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USAID Applauds Launch of the 2013 WHO Global Tuberculosis Report

I applaud the World Health Organization (WHO) today on the release of the Global Tuberculosis Report 2013, which includes among its recommendations, a call to action to reach millions of people still awaiting quality tuberculosis (TB) care and a stronger approach to fighting the emerging threat of multidrug-resistant TB.

While this year’s report is an important reminder that TB continues to claim millions of lives globally, it also demonstrates that significant progress in preventing, detecting, and curing people of the world’s second biggest infectious killer can be made through strong political will, adequate resources, and a focus on the poorest and most vulnerable communities around the world.

On the positive, we are seeing a steady decline in TB mortality rates since 1990, bringing us closer to the UN Millennium Development Goal to halve TB prevalence and deaths by 2015, with fewer people now falling ill from the disease. However, as the report warns, large numbers of individuals with TB still remain undetected and untreated, and hard to treat multidrug-resistant (MDR) TB is now on the rise.

The WHO recommendations are based on new data from almost 200 countries and territories around the world. The report includes the most recent numbers on people who became sick or died from TB, MDR-TB and TB/HIV, as well as lives saved, treatment successes and gaps, and recent progress in roll-out of new TB diagnostics.

Out of the five priority actions recommend in the report, I would like to highlight two key challenges in particular. First, we should make every effort to reach the 3 million people a year (“missed” patients as the report calls them) who get ill with TB but don’t receive the quality care they urgently need. Many of these people are among the most vulnerable and stigmatized, often at the bottom of the social spectrum.  Universal health coverage and poverty alleviation are critical for bridging this gap and providing better access and quality TB services to those at risk.

Second, the global health community must have a strong plan of attack for addressing the alarming increase in MDR-TB. Data in the WHO report show that progress towards targets for diagnosis and treatment of MDR-TB is far off-track. Worldwide, and in most countries with a high burden of MDR-TB, less than 25% of the people estimated to have MDR-TB were detected in 2012.   MDR-TB is not only a tragedy for the patient, the effects can be disastrous, as an entire community can become infected with the drug-resistant organisms.

USAID is leading the charge in both of these areas by expanding access and quality of TB services including further prevention of the disease through interventions such as contact tracing and infection control.  We are also collaborating with countries and partners to introduce and scale-up MDR-TB programs in countries with the highest burden. If successful, The USAID-funded STREAM study will be a significant win in the fight against MDR-TB.   This innovative study will not only reduce the treatment regimen for MDR-TB from the current 20+ months to 9 months, it will also result in considerable cost savings to the health care system and in alleviating suffering by the patient. Until then, we must optimize DOTS programs and improve infection control to prevent the creation and transmission of MDR-TB.

The United States has a strong record of success in partnering with local governments, civil societies and the private sector to harness the power of science, technology and innovation to deliver health better, more effectively, and at lower cost.  Rapid acceptance of new tools, through technology transfer, and support for path breaking research will be essential in ensuring that at-risk communities can benefit from new innovations in our fight against TB.

The U.S. Government remains a major contributor to the Global Fund to Fight AIDS, TB, and Malaria, a unique partnership of governments, the private sector, civil society and affected communities joined together, unanimous in their desire to fight TB. Many low-income countries rely heavily on international donor funding, with the Global Fund providing around 75% of these financial resources. We need to ensure continued leadership in financing for high burden TB programs while advocating for increases in domestic resources to close the resource gaps, estimated at about US $2 billion per year. Commitment from the international community is crucial for addressing this funding gap.

Investing in global health is not only the smart thing to do – it is the right thing to do. We stand together with WHO and our international partners to save lives from TB and other diseases, and to develop healthier societies in the countries with the most need. We are also pleased to support the documentation and analysis of trends in diagnosis, treatment, and outcome. These data are essential to informing national programs and donor strategies.

I congratulate WHO, our other global partners, and the governments of high burden countries around the world for their leadership in global TB control and look forward to continued progress in this area.

Learn more about USAID’s tuberculosis programs.

Get details on the 2013 WHO Global Tuberculosis Report.

Empowering Mothers to Save Lives

Leading global health soap brand Lifebuoy is harnessing the power of women to make handwashing with soap an everyday habit. Mothers, health providers and birth attendants can be influential advocates. In particular, motherhood is one of the most profound and lifechanging events in a woman’s life irrespective of culture or geography. Mothers hold the key to instilling positive handwashing behaviours in their homes and communities.

