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Archives for Global Health

Tackling Malaria and Other Transboundary Challenges in the Lower Mekong through Regional Cooperation

Gregory Beck serves as deputy assistant administrator for Asia

Greg Beck serves as deputy assistant administrator for Asia

More than 60 million people live in the lower Mekong River basin, a region of the world currently struggling with drug-resistant malaria. While the introduction of artemisinin-based combination therapy (ACTs) for treatment of malaria has helped to greatly reduce its prevalence over the past decade, a high percentage of malaria cases are now failing treatment with ACTs, endangering global progress in fighting this communicable disease. With no alternative antimalarial medicine available, this presents a serious health security risk that requires robust regional and global cooperation to effectively overcome.

CSIS2Such was a major topic of discussion at an event on the Mekong’s health and development future that I participated in on Tuesday morning, November 12, at the Center for Strategic International Studies (CSIS). Robust regional cooperation is key to developing and implementing sustainable solutions to global challenges such as drug-resistant malaria. That’s why at USAID, we are deepening our engagement with regional institutions working to promote integration and shared solutions in a region of the world closely tied to America’s security and prosperity — the Asia-Pacific.

One such regional body is the Lower Mekong Initiative, or LMI. Comprised of the governments of the United States, Cambodia, Laos, Burma, Thailand and Vietnam, LMI works to identify collaborative solutions to challenges shared by the five lower Mekong nations — from water resources management to vulnerability to climate change. As a result of the LMI infrastructure we’ve helped put in place, regional working groups have been established with both U.S. and lower Mekong country counterparts to discuss for the first time in a regional setting how best to achieve shared development goals. Over the past year we have established a new LMI coordination hub at our Regional Development Mission for Asia in Bangkok. In conjunction with LMI, we are also actively supporting the Friends of the Lower Mekong, which coordinates the development work of donors in the region.

Photo Credit: CIA World Factbook

Photo Credit: CIA World Factbook

We are making progress. Our shared successes have been clearly demonstrated in the regional collaboration and coordination that took place in response to the emergence of H7N9 avian influenza in 2013, as compared to the SARS pandemic 10 years ago when information was not adequately shared. For H7N9 avian influenza, the sharing of surveillance results, samples and lab methodologies within China and globally started about 40 days after the first case developed symptoms. This information was used to rapidly take steps to limit the spread of the virus and establish animal and human surveillance and lab testing for H7N9 in the LMI countries using platforms previously developed for H5N1 avian influenza. As a result, only 139 human infections with H7N9 virus have been documented and only one country has been affected to date. In comparison, SARS cases had accumulated for about three months before the virus was detected. By the time the SARS pandemic subsided in late 2003, there had been over 8,400 human infections in 29 countries and the economic impact was estimated to be at least $80 billion.

We are forging partnerships to combine resources for maximum impact. Through the U.S. President’s Malaria Initiative, we’ve joined AusAID, DFID, and the Bill & Melinda Gates Foundation — organizations highly concerned by the emergence of artemisinin-resistant malaria and the impact that this may have on regional and global efforts to control and eliminate this disease. We continue to work with these agencies and with the World Health Organization and the Global Fund in the region to speed up efforts to reach all populations at risk with effective treatment and prevention. Our support for the President’s Malaria initiative has been at the forefront of efforts in the region to protect drug quality and efficacy by detecting and banning counterfeit and sub-standard drugs and providing effective treatment to vulnerable populations. Significant progress has already been made, for example, in western Cambodia, where malaria transmission has decreased markedly since the problem of artemisinin resistance was first identified there.

Also, earlier this year, the United States, Thailand and Burma signed a Mutual Declaration for cooperation on malaria prevention and control in the Thai/Burma border region. This is especially important as Burma opens its doors to the international community. Burma has the greatest malaria burden in the Mekong region at 591,000 suspected cases a year — three times the number of cases in Laos, China, Cambodia, Vietnam and Thailand combined. Activities under the new trilateral program are expected to include training health care workers in Burma, piloting innovative service delivery strategies, and facilitating information sharing between twin cities.

Our regional cooperation includes the opportunity to highlight innovative advancements from research, science and technology. This is core to USAID’s development programming that harnesses the efforts in the region as well as in the United States to most effectively and efficiently address development challenges. As a result of our investments in science and technology through LMI, eight veterinary and 17 public health diagnostic laboratories in the lower Mekong region have enhanced capacity for safe, accurate and rapid diagnosis of significant endemic and emerging infectious diseases.

