Archives for Health
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.
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.
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.
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.
Read the latest edition of FrontLines to learn about the Agency’s work in global health and in Iraq, including these stories:
- 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.
- An exclusive interview with WHO’s Dr. Margaret Chan, who speaks about how educating girls and empowering women yields generational health gains
- Long-term stability is goal of the Agency’s continuing work in Iraq
Lois Quam is the Executive Director of the Global Health Initiative.
In the Senegalese village of Nianing, I joined a group of elderly ladies in a circle of plastic chairs as they sang a simple song, a drum keeping time with their claps. Despite their years, each stood up one by one to dance a few steps. But this “grandmothers’ group” does more than dance – they counsel young wives of the village to limit childbearing from 18 and 35 years of age and space births two years apart.
I met lots of other people in the village who cared about the good health of their community too: political and religious leaders, volunteer health workers, and the counterpart to the grandmothers, a newlyweds association. Their focal point is a “health hut,” which USAID supports through equipment and training of volunteer community mobilizers and health practitioners.
The health hut belongs to the village and you can see the difference it makes. It’s been four months since they’ve had a positive malaria test, and in March nearly 40 women have come in to receive family planning services. At the district health post down the road, we learned that they hadn’t lost a mother since the renovation of its maternity ward, thanks to safe, delivery services provided by qualified personnel – including a young, dynamic midwife named Felicity, who had been recruited by the district health post health committee.
As they opened their records for me, I could see their pride in the statistics they shared, which testified to the fact that practically everyone is engaged in the good health of the community. It moved me to see the way village leaders and extended families work together on a daily basis to develop and operate the health care services that they really need.
During my trip, I also met with religious, civil society, and implementation partners in a lovely reception at the Ambassador’s residence. A highlight of this evening was meeting the Senegalese military leaders engaged in combating HIV/AIDS.
You can see that they have been built up over time with the long term support of the American people. The health hut – and their good health – belongs to them. I am really proud of the work that the United States government, through USAID, the Peace Corps, the Department of Defense, PEPFAR and Centers for Disease Control have done to help make that possible. And I am so proud of how effectively our team works together. To learn more about health huts in Senegal, click here.
Also posted at DipNote, the U.S. Department of State Official Blog
Ambassador Eric Goosby serves as U.S. Global AIDS Coordinator.
During today’s opening of the PEPFAR annual meeting, we focused on PEPFAR’s role in supporting countries to establish a “continuum of response.” Through this continuum, countries can provide a comprehensive system of care and support to meets their health needs to their people. As our Global Health Initiative (GHI) recognizes, the continuum is needed not only for particular diseases such as HIV, but for the whole range of public health issues.
At the individual level, a continuum of response means that the government orchestrates a health system that identifies populations at risk and follows them, addressing through all their needs through their lifespan — for prevention, and then for care and treatment if they become infected. And it means following them through all their non-HIV needs as well.
The continuum of response is anchored in the principle of country ownership. PEPFAR is working to support governments in orchestrating national efforts to address the health needs of their citizens, and enabling the strong participation of civil society in those efforts. Deputy Secretary of State Tom Nides affirmed the importance of country ownership in the U.S. foreign policy portfolio. And I was fortunate enough to join discussion on global health diplomacy and leadership with CDC Director Tom Frieden, USAID Administrator Raj Shah, and GHI Executive Director Lois Quam to focus on different dimensions of U.S. global health strategic priorities.
Thanks in part to the mechanism of PEPFAR Partnership Frameworks, I believe we are at the precipice of real country ownership of the fight against HIV/AIDS in a growing number of countries. Partnership Frameworks provide a 5-year joint strategic framework for cooperation among the U.S. Government, the partner government, and others to combat HIV/AIDS in the partner country. With our support, countries are putting structures in place that position them to meet not only HIV/AIDS needs, but whatever future public health challenges they face. To date, U.S. Chiefs of Mission and 21 partner governments have signed Frameworks, with more to follow. Today, we were welcomed by the South Africa Minister of Health, Dr. Aaron Motsoaledi, whose government recently signed a Framework with the United States. Turning a decisive page, the South African Government has assumed increasing leadership, including a dramatically heightened financial contribution and an intention to approach full financial responsibility for its program by 2016.
