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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.

A Success: USAID’s Neglected Tropical Disease Program

There is a group of diseases you don’t hear much about but that has a terrible impact on more than 1 billion people around the world – that’s one sixth of the world’s population. The World Health Organization (WHO) has classified 13 of these as neglected tropical diseases (NTDs) and they include such dreaded illnesses as elephantiasis, leprosy, blinding trachoma, and intestinal worms.  Together, NTDs have a disproportionately large impact on poor and rural populations, causing severe illness, disfigurement, and disability. They also perpetuate poverty by reducing people’s ability to work and children’s intellectual and physical development.

Until recently, many countries were treating NTDs through separate, uncoordinated programs. However, pilot studies suggest that it is possible to integrate programs to control and treat seven of these diseases together by providing safe and effective drug treatments once or twice a year to all people in an affected community. This approach, which has been endorsed by WHO and is called mass drug administration (MDA), targets large, at-risk populations, rather than individuals, since NTDs tend to occur together in the same geographic area.  Pilot studies of MDAs of the seven targeted NTDs resulted in significant reductions of illness and transmission of these diseases and indicated that, though there were major challenges, integrating control programs was possible and could result in cost savings and efficiencies. However, it was not clear if integrated programs could be scaled up to the national level.

Fortunately, an opportunity arose to find out whether such programs could be successful. In 2006, an act of Congress authorized funding of national integrated NTD control programs in 15 countries over a five year period and USAID launched its NTD program that September. The NTD Program focuses on integrated control of the seven NTDs that can be treated through MDA: elephantiasis, (referred to by scientists as lymphatic filariasis), schistosomiasis (also known as bilharzia), trachoma, onchocerciasis (river blindness), and three soil-transmitted helminthes (worms): roundworm, hookworm, and whipworm.  USAID’s NTD Program is one of the first global efforts to integrate existing disease-specific treatment programs to control these diseases.

A recent article in the American Journal of Tropical Medicine and Hygiene reviews the first three years of USAID’s NTD Program, during that time MDA programs had been implemented in seven countries (Burkina Faso, Ghana, Haiti, Mali, Niger, Sierra Leone, and Uganda) and the program was scaling up in five other countries.  Working with its prime contractor, RTI International, and in coordination with national NTD programs, USAID has provided funds to support the launch and scale up of integrated NTD programs. Through these programs, nearly 16 million people were treated during the first year; the number treated rose to 55 million people by the third year, proving the feasibility of the integrated approach.  USAID’s NTD Program was able to treat millions of people by tapping into existing networks, including ministries of health, schools, non-governmental organizations, which together provide the program with greater efficiency and long-term sustainability as well as strengthen the capacity of national programs.

Remarkably, most of the drugs distributed to treat all these people – 222 million treatments during the first three years – were provided through public-private partnerships between the national NTD programs and major drug donors: GlaxoSmithKline; Johnson & Johnson; Merck & Co., Inc.; and Pfizer.  The estimated value of the drugs donated during the first three years totaled more than $1.4 billion.

The article points out that, while there continues to be technical and political challenges, USAID’s NTD Program exceeded expectations during its first three years, demonstrating the feasibility and cost effectiveness of scaling up integrated NTD program to the national level.  It is now clear that with proper support, integrated NTD control programs, following WHO guidelines, can be implemented in other countries, relieving the terrible burden of these diseases for millions of people around the world.

Beyond ARVs: Comprehensive HIV Interventions in Ethiopia

An estimated 1.1 million people in Ethiopia are living with HIV/AIDS, which makes the country home to one of the largest populations of HIV-infected individuals in the world, according to UNAIDS.  Ethiopia is also one of the poorest countries in the world; only four countries fare worse than Ethiopia on the UN Development Program’s Human Poverty Index.

For people living with HIV in Ethiopia, health care is not just about medicine.  Without adequate nutrition, income, and social support, they are unable to complete their treatments and stay healthy.  The videos below show how U.S. support is comprehensively addressing the needs of HIV-positive individuals and their communities.