Children benefit from handwashing. Photo credit: Lifebuoy

Children benefit from handwashing. Photo credit: Lifebuoy

Lifebuoy joined forces with the U.S. Agency for International Development  and its Maternal and Child Health Integrated Program (MCHIP) to create a neonatal programme to raise awareness of the link between newborn survival and handwashing with soap.  Help a Child Reach 5 uses innovative videos to share the importance of handwashing.

Lifebuoy has an ambitious target of changing the handwashing behaviour of one billion people by 2015, thereby reducing preventable deaths of children under 5 from diseases like diarrhoea and pneumonia. It is this profound cause that helps us to get persuasive advocates- distinguished Indian actress Kajol supports the cause of handwashing with soap and Help a Child Reach 5. She is calling on people, governments, UN agencies and policymakers to scale up handwashing as the most cost effective intervention to save child lives.

Over 40% of under-five deaths occur within the first 28 days of a child’s life, the neonatal period. Simple, low-cost health interventions – such as handwashing with soap at key occasions- can reduce this figure by up to 70 per cent. Despite this, handwashing with soap is not universally practiced. We know that a simple solution- handwashing with soap- can make a drastic difference in stopping preventable newborn deaths. Lifebuoy is passionate about saving child lives and has the global scale to do something about it.

The program targets new mothers and birth attendants through antenatal clinics and health workers. We communicate the potential of handwashing with soap to reduce neonatal infections, but do not stop there. The Help a Child Reach 5 campaign makes a health appeal to the most powerful of all emotions- the maternal instinct. ‘Helping your child survive’ – is the sole message to initiate long lasting changes. Handwashing messages are delivered to generate awareness, but also get commitment to handwash, habitual routine practice of handwashing, and positive reinforcement for handwashing. It builds in the motivators of behaviour change among new mothers such as the desire to nurture and for social recognition. It empowers mothers to keep their babies protected, which is of ultimate emotional significance to mothers.

Public private partnerships are critical to deliver messages to new mothers. Health organizations and governments have on the ground expertise to ensure health workers deliver the messages to new mothers in a scalable and sustainable way. This programme draws on Lifebuoy’s marketing and consumer expertise as well as MCHIP’s ability to reach and scale up outreach to millions of new mothers achieve maximum impact.

Building healthy habits among mothers means changing behaviours and choices. Lifebuoy aims to be much more than just a soap and stand in women’s minds as something positive and meaningful for life. Once a new mother’s mindset is changed, habitual handwashing with soap will become a naturally ingrained behaviour. This can have a ripple effect to other new mothers and the entire community and will help fulfil Lifebuoy’s vision of bringing health and hygiene to 1 billion people.

Learn more about USAID’s work in water, sanitation, and hygiene.

For more information on the Help a Child Reach 5 campaign, please watch some of these videos: www.youtube.com/helpachildreach5

Communities in Cote d’Ivoire Benefit from USAID’s Investments

USAID is helping communities in rural Cote d’Ivoire develop economic resiliency. Through our partners SAVE the Children and AVSI, we are supporting several types of economic strengthening activities, all of which increase the productive resources available for families. Through this work, we target the families and caregivers of children orphaned or made vulnerable by HIV/AIDS.

As they gathered for their savings group meeting, group members met us with a traditional welcome. Andrea Halverson. Photo credit: Andrea Halverson, USAID

As they gathered for their savings group meeting, group members met us with a traditional welcome. Photo credit: Andrea Halverson, USAID

In the mountainous, western city of Man, near Cote d’Ivoire’s border with Liberia, we met women gathering for their regular community savings group meeting. This region was one of the hardest hit during Cote d’Ivoire’s civil unrest. With poverty rates increasing over the past decade, savings groups combat a common problem in developing countries: lack of access to credit. Through these self-selected groups, members (usually all-women) will share a small portion of their money at each bi-monthly meeting, and are eligible to take loans, with interest, from this shared pool. At the end of the group sharing cycle, the amount saved is paid out to the group members. The additional money is making a difference in their lives and the lives of their children. Almost every woman uses her savings for school fees and school uniforms for her children.

