USAID Impact Photo Credit: USAID and Partners

Archives for Health

From the Field

In Madagascar, as part of the President’s Malaria Initiative (PMI), we will launch an indoor residual spraying campaign (IRS).  The campaign will cover 16 districts in Madagascar, including 6 in the central highlands, and 10 in the northwest and southwest. IRS involves the coordinated, timely spraying of the inside walls of houses with insecticides. Mosquitoes are killed when they land on these sprayed walls, reducing malaria transmission.

In Senegal, a report of a study on the Feminization of HIV/AIDS in Senegal will be released.  According to the 2008 United Nations General Assembly Special Session (UNGASS) report, approximately two women are HIV positive for every HIV-positive man. This feminization of the epidemic is a sharp shift from the beginning of the epidemic, when the numbers of HIV-positive men were higher. Women 25 to 29 years of age now have the highest prevalence of any age group at 1.5 percent, according to the 2005 Senegal Demographic and Health Survey (SDHS), with the next highest group, men 35 to 39 years of age, at 0.7 percent.

In Zimbabwe, we will launch the Promoting Recovery in Zimbabwe (PRIZE) Consortium.  The PRIZE consortium is an initiative funded through the Food for Peace program to address the acute relief and recovery needs of Zimbabweans arising from economic, political and environmental shocks that have plagued Zimbabwe.  It provides emergency food aid and seeks to improve long term food security through agricultural program and development of community skills.

Maternal Health Matters to Everyone

The maternal mortality rate in northern Nigeria is one of the highest in the world. In Bauchi State, women bear an average of eight children in their lifetimes, yet only 45 percent of them receive prenatal care. Less than 1 percent of Bauchi’s children under age one are fully immunized. Bauchi is one of the last places where the wild polio virus is still a threat. And the average person living in Bauchi experiences two malaria episodes a year—with pregnant women and small children affected the most.

Traditonal and religious leaders in Bauchi State meet with officials to explore how leaders can work with government to improve community health care. Photo Credit: USAID/ Nigeria

Overcoming the extraordinary health challenges for women and children requires commitment and partnership at all levels, particularly with traditional and religious leaders, who can use their trust and authority to change health behavior.

USAID’s Targeted States High Impact Project (TSHIP), a five-year maternal, child, reproductive health and family planning initiative, is engaging traditional and religious leaders to change community behaviors and perceptions about health care. TSHIP strengthens community-based organizations, making them more responsive to the basic health requirements of members of their communities, especially women and children. TSHIP collaborated with the Bauchi government to host a two-day meeting to enable these leaders to discuss with health officials how they can improve health outcomes in their communities. The group explored issues such as the health status of girls and women, birth spacing options, and the importance of children receiving immunizations on schedule.

Change is never quick or easy; but because traditional and religious leaders have longstanding relationships with their communities based on trust, they are in a strong position to help overcome the cultural barriers preventing health-seeking behavior.

Traditional and religious leaders are now engaged in improving community health through advocacy. Interestingly, the meeting also illuminated that the concept of safe motherhood is entrenched in Islamic tradition that states that the shortest period between the births of two babies should be two years, and women are advised to breastfeed for two years. This changed many attendees’ perceptions, and leaders acknowledged that women should be empowered to seek medical services when needed.

Nigeria @ 50: Microenterprises Support Caregiver Families

Like many caregivers in Kano, northern Nigeria, Jamila is responsible for raising her children and caring for relatives affected by HIV/AIDS. Previously, she relied on her husband or other sources for financial support. After her husband lost his job, and with six people in her household, Jamila had to find a means to provide for her family financially.

Jamila and her husband display their peanut butter. Business skills training has empowered many women caregivers to engage in effective business practices. Photo Credit: Fernando Maldonado, USAID/MARKETS

In 2009, Jamila joined about 90 other caregivers from Bauchi, Kano, and Cross River States to attend the MicroEnterprise Fundamentals™ training course offered by USAID through its Maximizing Agricultural Revenue and Key Enterprises in Targeted Sites project. This training equips participants with practical business skills to become successful entrepreneurs.

After the course, Jamila combined her modest savings with a small loan from a community savings and loan group to finance her business. Within a couple of weeks she was able to generate a healthy profit and contribute to her household’s upkeep.

