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Archives for Global Health

The Question is King – Turning Princely Investments into Practical Solutions

“The question is king,” states the Implementation Research in Health: A Practical Guide (PDF), a new World Health Organization resource from The Alliance for Health Policy and Systems Research/Implementation Research Platform. Launched this month, the guide strives to answer a critical question facing public health today: As we invest increasingly princely sums for health interventions throughout the world, why do we continue to stare down statistics such as an estimated 2.5 million people getting infected with HIV and over 7.6 million children succumbing to preventable deaths each year?ImplementationResearchInHealth

For some, terms such as implementation research, implementation and delivery science are the language of the day. Many more, we suspect, use the terms with a degree of hesitation. The basic underlying principle is clear. Promising programs and research – those with exciting results from a proof of principle study or small stage implementation – may not be readily replicated on a larger scale, or demonstrate similar impact in a different location.

Implementation Research in Health provides a rigorous approach to addressing these gaps. The guide offers researchers and program implementers the rationale for implementation science, and an introduction to its practical mixed methodological approach – drawing from epidemiology to market research, health services research and even political science. Some may recognize much of the content – the guide updates the 2003 Implementation Research in TDR: Conceptual and Operational Framework, for example. But, the easy-to-use-format (key points are summarized for each chapter; helpful graphics summarize everything from implementation science strategies, outcome variables and the research continuum) makes the guide a welcome new addition.

At a recent Investigators’ Meeting for USAID partners supporting implementation science studies to improve PEPFAR programs, participants discussed the importance of publishing not only on the results of these studies, but the rigorous approaches used to generate the results. We applaud such efforts. We encourage more researchers to publish on the rigorous implementation science methods they’ve used – it can only help build a common understanding of the underlying rigor that is the hallmark of quality implementation science research (read a description of USAID’s implementation science portfolio to support PEPFAR programs and on USAID’s implementation science related to maternal, newborn, and child health).

Implementation science can look beyond the impact of individual interventions to evaluate interventions aimed at improving broader health systems. As we ask questions in our increasingly complex global health world – from “how to best integrate previously separate programs?” to “how do we measure impact as we increasingly work through and with our partner governments and donors?” – implementation research plays a critical role in helping us address these issues. We encourage future editions of this and other implementation science resources to share how rigorous implementation science has helped address these broader questions.

Implementation Research in Health calls its subject “new” and “neglected.” Yet, people have been doing implementation research (or variants of it) for decades. The guide is a promising resource to bring implementation research into the spotlight where we think it belongs – we encourage you to read the guide and decide for yourself.

Harnessing S&T for Global Development

This originally appeared on the White House Blog

Recently, I interviewed Dr. Andrew Sisson, the U.S. Agency for International Development (USAID) Mission Director in Indonesia, who is leveraging science and technology (S&T) and innovation to help tackle development challenges in Indonesia.

Why is USAID focusing on S&T and innovation in Indonesia? What are some of the economic and societal challenges that S&T can help address?

Science, technology, and innovation have the potential to solve important global development problems. S&T can help communities and governments control the impact and spread of infectious diseases; protect marine environments; strengthen resilience to natural disasters and climate change; and much more. In just one example, we are working with the Indonesia National Tuberculosis Program (NTP) to test a new, simple and rapid tuberculosis (TB) diagnostic called GeneXpert. The goal of this technology is to increase the rapid detection and treatment of TB in HIV patients. The results of pilot testing in 17 locations across Indonesia will be published soon and, with support from the Global Fund and TB REACH, the Indonesia NTP has already expanded  use of the new diagnostic to private-sector hospitals.

Indonesia Laboratory technical at Hasan Sadikin Hospital in Bandung (West Java) performs multi-drug resistant TB tests using GeneXpert as part of a pilot project supported by USAID. Photo credit: Roni Chandra

Indonesia Laboratory technical at Hasan Sadikin Hospital in Bandung (West Java) performs multi-drug resistant TB tests using GeneXpert as part of a pilot project supported by USAID. Photo credit: Roni Chandra

What is the mission’s strategy around S&T over the next few years?

USAID is partnering with the Government of Indonesia to use new and innovative approaches to achieve Indonesia-specific development goals. We’ve also decided together to focus part of our investment on developing components of Indonesia’s “scientific ecosystem,” including by developing merit-based research systems and strengthening the scientific evidence-to-policymaking cycle. Our joint work also includes scholarship opportunities, joint research between Indonesian and American scientists, and private-sector partnerships to adopt advanced technologies for development goals.

