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Archives for Health

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.

The Issue of Inequalities: A Look at the Underlying Causes of Maternal and Child 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.

In the past decade, most economies in Latin America and Caribbean (LAC) have grown at a rapid pace, which has allowed an approximate 70 million people to rise out of poverty and approximately 50 million to join the middle class. Despite the recent global economic slowdown, the World Bank expects the region to see a 3.5 percent average GDP growth rate this year.

PromiseRenewedUnfortunately, this growth has not benefited everyone in the region. Household living standards and availability of social services, including health and education, are still low for millions of people. This in turn, is reflected in major variations in health indicators, both between and within countries in the region. Among disadvantaged groups, the chance of death or permanent ill-health is much higher than for the middle- and upper-classes. Eliminating preventable maternal, newborn and child deaths globally is an overarching goal of USAID’s work, so we must address the underlying causes.

There has been significant progress in Latin America and the Caribbean in recent decades. Many countries have reached or exceeded their Millennium Development Goal (MDG) 5 levels, reducing maternal deaths by 75 percent between 1990 and 2015. Most LAC countries will meet the MDG 4 goal of reducing under-five deaths by two-thirds over that period.

Moreover, many countries have or will soon achieve the new global goal of ending preventable child deaths (defined as an under-5 mortality rate of 20 deaths per 1,000 live births) by 2035. Currently, ten other countries in the region have under-five mortality rates between 20 and 30. Only Haiti (70), Bolivia (51) and Guyana (36) have an above 30 mortality rate. However, nationally averaged numbers mask health inequalities within many of the region’s countries, so variations among population sub-groups must be taken into account to understand that risk of death is not evenly distributed. In Latin America and the Caribbean, over 180,000 children under 5 years old and nearly 9,000 mothers still die annually — most of them among poor, indigenous, and marginalized groups.

The impact of sub-group disparities on key health indicators, such as under-five mortality is well established – but it is telling to compare LAC with other regions. This indicator is higher in rural than in urban areas across the world, but the largest gap is in Latin America. Overall, in developing countries, under-five mortality is 50 percent higher in rural areas, whereas for Latin America under-five mortality is 70 percent higher in rural areas. Similarly, under-five mortality in LAC is almost three times higher among the poorest quintile than the richest quintile, which is the worst ratio worldwide; the average among developing regions is less than two times higher among the poorest quintile.

Another area where inequities lead to stark differences in health status is in regard to nutrition. According to estimates based on household income, 13 percent of LAC’s population lives in households with incomes insufficient to satisfy their basic nutritional needs. Given that the 2013 Lancet series on nutrition found that “undernutrition is responsible for 45 percent of deaths of children younger than 5 years,” addressing these inequities with regard to basic needs is critical to reducing child mortality in the region. According to the Lancet, “[t]he effect on maternal and child health outcomes and health-care provision is striking, regardless of the indicator used to measure inequity. For example, maternal mortality ratios are 10-44 times higher in the poorest provinces of several countries in Latin America. The poorest quintile of the population showed 3-10 times the prevalence of stunted children than the richest quintile in nine countries.”

Fortunately, LAC has developed a number of tools to address inequities. For example, the region pioneered to use of conditional cash transfers. Starting in the late 1990s, Brazil and Mexico began experimenting with these programs, which aimed to reduce poverty and improve health and other outcomes through provision of incentive payments for certain behaviors. The innovative approach spread throughout the region, so that by 2011 eighteen countries had a CCT program, with a total of 129 million beneficiaries. Rigorous program evaluations have found CCTs to increase demand for health services and reduce poverty, although they should be carefully targeted to the poor to reduce inequities and often require improvements in the quality of care to maximize health impact. Conditional Cash Transfers are a successful example of the benefits that can be gained through consideration of the broader context to health. In addition, the region has pioneered cost-effective approaches to infant and child health, such as integrated management of childhood illness and Kangaroo Mother Care, which can be used to improve health in a variety of settings, particularly resource-constrained ones.

The regional Promise Renewed event taking place in Panama this week aims to build momentum for countries and partners in the region to address inequities that impact health status. It’s too early to declare victory in the area of maternal and child health in the LAC region. We must work together to address remaining pockets of need in order to continue to reduce maternal and child mortality, and we should do so by building upon the region’s experience, expertise, and sense of solidarity.

