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Saving Korto and Josephine

This post originally appeared December 31, 2014 on the International Medical Corps website. It has been reposted here with permission.

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Photo courtesy of International Medical Corps

Bong County, Liberia – Korto was admitted to International Medical Corps’ Ebola Treatment Unit (ETU) in late November, while her four-month old daughter Josephine, who tested negative for Ebola, was cared for nearby. Although deeply saddened by being separated from her young baby, Korto maintained such positivity during her treatment. The whole medical team couldn’t help but believe she was going to make it and see her daughter again.

On December 3, a delegation from the U.S. government was visiting the ETU. This happened to be the same day Korto finally received her negative Ebola test, clearing her for discharge. Korto left the patient ward giggling, laughing, and soaking in the cheers from the delegation and ETU staff, and she was finally reunited with Josephine that day.

Korto noticed late that evening that Josephine had diarrhea, as well as a cough and fever. The next morning, Korto was back at the ETU, and our whole team sighed with the saddest disappointment. Seeing mother and baby back in the patient ward was difficult, but our doctors, nurses, and psychosocial support staff encouraged Korto to keep breastfeeding, which provides the best source of nutrition for an infant.

For more than two weeks, Josephine’s condition fluctuated. She would become very sick one day, then a bit stronger the next day, and then very feverish the next. Because Josephine was so small, the only way to give her the additional fluids she needed was through an intravenous drip placed in a vein on her head. There were several days when we held our breath, hoping to see Josephine alive as we began each shift. Eventually she gained strength. Her eyes were no longer puffy and tired but became bright and attentive. She held her little head, now shaved for the IV, higher and higher each day.

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Photo courtesy of International Medical Corps

Finally on December 22, our colleague from the U.S. Navy lab, brought in to expedite Ebola testing in the area, could not hide the excitement in his voice when he relayed the news to the team. Josephine had tested negative for Ebola. Many tears of joy flowed from all of our staff and about everyone else who heard the news. Korto, of course, started dancing and clapping, smiling big with her grin we all love. And for the first time in weeks, Josephine let a small smile peek through.

We have all seen so much devastation working on this outbreak in West Africa. In our ETU, we’ve lost several young patients, but bright moments like seeing Korto and Josephine together and well spur our team to continue the fight against Ebola alongside our partners and the people of Liberia.

To date, International Medical Corps’ Ebola Treatment Unit in Bong County, Liberia, has discharged 74 survivors, including Korto and Josephine. International Medical Corps is operating an additional ETU in Margibi County, Liberia, and has trained over 150 health care and other workers in Liberia to date, including senior management and experts from the Liberian Ministry of Public Works, Ministry of Health and Social Welfare, and the Ministry of Defense. In addition, International Medical Corps teams are also working to fight Ebola in Sierra Leone and Mali.

Breaking New Ground: A Different Approach to Building Ebola Clinics in Liberia

Liberian capital of Monrovia and is close to the border with Cote d’Ivoire. It’s one of 15 locations where the U.S. is building and staffing Ebola treatment units in Liberia. / Carol Han, USAID

The town of Zwedru is approximately 300 miles east of the Liberian capital of Monrovia and is close to the border with Cote d’Ivoire. It’s one of 15 locations where the U.S. is building and staffing Ebola treatment units in Liberia. / Carol Han, USAID

“It looks like something out of Gilligan’s Island,” said one visitor.

“It reminds me of Southeast Asia,” said another.

These are not the comments one typically overhears while visiting an Ebola treatment unit (ETU) facility in Liberia. But then, the ETU in the town of Zwedru—about 300 miles east of Monrovia—is far from typical.

The Zwedru Ebola treatment unit (ETU)—the first ETU in southeast Liberia—took six weeks to build. USAID funded Welthungerhilfe, a German non-governmental organization, to construct this and 3 other ETUs in Liberia. / Carol Han, USAID

The Zwedru Ebola treatment unit (ETU)—the first ETU in southeast Liberia—took six weeks to build. USAID funded Welthungerhilfe, a German non-governmental organization, to construct this and 3 other ETUs in Liberia. / Carol Han, USAID

The first thing you notice is the bamboo. It lines the outside of all the structures, from the patient triage area to the visitor’s tent. As it turns out, there is a practical reason for using this decorative material.

In Liberia, where temperatures routinely climb into the 90s, the inside of the clinical care tents can be suffocatingly hot—a danger not only for the patients who are losing critical fluids but also for the health care workers clad in layers of protective clothing.

“I used bamboo because it is hollow and helps absorb the heat,” explained Thomas ten Boer with the German non-governmental organization (NGO) Welthungerhilfe, which USAID is funding to build four ETUs in Liberia. “Feel the plastic on the inside of the tent, it is cool to the touch.”

Engineers of the USAID-funded Zwedru (ETU) used bamboo to line the buildings because the hollow reeds capture heat and help keep the interiors cool. / Carol Han, USAID

Engineers of the USAID-funded Zwedru (ETU) used bamboo to line the buildings because the hollow reeds capture heat and help keep the interiors cool. / Carol Han, USAID

The bamboo and all the other construction materials used to build the ETU were purchased locally, a move that kept costs down while also helping the community. Welthungerhilfe purchased gravel from local workers who hammered rock into small pieces by hand. These workers—and the more than 260 local people hired to build the ETU—in turn, had more disposable income to spend. Now, even the man selling meat sticks outside the facility has more money in his pocket.

“You include the community and it helps them accept your project and gives them hope,” said ten Boer.

Thomas ten Boer, the project manager for the Zwedru ETU, had to deal with stuck trucks, construction materials shortages, and the rainy season to construct the facility and three others for USAID. / Carol Han, USAID

Thomas ten Boer, the project manager for the Zwedru ETU, had to deal with stuck trucks, construction materials shortages, and the rainy season to construct the facility and three others for USAID. / Carol Han, USAID

The construction team encountered road bumps along the way—literally. Zwedru is a 10-hour drive from Monrovia along pitted roads that were impassable until mid-November due to the rainy season. When trucks started moving, they often got stuck for days. Then, there was the shortage of construction materials.

ten Boer’s team had purchased all the cement available in Southeastern Liberia. More was needed, but driving it from Monrovia was out of the question given the road conditions. The U.S. military had to be brought in to transport additional cement by helicopter.

