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Archives for Sub-Saharan Africa

Solving Transportation Problems and Preventing AIDS Deaths in Lesotho

What’s the first thing that comes to mind when you think about innovation for health? DNA tests? Smart phones? How about ponies? In Lesotho, these four-legged vehicles might just be the best idea yet.

Lesotho is a tiny country landlocked within South Africa about the size of Maryland. Its 2 million people live mostly in rural areas. But despite its small size, it has big HIV statistics. One in four adults is HIV-positive, and more than 20,000 people are newly infected each year. Many people live in mountainous areas that are connected to larger towns and cities by a network of winding and unreliable roads.

Small clinics in the mountains serve as crucial outposts for health care. The roads to the mountains, however, are often unusable due to heavy summer rains and winter snowstorms. Clinics consequently can’t order lab tests or receive a reliable flow of drugs and supplies for four months or more every year. HIV patients, who need medication daily, and those seeking to find out their HIV status, can’t wait that long.

To fill this need, USAID supports the Elizabeth Glaser Pediatric AIDS Foundation to collaborate on an innovative way to reach those in need. The Horse Riding for Health program engages local pony riders to transport blood tests, drugs, and supplies between remote mountain health clinics and better-equipped hospitals at sea level. When roads are navigable by two wheels, motorcycle riders join the journey to further speed the process of rushing blood to the lab or medication to those sick with HIV. The transport system allows people to receive HIV test results sooner, access life-saving drugs, and ensure an uninterrupted supply of medication. (See more photos of the horse riders.)

The benefits aren’t limited to individuals receiving care; research shows that faster diagnosis and treatment for HIV leads to fewer future cases in the community. This is partly because the more people know their HIV status, the less likely they are to transmit the disease to others. Especially for pregnant women, learning her HIV status can be the difference between life and death for her baby.

Just a few years ago, even if expectant mothers knew they were HIV-positive, all they could do was hope for the best. In addition to improving transportation systems, USAID and the Glaser Foundation have rolled out comprehensive services to prevent mother-to-child HIV transmission throughout Lesotho. Today, 80 percent of mothers have access to treatment and counseling programs that can allow their babies to be born HIV-free. The fight against HIV in Lesotho has been bolstered by strong leadership by Minister of Health Mphu Ramatlapeng as well as active involvement by the community.

To see the Lesotho programs in action, ABC News is featuring two videos on its website and will air a story Friday night on 20/20 for the first in a series of reports on global health. The event will span Good Morning America, World News with Diane Sawyer, Nightline, and 20/20 to showcase innovations in global health as well as the people behind the progress.

Voter Registration for Referendum Completed in Sudan

Last week, voter registration for the January referendum on self-determination for southern Sudan came to a close in Sudan after a process described as peaceful, well-managed, and participatory.  To see first-hand what voter registration was like, USAID staff captured video at the registration kickoff in Juba, the regional capital of southern Sudan, and Torit, the capital of Eastern Equatoria state.  U.S. Consul General in Juba Barrie Walkley encouraged southern Sudanese to register:  “It is your decision, whether it’s for unity or for separation.  The decision is yours.”

During Sudan’s 22-year civil war, 2 million people died and 4 million were driven from their homes.  The referendum on whether southern Sudan will become an independent country or remain part of a united Sudan is a key provision of the 2005 Comprehensive Peace Agreement between the Government of Sudan and the southern Sudan People’s Liberation Movement/Army that finally ended the devastating war.  Two major components of the agreement have already been completed:  a national census in 2008 and national multi-party presidential and parliamentary elections earlier this year.

As part of efforts to promote peace in Sudan, USAID is supporting a free and fair referendum process.  In particular, USAID is:

  • Providing expert advice, training, and office space for the Sudanese commission in charge of carrying out the referendum
  • Delivering critical materials such as voter registration books and cards, training manuals, and polling kits
  • Training voter registration and poll workers
  • Educating voters about the referendum process through mass media and community outreach
  • Funding registration and voting for the Sudanese diaspora in eight countries
  • Supporting observation by both Sudanese and international organizations

Voter registration in Sudan was held from November 15 to December 8.  Registration in eight other countries with large southern Sudanese populations will be completed by December 22.  The referendum is scheduled for January 9-15, 2011.

For more information:

Taking a Stand Against Violence Now

“Girls have been made to believe that they need someone to survive.”

These powerful words came from one of the commentators in the short documentary, SASA!, a film about women, violence and HIV/AIDS.

Sasa is Kiswahili for “now.” As in now is the time to take a stand against women’s violence. And we need to make this change now.

SASA! tells the powerful story of Josephine and Mama Joyce, two women from different countries, but in similar situations. Beaten, abused, pushed down, and left HIV positive by the men they married.

As young women, they were made to feel powerless and told they wouldn’t be happy unless they were with a man—even a man who abuses them.

