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Delivering Quality, Affordable and Equitable Care to Improve Health

The U.N. High Level Meeting on Prevention and Control of Non-communicable Diseases marks only the second time in history the UN has held a special meeting on a health issue: the first was for HIV/AIDS in 2001.

Non-communicable diseases (NCDs) represent an urgent and growing global public health concern. In 2008, NCDs — diseases such as cardiovascular disease, respiratory disease, cancer and diabetes — claimed the lives of more than 39 million people, according to the World Health Organization (WHO). And we know that the majority of poor people, the bottom billion, bear most of this burden in lower- and middle-income countries.

As the world’s epidemiology evolves, preventing NCDs will help to prolong life expectancy, reduce disability and extend opportunity. A healthier lifestyle delivers the biggest dividend.

The Agency’s significant investments in health systems strengthening (pdf, 3.15mb) underpin the foundation for integrated, country-led NCD prevention and control programs.

This means our current programs are building the foundation upon which future NCD efforts can be based. The same approaches that strengthen health workforces, ensure reliable supplies of vaccines and contraceptives, collect and analyze health information, and promote more effective governance, can also be adapted and applied to addressing NCDs.

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USAID Renews Commitment to Finding a Viable HIV Vaccine

Having worked in the HIV/AIDS realm for many years, I’ve gotten my share of questions on when I think an effective vaccine will finally be discovered and the world will bear witness to an AIDS free generation. Some wonder why, after 30 years, our path towards finding a cure for HIV—a virus that has taken the lives of more than 25 million people around the globe since it first surfaced—remains complex and plagued with so many challenges. Others are just plain frustrated with what they feel has become a fictional idea.

What people often forget is that vaccines for diseases that have been eliminated—such as polio and smallpox—have taken, in many cases, decades to develop. Discovering an effective vaccine, especially one for a virus that is so tricky and where the body has no naturally protective response, takes enormous dedication, persistence and research.

Dedication, persistence and research: all qualities in which USAID is well-versed and has a longstanding history. Since the early years of the epidemic, USAID was steadfast in supporting initiatives dedicated to prevention and finding a cure for HIV/AIDS. This is just as true today as it was 30 years ago. The Agency, just this month, renewed its commitment to the InternationalAIDSVaccineInitiative (IAVI), a longtime partner and leading research NGO whose mission is to discover and make accessible a preventive AIDS vaccine.

In partnership with IAVI, USAID will continue to be a global thought leader and leading voice on the importance of the discovery of an effective vaccine for HIV/AIDS. USAID has made it a priority to continue supporting leading organizations dedicated to working in this area. To date, USAID-supported IAVI studies have led to the discovery of the first of now several powerful, broadly neutralizing antibodies capable of blocking HIV, which were isolated from an African donor.  IAVI has also developed novel vectors that show great promise in pre-clinical stages.

I am also pleased to see IAVI expand its partnerships with other U.S. Government agencies, such as its collaboration on the National Institute of Health’s HIV Vaccine Trials Network (HVTW). IAVI has also built capacity in countries, such as in Kenya where the Kenya AIDS Vaccine Initiative is currently a model for developing country research institutions, capable of rigorously and ethically evaluating AIDS vaccine candidates and playing a crucial role in the global quest for the vaccine.

Investing in science, technology and innovation is imperative to be strategic and cost effective in our fight against AIDS. New technologies can dramatically improve health and development outcomes, resulting in pivotal progress toward preventing new infections in the developing world, where the burden of HIV is most painfully felt. New biomedical prevention tools are of critical importance in this battle – particularly that of a safe and effective HIV vaccine. We must continue to build our arsenal of biomedical prevention tools, given the game-changing impact they can have both on global health outcomes and overall economic development.

I am delighted that our work with partners, like IAVI, will continue as we strive to find an effective vaccine – a tool that is essential in our fight against HIV/AIDS.

On the Road with SCMS, Part 3: In South Africa, a provincial depot’s dream team mobilizes to support scale up of HIV/AIDS care and treatment

In this three part series, Jay Heavner, Director of Knowledge Sharing and Communication at Supply Chain Management System (SCMS), highlights his experiences visiting three countries in Africa to observe SCMS project sites.

