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Archives for Sub-Saharan Africa

Celebrating Southern Sudanese Freedom to Determine Their Future

It has been an uplifting and moving week in Sudan, as we have witnessed the joy and resolve of millions of southern Sudanese as they exercise their right to vote in the referendum on self-determination promised to them in the 2005 Comprehensive Peace Agreement, which ended more than 20 years of deadly and ruinous war between northern and southern Sudan.

U.S. government observers from USAID and the Department of State have witnessed voters stand for hours in long lines in the hot sun, patiently and cheerfully determined to vote, particularly on Sunday, the first of seven days of voting.  We have seen voters swim across a tributary of the Nile to reach their polling station after a local ferry broke down.  We have witnessed elderly and handicapped voters being assisted by poll workers who were trained, with USAID assistance, to help voters in need of assistance to cast their vote.  We have seen poll workers cheerfully cradling infants in their arms while the babies’ mothers voted.  Southern Sudanese have been singing in the streets to express the joy of being able to freely choose their own future.

Voting is scheduled to end on Saturday, but this will not be the end of USAID assistance to the referendum process.  USAID’s comprehensive assistance to the referendum process included the establishment of a data center at the Southern Sudan Referendum Commission (SSRC) bureau in Juba, which will tabulate the total number of registered voters and polling results for the referendum.  We are also supporting domestic and international observation of the referendum, which is ongoing.  In partnership with other donors, including the United Nations, and the SSRC, the Sudanese body in charge of the process, we are extremely gratified that the referendum began on time, and has been peaceful and orderly, with a high level of participation.

Regardless of the outcome of the referendum—whether southern Sudanese choose continued unity with northern Sudan or secession and the launch of a new nation—USAID will continue to work in partnership with the people of Sudan, north and south, to reinforce peace and improve lives and livelihoods.

The Role of Teachers and Textbooks in a Democracy

Submitted by: Diana Harper

“Knowledge will forever govern ignorance, and a people who mean to be their own Governors must arm themselves with the power knowledge gives.”

—James Madison, 1788

This month’s historic referendum will determine southern Sudan’s future, either as an independent country of part of a unified Sudan.  Voting ends on Saturday, January 15, and enormous efforts have been launched by U.S., Sudanese, and international agencies to support a credible process—that voters know how and where to vote, that the Sudanese referendum commission is equipped to carry out referendum logistics, that sufficient ballots and voting materials are available, and that poll workers and election observers are properly trained.

At the same time, the United States has continued to provide development assistance that strengthens democracy as well as demonstrates the benefits of peace.  These efforts include improving health care and access to clean water, building roads and transportation infrastructure, providing microcredit loans to spur economic growth,  and—of particular importance—increasing access to and the quality of education.

Formal education is not a prerequisite for wisdom, but it is a critical part of active participation in the democratic process.  Literacy is crucial for making informed voting decisions and lobbying representatives for change.  The public’s ability to effectively organize and work in groups provides protection against political abuses and dictatorships.  Research supports the intuition that investments in education pay returns in peace and democracy.  (See a related interactive graph.)

In 2005, when Sudan ended its 22-year civil war, only 37% of southern Sudanese men and 12% of women were literate.  Primary school enrollment was low, and girls in particular faced many obstacles to attending school.  These obstacles included high direct and indirect costs, discriminatory attitudes and school policies, and poor access to feminine hygiene products and lack of sanitation facilities.

USAID has worked closely with the Government of Southern Sudan Ministry of Education, Science, and Technology to improve its ability to plan and implement educational reforms, increase access to primary education especially among girls, train teachers, and foster community-wide support for education.

One example of USAID’s work is the opening of a school in the Blue Nile State—a region on the north-south border of Sudan that was a major site of conflict during the civil war.  The Granville-Abbas School serves 120 female students and serves as a model of girls’ education in the region, with three sets of classrooms, a library, theater, and a computer center with internet access.  Better education for girls leads to benefits for their families and communities including increased economic growth, reduced poverty, improved health and nutrition, and better HIV/AIDS control.

U.S. educational programs throughout Sudan helped to increase primary school enrollment from 1.1 million in 2007 to 1.4 million in 2009.  In addition, U.S. programs have trained over 2,300 teachers, including many female instructors who serve as critical role models to young girls.  Beyond bricks and mortar institutions, USAID has also supported radio education to help students study English, math, local languages, and life skills.  In 2009 alone, the radio programs reached over 350,000 youth and adults.

