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Archives for Global Health

Bangladesh: Maternal Deaths Decline by 40 Percent in Less Than 10 Years

Bangladesh is on track to meet the 2015 deadline for U.N. Millennium Development Goal 5 (50 percent reduction in maternal deaths).   The Bangladesh Maternal Mortality and Health Service Survey [PDF] jointly funded by the Government of Bangladesh, USAID, Australian Aid (AusAID) and the United Nations Population Fund (UNFPA) found that maternal deaths in Bangladesh fell from 322 per 100,000 in 2001 to 194 in 2010, a 40 percent decline in 9 years.

The decline in direct obstetric deaths is most likely the consequence of better care seeking practices and improved access to and use of higher-level referral care.  The decline in total fertility rate due to the successful family planning program has reduced exposure to high risk pregnancies and has thus prevented a large number of maternal deaths.

USAID’s program in Bangladesh has historically been very strong in family planning through the world’s largest social marketing program for non-clinical contraceptive methods and through the public sector for long-acting permanent methods.  We can confidently say that our long and unwavering investments in family planning have had direct impact in lowering the total fertility rate, and thus the maternal mortality rate, in Bangladesh.  Over the past five years, USAID has also invested in scaling up active management of the third stage of labor to prevent postpartum hemorrhage in the public and NGO sector.

The USAID program has also long invested in promoting and providing antenatal care through the NGO sector which linked women to the health system thus contributing to increased awareness and care-seeking for obstetric complications. USAID and CDC’s long term commitment to the in depth training of local scientists has resulted in the creation of Bangladesh’s premiere research institute, the International Center for Diarrheal Disease and Research, Bangladesh (ICCDDRB) which has the capacity to effectively guide valid and reliable research efforts such as the 2010 Bangladesh Maternal Mortality and Health Care Survey (BMMS).

USAID supported and provided technical leadership in implementation of the 2001 and 2010 BMMS to monitor the performance of the overall maternal health program. Without these two surveys it would not be possible for Bangladesh to monitor its progress towards achieving the MDG 5 goal.

Amanda Glassman, Director of Global Health Policy and a research fellow at the Center for Global Development, wrote “the results are also a good reminder that investments in family planning and girls’ education drive much of maternal health outcomes, and that USAID investment in social marketing of family planning and health seems to be paying off in improved health (see blog post).”

The Bangladesh Ministry of Health and Family Welfare is scaling up emergency obstetric care and active management of the third stage of labor; the Ministry has also recently approved distribution of Misoprostol tablets to all pregnant women shortly after delivery to prevent postpartum hemorrhage. There is also increasing availability of Magnesium Sulphate for management of pre-eclampsia. The predominance of hemorrhage and eclampsia deaths and deaths after delivery indicate a need to strengthen access to treatment for these two conditions, improve referral systems, and improve referral level care.

Every year, USAID provides basic health care services to nearly 20 million Bangladeshis, including provision of low-cost, quality family planning services and maternal and child health care. With USAID and international support, under-five mortality rates have declined by more than 50 percent in Bangladesh since 1990. USAID has trained and mobilized community health workers to provide critical maternal and child health care to supplement broader health interventions and support country-level capacity. Bangladesh already received a country award from the United Nations for significant progress in reaching MDG 4 (reducing child mortality) during the MDG Summit in New York on September 19.

The Government of Bangladesh and the United States jointly rolled out President Obama’s Global Health Initiative in Bangladesh on November 23. GHI in Bangladesh will focus on providing quality services to reduce maternal and child mortality, resuscitate family planning programs, improve nutrition status among children under age five, and strengthen overall health systems over the next five years.

Calling All Probem Solvers: Help Make Birth Safe

This blog is cross posted from the OSTP blog.

The birth of a child is a momentous event anywhere in the world.  In many countries, though, the occasion is not just one of joy, but one of fear – fear for the life of the mother and the newborn baby.  The time between when a woman begins labor and 48 hours after the birth of a baby is a high-risk period during which millions of newborn babies and new mothers die each year.

