vaginal gel to protect themselves against HIV. International Partnership for Microbicides

Credit: International Partnership for Microbicides

For the first time, the U.S. Agency for International Development (USAID) – through its Office of Science and Technology - has created an awards program that embodies the agency’s commitment to supporting innovation in science and technology applications. The Pioneers Prize pays tribute to technological advances that offer innovative solutions to critical issues facing global development. By utilizing science, technology and innovation, USAID is working toward its mission to end extreme poverty and promote resilient democratic societies.

As a key implementer of PEPFAR, USAID’s work in HIV and AIDS was well-recognized with this year’s Pioneer Prizes. Awarded three grand prizes, the Office of HIV/AIDS, along with its partners, has been able to share the transformative nature of its work with the rest of the global health and development community.

Among the grand prize winners is the Delivery Team Topping Up (DTTU) program, which uses vendor-managed inventory principles to “top up” supplies, such as condoms and HIV test kits, at public health facilities. To date, the program has serviced 1,800 clinics in Zimbabwe.

The PLACE Method, also a recipient, applies new technologies in HIV and STI testing, spatial mapping, epidemiologic theory and empiric evidence to address the problem of obtaining valid information that can prevent the spread of infections in sex workers and injecting drug users. It targets geographic areas with high rates of infection and the venues where people at high-risk meet. It then uses low-cost GPS receivers and Google Earth to identify gaps in prevention programs.

Finally, Tenofovir gel, a vaginally applied antiretroviral microbicide used to prevent HIV infection, gives women an alternative method to keep themselves safe during unprotected sex. Tested in the CAPRISA 004 trial, Tenofovir gel reduced HIV acquisition by an estimated 39 percent overall and by 54 percent in women with high gel adherence. While still awaiting the results of an ongoing confirmatory trial, regulatory approval, and scale-up, the CAPRISA 004 trial demonstrated for the first time that a microbicide has the potential to drastically reduce HIV infection for women.

With these awarded innovations, it is clear that USAID’s work toward HIV and AIDS prevention through PEPFAR remains essential to achieving our mission of ending extreme poverty. With the commitment, innovative spirit, creativity and hard work of our partners, USAID is continuously using science and technology in unprecedented ways to make great strides toward an AIDS-free generation.

Let’s Stand Up For Inclusion, Not Exclusion

The stigma and discrimination faced by people living with HIV/AIDS continues to be a roadblock for access to critical prevention and care. Yet every day I see significant steps that are being taken to overcome this obstacle, especially efforts led by USAID.

I was invited to speak at the USAID-funded Panos Caribbean media launch of its latest publication, “Speaking Out! Voices of Jamaican MSM.” This publication is a compilation of oral testimonies from the men having sex with men (MSM) community in Jamaica and an important product by the Panos Caribbean/World Learning project which works to strengthen and improve the livelihoods of these men. Through this publication, Panos Caribbean develops public awareness about the issues affecting the MSM community and promotes through the media, tolerance and accountability for MSM who are impacted by HIV/AIDS.

Denise A. Herbol

Denise A. Herbol

The social complexities surrounding the MSM community in Jamaica is often polarizing to the public.  There is serious stigma attached to any activities by this community. This is compounded by the fact that HIV remains a complex issue among the most-at-risk populations in Jamaica, including the MSM community. Current statistics on HIV prevalence rates in Jamaica are 1.7% in the general population, or roughly 32,000 persons living with AIDS. Figures are significantly higher in a number of high risk groups: for the MSMs, the prevalence rate is 32%, which in many cases can be directly attributed to the stigma, discrimination and fear of violence or legal sanctions.

In an effort to achieve an AIDS-free generation, breaking down the barriers for all individuals is essential. With support from the President’s Emergency Plan for AIDS Relief (PEPFAR), USAID is allocating significant resources to reach populations most at risk for transmitting or becoming infected with HIV/AIDS. PEPFAR seeks to promote an enabling environment of supportive laws, regulations, policies and social norms in order to facilitate meaningful access to HIV services for these populations at both the facility- and community-level.

USAID, in partnership with Panos, is leading positive efforts to promote tolerance and accountability in response to HIV through constructive use of the media.  Panos continues to equip these men with effective tools to expand their voices and concerns so that they can be heard across Jamaica.

Progress will continue to be hampered until we include all people to achieve an AIDS-free generation.  Each of us must do our part to promote inclusivity, celebrate diversity, and eliminate stigma and dehumanizing stereotypes.

Empowering Moms Through mHealth

This blog post originally appeared on The Huffington Post.

