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Archives for Global Health

10 Years in the Making: Celebrating USAID’s Achievements Under PEPFAR

USAID is observing World AIDS Day this year by celebrating ten years of our HIV and AIDS work under PEPFAR.

In less than two short weeks, the global health community will unite to commemorate the fight against AIDS. The United States, foreign governments, civil society, local communities and many others dedicated to reaching an AIDS-free generation will mobilize around the world to celebrate the incredible achievements that have been made since the epidemic was first identified over 30 years ago.

We’ve come a long way in the last three decades: unexplained immune system failure and a race to identify the cause in the early 1980s; life-sustaining therapy introduced in the mid-1990s; a landmark foreign assistance initiative in 2003 that brought treatment to millions of people who had no access before; and a groundbreaking study in 2011 showing that healthy people living with HIV on antiretrovirals can limit transmission by 96 percent. The worldview of the HIV pandemic has changed dramatically in our lifetime.

The Building Local Capacity Project has reached 57,223 orphans and vulnerable children (OCV) and caregivers with child health services in southern Africa. Photo credit: Management Sciences for Health

The Building Local Capacity Project has reached 57,223 orphans and vulnerable children (OCV) and caregivers with child health services in southern Africa. Photo credit: Management Sciences for Health

Our work is not over. As Secretary of State John Kerry said during a speech earlier this year, “As progress continues, we will gradually evolve as our fight against this disease evolves, and that is going to happen both by necessity and by design. Achieving an AIDS-free generation is a shared responsibility and it is going to be a shared accomplishment.”

Some of the most monumental achievements in combating HIV and AIDS have occurred in the past 10 years with the creation of two unprecedented global health programs – the Global Fund Against AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR was, and continues to be, ambitious, visionary, and far-reaching. Through access to antiretroviral treatment, it has literally brought people living with HIV back from the brink of death and enabled them to live long and healthy lives.

It’s been ten years since the United States Leadership Against HIV/AIDS Tuberculosis, and Malaria Act of 2003 was passed into law, creating PEPFAR. And today, we can confidently say that the program has saved millions of lives and delivered hope to communities where it was so desperately needed.

As a key implementing agency, USAID has contributed significantly to these remarkable achievements. Through programs that prevent mother-to-child transmission, offer voluntary medical male circumcision and improve condom use, to those that reduce gender-based violence and risky behaviors for select populations; through our commitment to deliver effective treatments and care for the most vulnerable – especially orphans and other affected children – to our support for the development of an HIV vaccine, USAID has played a significant role in changing the face of the pandemic around the world.

In the 10 days leading up to World AIDS Day  - through a digital campaign called 10 for 10 (PDF) – USAID will share stories from the last decade that touch on the various ways the agency has contributed to one of the most successful foreign assistance programs ever created. This campaign will culminate in the launch of “Gift’s Last Ten Years” – an animated video that tells the story of our work through the eyes of a fictional 10-year old southern African girl.

AIDS used to be a disease that everyone feared and discussed only in private. Today, there is a global sense of optimism that did not seem possible at the beginning of this century. What a difference a decade makes – we’re proud to have played our part.

Follow @USAIDGH on Twitter through World AIDS Day, observed on December 2, for key facts, resources, and photos from our programs and partners and join the conversation using the hashtag #WAD2013.

Achieving Equity Through Women in Leadership

I’ve just returned from the International Conference on Family Planning in Addis Ababa, Ethiopia, where thousands of leaders and experts came together to discuss how to improve access and choice in family planning services across the globe. One of the highlights of the conference for me was speaking on a panel about the role women leaders can play in this arena.

I don’t think you have to be a woman to be committed to achieving equity in access to family planning services.  There are countless men in leadership roles that are deeply committed to expanding equity across the board, including in access to family planning.  That said, I think having women in leadership positions is incredibly important.

Mother and child at a health clinic in Ethiopia. Photo credit: USAID

Mother and child at a health clinic in Ethiopia. Photo credit: USAID

We often talk about women leaders as role models for girls.  Certainly having women in leadership roles lets girls see someone who looks like them doing things they might dream of doing and helps validate those dreams.  But women in leadership positions are role models for boys too—that women belong in leadership positions, that having women in these roles is normative. Having women in leadership roles in government is an especially public acknowledgement of legitimacy.

Governments have a responsibility to treat their citizens equitably, which means they have a special role to play in addressing disparities, whether that is as a direct provider of health services or by making it attractive for the private sector to serve the underserved or both. When governments prioritize making it possible for poor women, rural families, adolescents, and racial or ethnic minorities to exercise their right to choose the number, timing, and spacing of their children by expanding access to high quality, voluntary family planning information, services, and methods, they send a message about their commitment to equity and rights.