“What has been pulled off here has been really amazing,” said Welthungerhilfe Country Director Asja Hanano.

Inside the confirmed ward of the Zwedru ETU: the ETU is expected to start receiving patients by Christmas. “We pray that no patient will come here,” said one local official. / Carol Han, USAID

Inside the confirmed ward of the Zwedru ETU: the ETU is expected to start receiving patients by Christmas. “We pray that no patient will come here,” said one local official. / Carol Han, USAID

For head engineer Daniel Dined—known as the “mastermind” of the project—designing the USAID-supported ETU has been a personal mission. It allowed him to use his technical expertise in a way he never imagined to help his country.

“For the past few years, I’ve been working for humanitarian organizations so I’ve been helping people,” Dined said. “But working for the Liberian people, that’s my primary goal, and I love doing that.”

Team effort: USAID is supporting NGO Welthungerhilfe to build the Zwedru ETU; Partners in Health to provide health care; and PAE to manage the facility. / Carol Han, USAID

Team effort: USAID is supporting NGO Welthungerhilfe to build the Zwedru ETU; Partners in Health to provide health care; and PAE to manage the facility. / Carol Han, USAID

Community leaders were invited to take a tour of the ETU soon after construction wrapped up. Hands touched the bamboo. Many had praise for the construction workers who built the facility. Despite all this, no one expressed excitement about the inevitable next step.

Dr. Elsie Karmbor of the Zwedru County Health Office said it best, “We pray that no patient will come here.”

Known as the “mastermind,” Daniel Dined is the head engineer who designed the Zwedru ETU and three others for USAID in southeastern Liberia. “Working for the Liberian people, that’s my primary goal and I love doing that,” Dined said. / Carol Han, USAID

Known as the “mastermind,” Daniel Dined is the head engineer who designed the Zwedru ETU and three others for USAID in southeastern Liberia. “Working for the Liberian people, that’s my primary goal and I love doing that,” Dined said. / Carol Han, USAID

ABOUT THE AUTHOR

Carol Han is a Press Officer for the Ebola Disaster Assistance Response Team>

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.

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Lessons Learned a Decade after the Indian Ocean Tsunami

Ten years ago today, the Indian Ocean tsunami roared across more than 3,000 miles and a dozen countries from Southeast Asia to Africa, killing 200,000 people and leaving 40,000 missing. I remember watching the news from my parents’ kitchen, in the aftermath of Christmas, as hour by hour the enormity of the disaster registered on the world.  And it was Aceh, a conflict affected province of Indonesia, that suffered the greatest impact, accounting for nearly half of the total casualties.

Eight days later, I was in Aceh.   I will never forget the surreal sights and stench of such massive destruction.  In a humid heat, bodies were still trapped beneath towers of debris and piled along the road.  Boats were in trees and houses were upended.  Survivors and humanitarian workers alike had a dazed look.

The December 2004 Indian Ocean tsunami was one of the worst natural disasters in recorded history, destroying lives, homes, and livelihoods. In the disaster’s immediate aftermath, USAID provided emergency support in the form of food, shelter, water, sanitation, and medical supplies. In the years that followed, USAID has continued to work alongside survivors to help affected communities rebuild and create jobs.

The December 2004 Indian Ocean tsunami was one of the worst natural disasters in recorded history, destroying lives, homes, and livelihoods. In the disaster’s immediate aftermath, USAID provided emergency support in the form of food, shelter, water, sanitation, and medical supplies. In the years that followed, USAID has continued to work alongside survivors to help affected communities rebuild and create jobs. / USAID

In the face of this utter tragedy, the world mobilized to save lives and reconstruct.  The tsunami generated an unprecedented outpouring of support from the international community. Indonesia received more than $7 billion in aid, the most generous response ever to a natural disaster.  In three years, Indonesia built new airports, roads, schools, and over 130,000 new homes.

USAID was front and center in the response, deploying a multi-country Disaster Assistance Response Team to the most affected areas immediately following the tsunami. USAID’s Office of U.S. Foreign Disaster Assistance and Food for Peace provided more than $96 million in emergency support in the form of food, shelter, water, sanitation, and medical supplies. In the immediate aftermath USAID airlifted 20,000 kitchen sets, 20,000 mosquito nets, 8,400 ten-liter water containers, 2,000 hygiene kits, 230 rolls of plastic sheeting, and two 12,000-liter water bladders. Partners built or rehabilitated more than 1,600 water systems in villages throughout Aceh, benefitting more than 77,000 people. Repaired sewages systems and sanitation facilities improved hygiene conditions for over 90,000 people. In the years that followed, USAID has continued to work alongside survivors to help affected communities rebuild and create jobs.

So what have we learned since 2005? Below are six lessons that inform the way we respond to disasters a decade after the Indian Ocean tsunami:

1. Early Warning Leads to Early Action

Although there was a lag of several hours between the earthquake and the tsunami, almost all of the victims of the Indian Ocean tsunami were taken by surprise, because there were no early detection or early warning systems in place.   In the aftermath of the tsunami, USAID provided $16.6 million to support the development of the Indian Ocean Tsunami Warning System (IOTWS), an integrated early warning and mitigation system that allows countries in the Indian Ocean region to detect and prepare for tsunamis and other coastal hazards. When the Banda Aceh earthquake struck in 2012, the IOTWS system successfully alerted communities across the Indian Ocean and millions of people were able to move away from the coastline.  As a result of these and other early warning efforts, countries and communities, USAID and its development partners are better prepared to respond and mitigate the impact of disasters before they strike.

