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Archives for Health

Strategic Investment Helps South Africa Scale Up HIV Treatment

With 2009’s change in political leadership in South Africa, we’ve seen a rapid scale-up of HIV/AIDS testing, treatment and prevention services.  After years of neglect, we have a 17.8 percent adult HIV prevalence rate and 5.33 million adults and 330,000 children who are HIV positive, the largest in the world.  And only 37 percent of people in need of treatment are receiving it.

As a South African, I was delighted to see my government putting so much energy and attention to saving the lives of the millions of people needing treatment.  Then in 2009 Secretary Clinton announced a strategic initiative with the Government of South Africa to help accelerate scale up. Ambassador Goosby and the PEPFAR program committed to a one-time, two-year infusion of $110 million through USAID for PEPFAR’s Supply Chain Management System (SCMS) to purchase antiretroviral drugs (ARVs) on the international market at prices lower than those paid by the government of South Africa. PEPFAR South Africa and the SCMS team did a quick cost comparison of our prices versus the Government of South Africa’s prices and, working closely with our partners at the Ministry of Health, agreed on a list of ARVs for which we could get particularly competitive pricing.

Last year we completed the procurement of more than $70 million of the total $110 million with more than 7 million units of ARV’s being distributed to the provincial depots.  Comparing our prices with those paid by previous South African procurements, we saved $61 million (46 percent) procuring generic ARV’s purchased at international prices.  PEPFAR’s investment showed it was possible for the South African government to match international prices and set informal benchmarks for subsequent purchases.

In December, South Africa’s Minister of Health, Dr. Aaron Motsoaledi, announced success with South Africa’s own procurement of ARVs noting a “massive reduction in the prices of antiretroviral drugs which has resulted in the 53.1% reduction in the cost of the total tender which translates to a R4,7 billion [US$630 million] savings. The percentage decrease in the cost of each item ranges from 4% to 81% implies that South Africa can now afford to treat twice as many people on ARVs compared to that which was previously budgeted.”

By the end of this two-year initiative, PEPFAR’s investment of $110 million will have leveraged about $90 million in savings from SCMS’s procurement and a further $600 million for the South African government.  That’s quite a return on investment.

Strengthening the Social Service Workforce

Jean-Claude works as a social worker for a small community-based orphan care program based in Port-au-Prince, Haiti. In this capacity, he is responsible for assessing the welfare of children and families, helping them to identify and access essential services and resources, organizing support groups for children and their parents and guardians, investigating allegations of child abuse, mediating family conflicts, and developing and implementing case plans in an effort to keep families strong and together.

Following the earthquake last year, Jean-Claude’s very full job description was further stretched to include negotiating temporary placement and locating caregivers for nearly 150 children who lost contact with their families or whose parents were killed in the earthquake’s aftermath. As a social worker, particularly a social worker in an environment devastated by natural disaster, political turmoil and disease, Jean-Claude has a critically important and almost impossible scope of work. Yet when asked what he considers to be the most difficult aspect of his job, Jean-Claude explains, “Everyone thinks they can do my job, but nobody wants to.”

Around the world, social work is one of the most misunderstood and underappreciated professions. While we recognize that social concerns have a tremendous impact on health, education, economic and other development outcomes, we rarely recognize the skills and expertise of those professionals who address these concerns. Like the health sector, the social service sector struggles to attract and retain qualified workers. Vacancy rates for established professional and para-professional positions within Africa range between 50%–60%, and half those employed leave their jobs within five years (as compared to seven years for healthcare workers). These statistics indicate a global crisis within systems of care and support for vulnerable children and a serious threat to global development.

This past November, the President’s Emergency Plan for AIDS Relief, under the auspices of USAID, funded a global conference in South Africa to highlight this crisis and explore strategies for addressing the crisis at a country level and global level. “The Social Welfare Workforce Strengthening Conference: Investing in those who care for children” brought together teams from 18 countries to share experiences, promising practices, and develop concrete action plans.  Each team included representatives from relevant government ministries, non-governmental organizations, donor organizations, social work training institutions, and professional associations, which provided an opportunity for multi-disciplinary problem solving and team building.

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Using Science to Accelerate Progress on Global Health

Originally posted on the White House Office of Science and Technology Policy Blog

Speaking at the National Institutes of Health yesterday, U.S. Agency for International Development (USAID) Administrator Raj Shah delivered a compelling vision of global development: that we can accelerate progress on global health by harnessing science, technology, and innovation.