In March, Diane Reynolds, Supply Chain Management System (SCMS)’s country director in South Africa,wrote about President’s Emergency Plan for AIDS Relief (PEPFAR) and USAID’s partnership with the government of South Africa to help bring down the price of antiretroviral drugs (ARVs) in that country. ThisBridging Fund program has been a game-changer for South Africa as it rapidly scales up HIV/AIDS treatment, so I jumped at the opportunity to visit the country and see first-hand the impact of this innovative initiative.

One of the most memorable experiences of my recent trip was a site visit to the KwaZulu-Natal Provincial Pharmaceutical Supply Depot near Durban. Although one of ten provincial depots, it stores and distributes an impressive 32 percent of the country’s lifesaving ARVs to 28 hospitals and 600 clinics in the province.  Before arriving, I heard about the depot’s dream team who worked wonders to accommodate a large influx of ARVs in a warehouse that was already stretched to capacity.

A hand-operated fork lift helps navigate tight warehouse spaces.Photo Credit: Desiree Swart

To understand their achievement, consider the following:

  • The depot was designed 27 years ago to serve a population a fraction of the current one and before the first case of AIDS was reported in South Africa.
  • Most ARV regimens in South Africa still use three separate pills in combination rather than have patients take one pill containing three different medicines (fixed-dose combination).
  • More than 500 pallets of ARVs were occupying 27 percent of the total space in the depot the day I visited, meaning that the staff are managing all other public health commodities in roughly three quarters of the space they used to have available.
  • The ARV stock turns at the hub are almost weekly; monthly stock turns at any warehouse would be considered an accomplishment.

The team who runs the depot is a passionate bunch.  When I asked how they pulled off such an amazing feat, one replied, “Each person here is a perfectionist. We are the people who have to do it. The implications of not doing it are too great.”

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Stopping the Spread of Polio in Central Asia

When my daughter Caitlin cried getting her polio booster, I was able to staunch the flow of her tears by describing the amazing work USAID/Central Asian Republics did in Tajikistan last spring when USAID’s rapid response and advocacy with the host governments and other donors resulted in more than 7 million children getting vaccinated (that’s more than 95 percent of the under-five population).

Caitlin’s response to me was “I’d be happy to give my vaccine to the kids who need it. But what else can I do to help?”  Her innocent comments reflect the spirit of our team as we rolled up our sleeves and mobilized the Tajik Health Ministry and other donors to respond decisively with a series of national immunization campaigns that effectively stopped the spread of the outbreak in six months.

I was reminded of this victory last week when the European Regional Certification Commission for Poliomyelitis Eradication (RCC) announced that Europe will keep its polio-free status.  Last week, in Copenhagen, the RCC said that wild poliovirus transmission had been interrupted.  “No new cases of polio had been reported since September 2010 because countries took effective action.”  That statement is referencing Central Asian countries—for example, Tajikistan—which in 2010 saw its largest polio outbreak in decades.  There were 898 reported cases of acute flaccid paralysis in Central Asia in 2010.  Acute flaccid paralysis is the most common symptom of polio and is one indicator for polio surveillance during an outbreak.

A Tajik mother holds her son while he gets his polio vaccination. Photo Credit: USAID

The RCC acknowledged the contribution and technical support of the World Health Organization Regional Office for Europe, the Global Polio Eradication Initiative partners and the Russian Federation, India, and USAID.  Not only did our work halt this devastating disease, but it also built the foundations of new U.S.-Russia bilateral cooperation on joint efforts to assist with strengthening health systems and surveillance in the region.

Polio has no cure, and only vaccination can prevent it.  But additional funding, coupled with technical assistance and strong advocacy, increases the ability to mount high-quality campaigns and sustain a population’s immunity, which is the best we can do until global eradication is achieved.  The Central Asian Republics have eradicated polio successfully in the past, and serve as an important lesson to stay vigilant and maintain a strong immunization program.

USAID Applauds New White Paper Regarding the Trans-Pacific Partnership and Access to Medicines

Today at Round 8 of the Trans-Pacific Partnership negotiations in Chicago, IL, the Office of the U.S. Trade Representative (USTR) issued a white paper outlining a new strategic initiative entitled “Trade Enhancing Access to Medicines (TEAM).” TEAM is designed to deploy the tools of trade policy to promote trade and reduce obstacles to access to both innovative and generic medicines, while supporting the innovation that is vital to developing new medicines and achieving other medical breakthroughs.

