USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Securing Health for the Sake of Security

Colonel Mbaye Khary Dieng of the Senegalese Armed Forces made one point very clear: “This is a global security issue.”

One thing you can count on in Senegal is rolling power outages. In fact, that’s how our meeting with the Colonel began. What we learned about the Senegalese Armed Forces’ approach to national security, however, was less expected.

Colonel Dieng enrolled as a cadet at age the age of 11 in 1965. Now, forty-six years later, he commands a team of military personnel that includes an Obstetrician-Gynecologist , a biologist, a pharmacist, a psychiatrist, a social worker and a medical school dean.

Senegal has largely been spared the devastating economic and health effects caused by HIV. In this small, westernmost African nation, only 0.7 percent of the general population (12.5 million) has tested positive for the disease. Interestingly, according to a 2005 Combined Behavioral Surveillance Survey, the prevalence rate in the military was also 0.7 percent – the same as in the general population.

“The reason this country enjoys such a low rate of HIV,” Colonel Dieng explains, “is because we were not afraid to recognize this as a major problem from the very beginning.”

He recalls that commanding officers, as far back as 1978, openly talked about safe sex and encouraged the use of condoms. So when scientists discovered how HIV is transmitted in the mid-1980s, this message became even more important as a preventative measure. Realizing the need to do more to protect his troops, Colonel Dieng expanded the role of the military to include sites that specifically address the prevention of mother-to-child-transmission of HIV, provide voluntary counseling and testing, laboratory services, training centers for health professionals and psychological support. To reach more people, many of these services are brought directly into communities.

As a result, more than 85 percent of the Armed Forces have voluntarily been tested for HIV. More than 16,000 soldiers and family members, as well as 5,000 national police benefit from the services offered by the Colonel’s team. He maintains this level of care by working closely with national health officials and an international community of donors, including the US Government through the Department of Defense HIV/AIDS Prevention Program, that provide funding and technical support to the cause.

“The Colonel understands that sowing the seeds for long-term stability requires examining the root causes of instability,” says Assistant Administrator for Global Health at USAID, Dr. Ariel Pablos-Mendez. “There’s no question that poor health affects the military’s ability to protect the country. His efforts have been critical to preventing the spread of HIV.”

The Senegalese Armed Forces also operate peacekeeping missions in 15 countries across Africa, Middle East and the Caribbean. For a variety of reasons, including poor education, sexual violence or broken health systems, the rates of HIV are typically much higher in countries experiencing conflict.

The Colonel reflected on the fact that soldiers posted abroad often engage in riskier behavior because social barriers are removed; they have expendable money; and sometimes, on a cause of loneliness, they seek companionship. The information and services provided by the Colonel’s team—which are supported and reinforced by the hierarchy within the Armed Forces—increases the likelihood that Senegal can continue its peacekeeping missions with less risk to the health of troops and the people of Senegal.

“I have 10 men in a brigade on our northern border,” says Colonel Dieng, “if five of them were sick, how can we protect the border?” To drive home his point, the Colonel added, “What if 60-80 percent of the soldiers were HIV positive, how would we protect this country?”

On the road with SCMS, Part One: In Nigeria, PEPFAR partners pool procurement of life-saving commodities

In this three part series, Jay Heavner, Director of Knowledge Sharing and Communication at Supply Chain Management System (SCMS), highlights his experiences visiting three countries in Africa to observe SCMS project sites.

On a documentation tour of Nigeria earlier this month, I visited sites in four states plus the capital, Abuja, to document the progress of SCMS and find out how well the country is doing in managing its public health medicines and other supplies.  The tour was a study in contrasts: One state boasts a central medical store that is ISO Certified and has a computerized system that helps manage inventory and orders.  Nearby, a private hospital has a small, well organized and air-conditioned room dedicated to the storage of AIDS medicines.  On the other hand, in a neighboring state, the central medical store lacks even basic equipment.  Its dedicated staff, after a recent SCMS training in warehouse management, is taking a first step to improve their operations by requesting wooden pallets to reduce the risk of water damage to boxes that currently sit on the floor.

