Archives for Global Health
Yesterday I joined former USAID Administrator Peter McPherson, Egypt Embassy Counselor Motaz Zahran, and more than 100 members of the Egyptian diaspora and global health communities to launch USAID/Egypt’s Health and Population Legacy Review (pdf, 1.5mb).
The report demonstrates impressive long-term results of USAID health sector assistance in Egypt over 32 years. For example, over the past three decades, there have been declines in maternal mortality by more than 50 percent and in infant mortality by more than 70 percent, as documented by Egypt’s regularly released Demographic and Health Surveys. Medically assisted deliveries increased from 35 percent in 1988 to almost 80 percent in 2008.
I served in USAID’s Egypt mission from 1976 to 1980 and again from 1984 to 1988, and I have seen with my own eyes the remarkable progress that has been achieved. When I left Cairo in 1980 oral rehydration therapy was not part of Egypt’s health program. When I returned in 1984 it appeared to me that there was an oral rehydration center in every neighborhood of Cairo and every village throughout the country.
The Egypt Health and Population Legacy Review attributes the success of programs like this to the duration of assistance and to robust funding and staffing levels. Because USAID was a reliable partner with the Ministry of Health and Population over a 32-year period, it allowed not only for introducing new programs, but also for seeing them through various stages of program evolution. The substantial level of funding over the decades also helped ensure that programs were implemented on a large enough scale to achieve significant impact.
Despite the accomplishments, much work remains to be done. And in many ways, the moment is ripe. This has been a historic time for the people of Egypt and the Middle East. And now, more than ever, it is vital that we use studies like these to learn from the past.
U.S. Ambassador to Egypt Margaret Scobey said it best:
The emergence of a new political order in Egypt sets the stage for even greater improvements in the lives of Egyptians. The accomplishments, the institutional strengthening, the data and policy analysis, and – most important – the many new Egyptian health professionals and leaders, are a solid platform from which to launch new initiatives and innovations of many kinds. In the Egyptian health sector, the past can inform the future.
Read the latest edition of FrontLines to learn about the Agency’s work in global health and in Iraq, including these stories:
- An exclusive interview with U.S. Lt. Gen. John Allen on how the United States’ military and civilian arms found common ground in Iraq. Allen is President Obama’s new nominee to lead U.S. and NATO forces in Afghanistan
- How the new Global Health Initiative is building on a foundation of partnerships as key to healthier families, communities and countries
- How the historic Food for Peace program has proven to be an extremely versatile development tool in rural Mozambique. Listen to FrontLines’ first ever podcast.
- An exclusive interview with WHO’s Dr. Margaret Chan, who speaks about how educating girls and empowering women yields generational health gains
- Long-term stability is goal of the Agency’s continuing work in Iraq
Also posted at DipNote, the U.S. Department of State Official Blog
Ambassador Eric Goosby serves as U.S. Global AIDS Coordinator.
During today’s opening of the PEPFAR annual meeting, we focused on PEPFAR’s role in supporting countries to establish a “continuum of response.” Through this continuum, countries can provide a comprehensive system of care and support to meets their health needs to their people. As our Global Health Initiative (GHI) recognizes, the continuum is needed not only for particular diseases such as HIV, but for the whole range of public health issues.
At the individual level, a continuum of response means that the government orchestrates a health system that identifies populations at risk and follows them, addressing through all their needs through their lifespan — for prevention, and then for care and treatment if they become infected. And it means following them through all their non-HIV needs as well.
The continuum of response is anchored in the principle of country ownership. PEPFAR is working to support governments in orchestrating national efforts to address the health needs of their citizens, and enabling the strong participation of civil society in those efforts. Deputy Secretary of State Tom Nides affirmed the importance of country ownership in the U.S. foreign policy portfolio. And I was fortunate enough to join discussion on global health diplomacy and leadership with CDC Director Tom Frieden, USAID Administrator Raj Shah, and GHI Executive Director Lois Quam to focus on different dimensions of U.S. global health strategic priorities.
