USAID Impact Photo Credit: USAID and Partners

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From Lab to Communities: Pioneering Low-Cost Approaches to Prevent Death and Treat Severe Illness

The third installment of the 2010 Health Research Report to Congress is newborn health. Today, we look at USAID’s seminal role in working to focus global attention on the issue of newborn survival as well as its investments in establishing the research foundation for action in this area.

USAID works to accelerate innovations through the complete development cycle — out of the labs and through a massive scale-up, into the communities to directly benefit the world’s poor. Our goal is to develop ways to save more lives and reduce the burden of diseases as effectively and efficiently as possible.

Of the estimated 8.8 million children under 5 that die each year – 3.7 million are newborn infants who die within the first four weeks after birth. Up to two-thirds of these deaths can be prevented through existing effective interventions delivered during pregnancy, childbirth and in the first hours, days and week after birth. USAID develops and tests simple, low-cost approaches with the greatest potential to prevent death and treat severe illness in low-resource settings with limited access to quality facility-based care.

An Afghan nurse checks a crying newborn boy who was born that morning in the maternity ward of a hospital in Kabul on March 15, 2010. Afghanistan has one of the highest maternal mortality rates in the world with an estimated 1,800 maternal deaths per 100,000 live births.  Photo Credit: AFP PHOTO/BEHROUZ MEHRI

A growing body of knowledge has shown that home visits by appropriately trained workers to provide newborn care can significantly reduce neonatal mortality even where health systems are weak. Building on an evidence review, WHO/UNICEF released recommendations in 2009 providing new guidance on the importance of home visits in a baby’s first week of life. USAID is promoting and supporting partner country adoption of these recommendations into national programs, encouraging further investment in this area and assisting with capacity building efforts for health care providers and community cadres providing home-based care.

In countries with high mortality rates and weak health systems, high impact community-based approaches such as diagnosis and treatment of child pneumonia and newborn sepsis must be as accessible when it is needed to the people who stand to benefit the most. Approximately one-third of newborn deaths can be attributed to infections caused by birth in unhygienic conditions. A multi-country trial supported by USAID, in partnership with the Bill & Melinda Gates Foundation’s Save the Children/Saving Newborn Lives program; and WHO, is researching different combinations of oral and intramuscular antibiotic regimens for simplified treatment of newborn sepsis in the community.

Each year, 10 million babies suffer from birth asphyxia; 10 percent of these newborns do not survive. USAID has supported the development and validation of newborn resuscitation training materials and devices used to develop the American Academy of Pediatrics’ Helping Babies Breathe (HBB) training curriculum. The Helping Babies Breathe Global Development Alliance (GDA), a public-private partnership launched by USAID along with several partners, is introducing HBB in multiple countries and offers evidence-based training and technical support on newborn resuscitation and high quality, affordable resuscitation devices to birth attendants in low-resource settings.

USAID is also supporting studies looking at the prevention and treatment of neonatal infections through the application of antiseptic to the newborn cord in parallel with research efforts to determine optimal product packaging; the effectiveness of low-cost resuscitation devices in treating birth asphyxia; and strategies to manage care for low-birth weight children including kangaroo mother care or skin-to-skin care.

A recent article in the Lancet noted USAID’s seminal role in working to focus global attention on the issue of newborn survival as well as its investments in establishing the research foundation for action in this area. Under the President’s Global Health Initiative, USAID will expand investments in game-changing innovation through promotion of research and development. Expanding these programs will mean providing easier access at a single location for a broader set of medical and health interventions. It means focusing more clearly and getting the full package of basic health services out to those people who are most vulnerable because they lack access to any protective care at all.

 

Photo Essay: Riding for Health in Lesotho

The USAID-supported Horse Riding for Health program engages pony riders and motorcycle riders to transport blood tests, drugs, and supplies to Lesotho‘s remote mountain health clinics.

The system allows people to receive HIV test results sooner, access life-saving drugs, and ensure an uninterrupted supply of medication.