What are some opportunities to strengthen collaboration between Indonesian and American scientists?

Indonesia and the United States have many overlapping scientific interests: climate change, marine conservation, healthcare diagnostics, renewable energy, disaster risk reduction, and more. And so we’d like to open more doors for scientific collaborations to take root in these areas. The State Department has established an official dialogue with Indonesia on making scientific exchanges a top priority. But, it can’t only be a government-to-government effort. For scientific collaboration to flourish we’ve got to place it in the hands of our top scientists and students – and so networking among students and universities in both countries has also been a promising area of partnership.

Can you give an example of an individual or project that exemplifies USAID and Indonesia’s collaborative work in S&T?

What’s been incredible to see is how quickly an international network of scientists can come together to create something big when given the opportunity. One great example is the broad network for biodiversity research that has been created by the University of California, Los Angeles (UCLA), Udayana University in Bali, and the State University of Papua through the support of USAID and the National Science Foundation. Some of the researchers that are part of this network converge at the Indonesian Biodiversity Research Center – a facility in Indonesia where American and Indonesian students come together every summer to get trained in the latest genetic techniques for applications in marine biodiversity and conservation.

What advice do you have for other USAID Missions that are interested in elevating S&T efforts?

We’re still on the early part of the curve so there is a lot to learn, but we’re eager to share as we move forward. What’s been very important in our strategy development are the ongoing conversations and consultations with Indonesian counterparts who are helping define what areas of science and technology we can work on together. For this to be a successful and sustainable part of the U.S.-Indonesia long-term relationship means that Indonesia will be an equal partner each step of the way, as a collaborator and co-investor – and I believe we are making good progress down that path together.

Tom Kalil is Deputy Director for Technology and Innovation at OSTP

FrontLines: What is Open Development?

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Read the latest edition of USAID’s FrontLines to learn how the Agency is embracing open development to further its work. Also in this issue, read about some of the places where USAID’s interests intersect with those of the U.S. military. Some highlights:

 

  • “What we are trying to do is be a global one-stop shop for a good idea.” Jeff Brown has more to say about the projects USAID’s three-year-old Development Innovation Ventures is backing and how those projects are faring in countries around the world.
  • Diving for lobster in Honduras’s Miskito Coast has left more than 1,000 divers disabled or dead since the 1970s and 1980s when the crustacean became popular on dinner menus. However, a large American restaurant chain is doing its part to ensure that practice ends alongside more than 80 local and international groups, businesses and government agencies
  • What’s next for USAID’s Saving Lives at Birth million dollar winners? Four inspired doctors talk about the innovations they’ve helped devise and their hopes for saving new moms’ lives as a result. 
  • A bustling secondary school farm in Jamaica can trace its roots of success to a collaboration between local police, U.S. soldiers and a group of determined parents and educators.
  • With half of Afghans living in a disaster belt studded with earthquakes, landslides and flooding, USAID and the U.S. military are helping the country’s citizens acquire the skills they need to survive natural disasters and save the lives of their neighbors.

If you want an e-mail reminder in your inbox when the latest issue of FrontLines has been posted online, subscribe here.

Knowledge-Sharing in MHealth is Critical to Providing Life-Saving Solutions for Moms

This originally appeared on the Mobile Alliance for Maternal Action Blog

Every minute at least one woman dies from complications related to pregnancy or childbirth and every year 6.6 million children die before the age of five. We know what interventions make a difference on maternal and infant mortality. We now know that one billion women in low to middle-income countries own a mobile phone – a tool that can be used to engage, educate, and empower mothers. In order for mobile to be scaled to address health issues, global communities must come together to openly share lessons learned, failures, best practices and introduce new solutions to help underserved populations – women in developing countries.

Participants looking pleased with access to health information on their mobile phones. Photo credit: Living Goods

Participants looking pleased with access to health information on their mobile phones. Photo credit: Living Goods

Mobile health (mHealth) is a solution for women, providing immediate, life-saving services to address dire maternal, newborn, and child health (MNCH) challenges. This emerging field – a global movement – is reaching mothers, who need health services the most. No one organization, ministry of health, or company can do it alone, which is why knowledge-sharing through a global, mobile community is needed more than ever.