Children watch as the community members cook the Attiéké, the final step in its production. Photo credit: Andrea Halverson, USAID

Children watch as the community members cook the Attiéké, the final step in its production. Photo credit: Andrea Halverson, USAID

In addition to savings groups, we also visited a community who had received start-up capital to fund a small business activity, producing a local delicacy called attiéké. Similar to couscous, attiéké is a fermented Ivoiran side dish, highly sought after in the region. Through the donation of a mill and a creative cassava partnership, the women had what they needed to start their small business. They are now making and selling attiéké. With pride, women told us of their informal distribution channels that stretched all the way to Mali. These and other investments are helping shape the future of Cote d’Ivoire, and reducing the vulnerability of Ivorian children by using profits to ensure they can enroll in school.

USAID in the News

AllAfrica reported on a newly-announced USAID partnership with the Nelson Mandela Children’s Fund USA and the Nelson Mandela Children’s Hospital Trust, which is aimed at supporting the proposed Nelson Mandela Children’s Hospital in Johannesburg, South Africa. The new hospital, scheduled to open in June 2015, will provide high-quality medical care to children regardless of their social or economic status.

A statue of Nelson Mandela was unveiled on Sep. 21, 2013 at the Embassy of South Africa in Washington, DC. Photo credit: USAID

A statue of Nelson Mandela was unveiled on Sep. 21, 2013 at the Embassy of South Africa in Washington, DC. Photo credit: USAID

The Express Tribune featured a story about the fourth National Youth Peace Festival in Lahore, Pakistan, which is being supported in part by USAID. The organizers expects to see 500 young people from across Pakistan attend the festival, the theme of which is “One Nation, One Agenda; Democracy and Peace.” Politicians will attend the festival in hopes of engaging youth by taking up issues that are relevant to them.

Jamaica Observer reported USAID’s tool donation  to 105 cocoa farmers in Jamaica as a part of a two-year project, which focuses on “protecting rural lives, livelihoods and ecosystems” in communities affected by climate change. The tools will be used by farmers to combat the negative effects of climate change on agriculture.

Vibe Ghana detailed USAID efforts to support the Western Regional Health Directorate in Ghana. USAID contributions to the health directorate include training, performance-based grants, and equipment that will be distributed throughout district hospitals and health care centers. Dr. Edward Bonko, Leader of the Focus Region Health Project of USAID, explained that the efforts would assist with “maternal, reproductive and child health, HIV/AIDS and malaria preventions and neonatal care” in the Western Region.

Pakistan’s The Nation reported on the visit of a group of U.S. government officials, including USAID Mission Director for Pakistan Gregory Gottleib, to the Jamshoro Thermal Power Station. The power plant will provide an additional 270 megawatts of power to the national grid.  In addition to the Jamshoro power plant, USAID is working to rehabilitate thermal plants in Muzaffargarh and Guddu and a hydro-plant in Tarbela.

The website OpenEqualFree detailed a USAID effort to educate student gardeners in Liberia through the Advancing Youth Project—a partnership with Liberia’s Ministry of Education and community organizations that offers “alternative basic education services and entrepreneurship training for young people across Liberia.” The initiative will provide agricultural experts to train students to grow their own gardens and teach them the about agribusiness as a possible career choice.

The Hill featured a piece written by Representatives Albio Sires and Mario Diaz-Balart spotlighting USAID efforts to combat tuberculosis. The story, which describes legislation geared toward encouraging development of health care products in low-resource health systems, includes an overview of USAID’s contributions in the area of research and development in global health, saying, “As a leading funder of breakthrough products for global health, USAID is a key partner in later-stage research that ensures the development of safe and effective health tools.”

Family Planning Improves and Saves Lives

September 26 is World Contraception Day

For more than 25 years, my professional and personal mission has focused on helping women and couples across the world have the ability to decide whether, when and how many children to have. I strongly believe in the importance of increasing access to voluntary family planning, because the evidence is so clear. Enabling women and men to plan their families, results in multiple health, economic and social benefits for families, communities and nations. On September 26, 2013, World Contraception Day draws attention to the fact that more than 222 million women in the developing world say they want to delay or avoid pregnancy but are not using a modern method of contraception.