A continuum of response requires both commitment and capacity on the part of the government. And today, I was pleased to have the opportunity to affirm the leadership role of the U.S. Ambassador in working with our partnership governments. Our Chiefs of Mission are leading their teams to make sure that Partnership Framework commitments are fleshed out in Implementation Plans, which enable real accountability. In terms of the capacity required to establish ownership, tomorrow we will hear from field teams about their hard work to develop capacity at the country level. The locally employed staff of PEPFAR is at the forefront of our efforts on country ownership, focusing on building the technical and managerial capacity of partner nations. This capacity is a key contribution to our effort to foster country ownership and create a continuum of response. All of this is critical to saving lives.
By: Aneesh Chopra, U.S. Chief Technology Officer
Kudos to Secretary of State Hillary Clinton, USAID Administrator Raj Shah, Johnson & Johnson CEO William Weldon, and their colleagues at the United Nations Foundation, the mHealth Alliance, and BabyCenter on the launch of the Mobile Alliance for Maternal Action, a new public-private partnership to improve maternal and child health by harnessing the power of mobile technology to deliver vital health information to expectant and new mothers.
Many women around the world have limited or no access to basic health information necessary for safe pregnancies and healthy babies. These women typically live in resource-constrained settings that lack the first-line providers of such information — nurses, midwives, and trained birth attendants.
Enter technological innovation, which has the potential to be a force multiplier – enabling us to reach more people, more efficiently and at lower cost. Technologies like the mobile phone, for example, can unlock novel and transformative solutions to longstanding development challenges if we utilize them effectively. We need to make sure that people have access to new technologies, which is happening at a rapid pace with cell phones around the world (more than 1 billion women in low- and middle-income countries own a mobile phone). In fact, global smartphone sales exceeded PCs for the first in the fourth quarter of 2010, ahead of market predictions. That said, we need to understand how technology can make a difference.
What’s exciting about the Mobile Alliance for Maternal Action is that it acts both locally and globally to achieve scale and impact. Over the next three years, it will work across an initial set of three countries, Bangladesh, South Africa and India, to help coordinate and increase the impact of existing mobile health programs, provide resources and technical assistance to developers of promising new business models, and build the evidence base on the effective application of mobile technology to improve maternal health. Lessons learned from these and other initiatives will be shared globally in a coordinated exchange of information. The partnership will foster collaboration among similar initiatives in other countries to accelerate efforts to reach millions of women with mobile phone access around the world with critical health information.
We have had some experience with mobile health programs for moms here in the US. Last February, I had the pleasure of announcing the domestic text4baby program that has now reached nearly 170,000 moms. And early this March, our colleagues in Russia announced that they are creating a similar program, which will bring mobile health information to moms in Russia as well. Moreover, the Administration’s FY12 budget establishes a Wireless Innovation (WIN) Fund to spur innovation through investments in research and development of wireless technologies and applications. In particular, the WIN Fund proposes a $100 million investment over five years to CMS for emerging wireless technologies in the health care sector in order to spur applications that educate consumers, offers new tools to assist in patient care, and reduces health care costs.
Measuring results and using evaluation data – lessons learned from mobile health information programs in the United States, Russia, Bangladesh, India, South Africa, and many others — to develop best practices and improve our understanding of what works and why will be a critical part of the MAMA partnership. As we strengthen the global knowledge base and share best practices around effective ways to provide these services, designers of new and existing programs will be able to learn from tap into each other’s experiences to increase their impact, sustainability, and scale.
