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How Progress Works: A Disappointing Microbicides Trial and Why We’re Not Discouraged

The FACTS 001 trial made use of applicators to dispense 1 percent tenofovir gel before and after sex. / Andrew Loxley Photography

The FACTS 001 trial made use of applicators to dispense 1 percent tenofovir gel before and after sex. / Andrew Loxley Photography

Science is messy. Data don’t always show us what we hope they will. But science is reality, and that’s why we must be unflinching in our pursuit of getting honest feedback on what works.  Today, we got that honest feedback, and it was disappointing: What once appeared to be a major breakthrough in HIV prevention was not confirmed. Results released from a large USAID-supported trial indicate that an antiretroviral-based vaginal gel may not be effective in reducing the risk of HIV infection in women when used before and after sex.

With women increasingly vulnerable to HIV infection, we must work towards finding a prevention method to protect them.  / USAID, Tash McCarroll

With women increasingly vulnerable to HIV infection, we must work towards finding a prevention method to protect them.
/ USAID, Tash McCarroll

The FACTS 001 trial—named after the Follow-on African Consortium for Tenofovir Studies (FACTS)—was designed to test the safety and effectiveness of a vaginal microbicide that contains 1 percent tenofovir gel. The study aimed to replicate the groundbreaking results of a 2010 trial called CAPRISA 004, which found a 39 percent reduced risk of HIV infection. Unfortunately, the FACTS 001 study did not replicate those results on a larger scale. Although the answer wasn’t what we’d hoped, in the process of asking we have learned and grown, and we’ll  redouble our efforts to take the next steps forward.

In sharing this news, I am struck by a simple observation made by the editor in chief of “Science News,” Eva Emerson: “This is how science is supposed to work.” Her remark referred to a recent discovery in physics that upon further investigation could not be confirmed. Emerson’s conclusion was matter of fact. Scientists are in the business of asking questions, whether it is the existence of gravitational waves or the ability of a gel to protect vulnerable women.

The process of “asking” also re-emphasized the reason why we pursue new technologies for HIV prevention. The young South African women who participated in the study live in communities with some of the highest incidence rates of HIV infection in the world. Their lives are complex and the decisions they face daily are staggering. Everything we do, whether it be investigating new methods of HIV prevention or conducting thorough evaluations, is in the effort of bringing relief to these women and achieving an AIDS-free generation.

The FACTS 001 study was launched in October 2011 at nine clinical trial sites in South Africa and included 2,059 female participants aged 18-30. By the end of the trial in September 2014, about 4 percent of both the placebo group and the treatment group receiving the gel became infected with HIV.

In spite of this setback, USAID has already developed a robust pipeline of new products, many of which are jointly supported by the National Institutes of Health, the Bill & Melinda Gates Foundation and others. These include innovative methods such as vaginal rings, long-acting injectable antiretroviral drugs, and products that combine contraceptives and HIV prevention technologies. For each hurdle we encounter, USAID is determined to jump two steps forward—our commitment to helping women protect themselves from HIV has never been stronger.

To the women who participated in this trial: Thank you. You are why the trial was done, and you are why we will persevere.

The FACTS 001 trial was led by Wits Reproductive Health and HIV Institute, sponsored by CONRAD, and funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID, the Bill & Melinda Gates Foundation, and the Government of South Africa, with support from Gilead Sciences.

ABOUT THE AUTHOR

David Stanton is the director of USAID’s Office of HIV/AIDS

New tools for LGBTI-inclusive development

On May 16, 2014, the US Embassy in Sarajevo was lit up in rainbow colors to show its support for LGBTI activities and community members. / Embassy of the United States, Bosnia & Herzegovina

On May 16, 2014, the U.S. Embassy in Sarajevo was lit up in rainbow colors to show its support for LGBTI activities and community members. / U.S. Embassy, Bosnia & Herzegovina

In May 2013, the U.S. Embassy in Sarajevo illuminated its building with rainbow colors in support of International Day Against Homophobia and Transphobia. A few months later, the U.S. Embassy in Prague followed suit in honor of Prague Pride week. Reading about these events in the newspaper, I felt both proud of my government and afraid of the reaction such bold support of lesbian, gay, bisexual and transgender (LGBT) rights might provoke in an Eastern European country.

At the time, hate speech and physical violence against LGBT people were breaking out all over the world: from Russia, to Uganda, to here at home in the United States. Little did I know at the time that these supportive public statements were just the beginning: In the following years, the U.S. Government would increasingly commit to advancing the fundamental human rights of LGBT people at home and abroad.

This commitment in terms of international development was initially laid out in USAID’s LGBT Vision for Action in June 2014. This week, USAID is launching a publication to help development professionals implement LGBT-inclusive programs in the countries of Europe and Eurasia: the Toolkit for Integrating LGBT Rights Activities into Programming in the E&E Region [PDF].

These steps forward are of vital importance. LGBT people in Europe and Eurasia encounter a wide range of everyday discrimination, human rights violations, psychological trauma and sometimes physical violence. These legal, social and psychological conditions are described in an earlier USAID report called Testing the Waters: LGBT People in the Europe & Eurasia Region.

But the case for LGBT inclusion is not just a question of rights; it’s also a question of good development practices. USAID and its partners are building the case that the economic exclusion of LGBT people wastes human capital, deepens poverty, magnifies inequality and hurts GDP. But what is to be done?

The new USAID toolkit presents case studies and advice for how LGBT inclusion can advance development agendas. Examples not only include programs that focus specifically on LGBT rights, but also projects where LGBT people are part of a broader target population. For example, the toolkit recommends that programs to empower women entrepreneurs deliberately seek out lesbian and transgender women, who can then help the program reach new participants. The toolkit also suggests that community leaders connect LBT women entrepreneurs to business development programs that provide mentorship opportunities. At the heart of all of these programs and examples is a good working relationship with local LGBT communities.

