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Archives for Global Health

U.S. Pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria

This originally appeared on  DipNote.

I am in New York for the Replenishment Conference of the Global Fund to Fight AIDS, tuberculosis and malaria. The United States is committed to the success of the Global Fund as part of our shared goal to save lives devastated by these diseases. Our investment is a central component of President Obama’s Global Health Initiative, along with our large bilateral programs such as the President’s Emergency Plan for AIDS Relief, the President’s Malaria Initiative, and U.S. programs focused on issues such as maternal and child health.

We strongly support the Global Fund’s collaborative, country-driven, performance-based approach, and we are proud to be its largest donor, having provided more than $5.1 billion to date. As President Obama said in his speech at the Millennium Development Goals Summit last month, we are strengthening our commitment to the Global Fund.

I was pleased to announce yesterday that the Obama Administration is making a three-year pledge of $4 billion to the Global Fund for 2011 through 2013. This marks the first time that the United States has made a multi-year pledge to the Global Fund.

What’s more, this pledge is a 38 percent increase in the U.S. investment over the preceding three years and is by far the largest dollar increase of any donor nation this year.

Why are we taking this step? It will save and improve lives of those devastated by these three diseases. It will increase life expectancies in affected countries.

Moreover, this pledge is linked to a firm call to action that calls upon the Fund to make needed reforms and for other donor nations to share in the responsibility of saving more lives effectively and efficiently.

Simply put, we have three goals with this historic pledge:

First, we need to drive needed reforms and ensure smart, effective investments that will build upon the success of the Fund and save more lives. At this conference, the U.S. has called upon the Global Fund Board to develop an action agenda that includes clear timelines and measures progress so all parties can be held accountable for clear action steps. You can read our “Call to Action” at www.PEPFAR.gov.

Second, we made this pledge to leverage other donors’ contributions. This commitment serves as a challenge to other donors — including other governments and the private sector — to do their share to save more lives, alleviate suffering and increase life expectancies. Meeting the need is a global responsibility. All donors have a shared responsibility to not only sufficiently invest in the Fund, but to ensure that its investments are achieving the ultimate goal of saving lives. Moreover, country grantees have an obligation to continue to improve their health systems to ensure that investments are made effectively and efficiently, and the U.S. will continue to support them in building the capacity to do so.

Finally, this pledge shows continued U.S. leadership to the ultimate measurement of success — increasing the number of lives saved. This pledge is part of a comprehensive approach to combating AIDS, TB, and malaria through President Obama’s Global Health Initiative. In addition to financing, as part of our effort to strengthen Global Fund grant performance and impact, the U.S. will increase our already substantial investment in technical assistance, capacity building, and country level coordination.

Any future increases in U.S. funding will be tied to fulfillment of the Global Fund’s action plan, as well as to the relative scale-up of contributions by other donors to the Fund. In short, all stakeholders must come together to build upon the past success achieved by the Fund.

Ultimately, this pledge will allow the Global Fund to do its job — and do it better. We are proud of our relationship with and commitment to the Fund and the work it has done over the years. This unprecedented pledge is a signal to the world that even in these difficult times, the U.S. is firmly committed to fighting these devastating diseases and ultimately saving more lives.

This Week at USAID – October 4, 2010

USAID joins the global community in recognition of World Habitat Day. The United Nations has designated the first Monday in October as annual World Habitat Day to raise awareness of the need for improved shelter and highlight the connection between human health and housing.  This year’s Habitat theme is “Better City, Better Life.”

Administrator Shah travels to Columbia University to address their Business School’s Social Enterprise Conference.  Dr Shah will focus on how USAID is pursuing innovative models by working with the private sector and leveraging social enterprise.

USAID’s Global Health Bureau along with the George Washington University Center for Global Health will host the 10th Annual Global Health Min-University.  Over 1,000 people will attend more than 50 unique sessions to learn evidence-based best practices and state-of-the-art information across the global health field.

The United Nations Designated the First Monday in October as Annual World Habitat Day

On Oct. 4, 2010, USAID will join the global community in recognition of World Habitat Day. The United Nations has designated the first Monday in October as annual World Habitat Day to raise awareness of the need for improved shelter and highlight the connection between human health and housing.  This year’s Habitat theme is “Better City, Better Life.”