This vision builds on the science and technology theme in President Obama’s State of the Union Address and his 2012 Budget released Monday, both of which prioritize investments in innovation for domestic growth and security.

The Administrator’s commitment to science, technology, and innovation as key drivers of development is also consistent with the President’s Global Development Policy, which emphasizes broad-based economic growth, democratic governance, game-changing innovations, and sustainable systems for meeting basic human needs.

There is a long history of innovation driving progress in developing and developed countries alike.  Consider the impacts of the steam engine, electricity, antibiotics, and more recently the Internet and cell phones, on human wellbeing and economic development.  Specifically in global health, previous U.S. Government investments in innovation have led to high-impact results: new vaccines and vaccine delivery devices, oral rehydration therapy, and distribution of insecticide-treated bed nets have all led to dramatic improvements in quality of life for people around the world.  And in addition to the human benefits, it’s important to note that these innovations have increased the efficiency of our investments by bringing greater results for each dollar spent.

Administrator Shah described how innovation delivers more than just new technologies; it can bring new ways of doing business.  For example, the President’s Global Health Initiative is freeing up resources by integrating parallel systems of care—such as coupling HIV/AIDS treatment with maternal and child health services—to simultaneously cut costs and improve access to care.  Building on this approach, USAID is focusing on recent and emerging scientific, technical, and operational breakthroughs to bend the curve of global health progress in a number of areas: vaccine development and delivery, maternal and child health, malaria, HIV/AIDS, tuberculosis, and health systems.

It was no coincidence that Administrator Shah chose to bring his message to NIH staff.  Many of the breakthroughs USAID will rely on to improve global health will involve past or ongoing research by the NIH and other Federal science agencies. USAID’s CAPRISA 004 microbicide announcement, for example, involved an NIH-supported research facility.  Administrator Shah’s address—the first-ever given by a sitting USAID Administrator to NIH staff at-large—reinforced the importance and opportunity of connecting Federal research with real-time global development challenges and using America’s unique strengths in science, technology, and innovation to accelerate progress toward practical solutions around the world.

USAID’s commitment to science, technology, and innovation as a cost-effective path to accelerate progress in global health is supported by history and leverages one of the core strengths of the United States.  Kudos to Administrator Shah and his staff at USAID for their leadership on this issue.

USAID’s Battleground: Expanding Access and Strengthening Health Systems

Administrator Shah: “Our experience with GHI has made it clear: our largest opportunities to improve human health do not lie in optimizing services to the 20% of people in the developing world currently reached by health systems; they lie in extending our reach to the 80% who lack access to health facilities. That is where the success of everything I’ve discussed today will be determined.  That is our battleground.  And I am proud to say: that is where USAID will lead the fight.”

Today, in a packed auditorium at NIH, Administrator Shah outlined a global health agenda around five transformational goals.  Dr. Shah believes that we can achieve the following by 2016: save the lives of over 3 million children; prevent more than 12 million HIV infections, avert 700,000 malaria deaths, ensure nearly 200,000 pregnant women can safely give birth, prevent 54 million unintended pregnancies, and cure 2.4 million people infected with TB.  To achieve these ambitious goals, he emphasized the need to strengthen health systems by empowering community health workers and midwives by equipping them with better diagnostics and treatments.

As part of the President’s Global Health Initiative, USAID helps countries integrate their health systems across WHO’s six health system “building blocks” (human resources; medical supplies, vaccines, and technology; health financing; information; leadership and governance; and service delivery) and within their national infrastructure.  Recent activities included: strengthening health care financing in Armenia, Azerbaijan, Georgia, and Senegal through the use of national health accounts; helping nine countries implement human resource information systems; and instituting performance assessments to raise standards for HIV services in six Central American countries.

Deputy Administrator Steinberg Highlights U.S.-Georgian Partnership In Health

By Jonathan Hale, Deputy Assistant Administrator, Bureau for Europe and Eurasia

Donald Steinberg, gives closing remarks at the Georgian Health Care 2020 Conference

USAID Deputy Administrator, Donald Steinberg, gives closing remarks at the Georgian Health Care 2020 Conference. He is accompanied by George Tsereteli, Vice Speaker of the Georgian Parliament, (far left) and Andrew Urushadze, Minister of Labor, Health and Social Affairs of Georgia (left). Photo Credit. Patricia Adams/USAID.