Staff from the U.S. Embassy in Prague marched in support of Prague Pride in August 2014 / Embassy of the United States, Czech Republic

Staff from the U.S. Embassy in Prague marched in support of Prague Pride in August 2014 / U.S. Embassy, Czech Republic

Having worked in the Europe and Eurasia region, I was especially impressed by the story of an HIV/AIDS program in Ukraine called SUNRISE. To reach isolated and underserved rural populations, SUNRISE mobilized urban volunteers—health workers and members of populations vulnerable to HIV, such as men who have sex with men—and trained them to provide sustainable outreach to rural areas. These volunteers formed and guided self-help groups to provide education, counseling, and testing and prevention services.

Dmytro Pichakhchi, who works with a charity that partnered with SUNRISE, noted in a report that the project also strengthened civil society by uniting leaders and activists from regions and cities across Ukraine

While HIV/AIDS programs are a natural fit for LGBT-inclusive development work, the toolkit also looks at programming in the areas of rule of law, civil society, accountable governance, media, entrepreneurship, education, health, vulnerable groups, youth and gender-based violence. The toolkit’s presentation of lessons learned, points for possible intervention, and illustrative indicators for measuring success can easily be applied to other regions.

Although just a starting point, when it comes to advancing LGBT human rights and well-being, USAID’s toolkit gives us some concrete new answers to the famous old question of what is to be done.

ABOUT THE AUTHOR

Laura Adams is an AAAS Science & Technology Policy Fellow in the LGBT office at USAID. Follow her @lauristan

One Team, One Mission. USAID Employees Share Their Stories on Agency Transformation

USAID employees reflect on their experiences working with the Agency. / Morgana Wingard, USAID

USAID employees reflect on their experiences working with the Agency. / Morgana Wingard, USAID

In the last five years, USAID has pioneered a new model of development that harnesses the power of business and innovation to end extreme poverty and promote resilient, democratic societies.

Today, on Dr. Rajiv Shah’s last day as USAID Administrator, we wanted to share stories from employees around the world. Thank you to the more than 80 members of USAID who took part in this project. Here are some of the highlights:
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  1. Finding New Ways to Bring Capital to the Developing World. In emerging markets, eight out of 10 small businesses cannot access the loans they need to grow. USAID’s Development Credit Authority (DCA) helps fill this gap, using risk-sharing agreements to mobilize local private capital. Mike Muldoon, DCA Investment Officer, reflects on DCA hitting a new record: reaching 54 transactions in one year and making available $769 million in capital through guarantees. He says, “Our tool can be called on regardless of sector or environment—regardless of whether we are working in an undeveloped market like Cameroon or Sierra Leone or a comparatively more developed market like Nigeria or South Africa.” Read the full interview.
  2. Enshrining New Model Partnerships. Launched in June 2013, Power Africa aims to add more than 30,000 megawatts of cleaner, more efficient electricity generation capacity, as well as increase electricity access by adding 60 million new home and business connections throughout Africa. Coordinator for Power Africa and Trade Africa Andrew Herscowitz, who is leading the charge to fight energy poverty throughout the continent, says experiencing sustained power outages in the Dominican Republic when he was a teenage exchange student made an impact on him: “(The power outages) affected everyone—rich or poor. Factories would stop production. Clinics closed. Food spoiled.” Read full interview
  3. Supporting Civil Society. Essential to USAID’s mission is assisting countries in making the transition to resilient, thriving democracies.Urim Ahmeti, team leader for the Democracy and Governance Office in Kosovo, reflects on USAID’s work helping Kosovo’s civil society boost demand for accountability in this new nation after its declaration of independence in 2008. Ahmeti says, “This period—the birth of my country—is very memorable to me and an entire generation. It is a point in history that will never be forgotten.” Read the full interview.
  4. Fighting for a Strong Leadership Voice. A development agency that is strong, empowered, and accountable is necessary for achieving USAID’s mission. Carla Koppell, Chief Strategy Officer, shares her thoughts on the revitalization of the Agency, its brand, and its role in foreign policy. She says, “We are integral to U.S. foreign policy, and we will continue to proactively promote that agenda.” Read the full interview.
  5. Celebrating Our Staff as National Heroes. From Typhoon Haiyan, to the ongoing Ebola crisis, USAID staff are often called upon to lead responses to the world’s greatest challenges. Captain Colleen Gallagher, Navy Liaison to USAID, Office of Civil Military Cooperation, speaks about being deployed to Haiti immediately after the earthquake on a hospital ship—the USNS Comfort. As aftershocks rocked the giant ship, Gallagher persevered each day by meeting with a USAID team to coordinate the avalanche of incoming trauma patients. She says, “By the end of that first day, we went from a census of zero to 80 patients—most of whom had significant trauma.” Read the full interview.

ABOUT THE AUTHOR

Stephanie Bluma is the Deputy Assistant Administrator for Public Affairs at USAID. Follow her on Twitter: @stephaniebluma

Building the Bridges of the New Silk Road

Silk still plays a role in the New Silk Road. Household silk production feeds Afghanistan’s carpet and textile industry. USAID is helping open up trade routes and increase economic connectivity between Central and South Asia as part the New Silk Road Initiative. / USAID

Silk still plays a role in the New Silk Road: Household silk production feeds Afghanistan’s carpet and textile industry. USAID is helping open up trade routes and increase economic connectivity between Central and South Asia as part the New Silk Road Initiative. / USAID

For hundreds of years, the main trade routes between Europe and the Pacific passed directly through what are now the countries of Central Asia. These trade routes brought prosperity and fostered the exchange of ideas and technology across cultural boundaries. In recent decades, civil unrest, ethnic tension, and mistrust have led to Central Asia being a roadblock instead of a thoroughfare for trade.

What would it take to reconnect Central and South Asia?

Support for new transmission lines connecting the sources of power in one country with customers in another?

Or millions of dollars in trade agreements, reviving age-old connections between traditional trading partners?

Maybe it’s a fortified wheat program, poised to improve nutrition for millions of Afghanistan’s children; or strengthened cooperation in transboundary watersheds to enhance regional peace and stability?

