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Archives for Health

Treat the Whole Person: On Mental Health Day, USAID Recognizes the Importance of Mental Health for People Living with HIV

Submitted by: Melissa Sharer AIDSTAR-One Senior Care and Support Officer, John Snow, Inc.

AIDSTAR-One is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government (USG) country teams to build effective, well-managed, and sustainable HIV and AIDS programs, and promotes new leadership in the global campaign against HIV.

“First we need ARVs, second is Duong Sinh TuNa, third is psychosocial support,” said an HIV-positive female client at an HIV clinic in Van Don, Vietnam. Her spontaneous response to a question about the needs of people living with HIV (PLHIV) includes a double dose of mental health care and support. Duong Sinh TuNa is a rhythmic poem recited during relaxation and stretching exercises hosted at the clinic she attends. It reads in part: “Breathe, meditate, relax, exercise, think positively…Healthy minds and clearer thinking help recovery.”

This client knows what she’s talking about. An individual’s well-being underpins everything she or he does. Emotional health facilitates opportunities to form relationships, to love, to work, allowing a person to continue making choices that support good physical health. The World Health Organization defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community,” a definition that should inform all programs and policies targeting individuals living with HIV.

Mental health services are thus critical to a continuum-of-care approach for people living with HIV (PLHIV).  A recent meta-analysis looking at depression and adherence shows a consistent relationship between depression and HIV treatment non-adherence (Gonzalez et al. 2011). Estimated rates of depression among PLHIV soar as high as 72 percent in resource-constrained countries (Adewuya et al. 2007), which threatens the consistent use of the antiretroviral therapy (ART) that keeps them alive.

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Picture of the Week: A Social Pharmacy in Paraguay

A woman in Paraguay at a social pharmacy. Photo Credit: Laura Alvarez, USAID/Paraguay.

A woman in Carmen del Paraná, a small town in rural Paraguay works at a social pharmacy program at the local hospital. This program implemented by local health councils with technical assistance from USAID/Paraguay helps pharmacies keep prices for medicine affordable for low-income communities who do not normally have access to medical supplies and often cannot afford regular prices of basic medicines. Money for the pharmacies is channeled through a revolving fund managed by the local health councils in each community, in coordination with the municipal and departmental governments and the departmental health council.

Darfuri Woman Working for USAID Inspires Community

Story submitted by Millennium Relief and Development Services/Partner Aid International

When Ikhlas was a young girl in El Fasher, North Darfur, her life took a tragic turn when she contracted polio. The disease has been nearly eradicated worldwide following the advent of safe and effective childhood vaccinations, but in a few pockets of the world, poor access to health care means that children become disabled or die from preventable causes.

Throughout her life, Ikhlas has battled others’ misguided perceptions that because she is disabled, she is unable to hold a normal job or do anything of value. Although she was an active member of the Darfur Disability Society, people only focused on her handicap when she interviewed for jobs.

In 2010, Ikhlas interviewed with USAID partner Millennium Relief and Development Services/Partner Aid International (MRDS/PAI) in North Darfur to become the supervisor of rural clinics. Many MRDS/PAI staff were concerned that she would not be able to travel to villages or would be a burden to others during field trips, but some saw in Ikhlas a spark with great potential. Ikhlas’ first assignment was to help start a new clinic in Grawid Besham, a village with no health care services within 20 kilometers. Ikhlas organized a village health committee to oversee the work of the clinic, involving all relevant government organizations.

Ikhlas spent several months traveling to rugged rural areas, working with the community to remodel the clinic and to build residential facilities for medical, monitoring, and support staff.  After months of hard work mobilizing the community and government agencies into action, the clinic opened in 2010 and the community celebrated the arrival of health care services to the village.

With USAID support, the clinic in Grawid Besham is providing health care for up to 8,000 rural Darfuris. Ikhlas is now helping to prevent other children from contracting a disease that has created so many challenges in her own life. Grawid Besham is the first of four clinics that Ikhlas has helped USAID and its partners open in the area.

“I am really fortunate to show that I am able to work in spite of my disability,” Ikhlas said. “The stigma is still very high in people thinking disabled people can’t do anything. So I thank God, my family—for giving me permission to work outside of town—and I thank my employers for not seeing only the outside and my inability but encouraging me to show my abilities. To me, this is real partnership and it has changed my life and I hope the lives of many others not only in health care but also in their attitude towards other people living with disabilities.”

Local Health Support Builds Better Lives for Mothers and Babies

As we headed out for a health-focused field trip in Timor-Leste’s central highlands, we were treated to almost all the geographical delights of the country.  Along the coast road, the dry season winds were whipping up the sea into the biggest waves I’d seen since I arrived in Timor-Leste.  As we turned inland, the brown fields among the rising hills attested to the end of the harvest.  Driving ever higher—along narrower and narrower roads—the altitude brought back the green of forests.