Please join us via Livestream to learn more about the A Promise Renewed in the Americas: ”Reducing Inequalities in Reproductive, Maternal and Child Health Summit.

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

The LAC Effect: Addressing Inequalities to Save Lives

Ariel Pablos-Mendez, PhD, is the Assistant Administrator for Global Health

Ariel Pablos-Mendez, MD, MPH, is the Assistant Administrator for Global HealthThis 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.

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.

I’m in Panama City, Panama for the A Promise Renewed in the Americas: “Reducing Inequalities in Reproductive, Maternal and Child Health Summit“, where 19 ministers and vice ministers of health from 17 countries throughout the Latin America and Caribbean (LAC) region are gathering together to figure out a game plan on how to further progress in ending preventable child and maternal deaths.

But before I launch in to what I think would be one significant contribution from USAID and others in the donor community, I’d like to brag a bit. Being from Mexico, I’m immensely proud of what the region has been able to accomplish in a relatively short period of time. Almost all LAC countries have reached or are close to reaching their Millennium Development Goals (MDGs) 4 and 5, which address child and maternal health respectively.

The LAC region has led the way with innovative solutions. The concept of Kangaroo Care originated in Colombia in 1982, and is a simple, no-cost intervention that involves skin-to-skin contact between parent and newborn, is responsible for saving newborns by keeping them warm and encourages exclusive breastfeeding. Latin America’s storied success in immunization and polio eradication inspired the rest of the world. Starting in the late 1990’s, Brazil and Mexico began experimenting with conditional cash transfer programs, which has reduced poverty and improved health and other outcomes through the provision of incentive payments for certain behaviors. The approach has since spread throughout the region and now 18 countries have a CCT program with nearly 130 million beneficiaries. The LAC region was also one of the first to adopt the Integrated Management of Childhood Illness (IMCI) approach, which builds on existing efforts to integrate child survival programs at the community level.

Then there is my favorite topic…Universal Health Coverage, which is defined as access for all to appropriate health services without incurring financial hardship. The region has made tremendous strides in UHC with significant health reforms that include the Unified Health System in Brazil, The Social Health Insurance program in Chile, and coverage for 50 million Mexicans under the Popular Health Insurance Program. This fall, Brazil will host the Global Forum on Human Resources for Health dedicated to sharing experiences with the world on how to move towards UHC.

The LAC region should feel deep pride in its health accomplishments, country graduations from assistance and many, many other success stories. But if it were all good news, all these ministers, global health leaders and donors would not be coming together for a summit.  We still have work to do.

In Latin America and the Caribbean, more than 180,000 children under 5 years old and nearly 9,000 mothers still die annually, most of them poor, indigenous and marginalized groups.  Despite two decades of development gains and recent economic growth in LAC countries, a large health disparity remains among and within countries with regard to access and quality of health services. This is especially true for voluntary family planning services which we know dramatically improves maternal and child health and can more broadly contribute to economic and social development and stability.  And on average, countries in the region only spend 3.5 percent of their GDPs on health, and out of pocket expenditures remain high at nearly half of national health expenditure overall.  This is a recipe guaranteed to drive a low- to middle- class family back into poverty with one catastrophic health episode.

But there are things we can do as a global health community, even as we evolve our role as partners in the LAC region.

Here’s the good news. Due to the years of rapid growth, the World Bank estimates that 70 million people in the region have risen out of poverty and 50 million have joined the middle class during the past 10 years. With this transition of economic growth, most low-income countries are reaching middle-income status and it makes sense that international donors would reduce bilateral grants for program implementation and shift toward providing more technical assistance to support government priorities and country ownership. And the LAC region has shown that social inequalities can be generated by economic growth but also tackled with political will.

Governments have led or are currently leading the effort to sharpen and refine their national action plans with costed strategies for maternal, newborn and child survival, and by setting and monitoring five-year milestones. Development partners, in turn, can support national targets by pledging to align their support with government-led action plans and priorities. Private sector partners can spur innovation and help identify new resources for child survival. And through action and advocacy, civil society and faith leaders can support the communities and families whose decisions profoundly influence prospects for maternal and child survival.