US Agency for International Development(USAID) Administrator Rajiv Shah delivers remarks at the launch of a Global Partnership on Maternal and Child Health on March 9, 2011 at the Ronald Reagan Building in Washington, DC. US Secretary of State Hillary Clinton introduced a new partnership between the US Agency for International Development, the Government of Norway, The Bill and Melinda Gates Foundation, Grand Challenges Canada and The World Bank that will seek innovative solutions to reduce maternal and child mortality in developing countries. Photo Credit: Chris KLEPONIS/AFP

That’s why today the U.S. Agency for International Development (USAID) is leveraging the collective resources of our partners—the Bill & Melinda Gates Foundation, Grand Challenges Canada, the Government of Norway, and The World Bank—to launch Saving Lives at Birth: A Grand Challenge for Development. This grant-based program will seek groundbreaking prevention and treatment approaches for pregnant mothers and newborns around the time of delivery in rural, low-resource settings.

This extraordinary partnership underscores the fact that saving lives at birth is one of the most critical challenges facing people in developing countries.  Finding new technologies, such as low-cost infant resuscitation devices or incubators, and new approaches to improve birth outcomes for mothers and newborns would not only alleviate suffering, but would also have a significant impact on public health and economic productivity.

It would also accelerate progress toward achieving the Millennium Development Goals 4 and 5, which call for a two-thirds reduction in under-five mortality, a three-quarters reduction in maternal mortality, and universal access to reproductive health services.

Saving Lives at Birth is the first in a series of Grand Challenges for Development that will be announced by USAID in the coming years to mobilize focused attention and resources around the most pressing obstacles to achieving our development goals.  These Grand Challenges for Development are definable, quantifiable goals that address some of the largest solvable problems poor countries currently face.  USAID will partner with other funders and encourage others to invest in finding innovative solutions to these Challenges that are sustainable, scalable, easily adopted, and that build on and utilize 21st-century infrastructure and technology.

These Challenges also reflect President Obama’s commitment to game-changing innovation as a powerful and cost-effective instrument for achieving development goals.  The President’s Policy Directive on Global Development focuses on sustainable development outcomes by placing a premium on broad-based economic growth, democratic governance, sustainable systems, and the creation and application of game-changing innovation to transform longstanding development challenges into solvable problems.

We believe that these Grand Challenges can address key priorities, catalyze innovations that drive economic growth, spur the formation of multidisciplinary teams of researcher and multi-sector collaborators, bring new expertise to bear on important problems, strengthen the ‘social contract’ between science and society, and inspire students and non-development experts to get involved in problem-solving for development.

USAID and its partners cannot solve the Grand Challenges for Development alone.  We hope that the effort to meet these challenges will be taken up by non-governmental organizations, the private sector, governments, and individuals around the world.  We know there are millions of people and organizations around the world who want to help but don’t know how to start.  This is a place to start.

For more information on the Challenge and application process, visit here.

Dr. Rajiv Shah is the USAID Administrator and Tom Kalil Deputy Director for Policy for the White House Office of Science and Technology Policy and Senior Advisor for Science

USAID Partner Hosts Scientific Writing Program for African AIDS Researchers

During his fellowship from September 2010 to March 2011, Mr. Randy Kaja, a Pfizer Global Health Fellow based at the International AIDS Vaccine Initiative (IAVI) Regional Office in Kenya, has been coaching IAVI-partner scientists to develop and publish scientific articles from their research results. This effort is a part of the ongoing training and support of USAID partner IAVI, to build capacity of African AIDS researchers in the field, while in the pursuit of an HIV vaccine.

Late in the summer of 2009, IAVI held a scientific abstract writing course for staff from Ugandan clinical research centers.  The course was designed to develop the skills and confidence of the research teams to independently construct complete, concise and clear scientific abstracts for submission to conferences.  Fourteen staff from the Uganda Virus Research Institute (UVRI) in Entebbe and the Medical Research Council (MRC) in Masaka participated in the program.  The program was a success; following this training, abstracts from two program participants were accepted for presentation at major international scientific conferences this year:

  • “Innovations in Addressing Communication Gaps in HIV Prevention Research: Experiences from a Lake Victoria Fishing Community.” Submitted by Simon Sigirenda and presented as a poster at the 2010 International AIDS Conference held in Vienna.
  • “Comparison of HIV Prevalence among Study Participants Screened for an HIV Vaccine Preparedness Cohort and VCT Clients in a Ugandan Fishing Population.” Submitted by Annet Nanvubya and presented as a poster at the 2010 AIDS Vaccine Conference in Atlanta.

