A USAID-funded dike in Senegal‘s Boli Valley has extended the rice growing season to nine months a year, and permitted recovery of hundreds of hectares of land for cultivation to help ensure food security in the region. USAID also provides seeds and financing to local farmers, including women, who make a significant contribution to sowing the land and maintaining the dike.
Archives for Sub-Saharan Africa
This originally appeared on Smart Global Health.
“In Zambia, when women have delivered, we say ‘Oh, you have survived.’” This chilling reminder of the impact of maternal mortality in sub-Saharan Africa came from Professor Elwyn Chomba, a Zambian government public health official interviewed by CSIS for a new video about the challenges of maternal mortality and a new initiative to address it.
Pregnancy-related deaths remain an acute problem in many places, despite overall global declines in rates of maternal mortality. Every day, nearly 800 women die from complications in pregnancy or childbirth, and 99 percent of these deaths occur in developing countries. These deaths are largely preventable with interventions and training to prevent or treat complications such as hemorrhage, infection, and obstructed labor, and with increased access to reproductive health services and emergency care.
We traveled to Zambia because it has a disproportionately high rate of maternal mortality – an estimated 440 women dying for every 100,000 live births, which is 20 times higher than the U.S. But Zambia, as well as Uganda, is also the site of a new program, called Saving Mothers, Giving Life (SMGL), designed to reduce maternal mortality by up to 50 percent in selected districts in a year.
SMGL builds on the fact that most maternal deaths result from one or more of three delays: in seeking care, in arriving at a health facility, and in receiving appropriate care. SMGL is working to address those delays by supporting linkages between communities and health facilities through Safe Motherhood Action Groups (SMAGs); by improving communications and transportation in the districts to speed the care and referrals of pregnant women; and by training and hiring health care providers, while improving equipment and standards of care at health facilities.
Although the U.S. government has been a driving force behind SMGL, it is a public-private partnership. The U.S. Agency for International Development leads SMGL for the U.S. Government, in partnership with the President’s Emergency Plan for AIDS Relief (PEPFAR), the Centers for Disease Control and Prevention, the Peace Corps, and the Department of Defense. The other SMGL partners include the governments of Norway, Zambia, and Uganda, the Merck for Mothers program, the American College of Obstetricians and Gynecologists, and Every Mother Counts.
SMGL has generated excitement, but its implementers know that there is no quick fix for reducing maternal mortality. Accordingly, the initiative faces significant challenges to national scale up and to sustainability, and many experts believe that the changes required will take years – not months — to achieve.
Effectively addressing maternal mortality — in Zambia and elsewhere — will demand ongoing commitment, from national governments and international partners– and investments in community awareness, in improving health facilities and transportation, and in expanding women’s access to health services, including family planning programs. As Professor Chomba said, we want to get to a point where “every woman can look forward to labor, and not say, I may die.”
This week we feature USAID Kenya as Mission of the Week. USAID Kenya’s “Yes Youth Can” program is a youth-owned, youth-led, and youth-managed effort to empower Kenya’s young people to create a greater voice in their communities and government. Created in response to the 2007/08 post-election violence, Yes Youth Can works to combat some of the causes of conflict, including feelings of alienation and lost of trust in elected leaders. In the last 15 months, Yes Youth Can has mobilized over one million youth to join “bunges” or informal parliaments, which plan peace-building activities, promote democracy and governance, and inspire the next generation of Kenya’s leaders.
Read more about the Kenyan bunges in a past FrontLines article.
USAID has supported peace-building along Kenya’s northern borders for over a decade. The current program focuses on communities on the Kenya-Uganda and Kenya-Somalia borderlands and enables residents to take peace into their own hands. USAID helps communities on opposite sides of the border select, plan, build and manage projects for joint use. These “peace dividend” projects include schools, marketplaces, and clinics.
All photos by Aernout Zevenbergen and Abraham Ali from Pact.