Last week I attended the “Georgian Health Care 2020: MEDEA 2011” conference, organized by the Embassy of Georgia to the United States and the Ministry of Labor, Health and Social Affairs, with support of the First Lady of Georgia Sandra Roelofs. The two day conference brought together American and Georgian medical professionals to solicit ideas for the next ten years of health reform in Georgia.

I was impressed by Georgia’s commitment to reform and I believe Georgians have proven to be bold and creative thinkers. I hope this energy will carry the reform effort to success.

In closing remarks, USAID Deputy Administrator Steinberg highlighted that USAID has been working in the health sector in Georgia for 12 years and has worked in successful partnership with the Government of Georgia. USAID assisted Georgia to establish the Health Insurance Mediation Service, to construct or renovate 8 hospitals by providing a 50% loan guarantee to private banks, and to train hundreds of health professionals every year.

I learned more about the bold health reform initiative the Government of Georgia is undertaking which relies on market mechanisms to increase the population’s access to health care; improve the quality of care; and increase the efficiency of service provision. Since the Rose Revolution, the Government of Georgia’s health expenditures have increased more than five-fold from $48 million in 2003 to $250 million in 2009 and the Government of Georgia has extended health insurance to over 1.2 million beneficiaries.

Still, nearly 2/3 of the population remains without health insurance and more than 70% of total health expenditures are “out of pocket.” Additionally, there remain concerns about the quality of care and other issues. So there’s lots of work still to do.

Many of the participants were Georgian doctors practicing in the United States and they were asked to come back and provide short-term training and support.  They have learned valuable lessons and have experiences to share.  Diaspora groups, like these Georgian doctors, have an important role to play in improving customs in their home countries.  In the weeks ahead, we will be taking a close look at how we might be able to work together for the good of countries like Georgia.

A Success: USAID’s Neglected Tropical Disease Program

There is a group of diseases you don’t hear much about but that has a terrible impact on more than 1 billion people around the world – that’s one sixth of the world’s population. The World Health Organization (WHO) has classified 13 of these as neglected tropical diseases (NTDs) and they include such dreaded illnesses as elephantiasis, leprosy, blinding trachoma, and intestinal worms.  Together, NTDs have a disproportionately large impact on poor and rural populations, causing severe illness, disfigurement, and disability. They also perpetuate poverty by reducing people’s ability to work and children’s intellectual and physical development.

Until recently, many countries were treating NTDs through separate, uncoordinated programs. However, pilot studies suggest that it is possible to integrate programs to control and treat seven of these diseases together by providing safe and effective drug treatments once or twice a year to all people in an affected community. This approach, which has been endorsed by WHO and is called mass drug administration (MDA), targets large, at-risk populations, rather than individuals, since NTDs tend to occur together in the same geographic area.  Pilot studies of MDAs of the seven targeted NTDs resulted in significant reductions of illness and transmission of these diseases and indicated that, though there were major challenges, integrating control programs was possible and could result in cost savings and efficiencies. However, it was not clear if integrated programs could be scaled up to the national level.

Fortunately, an opportunity arose to find out whether such programs could be successful. In 2006, an act of Congress authorized funding of national integrated NTD control programs in 15 countries over a five year period and USAID launched its NTD program that September. The NTD Program focuses on integrated control of the seven NTDs that can be treated through MDA: elephantiasis, (referred to by scientists as lymphatic filariasis), schistosomiasis (also known as bilharzia), trachoma, onchocerciasis (river blindness), and three soil-transmitted helminthes (worms): roundworm, hookworm, and whipworm.  USAID’s NTD Program is one of the first global efforts to integrate existing disease-specific treatment programs to control these diseases.

A recent article in the American Journal of Tropical Medicine and Hygiene reviews the first three years of USAID’s NTD Program, during that time MDA programs had been implemented in seven countries (Burkina Faso, Ghana, Haiti, Mali, Niger, Sierra Leone, and Uganda) and the program was scaling up in five other countries.  Working with its prime contractor, RTI International, and in coordination with national NTD programs, USAID has provided funds to support the launch and scale up of integrated NTD programs. Through these programs, nearly 16 million people were treated during the first year; the number treated rose to 55 million people by the third year, proving the feasibility of the integrated approach.  USAID’s NTD Program was able to treat millions of people by tapping into existing networks, including ministries of health, schools, non-governmental organizations, which together provide the program with greater efficiency and long-term sustainability as well as strengthen the capacity of national programs.

