USAID’s Worldwide Polio Eradication Coordinator, Ellyn Ogden, has devoted her career to eradicating polio and advocating for children’s health.
Read more about her life and work in this week’s VOA profile.
USAID’s Worldwide Polio Eradication Coordinator, Ellyn Ogden, has devoted her career to eradicating polio and advocating for children’s health.
Read more about her life and work in this week’s VOA profile.
Written by Christian Holmes, USAID’s Global Water Coordinator
As we enter World Water Week 2011, it is a good time to reflect on the significance of this vital resource that we often take for granted here in the United States, but is such a precious commodity in many other parts of the world.
For me, World Water Week most importantly and fundamentally is about the harsh reality of life and death. It is staggering, almost beyond comprehension, that each day approximately 6,000 people, most children under five, die from preventable diarrheal diseases and that diarrheal disease remains the second leading cause of death in children worldwide. Yet, that is the case. These children die in a world where over 800 million people lack access to an improved water source and more than two and a half billion people lack access to sanitation. This is the world we have to change.
But change is possible. This is also a world where individuals and organizations have the skills and resources to make extraordinary differences in the lives of others. A great many of these people have come together in Washington this week to express their commitment to saving and improving lives and to helping sustain the environment in which people live and on which they are dependent. In so doing, much of the week involves important activities related to sharing and learning about approaches which will improve our ability to reduce the loss of life and human suffering.
I’ll be participating in a number of events which I’m convinced will help lead to change.
On March 22 I’ll be at a World Bank World Water Day Cross Sectoral Working Group on WASH and Healthy Ecosystems: Advancing Freshwater Management Through Integrated WASH Programming.
Also on March 22, Secretary of State Hillary Clinton will join World Bank president Robert Zoellick to sign a Memorandum of Understanding between the Bank Group and the US Government to expand and enhance our collaboration in the water sector. USAID Deputy Administrator Don Steinberg will also participate, and the event will be webcast live.
On March 23, I’ll join NGO colleagues on the Hill as part of World Water Advocacy Day.
I look forward to sharing thoughts and impressions of these events with you as the week progresses.
Submitted by Sally Cooper,
Communications and Knowledge Exchange Officer at USAID Tech-Serve
Dr. Zareena sits quietly at her desk in the corner of a large office, her attention focused on the files open on the laptop screen in front of her. “We are very busy here today,” she said, adding with a smile, “actually we are very busy here most days.”
Zareena works at Tech-Serve, a USAID-funded project building capacity at the Ministry of Public Health (MoPH). She works with health professionals at MoPH offices in USAID-supported provinces throughout the country, building their capacity to enable them to deliver quality health services for all Afghans. As part of a team looking after 17 provinces, Zareena’s days are full.
As a child growing up in Kabul through the years of the Russian occupation and the bloody civil war that followed, she recalls her family moving from neighborhood to neighborhood, escaping the fighting and seeking occasional refuge with relatives living in the provinces when the capital became too chaotic.
The fall of the Taliban government in 2001 re-opened a world of opportunities for young women like Zareena. After finishing school, with her family’s permission, she enrolled in the prestigious Kabul Medical University to pursue a career in health care. She was the first girl in her family to study, a choice that brought with it a raft of social pressures. “It was different,” she said, “but it was not wrong.”
After graduation, Zareena said, “I wanted to work in health and learn more.” She worked for a number of health-focused organizations, gaining valuable experience in each before joining Tech-Serve.
One area in which she is particularly interested is Tech-Serve’s leadership and management program which works with public health managers around the country to enable them to lead their teams, face challenges and achieve results. “It encourages me to develop my career in management so I can work for better health of women and all patients,” said Zareena.
Afghanistan has rebuilt its public health system from scratch in the last decade. More women are accessing quality health care than ever before for both themselves and their families. Progress has been slow but, as Zareena notes, “progress has been made. The health of mother and child is better than it was even three years ago.” In 2010, seventy five percent of Afghans seeking health care services were women and children under the age of 5.