USAID has made these contributions and more as a part of the U.S. Government’s New Silk Road initiative, an ambitious effort to build a more secure, stable and prosperous region with Afghanistan at its heart.

While the goals of the program are lofty, the benefits of these programs are quite specific.

Manzura Zhabarova is an Uzbek entrepreneur who owns a clothing and thread manufacturing company. Our programs helped connect her with a new market: prospective clients in Mazar-i-Sharif, Afghanistan. “I could not believe that this world existed 800 meters away from us on the other side of the bridge,” she said. “It’s our responsibility to help our neighbors in Afghanistan. Trade is how we can help.”

USAID’s Deputy Assistant Administrator Manpreet Anand meets with regional traders attending USAID’s Central Asia Trade Forum held last year in Almaty, Kazakhstan. / USAID.

USAID’s Deputy Assistant Administrator Manpreet Anand meets with regional traders attending USAID’s Central Asia Trade Forum held last year in Almaty, Kazakhstan. / USAID.

There are few greater challenges for U.S. foreign policy today than the continued development and stabilization of Afghanistan. As military engagement winds down there, it becomes even more critical to build on the gains of U.S. defense, diplomacy and development efforts.

Afghanistan’s new administration is working to bolster its regional ties in order to promote the economic growth and stability its citizens need. As Afghan President Ashraf Ghani noted during a recent visit to Turkmenistan, “At the moment, Afghanistan has turned into a bridge.  Our trade and transit can create many opportunities; energy and electricity and natural gas will be sent to Afghanistan and to other countries through Afghanistan.”

Our efforts are helping to make this vision a reality. For example, we’re advancing regional electricity efforts, particularly through our support for CASA-1000, an ambitious electricity transmission system sending surplus summer hydropower from Kyrgyzstan and Tajikistan to energy-strapped markets in Afghanistan and Pakistan.

USAID helped the Aga Khan Foundation and Pamir Energy inaugurate newly constructed power transmission lines in Khorugh, Tajikistan, to meet the energy needs of Afghanistan's Badakhshon province. / USAID

USAID helped inaugurate newly constructed power transmission lines in Khorugh, Tajikistan, to meet the energy needs of Afghanistan’s Badakhshon province. / USAID

Recently, our support helped finalize a regional pricing agreement, helping pave the way for regional electricity transfers which would bring much needed revenue to Central Asia as early as 2018.

The benefits would be felt well beyond the exchange of energy. As State Department Deputy Assistant Secretary Fatema Sumar said, “CASA isn’t really about turning the lights on. It’s about getting countries to work together. That’s priceless.”

From Karaganda to Karachi, our programs are breaking down trade barriers and creating economic opportunity in ways that promote political understanding. Around the region, we are helping countries join and participate in the World Trade Organization, bringing businesses together, leading to millions of dollars in regional deals and sparking new demand for intra-regional trade between Central and South Asia.

These efforts have prompted us to think in new ways about how we work together as an Agency. Our New Silk Road initiatives involve the coordinated efforts of five separate USAID missions, representing two regional Bureaus and leveraging shared human and financial capital toward achieving shared objectives.

In Tajikistan, about half of all Tajik rural households do not have access to safe, potable water. USAID helps turn water from a source of conflict to a source of cooperation. / USAID

In Tajikistan, about half of all rural households do not have access to safe, potable water. USAID helps turn water from a source of conflict to a source of cooperation. / USAID

This is a pivotal time for Central and South Asia. This vast region faces challenges and opportunities. On the one hand, the Central Asian states have begun to grapple with the potential rise of violent extremism. On the other, in South Asia the world’s largest population centers seek faster economic development and integration into the global economy. We have responded accordingly – with diplomatic engagement and development leadership – because increasing prosperity and stability in this part of the world benefits us all.

At the recent London Conference on Afghanistan, Secretary Kerry reaffirmed that “Afghanistan’s economic future depends on improved connectivity with regional and international markets.”

The New Silk Road is an example of the far-reaching impact our development programs can have, and raises the bar of what we can expect from our investments in international development.

ABOUT THE AUTHORS

Assistant Donald “Larry” Sampler serves as Assistant to the Administrator in the Office of Afghanistan and Pakistan Affairs (OAPA). Jonathan Stivers serves as the Assistant to the Administrator in the Asia Bureau.

Historic Donor Agreement: More Money Where It Is Needed Most

In Barisal Sadar, Bangladesh, Ayub Ali serves his community by producing quality fingerlings (young fish), which is a key factor for local fish farming. As part of the USAID-Aquaculture project, he learns about modern method of aquaculture through training. This knowledge and support has made him a successful entrepreneur. / World Fish, A. W. M. Anisuzzaman

In Barisal Sadar, Bangladesh, Ayub Ali serves his community by producing quality fingerlings (young fish). As part of the USAID-Aquaculture project, he learns about modern method of aquaculture through training. / World Fish, A. W. M. Anisuzzaman

This year, 2015, will be seminal in setting not only bold new goals – like ending extreme poverty – but also in making bold reforms that change the way things get done.

As donors, one of our primary concerns is to use our taxpayers dollars as effectively and efficiently as possible in order to leverage significant change. That means attracting other forms of capital (public, private, social, multilateral – you name it) and directing those resources to where they can best have the sort of transformative development impact that we all want.

At December’s High-Level Meeting of the Organization for Economic Cooperation and Development’s Development Assistance Committee (OECD-DAC) in Paris, we advocated for and achieved important policy and structural changes to how donors allocate resources and report those numbers. These changes will impact the future of Official Development Assistance (ODA) — the international definition of foreign aid that is used to track donors’ foreign aid commitments.

First, 29 DAC members agreed to “allocate more of total ODA to countries most in need,” including low-income countries, the least-developed countries (LDCs), small island developing states, landlocked developing countries, and fragile and conflict-affected states.

We believe this policy is critical. The countries that can least afford to self-finance are the same ones lagging behind on the eradication of extreme poverty and the basic human development needs that form the foundation of the Millennium Development Goals.