My heart smiled the moment the four women entered the meeting room where I had been waiting. I stood to greet them and the babies they carried, eager to hear their stories. The young mothers sat in the chairs across from us and soon the babies were all up on the table, their proud moms making certain that we could see their precious little ones. The youngest baby was 4½ months old, the oldest 14 months. They were all adorable.

USAID harnesses the power of mobile phones to achieve results.

Credit: USAID

The conversation was lively. One young mother, Letty, described her pregnancy. Living in Johannesburg, she was far from her home country, Zimbabwe, and far from her mother,aunts,grandmother or anyone she trusted to give her the advice and information she craved.The cost of phoning these trusted relatives was prohibitive, so Letty found support when she enrolled to receive text messages via her mobile phone from MAMA, the Mobile Alliance for Maternal Action. “I’m here. I’m alone. The SMS messages helped me a lot. They helped me feel that someone is there,” Letty told me.

MAMA South Africa was launched with the support of global partners USAID, Johnson & Johnson, the United Nations Foundation, the mHealth Alliance, and BabyCenter. In addition, Vodacom joined the South Africa partnership, offering MAMA’s mobile website, askmama.mobi, free-of-charge to its 25 million customers. The goal of MAMA is to deliver health messages that moms need at specific milestones during pregnancy and during the first year of their baby’s development.

An existing South African mHealth partnership helped bring MAMA South Africa to life: Cell-Life, Praekelt Foundation and WRHI at the University of the Witwatersrand. Through MAMA, new and expectant mothers receive messages that address important topics such as nutrition during pregnancy, how to prepare for childbirth and recognizing signs of trouble which, if unheeded, can lead to difficulties in labor and delivery.

I sat across from these four women who had benefited from the MAMA partnership and listened carefully as they described their experiences. For these mothers, the SMS messages calmed their fears. One of the women, Faith, said that she had enrolled in the program when she was five months pregnant and had found reassurance in the MAMA texts. “The messages sometimes tell you, ‘This is normal’ and then you don’t worry,” she said. Letty added that when her baby was up all night, she received a message that said “Your baby may be teething” and this convinced her that nothing was wrong with her baby.

Another mom, Ntando was seven months pregnant and already had one child when she enrolled in the MAMA program. On the day of our meeting, her baby boy was already five months old. “The way we raised the first one is different from the way we raise this one.” She looked at her son and then added a comment about MAMA. “They’ll help me raise this one,” she said.

The third woman, Memory, signed up to receive MAMA messages when her baby was five months old. She said that she appreciated the help in “how to say ‘no’ to my son.” Memory also told us that she found the messages so helpful that she shares them with a friend who does not have a phone.

Faith visits the MAMA website with her husband and they learn together. Her praise for MAMA struck a particular chord for me – “I like them because they don’t just take care of the baby, they also take care of the moms.”

As our time together drew to a close, I thanked Letty, Memory, Faith and Ntando for taking the time to meet with us. Many of their comments have stayed with me, but none more than this one: “You feel like you are alone, and these SMS messages make you feel loved.”

The MAMA partnership is based on the power and promise of mobile phones in empowering mothers to make healthy decisions for themselves and their babies. What a wonderful added – and unexpected — benefit that MAMA also makes moms feel loved.

How Data Drives Decisions at USAID

This post originally appeared on Impact magazine

Impact magazine interviews Ellen Starbird, Director of the Office of Population and Reproductive Health, USAID.

IMPACT: How does USAID assess the effectiveness of its health investments?

ELLEN STARBIRD: USAID assesses the effectiveness of its health interventions by looking at trend data in health indicators that are related to the programmatic interventions that we support. For our family planning and reproductive health programs, contraceptive prevalence, improvements in birth spacing and increasing age at marriage are all measured by surveys, including the Demographic and Health Survey. Changes in these indicators can be related to our investments. USAID uses evaluation findings to inform decisions, improve program effectiveness, be accountable to stakeholders, and support organizational learning. Research tests the effectiveness of possible interventions and is used to identify high-impact practices for our family planning and reproductive health programs. Pilot studies and introduction studies test the effectiveness of interventions in specific contexts or countries. Those interventions that best “fit” a particular context (i.e., level of program development, epidemiological context, resources available, etc.) are selected.

IMPACT: USAID has a long history of using a “logical framework of results” to monitor health programs. Could you describe this framework and how it is used to facilitate decision-making?