But in 2011, Afghanistan’s future remains uncertain. Political tensions and a revived insurgency eat away at many of the gains made in the past decade, particularly for the country’s women. Asked what she thinks Afghanistan will be like in three years, Zareena shrugs. “I wish a brighter situation than today. We see the reality but we shouldn’t lose our courage.” She turns once more to her computer screen, “this is our hope.”
Technical Support to the Central and Provincial Ministry of Public Health (Tech-Serve) is implemented by the Afghanistan Ministry of Public Health and Management Sciences for Health. Dr. Zareena’s name has been changed to maintain her privacy.
Bangladesh is on track to meet the 2015 deadline for U.N. Millennium Development Goal 5 (50 percent reduction in maternal deaths). The Bangladesh Maternal Mortality and Health Service Survey [PDF] jointly funded by the Government of Bangladesh, USAID, Australian Aid (AusAID) and the United Nations Population Fund (UNFPA) found that maternal deaths in Bangladesh fell from 322 per 100,000 in 2001 to 194 in 2010, a 40 percent decline in 9 years.
The decline in direct obstetric deaths is most likely the consequence of better care seeking practices and improved access to and use of higher-level referral care. The decline in total fertility rate due to the successful family planning program has reduced exposure to high risk pregnancies and has thus prevented a large number of maternal deaths.
USAID’s program in Bangladesh has historically been very strong in family planning through the world’s largest social marketing program for non-clinical contraceptive methods and through the public sector for long-acting permanent methods. We can confidently say that our long and unwavering investments in family planning have had direct impact in lowering the total fertility rate, and thus the maternal mortality rate, in Bangladesh. Over the past five years, USAID has also invested in scaling up active management of the third stage of labor to prevent postpartum hemorrhage in the public and NGO sector.
The USAID program has also long invested in promoting and providing antenatal care through the NGO sector which linked women to the health system thus contributing to increased awareness and care-seeking for obstetric complications. USAID and CDC’s long term commitment to the in depth training of local scientists has resulted in the creation of Bangladesh’s premiere research institute, the International Center for Diarrheal Disease and Research, Bangladesh (ICCDDRB) which has the capacity to effectively guide valid and reliable research efforts such as the 2010 Bangladesh Maternal Mortality and Health Care Survey (BMMS).
USAID supported and provided technical leadership in implementation of the 2001 and 2010 BMMS to monitor the performance of the overall maternal health program. Without these two surveys it would not be possible for Bangladesh to monitor its progress towards achieving the MDG 5 goal.
Amanda Glassman, Director of Global Health Policy and a research fellow at the Center for Global Development, wrote “the results are also a good reminder that investments in family planning and girls’ education drive much of maternal health outcomes, and that USAID investment in social marketing of family planning and health seems to be paying off in improved health (see blog post).”
The Bangladesh Ministry of Health and Family Welfare is scaling up emergency obstetric care and active management of the third stage of labor; the Ministry has also recently approved distribution of Misoprostol tablets to all pregnant women shortly after delivery to prevent postpartum hemorrhage. There is also increasing availability of Magnesium Sulphate for management of pre-eclampsia. The predominance of hemorrhage and eclampsia deaths and deaths after delivery indicate a need to strengthen access to treatment for these two conditions, improve referral systems, and improve referral level care.
Every year, USAID provides basic health care services to nearly 20 million Bangladeshis, including provision of low-cost, quality family planning services and maternal and child health care. With USAID and international support, under-five mortality rates have declined by more than 50 percent in Bangladesh since 1990. USAID has trained and mobilized community health workers to provide critical maternal and child health care to supplement broader health interventions and support country-level capacity. Bangladesh already received a country award from the United Nations for significant progress in reaching MDG 4 (reducing child mortality) during the MDG Summit in New York on September 19.
The Government of Bangladesh and the United States jointly rolled out President Obama’s Global Health Initiative in Bangladesh on November 23. GHI in Bangladesh will focus on providing quality services to reduce maternal and child mortality, resuscitate family planning programs, improve nutrition status among children under age five, and strengthen overall health systems over the next five years.
This blog is cross posted from the OSTP blog.