Second, we created a fairer, more transparent, and better targeted system for development-focused lending. Three integral changes include:

  • Creating a fairer accounting system. Previously, donors got equal credit for grants and qualifying loans¹ – even though the loans needed to be repaid.  Under the new rules, only the grants and a portion of loans (known as the “Grant Element”) will count as Official Development Assistance (ODA). The United States only provides assistance in the form of grants.
  • Directing money to the most needy. The formula for deciding what counts as ODA now rewards donors who lend money to least-developed countries – i.e., those who can least afford commercial terms or self-financing.
  • Increasing transparency. During the meeting, members agreed to publish all ODA statistics more regularly, with frequent reviews and updates.
A worker at Muya Ethiopia weaves fabric that will become clothing and accessories sold on store shelves thousands of miles away. From 2005 to 2014, with support from USAID, Muya expanded from seven to 400 full-time employees and now sells 90 percent of its products overseas. / IESC, Steve Dorst

A worker at Muya Ethiopia weaves fabric that will become clothing and accessories sold on store shelves thousands of miles away. From 2005 to 2014, with support from USAID, Muya expanded from seven to 400 full-time employees and now sells 90 percent of its products overseas. / IESC, Steve Dorst

In order to unlock more development funding for the least-developed countries, the changes also endorse focusing on work with the private sector in support of the New Model of Development. These changes will also bring transparency to development transactions and encourage donors to send money to the neediest countries. They could not come at a more perfect time.

This year, the Millennium Development Goals will expire and the world will come together to decide on a new set of post-2015 sustainable development goals. These new benchmarks are likely to redefine USAID’s target of ending extreme poverty–a mission that will rely heavily on effective financial policies. Thanks to the lending reforms and support from other donor countries, USAID is in a strong position to move forward in tackling the development of countries most in need.

We can provide support to boost the economies of low-income countries to minimize poverty, but this renewed emphasis on countries most in need, including LDCs, small island developing states, landlocked developing countries, and fragile and conflict-affected states, stands to make an even greater difference.

This summer, donor countries and recipients will have a chance to further refine their approach to these issues at the third International Conference on Financing for Development in Addis Ababa, Ethiopia in order to achieve the next set of global development goals.

Currently, we are poised to bring significant changes to global development. With this early success in agreeing to changes in the recording of ODA loans and a renewed focus on countries most in need, large steps have been taken to help us realize an end to extreme poverty.


¹To be counted, loans had to be concessional in character and convey a grant element of at least 25 percent (calculated at a rate of discount of 10 per cent), a formula that has grown very out of date. Click here for more information.

ABOUT THE AUTHOR

Alex Thier is USAID Assistant to the Administrator for Policy, Planning and Learning. Follow him @Thieristan

In National Security Strategy, Key Role for Development

Fazal Wahid, 66, a bee farmer in Pakistan’s turbulent SWAT region is now able to sustain his family because of assistance from a USAID program. The economy in Pakistan’s Swat Region was devastated by  militants and devastating floods. / USAID, Pakistan

Fazal Wahid, 66, a bee farmer in Pakistan’s turbulent SWAT region is now able to sustain his family because of assistance from a USAID program. The economy in Pakistan’s Swat Region was devastated by militants and devastating floods. / USAID, Pakistan

The 2015 National Security Strategy (NSS), released today by President Obama, makes a powerful argument about how central development is to our national security and prosperity.

Our biggest global challenges: improving global health security; addressing inequality; confronting climate change; countering authoritarian regimes and extremism; and ending conflict all require successful humanitarian and development responses.

USAID’s mission to end extreme poverty and promote resilient, democratic societies is right at the center of this strategy.

It states:

“We have an historic opportunity to end extreme poverty within a generation and put our societies on a path of shared and sustained prosperity. In so doing, we will foster export markets for U.S. businesses, improve investment opportunities, and decrease the need for costly military interventions.”

The new NSS comes at a seminal moment for international development, as the world comes together in 2015 to create new goals for development, for climate, and figures out how to get them done.

Employees assemble tablets at the Surtab Factory in Port au Prince, Haiti. Surtab, which was established in 2013 with funding from USAID, has been a huge boost to the technology sector in Haiti, creating a highly skilled local workforce through training programs and on-site instruction. The company's tablets are used in social programs in education, health care and agriculture. / David Rochkind, USAID

Employees assemble tablets at the Surtab Factory in Port au Prince, Haiti. Surtab, which was established in 2013 with funding from USAID, has been a huge boost to the technology sector in Haiti, creating a highly skilled local workforce through training programs and on-site instruction. The company’s tablets are used in social programs in education, health care and agriculture. / David Rochkind, USAID

Strong and sustainable American leadership is the central theme of the strategy. In it, President Obama calls for the United States to play “a leading role in defining the international community’s post-2015 agenda for eliminating extreme poverty and promoting sustainable development.”

USAID is delivering on this pledge through efforts with our civil society partners, at the United Nations, and in the 80 countries around the world where we practice what we preach.

Development is a whole-of-government and whole-of-society approach. The challenges we face, and ambitions we harbor, require this. Our New Model for Development ties together the need for local ownership and good governance with big public private partnerships that deliver big results.

The strategy doubles down on this by calling for us to “use our leadership to promote a model of financing that leverages billions in investment from the private sector and draws on America’s scientific, technological, and entrepreneurial strengths to take to scale proven solutions in partnership with governments, business, and civil society.”

In the West Bank, girls are thriving in the classroom. Since 2000, USAID has constructed nearly 3,000 classrooms and renovated 2,700 more--allowing many schools to cut class size and eliminate the need for students to learn in shifts. / Bobby Neptune, USAID

In the West Bank, girls are thriving in the classroom. Since 2000, USAID has constructed nearly 3,000 classrooms and renovated 2,700 more–allowing many schools to cut class size and eliminate the need for students to learn in shifts. / Bobby Neptune, USAID

In 2010, President Obama said that USAID must be the world’s premier development agency. This is needed to bring the historic changes to women and girls, people burdened by hunger and disease, and those struggling for freedom that our values and our national security require. The 2015 NSS reflects an Agency transformed.

