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Archives for Health

COUNTDOWN TO THE MDG SUMMIT: Global Investment in Malaria Prevention Could Save 3 Million Lives Over Next Five Years

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

This morning at the National Press Club, I joined the Roll Back Malaria Partnership (RBM) to launch the third report from the Progress & Impact Series “Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals”.  The report states that the lives of almost three quarters of a million children in 34 African countries are estimated to have been saved in the past 10 years through the use of insecticide treated mosquito nets, indoor residual spraying, and preventive treatment of malaria during pregnancy.  The Lives Saved Tool (or LiST model) provides the first assessment of lives saved based on the level of coverage achieved with currently available malaria prevention tools. The report estimates that an additional 3 million lives could be saved by 2015 if the world continues to increase investment in tackling the disease.

Admiral Ziemer hands out a bednet at a distribution site. Photo Credit: USAID/Global Health

The results in global malaria prevention and control are encouraging, but, as we have seen before, this progress is fragile and can be easily reversed.  As we expand and consolidate these gains, it is vitally important to ensure that our efforts not only maintain momentum, but also continue to adapt to emerging challenges such as drug and insecticide resistance. That’s why a key imperative in the United States’ Strategy for meeting the MDGs is to leverage innovation as a powerful catalyst for development.

The U.S. Government’s commitment to fight malaria is a key component of our nation’s foreign assistance strategy and the Administration’s Global Health Initiative to expand the promise of good health that is the foundation of stronger and more stable families, communities, and societies.  On behalf of the American people, the U.S. Government has taken extraordinary steps to curb the spread of this preventable and curable disease.  Working with national governments and other donors, the President’s Malaria Initiative (PMI), led by USAID and implemented together with the Centers for Disease Control and Prevention, reached more than 50 million people in the past year with highly effective malaria prevention or treatment measures in 15 focus countries in Africa.

Education + Health = Opportunity

Submitted by Wendy Coursen

This is Education Week at USAID. We work across the globe from Dhaka to Dakar; and Kabul to Kinshasa to promote development and save lives by helping people and societies recover from disaster, escape poverty, and improve health and education.  All efforts are conducted on behalf of the American people – reflecting the care and generosity of our nation that people across the globe admire and respect.

Throughout our nearly 50-year history, USAID has developed robust education programs that have increased literacy, built local capacity to deliver basic education services, encouraged workforce development, and developed generations of leaders through scholarships and access to higher education. On a fundamental level, education empowers societies: It leads to opportunities for economic growth, promotes civic engagement and good governance, and supports (PDF)sustainable democracy.  In the development community, we often say the same about the benefits of ; in fact, education and health not only complement, but depend on each other for maximum impact.

Community Health Worker

A community health worker in Nemba, Rwanda, teaches a health education class to women. USAID, with partner Jhpiego, has trained 800 community health workers in Rwanda. Credit: Jhpeigo

For disease prevention and treatment, the communities we serve often need access to commodities like bed nets , antiretroviral drugs, and safe water.  They also need the tools and access to information about critical health concerns and what to do about them. Women who participate in literacy programs have better knowledge of health and family planning and are more likely to adopt preventive health measures or seek medical help for themselves and their children. Family planning also enables women to stay in school longer, which contributes to improved maternal and child survival and increased ability for parents to raise healthy, well-nourished children.  Healthy children, we know, are more likely to learn, more likely to thrive throughout their lives and contribute to their communities as adults.  Early and sustained investments in health and education – for men, women, and children — are truly investments for life.

In the late 1990s, USAID was instrumental in bringing the educational children’s series Sesame Street to South Africa. The country has been significantly impacted by the HIV/AIDS epidemic, and in 2002, the show introduced Kami, the world’s first HIV-positive Muppet. Through Kami, age-appropriate HIV/AIDS messages reach millions of children, parents, caregivers, and educators. Her message is also helping to reduce the fear of stigma that prevents many from seeking treatment.