Last Friday, it was a real honor for me to take part in the closing ceremony of the African Leadership on Child Survival – A Promise Renewed (ALCS/APR), together with H. E. Kesetebirhan Admasu, Minister of Health in Ethiopia, my esteemed colleague Dennis Weller, USAID mission director to Ethiopia, and my African colleagues in health and development.
In June 2012, during the first Call to Action – Promise Renewed meeting in Washington D.C., Dr. Tedros had committed that Ethiopia would host an African Leadership for Child Survival Conference that was linked to the AU summit. That promise is now fulfilled and I wish to thank Dr. Tedros and Dr. Kesete and all of the colleagues at the Ministry of Health for making this all African meeting a reality and a success.
The pledge signed by the African countries present and the consensus reached by the conference are both significant and historic. The event has marked a new era for the African continent in which it is no longer acceptable for any child to die an untimely and preventable death.
As we have seen at this meeting, in many ways the progress made in the health sector in Ethiopia, as well as many other African countries, has become a powerful global symbol of what can be achieved in resource-constrained environments and has given many international partners renewed faith in the development enterprise.
To accelerate progress we need to do some things differently. Dramatic reductions in preventable child deaths can be achieved through concerted action in five critical areas, outlined in the global roadmap: geographical focus, high burden populations, high impact solutions, gender equality, and mutual accountability and financing.
The theme of equity, in all its dimensions, has come out very strongly through the conference conclusions on geography, gender equality and high burden populations. We know that as much as we have made global progress on child survival in recent decades so too have we seen an increasing concentration of child deaths in Africa which now accounts for around half of all the world’s child mortality.
During the three days, we have also seen that the highest rates of death are now overwhelming in fragile states and conflict-affected countries and regions. This demands that our attention also be placed on governance issues and on human security. There is a major role here, not only for the United Nations but also for regional institutions, and is why the role of the AU will be even more paramount as we move forward on this initiative. Indeed we are very hopeful that with the Ethiopia government taking over the chair of the AU in 2013, maternal and child survival will be seen as not only a health and development issue but as a peace and security issue. It seems auspicious that the African Leadership on Child Survival has taken place right before the AU heads of state meeting next week. I sincerely hope that the recommendations of this conference are shared with the AU leadership and head of states for their endorsement.
We have seen the strong leadership of African governments in this process. This is not an initiative led by UNICEF or USAID or any other partner, and it is very refreshing to see that this initiative and the commitments being made are home-grown. All countries have existing strategies and plans for improving maternal, newborn and child health. Integration of the ALSC/APR initiative with local processes, rather than setting up vertical mechanisms, will be important. Government should also coordinate efforts of various partners and the different initiatives and synthesize them into a coherent whole at the country level.
One of the most exciting aspects of the meeting and the overall process for me is to have seen the peer to peer dynamic in action. I know the lesson learning and sharing of good practices from country to country will continue over the coming months and that many countries are planning study visits to other African countries. We should nurture this dynamic at all costs. I believe the seeds of success and of sustainability for us in African have been planted by all at this meeting. By working hand in hand, we can and we will end all preventable maternal, newborn and child deaths, and thus complete the work begun under the child survival revolution.
Today it was an honor for me to join African colleagues in health and development at the opening of the African Leadership for Child Survival – A Promise Renewed. Minister of Foreign Affairs Tedros Adhanom, Minister of Health Kesetebirhan Admasu, and the rest of the Ethiopian Government should be congratulated for hosting this meeting to accelerate the reduction of Africa’s child mortality rates.
Ethiopia has made great progress in tackling child survival and strengthening their health sector. Since the development of Ethiopia’s first national health policy in the mid-1990s, Ethiopia and the United States Government have partnered to increase and expand access of quality health services to Ethiopians nationwide. The United States is proud to have a long-standing health program in Ethiopia with many of our agencies working in the health sector: CDC, DOD, Peace Corps and my agency, USAID.
Last June, Ethiopia joined India and the United States in cooperation with UNICEF to host a Child Survival Call to Action in Washington. More than 700 global leaders came together and challenged each other to reduce child mortality to 20 deaths per 1,000 births, or lower, in every country around the world by 2035. Assuming countries already making progress continue at their current trends, achieving this rate will save an additional 5.6 million children’s lives every year.