USAID understands there is a direct correlation between a country’s population, and the pressure growing demographic trends place on the environment, health systems, economy and housing availability.  Since 1965, USAID’s Office of Population and Reproductive Health has worked to create programs that better understand this synergistic relationship. These programs play an important role in helping countries achieve a sustainable population size so they are better able to balance available resources. Achieving sustainable populations will help ensure the availability of decent housing for all.

Visit Habitat.org for ideas on how you can take action in your community this year on World Habitat Day.

From the Field

In Madagascar, as part of the President’s Malaria Initiative (PMI), we will launch an indoor residual spraying campaign (IRS).  The campaign will cover 16 districts in Madagascar, including 6 in the central highlands, and 10 in the northwest and southwest. IRS involves the coordinated, timely spraying of the inside walls of houses with insecticides. Mosquitoes are killed when they land on these sprayed walls, reducing malaria transmission.

In Senegal, a report of a study on the Feminization of HIV/AIDS in Senegal will be released.  According to the 2008 United Nations General Assembly Special Session (UNGASS) report, approximately two women are HIV positive for every HIV-positive man. This feminization of the epidemic is a sharp shift from the beginning of the epidemic, when the numbers of HIV-positive men were higher. Women 25 to 29 years of age now have the highest prevalence of any age group at 1.5 percent, according to the 2005 Senegal Demographic and Health Survey (SDHS), with the next highest group, men 35 to 39 years of age, at 0.7 percent.

In Zimbabwe, we will launch the Promoting Recovery in Zimbabwe (PRIZE) Consortium.  The PRIZE consortium is an initiative funded through the Food for Peace program to address the acute relief and recovery needs of Zimbabweans arising from economic, political and environmental shocks that have plagued Zimbabwe.  It provides emergency food aid and seeks to improve long term food security through agricultural program and development of community skills.

Nigeria @ 50: Microenterprises Support Caregiver Families

Like many caregivers in Kano, northern Nigeria, Jamila is responsible for raising her children and caring for relatives affected by HIV/AIDS. Previously, she relied on her husband or other sources for financial support. After her husband lost his job, and with six people in her household, Jamila had to find a means to provide for her family financially.

Jamila and her husband display their peanut butter. Business skills training has empowered many women caregivers to engage in effective business practices. Photo Credit: Fernando Maldonado, USAID/MARKETS

In 2009, Jamila joined about 90 other caregivers from Bauchi, Kano, and Cross River States to attend the MicroEnterprise Fundamentals™ training course offered by USAID through its Maximizing Agricultural Revenue and Key Enterprises in Targeted Sites project. This training equips participants with practical business skills to become successful entrepreneurs.

After the course, Jamila combined her modest savings with a small loan from a community savings and loan group to finance her business. Within a couple of weeks she was able to generate a healthy profit and contribute to her household’s upkeep.

“The most important learning I took from the training was how to plan my business. I now allocate my income between business expenses, personal expenses, and savings,” said Jamila.

Jamila is currently expanding her business. As a result of training on product differentiation, Jamila adds spices to her peanut butter, which she packs in attractive containers. Demand for her product has increased. She has even gained the confidence and financial resources to start a poultry business.

“I am now the main contributor to my household and we make up to $200 in profit each month.”

Like Jamila, many caregivers are reaping the benefits of the USAID training. A recent survey of caregivers trained in 2009 showed that over 50 percent started new businesses, and nearly 100 percent of the respondents reported an increase in income.

Nigeria @ 50: Partnership with USAID

USAID is helping farmers’ organizations, like this group in Kano, Nigeria, to plant and harvest higher-yielding crops. These women have boosted their incomes by producing more cowpeas than in previous years. Photo Credit:Ann Fleuret, USAID/Nigeria

In 1960, the face of Africa changed, as more than a dozen countries seized their futures and became independent nations. Nigeria was one of those countries, and the last half century has seen both successes and challenges. While the country’s economy is growing at a good clip, its healthcare and education still lag, and deeply entrenched poverty and unemployment remain two of the greatest obstacles to Nigeria reaching its full potential for development. USAID works in Nigeria to sustain development in the long term, especially in health, education, and economic growth.

Health

Nigeria is making much slower progress on improving health among mothers and children than most other African countries. A million Nigerian children die each year before their fifth birthday, and the maternal mortality rate is among the highest in the world. Nigeria also has one of the highest tuberculosis burdens in the world, and although the HIV/AIDS infection rate is low compared to other parts of Africa, an estimated 3 million Nigerians are still infected. As a result, Nigeria’s life expectancy has declined significantly: in 1991 the average life expectancy was 54 years for women and 53 years for men; by 2009 these figures had fallen to 48 for women and 46 for men.