Regional solidarity can also play a key role. Region-wide collaboration and exchanges of ideas and knowledge will be a magic ingredient that contributes markedly to the reduction of inequalities. Several countries, including Brazil and Mexico, have already been reaching out with their own know-how and funding, and have begun to forge their own approach to development assistance. This meeting in Panama, like the global Call to Action last June, is but another step in this important effort.

Although USAID LAC will have only two bilateral health programs in Haiti and Guatemala as of 2014, we will continue to provide technical assistance through regional programs aimed at building country capacity on key health issues: health systems, TB control, family planning, and maternal, newborn and child health.  We will continue to coordinate with other U.S. government agencies in-country to maximize the full breadth of our resources and collaborate with country Ministries of Health and other partners “on the ground” to integrate programs and build health systems that support quality care. And we will work to improve information for accountability, and encourage expanded participation in decision-making for better problem solving.

Zero child deaths are hard to attain even in rich countries, but the world as a whole can indeed reach the low mortality levels enjoyed in those countries. And this milestone for our civilization can be attained by our generation. No one government, donor, organization, or campaign will end preventable child and maternal deaths, but together, this IS an attainable goal. I’m looking forward to the outcomes of this Summit over the next few days and look to continue USAID’s deep and successful relationship with the LAC region, understanding full well that success means our eventual departure. As stated in USAID charter by President Kennedy, “We intend during this coming decade of development to achieve a decisive turn-around in the fate of the less-developed world, looking toward the ultimate day when all nations can be self-reliant and when foreign aid will no longer be needed.”  LAC is leading the way.

Resources:

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

From the Field in Vietnam: Small Loans Mean Big Changes for People Living with HIV

Vietnam’s mountainous Dien Bien Province, 500 km (about 310 miles) west of Hanoi, is home to the well-known battleground of Dien Bien Phu, where Vietnamese soldiers fought and won a decisive 55-day battle in 1954 against the French Union that brought an end to that war. Today, Vietnam is now engaged in another battle — against HIV/AIDS. And Dien Bien is one of Vietnam’s two provinces with the highest HIV prevalence.

Ms. Ca Thi Hinh, 32, a member of the Thai ethnic minority group in northern Vietnam, grew up in the province’s Tuan Giao district, an HIV hotspot. Born into a poor family, Hinh married in her early twenties. Her husband was also poor, and all they had was a temporary shelter. They both worked hard as hired laborers, saving as much as they could and looking forward to the moment when they could afford a decent house.

In her traditional costume typical of the Thai ethnic minority group in northern Vietnam, Hinh tells her story to a reporter from Vietnam Television with confidence, shining eyes and a radiant smile. Photo Credit: Richard Nyberg/USAID

In her traditional costume typical of the Thai ethnic minority group in northern Vietnam, Hinh tells her story to a reporter from Vietnam Television with confidence, shining eyes and a radiant smile. Photo Credit: Richard Nyberg/USAID

In 2007, Hinh’s husband was diagnosed with HIV when he was treated for a high fever, and died shortly after. Hinh then found out that she had contracted HIV from her husband, and the sky seemed to fall down on her. She could only gather her courage when she thought about her two small children. “I must live,” she thought. “My children need me to take care of them.”

As stigma and discrimination against people living with HIV/AIDS are still problems in Vietnam, people like Hinh have difficulty finding jobs, face unfair treatment in accessing social services and experience discrimination in healthcare and other settings.

Hinh looked to animal breeding as one option to earn an income, but she was turned down for a loan from a state-owned bank. Then she learned about M7/CFRC, a microfinance service provider supported by the USAID HIV Workplace Project. M7/CFRC staff trained her in financial management and gave her a microloan of $150. Adding $50 from her own savings, she bought two goats, one of which was pregnant. Three months later, her herd had grown to eight and she sold two goats for $215. With this money, she is able to support her children and her sister.

“I am very grateful for the support and care from the project. My children are now well-fed and educated, and I, myself, am more confident,” Hinh said. She hopes to have more goats soon, so that she can sustain her income.

Since 2008, the project, funded under the U.S. President’s Emergency Plan for AIDS relief (PEPFAR), has helped 1,400 people living with or affected by HIV in Vietnam. With microloans from the project, people like Hinh have found jobs and realized their dreams of running their own businesses. The success of the microfinance model for people living with HIV has encouraged local microloan providers to commit $1 million in loans to this target group.