The development voice is strong, and we are delivering on ambitious goals like lifting 7 million farmers out of extreme poverty, getting 100 million children reading, and driving infant and maternal mortality to record lows.

“We embrace our exceptional role and responsibilities at a time when our unique contributions and capabilities are needed most, and when the choices we make today can mean greater security and prosperity for our Nation for decades to come.”

USAID’s work has never been more central to this goal.

ABOUT THE AUTHOR

Alex Thier is USAID Assistant to the Administrator for Policy, Planning and Learning. Follow him @Thieristan

Anatomy of a Logistics Operation: How USAID is Equipping Ebola Fighters on the Frontlines

Transporting vital supplies and critical commodities quickly to the epicenter of an international disaster is what USAID’s Office of U.S. Foreign Disaster Assistance does every day. However, the Ebola response has proved especially challenging for USAID’s disaster experts.

A USAID-chartered plane lands in Monrovia, Liberia, transporting critically-needed medical supplies to the frontlines of the Ebola response. Photo courtesy: Carol Han, USAID/OFDA

A USAID-chartered plane lands in Monrovia, Liberia, transporting critically-needed medical supplies to the frontlines of the Ebola response. Photo courtesy: Carol Han, USAID/OFDA

“Most disasters we respond to are either natural disasters—such as an earthquake, where the acute needs peak and then go down very quickly—or it’s a war,” explained Kelly Bradley, a logistician with USAID’s Ebola Disaster Assistance Response Team (DART). “Ebola is essentially a brand-new type of response because outside of a few groups, no one has dealt with it on a large scale before.”

Inside the cargo hold, thousands of sets of protective equipment (PPE) to protect Ebola health care workers. As of January 2015, the U.S. has transported more than 400 metric tons of medical and disaster supplies to West Africa. / Carol Han, USAID/OFDA

Inside the cargo hold, thousands of sets of protective equipment (PPE) to protect Ebola health care workers. As of January 2015, the U.S. has transported more than 400 metric tons of medical and disaster supplies to West Africa. / Carol Han, USAID/OFDA

One major obstacle: Affected West African countries did not have robust infrastructure in place to receive and distribute all the goods pouring into their airports. As a result, the United States found itself in the unique position of moving an unprecedented amount of medical supplies to a region while simultaneously working to build a logistics supply chain almost from scratch—all to ensure that health care workers are able to get what they need to save lives.

USAID Ebola Disaster Assistance Response Team (DART) logisticians Kelly Bradley and Rogers Warren receive medical supplies at Roberts International Airport in Monrovia, Liberia. In addition to airlifting critical commodities, they had to help build a supply chain to ensure that the medical supplies got to areas of need. / Carol Han, USAID/OFDA

USAID Ebola Disaster Assistance Response Team (DART) logisticians Kelly Bradley and Rogers Warren receive medical supplies at Roberts International Airport in Monrovia, Liberia. In addition to airlifting critical commodities, they had to help build a supply chain to ensure that the medical supplies got to areas of need. / Carol Han, USAID/OFDA

“We were getting requests left, right and center,” said Bradley. “People didn’t know what they were asking for. We didn’t know what was coming in a lot of the time. Even the experts who do medical responses didn’t fully understand the scope of the need.”

Inside a warehouse in Monrovia, the U.S. military and USAID put together “starter kits” of medical and cleaning supplies to sustain U.S.-supported Ebola clinics for the first critical days of operation. / Carol Han, USAID/OFDA

Inside a warehouse in Monrovia, the U.S. military and USAID put together “starter kits” of medical and cleaning supplies to sustain U.S.-supported Ebola clinics for the first critical days of operation. / Carol Han, USAID/OFDA

Much of the need centered on delivering enough personal protective equipment (PPE) – including gloves, goggles, coveralls, masks and boots—to health care workers. Enter the U.S. military, which has been working closely with USAID to airlift more than 1.4 million sets of PPE to Monrovia, the country’s capital.

However, once the supplies were flown in, there was no dedicated system in place to transport them to the Ebola treatment units (ETUs) being constructed and staffed by the United States.

USAID funded the UN World Food Program (WFP) to build a system of warehouses in five strategic locations throughout Liberia. Photo courtesy: Carol Han, USAID/OFDA

USAID funded the UN World Food Program (WFP) to build a system of warehouses in five strategic locations throughout Liberia. Photo courtesy: Carol Han, USAID/OFDA

That’s when USAID partnered closely with the UN World Food Program (WFP) and supported its work to build a system of warehouses throughout the country and develop a supply chain of medical equipment to ensure ETUs received ample resources to open its doors and stay operational.

With this supply chain in place, PPE and other medical supplies could now be transported by truck to logistics bases located in five strategic Liberian cities, close to U.S.-supported ETUs.

In addition to supplying Ebola Treatment Units with medical equipment, USAID has been providing communities with household kits containing bleach, masks, soap and gloves so that families taking care of sick loved ones could be better protected against Ebola. / Carol Han, USAID/OFDA

In addition to supplying Ebola Treatment Units with medical equipment, USAID has been providing communities with household kits containing bleach, masks, soap and gloves so that families taking care of sick loved ones could be better protected against Ebola. / Carol Han, USAID/OFDA

Mira Baddour, a logistician with WFP in Liberia, admits that getting all the main players on the same page was initially very challenging.

Coordination in action: U.S. Army logistician Terri Mcfadden (center) consults with USAID logistician Kelly Bradley (right) at a WFP warehouse in Harper, Liberia, on best ways to transport supplies to U.S.-supported Ebola clinics. / Carol Han, USAID/OFDA

Coordination in action: U.S. Army logistician Terri Mcfadden (center) consults with USAID logistician Kelly Bradley (right) at a WFP warehouse in Harper, Liberia, on best ways to transport supplies to U.S.-supported Ebola clinics. / Carol Han, USAID/OFDA

“For us, for WFP, we usually deal with delivering food,” Baddour explained. “Now, we were dealing with unfamiliar concepts like ETUs and working with different partners. But [being here] is really a great experience for me… and everyone is now working very well with each other.”