A community health worker in Malawi counsels a woman on her family planning options at a gathering place in her community. USAID works in more than 45 countries around the globe to increase access to family planning information and services for all who want them. Photo credit: Liz Bayer

A community health worker in Malawi counsels a woman on her family planning options at a gathering place in her community. USAID works in more than 45 countries around the globe to increase access to family planning information and services for all who want them. Photo credit: Liz Bayer

Everyday an estimated 800 women lose their lives in pregnancy and childbirth. Voluntary family planning could reduce these deaths by 30 percent and save the lives of more than 1.6 million children under five each year by enabling women to delay first pregnancy, space later pregnancies at safe intervals, and stop bearing children when they have reached their desired family size.

USAID works across the globe to enable individuals to access and use affordable, high-quality family planning information, commodities, and services as a means to improve their health and quality of life. For many women, currently available contraceptive methods don’t meet their needs. USAID is one of the few organizations that prioritizes the development of new contraceptives that will be affordable in low resource settings. USAID-supported products on the verge of introduction include:

  • The SILCS Diaphragm, a “one size fits most” reusable diaphragm that does not need clinical fitting
  • The NES+EE Contraceptive Vaginal Ring,  the first long-term hormonal method completely under the woman’s control that lasts for one year
  • The Woman’s Condom,  designed to be easy to insert, use and remove, making it unique compared to other female condoms

As the world’s largest bilateral donor of family planning, USAID is committed to expanding choice and access to a variety of contraceptive options. The ability to make important decisions about childbearing is one of the most basic human rights. Improving access to voluntary family planning information, products, and services is a necessary ingredient to helping women care for their families, participate in their communities, and build their countries.

Learn more about USAID’s work in family planning

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Realizing the Health Goals of the Panama Declaration

This blog is part of a series to coincide with A Promise Renewed in the Americas: ”Reducing Inequalities in Reproductive, Maternal and Child Health Summit,“ that was held during September 10-12 in Panama.

The Promise Renewed for the Americas conference, just held in Panama City September 10-12, was attended by over 280 people representing governments, NGOs, faith organizations, multi- and bi-lateral organizations and civil society from throughout Latin America and Caribbean (LAC) region. The conference was a call to action to address persisting inequalities in maternal and child health in the region. The Declaration of Panama signed on the first day expressed the commitment of 26 governments  and many organizations to heed that call. The conference concluded with a provisional framework for reducing health inequities for women, children and youth in the LAC region. Now that I’ve had a week to reflect on the event, I’d like to share some thoughts with the broader global health community and so many others who contribute to furthering health in LAC, focusing on: “why this conference was so important to have in the first place,” “why now?”  and “what’s ahead?”

A Promise RenewedWhy convene this meeting in the first place? In 2015, most LAC countries will meet Millennium Development Goal (MDG) 4 (child health), and many will meet MDG 5 (maternal health.) However, it is certainly too early to declare victory in maternal and child health in LAC. Some countries will not meet either MDG 4 or 5, and Haiti’s indicators will fall considerably short of its goals. Moreover, averaged, national-level statistics mask major inequalities in maternal and child health in almost all countries in the region. And, the groups with much-worse-than-average health outcomes – most notably in maternal and neonatal deaths – are LAC’s most vulnerable and marginalized populations. Often these are also people whose voice is not heard in policy-making. Further, as outlined in an article for the Journal de  Perinatología y Reproduccion Humana, the pace of progress in reducing preventable maternal, child, and newborn deaths has slowed considerably throughout the region. At the same time, the investment of international donors in the health sector in LAC has declined markedly over the last two decades. So, the capacity and resources of the region itself will have to be better focused to reduce its major “equity gaps” in maternal and child health. In this context, the Panama conference was initiated by USAID’s Bureau for Latin America and the Caribbean, and sponsored by a consortium of donor agencies, USAID, PAHO/WHO, UNICEF, UNFPA, UNAIDS, the Inter-American Development Bank, and the World Bank, to catalyze a more concerted regional effort to address those gaps.

So, why now? In addition to the convergence of the region-specific factors just mentioned, the timing of the Panama conference was important in a global context because it forged a link between the Latin America and Caribbean region and the new global movement “A Promise Renewed” (APR). That movement was launched in June 2012 at the Child Survival Call to Action event in Washington, D.C. that was hosted by the governments of Ethiopia, India, and the United States, in collaboration with UNICEF. APR aims to re-energize those working on maternal and child health world-wide, and increase attention and investments toward the goal of ending preventable maternal and child deaths within the next generation – by 2035. Several follow-up conferences in Africa and Asia have helped sub-regions and individual countries to begin development of detailed roadmaps to reach this goal. For the LAC region, reaching the global goal will require a fundamental commitment to bridging equity gaps. Going forward, we expect that LAC’s active participation in the global APR platform will lead to accelerated learning and better metrics for gauging progress.

