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The Other Half of the Family Planning Equation

As Father’s Day approaches I look back to when my wife and I first decided to have children. We married fairly late, both in our early 30s, so we planned to have our first child just a couple years after we married. It was an exciting time; much thought went into planning our family. We are now proud parents of two healthy and happy girls. It’s normal in the U.S. for both men and women to play an active role in planning their families; however, in much of the developing world that is not the case.

Involving men in international family planning programs is an uphill battle. There is a lack of information among men on the importance of delaying first birth, of spacing births, and of avoiding high parity births for the health of the woman and the child. Family planning saves lives and improves maternal and child health. In the developing world, an estimated 90 percent of infants whose mothers die after childbirth will die by their first birthday.

Men play an essential role as they are the gatekeepers in many countries to what women can and cannot do: whether women can use contraception or whether family resources should go to pay for other methods. A number of USAID’s programs address gender issues, focusing on improving male participation in family planning.

We are making progress. Twenty years ago in Kenya, 10 percent of women who were not using or planning to use family planning said that their husband’s disapproval of family planning was the main reason. Today, this percentage has been reduced to 6 percent. Meanwhile, countries like Nigeria have 10 percent of these women attributing non-use of family planning to husband’s disapproval. So while we have seen improvements, there is still much work to be done.

Educating men on the importance of family planning and birth spacing is only part of the equation. There should also be a greater emphasis on male methods, including condoms and vasectomy.

The challenge is many men around the world don’t have good health seeking behavior so we must get creative in our opportunities to reach men. For example, now that there is incontrovertible evidence that male circumcision significantly reduces acquisition of HIV by men, there are male circumcision programs for adult men blossoming all over sub-Saharan Africa. We should make sure there are no missed opportunities to speak to men about other health issues, including planning for their families.

This Sunday, as we celebrate fathers everywhere, let us not forget that men’s participation in planning for their families will result in better health and improved lives.

Photo blog: If countries lead will donors follow?

Originally posted on the Ministerial Leadership for Global Health (MLI) Blog

All five MLI countries were represented Thursday afternoon at the MLI event, “If Countries Lead Will Donors Follow?” at the Global Health Council’s annual conference in Washington, D.C. Delegates spoke on a panel moderated by John Donnelly in The Ambassador Room, sharing stories about how country leadership has advanced health outcomes in their countries.

Read the rest of this entry »

The Health Professional Crisis: A Personal Perspective

Phetogo Phoi, Lab Logistics Advisor, Supply Chain Management System (SCMS)

Botswana, like many countries, struggles with a limited amount of health workers, especially personnel qualified in the area of lab management.  In Botswana, this challenge is compounded by a limited number of graduate and undergraduate health programs. Professional courses, especially in the health area, are not offered here. Like many, I went abroad to the United States and the United Kingdom for my undergraduate and graduate degrees.

In the absence of a comprehensive health education infrastructure, the technical assistance provided by President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID to enhance the skills of the health workforce plays a critical role in strengthening the health sector. In the area of lab logistics, lab commodity management ensures that tests and other supplies are available when a doctor or nurse needs them. This field of study is often the furthest thing from a laboratory scientist or pharmacist’s mind when they enter the workforce.

In my work as a Lab Logistics Advisor for the Supply Chain ManagementSystem (SCMS), a project under PEPFAR and administered by USAID, I train health workers, mainly lab personnel, on laboratory commodity logistics management. One thing I’ve learned:  lab supplies are critical to health programs. Someone will visit a clinic and be tested for HIV. If they test positive, based on their CD4 count, they are placed on lifesaving treatment. Health workers then monitor the patient’s treatment regimen and most importantly, their health.

If a lab isn’t properly tracking its inventory, there is an opportunity for stockouts of test kits, which could lead to very sick people going without treatment because they never learned their status.  By learning to better manage their inventory of medicines, test kits and laboratory supplies, health workers can ensure their facilities are well stocked and the products they need are available for patient diagnosis and treatment.

I’m working with laboratory staff to help them implement the systems they didn’t learn about in their university studies or other pre-service trainings. I try to focus staff on addressing challenges and identifying how the system should look. Systems are more important than some may think. Without a system, there are many challenges in managing a health facility. But even with all the complaints and finger pointing, there was no structured system to resolve challenges.