ES: The logical framework is an important part of project design, as it identifies and briefly describes the problem the project intends to address and the expected outcomes of the project. The framework includes inputs, outputs, outcomes and impact. USAID uses Project Monitoring Plans to monitor at each step in this process. These plans examine answers to questions such as: Are inputs being delivered as planned? Are inputs leading to the anticipated outputs? Are outputs leading to the desired outcomes? If not, is the problem failure to deliver the input, or is the problem that inputs are delivered but for some unanticipated reason are not leading to the expected outcome?

IMPACT: USAID recently conducted a thorough review of its evaluation practices and developed a new policy on evaluation to guide the organization. What does USAID want to learn through implementation of this policy, and what does this mean specifically for health programs?

ES: USAID conducted this review to ensure that effective evaluations were taking place and guiding programmatic decisions. There was a concern that over the last several years fewer evaluations were being done, and the agency wanted evaluations to play a more prominent role in program decision-making. By implementing the new policy, USAID hopes to get a better understanding of the success with which its programs are implemented (process evaluations) and the impact of those programs (impact evaluation). This means that our health programs will put more focus on the implementation and impact of its projects, and that this information will guide future programming decisions. Ultimately, this creates a quality-improvement process, capturing experience to develop increasingly effective programs.

IMPACT: Can you share a recent example of receiving surprising results from work our office has been supporting? How did these results shape the decisions you and your colleagues had to make?

ES: In recent years, results from the DHS, especially those from Africa, showed an unexpected level of interest in and demand for long-acting contraceptive methods. These findings led us to expand our efforts to make these methods more widely available in an acceptable, accessible and affordable ways. Another example is that survey and qualitative research have identified a substantial demand for contraceptive information and services among youth in developing countries. M-Health is providing access to information on methods and source of supply to youth via electronic communication. Information collected on these programs indicated that youth are interested in a wide variety of methods, including natural methods, injectables and longer-acting methods.

IMPACT: What are some challenges you anticipate in generating meaningful data for decision-making post-2015?

ES: As we continue to make progress, what and how we measure will also have to change. In the area of family planning and reproductive health, for example, we’ll need better measurement around costs, as well as better understanding of how to measure choice and rights. The current data collection mechanisms in place will need to be adapted for such advances, or new ones will need to be developed.

Webinar to Highlight How Extension, Technology, and Behavior Change Combine to Improve Agriculture and Nutrition

This blog post is by John Nicholson, SPRING Knowledge Management Manager, JSI Research and Training Institute, and Kristina Beall, SPRING SBCC Project Officer, The Manoff Group.  SPRING is funded by the United States Agency for International Development (USAID) and helps to strengthen country efforts to scale up high-impact nutrition practices and policies.

Leveraging the power of social capital and technology, Digital Green has pioneered the use of low-cost, community videos as an agriculture extension tool that allows farmers to record and share successful techniques with other farmers in their community. The work began as a part of Microsoft Research India’s Technology for Emerging Markets team in 2006, eventually spinning off into the non-governmental organization (NGO), Digital Green. This young, dynamic NGO has already helped produce over 2,600 videos that have been shared with more than 150,000 rural households across India, Ethiopia, Tanzania, and Ghana. Digital Green’s grassroots approach — producing context-specific videos by the community and for the community—improves the efficiency of existing agricultural development efforts by a factor of ten times, per dollar spent.

Example of Digital Green video production

Example of Digital Green video production

USAID’s global nutrition project, Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING), is partnering with Digital Green in Odisha, India, to test the feasibility of adapting this video-based methodology specifically to promote high-impact maternal, infant and young child nutrition, and hygiene practices. Under the SPRING/Digital Green model, a local NGO partner – VARRAT – has worked in Keonhjar District of Odisha to produce 10 videos that showcase key nutrition and hygiene behaviors, often celebrating early adopters of these important nutrition practices. Videos are shared among small community women’s groups on a weekly basis using portable, battery-operated pico projectors. A robust suite of analytic tools, coupled with feedback from community members, then provides Digital Green and its partners with timely data to better target both production and distribution of videos. The collection of 10 nutrition- and hygiene-specific videos produced under this collaboration can be viewed along with the corresponding adoption analytics on the Digital Green website.

On December 17th, SPRING will host a webinar examining the Digital Green work through a multispectral lens, focusing on their unique approach and the growing partnership to scale-up technology to improve both agricultural and nutrition outcomes. Visit the SPRING website for more information and to register for the webinar.

This webinar is part of SPRING’s continuing collaboration with the Bureau for Food Security and Bureau of Global Health to identify promising approaches to better link nutrition and agriculture.

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