“The most important learning I took from the training was how to plan my business. I now allocate my income between business expenses, personal expenses, and savings,” said Jamila.

Jamila is currently expanding her business. As a result of training on product differentiation, Jamila adds spices to her peanut butter, which she packs in attractive containers. Demand for her product has increased. She has even gained the confidence and financial resources to start a poultry business.

“I am now the main contributor to my household and we make up to $200 in profit each month.”

Like Jamila, many caregivers are reaping the benefits of the USAID training. A recent survey of caregivers trained in 2009 showed that over 50 percent started new businesses, and nearly 100 percent of the respondents reported an increase in income.

Nigeria @ 50: Partnership with USAID

USAID is helping farmers’ organizations, like this group in Kano, Nigeria, to plant and harvest higher-yielding crops. These women have boosted their incomes by producing more cowpeas than in previous years. Photo Credit:Ann Fleuret, USAID/Nigeria

In 1960, the face of Africa changed, as more than a dozen countries seized their futures and became independent nations. Nigeria was one of those countries, and the last half century has seen both successes and challenges. While the country’s economy is growing at a good clip, its healthcare and education still lag, and deeply entrenched poverty and unemployment remain two of the greatest obstacles to Nigeria reaching its full potential for development. USAID works in Nigeria to sustain development in the long term, especially in health, education, and economic growth.

Health

Nigeria is making much slower progress on improving health among mothers and children than most other African countries. A million Nigerian children die each year before their fifth birthday, and the maternal mortality rate is among the highest in the world. Nigeria also has one of the highest tuberculosis burdens in the world, and although the HIV/AIDS infection rate is low compared to other parts of Africa, an estimated 3 million Nigerians are still infected. As a result, Nigeria’s life expectancy has declined significantly: in 1991 the average life expectancy was 54 years for women and 53 years for men; by 2009 these figures had fallen to 48 for women and 46 for men.

Strengthening the health sector and improving overall health for Nigerians are among the most important development issues facing Nigeria. USAID is supporting increased access to quality family planning and reproductive health services. Maternal and child health efforts focus on routine immunization, polio eradication, birth preparedness, maternity services, and obstetric fistula repairs. The United States is increasing access to proven preventive and curative interventions—insecticide-treated bednets and malaria treatment—for children and pregnant women. To reduce death and disability due to TB, especially in the vulnerable co-infected HIV/AIDS population, USAID is working to double the case detection rate and halve the incidence of tuberculosis by 2018.

Education

The state of education in Nigeria is poor. Of the 30 million primary school-aged children in the country, an estimated seven million are not enrolled in school. Of those currently in primary school, less than one in three will attend secondary school. Nigeria has a massive number of out-of-school children and young adults with limited literacy and numeracy skills who have little hope of ever joining the formal workforce.

USAID programs support equitable access to quality basic education through teacher training, support for girls’ learning, infrastructure improvement, and community involvement, focusing on public schools, as well as Islamiyyah schools, which provide both secular and religious education. U.S. assistance also fosters higher education partnerships between American and Nigerian universities, especially those in the north and the volatile Delta regions.

Economic Growth

Nigeria has enjoyed relatively strong economic growth following a series of economic reforms in 2003. Annual agricultural growth rose from 3.5 percent between 1990 and 1999 to nearly 6 percent between 2005 and 2009. Poverty has fallen, but only from 65 percent in 1996 to 60 percent today. Nigeria, once a major food exporter to the West African region, now imports around 15 percent of its basic food requirements. Its agricultural sector is the primary source of livelihood for 70 percent of Nigeria’s people, but the sector is not productive. Only half of Nigeria’s 79 million hectares of fertile land are under cultivation, and over 90 percent of agricultural output comes from farms smaller than five hectares.

USAID programs are accelerating the uptake of proven agricultural production, processing, and marketing technologies and stimulating job creation through agribusiness enterprises. USAID is also helping to develop a policy environment for micro, small, and medium-sized enterprises, and expand access to market-driven vocational and technical training linked with private sector employment opportunities. Customs regulations and policy reform will encourage internal and external trade, and the incentives offered by the U.S. African Growth and Opportunity Act develops private sector capacity to meet international trade and export standards.

Repairing Obstetric Fistula in Nigeria

USAID-supported fistula services in Nigeria began in 2007. USAID’s Fistula Care project works with six hospitals to prevent and repair fistula and/or to train health professionals about fistula case management.