“It’s a totally different crisis,” said WFP logistician Mira Baddour at one of the warehouses in Liberia that her agency is running. “It has been challenging, but at the same time it is a really great experience for me.” / Carol Han, USAID/OFDA

“It’s a totally different crisis,” said WFP logistician Mira Baddour at one of the warehouses in Liberia that her agency is running. “It has been challenging, but at the same time it is a really great experience for me.” / Carol Han, USAID/OFDA

USAID’s Kelly Bradley, who is a veteran of several disasters, agrees that the experience has been personally rewarding.

“Think about the sheer volume of personal protective equipment that [has been] coming in,” said Bradley. “My unit is directly responsible for making sure that it gets to our partners… the Ebola health care workers on the frontlines. It’s a really big responsibility and a really rewarding thing to be a part of it all.”

Meet the team of experts with USAID, the U.S. military, and the UN World Food Program that have been working around the clock to transport, track and deliver critical medical supplies for the Ebola response. / Carol Han, USAID/OFDA

Meet the team of experts with USAID, the U.S. military, and the UN World Food Program that have been working around the clock to transport, track and deliver critical medical supplies for the Ebola response. / Carol Han, USAID/OFDA

ABOUT THE AUTHOR

The Ebola Disaster Assistance Response Team (DART) is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the U.S. Government, including USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), the U.S. Centers for Disease Control and Prevention (CDC), and the Departments of Defense and Health and Human Services.

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Training the Next Generation of Ebola Fighters

To learn how to safely treat Ebola patients while staying alive, doctors and nurses must learn how to navigate an Ebola “maze” run by the U.S. military in Liberia. / Carol Han, USAID

To learn how to safely treat Ebola patients while staying alive, doctors and nurses must learn how to navigate an Ebola “maze” run by the U.S. military in Liberia. / Carol Han, USAID

Walk into the gymnasium of the Liberian National Police Training Academy and you’ll come across a maze so bizarre—and as it turns out so high-stakes—that  successfully navigating it could mean the difference between life and death.

Welcome to the nerve center of the U.S. health care worker training program. It’s a replica of an Ebola treatment unit (ETU), where doctors, nurses, hygienists, and others learn how to safely care for Ebola patients while staying alive.


The U.S.-run Ebola health care worker training takes place at the Liberian National Police Academy, where the gymnasium has been transformed into a mock Ebola treatment unit.  / Carol Han, USAID

The U.S.-run Ebola health care worker training takes place at the Liberian National Police Academy, where the gymnasium has been transformed into a mock Ebola treatment unit. / Carol Han, USAID

“Everything is about safety—the safety of the staff and the safety of the patients,” said U.S. Army Colonel Laura Favand, who helps oversee the Ebola health care worker training program.

During the week-long class, students first spend three days in the classroom where U.S. military doctors, nurses and medics teach them every aspect of Ebola care, from diagnosis and patient recordkeeping to proper disinfection techniques and safe handling of the dead.

Cross-contamination is the biggest threat in an ETU, which is why there’s an entire class dedicated to proper hand-washing techniques. Another critical lesson: how to take off protective suits, goggles, and gloves without inadvertently contracting the disease.

According to Colonel Favand, this is one of the most vulnerable times for Ebola health care workers.


Taking off protective suits—like what’s being done here at a USAID-supported ETU in Sierra Leone—is a vulnerable time for health care workers. That’s why so much time is spent teaching health care workers how to prevent cross-contamination.  / Carol Han, USAID

Taking off protective suits—like what’s being done here at a USAID-supported ETU in Sierra Leone—is a vulnerable time for health care workers. That’s why so much time is spent teaching health care workers how to prevent cross-contamination. / Carol Han, USAID

“You’ll see someone getting ready to take their gloves off and their hands are shaking,” said Favand. “They know how important this is.”

Classroom time is followed by two days spent in the “mock ETU” where students are taught how to navigate in a clinical setting and practically apply all that they have learned. Actual Ebola survivors play the role of patients, offering invaluable insight into what actually happens in an ETU. According to participants, the survivors also help teach them how to communicate with patients.


Actual Ebola survivors play the role of patients at U.S. Ebola health care worker trainings, providing invaluable insight. Here, a student assesses a child patient and Ebola survivor during a training session in Greenville, Liberia under the watchful eyes of the instructor. / Col. Laura Favand, U.S. Army

Actual Ebola survivors play the role of patients at U.S. Ebola health care worker trainings, providing invaluable insight. Here, a student assesses a child patient and Ebola survivor during a training session in Greenville, Liberia under the watchful eyes of the instructor. / Col. Laura Favand, U.S. Army

“We learn some different terms in Liberian English that allows us to have a more accurate perception of the patient,” said Ephraim Palmero, medical director for the International Organization of Migration, an organization being supported by USAID to run three U.S.-built ETUs in Liberia.

“For example, instead of saying ‘how are you,’ Liberians ask, ‘how’s the body,’” Palmero explained.


On the Road: The U.S. military has deployed mobile training teams throughout Liberia to offer the same course to those who can’t travel to the main training site in the Monrovia metro area. / Carol Han, USAID

On the Road: The U.S. military has deployed mobile training teams throughout Liberia to offer the same course to those who can’t travel to the main training site in the Monrovia metro area. / Carol Han, USAID

Besides running the training at the Liberian police academy, the U.S. military deploys four mobile training teams throughout Liberia to offer the same course to health care workers who are unable to make it to Monrovia.  Liberian health officials — in charge of training the next generation of Ebola health care workers — also take the class.

“I love doing this mission,” said U.S. Army Captain Alex Ailer. “I like that people here are being helped and that we are also helping local people help themselves.”


