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Archives for Sub-Saharan Africa

Extending Quality Health Services to Underserved Groups through Faith Networks

In Ghana last week, I had the privilege to participate in the Africa Christian Health Associations’ 5th Biennial Conference, “Improving Women’s and Children’s Health in Africa.”

Christian Health Associations and networks from Africa and partner organizations met to take stock of their efforts in support of the Millennium Development Goals (MDGs) and discuss opportunities to strengthen local capacity to deliver services for women and children.

USAID’s Bureau for Global Health has worked with numerous organizations to support the critical roles played by churches, mosques, synagogues and other faith networks in their broader communities.  We have successfully empowered various faith-based leaders to speak openly in their respective communities about the crippling effects of HIV and AIDS and about the importance of planning one’s family and preventing children and families from falling ill and dying from malaria.

Last week, USAID Administrator Rajiv Shah delivered the David E. Barmes Global Health Lecture at the National Institutes of Health.  Recounting the successes that have been achieved in recent decades in global health, Dr. Shah outlined the challenges that currently exist and set out a roadmap for USAID and the wider health community to take advantage of the window of opportunity in front of us to accomplish a new wave of successes that can dramatically improve health around the world, particularly for children under age five and women.

He said, “Our largest opportunities to improve human health do not lie in optimizing services to the 20 percent of people in the developing world currently reached by health systems; they lie in extending our reach to the 80 percent who lack access to health facilities.”

Partnerships with faith-based and community organizations are essential to reaching that 80 percent because faith communities provide critical health services  — in some countries, faith groups operate anywhere from 25 to 50 percent of health facilities.

USAID has decades of experience in community-based work that takes health care out of fixed facilities and into the community.

Saving the lives of women and children requires a range of care that includes improving nutrition and training of birth attendants, who can help women give birth safely. It also requires increased access to family planning information and services and the widespread adoption of proven, inexpensive tools and key practices like rehydration liquids to combat diarrhea, immunizations for childhood diseases and vitamin supplements to fight malnutrition.

In September, President Obama signed the first-ever presidential policy directive on U.S. global development, elevating development — and with it global health — as a pillar of US foreign policy, along with diplomacy and defense. The Global Health Initiative embodies this new policy.  It builds on the experience of the last decade, maximizing development impact and leveraging knowledge and human ingenuity.

As President Obama so ably put it, “When a child dies from a preventable disease, it shocks our conscience.”

There is no better time to act. The Global Strategy for Women’s and Children’s Health, launched by the UN Secretary-General in September, is an unprecedented effort to improve the lives of women and children in the developing world and meet the MDGs of reducing child mortality by two-thirds and maternal mortality by three-quarters by 2015.

Strategic Investment Helps South Africa Scale Up HIV Treatment

With 2009’s change in political leadership in South Africa, we’ve seen a rapid scale-up of HIV/AIDS testing, treatment and prevention services.  After years of neglect, we have a 17.8 percent adult HIV prevalence rate and 5.33 million adults and 330,000 children who are HIV positive, the largest in the world.  And only 37 percent of people in need of treatment are receiving it.

As a South African, I was delighted to see my government putting so much energy and attention to saving the lives of the millions of people needing treatment.  Then in 2009 Secretary Clinton announced a strategic initiative with the Government of South Africa to help accelerate scale up. Ambassador Goosby and the PEPFAR program committed to a one-time, two-year infusion of $110 million through USAID for PEPFAR’s Supply Chain Management System (SCMS) to purchase antiretroviral drugs (ARVs) on the international market at prices lower than those paid by the government of South Africa. PEPFAR South Africa and the SCMS team did a quick cost comparison of our prices versus the Government of South Africa’s prices and, working closely with our partners at the Ministry of Health, agreed on a list of ARVs for which we could get particularly competitive pricing.

Last year we completed the procurement of more than $70 million of the total $110 million with more than 7 million units of ARV’s being distributed to the provincial depots.  Comparing our prices with those paid by previous South African procurements, we saved $61 million (46 percent) procuring generic ARV’s purchased at international prices.  PEPFAR’s investment showed it was possible for the South African government to match international prices and set informal benchmarks for subsequent purchases.