In addition to aiding recovery and reconstruction, USAID has supported the development of a tsunami warning system in the Indian Ocean region to help governments detect and prepare for tsunamis in the future. / USAID

In addition to aiding recovery and reconstruction, USAID has supported the development of a tsunami warning system in the Indian Ocean region to help governments detect and prepare for tsunamis in the future. / USAID

2. Effective Civil-Military Cooperation is Essential

More than 15,000 U.S. soldiers participated in Operation Unified Assistance, the U.S. military’s response to the Indian Ocean tsunami.  Without the unique strategic and tactical lift capabilities of the military, we would not have reached remote places with life-saving supplies as quickly.  Yet, civil-military coordination was a major challenge, with 17 militaries and hundreds of international NGOs responding.  Over the past decade, UN agencies, donors, relief organizations, and the U.S. and other militaries have learned to coordinate more effectively on disaster responses, from the 2010 earthquake in Haiti to last year’s typhoon in the Philippines. USAID’s Office of Foreign Disaster Assistance is the designated U.S. government lead agency in disasters and has worked closely with the military and other U.S. government agencies to create a more seamless system for calling forward needed capabilities. In the current Ebola crisis, USAID and the U.S. military are working hand in glove to sustain an agile and effective response to one of the most complex emergencies of our time.

3. Focus on Jumpstarting Economies

In Aceh, Indonesia, USAID, in partnership with Chevron developed and hosted three-month vocational courses for hundreds of young people from the region, like Junaidi and Syahrizal (pictured). Courses ranged from welding and masonry to bookkeeping and automobile repair. These courses gave graduates the skills they needed to rebuild their communities, and also improved their ability to find jobs with higher wages. / USAID

In Aceh, Indonesia, USAID, in partnership with Chevron developed and hosted three-month vocational courses for hundreds of young people from the region, like Junaidi and Syahrizal (pictured). Courses ranged from welding and masonry to bookkeeping and automobile repair. These courses gave graduates the skills they needed to rebuild their communities, and also improved their ability to find jobs with higher wages. / USAID

In Indonesia, the 2004 tsunami completely razed coastal towns like Banda Aceh, but left others further from the shore untouched. The massive outpouring of aid in the aftermath of the tsunami provided life-saving relief to devastated communities, but also threatened to create a second crisis by smothering local markets that remained active across the country. The tsunami helped catalyze a greater understanding of the power of pivoting quickly from delivering commodities to a focus on using cash for work and other strategies to revive local markets.  USAID supported cash-for-work recovery projects that employed 70,000 people, and helped finance the construction of 278 fishing boats to revive Aceh’s fishing industry. In partnership with Chevron, USAID also developed and hosted three-month vocational courses for hundreds of young people in Aceh, like Junaidi and Syahrizal (pictured above). In the decade since the tsunami, the humanitarian community has increasingly recognized the value of cash-based approaches to emergency responses. USAID has continued to be a trailblazer in these efforts, using mobile e-payments and harnessing public-private partnerships to help jumpstart economies after a crisis, including in the aftermath of Typhoon Haiyan.

4. Give Cash, not Goods

The second stop on my 2005 trip was Sri Lanka, where I encountered a depot of donated goods—a new shipment of bikinis, ties and other donations clearly ill-suited to meet the needs of ordinary people trying to survive the aftermath of the tsunami. The outpouring of generosity after the Indian Ocean tsunami was truly impressive and unprecedented. However, it also led to massive “goodwill dumping,” as well-meaning people flooded the region with unnecessary goods that overwhelmed transit points and ended up as trash. As this experience and many other disasters have illustrated, donating cash instead of goods is always the best option, allowing victims to get the quickest access to basic items in local markets

5. Disasters Can Spur Conflict Resolution

The Indian Ocean tsunami caused massive social upheaval, uprooting the lives and livelihoods of hundreds of thousands of people.  Sinhalese and Tamil communities came together in Sri Lanka around the common enemy of a natural disaster.  In Sri Lanka, I saw an Office of Transition Initiatives program that brought together Sinhalese and Tamil youth to work side by side to clean the debris and rebuild their communities. And, recognizing that their own people needed to rebuild not fight, the Free Aceh movement signed a peace deal with the Indonesian government in August 2005. Indonesia’s experience sparks important lessons for how— if given the right circumstances and leaders willing to put their people first— disaster response can catalyze opportunities for peace and inclusive governance.

6. Build Resilience

Most importantly, we know that tsunamis, typhoons, droughts and other shocks will continue to batter communities, hitting the most vulnerable the hardest.  Since 2011, USAID has been at the forefront of a global conversation on building resilience.  We know that all our development gains can be wiped out in an instance if households, communities, countries and regions are not better able to adapt, prepare, and recover from the shocks we know will continue to occur. That is why in partnership with the Rockefeller Foundation and Swedish sida, we launched the Global Resilience Partnership, which will drive evidence-based investments and innovations that enable cities, communities, and households to better manage and adapt to inevitable shocks.

ABOUT THE AUTHOR

Nancy Lindborg is the USAID Assistant Administrator for the Bureau for Democracy, Conflict and Humanitarian Assistance. Follow her @nancylindborg

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Why Strengthening Civil Society Matters + Co-Creating Solutions Rocks

A team focused on the Middle East and North Africa collaborates on challenges facing civil society at the Civil Society İnnovation initiative workshop in Istanbul, Turkey, Nov. 6, 2014. / Joshua Haynes, USAID

A team focused on the Middle East and North Africa collaborates on challenges facing civil society at the Civil Society İnnovation initiative workshop in Istanbul, Turkey, Nov. 6, 2014. / Joshua Haynes, USAID

USAID is facing a development challenge that is not discussed as much as higher profile threats like Ebola, climate change or extreme poverty, but one that threatens to exacerbate all of those crises and impede the world’s ability to ameliorate them. It’s the growing restrictions against freedom of association, assembly and expression.

In the past two years, over 50 laws limiting civil society space have been proposed or enacted by governments around the world trying to tame the power of citizens to meet, organize, write and inspire, according to the International Center for Not-for-Profit Law, a USAID partner.

For example, in Kyrgyzstan, the government is considering a law that would echo the draconian stifling of dissent in Russia. In Kenya, the government is again floating a law that would restrict civil society organizations (CSOs) from accessing foreign funding. Again and again, we are seeing these restrictions in an increasing number of countries around the world, even those with democratically elected governments.

As a small aid agency, USAID relies on international and local CSOs that do the work of development. We also support the development of vibrant civil society sectors where we work because we know that civil society is necessary for the growth of democracy, which is in turn necessary to sustain development outcomes.