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USAID-World Bank Debate Series Opens Important Dialogue on HIV Prevention in Africa

Submitted by: Bureau for Global Health

Do discordant couples, or those in which only one partner is HIV-positive, really contribute a majority of new HIV infections?  Should interventions to address discordant couples receive a majority of funding? As the global response to HIV and AIDS evolves, fostering an open dialogue about what approaches work best is essential to mounting an effective response to the global pandemic. To achieve this, the Office of HIV/AIDS at USAID and the World Bank’s Global HIV/AIDS Program are co-sponsoring a debate series to examine emerging and sometimes controversial issues in HIV prevention. The latest debate, held August 26, at the World Bank headquarters in D.C. with webcast participants from over 20 countries, examined the role of HIV counseling and testing among couples in which only one of the two partners has HIV.

Drs. Susan Allen and Elizabeth Marum presented several sets of data to support the proposition. According to Dr. Allen’s work in Rwanda and Zambia, a majority of new infections were the result of transmission within co-habiting or married couples. Drs. Allen and Marum additionally argued that couples testing and counseling was an evidence-based and cost-effective intervention, which should be scaled up to prevent large numbers of new infections.

On the contrary, Drs. Gray and Halperin provided data opposing the proposition. For instance, in Rakai, Uganda, intra couple transmission within known HIV discordant couples contributed approximately 30 percent of new infections.  Among other arguments, Dr. Halperin stated that a majority of new infections cannot logically emerge from long-term stable couples in countries where marriage and cohabitation rates are low.  Drs. Gray and Halperin concluded that a majority of new infections emerge from multiple and concurrent partnering practices and therefore that a majority of prevention funding should not be utilized for addressing sero-discordance among long-term stable partnerships.

These and other points of views made for a lively discussion that will hopefully improve our understanding about what drives HIV epidemics in Southern Africa.

Save the date of October 18, 2010, for the fourth debate in this series that will examine concurrent sexual partnerships.

Visit the Office of HIV/AIDS AIDSTAR-One HIV Prevention Knowledge Base to access resources about HIV Prevention for Serodiscordant Couples drawing on epidemiologic and demographic data.

Saving Mothers and Newborns in Afghanistan

Submitted by the USAID Maternal and Child Health Integrated Project (MCHIP)

Every 27 minutes, a woman in Afghanistan dies from complications due to pregnancy or birth. Across the country, midwives are the frontline health care providers working day and night to save these women. Educated with USAID support, Sadiqa Husseini, 24, is among the more than 2,000 new midwives who are helping to significantly reduce Afghanistan’s maternal mortality rate, which is among the highest in the world. Sadiqa was featured in a recent BBC audio slideshow on a day in the life of an Afghan midwife. The piece is a moving portrayal that demonstrates how USAID contributes to empowering women, rebuilding essential networks of skilled health care providers, improving health care services for women and families, reducing deaths of mothers and newborns, and strengthening communities.

Sadiqa had wanted to become a midwife ever since her sister nearly bled to death giving birth to her first child. At the time, Sadiqa and other family members relied on traditional means and home remedies to try to stop the bleeding. Ultimately, Sadiqa’s sister had to be taken to a hospital some 20 kilometers away. She and her newborn daughter survived, but Sadiqa’s sister never fully recovered and had no more children. The experience had a profound impact on Sadiqa.

“When I saw this happen in my own family, I wanted to become a midwife,” Sadiqa said. “I didn’t want other women to suffer like my sister and her family.”

Najiba Fazzay, a 35-year-old Community Health Worker (far right), gives a talk on maternal health care to expectant mothers in the village of Aquachanoy near Jawjzan, Afghanistan. USAID-funded programs have helped train 8,500 community health workers in Afghanistan. CREDIT: Jhpiego

USAID’s Health Services Support Project, in partnership with the Afghan Ministry of Health, allowed Sadiqa to realize her ambition. Through the project, accredited midwifery schools have been established in nearly every province of Afghanistan. These schools, assisted by USAID with partner organization Jhpiego, provide essential training for midwives like Sadiqa, helping increase the number of trained midwives to more than 2,000 (from about 450) since the fall of the Taliban.