Saving Lives in Rural Malawi with Knowledge Management and Mobile Phones

“An informal, but very insightful, first-person account of how cell phones are rapidly changing the way USAID implements health programs in the field. With a bit more focus and targeted resources, USAID could dramatically accelerate the mainstreaming of mHealth interventions, helping us achieve our GHI targets more rapidly, and leaving behind a legacy with enduring returns.”- Adam Slote, USAID/Global Health

By: Natalie Campbell, Management Sciences for Health

The most important item in Amon Chimphepo’s medical kit is a small cell phone. This single piece of technology has proved to be a lifeline for people living in one of the most remote regions of Malawi. Its power to reach and initiate help immediately from the closest hospital is saving lives and improving health outcomes. In fact, I met a woman, alive today, because Mr. Chimphepo and his cell phone were there to make an emergency call to the district hospital and get an ambulance.

A group of Malawian community health workers. Photo Credit: K4Health

I traveled to Malawi in December to take a closer look at our pilot project — K4Health Malawi — we launched in February 2010. One of its main interventions equips community health workers with cell phones and solar chargers. In his capacity as a community health worker, Mr. Chimphepo makes regular door-to-door visits in his area delivering HIV tests, and health and hygiene counseling. We knew this kind of outreach provides important health support in remote areas but had no idea how the rapid response component of cell phone communication was transforming health outcomes across the area.

Fast changes in health status are rare in this line of work. My background is food security and nutrition programs, and my timer was set to long-term changes from poor nutrition into better health status and, with any luck, the slow parallel development of sustainable food sources. Timeframes run in years. That a knowledge management project could lead to fast, life-saving aid and an immediate improvement in health and well being across this hard-to-reach population was highly impressive.

21st Century Communication Saves Lives in Remote Areas

When you connect community health workers by cell phone to the people, information and resources of a hospital you open a conduit of immediate aid that can save lives. Time telescopes — what took days and weeks before wireless communication, now takes minutes and hours. Visiting with Mr. Chimphepo, we were able to meet the people and hear the stories of injuries and conditions and sicknesses treated quickly and correctly because Mr. Chimphepo has access to professional advice and direct health services through the district hospital.

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Voting Begins in the Southern Sudan Referendum

On Sunday, voting began in the historic southern Sudan referendum.  Through January 15, southern Sudanese will cast their ballots to determine whether the region will stay unified with the north or secede and become an independent country.  More than 3.9 million people are registered to vote in Sudan, and more than 60,000 are registered in eight countries that have large populations of southern Sudanese, including the United States.

Southern Sudanese wait to vote in Juba on the first of seven days of polling for the referendum that will decide whether southern Sudan will remain united with northern Sudan or will secede and form a new nation. The referendum is part of the 2005 Comprehensive Peace Agreement. Credit: Angela Stephens/USAID

President Obama wrote in a New York Times op-ed on Saturday, “Not every generation is given the chance to turn the page on the past and write a new chapter in history. Yet today — after 50 years of civil wars that have killed two million people and turned millions more into refugees — this is the opportunity before the people of southern Sudan.”  The White House also released a written statement yesterday in praise of the referendum and its implications for the peace process.

On Saturday, Senator John Kerry and U.S. Special Envoy to Sudan Scott Gration held a press conference in Sudan.  On the importance of the vote, Senator Kerry said:

“What happens in Sudan – some people may be scratching their heads in some parts of the world and say, ‘Well how does this affect me?’  The truth is that the stability of Sudan is important to all of us.  In a world that has become increasingly more complicated, increasingly more volatile, increasingly more extreme in various places, we want to see Sudan — north and south — contribute to global stability, and become a partner for peace all around the world.  That’s the future that we can grab onto tomorrow, and we’re proud to be here today to help contribute to it.”

 

Supporting Sustainable Livelihoods and Nutritious Meals

Food and nutrition are important elements across all cultures. In America there is a renewed sense of instilling good nutritional habits in children through the First Lady’s campaign against childhood obesity and the newly signed Healthy, Hunger-Free Kids Act. At USAID, we are concerned with not only feeding those in need around the world, but making sure they have access to healthy and nutritious meals on a regular basis, as well as a sustainable livelihood.

But for many people living with HIV/AIDS (PLWHA) like Thabit Obed, a farmer from Uganda, managing one’s health is no easy task. The infection causes or aggravates malnutrition through reduced food intake, increased energy needs, and poor nutrient absorption. Malnutrition weakens the immune system, which can hasten the progression of HIV, increase susceptibility to opportunistic infections, and reduce the effectiveness of treatment. Since food and nutrition support is such a critical component of successful HIV/AIDS care and treatment, USAID has an invested program to help those in need.