In a new report, Sparking a Global Movement with MAMA (PDF), commissioned by Johnson & Johnson, a partner of the Mobile Alliance for Maternal Action (MAMA), over 230 organizations, from almost 60 countries downloaded MAMA’s free, adaptable vital health mobile messages. Organizations continue to use these messages to guide mothers through pregnancy and now up to their baby’s third birthday.  As a result, more organizations using these messages are sharing back their key findings and translated the messages in 20 languages. Because of these organizations, which include social enterprises, health organizations, and governments, we all have a new resource in the mHealth space focused on MNCH. MAMA, founded by USAID, Johnson & Johnson, UN Foundation, BabyCenter and mHealth Alliance, is getting critical health information out to mothers through partnerships around the world.

Having access to these culturally sensitive, vital health mobile messages is like “having a hospital at home,” said Nahura Sharon, a new mother in Uganda, receives mobile messages through Living Goods, an organization that empowers women and operates networks of micro-entrepreneurs, who provide life-changing products and services.

Other organizations like Liga Inan in Timor-Leste translated mobile messages in Tetum, a local language and are reaching mothers, family members and community health workers. In Tanzania, Wazazi Nipendeni, a national multi-media campaign on health pregnancy, is using vital health mobile messages in partnership with the Ministry of Health. In less than six months, Wazazi Nipendeni reached 150,000 active subscribers and delivered over nine million text messages.

The desire for knowledge-sharing continues to grow as well as the need for mobile content like messages for family planning and for mothers with children ages 1-3 years old.

This report and other knowledge-sharing resources help foster global learning and build alliances with a growing community interested in working together, aiming to save lives through mobile technology.

Kirsten Gagnaire is the Global Director of the Mobile Alliance for Maternal Action (MAMA). Prior to MAMA, Gagnaire was the Ghana Country Director for the Grameen Foundation and led the initial implementation of MOTECH.  She was the Founder of the Social Enterprise Group (SEG) and Sustayne, and has a depth of experience and passion for addressing social and environmental issues through profitable business ventures. Gagnaire was a consultant with KPMG Peat Marwick, specializing in management, technology, and organizational development consulting for health and human service agencies.

USAID Applauds Launch of the 2013 WHO Global Tuberculosis Report

I applaud the World Health Organization (WHO) today on the release of the Global Tuberculosis Report 2013, which includes among its recommendations, a call to action to reach millions of people still awaiting quality tuberculosis (TB) care and a stronger approach to fighting the emerging threat of multidrug-resistant TB.

While this year’s report is an important reminder that TB continues to claim millions of lives globally, it also demonstrates that significant progress in preventing, detecting, and curing people of the world’s second biggest infectious killer can be made through strong political will, adequate resources, and a focus on the poorest and most vulnerable communities around the world.

On the positive, we are seeing a steady decline in TB mortality rates since 1990, bringing us closer to the UN Millennium Development Goal to halve TB prevalence and deaths by 2015, with fewer people now falling ill from the disease. However, as the report warns, large numbers of individuals with TB still remain undetected and untreated, and hard to treat multidrug-resistant (MDR) TB is now on the rise.

The WHO recommendations are based on new data from almost 200 countries and territories around the world. The report includes the most recent numbers on people who became sick or died from TB, MDR-TB and TB/HIV, as well as lives saved, treatment successes and gaps, and recent progress in roll-out of new TB diagnostics.

Out of the five priority actions recommend in the report, I would like to highlight two key challenges in particular. First, we should make every effort to reach the 3 million people a year (“missed” patients as the report calls them) who get ill with TB but don’t receive the quality care they urgently need. Many of these people are among the most vulnerable and stigmatized, often at the bottom of the social spectrum.  Universal health coverage and poverty alleviation are critical for bridging this gap and providing better access and quality TB services to those at risk.

Second, the global health community must have a strong plan of attack for addressing the alarming increase in MDR-TB. Data in the WHO report show that progress towards targets for diagnosis and treatment of MDR-TB is far off-track. Worldwide, and in most countries with a high burden of MDR-TB, less than 25% of the people estimated to have MDR-TB were detected in 2012.   MDR-TB is not only a tragedy for the patient, the effects can be disastrous, as an entire community can become infected with the drug-resistant organisms.