Every day, I see the difference PEPFAR and USAID and the Centers for Disease Control and Prevention are making in this area.  I used to visit one of the facilities we work with, and it was a painful sight to find everything so mixed up. Pharmacists and laboratory officers were unable to find the supplies they needed or were unable to use them before they expired. Now, I go to facilities where I’ve trained people and just smile to see so much changing.

There is still much to do. Change doesn’t happen overnight, but I believe that with more investment in training and technical assistance we can help build a public health workforce we can all be proud of.

Renewed Commitment to Global Vaccines and Immunizations Will Save Lives

Originally posted on the White House Blog

During a time when we all – including the federal government – need to live within our means and find places to cut spending, any investments made by your government need to meet the test of whether it is an effective and efficient use of taxpayer dollars.

Immunizing children from preventable diseases meets that test. As USAID Administrator Raj Shah announced in London on Monday, by making a multi-year commitment to the Global Alliance for Vaccines and Immunizations (GAVI), the US is able to get the most from our investment – leveraging a pledge of $450 million over three years more than eight-fold into billions of dollars in commitments from other donors, including the UK, the Gates Foundation, Norway and others.

Together, these commitments will help save the lives of 4 million children over the next five years, by getting more vaccines to more children and by helping to ensure the quantities of vaccines needed to lower the prices for new vaccines such as those that protect against pneumonia and diarrhea, the world’s two most potent childhood killers. All in all, we will be able to immunize more than 250 million children and prevent more than four million premature deaths.

Investments in vaccines are one of the best and most cost-effective life-saving investments for the world’s children, which is why we’ve made tough choices and trade-offs within our current global health portfolio to make this commitment.  As Administrator Shah said: “In this fiscal climate, a multi-year pledge is an extremely difficult commitment to make. But we have made tough reallocations across our portfolio in order to make that commitment because only a multi-year pledge will ensure the highest possible return for every taxpayer dollar.

Not only will our commitment inspire the generosity of other donors, it will help drive economies of scale that lower the cost of vaccines, allowing us to save even more lives. Just last week, GAVI reached an agreement with GlaxoSmithKline to cut the cost of the rotavirus vaccine by 67%. That kind of reduction is only possible with the guaranteed demand a multi-year pledge provides.”

In the lead up to GAVI’s conference, the White House received thousands of phone calls, emails, and signed petitions calling for continued U.S. support for GAVI.  The ONE Campaign issued a statement of support following our announcement, including praise from Bono who noted the President was “in it to win it.”

The U.S. has played a lead role in GAVI since its inception, and is a world leader in support of every aspect of the vaccines value chain, including research, development, vaccine affordability, delivery systems, and policy coordination.

Gayle Smith is Special Assistant to the President and Senior Director for Development and Democracy for the National Security Staff

Day of the Child: 250 Million Kids to Receive Life-Saving Immunization

Compiled by Chris Thomas, Ryan Cherlin

“The most transformative technology at our disposal, vaccines ensure protection against killer diseases whether children are immunized by pediatricians in the U.S. or by health workers in rural clinics in Africa,” said USAID Administrator Dr. Raj Shah.

Yet, vaccine-preventable diseases are still estimated to cause more than 2 million deaths every year in developing countries. The global effort to expand the coverage of existing vaccines and introduce new vaccines against pneumonia and diarrhea got a powerful shot in the arm Monday.

At a first-ever pledging conference for the Global Alliance for Vaccines and Immunization (GAVI), donors committed US$ 4.3 billion, exceeding the $3.7 billion target. The funding will immunize more than 250 million of the world’s poorest children against life-threatening diseases by 2015, and prevent more than four million premature deaths.

Dr. Shah announced a $450 million commitment from the United States over three years (subject to Congressional appropriation). With the pledge, the United States surpassed $1 billion in commitments to GAVI for the purchase of vaccines.

GAVI is a public-private global health partnership, created in 2000, to save children’s lives and protect people’s health by increasing access to immunization in the world’s poorest countries. The alliance funds childhood vaccines against diseases such as pneumococcal pneumonia, Haemophilus influenzae type b, or Hib disease, diphtheria, pertussis or whooping cough, meningitis, yellow fever, tetanus, and rotavirus.

Because infectious disease knows no borders, investment in this area is also one of the most cost effective ways to protect the global community from outbreaks that take an economic and physical toll on previously uninfected populations. In February, the largest outbreak of measles in the U.S. this year was linked to an unvaccinated child who recently travelled to Kenya. The cost in lives and money spent to contain and prevent further infection caused an unnecessary and avoidable burden on local health systems.

