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Archives for Global Health

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. To reinforce their message, officials made half-day visits to all facilities providing antenatal care services in Gem. To support the importance of this simplified approach, the same memo was re-sent six months later.

The Results

A year after the first memo was sent, a second survey was conducted with a sample of women who recently gave birth: 43 percent of these women had received the recommended two doses of IPTp, a dramatic increase in usage.  As a result the Kenyan government is now repeating the process of disseminating the memo and following up with supervisory visits in all other districts in Kenya where IPTp is policy.

This simple approach, if replicated, could help improve IPTp coverage elsewhere in Africa, where use of IPTp is government policy. This is just one example of the new approaches the President’s Malaria Initiative is supporting to improve program implementation and malaria control across Africa. These approaches are driving forward progress through simple and cost effective processes to save the lives of those who are most vulnerable to malaria – pregnant women and young children.

Do you have other examples of simple, effective solutions that could improve the delivery of health services? We invite you to provide your comments and suggestions below.

World Population Day: Why seven billion matters

By Scott Radloff, Director of the Office of Population and Reproductive Health

This October 31st the UN has projected that the world population will reach 7 billion.  In my lifetime, the world population has passed the 3, 4, 5, and 6 billion milestones.  During that time the world has become much more interconnected and great advances have been made to help people across the globe live healthier and longer lives.

Today, on World Population Day, as we anticipate the arrival of the seven billionth human being on earth, I’d like to pose the question: what more must we do to ensure the health, nutritional, and educational needs of all seven billion are met?

One place to start is by meeting the reproductive health needs of the more than 215 million women in the world who would like to postpone or stop having children but are not using modern contraception.  Investing in family planning translates to lower maternal and child mortality, reduced need for abortion, and it improves women’s opportunities and family well-being.  A USAID-supported study in Bangladesh (PDF,147kb) found that families who received reproductive health services experienced health benefits in addition to larger incomes, greater accumulation of wealth, higher levels of education, and improved access to water.

As we look forward to the next 60 years, it is certain that the world population will increase to 8 billion.  Beyond that the world’s population might stabilize at around 8 billion by the end of the century or could reach upwards of 16 billion, according to the UN projections.  The future course of population growth depends on our current and continued investment in and commitment to voluntary family planning programs, as well as investments in child survival and girls’ education.

 

In it to Save Lives: Scaling Up Voluntary Medical Male Circumcision for HIV Prevention for Maximum Public Health Impact

Emmanuel Njeuhmeli is the Senior Biomedical Prevention Advisor in the USAID Office of HIV/AIDS.

“Male circumcision can be done anywhere, and if you don’t believe me, I’ll prove it to you during this meeting.”

These were my last words during my first presentation at the 2011 PEPFAR Annual Meeting in Johannesburg this past May. Needless to say, there were a lot of raised eyebrows, a few laughs and a couple of questions as to whether I had a male circumcision tent set up in one of the breakout rooms.

But no – the goal, of course, was not to perform a medical procedure on my USG colleagues. It was to heighten their understanding of a cost saving and effective form of HIV prevention that, despite the science and clinical findings, still does not get the recognition and broad support it should.

Soon after the World Health Organization released findings from three randomized trials that showed  male circumcision prevents 60% of new HIV infections in men who have heterosexual sex, countries in Eastern and Southern Africa  with technical and financial support of PEPFAR, BMGF, WHO, UNAIDS began scaling up efforts around voluntary medical male circumcision (VMMC).

PEPFAR, through USAID, CDC, DOD, Peace Corps, and NIH, has continually supported country governments in their VMMC efforts. Kenya’s program is one worth noting. In two short years, the national program has reached 66 percent of its VMMC goals. This means – based on USAID and UNAIDS estimates that Kenya is on its way to averting 47,000 adult HIV infections between 2009 and 2025, and can save $247 million along the way. This is no small feat.

Now, working to support other countries in Africa, such as Swaziland – which is scaling up VMMC services through the Soka Uncobe, an accelerated saturation initiative – we are confident VMMC has the potential to avert more than 4 million adult HIV infections in Eastern and Southern Africa in the next 16 years.

That is what PEPFAR is all about: making smart investments to save more lives.

After our meetings, I felt my colleagues were more inclined to return home and explain VMMC to their country governments in a compelling and effective way. They saw the value of VMMC as a critical HIV prevention tool – one that can be done in a safe medical environment and rolled out on a wide scale in almost any community.

But, to reach our ultimate target – the decision makers and communities in country – we knew we had to go beyond the presentations. So, with the help of AIDSTAR One, we teamed up with Lisa Russell, an award-winning filmmaker, to create In It to Save Lives: Scaling Up Voluntary Medical Male Circumcision for HIV Prevention for Maximum Public Health Impact.

The film examines the expansion of male circumcision as an HIV prevention intervention and tells the story of how governments and communities in Kenya and Swaziland have embraced VMMC in their countries. The goal of the film is to show that VMMC services can be replicated and expanded to reach the critical mass needed for maximum public health impact.