Workshop participant Josh Machleder of Internews uses a creative prop during the “product in a box” exercise explaining how to nurture civil society activism under restrictive conditions. / Reboot

Workshop participant Josh Machleder of Internews uses a creative prop during the “product in a box” exercise explaining how to nurture civil society activism under restrictive conditions. / Reboot

So this backlash against civil society affects not only USAID’s democracy work, but its work in all sectors, including health, humanitarian assistance, the environment, education and economic growth.

In response to these headwinds, President Obama launched the Stand with Civil Society initiative in 2013, where he called on governments, multilaterals and private philanthropy to explore innovative ways to support civil society. USAID took up that challenge. At the Clinton Global Initiative in September 2014, the president announced the Civil Society İnnovation Initiative (CSİI): USAID, together with the Swedish International Development Cooperation Agency (Sida), the Aga Khan Development Network and other partners, will develop up to six regional civil society innovation hubs that will connect CSOs to each other through peer-to-peer learning and to tools (technological and otherwise) to support their work and amplify the voice of civil society.

But how can USAID launch a new program designed to support civil society and protect its space without input from civil society? More than soliciting input, USAID wanted to create a process that would allow civil society to co-design the CSI with us.

That’s where the Global Development Lab came in. The Lab is not only fostering innovative solutions to development problems, it is also exploring process innovations to make USAID a more nimble, smarter donor. The Development Innovation Accelerator is a new instrument that lets USAID co-create a program with its partners to allow more dialogue and input from many more stakeholders and create a more transparent process for project design.

USAID’s Swedish colleagues were along for every step of the way and, in July, we put out a call for expressions of interest for the CSI. We received over 300 responses from 85 countries around the world. Then we invited 45 of the applicants to a three-day co-creation workshop in Istanbul in early November.

I took a number of lessons away from the workshop.

First, the co-creation process generates a better outcome than the more traditional donor-led method of project design. One CSO called it an actual “consultation” and not an “insultation,” where civil society has two minutes to speak in front of a government/donor entity.

Second, expert facilitation is key. We had an incredibly diverse group of CSOs (international, regional, national, grassroots), representing many sectors (human rights, democracy, health, environment, humanitarian assistance). The more diverse the group, the more time needs to be spent on getting everyone on the same page.

Third, co-creation is complicated, but it’s worth the extra investment of time. It was clear that this global workshop will need to be followed by workshops at the regional level to bring in more regional, national and grassroots voices.

Only the energy, creativity and courage of civil society will stop the trend of governments to restrict citizens’ voices and assembly. The challenges are daunting and dangerous. But CSOs are not alone in fighting against the obstacles. USAID, Sida and the global civil society sector support them.

And that’s why co-creation rocks: It enables USAID to be a more open donor, one that is not only listening to civil society, but is also encouraging it to help solve development challenges. This was USAID’s most ambitious co-creation to date. It took a lot to bring it about, but it was worth the investment if it shifted the USAID-civil society relationship a step closer to true partnership.

ABOUT THE AUTHOR

Claire Ehmann is Civil Society and Media Division Leader for USAID’s Center of Excellence on Democracy, Human Rights and Governance

A Spotlight on the World’s ‘Invisible’ Workers

Haitian construction workers in the Dominican Republic include an estimated 900,000 to 1.2 million undocumented migrants. The USAID Global Labor Program is supporting research and advocacy for international standards to protect their rights. / Ricardo Rojas

Haitian construction workers in the Dominican Republic include an estimated 900,000 to 1.2 million undocumented migrants. The USAID Global Labor Program is supporting research and advocacy for international standards to protect their rights. / Ricardo Rojas

USAID invests in people and their communities. But the people who do the most to bring wealth, infrastructure and services to a globalizing world may be those who leave their communities behind. They are construction workers, nurses, dishwashers, farm workers and maids. They are not likely to vote, or be leaders in their communities, or even lead their own households. But they do provide nearly half of all financial flows to developing country economies. They are the world’s 232 million migrant workers.

“Than,” one of many Burmese migrant worker in Thailand’s fishing industry, who face some of the worst abuse in the world.  / Jeanne Marie Hallacy, Solidarity Center

“Than,” one of many Burmese migrant worker in Thailand’s fishing industry, who face some of the worst abuse in the world. / Jeanne Marie Hallacy, Solidarity Center

“Than,” whose full name is protected for his privacy,is a 16-year-old Burmese boy who came to Thailand with his parents to find work. He works on fishing boats, earning only a little over $200 for an entire one-month boat journey. His father was arrested for not having a work permit, so now Than must provide for his two younger sisters, and earn back the money his family paid for a labor broker to bring them across the Thai border. His sisters hope to attend a school for migrants. Than only completed a sixth grade education.

Than is one of the luckier ones. Many Burmese migrant workers in Thailand’s seafood industry are little more than forced laborers. A report by the Solidarity Center found many workers were forced to work 16 to 20 hours a day and went without pay for months. Employers told workers their wages were being used to repay the labor brokers who brought them to Thailand.

Unemployment and underemployment have forced over half of Dominican Republic workers, many domestic workers from Haiti, into the precarious informal economy.  USAID’s partner Solidarity Center is supporting these workers to organize for their rights. / Solidarity Center

Unemployment and underemployment have forced over half of Dominican Republic workers, many domestic workers from Haiti, into the precarious informal economy. USAID’s partner Solidarity Center is supporting these workers to organize for their rights. / Solidarity Center

Thanks to interventions supported by USAID, some of these workers have been able to win back wages and better working conditions.

Even when migration is voluntary, life can be very difficult. Domestic workers migrating from Asia to the Middle East often lose the ability to communicate with their families or even their children; yet they keep working for wages they hope will enable those children to have a better life.

Even though migrant workers’ contributions to global financial flows are stunning (in 2014, remittances from expatriate workers were estimated to be $436 billion up from $132 billion in 2000), these workers are almost never the beneficiaries of any development program. They are largely invisible, restricted by law from participating in political or civic life in their countries of destination, and cut off from family and community ties in their countries of origin. They fall outside of human rights norms, and therefore are often victims of exploitation.

Between 2 million and 4 million migrant workers toil in Thailand as dockworkers, in seafood and domestic work. / Jeanne Marie Hallacy, Solidarity Center

Between 2 million and 4 million migrant workers toil in Thailand as dockworkers, in seafood and domestic work. / Jeanne Marie Hallacy, Solidarity Center

However, human rights advocacy organizations are beginning to advocate for the rights of these workers in new and innovative ways, and USAID is supporting a range of activities in several countries with high numbers of migrating workers.