The U.S. has long recognized the moral imperative and the inherent economic value of vaccines and immunization, which is why we played a lead role in founding and supporting GAVI.

The first-ever pledging meeting convened prime ministers, ministers and high-level officials from donor and developing countries, leaders of UN Agencies, CEOs from private companies and senior civil society officials and philanthropist Bill Gates.

Dr. Shah also offered to organize a high-level meeting in a year’s time in Washington, D.C., so GAVI, donors and all immunization partners can review progress and impact.

At the conference, it was announced that a record 50 GAVI eligible countries have applied for vaccine funding from the Alliance in this latest application round. The number of countries is nearly double the previous record in 2007 when 27 countries requested support to introduce new or underused vaccines.

The increased demand highlights how developing countries are increasingly prepared to expand routine immunization programs and introduce new vaccines to save the lives of children and protect against illness and disability.

In studies in the Health Affairs and The Lancet journals, public health experts and scientists projected 6.4 million child deaths could be prevented in the next decade, which could save $6.2-billion in treatment costs and $145-billion in lost productivity if vaccine delivery were expanded in 72 low- and middle-income countries.

Picture of the Week

A young girl gets typhoid/diptheria vaccination at a medical clinic at Petionville golf club on July 13, 2010, in Port-au-Prince. USAID/OFDA funds 12 mobile and static International Medical Corps clinics that target rural and displaced populations in and around Port-au-Prince, Petit Goave and Leogane. Photo by Kendra Helmer/USAID

New USAID Report Highlights Achievements in Egypt’s Health Sector

Yesterday I joined former USAID Administrator Peter McPherson, Egypt Embassy Counselor Motaz Zahran, and more than 100 members of the Egyptian diaspora and global health communities to launch USAID/Egypt’s Health and Population Legacy Review (pdf, 1.5mb).

The report demonstrates impressive long-term results of USAID health sector assistance in Egypt over 32 years.  For example, over the past three decades, there have been declines in maternal mortality by more than 50 percent and in infant mortality by more than 70 percent, as documented by Egypt’s regularly released Demographic and Health Surveys. Medically assisted deliveries increased from 35 percent in 1988 to almost 80 percent in 2008.

I served in USAID’s Egypt mission from 1976 to 1980 and again from 1984 to 1988, and I have seen with my own eyes the remarkable progress that has been achieved.  When I left Cairo in 1980 oral rehydration therapy was not part of Egypt’s health program.  When I returned in 1984 it appeared to me that there was an oral rehydration center in every neighborhood of Cairo and every village throughout the country.

The Egypt Health and Population Legacy Review attributes the success of programs like this to the duration of assistance and to robust funding and staffing levels.  Because USAID was a reliable partner with the Ministry of Health and Population over a 32-year period, it allowed not only for introducing new programs, but also for seeing them through various stages of program evolution. The substantial level of funding over the decades also helped ensure that programs were implemented on a large enough scale to achieve significant impact.

Despite the accomplishments, much work remains to be done.  And in many ways, the moment is ripe.  This has been a historic time for the people of Egypt and the Middle East.  And now, more than ever, it is vital that we use studies like these to learn from the past.

U.S. Ambassador to Egypt Margaret Scobey said it best:

The emergence of a new political order in Egypt sets the stage for even greater improvements in the lives of Egyptians. The accomplishments, the institutional strengthening, the data and policy analysis, and – most important – the many new Egyptian health professionals and leaders, are a solid platform from which to launch new initiatives and innovations of many kinds.  In the Egyptian health sector, the past can inform the future.

USAID Helps a Father Find His Voice

When Angelo Domingos’ daughter came to him with news that she would be re-enrolling in school, his heart leapt with joy.  Only a short time had passed since she, like many young Mozambican girls, had dropped out of school after finding herself pregnant at a young age.   Angelo’s other daughter had followed suit, and it seemed likely that they were destined for the downward spiral of pregnancy and lack of education that  affects too many vulnerable young women in Africa.

As a nurse of twenty-four years, Angelo knew from both his professional and now personal experience that young girls are often the most susceptible to predatory adults, sexually transmitted diseases, and the trials that come from having few, if any, role models in the community.  Desperate to help his daughters find a way out of the seemingly intractable problems burdening his family, Angelo began to volunteer with a local program funded by USAID through PEPFAR, and implemented through the Johns Hopkins University Center for Communication Programs.