In December, South Africa’s Minister of Health, Dr. Aaron Motsoaledi, announced success with South Africa’s own procurement of ARVs noting a “massive reduction in the prices of antiretroviral drugs which has resulted in the 53.1% reduction in the cost of the total tender which translates to a R4,7 billion [US$630 million] savings. The percentage decrease in the cost of each item ranges from 4% to 81% implies that South Africa can now afford to treat twice as many people on ARVs compared to that which was previously budgeted.”

By the end of this two-year initiative, PEPFAR’s investment of $110 million will have leveraged about $90 million in savings from SCMS’s procurement and a further $600 million for the South African government.  That’s quite a return on investment.

Strengthening the Social Service Workforce

Jean-Claude works as a social worker for a small community-based orphan care program based in Port-au-Prince, Haiti. In this capacity, he is responsible for assessing the welfare of children and families, helping them to identify and access essential services and resources, organizing support groups for children and their parents and guardians, investigating allegations of child abuse, mediating family conflicts, and developing and implementing case plans in an effort to keep families strong and together.

Following the earthquake last year, Jean-Claude’s very full job description was further stretched to include negotiating temporary placement and locating caregivers for nearly 150 children who lost contact with their families or whose parents were killed in the earthquake’s aftermath. As a social worker, particularly a social worker in an environment devastated by natural disaster, political turmoil and disease, Jean-Claude has a critically important and almost impossible scope of work. Yet when asked what he considers to be the most difficult aspect of his job, Jean-Claude explains, “Everyone thinks they can do my job, but nobody wants to.”

Around the world, social work is one of the most misunderstood and underappreciated professions. While we recognize that social concerns have a tremendous impact on health, education, economic and other development outcomes, we rarely recognize the skills and expertise of those professionals who address these concerns. Like the health sector, the social service sector struggles to attract and retain qualified workers. Vacancy rates for established professional and para-professional positions within Africa range between 50%–60%, and half those employed leave their jobs within five years (as compared to seven years for healthcare workers). These statistics indicate a global crisis within systems of care and support for vulnerable children and a serious threat to global development.

This past November, the President’s Emergency Plan for AIDS Relief, under the auspices of USAID, funded a global conference in South Africa to highlight this crisis and explore strategies for addressing the crisis at a country level and global level. “The Social Welfare Workforce Strengthening Conference: Investing in those who care for children” brought together teams from 18 countries to share experiences, promising practices, and develop concrete action plans.  Each team included representatives from relevant government ministries, non-governmental organizations, donor organizations, social work training institutions, and professional associations, which provided an opportunity for multi-disciplinary problem solving and team building.

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Beyond ARVs: Comprehensive HIV Interventions in Ethiopia

An estimated 1.1 million people in Ethiopia are living with HIV/AIDS, which makes the country home to one of the largest populations of HIV-infected individuals in the world, according to UNAIDS.  Ethiopia is also one of the poorest countries in the world; only four countries fare worse than Ethiopia on the UN Development Program’s Human Poverty Index.

For people living with HIV in Ethiopia, health care is not just about medicine.  Without adequate nutrition, income, and social support, they are unable to complete their treatments and stay healthy.  The videos below show how U.S. support is comprehensively addressing the needs of HIV-positive individuals and their communities.

Follow Shewarged Kassa, an HIV-positive case worker, as she visits and counsels patients unable to travel to the local health center for treatment.

Visit the pastures near Addis Ababa, where HIV-positive dairy farmers are benefiting from improved livelihoods and a renewed sense of self-worth.

In fiscal year 2010, Ethiopia received over $320 million in U.S. HIV/AIDS funding.  Through the President’s Emergency Plan for HIV/AIDS Relief, in 2010 in Ethiopia, over 200,000 people received life-saving treatment, more than six million received counseling and testing, and millions more were reached by prevention programs.