Strengthening the health sector and improving overall health for Nigerians are among the most important development issues facing Nigeria. USAID is supporting increased access to quality family planning and reproductive health services. Maternal and child health efforts focus on routine immunization, polio eradication, birth preparedness, maternity services, and obstetric fistula repairs. The United States is increasing access to proven preventive and curative interventions—insecticide-treated bednets and malaria treatment—for children and pregnant women. To reduce death and disability due to TB, especially in the vulnerable co-infected HIV/AIDS population, USAID is working to double the case detection rate and halve the incidence of tuberculosis by 2018.

Education

The state of education in Nigeria is poor. Of the 30 million primary school-aged children in the country, an estimated seven million are not enrolled in school. Of those currently in primary school, less than one in three will attend secondary school. Nigeria has a massive number of out-of-school children and young adults with limited literacy and numeracy skills who have little hope of ever joining the formal workforce.

USAID programs support equitable access to quality basic education through teacher training, support for girls’ learning, infrastructure improvement, and community involvement, focusing on public schools, as well as Islamiyyah schools, which provide both secular and religious education. U.S. assistance also fosters higher education partnerships between American and Nigerian universities, especially those in the north and the volatile Delta regions.

Economic Growth

Nigeria has enjoyed relatively strong economic growth following a series of economic reforms in 2003. Annual agricultural growth rose from 3.5 percent between 1990 and 1999 to nearly 6 percent between 2005 and 2009. Poverty has fallen, but only from 65 percent in 1996 to 60 percent today. Nigeria, once a major food exporter to the West African region, now imports around 15 percent of its basic food requirements. Its agricultural sector is the primary source of livelihood for 70 percent of Nigeria’s people, but the sector is not productive. Only half of Nigeria’s 79 million hectares of fertile land are under cultivation, and over 90 percent of agricultural output comes from farms smaller than five hectares.

USAID programs are accelerating the uptake of proven agricultural production, processing, and marketing technologies and stimulating job creation through agribusiness enterprises. USAID is also helping to develop a policy environment for micro, small, and medium-sized enterprises, and expand access to market-driven vocational and technical training linked with private sector employment opportunities. Customs regulations and policy reform will encourage internal and external trade, and the incentives offered by the U.S. African Growth and Opportunity Act develops private sector capacity to meet international trade and export standards.

Repairing Obstetric Fistula in Nigeria

USAID-supported fistula services in Nigeria began in 2007. USAID’s Fistula Care project works with six hospitals to prevent and repair fistula and/or to train health professionals about fistula case management.

Obstetric fistula is the result of prolonged labor without prompt medical intervention, causing a hole in a woman’s birth canal which leaves her with chronic incontinence and in many cases, the loss of the baby.

Thirty-two-year-old Joy Emmanuel lived with fistula for half of her life. Long after giving up hope of a remedy, she heard on the radio that women could receive fistula surgery at the Faridat Yakubu Fistula Center, in Gusau, Nigeria. Emmanuel’s baby survived, but she was left with the serious medical condition. Women with fistula are stigmatized among their peers and by society in general.

USAID is supporting increased access to quality family planning and reproductive health services. Maternal and child health efforts focus on birth preparedness, maternity services, and obstetric fistula repairs.

The Nigerian National Strategic Framework for fistula prevention and control estimates that between 400,000 and 800,000 women are affected. Nearly half of worldwide fistula cases occur in Nigeria, with between 50,000 to 100,000 new cases each year. USAID is working to address the challenge of obstetric fistula in five states in northwestern Nigeria. During the project’s first three years 2,822 women received fistula repair surgery.

Increasing the Involvement of Men in Family Health

Reducing maternal deaths by 75 percent throughout the world by 2015 will take the involvement of men in countries where it matters most. Many of the countries where USAID works are male dominated cultures. To improve maternal health outcomes for women in developing countries, men must be equal partners since they are the decision makers about health care in the family. These decisions include determining family size, timings of pregnancies, and whether women have access to health care.

In programs around the world, USAID works to integrate men into maternal health activities at the community level. One example is through USAID’s Maternal and Child Health Integrated Program (MCHIP). Special efforts are made to emphasize men’s shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive health. This means reaching out to community elders, leaders, and religious groups – entreaties that could be rejected because of traditional cultural values and perceptions that maternal health is the responsibility of women only.