“A cornerstone of the Obama Administration’s global public health strategy has been to focus aid on strengthening entire health systems in developing countries in order to improve public health, including improved access to medicines,” said Ariel Pablos-Mendez, Assistant Administrator for Global Health, U.S. Agency for International Development. “Today’s announcement by the United States Trade Representative confirms the role of trade policy in the Administration’s broader efforts.”

The white paper describes how, under the TEAM approach, the United States proposes to work with partners Australia, Brunei Darussalam, Chile, Malaysia, New Zealand, Peru, Singapore, and Vietnam to achieve the following goals in a TPP agreement:

• Expedite access to innovative and generic medicines through a “TPP access window”
• Enhance legal certainty for manufacturers of generic medicines
• Eliminate tariffs on medicines
• Reduce customs obstacles to medicines
• Curb trade in counterfeit medicines
• Reduce internal barriers to distribution of medicines
• Promote transparency and procedural fairness
• Minimize unnecessary regulatory barriers
• Reaffirm TPP Parties’ commitment to the Doha Declaration on TRIPS and Public Health

For more information please visit: www.ustr.gov

This Week at USAID – September 12, 2011

Administrator Raj Shah participates in a panel discussion about “Leveraging Malaria Platforms to Improve Family Health” during the The Summit to Save Lives, which is presented by the George W. Bush Institute.

Later in the week, Administrator Shah heads to Haiti to meet with USAID Mission staff and to visit an agricultural training center.

The World at 7 Billion People: Deputy Administrator Don Steinberg speaks at the National Geographic Society Headquarters to raise awareness around global population issues related to women and girls.

Assistant to the Administrator Susan Reichle talks about USAID’s progress towards implementing President Obama’s Policy Directive on Global Development at a town hall hosted by the Modernizing Foreign Assistance Network.

Miriam’s Success in Changing Lives in her Community

When she was only 14 years old, Miriam was the primary caretaker of her family. Like many other girls in her situation in Guyana, Miriam turned to commercial sex work to provide for her family.

As a female sex worker (FSW), Miriam put herself at risk of HIV/AIDS and sexually transmitted infections. In Guyana, FSWs have an HIV prevalence rate of 16.6%; still, only 35% of FSWs surveyed knew two ways to prevent sexual transmission of HIV. In order to reach this population with education, prevention, care and treatment services the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), through USAID, funds several community based intervention programs.

At 15 years old, Miriam gave birth and soon found herself in an abusive relationship. She suffered through years of abuse until she left with her children and moved to a large city. Once again, she was on the streets trying to make a living.

In 2006, Miriam was reached through Keep the Light On, a project targeting sex workers implemented by Comforting Hearts, a USAID-supported NGO located in New Amsterdam. Through training and education, Miriam became a peer educator.

She said, “Being involved as a volunteer with Comforting Hearts benefited me greatly. In addition to reaching out to my peers, my own life was also changed, because of the knowledge I acquired which helped me to change my risky behaviors.”

Miriam reached out to sex workers and their clients and shared HIV/AIDS information with them.  She was also trained to provide care to people living with HIV, through the Home Based Care program, and provided bedside care to HIV positive people at the New Amsterdam Hospital. Miriam later became a member of the Caribbean Network of Sex Workers and president of the Caribbean Sex Work Coalition.

On a return visit to her hometown, Kwakwani, in 2008, with her greater insights on HIV/AIDS and her experience as a sex worker, she quickly assessed the plight within her childhood community.  Poverty was still rife; the sex trade, with many unsafe sexual practices, was more pronounced than ever in this small mining community.

To respond to these challenges, she decided to start a community-based organization, ONE LOVE, to educate commercial sex workers on HIV prevention.  The organization trains peer educators from the mining areas within Kwakwani and reaches sex workers and their clients with appropriate HIV prevention messages, condoms and HIV testing and counseling.  The organization also provides economic empowerment activities, which allowed some of the women to leave sex work.

ONE LOVE, through Mariam’s leadership and passion, is one of the newest recipients of USAID funding through PEPFAR, and is testimony to the fact that one person, based on her own experiences, can make a difference in the lives of others.

Miriam concludes, “Now I am living my dream of reaching the population that I was once a part of; many lives have been saved and many lives have been changed, all because of my work. This is very precious to me.”