In this photo essay, follow the riders to homes and clinics throughout tiny Lesotho to meet:

Maamohelang Hlaha: An HIV-positive mother of four whose village is inaccessible by vehicles and a three-hour hike from the nearest health clinic

Potso Seoto and Thuso Khanare: Dedicated riders who transport life-saving medicines while supporting their families through a stable job

Dr. Leopold Buhendwa: The Elizabeth Glaser Foundation’s Lesotho country director who works to prevent mother-to-child transmission of HIV

 

2010: A Year in Review

With 2011 on the horizon, USAID looks at back at its accomplishments in 2010. Among them:

  • Supported the game-changing CAPRISA study, which in July provided the first ever proof of concept that a vaginal microbicide could safely and effectively reduce the risk of heterosexual transmission of HIV from men to vulnerable women. Science Magazine recently named the CAPRISA study one of the top ten breakthroughs of 2010.
  • Piloted a groundbreaking mobile banking technology to increase Haitians’ access to much-needed financial resources following January’s devastating earthquake.
  • Provided shelter, food and medical supplies for the more than 20 million people affected by the floods in Pakistan this summer.
  • Assumed leadership of Feed the Future, the U.S. government’s signature food security initiative, in December. USAID quickly established the Bureau for Food Security committed to addressing chronic hunger.
  • Announced the first recipients of Development Innovation Ventures (DIV) funds that will, among other outcomes, improve rural solar access and produce affordable, fuel-cell powered bicycles. The DIV promotes innovative and scalable solutions to core development challenges.
  • Launched a country-based strategic planning approach, with 20 Country Development Cooperation Strategies (CDCS) already underway. The CDCS will help the agency make evidenced-based decisions, prioritize investments, and hold itself accountable for results.

For more about USAID, please visit www.usaid.gov.

Integrating Family Planning, HIV, and MNCH Services in Ethiopia and Kenya

Alice arrives at a health center in Western Province, Kenya, with her nine-month-old baby girl, who has a recurrent fever. Alice suspects malaria, which is endemic in the area. Two hours later, she leaves with malaria medication and a free insecticide-treated bed net. To the casual observer, Alice got what she came for and had her health needs met. She even received a bed net she wasn’t expecting.

A nurse in Meshualekia Health Center, in Addis Ababa, explains how to use the injectable contraceptive, Depo-Provera. The client will also be offered an HIV test as part of the Ministry of Health’s efforts to integrate HIV and family planning services. Photo Credit:Ed Scholl, AIDSTAR-One

But consider what Alice didn’t receive. Had her daughter been weighed, the nurse would have noticed that her growth was faltering because Alice is not yet supplementing her diet with nutritious weaning foods. Her daughter also missed the measles immunization she was due for. Alice was not offered an HIV test, which would have revealed that she is HIV-positive. Finally, no one asked Alice, who has six children and does not want to get pregnant again, if she is using a family planning method or would like information about contraceptives available at the health center. In short, Alice’s immediate need was met, but multiple underlying health needs went undetected by the health center staff.

Alice’s story is unremarkable. Similar scenes play out every day in health care settings around the world. In sub-Saharan Africa, where the burden of HIV, unintended pregnancies, and infant mortality is highest, missed opportunities to meet health care needs, such as those of Alice and her baby, can be deadly.

Fortunately, programs in Kenya and Ethiopia are leading the way in integrating family planning, HIV, and maternal/neonatal and child health (FP/HIV/MNCH) services. In Kenya, the government has made integration of FP and HIV a national policy. USAID/Kenya’s AIDS, Population and Health Integrated Assistance II (APHIA II) project promotes integrated service delivery throughout the country in public, private, and faith-based facilities. Visiting the APHIA II project in Western Province (implemented by PATH), I noted that the Ministry of Health trains nurses and health officers to deliver both FP and HIV services. The project has supported FP/HIV/MNCH integration at 276 health centers and hospitals in Western Province. USAID/Kenya’s new APHIA Plus Project will expand integrated services in 2011.