Follow Shewarged Kassa, an HIV-positive case worker, as she visits and counsels patients unable to travel to the local health center for treatment.

Visit the pastures near Addis Ababa, where HIV-positive dairy farmers are benefiting from improved livelihoods and a renewed sense of self-worth.

In fiscal year 2010, Ethiopia received over $320 million in U.S. HIV/AIDS funding.  Through the President’s Emergency Plan for HIV/AIDS Relief, in 2010 in Ethiopia, over 200,000 people received life-saving treatment, more than six million received counseling and testing, and millions more were reached by prevention programs.

Empowering Youth in India

By: Laura Rodriguez, USAID

At the age of 17, Ishita Chaudhry recalls watching violent riots in her home country of India and being struck by the lack of political will and voice that her fellow peers had in decision making.  It was 2002.  Ishita was a senior in high school and suddenly became motivated to do something. She founded The YP Foundation (TYPF),  now the biggest youth-led organization in India, a country in which 315 million people or 31 percent of the population is under the age of 24.

Youth empowerment is a key message for all of the YP Foundation's programs. Photo Credit: Shiv Ahuja/YP Foundation

The YP Foundation’s mission is to empower young people to address health and rights, gender and sexuality, HIV/AIDS, human rights and peace building, life skills, governance and pro-active citizenship.

Over the years Chaudhry and her staff of 16 young people have worked with over 5,000 individuals to set up over 200 projects in India, training youth at international, regional and local levels as well as networks such as Students for the Promotion of International Law, the Global MDG Summit India 2008 and the Indian Youth Climate Network.

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Real Results in Afghanistan

By: Louisa Bargeron and Lars Anderson

During the USAID delegation to Afghanistan, Administrator Rajiv Shah, Mission Director Earl Gast, and Alex Their, head of the Office of Afghanistan and Pakistan,  visited the Hesa Awal Community Development Council (CDC)—an initiative made possible through Afghanistan’s National Solidarity Programme (NSP)—located in Dakoy Payan Village, Kabul.  Also present was Deputy Minister Wais Ahmad Barmak for Programmes, Ministry of Rural Rehabilitation and Development, Government of the Islamic Republic of Afghanistan.

Dr. Rajiv Shah, Administrator for the United States Agency for International Development, visited a Community Development Council Health Clinic in Mirbacha Kot, north of Kabul, Afghanistan. Dr. Shah was accompanied by USAID Mission Director Earl Gast and Minister of Rural Rehabilitation and Development Jarullah Mansoori. Photo Credit: Lars Anderson/USAID

Created in 2003, the solidarity program develops the ability of Afghan communities to identify, plan, manage and monitor their own development projects.  NSP empowers communities to manage resources transparently during all stages of the project-cycle and make decisions affecting their own lives and livelihoods.  In Hesa Awal, the CDC serves 482 families totaling 2,802 people.  Sometimes the men and women of this village come together, at the same time, to discuss what matters to them most and on this day the villagers agreed that their clinic was a top-priority.  The clinic serves an average of 70 patients a day, most of them children and soon-to-be mothers.  For parents, the biggest impact has been the enhanced quality of maternal health care, as well as the improved health of their children as a result of vaccinations.

Administrator Shah was enthusiastic with the development council’s capacity to come together on a weekly basis and connect with the people to address local issues.  Shah noted how much of a huge difference and positive impact this program has had on the community, most notably the CDC’s work in establishing a well-stocked  and run clinic and completion of a local road project, which combined, cost less than sixty thousand dollars.

Click here to see video from the Administrator's trip to Afghanistan.

Minister Barmak reinforced the NSP’s goal of fostering a sense of local ownership and leadership and was grateful for USAID‘s support.

Both Earl Gast and Alex Thier recognized the programs proven results in connecting the local government to the provincial level.

The CDC, supported by USAID, is the largest component of Afghanistan’s National Solidarity Program.

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