The Government of Vietnam has also adopted the project’s microfinance models and is developing a new policy to provide loans to populations at highest risk of HIV in Vietnam.

Learn more about USAID’s work in Vietnam.

Like USAID Vietnam on Facebook and follow @USAIDVietnam on Twitter  for ongoing updates in the region. 

Photos of the Week: AID in Action: Delivering on Results

Driving human progress is at the core of USAID’s mission, but what do development results look like?

USAID is measuring our leadership in results — not dollars spent — implementing innovative, cost-effective strategies to save lives. Through investments in science, technology and innovation, USAID is harnessing new partners and young minds to transform more lives than ever before. Our new model for development embraces game-changing partnerships that leverage resources, expertise, and science and technology to maximize our impact and deliver real results.

Take a look at the Agency’s top recent and historical achievements in promoting better health; food security; democracy and good governance; education; economic growth, and in providing a helping hand to communities in need around the globe.

Read the stories behind the results in the special edition of FrontLines: Aid in Action: Delivering on Results.

Follow @USAID and @USAIDpubs for ongoing updates on the best of our results!

Launching the Global Social Service Workforce Alliance

During a visit to Zimbabwe last year, I asked a group of teenagers what they wanted to be when they grew up. Some suggested they wanted to be doctors, others said teachers. One outspoken young lady wanted to be a movie star. I asked if any of them dreamed of becoming social workers. They laughed and said that they wanted to get paid. For these kids, being a social worker was not a particularly prestigious profession – and definitely not lucrative.

But it is an important profession – and a profession that I aspired to since I was a little girl. I always wanted to be a helper. But being a helper is hard and I was under no illusions that helping would make me rich.

Now I have the great pleasure of helping the helpers. And with the launch of the new Global Social Service Workforce Alliance, my efforts to help the helpers will now have a global platform.

Group of young adults. Photo credit: World Education

The Alliance, which is funded by PEPFAR through USAID, as well as other donors, asserts that a well-planned, well-trained, and well-supported social service workforce can effectively deliver services to improve the lives of vulnerable populations around the world. However, a number of challenges confront this workforce and limit its ability to create protective environments for children and families who face poverty, discrimination, violence, and exploitation in their daily lives.

In its mission, the Alliance recognizes key challenges facing this workforce and aims to promote the knowledge, evidence, resources, tools, political will, and action needed to address them, especially within low to middle income countries. During the launch webinar held on June 6th, Amy Bess, the Alliance Coordinator, described how to get involved in the work of the Alliance and introduced participants to a website, which will act as a platform for information sharing and advocacy.

I am a member of the Alliance. You can become a member too by registering here. As a member, you can contribute to knowledge on the social service workforce, connect with others through the Alliance Webinar Series and interest groups, and join with me and others to help the helpers through global and more targeted advocacy efforts.

With any luck, we will inspire a new generation of social service workers to follow in our footsteps and social workers will become as popular as movie stars!

New Mobile Clinics Take to the Road in Lesotho

This originally appeared on the Elizabeth Glaser Pediatric AIDS Foundation Blog.

Last month, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) teamed up with the Lesotho Ministry of Health (MOH) to launch two mobile health care clinics that will provide HIV/AIDS and other health care services to residents in Lesotho’s rural communities. On July 11, EGPAF’s Chief Operating Officer (COO) Brad Kiley joined representatives from the Lesotho MOH and other high-level government officials at a ceremony to celebrate the new mobile units and how they will improve access to health care services to people throughout the country. The clinics are made possible thanks to generous support from the President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Agency for International Development (USAID).

Representatives from the Lesotho Ministry of Health, USAID, and EGPAF – including EGPAF COO Brad Kiley (in orange tie) – at a launch for two mobile clinics in Lesotho. Photo credit: EGPAF

Kiley noted that he is particularly proud of EGPAF’s success in Lesotho and is grateful for the kindness and support of the Government of Lesotho and the Ministry of Health. He also acknowledged and thanked USAID on behalf of the Foundation for its generous contributions to the key project of Strengthening Clinical Services in Lesotho.