Having women employed in visible roles in government programs, whether they are in formalized leadership positions or not, also sends that message.   And there are great examples all around us:

  • Managing the largest portfolio that USAID has in Asia, female Foreign Service Nationals at USAID’s Bangladesh mission have strengthened the family planning portfolio. Dr. Umme Meena in the mission there—and other men and women like her employed as Foreign Service Nationals by the U.S. government worldwide—demonstrate America’s commitment to equity in family planning every day.
  • In Amhara, Ethiopia, USAID supports activities to prevent child marriage by identifying young female community mentors who can advocate against marriage before the age of 18. These youth leaders are powerful agents of change and gender equity in their communities.
  • Community health workers are some of the most passionate and committed champions for equity in access to family planning and health services. Esther Nyokabi in Kenya is an illiterate woman who overcame significant personal obstacles to become a champion for post-abortion care. She mobilized her community to demand better health infrastructure from the government. She is now a passionate community health worker and part of a government –sponsored training team for post-abortion care. Her efforts have brought life-saving antenatal care, skilled attendance at delivery, and family planning services to a community that did not have health services previously.

It is the commitment, passion, and actions of leaders like these that will achieve full choice in family planning.

Watch a video clip of Ellen Starbird at the International Conference on Family Planning and read news and announcements made by USAID at the conference. 

A Lesson in Holistic Care: What I Learned from Working with Transgender Women and Health Providers in the LAC Region

November 20 is Transgender Day of Remembrance.

I have collaborated closely with transgender women and health providers in Latin America and the Caribbean to learn more about the needs of transgender populations and to train health workers to provide quality services. Working alongside transgender women on needs assessments, trainings for health providers, and in the development of a blueprint (PDF) for comprehensive transgender services, opened my eyes to their experiences, gaps in existing programs that limit access to critical services, and the opportunities we need to pursue. To help you understand my recommendations, I would like to share a story I heard repeatedly from transgender women:

I was 13 years old when my family threw me out of the house because of who I am. I tried to continue my studies, but I dropped out of school because my classmates insulted me every day and sometimes hit me, and I was afraid to use the boys’ bathroom (the only one I was allowed to use) because I was afraid of being assaulted by male students. The teachers looked the other way or called me names. I have developed a thick skin because when I step out of my home, people stare, make comments and give menacing gestures. Going to a clinic is also unpleasant. I get sick like everybody else, but the nurses always assume that I am a sex worker and that I have HIV. Frequently, they give me condoms and an HIV test and send me home. One time I was jumped by four guys in the street, and I ended up in the emergency room. When one of the nurses opened my robe and saw that I am a transgender woman, she gave me a look of disgust and called me a homosexual. She must have told others about me because several nurses came, opened my robe and walked away laughing. I waited for a long time before a doctor saw me. He told me that real men do not dress like women, and that I should cut my hair and stop wearing make-up so I could get a job. I had a cut in my head that needed stitches and the doctor did not even clean the blood in my hair.

REDTRANS and Miluska staff conducting a workshop on HIV and human rights. Photo credit: Manuel Contreras

REDTRANS and Miluska staff conducting a workshop on HIV and human rights. Photo credit: Manuel Contreras

This story, and the others that I heard through this work, underscored the need for a new approach to transgender health:

  1. Prevention efforts must engage families and schools to foster supportive environments.  Transgender teens frequently experience rejection from their families and bullying in school. Homelessness, low literacy, and lack of family protection not only increase the likelihood that these teens will experience exploitation, but also severely limit their opportunities to find jobs.
  2. Many people, including health providers, do not clearly understand the spectrum of sexualities, genders, and identities. Their confusion often leads to stigmatizing attitudes and discriminating practices in health care settings, which in turn discourages transgender women from seeking care.
  3. Increasing access to counseling and testing and other HIV services should not be an end in itself. Securing the human rights of transgender communities and creating a safer environment where they can access appropriate services without fear of violence or discrimination should be the focus.
  4. Increasing access to condoms and HIV information are cornerstones of HIV prevention, but national prevention programs need to go beyond these two strategies. Policies and programs should also support employment and education opportunities for transgender persons. The pressure to put food on the table and a roof over their families’ heads can lead to poor decision making, resulting in risk-taking behaviors.
  5. Engaging transgender persons in program activities as facilitators or data collectors strengthens their technical capacities and allows them to engage with health providers and communities as professionals and peers. This can effectively dispel myths and negative beliefs about transgender women, their capacity, and their behavior.

By sharing my observations and the stories I heard, I hope to raise awareness of the issues that come into play and to encourage all of us to reconsider how our programs can better contribute to the well-being of transgender persons and their communities. We can make that commitment today on Transgender Day of Remembrance, an internationally recognized day to memorialize those who suffered or died as a result of anti-transgender hatred or prejudice.

Aysa Saleh-Ramirez, MPH is AIDSTAR-One Senior Technical Advisor at John Snow, Inc. AIDSTAR-One is funded by PEPFAR through USAID.

Men for Others: Keeping Men Safe as They Battle Against HIV

November 19 is International Men’s Day.