Thanks in part to the mechanism of PEPFAR Partnership Frameworks, I believe we are at the precipice of real country ownership of the fight against HIV/AIDS in a growing number of countries. Partnership Frameworks provide a 5-year joint strategic framework for cooperation among the U.S. Government, the partner government, and others to combat HIV/AIDS in the partner country. With our support, countries are putting structures in place that position them to meet not only HIV/AIDS needs, but whatever future public health challenges they face. To date, U.S. Chiefs of Mission and 21 partner governments have signed Frameworks, with more to follow. Today, we were welcomed by the South Africa Minister of Health, Dr. Aaron Motsoaledi, whose government recently signed a Framework with the United States. Turning a decisive page, the South African Government has assumed increasing leadership, including a dramatically heightened financial contribution and an intention to approach full financial responsibility for its program by 2016.
A continuum of response requires both commitment and capacity on the part of the government. And today, I was pleased to have the opportunity to affirm the leadership role of the U.S. Ambassador in working with our partnership governments. Our Chiefs of Mission are leading their teams to make sure that Partnership Framework commitments are fleshed out in Implementation Plans, which enable real accountability. In terms of the capacity required to establish ownership, tomorrow we will hear from field teams about their hard work to develop capacity at the country level. The locally employed staff of PEPFAR is at the forefront of our efforts on country ownership, focusing on building the technical and managerial capacity of partner nations. This capacity is a key contribution to our effort to foster country ownership and create a continuum of response. All of this is critical to saving lives.
By: Aneesh Chopra, U.S. Chief Technology Officer
Kudos to Secretary of State Hillary Clinton, USAID Administrator Raj Shah, Johnson & Johnson CEO William Weldon, and their colleagues at the United Nations Foundation, the mHealth Alliance, and BabyCenter on the launch of the Mobile Alliance for Maternal Action, a new public-private partnership to improve maternal and child health by harnessing the power of mobile technology to deliver vital health information to expectant and new mothers.
Many women around the world have limited or no access to basic health information necessary for safe pregnancies and healthy babies. These women typically live in resource-constrained settings that lack the first-line providers of such information — nurses, midwives, and trained birth attendants.
Enter technological innovation, which has the potential to be a force multiplier – enabling us to reach more people, more efficiently and at lower cost. Technologies like the mobile phone, for example, can unlock novel and transformative solutions to longstanding development challenges if we utilize them effectively. We need to make sure that people have access to new technologies, which is happening at a rapid pace with cell phones around the world (more than 1 billion women in low- and middle-income countries own a mobile phone). In fact, global smartphone sales exceeded PCs for the first in the fourth quarter of 2010, ahead of market predictions. That said, we need to understand how technology can make a difference.
What’s exciting about the Mobile Alliance for Maternal Action is that it acts both locally and globally to achieve scale and impact. Over the next three years, it will work across an initial set of three countries, Bangladesh, South Africa and India, to help coordinate and increase the impact of existing mobile health programs, provide resources and technical assistance to developers of promising new business models, and build the evidence base on the effective application of mobile technology to improve maternal health. Lessons learned from these and other initiatives will be shared globally in a coordinated exchange of information. The partnership will foster collaboration among similar initiatives in other countries to accelerate efforts to reach millions of women with mobile phone access around the world with critical health information.
We have had some experience with mobile health programs for moms here in the US. Last February, I had the pleasure of announcing the domestic text4baby program that has now reached nearly 170,000 moms. And early this March, our colleagues in Russia announced that they are creating a similar program, which will bring mobile health information to moms in Russia as well. Moreover, the Administration’s FY12 budget establishes a Wireless Innovation (WIN) Fund to spur innovation through investments in research and development of wireless technologies and applications. In particular, the WIN Fund proposes a $100 million investment over five years to CMS for emerging wireless technologies in the health care sector in order to spur applications that educate consumers, offers new tools to assist in patient care, and reduces health care costs.
