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Archives for Latin America and the Caribbean

Video of the Week: Adapting to Melting Glaciers: A Partnership Approach

Through the USAID-supported High Mountain Partnership (HiMAP), Peru and Nepal are addressing the impacts and risks of rapidly melting glaciers in high mountain areas. The HiMAP brings scientists, governments officials, and local people together to share lessons learned on managing high-risk, high-impact floods caused by rapidly melting glaciers.

Learn more about USAID’s work in climate change and promotion of development based on climate-smart planning and clean technologies.

Housing Development Fuels New Hope for Haitian Families

The Haut Damier housing settlement stands neat and orderly near Cabaret off Route National 1, a main highway on the west coast of Haiti, north of Port-au-Prince. The development’s 156 pastel-painted houses received their first residents in September. The families, many of whom lost houses as a result of the 2010 earthquake and who until recently lived in tents and other substandard housing conditions, now have permanent homes, with running water and flush toilets, for the first time since the disaster.

“We are so pleased. We have never had piped-in water in the house before,” said Albert Julien, a father of a family of six.

A beneficiary prepares to move her belongings into her new USAID-funded house near Cabaret, Haiti, in September 2013. Photo credit: USAID

A beneficiary prepares to move her belongings into her new USAID-funded house near Cabaret, Haiti, in September 2013. Photo credit: USAID

The Haut Damier housing settlement, an $8.3 million housing and community development project, is one of several new settlements supported by USAID in partnership with the Government of Haiti and nongovernmental organization (NGO) partners to provide homeownership opportunities in proximity to employment and transportation hubs for earthquake-displaced families and other vulnerable households. Beneficiaries were chosen by the International Federation of the Red Cross (IFRC), in collaboration with local municipal authorities. IFRC is also partnering with USAID to assist in the move-in of the beneficiaries and help them begin a new life in the community.

Another key partner on this housing development is the Government of Haiti’s Public Agency for Social Housing, which has a team dedicated to provide management and maintenance of the housing complex. USAID will help the agency strengthen its management and governance capabilities.

The Haut Damier homes have two rooms, a bathroom with a shower, and a kitchen, and are connected to electricity and sanitation facilities. The buildings are made from locally available materials which allow the residents to repair and expand their homes as needed. To ensure structural durability, the houses meet the International Building Code earthquake and hurricane safety standards. Of the 156 houses, 16 are built with access ramps to accommodate people with disabilities, while all of the houses meet accessibility standards that include wider doorways and bathrooms.

“This will be a big change for my family,” said Etienne Masita, a mother of five. “In the tent, the children get diseases and life is difficult.”

Masita has already joined a variety of community development activities in her neighborhood. She and other incoming residents have worked five days a week tending vegetables in the gardens surrounding the houses. The IFRC-sponsored gardening project enables residents to assume responsibility for their neighborhood.

USAID’s NGO partners United Methodist Committee on Relief and IFRC are jointly providing nearly $3 million of their own funding to support community and livelihoods development programs. These partnerships along with community engagement in developing and maintaining the Haut Damier housing site are essential for creating an enriching and sustainable living environment.

The beneficiaries will be given title to their home after paying a monthly fee of about $45 for five years. This fee will help cover site management and maintenance costs, ensuring sustainability.

The new settlement, where streets are lit by solar lights at night and where residents will play a role in its future development, will significantly improve the well-being and safety for many.

“I am so thankful to USAID. We will finally get out of the tents, where we suffered so much,” said Max Fils-Aime, one of the beneficiaries slated to soon move to his new home.

Since the earthquake, USAID has helped more than 328,000 people (more than 20 percent of those displaced by the quake) find shelter solutions. These include a range of solutions from transitional shelters, repairs to damaged houses, support to host families who took in displaced people, and rental vouchers.

Resources:

Video of the Week: “Artisans in El Salvador Flourish”

USAID Small and Medium Enterprises Development Program, in alliance with SIMAN Stores, recently launched “ARTEC.A.”, a Central America-wide brand to distribute handicraft products by Salvadoran artisans in SIMAN department stores throughout the region. During the months of August and September, 30 artisans will be selling their products at the 12 SIMAN stores in El Salvador, Costa Rica, Nicaragua and Guatemala. The products include decorative handicrafts, toys, jewelry and clothing items, among others.