Local health committees are involved in identifying and selecting candidates, a unique aspect of the program that builds support for midwives who return to their communities to work. Villages and communities have directly benefited from the increase in midwives: The number of Afghan health centers that are staffed with more than one midwife has increased from 10 percent (2002) to 61 percent (2009) since USAID began focusing on maternal and child health in Afghanistan in 2003.

The success of USAID-funded projects in Afghanistan has also led to the training of 8,500 community health workers and the formation of a professional midwife’s association, which includes 1,600 members. The impact of this expanded force of maternal health specialists is reflected in the increasing number of Afghan women who give birth with skilled care, a key intervention to reducing maternal and newborn deaths. According to the most recently available data, deliveries assisted by a skilled birth attendant in Afghanistan increased from 8 percent in 2003 to 19 percent in 2006.

USAID Strengthens Malaria Control Efforts in Africa

Submitted by Elissa Jensen

Thanks to a little teamwork, efforts toward sustainable malaria control in Africa just received a boost.  Indoor residual spraying (IRS), a mainstay of malaria eradication efforts for decades, has typically involved oversight by health specialists trained in IRS application.  But the intervention also requires input from environmental experts, who have historically been overlooked in IRS operations.

This summer, with USAID support under the President’s Malaria Initiative (PMI), environmental experts from across Africa participated in a workshop in Kisumu, Kenya, to review and refine best practices to support health teams in providing oversight and management of IRS.  The workshop was the first of its kind to introduce such an integrated approach.

In addition to discussing the development of environmental assessments and proper waste disposal, participants addressed the challenges associated with proper implementation of IRS considering real-life constraints, such as scarcity of water and lack of infrastructure.

With their training, participants will increasingly work alongside counterparts from the health sector to provide oversight of environmental components of IRS operations, thereby strengthening local and regional capacity for sustainable malaria control.  Soon after the workshop, in fact, two of the participants conducted environmental inspections and provided technical assistance in new spray areas in Zambia and Ethiopia.

USAID is proud to contribute to PMI, which has provided IRS to nearly 7 million houses and protected 27 million people through spray campaigns since 2006.

Delivering Hope: One Pill At a Time

Submitted by: Jessica DiRocco

It’s shocking what two little pills can do for someone living with HIV/AIDS. Antiretroviral (ARV) drugs have been a lifesaving advance in the treatment of HIV/AIDS because they limit the virus’ power to weaken the immune system. A stronger immune system means stronger individuals. Instead of sickness and immediate death, HIV becomes a manageable disease. Mothers can continue to take care of their children, husbands can continue to support their families, and children can continue to attend school. All because of two little pills. The USG, through PEPFAR, has already put almost 2.5 million people on treatment worldwide, with plans to support four million people by 2015.

To assist in reaching this goal, USAID focuses on activities that directly and indirectly support the provision of antiretroviral therapy. USAID’s comprehensive AntiRetroViral program includes: increasing access to ARVs and other medications, improving the physical infrastructure of laboratories and facilities, ensuring a consistent supply of quality drugs and commodities, building the personal capacity for health care workers to manage antiretroviral therapy programs, nutritional supplementation programs, and provide psychosocial support of patients before and throughout treatment.

The transformation of most of the people on ARVs is nothing short of amazing. After only a couple moths of ARV treatment, many individuals who were bedridden and facing death, became strong advocates armed with huge smiles and their powerful stories. In fact, several studies have begun to support the idea that people living with HIV may achieve near-normal life-expectancies through the simple act of taking their ARV drugs every day.

These remarkable results have been captured over the years through words, photos, and videos.

In 2007, the Global Fund teamed with Magnum Photos to create Access to Life- a series of photo essays which documented the impact of antiretroviral treatment on the lives of individuals around the world.