We were headed through the district of Ermera to the “sub-village” of Hatugeo, tucked just below the peak of Timor-Leste’s highest mountain.  This district has some of the country’s worst health indictors:

  • Infant mortality is 70 babies per 1,000 births, far higher than the national average of 45/1,000, and higher than in neighboring Indonesia (34/1,000).
  • Only 3 percent of mothers deliver their babies in a health care facility, compared with 22 percent across the country.
  • A higher percentage of children show signs of malnourishment and illness than in the rest of Timor-Leste.

Why is that?  I’ve been told there are four main reasons (and I suppose that there are more).  First, the district is very mountainous; second, there are few roads; third, there is a shortage of professional health staff; and fourth, this district is known for its festivals and parties—people spend what little money they have on these, not on nutrition and health, so says the Deputy Director of the District Health Service Florindo De Araujo.  This is a big problem, and Mr. De Araujo and his staff are wracking their brains to figure out what to do about it.

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Seeking a Sustainable Solution for HIV Funding in Kenya

In March 2011, the Kenyan National AIDS Control Council prepared a Cabinet memorandum that outlines ways to raise funds for HIV programming.  Through innovative solutions, Kenya is looking for sustainable ways to combat the AIDS epidemic in country.

The memo is based on a recommendation from the USAID-funded Health Systems 20/20’s HIV/AIDS Program Sustainability Tool (HAPSAT) assessment.

Two government staff who helped prepare the memo tell us how it will help Kenya’s 1.5 million citizens living with HIV.

Regina Ombam, head of strategy for Kenya National AIDS Control Council (NACC), leads planning, implementation and evaluation of HIV programs. As part of the Cabinet memo initiative, she managed the process of gathering relevant health financing data on behalf of the director of NACC. Ms. Ombam holds master’s degrees in economics and public administration.

 

Irene Mukui is the antiretroviral therapy (ART) program manager for the National AIDS and STI Control Programme. She oversees the provision of ART and other associated care (i.e., nutrition, TB/HIV integration, etc.) for both children and adults in Kenya. Dr. Mukiu was a member of the technical working group that developed the Cabinet memo. She is a licensed medical doctor.

 

HS20/20: What does the Cabinet memorandum propose to raise funds for HIV programming?

 

RO: The Cabinet memo proposes that the Ministry of Finance create a HIV/AIDS Trust Fund that would support scaling up prevention, treatment, care and support in Kenya. If approved, the government would contribute 1% of its annual revenue to the fund. In addition, the fund would receive contributions from partners and the private sector through initiatives such as airtime and airline levies, levies on remittances from abroad, corporate and NGO donations, the national lottery system, and leveraging unclaimed financial assets (i.e., monies that are dormant or abandoned often as a result of death, name change, or relocation). The Ministry of State for Special Programmes, the Ministry of Public Health and Sanitation, and the Ministry for Medical Services would implement HIV programming supported by the fund.

IM: The Cabinet memo aims to establish long-term, sustainable financing through the existing National Health Insurance Fund and increase government funding to meet the Abuja target of allocating 15% of the annual budget to health.

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Photo Essay: Community Volunteers Help Women Suffering from Fistula in Guinea

The volunteers make their way to the next family in Faloboa village. Sometimes the volunteers encounter village women who have suffered with fistulas for many years without any access to medical help. USAID’s program is able to support these women with diagnosis and treatment. Photo Credit: Elizabeth Fakan, USAID/Guinea

The average Guinean woman will have six children during her lifetime, but due to the lack of obstetric care, many develop fistula, a painful injury that is especially traumatic due to the stigma associated with it. During obstructed labor, a baby’s head may be pressed against his mother’s pelvic bone, cutting off circulation to tissue in the area and literally creating a hole or “fistula” in her bladder or rectum. Aside from the physical pain, many also suffer psychological trauma, as they are often shunned by their families and communities due to the foul smell resulting from their injuries. The internationally renowned Hamlin Fistula Foundation says that although this condition was eradicated in the United States over a century ago, more than 2 million women in developing countries still suffer from it today.

USAID is helping more than 1,500 women in Guinea access treatment for fistula and working with communities-women and men, secular and religious leaders-to understand, prevent, and treat fistula while better supporting those who have suffered from it. In addition, USAID is strengthening the national health system by training doctors, nurses, and midwives in fistula prevention and care.

Contraceptive Technologies Offer New Options

The introduction of the contraceptive Depo-Provera in Uniject is suitable for delivery by community health workers and even for self-injection. Photo Credit:PATH/Patrick McKern

It is well-documented that contraception has multiple individual, national and global health and development benefits, including reductions in maternal and child mortality and maternal to child transmission of HIV, and increased opportunities for women in the workforce and global economy.  World Contraception Day, commemorated every year on September 26, highlights the growing need for improved access and awareness of modern contraception.