The birth of a child is a momentous event anywhere in the world. In many countries, though, the occasion is not just one of joy, but one of fear – fear for the life of the mother and the newborn baby. The time between when a woman begins labor and 48 hours after the birth of a baby is a high-risk period during which millions of newborn babies and new mothers die each year.
That’s why today the U.S. Agency for International Development (USAID) is leveraging the collective resources of our partners—the Bill & Melinda Gates Foundation, Grand Challenges Canada, the Government of Norway, and The World Bank—to launch Saving Lives at Birth: A Grand Challenge for Development. This grant-based program will seek groundbreaking prevention and treatment approaches for pregnant mothers and newborns around the time of delivery in rural, low-resource settings.
This extraordinary partnership underscores the fact that saving lives at birth is one of the most critical challenges facing people in developing countries. Finding new technologies, such as low-cost infant resuscitation devices or incubators, and new approaches to improve birth outcomes for mothers and newborns would not only alleviate suffering, but would also have a significant impact on public health and economic productivity.
It would also accelerate progress toward achieving the Millennium Development Goals 4 and 5, which call for a two-thirds reduction in under-five mortality, a three-quarters reduction in maternal mortality, and universal access to reproductive health services.
Saving Lives at Birth is the first in a series of Grand Challenges for Development that will be announced by USAID in the coming years to mobilize focused attention and resources around the most pressing obstacles to achieving our development goals. These Grand Challenges for Development are definable, quantifiable goals that address some of the largest solvable problems poor countries currently face. USAID will partner with other funders and encourage others to invest in finding innovative solutions to these Challenges that are sustainable, scalable, easily adopted, and that build on and utilize 21st-century infrastructure and technology.
These Challenges also reflect President Obama’s commitment to game-changing innovation as a powerful and cost-effective instrument for achieving development goals. The President’s Policy Directive on Global Development focuses on sustainable development outcomes by placing a premium on broad-based economic growth, democratic governance, sustainable systems, and the creation and application of game-changing innovation to transform longstanding development challenges into solvable problems.
We believe that these Grand Challenges can address key priorities, catalyze innovations that drive economic growth, spur the formation of multidisciplinary teams of researcher and multi-sector collaborators, bring new expertise to bear on important problems, strengthen the ‘social contract’ between science and society, and inspire students and non-development experts to get involved in problem-solving for development.
USAID and its partners cannot solve the Grand Challenges for Development alone. We hope that the effort to meet these challenges will be taken up by non-governmental organizations, the private sector, governments, and individuals around the world. We know there are millions of people and organizations around the world who want to help but don’t know how to start. This is a place to start.
For more information on the Challenge and application process, visit here.
Dr. Rajiv Shah is the USAID Administrator and Tom Kalil Deputy Director for Policy for the White House Office of Science and Technology Policy and Senior Advisor for Science
During his fellowship from September 2010 to March 2011, Mr. Randy Kaja, a Pfizer Global Health Fellow based at the International AIDS Vaccine Initiative (IAVI) Regional Office in Kenya, has been coaching IAVI-partner scientists to develop and publish scientific articles from their research results. This effort is a part of the ongoing training and support of USAID partner IAVI, to build capacity of African AIDS researchers in the field, while in the pursuit of an HIV vaccine.
Late in the summer of 2009, IAVI held a scientific abstract writing course for staff from Ugandan clinical research centers. The course was designed to develop the skills and confidence of the research teams to independently construct complete, concise and clear scientific abstracts for submission to conferences. Fourteen staff from the Uganda Virus Research Institute (UVRI) in Entebbe and the Medical Research Council (MRC) in Masaka participated in the program. The program was a success; following this training, abstracts from two program participants were accepted for presentation at major international scientific conferences this year:
In May 2010, IAVI hosted a more comprehensive scientific writing training for clinical research scientists in eastern and southern Africa. Staff from six organizations, including UVRI, the MRC, the Kenya AIDS Vaccine Initiative in Nairobi and the Center for Geographic Medicine Research-Coast in Kilifi, Kenya participated in the six-day course, which covered the detailed process of drafting a scientific paper, editing it, and submitting it to a journal. The curriculum addressed abstract preparation, mastery of writing styles, essentials of editing, the structure of a scientific paper, preparing tables and illustrations, and an overview of the publishing process.
