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Archives for Health

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.

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!

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