In May 2010, IAVI hosted a more comprehensive scientific writing training for clinical research scientists in eastern and southern Africa.  Staff from six organizations, including UVRI, the MRC, the Kenya AIDS Vaccine Initiative in Nairobi and the Center for Geographic Medicine Research-Coast in Kilifi, Kenya participated in the six-day course, which covered the detailed process of drafting a scientific paper, editing it, and submitting it to a journal. The curriculum addressed abstract preparation, mastery of writing styles, essentials of editing, the structure of a scientific paper, preparing tables and illustrations, and an overview of the publishing process.

Mr. Kaja saw early results as well. An article titled “Reasons for Ineligibility in Phase 1 and 2A HIV Vaccine Clinical Trials at Kenya Aids Vaccine Initiative (KAVI), Kenya” by Dr. Gloria Omosa-Manyonyi et al. was recently published in the journal PLoS ONE. More papers are currently in various stages of drafting.

In addition, Mr. Kaja, in collaboration with IAVI staff in Kenya, delivered comprehensive workshops on scientific writing early this year, covering a range of essential topics, such as overcoming writer’s block, language usage, choosing a journal, research ethics, and authorship. Sixteen research staff from Kenya and 13 from Uganda and Rwanda have benefitted from these workshops. The participants, around 60% of them women, have ranged from medical researchers to community liaison officers involved in IAVI-sponsored studies.

More about IAVI:

IAVI is a global not-for-profit, public-private partnership whose mission is to ensure the development of safe, effective, accessible, preventive AIDS vaccines for use throughout the world.  USAID and IAVI formed a partnership in 2001 to hasten development of an AIDS vaccine.

Women Shouldn’t Have to Be Sneaky to Get the Family Planning They Want

Yes, I said it. But it’s not my word. I’m just the messenger, relating to you what I heard: sneaky.

According to health care providers I interviewed recently in Western Province, Kenya, sneaking is exactly what women feel they need to do if they want to avoid or postpone pregnancy. Their male partners, for the most part, do not want them limiting the number of children they bear. Many men share the traditional attitude that the primary role of women is to give birth. Others believe that family planning makes women “promiscuous” or that certain contraceptive methods produce deformed children. So, faced with men’s resistance and socially disempowered, many women don’t tell their male partners about the contraception they use.

But family planning is more than a UN-recognized right for a woman “to decide freely and responsibly on the number and spacing of [her] children.” It’s also a powerful HIV prevention strategy, part of a comprehensive approach to prevent mother-to-child transmission of HIV (PMTCT). Each year, HIV-positive women in sub-Saharan Africa avert almost 175,000 HIV-positive births by using contraception, a figure that would nearly double if all HIV-positive African women were able to use family planning services.

Programs that integrate family planning and HIV services—such as the USAID-funded AIDS, Population, and Health Integrated Assistance II (APHIA II) Western Project—enable women to postpone pregnancy or avoid unintended pregnancy, which, in the case of HIV-positive women, decreases mother-to-child HIV transmission. Such programs also increase the number of community members who get tested, as well as the number of women and men enrolling in HIV care, support, and treatment programs.

How does APHIA II Western work? On the most basic level, if you are a woman going to a clinic for an HIV service—maybe a CD4 count—the provider will ask you if you are pregnant, if you are using a family planning method, and, if not, whether you would like to learn about the methods available. If the answer is yes, you will get counseling on family planning and either receive the contraceptives immediately (free of charge) or be referred elsewhere for them. Likewise, if you arrive and are seeking a family planning method, the provider will ask if you have been tested for HIV and, if not, whether you would like to be. The HIV rapid test is also free.

In fact, no matter what brought you to the clinic, providers will ask you these questions—and more.

So far, so good—but what about the sneaking?