Mr. Kaja saw early results as well. An article titled “Reasons for Ineligibility in Phase 1 and 2A HIV Vaccine Clinical Trials at Kenya Aids Vaccine Initiative (KAVI), Kenya” by Dr. Gloria Omosa-Manyonyi et al. was recently published in the journal PLoS ONE. More papers are currently in various stages of drafting.
In addition, Mr. Kaja, in collaboration with IAVI staff in Kenya, delivered comprehensive workshops on scientific writing early this year, covering a range of essential topics, such as overcoming writer’s block, language usage, choosing a journal, research ethics, and authorship. Sixteen research staff from Kenya and 13 from Uganda and Rwanda have benefitted from these workshops. The participants, around 60% of them women, have ranged from medical researchers to community liaison officers involved in IAVI-sponsored studies.
More about IAVI:
IAVI is a global not-for-profit, public-private partnership whose mission is to ensure the development of safe, effective, accessible, preventive AIDS vaccines for use throughout the world. USAID and IAVI formed a partnership in 2001 to hasten development of an AIDS vaccine.
Yes, I said it. But it’s not my word. I’m just the messenger, relating to you what I heard: sneaky.
According to health care providers I interviewed recently in Western Province, Kenya, sneaking is exactly what women feel they need to do if they want to avoid or postpone pregnancy. Their male partners, for the most part, do not want them limiting the number of children they bear. Many men share the traditional attitude that the primary role of women is to give birth. Others believe that family planning makes women “promiscuous” or that certain contraceptive methods produce deformed children. So, faced with men’s resistance and socially disempowered, many women don’t tell their male partners about the contraception they use.
But family planning is more than a UN-recognized right for a woman “to decide freely and responsibly on the number and spacing of [her] children.” It’s also a powerful HIV prevention strategy, part of a comprehensive approach to prevent mother-to-child transmission of HIV (PMTCT). Each year, HIV-positive women in sub-Saharan Africa avert almost 175,000 HIV-positive births by using contraception, a figure that would nearly double if all HIV-positive African women were able to use family planning services.
Programs that integrate family planning and HIV services—such as the USAID-funded AIDS, Population, and Health Integrated Assistance II (APHIA II) Western Project—enable women to postpone pregnancy or avoid unintended pregnancy, which, in the case of HIV-positive women, decreases mother-to-child HIV transmission. Such programs also increase the number of community members who get tested, as well as the number of women and men enrolling in HIV care, support, and treatment programs.
How does APHIA II Western work? On the most basic level, if you are a woman going to a clinic for an HIV service—maybe a CD4 count—the provider will ask you if you are pregnant, if you are using a family planning method, and, if not, whether you would like to learn about the methods available. If the answer is yes, you will get counseling on family planning and either receive the contraceptives immediately (free of charge) or be referred elsewhere for them. Likewise, if you arrive and are seeking a family planning method, the provider will ask if you have been tested for HIV and, if not, whether you would like to be. The HIV rapid test is also free.
In fact, no matter what brought you to the clinic, providers will ask you these questions—and more.
So far, so good—but what about the sneaking?
Despite an abundance of contraceptive methods available at the clinics, women always have to consider what might happen when they go home. So, many opt for “sneaky” contraceptives, such as the injectable Depo-Provera, that can be used without their partners’ knowledge. Depo-Provera is an effective contraceptive, but it must be re-injected every three months, and it does not protect against HIV. In fact, the only contraceptive methods that can help prevent HIV transmission are male and female condoms—both of which require either the male partner’s involvement or knowledge.
So how can family planning programs and policies bridge that wide gap between men’s attitudes and women’s contraceptive and HIV prevention needs? The short answer is that male norms and behaviors must change so that men learn to support women’s contraceptive choices and to participate in family planning themselves. This is not news: In 2009, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) advocated that HIV prevention, treatment, and care and support programs address male norms and behaviors.
