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Archives for Global Health

The Other Half of the Family Planning Equation

As Father’s Day approaches I look back to when my wife and I first decided to have children. We married fairly late, both in our early 30s, so we planned to have our first child just a couple years after we married. It was an exciting time; much thought went into planning our family. We are now proud parents of two healthy and happy girls. It’s normal in the U.S. for both men and women to play an active role in planning their families; however, in much of the developing world that is not the case.

Involving men in international family planning programs is an uphill battle. There is a lack of information among men on the importance of delaying first birth, of spacing births, and of avoiding high parity births for the health of the woman and the child. Family planning saves lives and improves maternal and child health. In the developing world, an estimated 90 percent of infants whose mothers die after childbirth will die by their first birthday.

Men play an essential role as they are the gatekeepers in many countries to what women can and cannot do: whether women can use contraception or whether family resources should go to pay for other methods. A number of USAID’s programs address gender issues, focusing on improving male participation in family planning.

We are making progress. Twenty years ago in Kenya, 10 percent of women who were not using or planning to use family planning said that their husband’s disapproval of family planning was the main reason. Today, this percentage has been reduced to 6 percent. Meanwhile, countries like Nigeria have 10 percent of these women attributing non-use of family planning to husband’s disapproval. So while we have seen improvements, there is still much work to be done.

Educating men on the importance of family planning and birth spacing is only part of the equation. There should also be a greater emphasis on male methods, including condoms and vasectomy.

The challenge is many men around the world don’t have good health seeking behavior so we must get creative in our opportunities to reach men. For example, now that there is incontrovertible evidence that male circumcision significantly reduces acquisition of HIV by men, there are male circumcision programs for adult men blossoming all over sub-Saharan Africa. We should make sure there are no missed opportunities to speak to men about other health issues, including planning for their families.

This Sunday, as we celebrate fathers everywhere, let us not forget that men’s participation in planning for their families will result in better health and improved lives.

Photo blog: If countries lead will donors follow?

Originally posted on the Ministerial Leadership for Global Health (MLI) Blog

All five MLI countries were represented Thursday afternoon at the MLI event, “If Countries Lead Will Donors Follow?” at the Global Health Council’s annual conference in Washington, D.C. Delegates spoke on a panel moderated by John Donnelly in The Ambassador Room, sharing stories about how country leadership has advanced health outcomes in their countries.

Read the rest of this entry »

The Health Professional Crisis: A Personal Perspective

Phetogo Phoi, Lab Logistics Advisor, Supply Chain Management System (SCMS)

Botswana, like many countries, struggles with a limited amount of health workers, especially personnel qualified in the area of lab management.  In Botswana, this challenge is compounded by a limited number of graduate and undergraduate health programs. Professional courses, especially in the health area, are not offered here. Like many, I went abroad to the United States and the United Kingdom for my undergraduate and graduate degrees.

In the absence of a comprehensive health education infrastructure, the technical assistance provided by President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID to enhance the skills of the health workforce plays a critical role in strengthening the health sector. In the area of lab logistics, lab commodity management ensures that tests and other supplies are available when a doctor or nurse needs them. This field of study is often the furthest thing from a laboratory scientist or pharmacist’s mind when they enter the workforce.

In my work as a Lab Logistics Advisor for the Supply Chain ManagementSystem (SCMS), a project under PEPFAR and administered by USAID, I train health workers, mainly lab personnel, on laboratory commodity logistics management. One thing I’ve learned:  lab supplies are critical to health programs. Someone will visit a clinic and be tested for HIV. If they test positive, based on their CD4 count, they are placed on lifesaving treatment. Health workers then monitor the patient’s treatment regimen and most importantly, their health.

If a lab isn’t properly tracking its inventory, there is an opportunity for stockouts of test kits, which could lead to very sick people going without treatment because they never learned their status.  By learning to better manage their inventory of medicines, test kits and laboratory supplies, health workers can ensure their facilities are well stocked and the products they need are available for patient diagnosis and treatment.

I’m working with laboratory staff to help them implement the systems they didn’t learn about in their university studies or other pre-service trainings. I try to focus staff on addressing challenges and identifying how the system should look. Systems are more important than some may think. Without a system, there are many challenges in managing a health facility. But even with all the complaints and finger pointing, there was no structured system to resolve challenges.

Every day, I see the difference PEPFAR and USAID and the Centers for Disease Control and Prevention are making in this area.  I used to visit one of the facilities we work with, and it was a painful sight to find everything so mixed up. Pharmacists and laboratory officers were unable to find the supplies they needed or were unable to use them before they expired. Now, I go to facilities where I’ve trained people and just smile to see so much changing.

There is still much to do. Change doesn’t happen overnight, but I believe that with more investment in training and technical assistance we can help build a public health workforce we can all be proud of.

Renewed Commitment to Global Vaccines and Immunizations Will Save Lives

Originally posted on the White House Blog

During a time when we all – including the federal government – need to live within our means and find places to cut spending, any investments made by your government need to meet the test of whether it is an effective and efficient use of taxpayer dollars.

Immunizing children from preventable diseases meets that test. As USAID Administrator Raj Shah announced in London on Monday, by making a multi-year commitment to the Global Alliance for Vaccines and Immunizations (GAVI), the US is able to get the most from our investment – leveraging a pledge of $450 million over three years more than eight-fold into billions of dollars in commitments from other donors, including the UK, the Gates Foundation, Norway and others.