Speaking at the same ceremony on behalf of the Health Minister, Principal Secretary to the Ministry of Health, Lefu Manyokole, said the mobile clinics come at the right time, when the Ministry is revitalizing primary health care and trying to strengthen the health system. He also commended the partnership and continued support EGPAF is giving to the Government of Lesotho.

He continued by emphasizing the MOH’s commitment to properly maintain and carefully coordinate the use of these mobile clinics so that they are effectively used for strengthening linkages and helping malnourished people in the region.

EGPAF will work with the MOH to provide integrated health services to patients in the remote areas of the mountainous districts of Thaba-Tseka and Mohale’s Hoek, where there is a high prevalence of HIV among pregnant women along with high rates of malnutrition among children and overall limited access to maternal, neonatal, and pediatric care. Each mobile clinic is equipped with two consulting rooms with collapsible examination couches, a metal stairway and emergency/wheelchair pathway, air conditioning, and built-in generators. Initially, services will include HIV/AIDS testing and treatment, prevention of the mother-to-child transmission (PMTCT) services, nutrition counseling, and other maternal and child health services.

These services are part of a larger effort by EGPAF and the Partnership for HIV-Free Survival (PHFS) and Nutrition Assessment Counseling Support (NACS) program to reduce malnutrition in the region, especially in HIV-positive women and children.

EGPAF has been active in promoting the use of mobile clinics throughout Africa. To learn more, click here.

To learn more about our work in Lesotho, click here.

Mapalesa Lemeke is Communications Officer for the Foundation, based in Lesotho.

Let’s Talk About HIV: The Importance of Dialogue and Information in Adolescent HIV Care

In recognition of International Youth Day, AIDSTAR-One Senior Treatment Officer discusses the importance of dialogue and information in adolescent HIV care. 

Imagine you are 15. It is your first year at a new school. You have to make new friends, meet all new teachers, struggle through your classes, and find a date for weekend parties. You want freedom and independence from your parents and caregivers. You want to be like everyone else. You worry about having cool clothes and fitting in.  You want to have a boyfriend or girlfriend. You want your friends to like you. You worry about getting in to university and what your future will be like.

Now, imagine you are 15 and you are HIV-positive. You have the same thoughts and concerns that your peers have, but you also have to worry about your health. HIV only makes being an adolescent harder. You wonder if you will still fit in if you have HIV, so you hide this information from your friends. When you start dating someone, you wonder if your boyfriend or girlfriend will still like you if you tell him or her your status. The pressure of getting good grades and planning a successful future is heightened by having to miss school for medical appointments or not feeling well.

Teen Talk, a new tool from AIDSTAR-One and BIPAI, is a resource for young adults living with HIV. Photo credit: AIDSTAR-One

Teen Talk, a new tool from AIDSTAR-One and BIPAI, is a resource for young adults living with HIV. Photo credit: AIDSTAR-One

Through advances in antiretroviral therapy (ART), children born with HIV are growing up, living, and thriving. In addition, UNAIDS reports that youth between the ages of 15-24 account for almost half of all new HIV infections. These youth are in need of comprehensive, youth-specific education to empower them to make responsible and informed decisions regarding disclosure of their HIV status, sexual behavior, and their health.

So, how do we help youth living with HIV adjust to the growing pains of adolescence, while also maintaining their health? We talk to them. Just as with any teenager, it is important for youth living with HIV to learn how to be responsible young adults, realize how their actions affect those around them, and know who they can talk to when they need help. For teenagers who are HIV-positive, it is also important to help them manage their health. They need to know how to remain healthy by eating well and remembering to take their medicine, how and when to talk to peers and teachers about their status, and why drinking or taking drugs could be particularly harmful to them.

It is hard for youth living with HIV and those who care for them to know the answers to all of these questions. AIDSTAR-One in partnership with Baylor International Pediatric AIDS Initiative (BIPAI) created Teen Talk: A Guide for Positive Living, a resource written for teens to use on their own, or for use in consultation with medical providers or caregivers. Covering issues such as adherence, nutrition, and safe sex, Teen Talk helps youth living with HIV think through their concerns and make healthy decisions. Teen Talk offers specific tools such as a calendar to help adolescents remember to take their medicine, a list of common medication side effects and possible solutions, and a question and answer guide about sex and sexual health.