Obstetric fistula is the result of prolonged labor without prompt medical intervention, causing a hole in a woman’s birth canal which leaves her with chronic incontinence and in many cases, the loss of the baby.

Thirty-two-year-old Joy Emmanuel lived with fistula for half of her life. Long after giving up hope of a remedy, she heard on the radio that women could receive fistula surgery at the Faridat Yakubu Fistula Center, in Gusau, Nigeria. Emmanuel’s baby survived, but she was left with the serious medical condition. Women with fistula are stigmatized among their peers and by society in general.

USAID is supporting increased access to quality family planning and reproductive health services. Maternal and child health efforts focus on birth preparedness, maternity services, and obstetric fistula repairs.

The Nigerian National Strategic Framework for fistula prevention and control estimates that between 400,000 and 800,000 women are affected. Nearly half of worldwide fistula cases occur in Nigeria, with between 50,000 to 100,000 new cases each year. USAID is working to address the challenge of obstetric fistula in five states in northwestern Nigeria. During the project’s first three years 2,822 women received fistula repair surgery.

Increasing the Involvement of Men in Family Health

Reducing maternal deaths by 75 percent throughout the world by 2015 will take the involvement of men in countries where it matters most. Many of the countries where USAID works are male dominated cultures. To improve maternal health outcomes for women in developing countries, men must be equal partners since they are the decision makers about health care in the family. These decisions include determining family size, timings of pregnancies, and whether women have access to health care.

In programs around the world, USAID works to integrate men into maternal health activities at the community level. One example is through USAID’s Maternal and Child Health Integrated Program (MCHIP). Special efforts are made to emphasize men’s shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive health. This means reaching out to community elders, leaders, and religious groups – entreaties that could be rejected because of traditional cultural values and perceptions that maternal health is the responsibility of women only.

In some areas of Nigeria— where a woman can’t leave the home without her husband’s permission— USAID sends in male motivators, community volunteers trained in communications, to help local men achieve their vision for a healthy family.

“In many of the countries where we work, these are male dominated cultures,” said Lily Kak, senior maternal and neonatal health advisor in USAID’s Bureau for Global Health for a feature in Frontlines. “We need to involve men in our programs since they are the decision makers about health care in the family.” These decisions include determining family size, timing of pregnancies, and whether women have access to health care.

To improve maternal health outcomes for women in developing countries—one of the targets of the United Nation’s Millennium Development Goals—men must be equal partners. “Men need to see the advantages for themselves,” Kak said.

African First Ladies Fellowship to Strengthen Leadership on Health and Social Ills

Today I participated in the first RAND African First Ladies Fellowship Program workshop, hosted in partnership with American University.  The fellowship program, together with Women’s Campaign International, is working to strengthen the capacity of Africa’s first ladies and their offices to address health and social problems across Africa.

Participants include chiefs of staff and other advisers to first ladies from Angola, Burkina Faso, Kenya, Lesotho, Mozambique, Namibia, Sierra Leone, Tanzania and Zambia.

Over a two-year period, first ladies and fellows will develop and implement a plan to address one of their nation’s top challenges, such as maternal and child health, women’s issues or education.

Drawing on experience with the African Leaders Malaria Alliance where 26 African Heads of State are positioning their countries to achieve universal net coverage and save millions of lives, I discussed the import policy and advocacy role first ladies can influence with focused participation. While not having statutory authority, African first ladies can raise the profile, funding and country commitment of key areas like improving the health status of women and removing barriers that could prevent women from accessing life-saving health services that are particular to women, such as assisted deliveries for her or her children and family planning for healthy timing and spacing of births.

During the four-day workshop, other presenters included Melanne Verveer, U.S. ambassador-at-large for global women’s issues; Jocelyn Frye, deputy assistant to President Obama for domestic policy and director of policy and projects for First Lady Michelle Obama; Anita McBride, chief of staff to first lady Laura Bush from 2005 to 2009 and currently executive in residence at American University’s School of Public Affairs; and Marjorie Margolies, president and founder of Women’s Campaign International.

USAID Celebrates World Contraception Day

Submitted by Ryan Cherlin

Every year on 26 September,  World Contraception Day draws attention to the importance of contraception and the role of the individual. This year’s World Contraception Day theme is “Take Responsibility”.