This initiative, called Avante Raparigas! (Go Girls!), aims to educate communities on how to communicate more effectively with young women about the endless series of dangers, difficulties, and discouragements they are so often forced to endure.   The program excels at bringing parents and children together to discuss difficult topics:  risky sexual behavior, peer pressure, alcohol abuse, and even the prevalence of pornography within the community.  Using a series of visuals, brochures, manuals, and trainings, the Go Girls! Program helps parents navigate the sensitive and often awkward conversations they need to have with their children to support safe and healthy futures.

Young women in Mozambique are disproportionately affected by the HIV epidemic.  With a specific focus on reducing the number of HIV infections in girls aged 10 to 17, Go Girls! has reached out to over 1,000 community leaders in eight different villages and has touched the lives of over 5,000 individuals in those targeted areas.  While Angelo had signed up as a volunteer to help as many young women as possible, the most immediate benefit was the improvement of his  relationships with his daughters.

“My daughters were in the target group that received training in life skills and adult-child communication,” he said at the recent closing ceremony held on May 11th in Maputo, Mozambique’s capital.  In front of an audience of dozens that included U.S. Ambassador to Mozambique Leslie Rowe, Angelo made it clear to all those listening: “My daughters have benefited from the course.”  During his speech, he talked movingly of how they achieved an early victory together when, after learning that many young girls were being lured by older men into video houses showing pornographic films, people in the program convinced the establishments to stop the practice of showing adult films during the day.  They even got the adult video houses to promise not to allow admission to any underage girls, no matter what the hour.

Jose Baessa, a 47 year old school headmaster, is another who has witnessed first-hand the results of this program.  Jose asked Go Girls! to work with his students, and quickly noticed the difference in the way the young girls carried themselves, and communicated with other. Most tangibly -they were no longer becoming pregnant.  In fact, just one year into the program, teen pregnancies in the Mogovolas District of Nampula Province—where Jose was headmaster—dropped all the way to zero.  A shocking—albeit thrilling—turn of events for a community too often beset by bad news. Jose even noted a closer relationship between teachers and students after Go Girls! began their work.  In one memorable case, school teachers were able to successfully intervene with four girls who were involved in prostitution—a practice all too common in rural Mozambican communities.  “Now the girls are enrolled in a training course for teachers,” Jose said, beaming with pride.

Not all the benefits have been anecdotal.  Results from the Go Girls! evaluation suggest that the lessons learned in meetings remain with the program’s beneficiaries – over 90% of adults who participated in Go Girls! recall the content of the adult-child communication sessions they attended, such as topics on how to talk to children about safe sex and HIV/AIDS.  Girls whose parents participated in the adult-child communication program reported improved relationships with their mothers and fathers, and girls whose teachers were in the program reported feeling safer in school relative to girls not in the program.  Of course, imitation is the most successful form of flattery and to that end many principals and teachers are hoping to replicate the program with children outside the current target ages of 10 to 17 years old.

The need for action is strong.  With HIV infection rates at extremely high levels amongst Mozambican youth, a program like Go Girls! that targets HIV reduction can make a life or death difference to vulnerable young women.  As U.S. Ambassador Rowe noted in her speech at the ceremony, “Survey results indicate that Mozambican girls aged 15 to 24 are currently afflicted with an HIV prevalence of 11.1% whereas their male counterparts only have a corresponding prevalence of 3.7%. This is unacceptable, period. It is up to all of us to work together to make sure that our programs – across all sectors – address the vulnerabilities of women and girls, especially to HIV and AIDS.”

While the bigger picture is very important to someone with a strong social conscience like Angelo Domingos, it was clearly his personal benefit from the program that brought him the greatest joy.  Despite all the adversity his daughters would continue to face, he could relax knowing that they were back on track to receive an education and hopefully, a brighter future.

World AIDS Vaccine Day: Igniting the prevention revolution

By: Seth Berkley, President and CEO of the International AIDS Vaccine Initiative

Crossposted from The Hill

There’s one bromide any decent physician endorses — the one about an ounce of prevention being worth a pound of cure. When it comes to ending the AIDS pandemic, U.S. policymakers from both sides of the aisle have embraced this notion as well, providing unwavering, bipartisan support for the global effort to end AIDS, which has already claimed nearly 30 million lives and left another 33 million infected.

U.S. government support for research into HIV prevention — most notably an AIDS vaccine — has been crucial to seeding what scientists are calling a prevention revolution. Without it, we would not be where we are today: The sheer risk of taking on AIDS vaccine development is a significant disincentive to private sector investment. This has resulted in a classic market failure that can only be surmounted with government support. World AIDS Vaccine Day provides an opportunity to consider why this support is also smart long-term policy — why it makes sense not just in medical terms, but in financial ones as well.