Despite an abundance of contraceptive methods available at the clinics, women always have to consider what might happen when they go home. So, many opt for “sneaky” contraceptives, such as the injectable Depo-Provera, that can be used without their partners’ knowledge. Depo-Provera is an effective contraceptive, but it must be re-injected every three months, and it does not protect against HIV. In fact, the only contraceptive methods that can help prevent HIV transmission are male and female condoms—both of which require either the male partner’s involvement or knowledge.

So how can family planning programs and policies bridge that wide gap between men’s attitudes and women’s contraceptive and HIV prevention needs? The short answer is that male norms and behaviors must change so that men learn to support women’s contraceptive choices and to participate in family planning themselves. This is not news: In 2009, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) advocated that HIV prevention, treatment, and care and support programs address male norms and behaviors.

One way to do this is to increase men’s interactions with the health care system, especially with programs that protect the health of their partners and children. APHIA II Western Project accomplishes this by holding “male clinics” on weekends, where men learn about PMTCT and other reproductive health topics, some of which are considered taboo for men to discuss. To attract participants, these male clinics do not focus exclusively on HIV, a subject that is raised only toward the end of the session, but also cover broader health issues that are important to men, such as high blood pressure. During each clinic, the men are given the option to be tested for HIV and asked to spread the message by returning the following week with a friend. By bringing men together in this way and around PMTCT, the project is tackling some of the norms that force women to feel sneaky about seeking care.

The program also encourages male involvement by sending PMTCT clients accompanied by their male partners to the front of the service queue. This policy has decreased loss-to-follow-up and offers an opportunity to enroll additional men in the male clinics.

If you work in the field of public health, you may already know about the value of integrating services. But the success of APHIA II Western’s efforts shows that it is important to not only integrate services but also to incorporate strategies that address gender inequity.

It is time for all the sneaking to stop. Instead, women and men should be proud to exercise their right to family planning. With support from gender-sensitive health programs, the mothers and fathers of Kenya can lead the effort to end vertical HIV transmission.

For other programs addressing male norms and behaviors, see the Gender Compendium.

AIDSTAR-One is managed by USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs and promotes new leadership in the global campaign against HIV.

Inspired and Humbled by Nepal’s Female Health Workers in the Rural Villages of Salyan

After a one-hour prop plane ride from Kathmandu, followed by an 11-hour rocky drive through the stunning hills and valleys of Mid-Western Nepal’s upper hilly region, our team reached Salyan District’s remote and rural villages. We were there to video the successes of the USAID-supported, 50,000-strong Female Community Health Volunteer project.  Working in every district of Nepal, these volunteers are often the only health care providers in such remote and isolated villages.

Female Community Health Volunteers of Marke District, Nepal, work to enhance health awareness, improve health standards, and save lives throughout their communities by utilizing the training they’ve received through the USAID-supported Nepal Family Health Program. Photo Credit: Gregg Rappaport/USAID

I’ve spent the last several days traveling with our group comprised of health specialists, program managers, and communicators (Gregg Rapaport, Senior Communications Manager, and Stuti Basnyet, USAID/Nepal) videoing, interviewing, listening and learning.  The stories are nothing short of amazing, and the volunteers’ passion to fulfill what they consider a calling to serve their communities has been inspiring.

It’s been humbling to hear the stories of these dedicated volunteers giving care under arduous circumstances and to meet the many villagers seeking care – a health volunteer who recently saved a newborn baby’s life minutes after delivery; another who has committed more than 22 years to serving her community through this project; a group of women who, in the last six months, have counseled more than 85 couples on family planning; a man seeking care for severe knee problems who arrived in the village on a stretcher after traveling nearly two hours, carried high above the heads of his four nephews. These volunteers are changing the behavior of their villages, increasing awareness to improve health standards, and most importantly, saving lives.  Of the 500 local children checked for pneumonia in the last six months, 73 were treated with antibiotics, 13 were referred to higher level health care at the district level, and all have made a full recovery.

One woman I spoke with, Laxmi Sharma, a volunteer in Salyan’s Ward 4, said that it’s not a matter of money, but rather a matter of helping her community. “We do this as volunteers,” she explained, “because we can improve the health of our communities.”  The women play a crucial role in providing vitamin A supplementation, immunizations, family planning education, safe motherhood interventions, and community-based integrated management of childhood illnesses, particularly in the detection and treatment of pneumonia and diarrhea – Nepal’s top two childhood killers.