Like our deepening engagement in the region, LMI continues to grow. LMI reflects the commitment of the United States to the well-being of the people and the long-term success of countries in the region, and we look forward to continued shared progress.

Learn more about the Lower Mekong Initiative.

 

MCHIP Plays Key Role Introducing Lifesaving Vaccine in Nine African Countries

This originally appeared on MCHIP in recognition of World Pneumonia Day.

Pneumonia is the deadliest disease among children under the age of five, killing an estimated 1.2 million children annually. Fortunately, Pneumococcal Conjugate Vaccine (PCV) can protect susceptible children, preventing against severe forms of pneumococcal diseases—mainly pneumonia, meningitis, bacteremia and sepsis.

Today, on World Pneumonia Day, MCHIP celebrates that this disease is preventable with safe, effective and affordable tools. Our team has played a key technical role in nine African countries to assist the introduction of this lifesaving vaccine, including in Senegal, where we introduced the vaccine most recently.

Mother and child at the launch ceremony. Photo credit: MCHIP

Mother and child at the launch ceremony. Photo credit: MCHIP

On November 5th, the Government of Senegal celebrated the launch of PCV13, which protects children against the 13 most virulent strains of pneumonia, a welcome innovation in a country where an estimated 13% of deaths under the age of five are attributed to pneumonia. The launch ceremony featured speeches by dignitaries—including Senegal’s President and its Minster of Health—as well as representatives from the GAVI Alliance.

The President emphasized the importance of reducing child mortality in Senegal by providing free health care for children under five, and strengthening partnerships. According to the November 6th edition of Le Soleil newspaper: “The introduction of this new vaccine as a preventative measure will strengthen and streamline all initiatives that support the well-being of the child.”

MCHIP in Senegal has been working with the National Expanded Program on Immunization (EPI) and partners to prepare the country’s immunization system for the introduction of new vaccines including (including PCV13, Meningitis A, and Measles-Rubella) while also strengthening the routine immunization system in poor performing districts to deliver these and traditional vaccines. In collaboration with partners, MCHIP has played a key technical role in the Senegal PCV13 preparation and rollout through national level technical assistance and as a member of the Interagency Coordinating Committee.

As part of a multi-partner collaboration, MCHIP has provided technical assistance to the EPI/Ministries of Health to prepare, plan and implement the introduction of new vaccines in 12 countries in the last five years. This assistance includes preparations of applications to GAVI for these new vaccines, immunization program readiness, post-introduction evaluation, and capacity building for health professionals.

Globally, MCHIP has now supported the introduction of PCV in Benin, the Democratic Republic of the Congo, Kenya, Malawi, Rwanda, Uganda, Senegal, Tanzania and Zimbabwe. Moreover, the Program has ensured that, once introduced, these new vaccines are incorporated into a routine immunization system that can provide safe, timely, equitable and affordable protection against some of the major contributors to child death, such as pneumonia.

 

Expanding Access and Choice for Family Planning

Next week more than 3,000 political leaders, scientists, health care professionals, advocates and young leaders from around the globe will gather in Addis Ababa, Ethiopia, for the third International Conference on Family Planning or ICFP2013. A year ago, the global community came together to launch Family Planning 2020, which has generated unprecedented political will and financial support to reduce global unmet need for family planning by giving 120 million more women access to modern contraceptives, information and services by 2020.  Conference participants in Addis will share the latest data, research and program findings to help achieve Family Planning 2020’s goal.

Organized around the theme “Full Access, Full Choice,” ICFP 2013 will call attention to the wide range of health, social, and economic benefits of helping couples plan and space their pregnancies. Holding the conference in Ethiopia is an opportunity to celebrate and showcase the success Ethiopia has had in greatly increasing access to family planning in a few short years. In 2005, 15% of married women used a form of modern contraception, and today nearly 29% are modern family planning users. However, there is still more to be done to ensure women’s needs are met.