What’s ahead? A major consensus emerging from the conference was that the true locus of control for closing these equity gaps lies in the countries of the region –their governments, civil society, academies, churches, and other institutions. The appropriate role for donor agencies is supportive, not primary, in setting goals, timelines, the route to reach them, and the metrics to measure them. Many conference participants called for a regional mechanism to help facilitate collaboration, information exchange, south-to-south sharing, and access to technical expertise to accelerate the reduction of inequities.

Following are some other key decisions and next steps that came out of the conference:

  • Conferees identified key principles to guide efforts to close equity gaps, among them: use of cross-sectoral approaches for multi-sectoral problems; a focus on marginalized populations (rather than expecting benefits to trickle-down); use of multicultural approaches; and promotion of gender awareness.
  • Conferees supported the establishment of a regional network dedicated to addressing health equity gaps, which would be open to countries, civil society, private sector, and international agencies.
  • Representatives from several countries indicated that they would initiate national, and potentially sub-national, meetings to address maternal, child and adolescent health inequities in their own countries.
  • The donor consortium agreed to continue support for the A Promise Renewed for the Americas website, to serve as a platform for virtual discussion and planning, an information repository, and mechanism for technical interchange.
  • Conferees provided ideas orally and in writing for a regional framework aimed at supporting country progress on reducing inequities. This framework, along with a limited organizational structure, will continue to be developed in the coming months, with modest funding from the seven-agency donor consortium.
  • Setting of region-wide goals for reduction of health inequities was deferred, given the diversity of circumstances and the lack of standardized data across the region that could help inform policies and decision making. There was also general agreement that imposing regional, uniform, health equity reporting requirements on countries would not be feasible or desirable at this point. However, it was widely agreed that gauging progress in reducing health inequities is essential for accountability. That will require countries to disaggregate their health data to allow analysis by geographic, economic, ethnic, and gender variables, over time.
  • Conferees also stressed the importance of LAC participation in shaping the post-MDG 2015 health development agenda.

For the LAC region, some of the most difficult challenges in maternal, child, and adolescent health still lie ahead, because they require reaching those who are hardest to reach, but the Panama conference showed that solidarity and commitment in the region are strong. The LAC region has a history of success in maternal and child health and can draw from the extensive knowledge and expertise already in the region. The Panama conference catalyzed an ambitious process that will be ongoing until, as one speaker observed, “we meet to celebrate ‘A Promise Fulfilled.’”

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Empowering Women with the Female Condom

September 16 is Global Female Condom Day. 

Believe it or not, the female condom is a controversial tool in the arsenal against HIV transmission. Donors argue that it’s expensive and not widely used. Women complain that it’s too big and hard to insert. What no one can argue is that it works.

Female condoms are the only woman-initiated method available that offers dual protection from unintended pregnancy and sexually transmitted infections (STIs), including HIV. Studies have shown that the female condom is at least as effective as the male condom in reducing the risk of contracting STIs and can reduce the per-act probability of HIV infection by 97 percent. Studies from Madagascar, Brazil, Kenya, India and the United States demonstrate that female condom promotion and use increases the total number of protected sex acts.

RH Councillor Jonathan Kabanda in a councilling session with client Pauline Phiri at SFH Obote Site, Livingstone, Zambia. Photo credit: PSI

RH Councillor Jonathan Kabanda with a female condom in a counselling session with client Pauline Phiri at SFH Obote Site, Livingstone, Zambia. Photo credit: PSI

But to provide the dual protection it was designed for, female condoms must be used. And while gaining acceptability and uptake among women is not an easy task, it can be done.

Patience Kunaka first heard about female condoms in Zimbabwe in the early 1990s. “I first thought it might be a good prevention tool. In those days, HIV was taking its toll and antiretroviral therapy was not yet known and available.”

Patience worked then as a midwife trainer for the National Health Ministry. While her training provided her with knowledge of reproductive anatomy, she was still shocked when she saw the female condom. “I wondered how it would remain inside me with the movement of the penis. I thought it would be sliding in and out and become a really messy act!”