U.S. Air Force Senior Airman Alexander Muniz and U.S. Army Captain Anna Bible take a break while teaching an Ebola health care training course in Harper, Liberia. They are part of a mobile training team. / Carol Han, USAID

U.S. Air Force Senior Airman Alexander Muniz and U.S. Army Captain Anna Bible take a break while teaching an Ebola health care training course in Harper, Liberia. They are part of a mobile training team. / Carol Han, USAID

As of early January 2015, more than 1,500 Liberian and international health care workers have taken part in the training, including several USAID partners that are now running the U.S.-built ETUs.

“The training was incredible and great for me because it alleviated my fears,” said Micaela Theisen with the International Organization for Migration. “It [made] me feel good and ready to get to work.”

Her colleague Catherine Thomas agreed.

“The staff there, their medical knowledge was very comforting to us who were just starting out.” said Thomas. “They were just great.”


(from left to right) Health care workers Catherine Thomas, Micaela Theisen, and Rene Vega—all working at USAID-supported ETUs—have taken the U.S. Ebola health care worker training course. “The training was incredible and great for me because it alleviated my fears,” said Theisen.  / Carol Han, USAID

From left to right: Health care workers Catherine Thomas, Micaela Theisen, and Rene Vega—all working at USAID-supported ETUs—have taken the U.S. Ebola health care worker training course. “The training was incredible and great for me because it alleviated my fears,” said Theisen. / Carol Han, USAID

 


The Ebola Disaster Assistance Response Team (DART) is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the government, including USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), the U.S. Centers for Disease Control and Prevention (CDC), and the Departments of Defense and Health and Human Services.

ABOUT THE AUTHOR

Carol Han is a Press Officer for the Ebola Disaster Assistance Response Team (DART), which oversees the U.S. Ebola response efforts in West Africa. The DART includes staff from across the government, including USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), the U.S. Centers for Disease Control and Prevention (CDC), and the Departments of Defense and Health and Human Services.

Feed the Future: Progress in the Goal of Ending Hunger

This post originally appeared on the U.S. Department of State DipNote blog.

Emiliano Dominguez Gonzalez displays his recently harvested strawberries in Honduras. Feed the Future helped nearly 7 million farmers like Emiliano last year boost harvests by using new and improved technologies and agricultural practices.  / USAID-ACCESO/Fintrac Inc.

Emiliano Dominguez Gonzalez displays his recently harvested strawberries in Honduras. Feed the Future helped nearly 7 million farmers like Emiliano last year boost harvests by using new and improved technologies and agricultural practices. / USAID-ACCESO/Fintrac Inc.

For generations, the United States has been a leader in providing development assistance across the globe to alleviate suffering. But global food price spikes and resulting instability in 2007 and 2008 were a wake-up call: More needed to be done to break the vicious cycle of hunger and poverty.

The answer: Unlock the potential of agriculture as the key to reducing hunger, extreme poverty and malnutrition through an initiative that became Feed the Future.

Ram Kumari Tharu displays her harvest in Nepal and smiles after collecting payment from a local trader. She’s tripled her annual income in just two years after extensive training on improved agriculture practices. / USAID NEAT

Ram Kumari Tharu displays her harvest in Nepal and smiles after collecting payment from a local trader. She’s tripled her annual income in just two years after extensive training on improved agriculture practices. / USAID NEAT

In just a few short years, Feed the Future is already changing the face of hunger and poverty for some of the world’s poorest families.  In May 2014, Feed the Future released its Progress Report on FY 2013 results , revealing that the initiative reached nearly 7 million smallholder farmers globally with new technologies and, together with the United States’ Global Health Initiative, reached 12.5 million children with effective nutrition services.

In 2014, the U.S. Government and its partners continued to build on Feed the Future’s early success to drive real change on a large scale.  Here are several examples:

Building on its 2013 commitments to scale up improvements in international agriculture, the U.S. Government launched eight new projects in 2014 supporting improved seed enterprises and other technology providers to accelerate adoption and uptake by smallholder farmers of the most promising agricultural technologies. This $60 million investment will impact Feed the Future focus countries across Africa, Asia, and Latin America and the Caribbean.

 

In May, the U.S. Agency for International Development launched its first Multi-Sectoral Nutrition Strategy , laying out a roadmap to reduce chronic malnutrition by 20 percent through the Feed the Future and Global Health initiatives, the Office of Food for Peace development programs, resilience efforts and other nutrition investments. This strategy precedes a forthcoming, government-wide Global Nutrition Coordination Plan. During October and November, the Department of State led a U.S. Government delegation that successfully negotiated the Rome Declaration on Nutrition and the Framework for Action, which were adopted by global consensus at the Second International Conference on Nutrition, co-convened by the World Health Organization and the Food and Agriculture Organization. Food security and nutrition will continue to be at the forefront of U.S. diplomatic efforts and ongoing negotiations on the Sustainable Development Goals in the Post-2015 framework, which build on the Millennium Development Goals.

In September, as global leaders gathered in New York City for the 69th Session of the UN General Assembly, Secretary of State John Kerry and Secretary of Agriculture Tom Vilsack helped launch the Global Alliance for Climate Smart Agriculture during the United Nations Climate Summit, which called on government, finance, business and civil society leaders to take action on climate change. The Alliance advances a global, evidence-based approach to food security and represents an ambitious step in U.S. efforts to integrate a holistic approach to climate change in every area of our work.

Sulton Tukhtaev, a smallholder farmer in Tajikistan, holds his grandchild. Feed the Future has helped his family grow fruits and vegetables in their kitchen garden for income and nutrition. Last year, Feed the Future helped reach more than 12 million children with nutrition interventions. / USAID

Sulton Tukhtaev, a smallholder farmer in Tajikistan, holds his grandchild. Feed the Future has helped his family grow fruits and vegetables in their kitchen garden for income and nutrition. Last year, Feed the Future helped reach more than 12 million children with nutrition interventions. / USAID

In September 2014, members of both the U.S. Senate and House of Representatives introduced authorizing legislation to codify and strengthen Feed the Future’s comprehensive approach to cultivating the transformative potential of agriculture sector-led growth. HR 5656 — the Feed the Future Global Food Security Act of 2014 — passed by a voice vote in the House of Representatives with strong bipartisan support in December.