Women gather at a health post in Ethiopia. USAID trains and supports health extension workers across Ethiopia's health system in the most populous regions of the country. Photo credit: Nena Terrell, USAID Ethiopia

Women gather at a health post in Ethiopia. USAID trains and supports health extension workers across Ethiopia’s health system in the most populous regions of the country. Photo credit: Nena Terrell, USAID Ethiopia

Women know what they want and when they demand it, we must listen: The ability to make important decisions about childbearing is one of the most basic human rights. Women deserve family planning options that are effective, affordable, available, and accessible and they need to be able to make their reproductive decisions freely and with full information. USAID is committed to developing new, affordable contraceptives and to supporting countries as they strengthen their health systems as part of an effort to fulfill full access and full choice for family planning. We’ve made great progress, but we must do more to ensure that everyone has true access to voluntary family planning information, services and methods that meet their needs.

USAID is proud to co-sponsor the International Conference on Family Planning, which is jointly organized by the Ministry of Health of Ethiopia and the Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins Bloomberg School of Public Health. A number of USAID’s technical experts will present at the conference on the latest progress and challenges around increasing access to family planning.

Visit USAID’s ICFP webpage to access a calendar of USAID-sponsored events, the latest news and updates from the conference, and useful technical resources for participants.

Follow USAID for Global Health on Twitter for live updates and use the hashtag #ICFP2013 to join the conversation.

What Does It Take to Get Contraceptives to Clients in Rural Nigeria?

Many of our clients learn about family planning from routine visits to rural health facilities. The health workers in this facility help patients and their families choose appropriate contraception methods and teach new clients how to use these methods correctly. The same health workers who are responsible for treating patients are often also responsible for monitoring the supply of contraception methods in the facility. When torn between caring for a waiting room full of patients and filling out paperwork to order new supplies, health workers discovered that they were stocking out of essential contraception supplies. This meant that they had to turn away patients—many of whom had traveled considerable distances to get these family planning services. The discouraged clients lost confidence in the health system and were less inclined to seek out family planning services if products they wanted were not available when they needed them.

DDIC truck delivering commodities at a rural health facility in Nigeria. Photo credit: USAID | DELIVER PROJECT

DDIC truck delivering commodities at a rural health facility in Nigeria. Photo credit: USAID | DELIVER PROJECT

To rectify the stock-out situation and improve access and availability to family planning commodities in Nigeria, the USAID|DELIVER PROJECT is piloting a system called Direct Delivery and Information Capture (DDIC) in Ebonyi and Bauchi states. Through DDIC, the project currently delivers 24 public health commodities, including contraceptives, antimalarial medications, and maternal, newborn and child health products to 365 selected service delivery points in the selected states.

The DDIC system utilizes a vendor-managed inventory model, whereby products are delivered from state warehouses directly to the health facilities on trucks that serve as mobile warehouses. The trucks arrive, carrying predetermined quantities of health commodities, based on the facilities’ past consumption data. By investing in reliable transportation, DDIC ensures that truck drivers and team leaders are available to deliver commodities to health facilities according to an established delivery schedule. A team leader traveling with the truck inspects the facilities’ storage space, counts stock-on-hand for the different health commodities, and enters this inventory data into a specifically-designed inventory management database. The database calculates the quantity of products to be issued to the facility to bring the quantity of stock of contraceptives back to the pre-determined levels. Data obtained from each facility are synchronized with a sister software to generate logistics reports that help monitor system performance and prepare for the next resupply period.

Commodities are supplied to the health facilities every two months. After just four consecutive supply trips, the availability of commodities at participating facilities has drastically improved. Stock-out rates of contraceptives and other common health products have been reduced from above 70% before DDIC was implemented to below 5%. Additionally, 100% of the targeted health facilities have received a bi-monthly visit with the team leader. Furthermore, essential logistics data are now readily available for public health supply chain experts to use in future decision making about future health commodity needs.

Though still in the pilot phase, DDIC has improved the availability of contraceptives and other commodities in rural health facilities in supported states. It has also relieved many of the health facility staff of paperwork duties, so they can focus more on providing better quality care to patients. Consequently, clients’ confidence in the health facility’s ability to provide health services is increasing.

So, what does it take to get contraceptives to clients in rural Nigeria?

Through DDIC, USAID is improving availability of contraceptives at rural health facilities on a regular bimonthly delivery schedule, thereby increasing families’ patronage and uptake of family planning services. DDIC has come to the rescue ensuring commodities availability at facilities and data for planning in Nigeria!

Learn more about how USAID is working towards ensuring safe motherhood and healthy families around the world.

Learn more about our Mission of the Month: USAID Nigeria. Follow @USAID for ongoing updates in the region and join the conversation with the hashtag #MissionofMonth!