Together, these commitments will help save the lives of 4 million children over the next five years, by getting more vaccines to more children and by helping to ensure the quantities of vaccines needed to lower the prices for new vaccines such as those that protect against pneumonia and diarrhea, the world’s two most potent childhood killers. All in all, we will be able to immunize more than 250 million children and prevent more than four million premature deaths.

Investments in vaccines are one of the best and most cost-effective life-saving investments for the world’s children, which is why we’ve made tough choices and trade-offs within our current global health portfolio to make this commitment.  As Administrator Shah said: “In this fiscal climate, a multi-year pledge is an extremely difficult commitment to make. But we have made tough reallocations across our portfolio in order to make that commitment because only a multi-year pledge will ensure the highest possible return for every taxpayer dollar.

Not only will our commitment inspire the generosity of other donors, it will help drive economies of scale that lower the cost of vaccines, allowing us to save even more lives. Just last week, GAVI reached an agreement with GlaxoSmithKline to cut the cost of the rotavirus vaccine by 67%. That kind of reduction is only possible with the guaranteed demand a multi-year pledge provides.”

In the lead up to GAVI’s conference, the White House received thousands of phone calls, emails, and signed petitions calling for continued U.S. support for GAVI.  The ONE Campaign issued a statement of support following our announcement, including praise from Bono who noted the President was “in it to win it.”

The U.S. has played a lead role in GAVI since its inception, and is a world leader in support of every aspect of the vaccines value chain, including research, development, vaccine affordability, delivery systems, and policy coordination.

Gayle Smith is Special Assistant to the President and Senior Director for Development and Democracy for the National Security Staff

Day of the Child: 250 Million Kids to Receive Life-Saving Immunization

Compiled by Chris Thomas, Ryan Cherlin

“The most transformative technology at our disposal, vaccines ensure protection against killer diseases whether children are immunized by pediatricians in the U.S. or by health workers in rural clinics in Africa,” said USAID Administrator Dr. Raj Shah.

Yet, vaccine-preventable diseases are still estimated to cause more than 2 million deaths every year in developing countries. The global effort to expand the coverage of existing vaccines and introduce new vaccines against pneumonia and diarrhea got a powerful shot in the arm Monday.

At a first-ever pledging conference for the Global Alliance for Vaccines and Immunization (GAVI), donors committed US$ 4.3 billion, exceeding the $3.7 billion target. The funding will immunize more than 250 million of the world’s poorest children against life-threatening diseases by 2015, and prevent more than four million premature deaths.

Dr. Shah announced a $450 million commitment from the United States over three years (subject to Congressional appropriation). With the pledge, the United States surpassed $1 billion in commitments to GAVI for the purchase of vaccines.

GAVI is a public-private global health partnership, created in 2000, to save children’s lives and protect people’s health by increasing access to immunization in the world’s poorest countries. The alliance funds childhood vaccines against diseases such as pneumococcal pneumonia, Haemophilus influenzae type b, or Hib disease, diphtheria, pertussis or whooping cough, meningitis, yellow fever, tetanus, and rotavirus.

Because infectious disease knows no borders, investment in this area is also one of the most cost effective ways to protect the global community from outbreaks that take an economic and physical toll on previously uninfected populations. In February, the largest outbreak of measles in the U.S. this year was linked to an unvaccinated child who recently travelled to Kenya. The cost in lives and money spent to contain and prevent further infection caused an unnecessary and avoidable burden on local health systems.

The U.S. has long recognized the moral imperative and the inherent economic value of vaccines and immunization, which is why we played a lead role in founding and supporting GAVI.

The first-ever pledging meeting convened prime ministers, ministers and high-level officials from donor and developing countries, leaders of UN Agencies, CEOs from private companies and senior civil society officials and philanthropist Bill Gates.

Dr. Shah also offered to organize a high-level meeting in a year’s time in Washington, D.C., so GAVI, donors and all immunization partners can review progress and impact.

At the conference, it was announced that a record 50 GAVI eligible countries have applied for vaccine funding from the Alliance in this latest application round. The number of countries is nearly double the previous record in 2007 when 27 countries requested support to introduce new or underused vaccines.

The increased demand highlights how developing countries are increasingly prepared to expand routine immunization programs and introduce new vaccines to save the lives of children and protect against illness and disability.

In studies in the Health Affairs and The Lancet journals, public health experts and scientists projected 6.4 million child deaths could be prevented in the next decade, which could save $6.2-billion in treatment costs and $145-billion in lost productivity if vaccine delivery were expanded in 72 low- and middle-income countries.

Picture of the Week

A young girl gets typhoid/diptheria vaccination at a medical clinic at Petionville golf club on July 13, 2010, in Port-au-Prince. USAID/OFDA funds 12 mobile and static International Medical Corps clinics that target rural and displaced populations in and around Port-au-Prince, Petit Goave and Leogane. Photo by Kendra Helmer/USAID

New USAID Report Highlights Achievements in Egypt’s Health Sector

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.

USAID’s Frontlines – April/May 2011

Frontlines Banner Graphic

Read the latest edition of FrontLines to learn about the Agency’s work in global health and in Iraq, including these stories:

This photo of a woman administering a polio vaccine took second place in the latest FrontLines photo contest. Photo credit: Alain Mukeba, USAID/Democratic Republic of Congo

  • 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.

Get these stories and more in the new issue of FrontLines. If you would like to receive a reminder about the latest FrontLines, you can subscribe here.

PEPFAR Support for a Country-Owned Continuum of Response to HIV/AIDS

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.

New Partnership to Strengthen Mobile Health Programs for Moms

Appeared in the White House Science & Technology Policy Blog

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.

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