Picture of the Week

Government of Southern Sudan President Salva Kiir Mayardit speaks February 10 at an event inaugurating USAID’s tarmacking of the Juba-Nimule road that links southern Sudan to Uganda, a key trade partner. At front right, Ambassador R. Barrie Walkley, the U.S. Consul General in Juba. Photo Credit: Jenn Warren/USAID

Southern Sudan Referendum Results: Independence

Submitted by: Angela Stephens, USAID Africa Bureau

Today it was announced that in a landslide vote nearly 99% of southern Sudanese voters opted to secede from Sudan.  The Government of Sudan has formally accepted the outcome, an important step in preserving peace in a region that has suffered through decades of war.

But just weeks ago, it was unclear whether it was politically, technically, and logistically possible to hold the referendum on time, in a way that would be considered legitimate and credible.  There were also real fears that if the referendum did not begin as scheduled on January 9, conflict could erupt.

Watch this video by USAID staff on the ground in Sudan about the international effort to assist the people of southern Sudan with their monumental and historic undertaking.

The successful voting process resulted from the coordinated efforts of USAID technical staff and their partners, U.S. diplomats, the Southern Sudan Referendum Commission and its Juba bureau, the United Nations, and other donors.  Despite extreme obstacles, the referendum began on time and was peaceful and orderly, with a turnout exceeding 97.5 percent and more than 3.8 million votes cast.  The process was uniformly lauded by international observers—such as the African Union, the Arab League, the European Union, the Intergovernmental Authority on Development, and The Carter Center—as legitimate and transparent.

Southern Sudan is expected to declare its independence and become a new nation on July 9.  USAID will continue to provide assistance to the people of Sudan, north and south, responding to humanitarian needs and helping to improve governance, food security, and livelihoods.

Learn more about USAID in Sudan.

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View all Sudan videos on YouTube.

Paving the Way for a Measles-Free Nigeria

Guest Post by: Andrea Gay, Executive Director of Children’s Health at the United Nations Foundation

A young boy in Fada, a rural village in northern Nigeria, about to receive a measles vaccination. Eric Porterfield/UN Foundation

A young boy in Fada, a rural village in northern Nigeria, about to receive a measles vaccination. Eric Porterfield/UN Foundation

For the last ten years, I have seen thousands of children cry after being pricked by needle for a vaccination against measles –a deadly disease that is preventable by one quick, albeit painful, shot.

I witnessed it again this week in northern Nigeria, as the country launched a nationwide integrated measles campaign to protect 31 million children against the deadly disease. Every child nine months to five years old is receiving a measles vaccine, in addition to an oral polio vaccine for newborns through five year-olds.

Americans, who haven’t seen widespread measles outbreaks in the U.S. in decades, might be surprised to learn that measles still kills more than 450 people each day and that children are still at risk of paralysis from contracting polio.

But we are making progress—a decade ago, more than 700,000 children died from measles every year, but now the mortality rate has declined significantly – 78 percent worldwide and more than 90 percent in Africa. Strengthening routine immunization systems and increasing the capacity of trained health workers from previous health campaigns have helped pave the way for the elimination of measles.

Thanks to the leadership of Nigeria’s Ministry of Health, U.N. Agencies, nongovernmental agencies, and the support of traditional and religious leaders ahead of and during immunization campaigns, measles and polio have nearly been eliminated in Nigeria.

USAID worked closely with Nigerian counterparts to reinforce these efforts and revitalized the polio immunization teams by hiring independent monitors to conduct spot checks to quickly identify problems and improve motivation and coverage. Working outside their own communities and the polio team structure, the monitors have proven to be very effective.

As I have witnessed during this and many other trips, integrated campaigns are one of the most cost-effective and efficient ways to eliminate both polio and measles. Immunizations for both diseases need to get to the same children who are often the most vulnerable and in the hardest to reach places. Eliminating both of these diseases can and should move forward together and it would be a missed opportunity not to put a stop to them both at the same time.

But we can’t do this alone. Funding shortfalls are threatening our recent gains. The Government of Nigeria is one of the African countries leading the way in financing immunization campaigns. However these diseases spread like wildfire, and even Nigeria has seen recent measles and polio outbreaks because not all of the children have been reached. The donor community must step up to support the elimination of measles and the eradication of polio as soon as possible so we can build off of our gains, instead of lose them.