The USAID’s program has contributed with technical assistance to help the artisans secure sales with SIMAN, as well as innovating and improving their design, production and distribution processes. Through these initiatives, USAID/El Salvador fulfills some of the commitments made by the governments of the United States and El Salvador in the “Partnership for Growth,” specifically those related to solving the factors that cause lower productivity of tradables.

The Bright Side of Taxes: More than Just a Headache

Many people equate taxes with confusing forms, incomprehensible rules, and general feelings of frustration. Others fear potential audits or vent about the ways in which their governments spend tax revenues. People pay less attention to the positive side of taxation; namely, that the resulting revenues allow a government to provide critical goods and services to citizens.

Tax revenues support both large-scale investments in areas such as health, education, citizen security, and roads, as well as community-level goods and services, like public lighting and garbage collection. Of course, efforts to improve tax collection should go hand-in-hand with advancements in public financial management more broadly. That is, beyond simply collecting more taxes, governments should improve the way they handle and invest public resources. Low revenue collection and sub-par public financial management practices have serious implications for the everyday lives and operations of citizens and businesses.

Click to read USAID's Detailed Guidelines for Improved Tax Administration in Latin America and the Caribbean.

Click to read USAID’s Detailed Guidelines for Improved Tax Administration in Latin America and the Caribbean.

For example, countries like El Salvador are facing crumbling public school infrastructure, a lack of basic medicines in public hospitals, and delayed tax refunds to businesses. Even in Brazil, a country with tax collection levels on par with the most developed countries in the world, recent protests have highlighted citizens’ discontent with the government’s management of public resources.

Along with promoting private investment, the ability of governments to collect and manage tax revenues is fundamental to reducing their reliance on foreign aid over the long term. As the Assistant Administrator for USAID’s Bureau for Latin America and the Caribbean, Mark Feierstein, noted in testimony earlier this year:

“The most important source of development funding for nearly any country is not USAID, or any other donor, but internally generated revenue. Absent sufficient host country funding, donors alone will not produce sustained prosperity and opportunity. That is why we are initiating new programs to help national and local governments raise revenue.”

Many readers may be surprised to find that, despite recent economic and social advances in the region, many Latin American and Caribbean countries seriously struggle to collect and manage public revenues.

Last year, two researchers from the Economic Commission for Latin America and the Caribbean (ECLAC) found that tax collection rates in Latin America averaged 18.4% of GDP, or roughly half the average of 34.8% for countries (including the United States) that belong to the Organisation for Economic Co-operation and Development (OECD) and 39.2% in the European Union. More shocking is that collection rates in Latin America are significantly lower than the 24.5% average that the researchers found in Sub-Saharan Africa. Meanwhile, the World Bank has noted that Latin American countries lag behind international standards in various aspects of public financial management, such as procurement, budget execution, and independent oversight of public expenditures.

Increasingly in recent years, the international community has emphasized the need for countries to improve the collection and management of tax revenues. USAID is providing leadership on these issues throughout the Americas. Our programs are working with national governments in countries like El Salvador and Jamaica to strengthen tax administration and public financial management.

USAID is a key contributor to the U.S. Government’s Domestic Finance for Development (DF4D) policy initiative that encourages countries throughout the world to increase revenue collection, improve budget transparency, and fight corruption. For example, we are challenging local governments at the municipal level in El Salvador and Honduras to increase revenue collection and improve the management of those resources. We will reward the highest performers with additional resources for key investments related to citizen security in their communities.

Today, USAID released a new publication entitled “Detailed Guidelines for Improved Tax Administration in Latin America and the Caribbean” that will enable tax administrations (i.e., the IRS equivalent in each country) to assess their own performance against leading practices in a variety of areas, including taxpayer registration, filing and payments, collections, and audit, among others. This tool will also help USAID staff and other donors engage with tax administrations on potential areas of technical assistance and prioritize interventions.

At USAID, we want to see all countries reach a level of development where they no longer require development assistance. Helping ensure that governments can mobilize domestic resources and invest them in their own development is a key step toward reaching that goal.