Choosing whether to use contraception is a deeply personal decision that each individual is responsible for making.  USAID works with countries and communities to develop strategies that ensure every individual who wants to use contraceptives is able to receive them for family planning (FP), and HIV/AIDS prevention purposes.

Pakistani mother Mozamman holds her 2-year old twin sons Amanollah (R) and Samiollah (L) at her house in a poor neighborhood of Islamabad on July 21, 2010. Pakistan has the sixth largest population in the world. Photo Credit: Behrouz Mehri/AFP

Modern contraceptive methods offer tremendous benefits through improved health and economic well-being.  They help ensure that every pregnancy is wanted, and subsequently reduce the number of abortions that result from unintended pregnancies, and also reduce the risk of spreading disease.  Ensuring the availability of these commodities is a priority not only because of the health and economic benefits, but also because of changes in demographic trends and the increasing demand for family planning. To ensure that women and men can choose, obtain, and use the contraceptive method they want, programs must be responsive to the needs of each individual client. Our programs work to ensure there is a wide range of methods available to choose from that suit each individual’s unique needs and lifestyle.


From the Field

In Albania, we are promoting World Contraception Day (September 26th). USAID’s two maternal and child health programs have partnered with Albania’s Institute of Public Health to raise awareness of using modern contraception to mark World Contraception Day. USAID will send out 20,000 text messages to Albanian adults 18-35 years old with the message, “It’s your life, it’s your choice – Use modern contraceptive methods to avoid unplanned pregnancies”. According to the 2009 Demographic Health Survey, Albania has one of the lowest levels of modern contraceptive use in the world; with only one in nine married women age 15–49 using a modern method of family planning. Modern contraceptives not only prevent unwanted pregnancies but are better for women’s reproductive health.

In Paraguay, we will recognize 90 municipalities improved performance under a local government assistance program. Since 2006, around 100 municipalities in Paraguay have been participating in a performance improvement process developed with local NGOs and the support of USAID. The project, called MIDAMOS (Let’s Measure in Spanish) aims at having municipalities open their institutions to to evaluate their performance and identify areas that must be improved in order to offer better services to citizens.

In West Sumatra, Indonesia, we will commemorate the Padang Earthquake Anniversary on September 28th. We will hold a brick laying event as part of the first anniversary of the West Sumatra Earthquake reconstruction efforts in which we have partnered with both the Australian and Indonesian Governments to support a large education program. The event will be located in a primary school in Kota Padang. USAID/ AusAID have committed to rebuild 34 primary schools in the area.

USAID @ UNGA: Malaria Efforts Are on Track to Meet to Reduce Malaria Deaths to Near Zero by 2015

By Rear Adm. (ret) Tim Ziemer, U.S. Global Malaria Coordinator

Prominent leaders in global health and development joined several African heads of state yesterday to announce new commitments to accelerate progress toward ending deaths from malaria, a disease that claims the lives of more than 850,000 Africans each year.

Participants included: Prime Minister Mizengo Pinda of Tanzania; Minister of Information Ibrahim Kargvo representing President Ernest Bai Koroma of Sierra Leone; President Ellen Johnson Sirleaf of Liberia; Andrew Mitchell from the UK representing Deputy Prime Minister Nick Clegg; Bill Gates, Co-chair and Trustee, Bill & Melinda Gates Foundation; Margaret Chan, Director-General, World Health Organization; Robert B. Zoellick, President, the World Bank Group; Michel Kazatchkine, Executive Director, the Global Fund to Fight AIDS, Tuberculosis, and Malaria; Ray Chambers, U.N. Secretary-General’s Special Envoy for Malaria; and Dr. Ezekiel J. Emanuel, special advisor for health policy at the White House’s Office of Management and Budget.

I had the honor to attend and read a letter from Secretary of State Hillary Clinton to participants and members of the African Leaders Malaria Alliance (ALMA). In her letter, she wrote … “African Heads of State have stood at the forefront of promoting malaria control for more than a decade.  I commend members of ALMA for leading by example. You are on the leading edge of health in development, in your countries and across the world.  It is vital that you share your experiences with the entire global health community.  Working together we will achieve better health outcomes and sustain those gains for many years to come.

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