Remarkably, most of the drugs distributed to treat all these people – 222 million treatments during the first three years – were provided through public-private partnerships between the national NTD programs and major drug donors: GlaxoSmithKline; Johnson & Johnson; Merck & Co., Inc.; and Pfizer.  The estimated value of the drugs donated during the first three years totaled more than $1.4 billion.

The article points out that, while there continues to be technical and political challenges, USAID’s NTD Program exceeded expectations during its first three years, demonstrating the feasibility and cost effectiveness of scaling up integrated NTD program to the national level.  It is now clear that with proper support, integrated NTD control programs, following WHO guidelines, can be implemented in other countries, relieving the terrible burden of these diseases for millions of people around the world.

Beyond ARVs: Comprehensive HIV Interventions in Ethiopia

An estimated 1.1 million people in Ethiopia are living with HIV/AIDS, which makes the country home to one of the largest populations of HIV-infected individuals in the world, according to UNAIDS.  Ethiopia is also one of the poorest countries in the world; only four countries fare worse than Ethiopia on the UN Development Program’s Human Poverty Index.

For people living with HIV in Ethiopia, health care is not just about medicine.  Without adequate nutrition, income, and social support, they are unable to complete their treatments and stay healthy.  The videos below show how U.S. support is comprehensively addressing the needs of HIV-positive individuals and their communities.

Follow Shewarged Kassa, an HIV-positive case worker, as she visits and counsels patients unable to travel to the local health center for treatment.

Visit the pastures near Addis Ababa, where HIV-positive dairy farmers are benefiting from improved livelihoods and a renewed sense of self-worth.

In fiscal year 2010, Ethiopia received over $320 million in U.S. HIV/AIDS funding.  Through the President’s Emergency Plan for HIV/AIDS Relief, in 2010 in Ethiopia, over 200,000 people received life-saving treatment, more than six million received counseling and testing, and millions more were reached by prevention programs.

Empowering Youth in India

By: Laura Rodriguez, USAID

At the age of 17, Ishita Chaudhry recalls watching violent riots in her home country of India and being struck by the lack of political will and voice that her fellow peers had in decision making.  It was 2002.  Ishita was a senior in high school and suddenly became motivated to do something. She founded The YP Foundation (TYPF),  now the biggest youth-led organization in India, a country in which 315 million people or 31 percent of the population is under the age of 24.

Youth empowerment is a key message for all of the YP Foundation's programs. Photo Credit: Shiv Ahuja/YP Foundation

The YP Foundation’s mission is to empower young people to address health and rights, gender and sexuality, HIV/AIDS, human rights and peace building, life skills, governance and pro-active citizenship.

Over the years Chaudhry and her staff of 16 young people have worked with over 5,000 individuals to set up over 200 projects in India, training youth at international, regional and local levels as well as networks such as Students for the Promotion of International Law, the Global MDG Summit India 2008 and the Indian Youth Climate Network.

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Real Results in Afghanistan

By: Louisa Bargeron and Lars Anderson

During the USAID delegation to Afghanistan, Administrator Rajiv Shah, Mission Director Earl Gast, and Alex Their, head of the Office of Afghanistan and Pakistan,  visited the Hesa Awal Community Development Council (CDC)—an initiative made possible through Afghanistan’s National Solidarity Programme (NSP)—located in Dakoy Payan Village, Kabul.  Also present was Deputy Minister Wais Ahmad Barmak for Programmes, Ministry of Rural Rehabilitation and Development, Government of the Islamic Republic of Afghanistan.

Dr. Rajiv Shah, Administrator for the United States Agency for International Development, visited a Community Development Council Health Clinic in Mirbacha Kot, north of Kabul, Afghanistan. Dr. Shah was accompanied by USAID Mission Director Earl Gast and Minister of Rural Rehabilitation and Development Jarullah Mansoori. Photo Credit: Lars Anderson/USAID

Created in 2003, the solidarity program develops the ability of Afghan communities to identify, plan, manage and monitor their own development projects.  NSP empowers communities to manage resources transparently during all stages of the project-cycle and make decisions affecting their own lives and livelihoods.  In Hesa Awal, the CDC serves 482 families totaling 2,802 people.  Sometimes the men and women of this village come together, at the same time, to discuss what matters to them most and on this day the villagers agreed that their clinic was a top-priority.  The clinic serves an average of 70 patients a day, most of them children and soon-to-be mothers.  For parents, the biggest impact has been the enhanced quality of maternal health care, as well as the improved health of their children as a result of vaccinations.