According to the national census data in Nepal, as of 2011 over 700,000 Nepalis were recorded as working in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates, with over a quarter of the country’s GDP coming from remittances. Unfortunately, too many Nepali workers are also exploited and trafficked as they migrate for work and in the destination country.

In Qatar, it’s been reported that more than 400 Nepali workers have already lost their lives working on World Cup construction sites. To help thwart the exploitation that may occur in the labor recruitment and migration process for foreign employment, USAID’s CTIP Project in Nepal has established 250 Safe Migration Networks to help educate community members on safe migration and monitor those who do migrate for employment. Much more needs to be done, such as ensuring ethical labor recruitment practices in countries of origin and decent working conditions in countries of destination.

The Thai fishing industry in Thailand has been described as being built on the slavery of migrant workers from Burma, Cambodia, and Laos. / Jeanne Marie Hallacy, Solidarity Center

The Thai fishing industry in Thailand has been described as being built on the slavery of migrant workers from Burma, Cambodia, and Laos. / Jeanne Marie Hallacy, Solidarity Center

USAID’s Global Labor Program has elevated the profile of some of the world’s most invisible workers: domestic workers around the world. A successful global campaign led by representatives of migrant domestic workers themselves succeeded in winning a new international convention on the rights of domestic workers, and bringing them from their homes into the world’s spotlight.

On this International Migrants Day, civil-society groups from around the world are presenting a framework for migration and development called the “Stockholm Agenda” to U.N. Secretary General Ban Ki-Moon. This initiative is a starting point for a broad and robust dialogue on how to ensure we spotlight and support the world’s migrant workers. It is our shared responsibility to ensure that “migration works for all.”

ABOUT THE AUTHORS

Bama Athreya is a Labor and Employment Rights Specialist
Marina Colby is a Senior Counter-Trafficking in Persons Advisor
Both work in USAID’s Center of Excellence on Democracy, Human Rights and Governance

A Look into the Hot Zone of Sierra Leone’s New Ebola Clinic

“Death is always difficult,” said Elizabeth Stevens, a nurse from Freetown, Sierra Leone.
At her new job, Stevens is forced to confront this stark reality every day, and in a way that she never has before.

“The first day, when I entered the [medical] ward, I was frightened,” said Stevens.  “But now it’s getting better.”

It’s been just a week since a new Ebola treatment unit (ETU) opened on December 1 in the town of Lunsar in Sierra Leone’s Port Loko district—an area with one of the highest rates of Ebola in the country. On its first day of operation, four patients were admitted to the facility being run by International Medical Corps (IMC) with USAID support. USAID provided more than $5 million for the staffing and management of the 50-bed ETU.

According to the ETU’s medical director, some of the facility’s 150 staff members were nervous to start caring for Ebola patients in spite of all the training they received. But by day three, things started coming together.

“For the first two days, you could see people’s anxiety…more of the fear of it being real,” said IMC medical director Vanessa Wolfman. “But we have a great psychosocial team to talk to staff about their fears.  Now we’re getting into a routine. Everyone’s much more comfortable and can rely on each other.”

This reliance and teamwork is evident even before the first patient is seen.  On one end of the medical complex, there’s a small group of people around emergency room nurse Lisa Woods, helping her get into the protective suit, gloves, apron, boots, and goggles that will keep her safe while treating Ebola patients.

“You don’t have any touch with the patients,” said Woods, her voice slightly muffled from the mask covering half her face; giant red goggles cover the other half. “I think that’s the hardest part, not being able to connect with my patients in a human way. Like right now there’s a 14-year-old in there, and boy, that’s hard.”

On the other end of the treatment complex, groups of men and women are washing hundreds of articles of clothing, boots, goggles, and gloves by hand. Right next to them, several people are hooking up a washing machine that was recently delivered—just in time to speed up the laundering process before more patients arrive and the ETU gets busier.

“We are really sympathetic with the patients,” said Idrissa Kamara, a nurse at the ETU. “These people are our people.  So we take great care of them because we don’t want to see them missing.”

Just then, the medical director announces that another ambulance is on its way with a confirmed Ebola patient. Idrissa and the other nurses walk out of the staff rest area, to suit up and take care of another one of their own.


12.4.14-IMC-Lunsar-ETU-one-of-few-places-where-food,-water-could-be-passed-from-safe-zone-to-hot-zone.-photo-Carol-Han-USAID-OFDA

A look into the hot zone: This is one of the few places where water and food could be passed from the safe zone to the patient areas. Orange fencing indicates the areas where staff must be wearing protective clothing. / Carol Han, USAID


12.4.14-Ambulance-delivers-new-patient-to-Lunsar-ETU.-Photo-Carol-Han-USAID-OFDA

An ambulance brings a patient to the newly opened Ebola treatment unit (ETU) in Sierra Leone’s Port Loko district, one of the areas hardest hit by the epidemic. / Carol Han, USAID


12.4.14-Look-inside-PPE-donning-area-at-USAID-supported-Lunsar-ETU-2-photo-Carol-Han-USAID-OFDA

USAID’s Office of U.S. Foreign Disaster Assistance provided $5 million dollars to staff and manage the ETU. USAID partner International Medical Corps (IMC) is running the facility. / Carol Han, USAID


12.4.14-IMC-Dr.-Lisa-Woods-at-Lunsar-ETU-in-middle-of-6-hour-shift-Photo-Carol-Han-USAID-OFDA

Lisa Woods is an emergency room nurse from San Francisco who came to Sierra Leone to work at the USAID-supported ETU.  “To give to somebody, what greater gift is that?” said Woods. Photo credit: / Carol Han, USAID


12.4.14-IMC-Lunsar-nurse-group-hero-shot-1-Photo-Carol-Han-USAID-OFDA

Most of the 150 people working at the ETU are Sierra Leonean. “All of us are working in unity,” said nurse Elizabeth Stevens (far left). / Carol Han, USAID


12.4.14-IMC-Lunsar-ETU-laundry-area-were-goggles-are-washed-1-photo-Carol-Han-USAID-OFDA

Hundreds of articles of clothing, goggles, boots, and gloves are washed every single day by hand. A newly installed washing machine will speed up the laundering process. / Carol Han, USAID


12.4.14-IMC-medical-dream-team-suits-up-for-another-round-in-clinical-ward.-photo-Carol-Han-USAID-OFDA

Dream Team: A group of nurses suit up to go into the patient ward during their six-hour shift. It takes teamwork not only to work with patients, but to get dressed for duty. “It’s really been a great experience,” said Lisa Woods (right). / Carol Han, USAID


12.4.14-IMC-Nurse-Idrissa-2-photo-Carol-Han-USAID-OFDA

“These people are our people,” said Idrissa Kamara, a nurse at the ETU. “So we take great care of them because we don’t want to see them missing.” / Carol Han, USAID

ABOUT THE AUTHORS

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.