Measuring results and using evaluation data – lessons learned from mobile health information programs in the United States, Russia, Bangladesh, India, South Africa, and many others — to develop best practices and improve our understanding of what works and why will be a critical part of the MAMA partnership. As we strengthen the global knowledge base and share best practices around effective ways to provide these services, designers of new and existing programs will be able to learn from tap into each other’s experiences to increase their impact, sustainability, and scale.
Most importantly, information initiatives such as the MAMA partnership empower women, which is important in its own right and is also essential to improving the health of families and communities. Access to a mobile phone can mean access to information about pregnancy, childbirth and the first year of life that enables women to make healthy decisions for themselves and their families.
Congratulations again to all the partners.
USAID and the Peace Corps celebrated World Malaria Day by announcing a collaboration to help reduce the burden of malaria in Africa. Here’s a rundown of the event from guest blogger Ben Brophy of the Malaria Policy Center.
Dr. Rajiv Shah, USAID Administrator, Aaron S. Williams, Peace Corps Director, and Rear Admiral Tim Ziemer, U.S. Global Malaria Coordinator, gathered today to announce the partnership of the President’s Malaria Initiative (PMI) and the Peace Corps as a component of broader USAID and Peace Corps collaboration in global health and to talk about the progress made against malaria so far.
Mr. Williams opened the event discussing the problem of malaria and the new partnership, named ‘Stomp Out Malaria’ between PMI and the Peace Corps. He lauded both Dr. Shah and Admiral Ziemer for their tireless efforts against malaria.
Dr. Shah gave a great overview of the amazing progress that has been made against malaria so far. He pointed to the fact that PMI is reducing overall childhood mortality and for this reason it is one of the best investments we can make. However, Shah also cautioned that “If we step back now we will see a rapid uptick in malaria and unnecessary child deaths.”
Admiral Ziemer echoed this message of success and talked about the emerging partnership between PMI and the Peace Corps. Essentially, PMI and organizations like Malaria No More, VOICES for a Malaria Free Future and WorldVision will train Peace Corps volunteers on malaria interventions and then those volunteers can take that knowledge with them to instruct their local villages and communities.
Washington Post columnist Michael Gerson hosted a panel of several speakers to talk about the malaria fight in more detail. Gerson also discussed his recent trip to Senegal with the Malaria Policy Center where he saw U.S. investments in malaria in action. Gerson came away from that experience saying ”This is how aid should be done.”
Ambassador Mark Green, Matt McLaughlin of the Peace Corps Malaria Initiative for Africa, Professor Awa Marie Coll-Seck of the Roll Back Malaria Partnership, and Andrea Gough, of the Nothing but Nets campaign were all on hand to talk about various aspects of the world’s efforts against the disease. The most notable quote came from Ambassador Green “Development dollars are being stretched thin and partnerships like this one between PMI and the Peace Corps are squeezing out every penny and producing great results.”
Ultimately, the partnership between PMI and the Peace Corps is producing yet another new tool to help end malaria deaths by 2015. It is these types of integrated partnerships that are uniting our efforts and amplifying our resources.
USAID, the United Nations, the Government of Southern Sudan (GOSS), and other international partners launched a polio immunization campaign March 28 in southern Sudan, where the crippling disease re-emerged in 2008.
“Due to the efforts of the GOSS, development partners, and people of southern Sudan, the outbreak that re-emerged in South Sudan in 2008 has been halted,” USAID/Sudan Mission Director William Hammink explained at the Juba Nyakuron Cultural Center, where the three-day campaign was launched. “Since 2005, USAID has committed over $8 million to support polio immunization and eradication as well as routine immunization activities across the region,” he added.
GOSS Minister of Health Dr. Luka Tombekana Monoja and Minister of Information Dr. Barnaba Marial Benjamin GOSS said it is time to “kick it and keep it out” when referring to polio and other preventable diseases. The ministers expressed their commitment to continue campaigns that vaccinate against preventable diseases, including polio. Along with international organizations such as USAID and Rotary, the GOSS pledged to reach those in need throughout southern Sudan, particularly children in remote areas.