One way to do this is to increase men’s interactions with the health care system, especially with programs that protect the health of their partners and children. APHIA II Western Project accomplishes this by holding “male clinics” on weekends, where men learn about PMTCT and other reproductive health topics, some of which are considered taboo for men to discuss. To attract participants, these male clinics do not focus exclusively on HIV, a subject that is raised only toward the end of the session, but also cover broader health issues that are important to men, such as high blood pressure. During each clinic, the men are given the option to be tested for HIV and asked to spread the message by returning the following week with a friend. By bringing men together in this way and around PMTCT, the project is tackling some of the norms that force women to feel sneaky about seeking care.
The program also encourages male involvement by sending PMTCT clients accompanied by their male partners to the front of the service queue. This policy has decreased loss-to-follow-up and offers an opportunity to enroll additional men in the male clinics.
If you work in the field of public health, you may already know about the value of integrating services. But the success of APHIA II Western’s efforts shows that it is important to not only integrate services but also to incorporate strategies that address gender inequity.
It is time for all the sneaking to stop. Instead, women and men should be proud to exercise their right to family planning. With support from gender-sensitive health programs, the mothers and fathers of Kenya can lead the effort to end vertical HIV transmission.
For other programs addressing male norms and behaviors, see the Gender Compendium.
AIDSTAR-One is managed by USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs and promotes new leadership in the global campaign against HIV.
After a one-hour prop plane ride from Kathmandu, followed by an 11-hour rocky drive through the stunning hills and valleys of Mid-Western Nepal’s upper hilly region, our team reached Salyan District’s remote and rural villages. We were there to video the successes of the USAID-supported, 50,000-strong Female Community Health Volunteer project. Working in every district of Nepal, these volunteers are often the only health care providers in such remote and isolated villages.
I’ve spent the last several days traveling with our group comprised of health specialists, program managers, and communicators (Gregg Rapaport, Senior Communications Manager, and Stuti Basnyet, USAID/Nepal) videoing, interviewing, listening and learning. The stories are nothing short of amazing, and the volunteers’ passion to fulfill what they consider a calling to serve their communities has been inspiring.
It’s been humbling to hear the stories of these dedicated volunteers giving care under arduous circumstances and to meet the many villagers seeking care – a health volunteer who recently saved a newborn baby’s life minutes after delivery; another who has committed more than 22 years to serving her community through this project; a group of women who, in the last six months, have counseled more than 85 couples on family planning; a man seeking care for severe knee problems who arrived in the village on a stretcher after traveling nearly two hours, carried high above the heads of his four nephews. These volunteers are changing the behavior of their villages, increasing awareness to improve health standards, and most importantly, saving lives. Of the 500 local children checked for pneumonia in the last six months, 73 were treated with antibiotics, 13 were referred to higher level health care at the district level, and all have made a full recovery.
One woman I spoke with, Laxmi Sharma, a volunteer in Salyan’s Ward 4, said that it’s not a matter of money, but rather a matter of helping her community. “We do this as volunteers,” she explained, “because we can improve the health of our communities.” The women play a crucial role in providing vitamin A supplementation, immunizations, family planning education, safe motherhood interventions, and community-based integrated management of childhood illnesses, particularly in the detection and treatment of pneumonia and diarrhea – Nepal’s top two childhood killers.
With support from USAID and other donors, Nepal is also one of only a handful of countries poised to meet more than one of the Millennium Development Goals (MDGs) in health by reducing the number of maternal and child deaths by nearly half in only 10 years! A remarkable achievement alone, that it was realized at the end of the nation’s prolonged 10-year internal conflict makes it even more profound.
Our return trip back through the town of Dang this afternoon was marked by a rather serendipitous event – hundreds of women, men, and children marched in solidarity to celebrate the global 100th anniversary of International Women’s Day. One woman I spoke with explained, “Through this (march) forum … we can work to ensure women have equity, empowerment, and are at the center of mainstream politics. If all the women come together, this is something that is achievable, we just need to work at it.”