USAID is leading the charge in both of these areas by expanding access and quality of TB services including further prevention of the disease through interventions such as contact tracing and infection control.  We are also collaborating with countries and partners to introduce and scale-up MDR-TB programs in countries with the highest burden. If successful, The USAID-funded STREAM study will be a significant win in the fight against MDR-TB.   This innovative study will not only reduce the treatment regimen for MDR-TB from the current 20+ months to 9 months, it will also result in considerable cost savings to the health care system and in alleviating suffering by the patient. Until then, we must optimize DOTS programs and improve infection control to prevent the creation and transmission of MDR-TB.

The United States has a strong record of success in partnering with local governments, civil societies and the private sector to harness the power of science, technology and innovation to deliver health better, more effectively, and at lower cost.  Rapid acceptance of new tools, through technology transfer, and support for path breaking research will be essential in ensuring that at-risk communities can benefit from new innovations in our fight against TB.

The U.S. Government remains a major contributor to the Global Fund to Fight AIDS, TB, and Malaria, a unique partnership of governments, the private sector, civil society and affected communities joined together, unanimous in their desire to fight TB. Many low-income countries rely heavily on international donor funding, with the Global Fund providing around 75% of these financial resources. We need to ensure continued leadership in financing for high burden TB programs while advocating for increases in domestic resources to close the resource gaps, estimated at about US $2 billion per year. Commitment from the international community is crucial for addressing this funding gap.

Investing in global health is not only the smart thing to do – it is the right thing to do. We stand together with WHO and our international partners to save lives from TB and other diseases, and to develop healthier societies in the countries with the most need. We are also pleased to support the documentation and analysis of trends in diagnosis, treatment, and outcome. These data are essential to informing national programs and donor strategies.

I congratulate WHO, our other global partners, and the governments of high burden countries around the world for their leadership in global TB control and look forward to continued progress in this area.

Learn more about USAID’s tuberculosis programs.

Get details on the 2013 WHO Global Tuberculosis Report.

Empowering Mothers to Save Lives

Leading global health soap brand Lifebuoy is harnessing the power of women to make handwashing with soap an everyday habit. Mothers, health providers and birth attendants can be influential advocates. In particular, motherhood is one of the most profound and lifechanging events in a woman’s life irrespective of culture or geography. Mothers hold the key to instilling positive handwashing behaviours in their homes and communities.

Children benefit from handwashing. Photo credit: Lifebuoy

Children benefit from handwashing. Photo credit: Lifebuoy

Lifebuoy joined forces with the U.S. Agency for International Development  and its Maternal and Child Health Integrated Program (MCHIP) to create a neonatal programme to raise awareness of the link between newborn survival and handwashing with soap.  Help a Child Reach 5 uses innovative videos to share the importance of handwashing.

Lifebuoy has an ambitious target of changing the handwashing behaviour of one billion people by 2015, thereby reducing preventable deaths of children under 5 from diseases like diarrhoea and pneumonia. It is this profound cause that helps us to get persuasive advocates- distinguished Indian actress Kajol supports the cause of handwashing with soap and Help a Child Reach 5. She is calling on people, governments, UN agencies and policymakers to scale up handwashing as the most cost effective intervention to save child lives.

Over 40% of under-five deaths occur within the first 28 days of a child’s life, the neonatal period. Simple, low-cost health interventions – such as handwashing with soap at key occasions- can reduce this figure by up to 70 per cent. Despite this, handwashing with soap is not universally practiced. We know that a simple solution- handwashing with soap- can make a drastic difference in stopping preventable newborn deaths. Lifebuoy is passionate about saving child lives and has the global scale to do something about it.

The program targets new mothers and birth attendants through antenatal clinics and health workers. We communicate the potential of handwashing with soap to reduce neonatal infections, but do not stop there. The Help a Child Reach 5 campaign makes a health appeal to the most powerful of all emotions- the maternal instinct. ‘Helping your child survive’ – is the sole message to initiate long lasting changes. Handwashing messages are delivered to generate awareness, but also get commitment to handwash, habitual routine practice of handwashing, and positive reinforcement for handwashing. It builds in the motivators of behaviour change among new mothers such as the desire to nurture and for social recognition. It empowers mothers to keep their babies protected, which is of ultimate emotional significance to mothers.

Public private partnerships are critical to deliver messages to new mothers. Health organizations and governments have on the ground expertise to ensure health workers deliver the messages to new mothers in a scalable and sustainable way. This programme draws on Lifebuoy’s marketing and consumer expertise as well as MCHIP’s ability to reach and scale up outreach to millions of new mothers achieve maximum impact.