Mothers attending the event were invited to have their young children vaccinated with ‘just two drops’ of the polio-preventing vaccine.
USAID assisted with the last polio immunization campaign in November 2010, which reached more than 3 million children under age 5 in southern Sudan with the vaccine, achieving polio immunization coverage of 99 percent.
A pharmacist by training, Yodit Assefa will complete her Master Degree in Public Health this year. Her long-term goal is to contribute to the vision of an HIV-free generation in Ethiopia.
As a procurement specialist with PEPFAR’s SCMS project, I am one of a growing number of women working in supply chain management in Ethiopia. I manage procurements of HIV/AIDS commodities – including the complex procurement of specialized medical equipment used to treat HIV/AIDS – as well as the vehicles that distribute those commodities.
Well planned, strategic procurement is a smart investment. Our team helps save money by minimizing costly unplanned and emergency procurements and buying low-value and bulky products locally.
I use my skills to help scale-up Ethiopia’s aggressive HIV/AIDS program. In just two short years, the number of people on treatment has tripled from 50,000 to over 167,000 and the number of clinics has increased more than fourfold from 170 to 843.
This type of scale-up requires a similar scale-up of supply chain systems. A little over a year ago, we joined USAID and local partners in a public ceremony to celebrate the arrival of equipment to strengthen warehousing and distribution for public health commodities. We now have 29 delivery vehicles, seven generators, 10 forklift trucks, 150 refrigerators, nine deep freezers, a 824-cubic meter cold room, racking for 5,400 pallets and 1,320 adjustable shelves for 12 warehouses, including six temporary warehouses leased through SCMS.
A typical day for me starts before sunrise. I get two kids ready for school – the youngest ready for her nanny – check the car and head for work. We have lots of problems with internet connections in a developing country like Ethiopia, so I am at my desk by 6:30 a.m. to get the best available connection before the lines get busy. I take information from the client management teams and create quotation requests to send to potential vendors. I analyze quotations to decide which meet our specifications and offer us the best value. Best value does not just mean lowest price – I also take into account things like product quality and timeframe for delivery. On-time delivery is one of our key performance indicators.
After choosing the supplier, I go through a complex process to ensure my purchase orders meet all necessary US government regulations and comply with Ethiopian law. Finally, I manage the supplier, making sure the products are delivered on time and in the right quantity. This may not sound like a lot, but remember, each procurement specialist manages around 50 different orders at a time.
Our procurement team is the first SCMS field office to “graduate” to do international procurement—in additional to local procurement—of commodities without any supervision from the SCMS headquarters procurement office. I’m proud of our graduation, but my greatest satisfaction comes from knowing our work contributes to restoring health to people living with HIV/AIDS. I have seen formerly bedridden patients return to work after receiving antiretroviral drugs. This is what inspired me to join SCMS. I believe helping one person really helps 5.4 people, the average family size in Ethiopia.
PEPFAR’s impact goes beyond saving lives and improving quality of life. It helps national development and economic growth by preventing people in the workforce from dying of AIDS.
By Rear Admiral Tim Ziemer, U.S. Global Malaria Coordinator
Over the past four years I have had the privilege of serving as Coordinator of the President’s Malaria Initiative. The initiative is led by USAID and implemented together with the Centers for Disease Control and Prevention. Our goal is to reduce malaria illnesses and death by half for 70 percent of at-risk populations in sub Saharan Africa, and to remove the disease as a major public health threat by 2015.
I also oversee two regional malaria programs outside of Africa. The Amazon Malaria Initiative covers 7 countries making up the Amazon Basin of South America, and the Mekong Malaria Program covers 5 countries in the Greater Mekong Sub-Region of Southeast Asia. In both of these areas, multi-drug resistance is a major problem.