Every shot, no matter how painful it is to watch for those brief seconds, offers a lifetime of health and promise for millions of children in Africa and around the world.

To learn more about how you can help visit the web sites for the Measles Initiative or the Global Polio Eradication Initiative.

Voters Chose Secession for Southern Sudan, Provisional Referendum Results Show

Provisional results announced in Juba Sunday for the referendum on self-determination for southern Sudan indicate that southern Sudanese voted overwhelmingly to secede and form a new nation. Of more than 3.8 million votes cast, nearly 99 percent chose secession, and just over 1 percent chose unity with northern Sudan.

Southern Sudan Referendum Commission Chairman Professor Mohamed Ibrahim Khalil and Deputy   Chairman Justice Chan Reec Madut, who is also chairman of the Southern Sudan Referendum Bureau in Juba, jointly declared provisional results of the referendum, which is part of the 2005 Comprehensive Peace Agreement (CPA) that ended more than two decades of civil war in Sudan.

“The people of South Sudan are … indebted to the government and people of the United States of America, USAID,” Justice Chan said in remarks at the announcement. “The Southern Sudan referendum on self-determination could not have taken place on time without the support of the international community,” he said.  “Our international partners and friends put in robust material, technical, and moral support that is still literally lapping on our doorsteps.”

USAID provided comprehensive assistance to help carry out the referendum, including technical and material assistance, civic and voter education, and support for domestic and international observation of the process, and funded out-of-country registration and voting in eight diaspora countries, including the United States.  This assistance is part of USAID’s broad goal of supporting peace in Sudan, including by helping to implement all provisions of the CPA.

Final results of the referendum are expected to be announced February 7 in Khartoum if no legal challenges are filed, and February 14 if legal challenges must first be addressed.  If secession is the final outcome of the referendum, establishment of a new nation would not occur before July 9, 2011, when the CPA expires.

Read more about USAID’s programs in Sudan.

Technology to Encourage Stability in Volatile East African Regions

Most people are familiar with how information can be used to promote conflict.  Media control and propaganda can spread misinformation, fear, and violence.  Purposeful jamming or outright destruction of communications lines during attacks can prolong the length and severity of conflict.  But can information and technology be used to promote peace instead?  In East Africa, USAID programs are doing just that.

Recipients test high frequency radios in East Africa. The USAID-funded radios allow information to be transmitted quickly to the local authorities and those involved in conflict mitigation. Photo credit: CEWARN.

In 2009, more than 300 people died and tens of thousands more were displaced as conflicts flared across the Ethiopian/Kenyan border.  The clashes involved pastoral communities who fought over livestock, land, and water rights.  These types of conflicts undermine progress in health, economic growth, and governance; create conditions favorable for extremism and terrorism; and at times require costly humanitarian assistance. (See a map of cross-border conflicts in Africa, PDF, 1.5MB.)

In partnership with the Intergovernmental Authority on Development (IGAD)’s Conflict Early Warning and Response Mechanism, USAID is implementing an Information and Communications Technologies for Peace program in the region with a focus on the pastoral border areas of Ethiopia, Kenya, and Uganda.

Most recently, USAID provided high-frequency radios to representatives of two communities living on the Ethiopian/Kenyan border in Jinka Town, southern Ethiopia.  These radios allow community members to rapidly report infractions—such as the theft of livestock—that might otherwise escalate into retaliation and violence.  And because technology alone is not enough, USAID also provided a two-day radio training workshop with provincial officials and peace monitors.

A typical scenario occurred in Uganda recently when Jie warriors from the Kotido District raided 40 head of cattle from Matheniko communities in the Moroto District.  The owners of the livestock informed the local chief, who contacted the radio operator, who quickly reached the local authorities.  As a result, all the stolen cattle were successfully recovered without injuries or deaths.  Peace monitors are now reporting many other cases where conflicts have been mitigated or prevented through improved communications.