In some areas of Nigeria— where a woman can’t leave the home without her husband’s permission— USAID sends in male motivators, community volunteers trained in communications, to help local men achieve their vision for a healthy family.

“In many of the countries where we work, these are male dominated cultures,” said Lily Kak, senior maternal and neonatal health advisor in USAID’s Bureau for Global Health for a feature in Frontlines. “We need to involve men in our programs since they are the decision makers about health care in the family.” These decisions include determining family size, timing of pregnancies, and whether women have access to health care.

To improve maternal health outcomes for women in developing countries—one of the targets of the United Nation’s Millennium Development Goals—men must be equal partners. “Men need to see the advantages for themselves,” Kak said.

Evidence Shows Historic Breakthrough Can Save Lives

Carol is in her mid-20s and raising her young daughter on her own.  With very few economic options available to her she turned to commercial sex work when she was 21 years old. Every day she puts herself at risk of HIV, other STIs, and unintended pregnancy. Because of a USAID-funded campaign, Carol knows she needs to use condoms to protect herself but as a commercial sex worker she does not always have the negotiating power to do so.

Often at USAID we support the ABC approach- abstain, be faithful, and correct and consistent condom use. While these methods can be effective in preventing HIV transmission, often it can be difficult for women to negotiate prevention interventions. With women representing nearly 60 percent of those living with HIV in sub-Saharan Africa, it is imperative to find a method of prevention that can be initiated by women.

Women participating in the CAPRISA 004 trial in the CAPRISA Vulindlela Clinic in KwaZulu-Natal Midlands, South Africa

Women participating in the CAPRISA 004 trial in the CAPRISA Vulindlela Clinic in KwaZulu-Natal Midlands, South Africa

For almost 25 years, USAID has been on the frontlines of the HIV/AIDS epidemic. Our development programs have been cutting-edge, and have long put women at the center of programming. Gender, prevention of mother-to-child transmission, male circumcision, counseling and testing, nutrition, and HIV vaccine research are just some of the comprehensive array of HIV/AIDS prevention, care, and treatment programs administered through USAID.

Progressive programs continue today with the USAID-funded clinical trial, CAPRISA 004. The trial, which took place in South Africa, provided the first evidence that use of a vaginal gel, or microbicide, containing an antiretroviral drug (ARV) known as tenofovir can prevent HIV infection in women.

Tenofovir gel is a clear, colorless, and odorless viscous gel in single-dose plastic applicators

Tenofovir gel is a clear, colorless, and odorless viscous gel in single-dose plastic applicators

In the trial, tenofovir gel administered topically before and after sexual activity provided moderate protection in women at high risk of HIV infection. At the end of the study, researchers found that the use of 1% tenofovir gel by 889 women at high risk of HIV infection in Durban, South Africa proved the method to be 39 percent effective in reducing a woman’s risk of becoming HIV infected. The gel could be a unique HIV prevention tool for women who are not able to negotiate HIV prevention methods.

The successes of CAPRISA 004 ties in with the core principles of the U.S. Government’s Global Health Initiative (GHI). USAID is committed to a women- and girl- centered approach, creating a strong partnership with countries to sustain country ownership, and focusing on learning and accountability.

Once the results are confirmed through ongoing and future studies, USAID will work at every level to ensure women are able to access this unique form of prevention. This means Carol, and other women in developing nations, will have a form of protection against HIV that they can control and initiate. This new discovery puts the power of protection against HIV transmission in the hands of the woman and can ultimately save lives.

Why Family Planning Matters

USAID is a global leader in the effort to provide voluntary family planning services and programs that allow couples to choose how many children to have, and when to have them. When men and women are given the knowledge and the right tools to plan their family, most couples choose to have fewer children.  In countries where families have fewer children, women are more likely to be educated, there is a higher paid female population, and women are increasingly involved in activities outside the home because they are not tied to the traditional household role.

USAID currently supports programs in more than 60 developing countries that work to ensure both men and women have access to these life changing services.  Our programs focus on educating people about pregnancy, how to plan it, and how to ensure the health of both the child and mother.  Increasing access to these services will also reduce the rates of abortion since more pregnancies will be planned.

Since the inception of USAID’s family planning programs in 1965, the use of modern family planning methods in the developing world has nearly quadrupled—from less than 10 percent to more than 39 percent today.  In the 39 countries with the largest USAID-supported programs, the average number of children per family has dropped – by choice – from more than 6 to fewer than 4.1.

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