I am fortunate to work with a talented group of technical staff and public health experts who implement U.S. global malaria programs. The incredible progress we have made against malaria is due in large part to effective partnerships with host governments, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank Booster Program for Malaria Control, the Bill and Melinda Gates Foundation and the U.N. Office of the Special Envoy for Malaria, as well as other non-governmental and private organizations too numerous to count. Now, five years into the Initiative, we are seeing substantial reductions in deaths in children under the age of five years, and we are seeing improvements in malaria-specific indicators in all PMI-supported countries where baseline and follow-up nationwide household surveys were conducted. These reductions are due in large part to a dramatic scale-up of malaria prevention and treatment measures since 2005, thanks to the collective efforts of national governments, other international donors; and multilateral and nongovernmental organizations.
PMI relies on a four-pronged, proven approach to prevent and treat malaria: the correct use of insecticide-treated mosquito nets above sleeping spaces; indoor spraying with insecticides; intermittent preventive treatment for pregnant women; and timely use of artemisinin-based combination therapies for those who have been diagnosed with malaria. Malaria is one of today’s best investments in global health; globally, these interventions are saving the lives of 485 children each day.
Each year, World Malaria Day is observed on April 25 to call attention to the disease and to mobilize action to combat it. It’s heartening to see the progress that has been made in delivering malaria prevention tools to those at risk of malaria and providing treatment to those with confirmed malaria. Progress against malaria is one of development’s most impressive stories. On this occasion, PMI releases its fifth annual report, which describes the role and contributions of the U.S. Government in the effort to reduce the burden of malaria in Africa.
Despite considerable progress, malaria remains a major public health problem on the African continent, with about 80 percent of malaria deaths occurring in African children under five years of age. However, over the past 50 years the U.S Government has been a major player in coordinated global efforts to beat back major killers like smallpox, polio and measles. So, with sufficient and sustained international commitment, we can continue to achieve sustainable progress in our fight against malaria.
To learn more about PMI, visit http://www.pmi.gov/
Rear Admiral Tim Ziemer is the U.S. Global Malaria Coordinator. He grew up in Asia, attended the missionary boarding school in Dalat, Vietnam, graduated from Wheaton College, served as a Naval aviator with the U.S. Navy, and was Executive Director of World Relief prior to being asked to lead the President’s Malaria Initiative.
Stigma and discrimination are two factors that continue to drive the HIV/AIDS epidemic forward. Employees face discrimination at work, women and men are afraid to get tested and run the risk of being ostracized by family and friends, and children are turned away from schools.
Stigma and discrimination based on HIV status are wrong, and the U.S. government does not condone stigmatization or discrimination of HIV-positive persons. USAID takes stigma and discrimination seriously, and we work with our partner countries to make sure the effect of this type of thinking is understood.
Through the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. is proud to be making a historic commitment to combat HIV/AIDS. PEPFAR is driven by a partnership between the U.S. government and the nations where it works, along with other donors, multilateral organizations, nonprofit groups, faith-based organizations, and people living with HIV, to make smart investments to save lives.
With support from USAID, U.S. government country programs have been addressing stigma since the beginning of the epidemic and with increased intensity with the advent of PEPFAR in 2003. Reducing stigma and discrimination is a prominent goal of PEPFAR’s current Partnership Framework agreements. Through this mechanism, the U.S. government actively works in partnership with countries to end stigma and discrimination.
Centrally, the U.S. government funds activities that reduce stigma and discrimination, such as providing the tools necessary for networks of HIV-positive individuals to engage in evidence-based advocacy. USAID’s recently completed Health Policy Initiative (HPI) worked with partners to develop indicators to measure various aspects of stigma and discrimination. By participating in expert working groups, the program built consensus for common action and took the lead on a Health Facility and Provider Stigma Measurement Tool. HPI also increased private sector engagement and encouraged religious leaders to speak out against stigma and discrimination.
Now, through the Health Policy Project (HPP), USAID continues work globally to strengthen policy and advocacy support for the reduction of stigma and discrimination, especially as it relates to HIV prevention, care and treatment services.
All of us who work on global AIDS issues are aware of the negative impacts of stigma and discrimination, and are committed to creating equal access to quality care and services for those living with HIV worldwide.