Mr. Thabit Obed, has mobilized fellow PLWHA to produce groundnuts for therapeutic food to treat malnourished PLWHA. Photo Credit: Mary Nabisere/NuLife

Thabit is a recipient of support from the USAID-funded program, NuLife—Food and Nutrition Interventions for Uganda, a program managed by University Research Co., LLC (URC) that works to improve the health and nutritional status of people infected and affected by HIV/AIDS through integration of nutritional assessment, counseling, and support (NACS) into HIV/AIDS services.

In addition to producing and prescribing food, such as RUTAFA a ready-to-use therapeutic food, the program also works to provide opportunities for farmers in Uganda to expand their businesses.

Through a partnership with RECO Industries, Ltd, a local manufacturer which produces RUTAFA, Thabit was able to expand his small coffee bean farm and begin growing groundnuts.

Thabit, an active community volunteer, became one of more than 4,000 farmers to grow groundnuts as input for RUTAFA. He was trained to support other PLWHA and raise awareness about HIV testing, counseling and treatment.

Through this program and similar partnerships, USAID NuLife has been able to help ensure HIV positive individuals who have recovered from malnutrition through treatment with ready-to-use therapeutic food are being offered an opportunity to earn a living, support their families’ and maintain a healthy nutritional status.

USAID/Uganda designed a program that not only reaches HIV positive clients with critical services and supports local industry and individual farmers, but connects those clients to sustainable livelihood opportunities producing inputs for the very product, RUTAFA, which can support their health and that of their fellow PLWHA.

Snapshot from Sudan

USAID Assistant Administrator Nancy Lindborg with Darfuri childrenUSAID Assistant Administrator Nancy Lindborg with Darfuri children at the Otash camp for internally displaced persons outside Nyala, South Darfur. Photo is from Doug Arbuckle.

The “Stuff” of Democracy – USAID Supports the Southern Sudan Referendum

Two hands clasped together, or one hand alone?  This is the choice that southern Sudanese voters will face in less than one week, when they choose either to remain part of a unified Sudan or to secede and form an independent country.

Several democratic milestones have paved the way for Sudan to reach this point: a peace agreement that ended 22 years of civil war, the first national census in 15 years, and the first multi-party elections in 24 years.  While these achievements were not without hurdles, the country is nevertheless still on track for its historic referendum on January 9 to 15, 2011.

The next step in the peace process invokes complex and controversial issues: self-determination and government cooperation, the re-integration of soldiers into civilian life, and a decision on the fate of Sudan’s profitable oil fields, just to name a few.

But for the vote to be successful, the smaller, tangible pieces also need to be in place.  Poll stations need to be well-equipped and orderly, with the right materials in the right places in the right quantities.  And perhaps most importantly, the frontline poll workers need to know how to use the materials to carry off a successful and fair vote.

For established and peaceful democracies, these voting logistics are a given.  But in a region that is still recovering from war and that has poor transportation, education, and communication infrastructures, details matter.

In recognition of this fact, on December 23, 2010, USAID and the United Nations delivered polling kits and ballots to assist the official Sudanese commission carrying out the referendum.  This delivery followed earlier support to the voter registration process.  USAID’s polling kits included critical materials for running a polling site, such as indelible ink, thumbprint pads, ballot box seals, and banners.

The ballots ask voters to place a thumbprint next to their choice—unity or secession, shown in English and Arabic text as well as pictures for voters who may speak one of the country’s more than 125 other languages.  In addition, thanks to USAID and its partners in Sudan, over 14,000 poll workers will have been trained in polling and counting procedures by the time the referendum takes place.

USAID’s attention to the details of a successful vote complements its broader activities to support peace, security, and good governance throughout Sudan.

Photo Essay: Riding for Health in Lesotho

The USAID-supported Horse Riding for Health program engages pony riders and motorcycle riders to transport blood tests, drugs, and supplies to Lesotho‘s remote mountain health clinics.

The system allows people to receive HIV test results sooner, access life-saving drugs, and ensure an uninterrupted supply of medication.