Building healthy habits among mothers means changing behaviours and choices. Lifebuoy aims to be much more than just a soap and stand in women’s minds as something positive and meaningful for life. Once a new mother’s mindset is changed, habitual handwashing with soap will become a naturally ingrained behaviour. This can have a ripple effect to other new mothers and the entire community and will help fulfil Lifebuoy’s vision of bringing health and hygiene to 1 billion people.

Learn more about USAID’s work in water, sanitation, and hygiene.

For more information on the Help a Child Reach 5 campaign, please watch some of these videos: www.youtube.com/helpachildreach5

Communities in Cote d’Ivoire Benefit from USAID’s Investments

USAID is helping communities in rural Cote d’Ivoire develop economic resiliency. Through our partners SAVE the Children and AVSI, we are supporting several types of economic strengthening activities, all of which increase the productive resources available for families. Through this work, we target the families and caregivers of children orphaned or made vulnerable by HIV/AIDS.

As they gathered for their savings group meeting, group members met us with a traditional welcome. Andrea Halverson. Photo credit: Andrea Halverson, USAID

As they gathered for their savings group meeting, group members met us with a traditional welcome. Photo credit: Andrea Halverson, USAID

In the mountainous, western city of Man, near Cote d’Ivoire’s border with Liberia, we met women gathering for their regular community savings group meeting. This region was one of the hardest hit during Cote d’Ivoire’s civil unrest. With poverty rates increasing over the past decade, savings groups combat a common problem in developing countries: lack of access to credit. Through these self-selected groups, members (usually all-women) will share a small portion of their money at each bi-monthly meeting, and are eligible to take loans, with interest, from this shared pool. At the end of the group sharing cycle, the amount saved is paid out to the group members. The additional money is making a difference in their lives and the lives of their children. Almost every woman uses her savings for school fees and school uniforms for her children.

Children watch as the community members cook the Attiéké, the final step in its production. Photo credit: Andrea Halverson, USAID

Children watch as the community members cook the Attiéké, the final step in its production. Photo credit: Andrea Halverson, USAID

In addition to savings groups, we also visited a community who had received start-up capital to fund a small business activity, producing a local delicacy called attiéké. Similar to couscous, attiéké is a fermented Ivoiran side dish, highly sought after in the region. Through the donation of a mill and a creative cassava partnership, the women had what they needed to start their small business. They are now making and selling attiéké. With pride, women told us of their informal distribution channels that stretched all the way to Mali. These and other investments are helping shape the future of Cote d’Ivoire, and reducing the vulnerability of Ivorian children by using profits to ensure they can enroll in school.

USAID in the News

AllAfrica reported on a newly-announced USAID partnership with the Nelson Mandela Children’s Fund USA and the Nelson Mandela Children’s Hospital Trust, which is aimed at supporting the proposed Nelson Mandela Children’s Hospital in Johannesburg, South Africa. The new hospital, scheduled to open in June 2015, will provide high-quality medical care to children regardless of their social or economic status.

A statue of Nelson Mandela was unveiled on Sep. 21, 2013 at the Embassy of South Africa in Washington, DC. Photo credit: USAID

A statue of Nelson Mandela was unveiled on Sep. 21, 2013 at the Embassy of South Africa in Washington, DC. Photo credit: USAID

The Express Tribune featured a story about the fourth National Youth Peace Festival in Lahore, Pakistan, which is being supported in part by USAID. The organizers expects to see 500 young people from across Pakistan attend the festival, the theme of which is “One Nation, One Agenda; Democracy and Peace.” Politicians will attend the festival in hopes of engaging youth by taking up issues that are relevant to them.

Jamaica Observer reported USAID’s tool donation  to 105 cocoa farmers in Jamaica as a part of a two-year project, which focuses on “protecting rural lives, livelihoods and ecosystems” in communities affected by climate change. The tools will be used by farmers to combat the negative effects of climate change on agriculture.

Vibe Ghana detailed USAID efforts to support the Western Regional Health Directorate in Ghana. USAID contributions to the health directorate include training, performance-based grants, and equipment that will be distributed throughout district hospitals and health care centers. Dr. Edward Bonko, Leader of the Focus Region Health Project of USAID, explained that the efforts would assist with “maternal, reproductive and child health, HIV/AIDS and malaria preventions and neonatal care” in the Western Region.