South Sudan’s People Deserve Peace

South Sudanese refugee girls in Gambella, Ethiopia receive assistance from International Medical Corps, funded by the United States Government / IMC Ethiopia

South Sudanese refugee girls in Gambella, Ethiopia receive assistance from International Medical Corps, funded by the United States Government / IMC Ethiopia

As leaders of United States Government humanitarian efforts, we currently contend with a long list of global disasters, conflicts and disease outbreaks. Yet none fills us with as much frustration and despair as the crisis in South Sudan. Why? Because this crisis should never have happened.

In 2011, after many years of fighting for independence, the nation of South Sudan was born. Last year, the Southern Sudanese people were on track with the work of developing their nation—development they dreamed of during decades of war. Our plan was to phase out aid to those South Sudanese who had returned from exile. Helping the new government to govern justly and serve its people was the top priority.

But on this day one year ago, fighting triggered by discord between political leaders and fueled by ethnic rivalries broke out among soldiers in Juba, which set off a wave of violence that spread to the far reaches of the country. The result was death, destruction, and, once again, innocent people on the run.

On this sad anniversary, our thoughts are with the victims of this conflict, whose hopes and aspirations have been overtaken by tragedy. Children are out of school and families have been torn apart.

Today, South Sudan is the most food insecure country in the world with parts of the country on the brink of famine. Roughly one-third of people in the Greater Upper Nile region are facing a food emergency. In areas ravaged by violence, farmers cannot harvest their crops.

When violence broke out last December, the United Nations Mission in South Sudan (UNMISS) opened the gates of their compounds to civilians desperate for a safe place to hide from the violence. Today nearly 100,000 South Sudanese are still there, crowded together in tents and facilities that were not meant to house so many families. Some venture out to check on their abandoned homes, farms or businesses, but most are too frightened to leave.

 USAID food commodities are distributed at U.N. House Protection of Civilians (POC) site in Juba, where more than 32,000 people are seeking shelter. / K. Donovan, UNICEF

USAID food commodities are distributed at U.N. House Protection of Civilians (POC) site in Juba, where more than 32,000 people are seeking shelter. / K. Donovan, UNICEF

Nearly 500,000 South Sudanese are now living as refugees in neighboring countries. These countries’ willingness to take them in has saved many lives.

Aid workers are doing all they can to help millions of people. Their efforts, supported by the U.S. Government, other governments and aid donors, have helped stave off famine, saved lives and ensured the victims of South Sudan’s violence could get food, shelter, clean drinking water, health care and psychological support. But resources are limited and many are forced to live in terrible conditions where diseases thrive and hardships multiply.

Violence, however, continues to make it dangerous, difficult and expensive to reach and protect the victims of this conflict—and South Sudan was already a very challenging place to deliver aid. In August, six humanitarian aid workers in Maban County were attacked and killed, one World Food Program staff member is missing and other aid workers have been targeted.

Aid organizations resort to exorbitantly expensive air operations to deliver food. Moving food by air can cost eight times more than delivering it by trucks. This senseless crisis is straining available resources during a time of unprecedented global need. Yet unless the fighting stops, the specter of famine will continue to loom over South Sudan and innocent men, women and children will continue to suffer.

Regional peace talks have so far been unsuccessful. It is more urgent than ever that the warring parties recommit to the ceasefire declared in January—and this time, they need to mean it. In South Sudan, political leaders and military commanders should stop the fighting and put their people first.

ABOUT THE AUTHORS

Nancy Lindborg is Assistant Administrator for USAID’s Bureau for Democracy, Conflict and Humanitarian Assistance
Anne C. Richard is Assistant Secretary for Population, Refugees and Migration at the Department of State

Delivering More Bang for Development Bucks: Cost-Benefit Analysis and Feed the Future

Ireen Mapfumo, a Zimbabwean farmer, shows off a handful of protein-rich soybeans she harvested as one of eight lead farmers contracted by a USAID project in Zimbabwe. /  Fintrac Inc.

Ireen Mapfumo, a Zimbabwean farmer, shows off a handful of protein-rich soybeans she harvested as one of eight lead farmers contracted by a USAID project in Zimbabwe. / Fintrac Inc.

Now more than ever, development professionals and policymakers ask a fundamental question: Is a project worth the investment? Many are looking to cost-benefit analysis (CBA) for an answer.

Starting in 2009, USAID re-committed to cost-benefit analysis (CBA) as a critical tool for effective decision-making, and dramatically expanded its usage and training. CBA is an economic model that weighs strengths and weaknesses to determine how to implement or modify a project. USAID uses CBA to help determine when and where to invest for maximum results.

Feed the Future, Meet Cost-Benefit Analysis

Coinciding with this renewed interest in CBA was an increase in U.S. investment in global food security. At the 2009 G8 Summit in L’Aquila, Italy, President Obama called on global leaders to reverse a three-decade decline in agriculture investment. The U.S. Government’s global hunger and food security initiative, Feed the Future, embodied the U.S. contribution to this global commitment to reduce poverty, hunger and undernutrition.

Feed the Future wasn’t just a commitment of funding. It signaled a new way of doing development, founded in support of country-led efforts, deep partnership, and a relentless focus on results. It’s fitting, then, that Feed the Future became a critical player in the renewed push for incorporating CBA into USAID’s efforts.