Despite her concerns, she attended a female condom training and decided to try one during her menstrual cycle. “It takes a lot of practice to get used to it. But it’s worth it in the end.”

Patience joined Population Services International (PSI) Zimbabwe in 2006 as the training manager and has become an outspoken advocate for female condoms. “It takes time to get used to female condoms but mainly it takes a positive attitude toward trying it. I am a regular user and talk to a lot of women about trying it.”

In the nearly 20 years since it started programming for female condoms, PSI has learned valuable lessons in supporting their uptake. Relying solely on traditional commercial marketing strategies is not effective. PSI targets female gathering places such as hair salons, which allow for prolonged interaction between potential users and promoters to encourage trial and repeat use. Promoters receive intensive training to demonstrate female condom use with interpersonal communication to their female peers. Non-traditional channels also include barber shops and gathering places for men, which can help programs achieve male partner buy-in.

As the international community gathers to celebrate Global Female Condom Day on September 16, it is important to remember that the female condom provides another option for women whose partners refuse to wear a male condom or women who want to take charge of their own reproductive health. As additional female condoms become commercially available, the prices will hopefully reduce, providing access to an even greater number of women. And while programming for female condoms can be complex—just as any behavior change can be—women like Patience Kunaka demand it.

Through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID supports PSI and other implementing partners’ female condom programming in a number of sub-Saharan African countries.

Educating A First-Time Mother

It was the height of the Indian monsoon season and I sat cross-legged on a concrete floor in the slums of outer Delhi. An excited chatter filled the air from the 25 new and expectant mothers packed into the small room. There, I met a young Bengali woman, Manali. Manali is a recently married 18-year-old who, less than a year ago, traveled a very far distance from her family’s village to join her now-husband in India’s second largest city. She sat shyly in the corner of the room.

Mother and child. Photo credit: MAMA

Mother and child. Photo credit: MAMA

I soon learned that she was expecting her first child. While she had the same joy in her expression and excitement in her voice as other expectant mothers I’ve met around the world, I realized there was something different: her knowledge level.

My colleague Daphne asked Manali how she will know when she is in labor, where she plans to deliver, and what to give her baby if he is sick. Second- and third-time moms will usually jump in to supply the information. Manali, on the other hand, smiled shyly and shrugged her shoulders. Surprisingly, the majority of women in the room had a mobile phone in their hand–basic “candy bar” phones, many with broken screens–but all had used their device to receive calls. When this is the case, these phones can be used to deliver vital health information and knowledge to mothers, especially first-time moms like Manali who need this information the most.

In two weeks, Johnson & Johnson will head to New York City, where the world’s global leaders will come together for the United Nations General Assembly to tackle some of the biggest issues facing the world, including meeting the Millennium Development Goals. With fewer than 850 days to 2015, we are far short of our goal to reduce child mortality and improve maternal health.

Progress has been made: 13 commodities have been identified by the UN Commission on Life-Saving Commodities to address preventable deaths in women and children. Countries such as Nigeria and Tanzania have put together plans and begun to implement these recommendations, saving millions of lives. However, less action has been taken to inform the women themselves of these life-saving commodities.

For example, if a mother knew about oral rehydration salts solution (ORS), which would help manage her baby’s dehydration from diarrhea (and that ORS solution costs just a few cents), she could seek out this simple treatment. If she knew about the warning signs for pre-eclampsia, she could recognize them and get to the clinic early for treatment with magnesium sulfate.

The World Health Organization recognizes that a lack of information is a contributing factor to women not getting the care they need. A first-time mother is especially vulnerable. She is younger, less experienced, and often feels isolated and less empowered amid her husband’s family. Mobile messages delivered via voice or text are a simple way to inform, support, and educate her with accurate health information.

The model to address this opportunity is an intriguing example of the power of public-private partnerships. MAMA founded by USAID, Johnson & Johnson, UN Foundation, Baby Center and mHealth Alliance, is getting this vital health information out to mothers through partnerships around the world. These stage-based messages—developed by BabyCenter, a Johnson & Johnson company, in partnership with global health experts—are timed to coincide with the stage at which the mother needs them. The messaging is adaptable, i.e., easily translated into other languages and dialects.

In its first two years, the model is showing promise. A growing alliance of partners–235 organizations across 59 countries–is reaching 530,000 new and expectant mothers. New MAMA child messages are now also available, developed in partnership with MDG Health Alliance, GBC Health, and UNICEF.