Just this year, (RED) worked with HBO to create The Lazarus Effect, a film which illustrates the transformative effect of ARV treatment through the stories of HIV-positive individuals in Zambia. USAID staff received a special screening of the film only a short time after it premiered on HBO, with representatives from (RED) present to show their support of USAID and PEPFAR work.

Most recently, the Topsy Foundation, which receives funding from Right to Care, a USAID and PEPFAR partner based in South Africa, created a short video on Selinah, a woman living with AIDS in South Africa, who experienced the disease effects of the disease being reversed over a three month period with the help of ARVs. The Topsy Foundation even won the Cannes Gold Lion award for the video at the 57th Cannes Lions International Advertising Festival.

USAID stays committed to the goals of PEPFAR and the Global Health Initiative to put more than four million people on treatment. USAID programs will continue to work so people like Selinah can maintain a healthy life.

This Week at USAID – August 16, 2010

Administrator Shah will officially swear-in Alex Dickie to be the Mission Director-designate to Iraq and Mike Harvey to be the Mission Director-designate to West Bank Gaza.

Secretary Clinton gives a speech on the Global Health Initiative (GHI) at the Johns Hopkins University Paul H. Nitze School of Advanced International Studies.  The GHI is building on the Bush Administration’s successful record in global health, and taking these remarkable achievements to the next level by further accelerating progress and investing in sustainable health delivery systems.

NBA and WNBA Bring Nets to Senegal but Grab Mosquitoes, not Baskets

Submitted by: Susan Telingator

On Friday, August 6, USAID/Senegal was pleased to be a part of the effort to distribute long-lasting, insecticide-treated mosquito nets with the United Nations Foundation’s Nothing But Nets Campaign and NBA Cares programs in Rufisque, a suburb of Dakar. Teams of NBA (National Basketball Association) and WNBA (Women’s National Basketball Association) players, USAID staff, US Peace Corps volunteers, government health workers and media crews ventured out into the town after a short ceremony emphasizing the importance of sleeping under a mosquito net in order to prevent malaria.

The visit was especially significant for those players who were born on the African continent. NBA Vice President for Development, Amadou Gallo Fall (originally from Senegal), talked to residents in their native Wolof language, followed by NBA legend Dikembe Mutombo (originally from Congo), who spoke in French.

USAID’s President’s Malaria Initiative, which has a nationwide bed net distribution program here, provided technical assistance and coordinated logistics among the various groups. The organizations spent the rest of the weekend running their “Basketball without Borders” program, a four-day camp, which received 65 of the top 19-and-under basketball players from across Africa. This was the first time these events were held in Senegal.

U.S., Russia Explore Opportunities to Collaborate to End Polio

A. Sabin and M. Chumakov work on Oral Poliomyelitis Vaccine (Moscow, 1950s)

Submitted by Jonathan Hale
Deputy Assistant Administrator for Europe & Eurasia

Today, I am back in Moscow.  The Russian government has already made significant contributions to stopping the polio outbreak in Central Asia. Now we are exploring opportunities for further U.S.-Russian collaboration on this issue to work toward ending polio once and for all. I met with Dr. Mikhail Mikhailov, Director of the M.P. Chumakov Institute of Poliomyelitis and Viral Encephalitis. We were joined by the Institute’s Deputy Director, Evgeniy Tkachenko, and some of our USAID Health Office staff to discuss U.S.-Russia collaboration on the response to the polio outbreak in Central Asia.

As Dr. Mikhailov asked me to sign the Institute’s 50-year old guest book, I was struck by the long history of cooperation between its Russian scientists and our own American scientists. In the late 1950s, Dr. Albert Sabin, the American scientist who would later become famous for developing the oral polio vaccine (OPV), needed more subjects for his vaccine clinical trials since earlier polio vaccines had been used so extensively in the United States.