As the lead agency for the Feed the Future initiative, USAID determined early on that it would roll out CBA analysis to Feed the Future countries through its overseas missions. This included specialized CBA training for agricultural officers and others working on Feed the Future’s early implementation so that CBA methods could be incorporated into agricultural program design.

Cost-Benefit Analysis Explained

CBA blends smart design with evidence to figure out if a project makes sense for the people USAID serves.

Analysts examine the incentives facing multiple stakeholders, including prices, profits, and losses over a long period of time. USAID uses this information to determine who is likely to win or lose as a result of a project, and adjusts design as necessary. Once the incentives are clear, the CBA model calculates the project’s costs and benefits.

Since we live in an inherently uncertain world, CBA analysts don’t stop there. CBA has helped Feed the Future projects account for volatile changes in circumstances, such as food price fluctuations over time.

Twenty-three missions around the world have used CBA to analyze or inform Feed the Future programming. Initial results have found that Feed the Future investments will achieve a 32 percent economic rate of return on average. By comparison, long term U.S. Government bonds only yield about three percent.

Perhaps even more important for the growth of CBA practice are the hundreds of USAID officers — including many agriculture officers — who have received training in how to incorporate CBA methods in program design. These agricultural officers will incorporate what they have learned into future projects, amplifying the effects of CBA.

USAID Cost Benefit analysis for Feed the FutureCreated by Gregory Gangelhoff

Cost-Benefit Analysis in Action

CBA is producing concrete results. In Haiti, USAID analysts conducted CBA of agricultural projects under Feed the Future West, an ongoing USAID program. Feed the Future West aims to modernize and create productive agricultural zones. Analysis determined that farmers would enjoy an internal rate of return (IRR) of 49 percent if all project targets were met. In other words, for every 1 dollar invested the host society receives an average of 49 cents in additional income over the project’s life.This result is significant: development institutions typically accept a minimum IRR of 12 percent for most projects.

Seventeen kilometers of improved roads in the Haitian mountain community of Fond-Baptiste now provide easy access to this local Monday market and larger markets on the coast. / Steve Goertz

Seventeen kilometers of improved roads in the Haitian mountain community of Fond-Baptiste now provide easy access to this local Monday market and larger markets on the coast. / Steve Goertz

USAID’s CBA analysts also examined how to remedy a shortage of rural roads in Haiti so that farmers could bring goods to market.

In Ethiopia, CBA helped guide $54 million in recent program planning. USAID estimates that these CBA-assisted programs have the potential to pull up to 400,000 people out of extreme poverty, explains Daniel Swift, an economist for USAID/Ethiopia.

In particular, USAID calculated the costs and benefits for Ethiopians of meat and dairy value chains as part of the Pastoralist Resiliency Improvement and Market Expansion (PRIME) project. The Mission’s original plan called for animal health and maintenance training, but CBA proved that the benefits of this training could not justify the investment. Instead, CBA led the mission to investments with more bang for the development buck.

This includes helping establish a meat processing plant that is expected to yield an estimated “$68 million in economic benefits for Ethiopia” in the form of a “tangible and sustainable market for poor pastoralists in the region,” according to Swift. Here and elsewhere, CBAs allowed decision makers to identify new opportunities and expand successful initiatives in the right places.

In concert with strategic analysis and a strong record of collaboration with private-sector partners, CBAs have become a part of the Feed the Future success story in this critical country.

Cost Benefit analysis in Feed the Future at USAIDCreated by Gregory Gangelhoff

CBA is more important than ever at USAID, but this work is far from complete. Tom DiVincenzo, USAID/Guatemala Mission Economist, notes that CBA analysts continue to seek new ways of explaining their work to decision-makers, who can struggle to fully understand the value of this type of analysis.

So what can the development community do to promote CBA and empower decision-makers in using it? Connect CBAs to “concrete examples” that non-economist decision-makers can understand easily, DiVincenzo notes. The results are worthwhile. When quantitative analysts work hand-in-hand with agricultural experts, their collaboration can plant the seeds for future prosperity.

ABOUT THE AUTHOR

Gregory Gangelhoff is an Economist in USAID’s Office of Economic Policy working on cost-benefit analysis, domestic resource mobilization, and growth diagnostics. Follow him @gwgangelhoff
Sally Rey is a Program Analyst in USAID’s Bureau for Food Security working on Feed the Future. Follow her @SalCary

Ending Extreme Poverty in Asia through Universal Health Coverage

A woman in the Philippines receives a tetanus shot during a pre-natal visit. / HealthPRO

A woman in the Philippines receives a tetanus shot during a pre-natal visit. / HealthPRO

The 2010 World Health Report on Health Systems Financing and the unanimous endorsement of Universal Health Coverage (UHC) by the United Nations in 2012 have paved the way for rich and poor countries alike to take a closer, more critical look at how raise resources and improve access to health services, particularly for the poor. Asia is home to 3.9 billion people and accounts for a third of the global economy. Despite the region’s robust economic growth, almost two thirds of those in extreme poverty still live in Asia.

While there are many paths that a country can choose to get out of poverty, mobilizing domestic resources towards the health sector – in the form of Universal Health Coverage policies that seek to increase access to services especially for the poor – is a sound and sustainable investment that can lead to great economic returns. These reforms that empower the poor are critical because poor health and health shocks are leading causes of chronic poverty and impoverishment.

An Indonesian patient awaits further instructions during a check-up. / USAID

An Indonesian patient awaits further instructions during a check-up. / USAID

Rapidly growing Asian countries, Bangladesh, Indonesia, Thailand, and Vietnam have shown that improving health indicators and reducing extreme poverty are clearly linked. Declines in infant and child mortality rates in these countries preceded periods of strong and sustained economic growth.

Clearly, an agenda to end extreme poverty must include UHC goals.

Ill health prevents the poor from climbing out of poverty and can impoverish the near poor. When a household member falls ill, this can mean diminished labor productivity. In addition, households often make catastrophic financial outlays paid for by selling their assets, reducing their consumption, dipping into their savings, or borrowing at high interest rates for seeking health care.

High rates of out-of-pocket spending, a highly regressive way of financing health systems, create financial barriers to accessing health care., This financing represents 36 percent and 61 percent of the total health spending in developing East Asia and Pacific and South Asia regions, respectively.