Learn more about USAID’s work in improving tax administration in Latin America and the Caribbean

Realizing the Health Goals of the Panama Declaration

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

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

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

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

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

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

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

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

Related blog posts:

Empowering LGBTI people in Colombia to Advocate for Their Own Rights

I recently had the privilege of traveling to Bogotá and Cartagena, Colombia to observe the incredible work USAID is doing to support Lesbian, Gay, Bisexual, Transgendered and Intersex (LGBTI) populations advocate for their own rights under the law. As an advocate and supporter of the LGBTI community here in the United States, I know firsthand the importance of LGBTI physical safety, the issues of workplace discrimination, and access to education and health care.

As part of USAID’s historic LGBT Global Development Partnership launched earlier this year, we are expanding our support to local civil society organizations in Colombia through our partnership with the Astraea Lesbian Foundation for Justice. Activities include partnering with the Gay and Lesbian Victory Institute to conduct trainings on how to run for office and participate in democratic processes. This partnership forms part of USAID’s wider commitment to inclusive development, and to engaging LGBTI communities as important actors in international development who have the potential and power to advance human rights, promote broad-based civic participation, and drive inclusive economic growth.

Victory Institute, with support from USAID, conducts training on on respecting and protecting LGBTI rights in Cartagena

Victory Institute, with support from USAID, conducts training on on respecting and protecting LGBTI rights in Cartagena. Photo credit: Victory Institute

Since 2006, USAID/Colombia has been a flagship bilateral mission for its work in supporting LGBTI community efforts fighting discrimination and stigmatization. In addition, USAID/Colombia has provided training for police and other public servants on respecting and protecting LGBTI rights. These continued efforts and strong ties to grassroots LGBTI organizations made Colombia a good fit for piloting the LGBTI Global Development Partnership trainings.

As reported in the Washington Blade, from August 29th-September 1st, the Victory Institute – with support from USAID – led a four-day training in Cartagena for 30 Colombian LGBTI activists interested in running for political office or managing campaigns. These inspiring individuals, who hailed from as far away as the Amazon rainforest, rural regions along the Atlantic Coast and Bogota, came together to learn the art and craft of running successful political campaigns in an effort to become more effective advocates for LGBTI rights in their own communities.

One such activist I had the pleasure of meeting was Jhosselyn Pájaro, a transsexual woman who ran for municipal council in the city of Arjona outside of Cartagena. She ran for office to let her community know that LGBTI people like her lived in the community and wanted to make a difference. Although she did not win a seat on the council, she was successful in raising awareness about LGBTI people and the rights and concerns they have living in Colombia. She attended the USAID-supported training to learn new skills as she hopes to again run for political office, and next time, win.

It is inspiring stories like these, from LGBTI individuals who face discrimination on an almost daily basis that makes the work of USAID all the more important. Through the LGBTI Global Development Partnership, USAID is working with our partners to strengthen LGBTI civil society organizations, enhance LGBTI participation in democratic processes, and undertake research on the economic impact of LGBTI discrimination.

At USAID, we are bringing together local activists and community leaders. In Colombia, organizations such as Colombia Diversa, Caribe Afirmativo, and Santamaria Fundación illustrate the dedication and service to their constituents that USAID values.We are helping these community leaders to advocate for a more inclusive society that embraces what LGBTI people have to offer in the development of their own societies, economies, and local institutions. Together, in partnership, we are working to ensure LGBTI people have equal rights as enshrined in international human rights and domestic law, and access to education, employment, health care and housing – what we consider as important elements of inclusive sustainable development.

Learn more about how USAID is advancing and protecting the human rights of the LGBTI community.

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

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

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

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

Mother and child. Photo credit: MCHIP

Mother and child. Photo credit: MCHIP

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

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

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

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

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

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

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

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

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

Woman feeds her child. Photo credit: INCAP

Woman nourishes her child. Photo credit: INCAP

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

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

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

Woman tends to crops. Photo credit: INCAP

Woman tends to crops. Photo credit: INCAP

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

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

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

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

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

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

The Issue of Inequalities: A Look at the Underlying Causes of Maternal and Child Death in Latin America and the Caribbean

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

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

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

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

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

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

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

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

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

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

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

The LAC Effect: Addressing Inequalities to Save Lives

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

Ariel Pablos-Mendez, MD, MPH, is the Assistant Administrator for Global HealthThis blog is part of a series to coincide with A Promise Renewed in the Americas: “Reducing Inequalities in Reproductive, Maternal and Child Health Summit” during September 10-12 in Panama.

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

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

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

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

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

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

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

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

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

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

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

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

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

Resources:

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

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