In Nigeria, a PEPFAR implementing partner picks up a shipment of HIV test kits from SCMS’s local distribution center Photo credit: David Fombot

A highlight of my trip was a visit to the warehouse in Abuja that was built with private funds to support coordinated “pooled” procurement by some 20 President’s Emergency Plan for AIDS Relief (PEPFAR) implementing partners (IPs).  Operated in a partnership between RTT, a South Africa-based company (also an SCMS team member organization), and MDS, a Nigerian company based in Lagos, the facility is a fully equipped pharmaceutical compliant warehouse.   The day I visited, the loading dock was a hub of activity.  Several IPs – Institute of Human Virology, Nigeria, Partners for Development and Vanderbilt/Friends in Global Health and AXIOS—were picking up their bi-monthly supply of HIV test kits.

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International Youth Day: Meeting the Reproductive Health Needs of Youth

I first came to D.C. in 1994, the year of the International Conference on Population and Development in Cairo, which marked a milestone in the field of population and reproductive health.  The conference set a turning point as the world agreed that population is not about numbers but about people and their rights.  It also solidified my commitment to youth, health and development which began when I served as a Peace Corps Volunteer working with youth in Ghana.  Today I am the youth advisor for USAID’s Office of Population and Reproductive Health.

Personal photo of Cate while serving as a Peace Corps Volunteer in Ghana circa 1994. Photo Credit: Cate Lane/USAID

More than half of the world’s population is under age 25.  I believe meeting the reproductive health needs for today’s young people is vital in ensuring future generations are able to lead healthy and dignified lives.  When girls are able to delay first pregnancy, they are more likely to obtain an education and end the cycle of poverty.  The United Nations proclaimed the past year commencing on August 12, 2010 as the International Year of Youth.  As the year comes to an end on International Youth Day, let us continue to stress the need for investment in programs that reach out to youth.

Listen to more of my thoughts on youth and development in this audio podcast by the Population Reference Bureau:

Involving Youth in Development Programming: Interview With Cate Lane, USAID by PopulationReferenceBureau


PEPFAR/USAID Kicks off Webinar Series to Strengthen the Social Welfare Workforce

On July 14, over 100 people from 18 countries logged on for our first ever Social Service Workforce Strengthening webinar! The webinar session entitled, “Lessons Learned from the Global Healthcare Workforce,” kicked off the first in a series of webinars intended to encourage the sharing of information, expertise and promising practices for addressing the needs of the social welfare workforce through a series of facilitated discussions.

The idea for the webinar series and webinar topics grew out from conversations at the PEPFAR-funded Social Welfare Workforce Strengthening Conference held in Cape Town last November.

The topics refer to specific initiatives for improving strategies for planning, training and supporting the broad variety of different workers – paid and unpaid, governmental and non-governmental – who make up the social service workforce and are responsible for the care and protection of vulnerable populations, including children orphaned and made vulnerable by HIV/AIDS.

The first webinar explored ways in which resources, tools and successful approaches piloted by those engaged in efforts to strengthen human resources for health (HRH) can benefit global and local social service workforce strengthening initiatives.

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Saving Lives Across Nepal: Female Community Health Volunteers

Taking a health sector initiative “to scale” and making it sustainable is a challenging development goal. Ambitious, but achievable. In Nepal, the Ministry of Health and Population has succeeded in bringing maternal and child health information and health services to every community in the country. This, in spite of the fact that the majority of Nepal’s 29 million people live in rural and often remote areas, far from any health service facility.

The Female Community Health Volunteer program, with the support of USAID and other partners, has built upon existing country resources to organize, train and supply a powerful “workforce” of approximately 50,000 women—each elected by her community, who contributes her time and effort to care for those in her village.

Doctors at the central/federal level drive a cascading series of trainings which pass vital knowledge to ever larger groups of health services workers at the various organizational and geographical levels of the Department of Health Services. At the final tiers, Health Post and Sub-Health Post staff train the volunteers from the surrounding areas. It is sort of like what would happen if a snowball was rolled off the summit of Nepal’s Mt. Everest… it would grow in size as it rolled downward, resulting in something extraordinarily large by the time it reached the base.