With such a large population of youth living with HIV, it is increasingly important to help adolescents address their HIV status, manage their own medical care, and live a healthy life.  Living with HIV will always be a challenge. However, with tools such as Teen Talk, youth living with HIV can thrive and remain healthy in their adolescent years, bringing us one step closer to reaching the global goal of an AIDS-free generation.

AIDSTAR-One is funded by PEPFAR through USAID’s Office of HIV/AIDS. The project provides technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs.

Learn more about youth programming at USAID. Join the conversation on Twitter using #IYD2013. 

Youth, Urbanization and Health

In celebration of International Youth Day, Global Health Youth Advisor discusses U.S. Government and USAID’s health programs impacting urban youth. 

In 2010 I took a bike tour of Dar es Salaam’s slums. Over tea and chapattis my young guide told me he had lost both parents to AIDS. As the eldest, he had to ensure the education of his younger siblings. He dropped out of high school and migrated to Dar to work. Now at 24 with a good job, his siblings had finished school, and he was ready to return to school himself.

This glimpse of the vibrant yet chaotic life in Dar’s slums is one that we rarely see. I was struck by the large numbers of school-age youth in the streets working as petty traders: selling bananas, phone cards, sunglasses and pirated DVDs.

The HealthyActions program in Liberia, under the Advancing Youth Project and in partnership with EDC delivers an HIV and family planning curriculum in alternative high schools for youth that have left the formal education system. Photo credit: USAID

The HealthyActions program in Liberia, under the Advancing Youth Project and in partnership with EDC delivers an HIV and family planning curriculum in alternative high schools for youth that have left the formal education system. Photo credit: USAID

Dar is not unique. Rural to urban migration is accelerating, yet governments are ill-prepared to deal with it. In Timor L’este, I heard that that the capital’s population was growing by 10,000 people every year. Poorly serviced squatter settlements, slums, and camps are the norm in many cities, which are increasingly populated by youth seeking opportunities.

In Latin America and Asia, young female urban migrants outnumber young males. Many migrate to escape forced marriage or abusive relationships. UNICEF data from 12 countries show one in five migrant children aged 12–14 and half of those aged 15–17 move without a parent. Young urban migrants often find themselves in violent, stressful and unhealthy environments.

Migration displaces and separate youth from their homes and the protective structure and guidance of families and communities. Separation from sources of learning, recreation, and support; alteration of community routine, normalcy; and lack of positive alternatives contribute to the exploitation and abuse of young people. Young people also engage in risky behaviors, including sexual ones with dire consequences.

Developmentally appropriate reproductive health and family planning information and youth friendly services can prevent poor health outcomes, and can ensure young people receive adequate care and  support for pregnancy, unsafe abortion, STIs/HIV, and violence.

Youth face many challenges to obtaining reproductive health services. Youth migrants are doubly challenged, since slums have limited health services. Urban programs must address and involve youth. Collaboration across sectors is essential to improving the health and opportunities of urban youth migrants.

U.S. Government and USAID’s health programs impacting urban youth:

  • Young Tanzanian women who migrate to the city are susceptible to the lure of a “sugar daddy.” The Fataki radio campaign (PDF) uses humor and familiar stories to foster dialogue around the dangers of intergenerational sex, empowering community members to intervene.

  • Fourteen years of civil war in Liberia displaced much of the population. Population Services International provides HIV and FP education in alternative high schools for youth now returning to Monrovia, with increased uptake of HIV testing and contraceptives.

  • One third of the 6 billion mobile subscribers are under the age of 30. Mobile for Reproductive Health (m4RH) is an on-demand SMS system with information about contraception and nearby clinics. Young Kenyans liked the simple language and confidentiality of the service. Tanzanian and Kenyan users reported increased contraceptive knowledge and use. FHI 360 and the Rwandan Ministry of Health are adapting m4RH with additional information for young people.

Globally, young people under 18 are considered children, and younger migrants are at especially high risk. The U.S. Government’s Action Plan for Children in Adversity recommends that U.S. Government assistance support and enable families to care for their children; prevent unnecessary family-child separation; and promote appropriate, protective, and permanent family care.

Learn more about youth programming at USAID. Join the conversation on Twitter using #IYD2013. 

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