Pakistan’s The Nation reported on the visit of a group of U.S. government officials, including USAID Mission Director for Pakistan Gregory Gottleib, to the Jamshoro Thermal Power Station. The power plant will provide an additional 270 megawatts of power to the national grid.  In addition to the Jamshoro power plant, USAID is working to rehabilitate thermal plants in Muzaffargarh and Guddu and a hydro-plant in Tarbela.

The website OpenEqualFree detailed a USAID effort to educate student gardeners in Liberia through the Advancing Youth Project—a partnership with Liberia’s Ministry of Education and community organizations that offers “alternative basic education services and entrepreneurship training for young people across Liberia.” The initiative will provide agricultural experts to train students to grow their own gardens and teach them the about agribusiness as a possible career choice.

The Hill featured a piece written by Representatives Albio Sires and Mario Diaz-Balart spotlighting USAID efforts to combat tuberculosis. The story, which describes legislation geared toward encouraging development of health care products in low-resource health systems, includes an overview of USAID’s contributions in the area of research and development in global health, saying, “As a leading funder of breakthrough products for global health, USAID is a key partner in later-stage research that ensures the development of safe and effective health tools.”

Family Planning Improves and Saves Lives

September 26 is World Contraception Day

For more than 25 years, my professional and personal mission has focused on helping women and couples across the world have the ability to decide whether, when and how many children to have. I strongly believe in the importance of increasing access to voluntary family planning, because the evidence is so clear. Enabling women and men to plan their families, results in multiple health, economic and social benefits for families, communities and nations. On September 26, 2013, World Contraception Day draws attention to the fact that more than 222 million women in the developing world say they want to delay or avoid pregnancy but are not using a modern method of contraception.

A community health worker in Malawi counsels a woman on her family planning options at a gathering place in her community. USAID works in more than 45 countries around the globe to increase access to family planning information and services for all who want them. Photo credit: Liz Bayer

A community health worker in Malawi counsels a woman on her family planning options at a gathering place in her community. USAID works in more than 45 countries around the globe to increase access to family planning information and services for all who want them. Photo credit: Liz Bayer

Everyday an estimated 800 women lose their lives in pregnancy and childbirth. Voluntary family planning could reduce these deaths by 30 percent and save the lives of more than 1.6 million children under five each year by enabling women to delay first pregnancy, space later pregnancies at safe intervals, and stop bearing children when they have reached their desired family size.

USAID works across the globe to enable individuals to access and use affordable, high-quality family planning information, commodities, and services as a means to improve their health and quality of life. For many women, currently available contraceptive methods don’t meet their needs. USAID is one of the few organizations that prioritizes the development of new contraceptives that will be affordable in low resource settings. USAID-supported products on the verge of introduction include:

  • The SILCS Diaphragm, a “one size fits most” reusable diaphragm that does not need clinical fitting
  • The NES+EE Contraceptive Vaginal Ring,  the first long-term hormonal method completely under the woman’s control that lasts for one year
  • The Woman’s Condom,  designed to be easy to insert, use and remove, making it unique compared to other female condoms

As the world’s largest bilateral donor of family planning, USAID is committed to expanding choice and access to a variety of contraceptive options. The ability to make important decisions about childbearing is one of the most basic human rights. Improving access to voluntary family planning information, products, and services is a necessary ingredient to helping women care for their families, participate in their communities, and build their countries.

Learn more about USAID’s work in family planning

Resource:

Realizing the Health Goals of the Panama Declaration

This blog is part of a series to coincide with A Promise Renewed in the Americas: ”Reducing Inequalities in Reproductive, Maternal and Child Health Summit,“ that was held during September 10-12 in Panama.

The Promise Renewed for the Americas conference, just held in Panama City September 10-12, was attended by over 280 people representing governments, NGOs, faith organizations, multi- and bi-lateral organizations and civil society from throughout Latin America and Caribbean (LAC) region. The conference was a call to action to address persisting inequalities in maternal and child health in the region. The Declaration of Panama signed on the first day expressed the commitment of 26 governments  and many organizations to heed that call. The conference concluded with a provisional framework for reducing health inequities for women, children and youth in the LAC region. Now that I’ve had a week to reflect on the event, I’d like to share some thoughts with the broader global health community and so many others who contribute to furthering health in LAC, focusing on: “why this conference was so important to have in the first place,” “why now?”  and “what’s ahead?”