Ethiopia’s Ministry of Health also supports integration and strives to offer an HIV test to all clients coming to public sector facilities. Clients are also assessed for family planning needs and offered counseling and FP methods. The government’s Health Extension Program, supported by USAID/Ethiopia, provides FP counseling and contraceptives in the home, HIV and child health counseling, and referral for services. These public sector efforts are complemented by such programs as FHI’s Home and Community-Based Care (HCBC) program (PDF), which strengthens integrated FP and HIV services offered in the community. The HCBC program is working with local iddirs—traditional neighborhood-based burial societies—that now provide mutual aid services to households affected by poverty and illness, including HIV. The iddirs recruit and manage community health volunteers, who provide home-based care and support to those living with HIV and counsel clients about FP and child health.

I observed many different models of FP/HIV/MNCH integration in Kenya and Ethiopia, including intra- and inter-facility referrals and strong linkages between home and community-based programs and health facilities. The type of integration model used is not as important as the fact that health workers in both countries now view clients more holistically and address more than a single health problem in a consultation or home visit.

The integrated programs I visited in Kenya and Ethiopia all report challenges, such as training health care workers in multiple disciplines and struggling to meet the complex needs of clients in crowded facilities, where it is difficult to focus on more than one health issue at a time. But providers are addressing these challenges through training and task shifting, the use of job aids and reporting systems that capture integrated services, and ensuring that contraceptives, HIV test kits, and other necessary commodities are available. The next time Alice visits a facility supported by these programs, odds are she will have more than just one child’s fever addressed.

Ed Scholl serves as AIDSTAR-One Project Director. AIDSTAR-One is funded 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.

Pic of the Week: “A Historical Look Back”

USAID 50th Anniversary Logo

Peace CorpsThe work of USAID has been far-reaching and long-standing as evidenced by this photo of a Peace Corps volunteer working in the ORT center funded by USAID. In the mid 1970′s Joan Wadelton, a Peace Corps Volunteer from Princeton, New Jersey, holds one of the children she helps at a maternal and child health center in Niger. The center is operated by ORT, a voluntary agency, and the Nigerienne Ministry of Health, is financed by USAID. Photo is from USAID.

Maternal Death Preventable and Treatable with Low-Cost Interventions

In September, the World Health Organization (WHO) reported that fewer women die each year from complications during pregnancy and childbirth than previously estimated, but efforts to sharply cut maternal mortality by 2015 are still off track. A new report found that 358,000 women died during pregnancy or childbirth in 2008, mostly in poor countries of sub-Saharan Africa and South Asia. While the number of deaths is disturbing enough, it is estimated that an additional 15-20 million women suffer debilitating consequences of pregnancy.

Despite the challenges faced in reducing maternal mortality, USAID has helped to demonstrate that real progress can be made.  Our work proved that many of the major causes of maternal death are substantially preventable and treatable with low-cost interventions.  USAID has sharpened its focus on a set of effective interventions targeting high-mortality complications of pregnancy and birth – hemorrhage, hypertension, infections, anemia, and prolonged labor.  Together, these complications account for two-thirds of maternal mortality.  Hemorrhage alone accounts for almost one-third, and USAID has been in the forefront of promoting “active management of the third stage of labor (AMTSL),” a highly-effective technique for preventing postpartum hemorrhage.

The active management of the third stage of labor is a combination of actions to speed the delivery of the placenta and prevent up to 60% of postpartum hemorrhage cases. Through these simple actions, trained providers can prevent postpartum hemorrhage and play a vital role in saving women’s lives.

Spreading best practices like AMSTL are critical to saving lives of women and improving health around the world.  The U.S. Global Health Initiative has set ambitious targets like a 30% decrease in maternal mortality in assisted countries, with a priority on supporting innovation and sharing best practices, as well as building up the health systems that deliver these interventions.

A nationally representative facility-based delivery survey funded by USAID and conducted in 10 countries found limited use of AMTSL in only 0.5 to 32 percent of observed deliveries, and revealed multiple deficiencies in practice. These surveys helped to identify barriers and served as important catalysts to action. With the evidence and this data, USAID has worked with professional societies, researchers, UN agencies, NGOs and the private sector to safely and effectively introduce and expand AMTSL use in at least 40 high-mortality countries.