For first-time moms like Manali, the information delivered increases their knowledge, helps to develop their confidence, and connects them to life-saving commodities. While phones cannot and should not replace doctors, nurses, or community health workers, the ubiquity of these devices offers new mothers the opportunity to have a healthy pregnancy and give her baby the best start to life.

This blog first appeared on the Huffington Post’s Global Motherhood page, as part of a month-long series in partnership with Johnson & Johnson to highlight the successes and remaining opportunities in the Every Woman Every Child movement. With the aim of improving the lives of women and child around the world, EWEC was launched by UN Secretary General Ban Ki-moon in 2010 to accelerate progress against the Millennium Development Goals (MDGs). To learn more, click here.

Neonatal Alliance Locks in on Largest Contributor to Under-5 Death in Latin America and the Caribbean

This blog is part of a series to coincide with A Promise Renewed in the Americas: ”Reducing Inequalities in Reproductive, Maternal and Child Health Summit“ during September 10-12 in Panama.

Each year, over 121,000 babies in Latin America and the Caribbean (LAC) will die during their first month of life. Nearly a quarter of these neonatal deaths are due to prematurity and low birth weight; and these deaths are more likely to happen if the baby is born to a mother who is poor, uneducated, or lives in a rural area.

To prevent neonatal deaths and advance neonatal health in general, many of the LAC region’s ministries of health, the United States Agency for International Development (USAID), several United Nations (UN) agencies, non-governmental organizations, and professional associations (pediatric, obstetrics-gynecology, midwifery, and nursing), have formed a partnership in 2005 called the LAC Neonatal Alliance.

Mother and child. Photo credit: MCHIP

Mother and child. Photo credit: MCHIP

This regional Alliance provides an ongoing platform for active engagement in neonatal issues at the regional and national levels. It champions key initiatives such as the promotion of the Neonatal Integrated Management for Childhood Illness (IMCI) strategy, development of “Trainer of Trainers” workshops for neonatal resuscitation using the Helping Babies Breathe (HBB) protocol, implementation of Kangaroo Mother Care, and creation of communities of practice for  the exchange of experience and dissemination of evidence-based practices. The Alliance model allows for quick action to address priority issues because of its organizational character: transparent and trusting collaboration, plus tightly defined and monitored goals that are supported by a shared annual work plan and budget. This structure has allowed the Alliance to make a significant impact on neonatal health in the LAC region.

An important example of the Alliance’s work involves the implementation of a low-technology, cost-efficient technique to save premature babies. Kangaroo Mother Care (KMC), which involves constant skin-to-skin contact between the newborn and his or her mother (or father), was developed in 1982 in Colombia in response to a lack of incubators. This simple intervention helps newborns regulate their temperature and other physiological processes – but its benefits have not been well understood until recently.  The intervention has been shown to reduce newborn mortality and morbidity in premature and low birth weight infants by approximately 50 percent more than traditional care. A recent USAID-funded study in Nicaragua found that use of KMC reduced hospital stays for newborns by four days, which results in less potential for hospital-acquired infections and allows the family to resume their normal life, including infant-related responsibilities, sooner, while saving an average of almost $400 per infant.

The Alliance has brought teams from 10 LAC countries to Colombia for training in KMC, and eight of these teams instituted training programs in their home countries to further disseminate KMC. Through this work, the Alliance is potentially reaching over 20,000 mothers and their infants per year.

With neonatal deaths remaining a major challenge in Latin America and the Caribbean, especially among disadvantaged groups, the Alliance will keep this issue in the forefront and continue to push for universal adoption of life-saving interventions in the region.

For detailed information on the LAC Newborn Alliance and Kangaroo Mother Care visit the following websites: Kangaroo Foundation, Maternal and Child Health Integrated Program, and the Newborn Alliance.

Follow @USAID and @USAIDGH from September 10-12 for live tweets and Facebook content from the conference. Follow the hashtag: #PromiseRenewed or #PromesaRenovada.

Optifood: A New Tool to Improve Diets and Prevent Child Malnutrition in Guatemala

This blog is part of a series to coincide with A Promise Renewed in the Americas: ”Reducing Inequalities in Reproductive, Maternal and Child Health Summit“ during September 10-12 in Panama.