With support from USAID and other donors, Nepal is also one of only a handful of countries poised to meet more than one of the Millennium Development Goals (MDGs) in health by reducing the number of maternal and child deaths by nearly half in only 10 years! A remarkable achievement alone, that it was realized at the end of the nation’s prolonged 10-year internal conflict makes it even more profound.

Our return trip back through the town of Dang this afternoon was marked by a rather serendipitous event – hundreds of women, men, and children marched in solidarity to celebrate the global 100th anniversary of International Women’s Day.  One woman I spoke with explained, “Through this (march) forum  … we can work to ensure women have equity, empowerment, and are at the center of mainstream politics. If all the women come together, this is something that is achievable, we just need to work at it.”

Check out this video on USAID/Nepal and their work on family health.

Around the world today, millions of people will flood the streets in their hometowns to voice their enduring support for the advancement of women and girls as key leaders in the creation of a better world.  As new ideas and innovative ways are introduced, USAID/Nepal continues to incorporate these pioneering initiatives in its program design, placing women and girls at the forefront of building the country’s peace and prosperity.

But USAID/Nepal is not only working in the health sector – it is also leading the way in partnership with the Nepalese people to finding solutions to the toughest challenges to driving economic progress, promoting educational opportunities, promoting political stability, sustaining the environment, and feeding the population.

The Education for Income Generation Activity has trained more than 65,000 disadvantaged youth from the Midwestern region—the most conflict affected and one of the poorest regions of Nepal—in basic and business literacy, vocational training and agriculture productivity and enterprise development in the last three years. Of these, 7,900 youth received vocational training with 80% gainfully employed as a result of the training.

Through the Women’s Leadership Academy program, USAID has provided training on the fundamentals of democratic politics and constitution drafting to over 200 elected women parliamentarians and civil servants, providing them with the tools needed to draft the constitution and participate fully in party and parliamentary proceedings.

We know that supporting investment in women and girls can be compelling force multiplier for development and innovation. At the heart of Nepal’s advancement, women will continue to advocate on behalf of their communities, and promote advancements in education, economic growth, politics, climate change, and initiatives to improve access to food.  USAID/Nepal will continue to move this agenda forward, and advance this priority by standing in solidarity with by the women and girls of Nepal.

Extending Quality Health Services to Underserved Groups through Faith Networks

In Ghana last week, I had the privilege to participate in the Africa Christian Health Associations’ 5th Biennial Conference, “Improving Women’s and Children’s Health in Africa.”

Christian Health Associations and networks from Africa and partner organizations met to take stock of their efforts in support of the Millennium Development Goals (MDGs) and discuss opportunities to strengthen local capacity to deliver services for women and children.

USAID’s Bureau for Global Health has worked with numerous organizations to support the critical roles played by churches, mosques, synagogues and other faith networks in their broader communities.  We have successfully empowered various faith-based leaders to speak openly in their respective communities about the crippling effects of HIV and AIDS and about the importance of planning one’s family and preventing children and families from falling ill and dying from malaria.

Last week, USAID Administrator Rajiv Shah delivered the David E. Barmes Global Health Lecture at the National Institutes of Health.  Recounting the successes that have been achieved in recent decades in global health, Dr. Shah outlined the challenges that currently exist and set out a roadmap for USAID and the wider health community to take advantage of the window of opportunity in front of us to accomplish a new wave of successes that can dramatically improve health around the world, particularly for children under age five and women.

He said, “Our largest opportunities to improve human health do not lie in optimizing services to the 20 percent of people in the developing world currently reached by health systems; they lie in extending our reach to the 80 percent who lack access to health facilities.”

Partnerships with faith-based and community organizations are essential to reaching that 80 percent because faith communities provide critical health services  — in some countries, faith groups operate anywhere from 25 to 50 percent of health facilities.

USAID has decades of experience in community-based work that takes health care out of fixed facilities and into the community.

Saving the lives of women and children requires a range of care that includes improving nutrition and training of birth attendants, who can help women give birth safely. It also requires increased access to family planning information and services and the widespread adoption of proven, inexpensive tools and key practices like rehydration liquids to combat diarrhea, immunizations for childhood diseases and vitamin supplements to fight malnutrition.