USAID supported efforts have led to policy changes in 16 countries in Asia, sub-Saharan Africa and South America. The Agency and its partners also contributed to the development and dissemination of the 2007 WHO recommendations for the Prevention of Postpartum Hemorrhage providing a clear global policy on the correct application of AMSTL and the 2009 WHO guidelines for the management of PPH and retained placenta. The strength of multiple implementation strategies—policy change, systems strengthening, social mobilization, technology development, and research— has yielded many valuable lessons about opportunities, challenges, and strategies for scaling up AMTSL.  A key lesson we have learned is that, when there is political commitment, AMTSL is rapidly scalable.

But USAID asks hard questions and supports the renewed attention to the programmatic implementation of this approach.  With that in mind, USAID is supporting a WHO-led study on the impact of eliminating the most complicated element- of AMSTL, controlled cord traction. If this study has positive results, a simplified AMTSL regimen would significantly reduce the complexity of training and AMTSL practice in health facilities and in the community.

Community-based strategies for preventing PPH are also important since between 40-50% of births occur at home.  USAID has piloted community-based distribution of misoprostol and  use of the Uniject® device prefilled with oxytocin, to address these needs.   Misoprostol is an effective uterotonic to prevent postpartum bleeding; unlike oxytocin, it can be administered orally and does not require refrigeration. USAID-supported studies in Nepal, Afghanistan, and Senegal have shown the feasibility of community-based distribution of misoprostol, indicating that the drug should be considered when oxytocin is not available at the community level. In Nepal, where 82 percent of women do not give birth in health facilities, a USAID-supported study showed that it is feasible to achieve high-population coverage of misoprostol through trained community health volunteers under the Government primary health care system and still have increased use of facility births due to the education provided to women/ families through the program.  USAID’s partnerships in Nepal contributed to a change in national policy and the pilot study has now become the Nepal government’s national program.  With support from multiple partners, the program is now being scaled up throughout the country.  Pilot projects or studies on oxytocin in Uniject in Mali proved that a 6-month trained birth attendant (matron) could provide oxytocin as safely as the midwives or physicians.  Mali has also changed its policy to allow matrons to use oxytocin and practice AMTSL.

Maternal mortality is still unacceptably high.  Together, we need to seize the momentum and enhance family planning and maternal health programs to quickly reduce the still unacceptably high toll of preventable maternal deaths. Secretary Clinton challenged USAID to build on existing global health programs and create lasting change. We have made great strides with previous investments, but as she noted, in many places a woman might be treated for HIV but die in childbirth.  This is not acceptable.

How You’re About to Help Save the Lives of 4 million Children

You may not know that the leading killers of children in the poorest countries are diarrhea and pneumonia.  You almost certainly don’t know that your contributions can help save the lives of 4 million children – many because of the introduction of two new vaccines to protect against those diseases.

Last week, I was in Rwanda, helping the Global Alliance for Vaccines and Immunization plan the introduction of vaccines for rotavirus and pneumococcal diseases, major causes of diarrhea and pneumonia.  With your support as well as corporations, foundations, and countries rich and poor, GAVI, will save the lives of 4 million children in the next five years.

That sounds ambitious, but it’s very doable – and you’re a big part of the reason. With your help, GAVI supported childhood immunization in poor countries over the last 10 years, saving the lives of 5.4 million children, and shielding millions more from the long-term effects of illness on growth and development.

The U.S. has been a leader in immunization, but we can’t do it alone. Working with and through groups like GAVI helps ensure that other donor countries, companies and foundations, as well as developing countries themselves, all contribute their share: a global solution to a global problem. In addition to the U.S., fourteen other countries and the European Union are donors, and The Bill & Melinda Gates Foundation is also a generous supporter.

People have been a big part of that success as well. GAVI has had strong, high-level leadership – the Rwanda meeting marked the last for Mary Robinson, the former president of Ireland who served as chair of GAVI’s board, who deserves thanks for her advocacy. Norway has been a global leader in the fight to immunize children in the poorest countries, and its former health minister, Dagfinn Hoybraten, took over as chair – underlining Norway’s continuing commitment.