In this photo essay, follow the riders to homes and clinics throughout tiny Lesotho to meet:

Maamohelang Hlaha: An HIV-positive mother of four whose village is inaccessible by vehicles and a three-hour hike from the nearest health clinic

Potso Seoto and Thuso Khanare: Dedicated riders who transport life-saving medicines while supporting their families through a stable job

Dr. Leopold Buhendwa: The Elizabeth Glaser Foundation’s Lesotho country director who works to prevent mother-to-child transmission of HIV

 

Integrating Family Planning, HIV, and MNCH Services in Ethiopia and Kenya

Alice arrives at a health center in Western Province, Kenya, with her nine-month-old baby girl, who has a recurrent fever. Alice suspects malaria, which is endemic in the area. Two hours later, she leaves with malaria medication and a free insecticide-treated bed net. To the casual observer, Alice got what she came for and had her health needs met. She even received a bed net she wasn’t expecting.

A nurse in Meshualekia Health Center, in Addis Ababa, explains how to use the injectable contraceptive, Depo-Provera. The client will also be offered an HIV test as part of the Ministry of Health’s efforts to integrate HIV and family planning services. Photo Credit:Ed Scholl, AIDSTAR-One

But consider what Alice didn’t receive. Had her daughter been weighed, the nurse would have noticed that her growth was faltering because Alice is not yet supplementing her diet with nutritious weaning foods. Her daughter also missed the measles immunization she was due for. Alice was not offered an HIV test, which would have revealed that she is HIV-positive. Finally, no one asked Alice, who has six children and does not want to get pregnant again, if she is using a family planning method or would like information about contraceptives available at the health center. In short, Alice’s immediate need was met, but multiple underlying health needs went undetected by the health center staff.

Alice’s story is unremarkable. Similar scenes play out every day in health care settings around the world. In sub-Saharan Africa, where the burden of HIV, unintended pregnancies, and infant mortality is highest, missed opportunities to meet health care needs, such as those of Alice and her baby, can be deadly.

Fortunately, programs in Kenya and Ethiopia are leading the way in integrating family planning, HIV, and maternal/neonatal and child health (FP/HIV/MNCH) services. In Kenya, the government has made integration of FP and HIV a national policy. USAID/Kenya’s AIDS, Population and Health Integrated Assistance II (APHIA II) project promotes integrated service delivery throughout the country in public, private, and faith-based facilities. Visiting the APHIA II project in Western Province (implemented by PATH), I noted that the Ministry of Health trains nurses and health officers to deliver both FP and HIV services. The project has supported FP/HIV/MNCH integration at 276 health centers and hospitals in Western Province. USAID/Kenya’s new APHIA Plus Project will expand integrated services in 2011.

Ethiopia’s Ministry of Health also supports integration and strives to offer an HIV test to all clients coming to public sector facilities. Clients are also assessed for family planning needs and offered counseling and FP methods. The government’s Health Extension Program, supported by USAID/Ethiopia, provides FP counseling and contraceptives in the home, HIV and child health counseling, and referral for services. These public sector efforts are complemented by such programs as FHI’s Home and Community-Based Care (HCBC) program (PDF), which strengthens integrated FP and HIV services offered in the community. The HCBC program is working with local iddirs—traditional neighborhood-based burial societies—that now provide mutual aid services to households affected by poverty and illness, including HIV. The iddirs recruit and manage community health volunteers, who provide home-based care and support to those living with HIV and counsel clients about FP and child health.

I observed many different models of FP/HIV/MNCH integration in Kenya and Ethiopia, including intra- and inter-facility referrals and strong linkages between home and community-based programs and health facilities. The type of integration model used is not as important as the fact that health workers in both countries now view clients more holistically and address more than a single health problem in a consultation or home visit.

The integrated programs I visited in Kenya and Ethiopia all report challenges, such as training health care workers in multiple disciplines and struggling to meet the complex needs of clients in crowded facilities, where it is difficult to focus on more than one health issue at a time. But providers are addressing these challenges through training and task shifting, the use of job aids and reporting systems that capture integrated services, and ensuring that contraceptives, HIV test kits, and other necessary commodities are available. The next time Alice visits a facility supported by these programs, odds are she will have more than just one child’s fever addressed.

Ed Scholl serves as AIDSTAR-One Project Director. AIDSTAR-One is funded by USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs and promotes new leadership in the global campaign against HIV.

Pic of the Week: Conserving Wildlife in Southern Sudan

Park rangers in southern SudanPark rangers patrol a wildlife habitat in southern Sudan. Supported by USAID, the Wildlife Conservation Society works to protect the area’s natural resources while creating local jobs and seeking alternatives to unsustainable hunting practices. Photo is from A. Schenk/WCS.

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