Administrator Shah was enthusiastic with the development council’s capacity to come together on a weekly basis and connect with the people to address local issues.  Shah noted how much of a huge difference and positive impact this program has had on the community, most notably the CDC’s work in establishing a well-stocked  and run clinic and completion of a local road project, which combined, cost less than sixty thousand dollars.

Click here to see video from the Administrator's trip to Afghanistan.

Minister Barmak reinforced the NSP’s goal of fostering a sense of local ownership and leadership and was grateful for USAID‘s support.

Both Earl Gast and Alex Thier recognized the programs proven results in connecting the local government to the provincial level.

The CDC, supported by USAID, is the largest component of Afghanistan’s National Solidarity Program.

Midwives and Roses

By Amie Batson, Deputy Assistant Administrator for USAID’s Global Health Bureau

I’ve just returned from my first ever week in Pakistan and what a week it was.  Working with my colleagues in the US embassy and USAID offices, and with their Pakistani counterparts, I came to appreciate that development work in Pakistan is exceptionally hard but also very rewarding.

On Monday, I visited to Peshawar, a 2 ½ hour drive from Islamabad, to meet with the health authorities and to visit a public health school for Lady Health Visitors, Community Midwives and other paramedical staff.  You might know Peshawar from the news as one of the areas close to the Afghan border where lots of refugees have settled in camps to escape the violence in Afghanistan.

Although I’ve worked in global health for 20 years, this is the first time I’ve ever needed an armored vehicle to visit a field site.   Once we arrived in Peshawar we changed cars, picked up both US and armed Pakistani security escorts –– and continued driving ahead through the confused traffic of cars, bicycles, donkey carts and people. After a hair-raising journey through downtown Peshawar, we finally arrived at our destination – the school of public health that trains women to be deliver babies and health care in the most remote areas of Pakistan – and I was given the all clear to open the car door.

Re-arranging the head scarf and long coat that I wore to show respect for local customs, I cautiously went to meet the school’s director.  She was already waiting on the front step with a big smile and bouquet of roses in her hand.  After introductions to her all-female teaching staff of doctors and midwives, she gave me a tour of the school.

First we visited two classrooms with 60 young women, each of whom had been selected from over 600 applicants from around the country.   These women were in their 2nd year of the two-year Lady Health Visitors program, and would soon be accredited as midwives and medical personnel.  After they complete their training, these women will return and work in health clinics that provide the only medical care that many in their community will ever receive.  Most clinics serve up to 10,000 people – and the Lady Health Visitors provide services ranging from vaccinating infants and children to protecting them from diseases like measles, whooping cough, polio and hepatitis, to providing care for pregnant women to delivering babies and educating families about the importance of nutrition and spacing of pregnancies.

The women were excited to meet someone from the US and to thank our country for supporting their school.   For only about $24 each month, our US government supports a range of small upgrades to the school to help improve the learning environment and the quality of education provided.  These items included training materials, models for anatomy class, and structural upgrades to the classrooms and students hostels. For the Community Midwives that were trained there, basic equipment was provided for the girls to take to their health post once they graduated – equipment like a birthing table, safe delivery equipment, sheets, a sterilizer, a stethoscope and small stipends for the women to live on.  The Director showed us the “anatomy room” with plastic models of the human body, the delivery room and labor room – a room with 5 beds, the immunization and consultation rooms and the dormitories.  The tour finished in the kitchen – where the delicious smells of lunch (which couldn’t be eaten until we left) came from an enormous pot sitting on a fire.   As we said our goodbyes in the courtyard we spotted an old Dodge school bus, a gift from decades ago that was carefully cajoled into starting every now and then.

I’m grateful for the opportunity to contribute to the work our government is doing to improve health around the world and for the opportunity to witness first-hand the impact U.S. assistance has in Pakistan.  I’m confident that the lives and impact of the Pakistani health workers I met have been forever changed by our assistance.  In 20 years of development work – I’ve never had the armed escort  – but I’ve also never been greeted with a bouquet of roses.

To read more, go to http://www.usaid.gov/pk/newsroom/news/disaster/101220.html

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