Every day, the first thing I see when I walk in the office is a picture of a young dad tenderly holding his little daughter in southern Africa. She is sick and they are on their way to clinic. With her head safely snuggled on his shoulder, the solace in her soft brown eyes and round face says, “Thank you Daddy. Thank you for being here for me.”  His face, an expression of both love and deep concern, says in return, “I will always be here for you.”

He is a man for others. Although I never met him, he is a daily inspiration to me. He is like so many men (and women) I have met along our global journey to end AIDS. Men who give so much of themselves to take care of sons, daughters, partners, spouses, friends, and even strangers. These men “step up,” often facing great risks, to support those who need assistance.

A family celebrates with their child, a sign of togetherness and healthy living. Photo credit: USAID/B. Deutsch

A family celebrates with their child, a sign of togetherness and healthy living. Photo credit: USAID/B. Deutsch

Today, as we celebrate International Men’s Day, we need to “step up” for every man and boy, keeping them safe as they continue the battle against HIV.

This means prioritizing access to HIV prevention services like voluntary medical male circumcision (VMMC). Men and boys armed with the evidence and given access to preventive services will better protect themselves, their loved ones, and their communities. Millions of men and boys in east and southern Africa are already taking the lead through the vigorous uptake of VMMC services.

This means scaling up evidence-based structural and behavioral interventions to remove barriers to HIV services. For instance, programs that encourage men and boys to seek life-saving health services can counteract the negative influence of certain gender expectations. In addition, it is important to improve access to services for men who have sex with men by training health care workers and mobilizing communities in high stigma settings.

This means identifying more men and boys who are HIV-positive and enrolling them in quality HIV care and treatment services. We know antiretroviral treatment can give men and boys with HIV the opportunity to live longer, healthier, and more productive lives. Furthermore, men and boys on treatment can successfully suppress HIV and are less likely to transmit the virus to others.

This means continuing the search for a safe and effective HIV vaccine and possibly even a cure.

On this International Men’s Day, let’s continue our work to keep men and boys safe from HIV.  Let’s step up like that young dad in southern Africa and keep our promise to always be there for them in our fight against HIV.

Human Resources for Health: Foundation for Universal Health Coverage

Many USAID staff from Washington and the field gathered in Recife, Brazil this week for the 3rd Global Forum on Human Resources for Health (HRH), joining over 2,000 HRH policymakers, experts, advocates and frontline health workers from 57 countries. The Global Health Workforce Alliance convened the forum to find solutions to address the health workforce crisis. The global shortage of skilled, motivated and supported health workers is a major development challenge and a barrier to meeting health goals.  A strong HRH strategy ensures that new healthcare graduates are absorbed by the health system, and then well supervised and supported throughout their careers. Therefore, investment in HRH is essential for the delivery of high-quality health services and for countries to achieve and sustain universal health coverage (UHC).

A Yezura Zenna, or volunteer health aide, is ready to work in Ghana with his project bicycle and pharmaceutical bag.  Photo credit: James E. Phillips, courtesy of Photoshare.

A Yezura Zenna, or volunteer health aide, is ready to work in Ghana with his project bicycle and pharmaceutical bag. Photo credit: James E. Phillips, courtesy of Photoshare.

This year’s forum focused on HRH as the foundation for universal health coverage and the post-2015 agenda. USAID co-sponsored the forum and our Assistant Administrator for Global Health, Dr. Ariel Pablos-Méndez, led the U.S. Government delegation that included participants from the State Department and Health and Human Services. Many PEPFAR-supported USAID projects, including CapacityPlus, ASSIST, Leadership Management and Governance, and Health Finance and Governance also showcased their investments in human resources for health.

We took away several key lessons from our participation in the forum. Foremost, there must be better integration of HRH into the broader dialogue about health system strengthening and development goals and challenges. As Dr. Pablos-Méndez emphasized, the economic transition occurring in many countries is impacting HRH and should inform human resources planning so that health goals can be realized. Finally, we must build a new generation of leaders to help carry the HRH agenda forward.

USAID will continue to support health workforce strengthening in order to improve access to and quality of health services for the most at-need populations.  Our approach to HRH is comprehensive, focusing on the availability, accessibility, acceptability and quality of a country’s health workforce.  In addition to strong health systems, USAID supports the development and needs of all cadres that make up a country’s health workforce, including doctors, nurses, midwives, paraprofessionals and community health workers.

A community health worker counts the respiratory rate of a young child in Dhanusha, Nepal.  Photo credit: Dillip Chandra Poudel, courtesy of Photoshare.

A community health worker counts the respiratory rate of a young child in Dhanusha, Nepal. Photo credit: Dillip Chandra Poudel, courtesy of Photoshare.

USAID’s strong relationships with the Global Health Workforce Alliance and its members have enabled valuable collaboration on the global HRH agenda.  The notable willingness of donors and countries to join in partnership to tackle HRH challenges with country-appropriate interventions has led to a significant increase in investment for HRH at the country level.  This alignment will be instrumental in moving the HRH agenda forward in the post-2015 era.

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.

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