Now, 30 years into the epidemic, there are roughly 34 million currently living with HIV/AIDS, with another 7,000 new HIV infections each day. With numbers like these, it’s more important than ever to focus on reaching those most in need with prevention, treatment, care and support messages and programs.

Through a variety of prevention interventions, including VMMC, we hope to turn the tide of the HIV epidemic.

Watch the video and download additional resources at AIDSTAR-One.

Mobile Clinics in India Take to the Road: Bringing HIV Testing and Counseling and STI Services to Those Most at Risk

Ed Scholl, AIDSTAR-One Project Director, John Snow, Inc. AIDSTAR-One is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government (USG) country teams to build effective, well-managed, and sustainable HIV and AIDS programs, and promotes new leadership in the global campaign against HIV.

Sanjay takes his lunch break on his construction job near the city of Nagpur in the state of Maharashtra, India.  He migrated here in search of work from his home in the northern state of Madhya Pradesh.  He’s 23 and single and hopes to earn enough to get married, start a family, and help his parents back home.

During his break, Sanjay (not his real name) decides to visit the big van parked near the construction site, where an outreach worker told him he can get free HIV and sexually transmitted infection (STI) testing.  He’s curious and a bit concerned about his HIV status, since he knows that visiting sex workers back in town, as he and his fellow workers occasionally do, puts him at risk for HIV.  He enters the van and is greeted by the counselor, who explains how HIV and STIs are transmitted and what he can do to avoid them. Sanjay then gives his consent for an HIV test.  The counselor shares some pamphlets that give him additional information about HIV and STI prevention.  Before she leaves, she demonstrates how to use a condom and offers him some.

Next, he visits the doctor, who goes through a checklist of STI symptoms and provides a physical exam.  Finally, he goes to the lab, where blood is drawn. He is told to come back for the results in four hours.  At the end of his shift, he returns to the van and the counselor tells him, much to his relief, that he is HIV-negative and does not have an STI.  She reminds him how he can stay healthy and avoid HIV and STIs and answers all of his additional questions.

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30 Years of HIV/AIDS: A USAID Historical Perspective

On June 5, 1981, the Morbidity and Mortality Weekly Report reported that five seemingly healthy young gay men were diagnosed with an infection that would typically affect only individuals with substantial damage to their immune system. As similar cases cropped up, national and international attention soared, and the scientific and public health community mobilized to ascertain the scope and root of this anomaly. Eventually, the causal factor was given the name AIDS.

This month marks 30 years since the first cases of AIDS were reported in the United States. After scientists identified and isolated HIV, and confirmed it caused AIDS, the U.S. Agency for International Development (USAID) began its HIV/AIDS development program. Starting in 1986, USAID’s work in this field has been ambitious and cutting edge, showcasing the best of American scientific ingenuity and demonstrating core American values.

In the 1980s and 1990s, we launched prevention, care and treatment programs through our missions around the world using approaches that fit within the social context of each country and targeted the most vulnerable populations. The proliferation of the disease across sub-Saharan Africa prompted us to intensify our focus on this region. In 2000, USAID convened the first agency-sponsored international meeting on male circumcision and HIV prevention. We also began some of the first prevention of mother-to-child transmission programs with the Elizabeth Glaser Pediatric AIDS Foundation.

We quickly realized fighting this disease would require more than just new medication and care. In 2001, we forged a partnership with the International AIDS Vaccine Initiative (IAVI) to invest in research and development for an effective vaccine. To date, IAVI has made a number of groundbreaking discoveries, including several potent new antibodies to HIV, adding more vitality to this game-changing effort. In the same year, USAID commenced three pilot trials of antiretroviral treatment in Kenya, Rwanda, and Ghana.

In 2003, President Bush announced an unprecedented initiative to ramp up the U.S. Government’s commitment to HIV/AIDS in the developing world. Today, the President’s Emergency Plan for AIDS Relief (PEPFAR) continues to be the largest bilateral AIDS program in the world, touching millions of lives through prevention, care, and treatment. Through our global network of missions and partners, USAID currently implements more than half of all PEPFAR programs.

Through PEPFAR, USAID has contributed to saving lives through a variety of voluntary prevention interventions, counseling, testing and care programs. Today, more than 3.2 million people receive lifesaving treatment through the support of the American people.

Building on the strength of PEPFAR  and other successful US global health initiatives, USAID is working at an interagency level to ensure President Obama’s Global Health Initiative replicates and amplifies the success of our HIV/AIDS programs through a continued focus on health system strengthening and investments in innovation. Our award-winning Supply Chain Management System project has provided more than $750 million in HIV/AIDS commodities and saved $700 million by pooling procurements of generic AIDS drugs. We also funded the CAPRISA 004 Trial, which was completed last summer and provided the first-ever proof of concept that a microbicide can reduce risk of transmission from men to women.

Our work is far from done. We have a shared responsibility as a global partner to save lives by focusing on smart investments. The generosity of the American people has made sustained progress against this deadly disease possible. Closing the chapter on HIV/AIDS will require a steadfast focus on remaining gaps and challenges as we chart the way forward.

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.

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