In September, President Obama signed the first-ever presidential policy directive on U.S. global development, elevating development — and with it global health — as a pillar of US foreign policy, along with diplomacy and defense. The Global Health Initiative embodies this new policy.  It builds on the experience of the last decade, maximizing development impact and leveraging knowledge and human ingenuity.

As President Obama so ably put it, “When a child dies from a preventable disease, it shocks our conscience.”

There is no better time to act. The Global Strategy for Women’s and Children’s Health, launched by the UN Secretary-General in September, is an unprecedented effort to improve the lives of women and children in the developing world and meet the MDGs of reducing child mortality by two-thirds and maternal mortality by three-quarters by 2015.

Life Savers in Africa

Submitted by Ari Alexander, Director for the Center for Faith-based & Community Initiatives and the Senior Advisor of NGO Partnerships and Global Engagement at USAID.

Thunderstorms took out the electricity. The conference proceeded without lights, microphones or air conditioning in 100 degree heat. Most of us would find ourselves understandably distracted and uncomfortable under such circumstances. But the attendees at this gathering were an extraordinary group of Africans.

Doctors, pastors, researchers and health care practitioners—leaders of the Christian Health Associations in their countries—came together in Accra, Ghana for a conference on the role of faith-based organizations in helping the world achieve the Millennium Development Goals on maternal and child health.  In most cases, the religious institutions, church networks and faith-based organizations that they represent have been providing health care to the citizens in their countries for decades longer than either the U.S. Government or their own governments.

I had the chance to speak with Joseph, soon to be a citizen of the newest country in the world— the Republic of South Sudan. He is responsible for dozens of HIV treatment facilities in some of the most difficult conditions in the world. I met Donna, a humble doctor from Kenya who happens to be a world expert on the pharmaceutical supply chain impacting the world’s poorest people. I listened intently to Donald, a brilliant physician from Nigeria coordinating over 250 health care facilities throughout Africa’s most populous country.

On the second day of the conference I presented on the Obama Administration’s commitment to working in partnership with faith-based and community-based organizations. My colleague, Susan Brems, Senior Deputy Assistant Administrator for Global Health at USAID, gave a fantastic talk about the Administration’s signature Global Health Initiative.

Then the real fun began. Our session went 90 minutes over the allocated time as participant after participant passionately advised, encouraged, and taught us as they responded to our comments.

This is as good as it gets.  Being in listening mode.  Gathering golden nuggets of information and advice from across the African continent. Learning from those who serve on the front lines of the world’s battle to care for the most vulnerable.

We want to hear your golden nuggets of information.  To share with us, please email fbci (at) usaid.gov.

To learn more about Ari Alexander’s trip to Ghana and his work at USAID see his recent interview with Frederick Nnoma-Addison of AMIP News.

Strategic Investment Helps South Africa Scale Up HIV Treatment

With 2009’s change in political leadership in South Africa, we’ve seen a rapid scale-up of HIV/AIDS testing, treatment and prevention services.  After years of neglect, we have a 17.8 percent adult HIV prevalence rate and 5.33 million adults and 330,000 children who are HIV positive, the largest in the world.  And only 37 percent of people in need of treatment are receiving it.

As a South African, I was delighted to see my government putting so much energy and attention to saving the lives of the millions of people needing treatment.  Then in 2009 Secretary Clinton announced a strategic initiative with the Government of South Africa to help accelerate scale up. Ambassador Goosby and the PEPFAR program committed to a one-time, two-year infusion of $110 million through USAID for PEPFAR’s Supply Chain Management System (SCMS) to purchase antiretroviral drugs (ARVs) on the international market at prices lower than those paid by the government of South Africa. PEPFAR South Africa and the SCMS team did a quick cost comparison of our prices versus the Government of South Africa’s prices and, working closely with our partners at the Ministry of Health, agreed on a list of ARVs for which we could get particularly competitive pricing.

Last year we completed the procurement of more than $70 million of the total $110 million with more than 7 million units of ARV’s being distributed to the provincial depots.  Comparing our prices with those paid by previous South African procurements, we saved $61 million (46 percent) procuring generic ARV’s purchased at international prices.  PEPFAR’s investment showed it was possible for the South African government to match international prices and set informal benchmarks for subsequent purchases.