At “Ama Samuha” mothers’ group meetings which volunteers hold each month, they act as health promoters covering topics such as the benefits of proper diet during pregnancy and how certain traditional beliefs can result in life-threatening situations during and after delivery. They also serve as health providers who, at their home or during house-calls, treat among other things the primary causes of childhood mortality (diarrhea and pneumonia) and administer vitamin A, which by itself saves the lives of an average of 15,000 children annually.

During the filming of the video embedded in this post, Director of International Communications Margy Bailey, Chief of Party of the Nepal Family Health Program Ashoke Shrestha, Health Program Officer Deepak Paudel, USAID Nepal Development Outreach and Communications Specialist Stuti Basnyet and I met truly selfless heroes like Laxmi Sharma from Damachaur village and Amrica KC from Marke ward in Salyan district. In no small part due to their commitment and that of the rest of the cadre of Female Community Health Volunteers, Nepal’s maternal and child mortality rates have dropped significantly. Under President Obama’s Global Health Initiative (GHI)—the next chapter in the way the U.S. Government conducts global health activities—Nepal, which is one of eight GHI focus countries, is expected to achieve its national 2015 health indicator targets.

WASH for Life: Testing Promising Solutions and Scaling Proven Successes in Water, Sanitation and Hygiene

Dr. Maura O’Neill is the Chief Innovation Officer and Senior Counselor to the Administrator at USAID.

In 2008, the Oscar-winning film Slumdog Millionaire brought the issue of unsafe sanitation to the silver screen. Audiences cringed as young Jamal is forced to jump into the open pit of feces in which he was previously seen relieving himself. But such scenes are not simply fodder for movie-goers and awards ceremonies. Today, 2.6 billion people lack access to safe sanitation. Of these, 1.1 billion people practice open defecation, meaning they have no sanitation facilities at all. Unsafe sanitation is not only unpleasant, it can be deadly. Improper waste disposal can pollute the drinking water supply, spreading water-borne disease.  More than 1 billion people do not have access to safe drinking water and those with some access cannot always rely on it being available or clean.

These failings have a profound effect on the health of people around the world. Proper access to water, sanitation, and hygiene (WASH) services is critical to saving lives. Contaminated drinking water infects people with diarrheal disease, typhoid, polio, guinea worm disease, schistosomiasis, Hepatitis A and E, and cholera. Diarrhea alone kills almost 2 million people around the world every year, of which 1.5 million are children. Children suffering from these diseases can become undernourished, resulting in stunting and often, death. Inadequate access to basic WASH services also damages the economy: water-related disease is costly, sick workers are less productive, weak children cannot attend school, and improper waste disposal can harm farmland, making it more difficult to grow food. Women and girls are disproportionately affected as they often must travel miles to collect water for the family, giving up the chance to work or go to school. While USAID and partners have been working to improve basic WASH services to save lives around the globe, we still strive to promote the importance of activities such as hand washing and point-of-use chlorination, introduce life-saving solutions at lower cost, and elevate the importance of sanitation and hygiene in the WASH triad. Simple, inexpensive measures that are massively deployed can save millions of lives.

Earlier today, Silvia Mathews-Burwell, President of the Global Development Program at the Bill & Melinda Gates Foundation, and I announced WASH for Life, a $17 million initiative which aims to address these very challenges.  With co-funding from the Gates Foundation, USAID will use Development Innovation Ventures (DIV), which produces development outcomes more effectively and more cost-efficiently while managing risks and obtaining leverage by focusing on rigorous testing, evidence, and scale, to solicit breakthrough ideas that will dramatically improve access to WASH services for the poor. Over the next four years, WASH for Life aims to identify and rigorously test new WASH technologies and delivery models, and then scale proven successes across multiple countries to reach millions of people. WASH for Life is particularly interested in potential solutions which: operate in Bangladesh, Ethiopia, Ghana, Haiti, India, Kenya and/or Nigeria; address issues in the sanitation and hygiene sectors in particular; and affect people earning under $2 a day.