What does it REALLY take to ensure young children get the proper nutrition to grow strong and healthy? This is an especially important question in poor rural communities in Guatemala, where about half of the children under five years of age are stunted (too short for their age—a sign of long-term deficits in the quantity and/or quality of food, including the right vitamins and minerals).  In some parts of western Guatemala, more than eight in ten young children are stunted.

Woman feeds her child. Photo credit: INCAP

Woman nourishes her child. Photo credit: INCAP

Now there’s a new tool to help answer the question:  Optifood is a computer software program, developed by the World Health Organization (WHO) in collaboration with the London School of Hygiene and Tropical Medicine, Food and Nutrition Technical Assistance III Project (FANTA), and Blue Infinity, that provides scientific evidence on how to best improve children’s diets at the lowest possible cost using locally available foods. Optifood identifies nutrient gaps and suggests food combinations the local diet can fill—or come as close to filling. It also helps identify local foods’ limits in meeting nutrient needs and test strategies for filling remaining nutrient gaps, such as using fortified foods or micronutrient powders that mothers mix into infant or young children’s porridge.

The Government of Guatemala is fighting stunting through its Zero Hunger Initiative, which aims to reduce stunting by 10 percent by 2015 and 24 percent by 2022 through nutrition, health, agriculture, and social safety net programs. The U.S. Government and USAID are supporting these efforts through Feed the Future and Global Health Initiatives focused on the Western Highlands. USAID/Guatemala asked the USAID-funded FANTA/FHI 360 to help find strategies to improve the nutritional quality of children’s diets in the region. The challenge was to develop realistic and affordable diets for children that both meet their needs and are firmly based on scientific evidence. FANTA worked with its local partner, the Institute of Nutrition of Central America and Panama (INCAP), to collect the diet data needed for Optifood from communities in two departments of the Western Highlands, Huehuetenango and Quiché. FANTA then used Optifood to analyze the information.

The Optifood analysis found that a combination of locally available foods including tortillas, potatoes, beans, eggs, green leafy vegetables, and a fortified cereal known as Incaparina, along with mother’s breast milk, could satisfy children’s nutrient needs, except for two nutrients required for children 6-8 months—iron and zinc. Optifood results showed that adding a micronutrient powder, known locally as Chispitas, would help make sure these very young children get enough iron and zinc.  It is important to note that the Guatemalan Ministry of Health already provides Chispitas in some areas, but it does not yet reach all parts of the country where it is needed.

Woman tends to crops. Photo credit: INCAP

Woman tends to crops. Photo credit: INCAP

FANTA then found out how much this diet would cost and whether families in the Western Highlands could afford it. One feature of Optifood is it provides cost information and can identify the lowest-cost diet that meets or comes close to meeting nutrient needs. Optifood found that it would cost about 25 to 50 U.S. cents a day to give this improved diet to a child 6–23 months old in Guatemala. At first, this may not seem like much money, but for the 51 percent of the population in the Western Highlands who earn less than US$3.15 a day, it amounts to 8 percent to 15 percent of their daily earnings.

Next steps in the process include testing the diet to see whether mothers can really feed it to their young children. We’ll be asking questions like, “Do mothers have any difficulties? Is cost really a problem? Are the recommendations hard to understand or follow? Do children like the combinations of food?”

Once the diet is found to be practical, feasible, and affordable, FANTA will work with partners to develop a strategy and plan to promote the recommended foods in the right combination, quantity, and frequency to improve children’s diet intake as well as promote the use of Chispitas to help meet iron and zinc needs.

FANTA is also working with the Government of Guatemala, USAID, development partners, and the private sector to make fortified foods for young children even better and test their nutrient levels with Optifood. FANTA is collaborating with the Guatemalan Ministry of Agriculture and Livestock to develop extension messages and materials to support production of the nutritious foods identified by Optifood, disseminate messages and improve practices through USAID-funded Feed the Future demonstration sites, with support from INCAP. In collaboration with the Ministry of Health, FANTA will also help health workers (through an e-learning program) and community health workers learn about and promote the Optifood diet, and as needed, FANTA will provide additional ongoing training and technical expertise.

Optifood, which will soon be available for free download on the WHO website, is a truly powerful tool that can strengthen Guatemala’s ability to help its children thrive and reach their full potential.

Follow @USAID and @USAIDGH from September 10-12 for live tweets and Facebook content from the conference. Follow the hashtag: #PromiseRenewed or #PromesaRenovada.

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