A Promise RenewedWhy convene this meeting in the first place? In 2015, most LAC countries will meet Millennium Development Goal (MDG) 4 (child health), and many will meet MDG 5 (maternal health.) However, it is certainly too early to declare victory in maternal and child health in LAC. Some countries will not meet either MDG 4 or 5, and Haiti’s indicators will fall considerably short of its goals. Moreover, averaged, national-level statistics mask major inequalities in maternal and child health in almost all countries in the region. And, the groups with much-worse-than-average health outcomes – most notably in maternal and neonatal deaths – are LAC’s most vulnerable and marginalized populations. Often these are also people whose voice is not heard in policy-making. Further, as outlined in an article for the Journal de  Perinatología y Reproduccion Humana, the pace of progress in reducing preventable maternal, child, and newborn deaths has slowed considerably throughout the region. At the same time, the investment of international donors in the health sector in LAC has declined markedly over the last two decades. So, the capacity and resources of the region itself will have to be better focused to reduce its major “equity gaps” in maternal and child health. In this context, the Panama conference was initiated by USAID’s Bureau for Latin America and the Caribbean, and sponsored by a consortium of donor agencies, USAID, PAHO/WHO, UNICEF, UNFPA, UNAIDS, the Inter-American Development Bank, and the World Bank, to catalyze a more concerted regional effort to address those gaps.

So, why now? In addition to the convergence of the region-specific factors just mentioned, the timing of the Panama conference was important in a global context because it forged a link between the Latin America and Caribbean region and the new global movement “A Promise Renewed“ (APR). That movement was launched in June 2012 at the Child Survival Call to Action event in Washington, D.C. that was hosted by the governments of Ethiopia, India, and the United States, in collaboration with UNICEF. APR aims to re-energize those working on maternal and child health world-wide, and increase attention and investments toward the goal of ending preventable maternal and child deaths within the next generation – by 2035. Several follow-up conferences in Africa and Asia have helped sub-regions and individual countries to begin development of detailed roadmaps to reach this goal. For the LAC region, reaching the global goal will require a fundamental commitment to bridging equity gaps. Going forward, we expect that LAC’s active participation in the global APR platform will lead to accelerated learning and better metrics for gauging progress.

What’s ahead? A major consensus emerging from the conference was that the true locus of control for closing these equity gaps lies in the countries of the region –their governments, civil society, academies, churches, and other institutions. The appropriate role for donor agencies is supportive, not primary, in setting goals, timelines, the route to reach them, and the metrics to measure them. Many conference participants called for a regional mechanism to help facilitate collaboration, information exchange, south-to-south sharing, and access to technical expertise to accelerate the reduction of inequities.

Following are some other key decisions and next steps that came out of the conference:

  • Conferees identified key principles to guide efforts to close equity gaps, among them: use of cross-sectoral approaches for multi-sectoral problems; a focus on marginalized populations (rather than expecting benefits to trickle-down); use of multicultural approaches; and promotion of gender awareness.
  • Conferees supported the establishment of a regional network dedicated to addressing health equity gaps, which would be open to countries, civil society, private sector, and international agencies.
  • Representatives from several countries indicated that they would initiate national, and potentially sub-national, meetings to address maternal, child and adolescent health inequities in their own countries.
  • The donor consortium agreed to continue support for the A Promise Renewed for the Americas website, to serve as a platform for virtual discussion and planning, an information repository, and mechanism for technical interchange.
  • Conferees provided ideas orally and in writing for a regional framework aimed at supporting country progress on reducing inequities. This framework, along with a limited organizational structure, will continue to be developed in the coming months, with modest funding from the seven-agency donor consortium.
  • Setting of region-wide goals for reduction of health inequities was deferred, given the diversity of circumstances and the lack of standardized data across the region that could help inform policies and decision making. There was also general agreement that imposing regional, uniform, health equity reporting requirements on countries would not be feasible or desirable at this point. However, it was widely agreed that gauging progress in reducing health inequities is essential for accountability. That will require countries to disaggregate their health data to allow analysis by geographic, economic, ethnic, and gender variables, over time.
  • Conferees also stressed the importance of LAC participation in shaping the post-MDG 2015 health development agenda.

For the LAC region, some of the most difficult challenges in maternal, child, and adolescent health still lie ahead, because they require reaching those who are hardest to reach, but the Panama conference showed that solidarity and commitment in the region are strong. The LAC region has a history of success in maternal and child health and can draw from the extensive knowledge and expertise already in the region. The Panama conference catalyzed an ambitious process that will be ongoing until, as one speaker observed, “we meet to celebrate ‘A Promise Fulfilled.’”

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