Pupils in Vietnam's Bac Giang Province take part in a USAID deworming project . /  Richard Nyberg, USAID)

Pupils in Vietnam’s Bac Giang Province take part in a USAID deworming project . / Richard Nyberg, USAID)

UHC reforms come in different shapes and sizes. Some common characteristics include improving revenue collection mechanisms so that they are fair and affordable;, helping people move away from paying for health services out of pocket and toward prepayment and risk pooling; improving value for money with strategic purchasing;, and targeting the poor through subsidies.

Many of these reforms across Asia have increased access and utilization of health care, provided financial protection, as well as improved health care outcomes.

Countries such as China and Bangladesh successfully piloted schemes. In Bangladesh, the pilot voucher program to improve maternal and child health successfully increased pre-and post-natal care and facility-based deliveries, while reducing out-of-pocket spending and the costs of these services, and decreasing neonatal mortality rates by a third to almost half in home-based interventions. Bangladesh has adopted UHC as a national policy goal and USAID is providing assistance to support implementation of their health financing strategy.

Vietnam and Indonesia have reached partial coverage of their populations by around two thirds, and have recently taken additional steps to expand their coverage.

Analysis of various UHC schemes in Vietnam (public voluntary health insurance, social insurance and the health care fund for the poor) showed that they had improved financial protection – significantly decreasing spending for the beneficiary insured and providing evidence of positive impacts on their nutrition indicators. And in January of this year, Indonesia set out on the path towards UHC with the goal of covering its entire population of 250 million people by 2019.

The dynamic economic environment in fast-growing Asia means that the role of donors like USAID and the development assistance architecture will need to evolve as well.

Individual countries and the region at large will need to grapple with growing migrant populations and the need for portable schemes that ensure access for migrant labor populations across porous borders. A large and growing informal sector, individuals not covered by the labor and social security provisions, will continue to test how countries communicate expanded coverage to remote and often marginalized communities. Equally as important will be the question of how to finance and address the changing mix of population health needs arising from demographic trends and the emergence of non-communicable diseases.

As many of the developing countries in Asia continue to grow, they will have sufficient resources to afford a basic package of health services for their entire population; however, governments tend to under-invest in their health sector relative to their economic potential.

As a result, oftentimes as countries grow wealthier, public health systems fall further behind.

In Asia and globally, growing domestic resources represent a critical window of opportunity where countries must have the vision and courage to strategically direct this increased wealth towards the health sector so that development dollars are crowded out.

By financing policies that focus on increasing equity and access to quality essential health services – the aim of universal health coverage – countries will be taking concrete steps towards the bold vision of ending extreme poverty.

ABOUT THE AUTHOR

Kristina Yarrow is a Senior Health Technical Specialist in the Asia Bureau, backstopping technical areas specific to health systems strengthening and research such as health financing, UHC, and implementation research.

Caroline Ly is a Health Economist in the Bureau for Global Health’s Office of Health Systems.

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Breaking Invisible Barriers in the West Bank and Gaza

USAID supports girls’ education in the West Bank. The Agency built the new Nahalin Secondary Girls' School in the Bethlehem Governorate  / Credit Alaa Badarneh

USAID supports girls’ education in the West Bank. The Agency built the new Nahalin Secondary Girls’ School in the Bethlehem Governorate / Alaa Badarneh

It’s nearly impossible to watch the news or read a newspaper without hearing about the West Bank and Gaza. It seems every week there’s a breaking story of violence and destruction. And yet when I visited USAID’s West Bank and Gaza Mission in November, the message I consistently heard was one of hope.

I went to see first-hand how USAID’s diverse programs are helping to ensure women and girls have the tools and capacity to realize their rights. From the justice system to small business, it was inspiring to witness the positive impact of USAID’s work.

The trip was also a powerful reminder that gender relations in the West Bank and Gaza are unique and complex but also obscured by the ongoing conflict. The main challenge Palestinians face is occupation, being both physically and socially restricted in everyday life that we take for granted.

Susan Markham meets with USAID staff, beneficiaries, and partners to promote the importance of gender equitable structures, institutions, and infrastructure in Palestinian society. USAID/West Bank/Gaza

Susan Markham meets with USAID staff, beneficiaries, and partners to promote the importance of gender equitable structures, institutions, and infrastructure in Palestinian society. / USAID/West Bank/Gaza

While the physical roadblocks inhibit movement, there are also invisible barriers that Palestinian women face. Despite a commitment to girl’s education, and a long tradition of women’s engagement in political life, separate social structures and a male dominated culture endure. However, instead of being demoralized, what really shone through was the enthusiasm and determination of both women and men to fully engage on equal terms.

I was energized to meet Maysa, a 26-year-old entrepreneur breaking ground within the tourism industry. By organizing photography tours throughout the West Bank, running her own YouTube channel, and designing original souvenirs, she is staying at the forefront of tourism and opening doors to women who wish to work in the industry.

I spoke with inspiring women entrepreneurs who are breaking barriers within their communities and launching successful businesses in information and communication technology (ICT), marketing, tourism and international training and certification. Thanks to assistance from USAID, many of these women are already planning to start a second business.

Through USAID’s Local Government and Infrastructure Program, I was able to hear from young women participating in and leading Youth Local Councils across the West Bank where women and men work together to advance community driven ideas around education, health, infrastructure and governance.

Perhaps nowhere was progress in gender equality so evident than at the Youth Development and Resource Center in Hebron. There I met Omar whose parents forbid him to go to the center as a boy because there would be girls there. Today, he runs the center, providing skills training, work experience, and a dynamic example of what’s possible when men and women work together.

From the teachers fighting for improved training for their students to the women working in cutting edge technology fields, there was optimism for a brighter future and a fierce resolve to get there.Vera Baboun, the mayor of Bethlehem, summed up the experience best when she quoted poet Mohja Kahf to me:

All women speak two languages:
the language of men
and the language of silent suffering.
Some women speak a third,
the language of queens.
They are marvelous
and they are my friends.

 

ABOUT THE AUTHOR

Susan Markham is the USAID Senior Coordinator for Gender Equality & Women’s Empowerment. Follow her @msmarkham

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