Seven out of 10 women in Sub-Saharan Africa, South Central Asia and Southeast Asia who want to avoid pregnancy but are not using modern contraceptives report the  major reasons they don’t use contraception include: concerns about health risks and side effects (23%), infrequent sex (21%), being  postpartum or breastfeeding (17%), and opposition of their partner (10%).  In other words, the currently available methods do not, necessarily, meet their needs.  It is imperative that we continue to work to develop innovative technologies, both adaptive technologies that improve current methods and totally new methods to ensure women and men use and have access to a wide range of modern contraceptive methods.

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Malaria Takes Stage at the Social Good Summit in NYC

As featured on MCHIP

Throughout the first two days of the Social Good Summit, hosted by Mashable, the UN Foundation, 92Y, and Ericsson, malaria has been making headlines. The disease is ripe for its time in the limelight. Preventable through simple, cost effective solutions and the recent subject of a high profile study validating the effectiveness of bednet use, malaria is a daily challenge in the lives of millions who live in malaria endemic areas, but has also become a global challenge due to the increase in travel across country borders.

Yesterday at the Summit, USAID Administrator Raj Shah highlighted expanding on the rapid reduction in child malaria deaths as one of three key action items for the Agency to reduce child mortality by up to one-half. Today, Mandy Moore and Randy Zuckerberg took the stage in the closing session to talk about Nothing But Nets, and Rear. Adm. Tim Ziemer, U.S. Global Malaria Coordinator, came by 92Y to see the presentation.

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Because No Mother Should Die Giving Life; Every Child Deserves a Healthy Start

Last night, the Saving Lives at Birth partnership announced three award nominations for transition-to-scale grants that have the potential to save the lives of mothers and newborns in rural areas of the developing world at the time of birth. We couldn’t be more excited about the announcement.

The award nominees – a mobile technology initiative in Ghana, an HIV and syphilis testing device in Rwanda and a treatment to prevent newborn infections in Nepal – have provided the most compelling evidence that their innovative and promising solutions are ready to be tested on much larger platforms.

USAID Administrator Raj Shah made the announcement at the high-level Every Woman, Every Child reception hosted by Ray Chambers, the UN Secretary-General’s Special Envoy for Malaria and MDG Advocate. These $2 million grants will be implemented over four years.  The partners – USAID, the Government of the Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and The World Bank – all congratulated the nominees for their ongoing efforts to reduce maternal and newborn deaths in rural areas of the world and encouraged them to keep going.

JSI, Columbia University, and Grameen Foundation – the latest Saving Lives nominees – are all eager to advance their work.

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Collective Action to Advance the Health of Women and Newborns

Global maternal mortality has dropped by one third since 1990, but still every day an estimated 1,000 women lose their life in childbirth.  For the past year, USAID, the UK Department for International Development, Australian Agency for International Development and the Bill and Melinda Gates Foundation have worked in partnership to accelerate progress in improving maternal and child health.  Launched at last year’s UN General Assembly Summit on the Millennium Development Goals, the Alliance for Reproductive, Maternal, and Newborn Health has supported the UN Secretary-General’s Every Woman, Every Child effort.

As director of USAID’s Office of Population and Reproductive Health, I’ve seen firsthand how this unique partnership has enhanced our efforts to improve the lives of women and children in the countries we work.  Through shared planning and funding, coordinated implementation, joint problem-solving, and joint learning, we’ve seen results that have far exceeded what any one organization could have achieved on its own.  For example, in Ethiopia, more women will have access to contraceptive implants and the government will save an estimated $2 million per year because Alliance partners worked with manufacturers to reduce the price of reproductive health commodities.

And in Pakistan, Alliance members helped increase the number of trained community midwives from 2,795 in 2010 to 7,764 in 2011, promising to reduce maternal and newborn death rates.  These are just examples from two of the ten countries in which the Alliance is focused on in its first year.

What makes the Alliance partnership different is that it brings added value, not added work, through smarter application of resources.  Through our joint efforts, by 2015, the Alliance aims to contribute to:

  • 100 million additional users of modern methods of family planning to reduce unmet need.
  • 67 million more women giving birth with the help of skilled attendants to reduce the maternal mortality ratio.
  • 80 million more infants exclusively breastfed through the first six months of life to reduce newborn mortality.

You can learn more about the Alliance’s work over the past year and our achievements in a one year progress report (pdf, 2.3mb) submitted this week to the UN Secretary-General’s Every Woman, Every Child effort.  In the coming year, the Alliance intends to expand to include additional partners and countries.

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