Indonesian volunteers light candles during a ceremony to mark World AIDS Day in Jakarta. Photo Credit: Adek Berry/AFP

Because there is no cure for AIDS, over the next few decades this merciless disease will continue to dismantle the familial networks that sustain and stabilize human society in many poor nations and, in some of them, sow the seeds of lasting political instability. As we have all learned in the past decade, such instability has a way of reaching around the world. Today some 5 million of the most vulnerable people in such places have access to HIV drugs today, thanks mainly to the President’s Emergency Plan for AIDS Relief launched by George W. Bush, and the U.S.-funded Global Fund to Fight AIDS, Tuberculosis and Malaria.

Still, every day, an additional 7,100 people become HIV positive, and for each person put on antiretroviral drugs, two are newly infected by the virus. While indispensible, the provision of HIV treatment cannot keep pace with this modern plague.

Even in the U.S., there are 56,000 new HIV infections each year, and the government spends $16.7 billion domestically on treatment and care for AIDS. The only medically and fiscally sane option we have is to find an efficient way to reverse the tide of new infections. Vaccines provide that option. As illustrated by recent efforts of the International AIDS Vaccine Initiative (IAVI) — which is led by the author of this piece — when done right, support for such research has the added benefit of spurring innovation in American industry.

Fortunately researchers have, with government support, made significant headway to that end. In 2009, a clinical trial in Thailand, conducted by U.S. military and Thai researchers, demonstrated for the first time that vaccines can in fact prevent HIV.

Meanwhile, researchers at and affiliated with IAVI have over the past two years isolated fifteen antibodies capable of neutralizing a broad spectrum of globally circulating HIV variants; others, at the National Institutes of Health, have independently found similarly powerful antibodies. Each of these discoveries holds valuable clues to the design of more effective HIV vaccine candidates.

But to harness them, we must find ways to bypass the market failure that discourages industry involvement. As a nonprofit public-private product development partnership, IAVI, with the support of its donors — most notably USAID — picks up much of the risk associated with developing promising AIDS vaccine concepts, and so draws industry into such efforts.

Second, the organization identifies and actively cultivates promising but neglected avenues of related research. As part of that effort, IAVI has in partnership with the Bill & Melinda Gates Foundation launched an Innovation Fund that seeks out biotech companies working on a variety of biomedical problems and supports the application their technology to solve the major problems of AIDS vaccine development.

It was from this fund that IAVI provided Theraclone Sciences, a small Seattle-based biotechnology firm seed funding to apply its technology to help isolate neutralizing antibodies. The success of this joint effort wasn’t just good for the field of HIV prevention. It was also good for Theraclone. Partly on the strength of its work with IAVI, the start-up won an agreement with a Japanese drug company to develop therapies and vaccines against influenza and, more recently, established an exclusive partnership with Pfizer for cancer and infectious disease therapies that could eventually be worth more than $600 million.

Just as the U.S. space program generated countless engineering innovations, solving the AIDS vaccine problem will have a lasting impact on one of the greatest growth industries of the future: biological therapies and vaccines, especially those relevant to emerging markets around the world.
We are today at a tipping point in our journey toward an AIDS vaccine. In these economically tough times, we must not forget the long term cost-savings promise of AIDS vaccines — and keep doing all we can to make that promise a reality.

Seth Berkley is the president and CEO of the International AIDS Vaccine Initiative.

USAID’s Frontlines – April/May 2011

Frontlines Banner Graphic

Read the latest edition of FrontLines to learn about the Agency’s work in global health and in Iraq, including these stories:

This photo of a woman administering a polio vaccine took second place in the latest FrontLines photo contest. Photo credit: Alain Mukeba, USAID/Democratic Republic of Congo

  • An exclusive interview with U.S. Lt. Gen. John Allen on how the United States’ military and civilian arms found common ground in Iraq. Allen is President Obama’s new nominee to lead U.S. and NATO forces in Afghanistan
  • How the new Global Health Initiative is building on a foundation of partnerships as key to healthier families, communities and countries
  • How the historic Food for Peace program has proven to be an extremely versatile development tool in rural Mozambique. Listen to FrontLines’ first ever podcast.

Get these stories and more in the new issue of FrontLines. If you would like to receive a reminder about the latest FrontLines, you can subscribe here.

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