Housed at some of the top U.S. universities, Feed the Future Innovation Labs are on the cutting edge of efforts to research, develop and scale up safe and effective agricultural technologies that can help feed a growing population.

Housed at some of the top U.S. universities, Feed the Future Innovation Labs are on the cutting edge of efforts to research, develop and scale up safe and effective agricultural technologies that can help feed a growing population.

Each of these examples is helping to create momentum for efforts this year, as we pursue a long-term vision of a world where the scourge of hunger, poverty, and malnutrition no longer threaten global peace and prosperity.

As we start 2015, please take a moment to learn about global hunger and consider what you can do to help end it.  You can start by reading Feed the Future’s “Year in Review” to learn more about our efforts and find out ways you can be involved.  You can also follow @FeedtheFuture for the latest information.

ABOUT THE AUTHOR

Nancy Stetson serves as U.S. Special Representative for Global Food Security at the U.S. Department of State, and Tjada D’Oyen McKenna is the Deputy Coordinator for Development for Feed the Future, the U.S. Government’s global hunger and food security initiative, as well as the Assistant to the Administrator in the U.S. Agency for International Development’s (USAID) Bureau for Food Security.

“I remember it like it was yesterday. The entire city just shrunk.”

Within mere seconds, more than 200,000 people were killed, and 1.5 million were displaced from their homes.  Buildings were completely destroyed. Phone connections were down. The scene was, in short, total devastation. It was January 12, 2010—five years ago today—when a magnitude 7.0 earthquake rocked Port-au-Prince and forever changed Haiti.

This earthquake would have been calamitous and overwhelming anywhere, but in Haiti—a poor country with weak building infrastructure—it hit at the heart, in the populous capital city, creating a massive urban disaster.

USAID’s Haiti Earthquake Disaster Assistance Response Team Leader Tim Callaghan and USAID Administrator Raj Shah during the 2010 response.  / USAID.

USAID’s Haiti Earthquake Disaster Assistance Response Team Leader Tim Callaghan and USAID Administrator Raj Shah during the 2010 response. / USAID.

As Team Leader for USAID’s Disaster Assistance Response Team (DART), I deployed in the first 24 hours and witnessed firsthand the perfect storm of challenging response issues: no communication as all phone connections were down; 1.5 million people were instantly displaced, with no shelter; in seconds, children were orphaned; Haitian Government officials and local disaster responders were affected themselves; transportation was severely hampered by the rubble; there was a myriad of health and nutrition concerns; and death was everywhere.

USAID-supported programs helped remove more than 50% of the total rubble cleared by the international community. / U.S. Navy, Chief Mass Communication Specialist Robert J. Fluegel

USAID-supported programs helped remove more than 50% of the total rubble cleared by the international community. / U.S. Navy, Chief Mass Communication Specialist Robert J. Fluegel

Rubble literally filled the streets. We found out later that the earthquake had generated enough rubble to fill dump trucks lined up from Maine to Florida twice. On the ground, this meant major obstacles to delivering life-saving assistance. It also required our DART to have a large urban-search-and-rescue (USAR) component with over 500 USAR members at its peak. These teams worked tirelessly, crawling through broken buildings, to find and save people who were trapped inside. One of my proudest memories was being on site early one morning around 3 a.m. to see our USAR teams pull people out of the wreckage. It is something I will never forget.

Members of the Los Angeles County Fire Department Search and Rescue Team rescue a Haitian woman from a collapsed building in downtown Port-au-Prince. The woman had been trapped in the building for five days without food or water. / U.S. Navy, Mass Communication Specialist 2nd Class Justin Stumberg

Members of the Los Angeles County Fire Department Search and Rescue Team rescue a Haitian woman from a collapsed building in downtown Port-au-Prince. The woman had been trapped in the building for five days without food or water. / U.S. Navy, Mass Communication Specialist 2nd Class Justin Stumberg

In addition to so many Haitian lives tragically taken on that day, several American colleagues from the U.S. Embassy also perished—the first time I had ever worked on a disaster response where this was the case.

Yet it’s during times like the Haiti earthquake that I am so vividly inspired by the mandate of the office I work for—USAID’s Office of U.S. Foreign Disaster Assistance—which is to save lives and alleviate human suffering. The DART did that in Haiti five years ago, rapidly providing humanitarian assistance and care to those in need. I was honored to manage a team of dedicated people who worked 20-hour days for weeks on end in grueling conditions.

Looking back, I also will never forget the incredible resilience and strength of the Haitian people. They lost so much, and yet were willing to roll up their sleeves amid all the tragedy to work with us in every way possible to build back their lives. The people of Ravine Pintade—one of the hardest hit areas—joined us and our partners Global Communities and Project Concern International to transform their devastated neighborhood into a model community.

Since 2010, USAID has continued to work together with the people of Haiti and their local and national governments traversing the long road from recovery to development and helping mitigate the damage of future crises. We’ve increased communities’ disaster resilience through preparedness and response planning, support to emergency operations centers and evacuation shelters, and small-scale infrastructure projects like retaining walls and drainage systems. We’ve also helped improve local capacity by training locals to handle disaster response efforts—everything from preparing first responders to designating leadership roles to managing relief supplies.

Haiti is vulnerable to many disasters including earthquakes, hurricanes, and flooding; but through these disaster risk reduction efforts, USAID is helping Haiti become more capable of preparing and responding to whatever disaster may strike next.

ABOUT THE AUTHOR

Tim Callaghan is the Senior Regional Advisor for Latin America and the Caribbean for USAID’s Office of U.S. Foreign Disaster Assistance. During the 2010 Haiti earthquake response, Callaghan served as USAID’s Disaster Assistance Response Team Leader.

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