Most importantly, information initiatives such as the MAMA partnership empower women, which is important in its own right and is also essential to improving the health of families and communities. Access to a mobile phone can mean access to information about pregnancy, childbirth and the first year of life that enables women to make healthy decisions for themselves and their families.
Congratulations again to all the partners.
USAID and the Peace Corps celebrated World Malaria Day by announcing a collaboration to help reduce the burden of malaria in Africa. Here’s a rundown of the event from guest blogger Ben Brophy of the Malaria Policy Center.
Dr. Rajiv Shah, USAID Administrator, Aaron S. Williams, Peace Corps Director, and Rear Admiral Tim Ziemer, U.S. Global Malaria Coordinator, gathered today to announce the partnership of the President’s Malaria Initiative (PMI) and the Peace Corps as a component of broader USAID and Peace Corps collaboration in global health and to talk about the progress made against malaria so far.
Mr. Williams opened the event discussing the problem of malaria and the new partnership, named ‘Stomp Out Malaria’ between PMI and the Peace Corps. He lauded both Dr. Shah and Admiral Ziemer for their tireless efforts against malaria.
Dr. Shah gave a great overview of the amazing progress that has been made against malaria so far. He pointed to the fact that PMI is reducing overall childhood mortality and for this reason it is one of the best investments we can make. However, Shah also cautioned that “If we step back now we will see a rapid uptick in malaria and unnecessary child deaths.”
Admiral Ziemer echoed this message of success and talked about the emerging partnership between PMI and the Peace Corps. Essentially, PMI and organizations like Malaria No More, VOICES for a Malaria Free Future and WorldVision will train Peace Corps volunteers on malaria interventions and then those volunteers can take that knowledge with them to instruct their local villages and communities.
Washington Post columnist Michael Gerson hosted a panel of several speakers to talk about the malaria fight in more detail. Gerson also discussed his recent trip to Senegal with the Malaria Policy Center where he saw U.S. investments in malaria in action. Gerson came away from that experience saying ”This is how aid should be done.”
Ambassador Mark Green, Matt McLaughlin of the Peace Corps Malaria Initiative for Africa, Professor Awa Marie Coll-Seck of the Roll Back Malaria Partnership, and Andrea Gough, of the Nothing but Nets campaign were all on hand to talk about various aspects of the world’s efforts against the disease. The most notable quote came from Ambassador Green “Development dollars are being stretched thin and partnerships like this one between PMI and the Peace Corps are squeezing out every penny and producing great results.”
Ultimately, the partnership between PMI and the Peace Corps is producing yet another new tool to help end malaria deaths by 2015. It is these types of integrated partnerships that are uniting our efforts and amplifying our resources.
USAID, the United Nations, the Government of Southern Sudan (GOSS), and other international partners launched a polio immunization campaign March 28 in southern Sudan, where the crippling disease re-emerged in 2008.
“Due to the efforts of the GOSS, development partners, and people of southern Sudan, the outbreak that re-emerged in South Sudan in 2008 has been halted,” USAID/Sudan Mission Director William Hammink explained at the Juba Nyakuron Cultural Center, where the three-day campaign was launched. “Since 2005, USAID has committed over $8 million to support polio immunization and eradication as well as routine immunization activities across the region,” he added.
GOSS Minister of Health Dr. Luka Tombekana Monoja and Minister of Information Dr. Barnaba Marial Benjamin GOSS said it is time to “kick it and keep it out” when referring to polio and other preventable diseases. The ministers expressed their commitment to continue campaigns that vaccinate against preventable diseases, including polio. Along with international organizations such as USAID and Rotary, the GOSS pledged to reach those in need throughout southern Sudan, particularly children in remote areas.
Mothers attending the event were invited to have their young children vaccinated with ‘just two drops’ of the polio-preventing vaccine.
USAID assisted with the last polio immunization campaign in November 2010, which reached more than 3 million children under age 5 in southern Sudan with the vaccine, achieving polio immunization coverage of 99 percent.