Around the world today, millions of people will flood the streets in their hometowns to voice their enduring support for the advancement of women and girls as key leaders in the creation of a better world. As new ideas and innovative ways are introduced, USAID/Nepal continues to incorporate these pioneering initiatives in its program design, placing women and girls at the forefront of building the country’s peace and prosperity.
But USAID/Nepal is not only working in the health sector – it is also leading the way in partnership with the Nepalese people to finding solutions to the toughest challenges to driving economic progress, promoting educational opportunities, promoting political stability, sustaining the environment, and feeding the population.
The Education for Income Generation Activity has trained more than 65,000 disadvantaged youth from the Midwestern region—the most conflict affected and one of the poorest regions of Nepal—in basic and business literacy, vocational training and agriculture productivity and enterprise development in the last three years. Of these, 7,900 youth received vocational training with 80% gainfully employed as a result of the training.
Through the Women’s Leadership Academy program, USAID has provided training on the fundamentals of democratic politics and constitution drafting to over 200 elected women parliamentarians and civil servants, providing them with the tools needed to draft the constitution and participate fully in party and parliamentary proceedings.
We know that supporting investment in women and girls can be compelling force multiplier for development and innovation. At the heart of Nepal’s advancement, women will continue to advocate on behalf of their communities, and promote advancements in education, economic growth, politics, climate change, and initiatives to improve access to food. USAID/Nepal will continue to move this agenda forward, and advance this priority by standing in solidarity with by the women and girls of Nepal.
In Ghana last week, I had the privilege to participate in the Africa Christian Health Associations’ 5th Biennial Conference, “Improving Women’s and Children’s Health in Africa.”
Christian Health Associations and networks from Africa and partner organizations met to take stock of their efforts in support of the Millennium Development Goals (MDGs) and discuss opportunities to strengthen local capacity to deliver services for women and children.
USAID’s Bureau for Global Health has worked with numerous organizations to support the critical roles played by churches, mosques, synagogues and other faith networks in their broader communities. We have successfully empowered various faith-based leaders to speak openly in their respective communities about the crippling effects of HIV and AIDS and about the importance of planning one’s family and preventing children and families from falling ill and dying from malaria.
Last week, USAID Administrator Rajiv Shah delivered the David E. Barmes Global Health Lecture at the National Institutes of Health. Recounting the successes that have been achieved in recent decades in global health, Dr. Shah outlined the challenges that currently exist and set out a roadmap for USAID and the wider health community to take advantage of the window of opportunity in front of us to accomplish a new wave of successes that can dramatically improve health around the world, particularly for children under age five and women.
He said, “Our largest opportunities to improve human health do not lie in optimizing services to the 20 percent of people in the developing world currently reached by health systems; they lie in extending our reach to the 80 percent who lack access to health facilities.”
Partnerships with faith-based and community organizations are essential to reaching that 80 percent because faith communities provide critical health services — in some countries, faith groups operate anywhere from 25 to 50 percent of health facilities.
USAID has decades of experience in community-based work that takes health care out of fixed facilities and into the community.
Saving the lives of women and children requires a range of care that includes improving nutrition and training of birth attendants, who can help women give birth safely. It also requires increased access to family planning information and services and the widespread adoption of proven, inexpensive tools and key practices like rehydration liquids to combat diarrhea, immunizations for childhood diseases and vitamin supplements to fight malnutrition.
In September, President Obama signed the first-ever presidential policy directive on U.S. global development, elevating development — and with it global health — as a pillar of US foreign policy, along with diplomacy and defense. The Global Health Initiative embodies this new policy. It builds on the experience of the last decade, maximizing development impact and leveraging knowledge and human ingenuity.
As President Obama so ably put it, “When a child dies from a preventable disease, it shocks our conscience.”
There is no better time to act. The Global Strategy for Women’s and Children’s Health, launched by the UN Secretary-General in September, is an unprecedented effort to improve the lives of women and children in the developing world and meet the MDGs of reducing child mortality by two-thirds and maternal mortality by three-quarters by 2015.