We view this partnership as an important validation of DIV’s approach, which systematically seeks, tests, incubates, and mainstreams cost-effective, breakthrough ideas to substantially improve the lives of people in developing countries. Leadership through this type of innovation is a key piece of USAID Forward and DIV aims to be both a model and incubator for other donors, host countries, and organizations looking to use proven successes to impact people in developing countries. We are proud to have the support of the Gates Foundation as we seek to ensure that open defecation is restricted only to the movie screens of theaters worldwide.

Mapping for Informed Decision Making in Rwanda

Mapping and Geographic Information System (GIS) have long been used in Rwanda for sectors such as agriculture and economic growth. The need for these innovative tools and skills, however, are just now being recognized in other fields, including health. As a monitoring and evaluation expert, I have seen how useful geography and maps can be to monitor and improve programs, and I was interested to learn more about how they were being used and enhanced in the field.

For four days, I joined 18 public health professionals at a GIS training in Kigali, Rwanda, organized by MEASURE Evaluation and Monitoring and Evaluation Management Systems (MEMS) and supported by USAID in collaboration with National AIDS Control Commission (CNLS ). The participants represented many local Rwandan organizations such as MEMS, the Ministry of Health, the Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics (TRAC Plus), and National University of Rwanda’s School of Public Health.

Andrew Inglis and training participants use qGIS and local data to produce maps that can be used for monitoring HIV programs. Photo Credit: Kristen Wares/USAID"

GIS is a unique tool that allows people to interact with their data. Rather than comparing data in charts or graphs, mapping data through geography allows data users to identify essential trends and associations that may not be apparent in other formats. By building local capacity in GIS, we are expanding “evidence-based decision making” for high quality and strategic health programs.

There was a lot of enthusiasm during the training about GIS. The training provided an excellent forum for the participants to talk about innovative ways they are already using the GIS tool. Participants discussed plans to create  new programs that would allow for better ownership and monitoring, to improve supply chain management, and to integrate services, all things that will support and enhance the projects that USAID and its partners are implementing.

MEASURE Evaluation trainers, Andrew Inglis and Clara Burgert, introduced the concept of GIS maps and their ability to link to a database that is capable of capturing, storing, querying, analyzing, displaying and outputting data. In addition to teaching concepts such as how to interpret maps and how to effectively use spatial data, the training provided participants an excellent opportunity to gain practical experience.

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How a Simple Memo Protected Mothers and Children from Malaria

Megan Fotheringham, Public Health Advisor, President’s Malaria Initiative

In the developing world, pregnancy is a dangerous time for women. In sub-Saharan Africa, malaria poses a major threat to the health of pregnant women and their developing babies; each year nearly 32 million pregnant women are at risk from this deadly disease. The dangers, which occur when malaria parasites infect the placenta, are serious and include maternal anemia, miscarriage, stillbirth, and low birth weight in newborns. The cost in lives and resources as a result of malaria infection places a heavy burden on families and national health systems.

Thankfully there is a solution. Women can reduce their risk of infection by taking an antimalarial drug as preventive treatment: intermittent preventative treatment for pregnant women or IPTp. For full protection, pregnant women take at least two doses of the treatment during pregnancy. In Africa, IPTp is widely available and usually given during routine antenatal care visits across the region. Despite this fact, IPTp rates are still surprisingly low.

The Kenyan government’s Division of Malaria Control recently found an innovative and simple way to respond to this problem and subsequently increased the percentage of women taking IPTp. In the Gem District of western Kenya, where only 7 percent of pregnant women received the recommended two doses of IPTp, the Government of Kenya teamed up with researchers from the Kenya Medical Research Institute and the U.S. Centers for Disease Control and Prevention to improve the use of IPTp.

With funding from the U.S. President’s Malaria Initiative, the researchers discovered one of the reasons for low compliance with recommended use was that health workers were confused about when to give IPTp. According to the official guidelines, pregnant women should only be given IPTp in their second trimester but the doses should be given at least 30 days apart. This is complicated by the fact that many women are not sure how far along they are in their pregnancy. In addition, a mother’s HIV status is also a factor in treatment protocol.

To address this confusion, the Government of Kenya piloted a simple approach.  They sent an official memorandum to all government health facilities located in the Gem District and followed up with supervisory visits. The memo clearly listed five key messages about IPTp and instructed health workers to comply with these simplified guidelines.