Deputy Assistant Administrator for Europe & Eurasia signs the guest book at the M.P. Chumakov Institute of Poliomyelitis and Viral Encephalitis.

Although this period marked the height of the Cold War, Dr. Sabin was allowed to conduct massive clinical trials in the Soviet Union, working with Dr. M.P. Chumakov, founder of the Institute. In the first five months of 1959, ten million children in the Soviet Union received the Sabin oral vaccine.  Shortly after, the Institute began manufacturing OPV for internal and international use. Later, Dr. Sabin would receive a medal of gratitude from the Soviet Union – one of the only Americans to do so. I hope more Americans can learn about this longtime U.S.-Russian cooperation that has literally saved millions of lives around the world.

Today, as Americans and Russians explore new ways to once again fight polio – this time in Central Asia – I look forward to deepening our collaboration with the Polio Institute and the Ministry of Health on this in the coming months.

Advancing Maternal and Child Health in the World We Live In

When the theme of the 15th African Union Summit in Kampala, Uganda was announced, there was tremendous excitement among the public health community. “Maternal, Infant, and Child Health and Development in Africa” would be a real opportunity to bring to the fore some of the most critical issues in health and development. While specific diseases have gained the attention of world leaders and the global community in recent years, the essential challenge of improving the health status of women and children has often been neglected. This Summit would finally be an opportunity to engage in high-level discussion about how to improve the status of women and children on the African continent. As a Health Officer at the USAID/Uganda Mission, I was looking forward to participating in the conference in support of our U.S. Delegation, anticipating new opportunities to advance the agenda for moms and kids.

And then, two weeks before the opening of the Summit, everything changed. Terrorist bombings tore through Kampala on what should have been a joyful Sunday evening marking the close of the World Cup. Families and friends participating in the global celebration had their lives ended or forever altered by acts of horrendous murder.

Adjusting to our new reality of a terrorist threat in what is usually a safe and relaxed city was quickly overtaken by additional security concerns related to the AU Summit. Ugandans have had to simultaneously mourn while also preparing to welcome the continent’s leaders to their hometown. Grieving for many was cut short.

As I sat in the opening ceremony of the Summit on Sunday, hearing numerous Heads of State and our own Attorney General condemn the unspeakable acts of murder in Kampala, it became clear that the focus of the Summit would be Somalia. As I supported the U.S. delegation’s efforts through the Summit, Somalia and terrorism on the African continent was indeed the central theme of most meetings.

As a public health practitioner, there is of course disappointment that maternal and child health did not gain as much central attention at the Summit as had been hoped for. But the Summit made it clearer to me than ever to me why taking a development approach to advancing health in Africa is so essential. Taking a development approach means working in the real world with the real world problems that conflict, poverty, and even terrorism bring. We need to pay as much credence to applying health interventions to real-world settings as we do to the scientific research that helps us understand what might work in the first place. Conflict, poverty, and terrorism are a real part of women and children’s lives in Africa. While scientific research and innovations remain fundamentally important, we do not have the luxury of applying health interventions in a controlled setting. To advance health status in a sustainable way, we need to be vigilant of the harsh realities that women and children in Africa are facing. For although maternal and child health deserves a great deal of attention in its own right, we cannot separate health interventions that need scale-up from the realities that moms and kids are living in.

So, on the closing day of the AU Summit, I applaud the public health practitioners and advocates who soldiered on during the Summit to maintain some focus on maternal and child health, as it is an issue that deserves the highest levels of attention. But I also challenge us as a public health community to remember that terrorism and conflict are not simply distractions to our goals. This is, unfortunately, the world we are working and living in. These issues shape the lives of the women and children we are working to save. We need to work with local institutions to understand local issues, and transform evidence-based interventions into reality-based interventions. It is only by addressing the reality of conflict, poverty, and now even terrorism that our goals for improving health can be realized. With a development approach to improving health, women and children all over the continent, including Somalia, stand a better chance.

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