Witnessing History in Southern Sudan

Juba, Sudan—One of the most inspiring and humbling parts of observing the referendum on southern Sudan’s self-determination was being in the room at a referendum center as votes were counted the night polling ended.

At the center where I observed, Lologo Center in Juba, five Sudanese poll workers, five Sudanese domestic observers, and four USAID staff members gathered in one of the two rooms of a primary school where all week the poll workers were on duty from 8 a.m. until 5 or 6 p.m. as their fellow citizens came to vote.  After working all day on the last polling day, January 15, the poll workers continued directly to counting the vote, despite that they had little to eat or drink all day.

Once the 14 of us were assembled in the room, a policeman posted outside to guard the vote-counting process shut the heavy metal classroom door so that no one else could enter, screeching the sliding door lock into place.

First the chairman of the referendum center, a secondary school teacher named Primo Celerino Monai, announced the number of registered voters at that location—2,596—and the cumulative number of votes cast according to the daily log, 2,536—a 98 percent turnout.  A poll worker took out seven envelopes that contained spoiled ballots from each of the seven days of voting, and opened each envelope, emptying the spoiled ballots onto a table in the center of the room.  There were a total of 5.  One of the poll workers then retrieved a tarp from the USAID-funded polling kit that contains supplies needed at the referendum center, including scissors, tape, a calculator, and battery-operated lanterns that were necessary because as is common in southern Sudan, there was no electricity at this center, and it soon became dark.

Southern Sudanese poll workers at Lologo Center, Juba, with USAID staff Mickey Richer, Cliff Lubitz, and Maura McCormick stand in front of 2,483 votes for secession after ballots were counted. Photo Credit: Angela Stephens/USAID

The poll workers spread the tarp over a large table in the center of the room.  One poll worker placed the translucent box that contained the ballots on the table, cut the plastic ties that had locked the box all week, removed the lid, and emptied all the ballots onto the table.  The five poll workers then bundled all the ballots into stacks of 50 for ease of counting, and once that was complete, counted to make sure the bundled ballots equaled the number of ballots cast as recorded each day in the center’s journal.

Occasionally during the course of the vote count, Mr. Monai read through the Southern Sudan Referendum Commission (SSRC) polling and counting manual provided to the more than 14,000 poll workers trained with the assistance of USAID partner the International Foundation for Electoral Systems (IFES), which explains step by step how to proceed with all the procedures of polling, including the vote count.

The poll workers wrote signs that read “Unity,” “Secession,” “Unmarked,” and “Invalid,” and taped them to the edge of the table nearest to us observers so they could pile the ballots into each category after opening and reading them.

One of the poll workers then stood in front of us and one by one, picked up a paper ballot, showed us whether or not the ballot had the required red stamp of the SSRC, the Sudanese body in charge of the referendum process, and then turning over the form, showed us the ink thumbprint that indicated whether the voter chose unity (written in Arabic and English, and indicated visually by two clasped hands) or secession (indicated visually by a single open palm).  A few ballots were unmarked, and a few were invalid, either because the voter’s thumbprint was apparent on both unity and secession, or because the ballot lacked the required red SSRC stamp.

As the reading out of votes began in the solemn room, lit only by three battery-operated lamps on the table, the poll worker announced as he held up each ballot one by one for us to see:  “The stamp is valid”—showing us the stamp and then turning the ballot over –“and the vote is secession.”  Five hours later, when the poll workers had opened all the ballots, the final count was 2,483 votes for secession, 19 votes for unity, 19 invalid, and 15 unmarked.

The transparency of the process and the sense of duty and professionalism the poll workers displayed was admirable.  Each of us in the room could see every ballot and every stage of the counting process.

The enormity of what those dedicated and exhausted poll workers were doing was lost on none of us—it was nothing short of transmitting the voice of the people of southern Sudan, after decades of war and hardship, through the ballot box as they decided their future course as a people.

For those of us USAID staff members in the room that night, and all of us throughout Sudan supporting the USAID Mission during this referendum period, it was an experience we were honored to witness and will never forget.

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