U.S. leadership isn’t just a matter of money.  The expertise of people at USAID has been crucial as well.  Since the ‘70s, USAID professionals have worked with partners across the globe to confront the challenge of vaccine-preventable diseases and help immunize children in remote parts of the world.  Working with an efficient partner like GAVI that mobilizes resources from other countries, foundations and companies multiplies the impact of U.S. expertise, as well as dollars.

GAVI is a model for the new approach the U.S. is taking through the Global Health Initiative: an innovation approach, a public-private partnership seeking innovative sources of finance for vaccines for poor countries, investing in children, with a clear focus on measurable results.  GAVI is a true partnership, accomplishing more than any nation could do on its own, and doing it efficiently, with a small staff.

As the U.S. expands the life-saving impact of our global health assistance through the Global Health Initiative announced by President Obama, our support for immunization will continue, because it is one of the most cost-effective ways to save lives and promote health.  Reaching children with this simple, affordable intervention is one of the smartest investments in global health – and the right thing to do.  And we can do it in a way that builds national systems, so they won’t need help forever.

These times demand that we provide more health for the money we invest in global health. Despite the success of immunization programs, vaccine-preventable diseases are still estimated to cause more than 2 million deaths every year.

We will help because compassion is a fundamental American value — and so is efficiency in using the resources we have, innovation to make those resources go further, and realism to know we can’t do it all by ourselves.  Working with and through GAVI, we have changed the future of millions of children and families. That’s effective, efficient realistic compassion, and it’s worth doing more.

Zambia: Where the Roads End, Logistics Continue

During the rainy season, an ox cart is the only reliable way to get health commodities across the flooded plains to rural health centers in Zambia’s Western province. Photo Credit: USAID/Zambia

Mwanawina Rural Health Center is located approximately 80 kilometers from Mongu, the capital of Zambia’s Western province. Each year, during the rainy season, the facility becomes inaccessible by motor vehicles.

To get drugs and medical supplies to the health center, the District Health Office hires an ox cart—the only reliable transport through the flooded plains between December and June. The journey takes no less than six hours.

With its expertise in logistics, particularly in challenging environments, the USAID | DELIVER PROJECT is partnering with Zambia’s Ministry of Health (MOH) to help bring drugs and medical supplies to patients by strengthening the supply chain.

In the Western province, the project trains health center staff in logistics and provides technical guidance and mentorship to MOH staff in provinces and districts, and at individual health centers.

The project is also enhancing the computerized systems in all hospitals and major health centers to include important logistics information. The new information will help improve systems performance and increase commodity security in the province.

The USAID | DELIVER PROJECT works in all of Zambia’s provinces to improve access to health commodities. For more information, please visit http://deliver.jsi.com.

U.S. Provides Equipment To Female Health Workers in Pakistan

More than 1,500 Lady Health Workers who work in areas in the areas of Punjab and Sindh provinces in Pakistan will receive kits of basic equipment to help them as they offer vital health care services to families in their communities. This donation is part of the United States’ continuing support for Pakistan’s flood relief and recovery efforts.

Deputy USAID mission director Rodger Garner is speaking to the lady health workers; Sakina Shanwari, supervisor of the lady health workers, thanks the American people. Photo Credit: USAID/Pakistan

The kits were donated by the U.S. Agency for International Development (USAID) to Pakistan’s National Program for Family Planning and Primary Health Care.  Kits include blood pressure monitors, scales, thermometers, blankets, tents, and basic furniture.  This equipment will enable Lady Health Workers to set up health houses to provide basic services in flood-affected communities.

Read more here.

From the Field

In Mozambique, as part of the President’s Malaria Initiative (PMI), we will launch the Malaria Communities Program (MCP).  This program will support the efforts of communities and indigenous organizations to combat malaria.  The primary beneficiary groups of the MCP are children under five and pregnant women.

In Zambia, a rural health center built with support from a USAID humanitarian assistance program will be handed over to the local community for its own management and use.

In Ghana, we will hold a Voucher Fair to distribute vouchers to those affected by recent flooding.  This one-day event will distribute vouchers to 700 households, an estimated 4,200 people that were affected by the recent floods in the Central Gonja District.  The vouchers can be used to purchase items such as blankets, clothes, plastic sheets, mattresses, kitchen supplies and school supplies from local

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