New Program Educates Health Sector Executives in Kenya

Kate Steger, MA, MPH is a Communications and Knowledge Exchange Coordinator for the Kenya Leadership, Management and Sustainability Program at Management Sciences for Health

Earlier this year, USAID supported the launch of the Leading High-Performing Healthcare Organizations program (LeHHO) for senior health leaders in Kenya.  Offered at Nairobi’s Strathmore Business School, the program is the result of a successful partnership between Strathmore and USAID’s Leadership, Management and Sustainability (LMS) project in Kenya.

Kenyatta National Hospital Chief Nurse Philomena Maina (center) receives her LeHHO certificate from Strathmore Business School Dean Edward Mungai (left) and Academic Director Joan Mansour of MSH (right). Photo Credit: MSH

A leadership development specialist from Management Sciences for Health, which implements the LMS project, worked with Strathmore Business School faculty to integrate key components of leadership development for the health sector with Strathmore’s business education model. The result: an ongoing six-month course that combines executive health systems education with applied leadership training, offered exclusively to the health sector’s most senior leaders.

Program participants expand the depth and breadth of their knowledge with modules on the healthcare environment, improving organizational performance, healthcare systems management, and managing change. At the same time, they are asked to choose a specific current challenge in their organization and set a goal for overcoming that challenge. At the recent graduation ceremony for the first cohort, participants boasted accomplishments that promise to have widespread and lasting effects on the health of Kenyans.

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This Week at USAID – September 6, 2011

After a hiatus, we will be continuing the “This Week at USAID” series on the first day of the work week.

Thursday, September 8th is International Literacy Day. The Center for Universal Education at Brookings, the Education for All-Fast Track Initiative, and USAID will mark the day by hosting a series of panel discussions on how a range of education stakeholders are addressing the challenge of improving literacy, particularly at lower primary levels, to help fulfill the promise of quality education for all.

Stephen Haykin will be sworn-in as USAID Mission Director to Georgia.

Raja Jandhyala, USAID’s Deputy Assistant Administrator for the Bureau for Africa, will testify before the U.S. House Subcommittee on Africa, Global Health, and Human Rights on the long-term needs in East Africa.

Alex Their, USAID’s Assistant to the Administrator and Director of the Office of Afghanistan and Pakistan Affairs, will testify before U.S. Senate Committee on Foreign Relations on development programs in Afghanistan.

On the Road with SCMS, Part 2: In Ethiopia, capacity building helps a health center manage its supply of HIV/AIDS commodities

In this three part series, Jay Heavner, Director of Knowledge Sharing and Communication at Supply Chain Management System (SCMS), highlights his experiences visiting three countries in Africa to observe SCMS project sites.

The Fital Health Center is located about 135 kilometers north of Ethiopia’s capital, Addis Ababa, in a beautiful agricultural region of small villages of thatched roof huts and fields of dark, rich soil.  HIV prevalence is low here.  Although the center tests about 1,000 people a month, the center has only 37 patients on treatment, three of whom are children.

The health center has a small but well organized store room filled with medical supplies, including adult anti-retroviral medicines and HIV test kits provided by the Global Fund and pediatric antiretroviral drugs (ARVs) and laboratory supplies procured by SCMS with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID.  The store room also serves as a distribution point for nine other smaller health centers in the area.

In Ethiopia, a PEPFAR implementing partner picks up a shipment of HIV test kits from SCMS’s local distribution center. Photo credit: David Fombot

As recently as 2009, the health center struggled to manage its relatively small number of medicines and other supplies. Staff here told me they faced challenges with drugs expiring and experienced stockouts of drugs and other supplies as well.

As part of a national capacity building program, SCMS has provided training and ongoing supportive supervision visits with key staff here and at 198 sites like it to strengthen the health center’s processes, including reporting and ordering to the regional warehouse hub, management of its medical supplies and distribution to other sites. Staff here showed me examples of the forms they fill out and use to report data—including consumption of commodities and current stock on hand—to the regional warehouse staff, who then enter the information in a national internet-based system developed by SCMS to support Ethiopia’s Pharmaceutical Fund and Supply Agency (PFSA) and international donors plan their funding and procurement of HIV/AIDS commodities.  They also showed me a number of other forms, including ones they use to manage their inventory and others used to process and track orders from the other sites they serve. SCMS prints and distributes many of the forms sites like this use to manage their HIV/AIDS medicines and supplies.

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