In the last two decades, Sub-Saharan Africa has experienced a 39 percent decline in the under-five mortality rate, a tremendous achievement that has been called part of the “the best story in development.” But despite this progress, we know that some countries are doing better than others. By joining together to share best practices, we can create a strong coalition to help each other’s children live to see their fifth birthdays.
An investment in Africa’s children is an investment in Africa’s future. I am pleased USAID is supporting the African Leadership on Child Survival meeting – and we are committed to being Africa’s partner in this effort for years to come.
Since 1990, the number of child deaths in sub-Saharan Africa has dropped by 39%. Many African countries are within reach of the 2015 millennium development goal to reduce the under-five mortality rate by two thirds. Yet even with the availability of proven, inexpensive, high-impact interventions for maternal, newborn, and child health, their adoption is slow and high rates of childhood illness and death persist in a number of countries. In sub-Saharan Africa 1 in 8 children die before they reach their fifth birthday.
In an effort to catalyze global action for child survival, the Governments of Ethiopia, India, and the United States together with UNICEF convened the ‘Child Survival Call to Action’ in Washington, D.C. in June 2012. Under the banner of ‘Committing to Child Survival: A Promise Renewed‘, more than 160 governments signed a pledge to renew their commitment to child survival, to eliminate all preventable child mortality in two decades.
To maintain this momentum, the Government of Ethiopia, and former Minister of Health Tedros Adhanom, whose leadership raised Ethiopia’s profile in child survival in the continent, committed to convene the ‘African Leadership for Child Survival—A Promise Renewed’ Meeting January 16-18, 2013, in Addis Ababa, the seat of the African Union.
Ministers of Health from 54 African countries have been invited to come together with peers and global experts to ensure child survival is at the forefront of the social development agendas across the continent and renew the focus of African leaders to head their own country’s efforts and sustain the gains made over the last two decades.
In advance of tomorrow’s African Leadership on Child Survival meeting in Addis Ababa, Ethiopia, the Ministry of Health organized a media site-visit to showcase their community health extension program and its impact on the country’s tremendous reductions in child mortality.
I was taken away from the hustle and bustle of Addis to the Aleltu district, which is north in the Oromia region. The visit began at a health center, then a health post and finally I visited households in a kebele (village). I saw firsthand how the health extension workers along with the voluntary community health promoters, called the “women health development army,” are key to Ethiopia’s health infrastructure. Health extension workers have finished secondary school, or grade 10, and have been through one-year of training that covered 16 components under four categories: family health; disease prevention and control; sanitation and hygiene; and health education. This is called the health extension worker package.
At the health center in Mikawa, the capital of Aleltu, I observed kids getting immunized and women accessing prenatal care. Two women with their newborns in the waiting area agreed to be interviewed by the press. Both commented on how they learned about family planning from the center and how birth spacing leads to healthier children. They planned to wait three years before their next child by using family planning methods offered by the center, which is funded by USAID as part of an Integrated Family Health Program through JSI and Pathfinder International.
At the Wogiti Dera health post, where they focus on maternal and child health in collaboration with the Mikawa health center, I met a 25-year old health extension worker named Mandarin. She showed me charts depicting data from the progress in her village. Practicing what she teaches, Mandarin is one of the women in the village who delivered her baby at the health center. When asked if she aspired to be a doctor, Mandarin replied, “Of course, anything is possible.”
Finally, I visited a household in the Wogiti Dera village, designated a “model household” because it successfully completed a checklist of 16 good behaviors consistent with the 16 components in the health extension worker package. Examples of good behaviors in the package include: women delivering their babies with a skilled birth attendant, children being vaccinated, and the household practicing good sanitation and hygiene.
What was consistent throughout the visit was an emphasis on data to measure impact and performance. This information feeds up to the regional and national level to populate a scorecard to measure Ethiopia’s progress in reducing maternal and child mortality in the region. The community health extension program is one of many best practices that will be shared at this week’s African Leadership on Child Survival meeting.