USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

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.