MCHIP Spurs Action to Protect Women from Excessive Bleeding After Childbirth

Dr. Vikas Yadav, the National Program Manager for Jhpiego’s India program, described his frustration during visits to birthing rooms in health facilities early in his career: “Lifesaving drugs were not correctly used or, in some cases, not used at all.” During childbirth, women may suffer from potentially life-threatening conditions, such as excessive bleeding. Known as postpartum hemorrhage (PPH), excessive bleeding can be prevented with a uterotonic—a drug to make the uterus contract.

According to Dr. Yadav, “You would see health care staff that didn’t know which uterotonic to use and when, because they lacked clear guidance. It is such a simple intervention, yet these staff didn’t have needed information to properly use drugs that could save lives.” Oxytocin is the uterotonic of choice for preventing PPH, but in certain situations, such as home birth, another uterotonic drug known as misoprostol has been recommended.

Women waiting for newborn care at a nursery. Photo credit: MCHIP

Women waiting for newborn care at a nursery. Photo credit: MCHIP

Dr. Yadav was happy to report that the situation has improved quite a bit in Jharkhand State since those early days. In fact, maternal deaths have decreased dramatically in recent years thanks to the increasing focus of the government and its development partners on training health facility staff and improving the quality of maternal care.

Despite recent improvements, PPH still causes 35% of maternal deaths in the State. And while providing uterotonic drugs is a well-known intervention to prevent PPH, the number of births that receive this intervention is unknown. As in most developing countries, there is no regular or reliable data available on whether uterotonic drugs are provided to women.

It was in part due to this lack of information that staff from USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) partnered with the Directorate of Health Services in Jharkhand state to pilot an innovative approach for estimating the number of women who use a uterotonic drug after birth to protect them from PPH.

Dr. Jeffrey Smith, MCHIP Maternal Health Team Leader, helped the team estimate uterotonic coverage in the State. “In many developing countries, there is more reliable data to measure whether children are receiving lifesaving drugs,” he said. With this knowledge, health experts can design better programs. “Why can’t we also track which women are receiving uterotonic drugs when so many are dying of PPH?” Dr. Smith asked.

Dr. Yadav welcomed the chance to participate in this valuable activity. During a stakeholder meeting, maternal health experts, officials from the state Ministry of Health, private and public hospitals, nongovernmental organizations, development partners, and key policy makers came to a consensus about their estimate after careful discussion and analysis. Using the guidance and worksheets developed by MCHIP, many were surprised to learn that relatively few women—only 43.5%—were protected from excessive bleeding. “This exercise was eye opening for program managers, since they realized that many women were not getting the care they are supposed to get,” Dr. Yadav said.

Oxytocin can be kept at room temperature for only a couple of months before it loses potency. Unlike oxytocin, misoprostol does not require refrigeration and it has also been proven effective at preventing excessive bleeding. Additionally, misoprostol comes in pill form and does not need to be injected using a needle and syringe by a skilled provider. As such, misoprostol is ideally suited for preventing PPH at home births and in resource-poor settings like Jharkhand due to its stability, ease of use, effectiveness and safety.

Distributing misoprostol to women in advance of the birth, enabling them to take it just after delivery, is known to be an effective method of PPH prevention. However, there is currently no program in Jharkhand State that ensures women who give birth at home receive misoprostol. And despite recent increases in facility births, there is still a sizeable portion of women (more than 45%) who choose to give birth at home. Sadly, when women give birth at home, they often do not have assistance from skilled health care workers or access to lifesaving drugs like oxytocin, and are therefore more likely to die of complications.

This estimation exercise came at the ideal time, as the government of India is currently developing guidelines for advanced distribution of misoprostol for women who give birth at home. Given the large population in Jharkhand State, efforts to make misoprostol widely available for use at the community level—especially if adopted nationally—could protect thousands of women from PPH.

USAID/MCHIP’s innovative estimation tool makes it possible to build an accurate picture of whether a country is doing everything it should to stop women from dying of this preventable condition. If there is strong political leadership, as in Jharkhand State and places like Mozambique, this estimation tool has the potential to help governments’ strengthen programs to prevent PPH. Such programs would ensure that oxytocin is available to women who give birth with trained health care workers, and that misoprostol is available to women who give birth at home. These combined efforts could save the lives of countless women, no matter where they give birth.

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?

Frontlines-Open-Dev-Banner_Web

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.

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