In December, South Africa’s Minister of Health, Dr. Aaron Motsoaledi, announced success with South Africa’s own procurement of ARVs noting a “massive reduction in the prices of antiretroviral drugs which has resulted in the 53.1% reduction in the cost of the total tender which translates to a R4,7 billion [US$630 million] savings. The percentage decrease in the cost of each item ranges from 4% to 81% implies that South Africa can now afford to treat twice as many people on ARVs compared to that which was previously budgeted.”

By the end of this two-year initiative, PEPFAR’s investment of $110 million will have leveraged about $90 million in savings from SCMS’s procurement and a further $600 million for the South African government.  That’s quite a return on investment.

Strengthening the Social Service Workforce

Jean-Claude works as a social worker for a small community-based orphan care program based in Port-au-Prince, Haiti. In this capacity, he is responsible for assessing the welfare of children and families, helping them to identify and access essential services and resources, organizing support groups for children and their parents and guardians, investigating allegations of child abuse, mediating family conflicts, and developing and implementing case plans in an effort to keep families strong and together.

Following the earthquake last year, Jean-Claude’s very full job description was further stretched to include negotiating temporary placement and locating caregivers for nearly 150 children who lost contact with their families or whose parents were killed in the earthquake’s aftermath. As a social worker, particularly a social worker in an environment devastated by natural disaster, political turmoil and disease, Jean-Claude has a critically important and almost impossible scope of work. Yet when asked what he considers to be the most difficult aspect of his job, Jean-Claude explains, “Everyone thinks they can do my job, but nobody wants to.”

Around the world, social work is one of the most misunderstood and underappreciated professions. While we recognize that social concerns have a tremendous impact on health, education, economic and other development outcomes, we rarely recognize the skills and expertise of those professionals who address these concerns. Like the health sector, the social service sector struggles to attract and retain qualified workers. Vacancy rates for established professional and para-professional positions within Africa range between 50%–60%, and half those employed leave their jobs within five years (as compared to seven years for healthcare workers). These statistics indicate a global crisis within systems of care and support for vulnerable children and a serious threat to global development.

This past November, the President’s Emergency Plan for AIDS Relief, under the auspices of USAID, funded a global conference in South Africa to highlight this crisis and explore strategies for addressing the crisis at a country level and global level. “The Social Welfare Workforce Strengthening Conference: Investing in those who care for children” brought together teams from 18 countries to share experiences, promising practices, and develop concrete action plans.  Each team included representatives from relevant government ministries, non-governmental organizations, donor organizations, social work training institutions, and professional associations, which provided an opportunity for multi-disciplinary problem solving and team building.

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USAID’s Battleground: Expanding Access and Strengthening Health Systems

Administrator Shah: “Our experience with GHI has made it clear: our largest opportunities to improve human health do not lie in optimizing services to the 20% of people in the developing world currently reached by health systems; they lie in extending our reach to the 80% who lack access to health facilities. That is where the success of everything I’ve discussed today will be determined.  That is our battleground.  And I am proud to say: that is where USAID will lead the fight.”

Today, in a packed auditorium at NIH, Administrator Shah outlined a global health agenda around five transformational goals.  Dr. Shah believes that we can achieve the following by 2016: save the lives of over 3 million children; prevent more than 12 million HIV infections, avert 700,000 malaria deaths, ensure nearly 200,000 pregnant women can safely give birth, prevent 54 million unintended pregnancies, and cure 2.4 million people infected with TB.  To achieve these ambitious goals, he emphasized the need to strengthen health systems by empowering community health workers and midwives by equipping them with better diagnostics and treatments.

As part of the President’s Global Health Initiative, USAID helps countries integrate their health systems across WHO’s six health system “building blocks” (human resources; medical supplies, vaccines, and technology; health financing; information; leadership and governance; and service delivery) and within their national infrastructure.  Recent activities included: strengthening health care financing in Armenia, Azerbaijan, Georgia, and Senegal through the use of national health accounts; helping nine countries implement human resource information systems; and instituting performance assessments to raise standards for HIV services in six Central American countries.

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