Their situations are not isolated cases; globally, at least one out of every four women is beaten, coerced into sex, or otherwise abused during her lifetime.

One out of four.

Gender based violence (GBV), is a pervasive public health and human rights issue throughout the world. GBV consists of sexual, physical, emotional and/or financial abuse and is manifested throughout the life cycle.

Furthermore, this type of violence against another human being has negative health consequences.

In Mama Joyce and Josephine’s situations, they were both left HIV positive. Josephine’s husband slept with other women, and when she brought up the use of a condom, he beat her. And even though she protested, he forced sex on her. Adding salt to the wound, her in-laws blamed their son’s death on her. Mama Joyce’s husband left her and his second wife, leaving Mama Joyce to take care of her ailing “co-wife.”

But these women remained strong. They became leaders in their communities, hold support groups, and encourage other women who are in similar situations.End Violence Against Women Graphic

USAID, through the Global Health Initiative, is fully committed to preventing and responding to gender-based violence. Interventions work with both men and women to address the multiple factors at various levels that fuel the issue, and we are looking to help make a change in these women’s lives now.

50 Weeks to 50 Years at USAID – Week 3: Fighting HIV/AIDS

I had just finished my first year of graduate school at UCLA when the first case of HIV was reported in Los Angeles. Little did I know how that event, happening so close to my school, would affect and influence my professional life. Over the next three decades, HIV/AIDS would play a central role in my USAID career and become a passion and driver of my work.

As deputy director of the Health and Nutrition Office in the 1990s, I helped oversee the HIV/AIDS division’s work and program. But HIV/AIDS was only a disease I read about and discussed. It took my Foreign Service posting in Zambia in 1998 for HIV/AIDS to become real.

One in five Zambians was HIV positive, and because the epidemic had been underway for 15 years, illness and death were at an all time peak. Our home was on the road to the city cemetery, and long funeral processions were daily occurrences.

It was during my first year there that I personally experienced the devastating death of one of my staff from AIDS. It changed our entire office and we were inspired to do all we could to ensure others did not face the same fate. It was those five years in Zambia, at the heart of the HIV/AIDS epidemic, which convinced me of the importance of prevention—especially reaching the next generation with effective messages.

Reading the predictions for the next HIV/AIDS wave to hit key Asian countries, I was motivated to share what I learned in southern Africa with this region.

With my five-year assignment to India, I was witness to the large scale expansion of the Indian response to high risk groups and key geographic areas. We focused the majority of our efforts on building the local capacity of the government and civil society to ensure sustainability.

The scale of this effort was enormous given that most Indian states’ populations are greater than those of many countries.

I am now back in Washington, leading the HIV/AIDS Office in the Bureau for Global Health. This is a very important time as the second phase of the President’s Emergency Plan for AIDS Relief (PEPFAR) is being implemented with a greater focus on sustainability and country ownership. And with President Obama’s Global Health Initiative underway, USAID is working with our U.S. Government partner agencies to improve integration among our programs.

We have made tremendous progress over these some 30 years—PEPFAR is currently supporting over 3.2 million people on lifesaving antiretroviral (ARV) drugs, and with USG support in fiscal year 2010 alone more than 114,000 infants were born HIV-free.  Through partnerships with more than 30 countries, PEPFAR  directly supported 11 million people with care and support and provided nearly 33 million people with HIV counseling a testing.

It has also been an exciting time for prevention with the results of the USAID-funded CAPRISA trial proving a microbicide could help prevent HIV transmission. This was met with enthusiasm by the HIV/AIDS community, and Administrator Shah is supportive of an aggressive way forward to advance microbicides from proof of concept to impact in the field to slow transmission of HIV.

So on this World AIDS Day and in the coming year, we should all honor the 33.3 million people who are currently living with HIV and the millions more who have died from this epidemic, and recommit ourselves to do all we can to address the personal tragedy caused by HIV/AIDS.

A Brief History of USAID’s Role in HIV/AIDS

•         1986: USAID officially begins HIV/AIDS programs in the developing world. This is only two years after HIV, the virus that causes AIDS, was isolated and identified.

•         1988: USAID’s Demographic and Health Survey begins collecting data on HIV.

•         1993: USAID is a founding member of the International HIV/AIDS Alliance

•         1998: USAID launches the IMPACT program for HIV prevention and care.

•         2000: USAID launched Regional HIV/AIDS Program for Southern Africa.

•         2001: USAID officially launches the Office of HIV/AIDS within the Bureau for Global Health.

•         2001: USAID begins partnership with the International AIDS Vaccine Initiative.

•         1998: USAID launches the IMPACT program for HIV prevention and care.

•         2000: USAID launched Regional HIV/AIDS Program for Southern Africa.

•         2001: USAID officially launches the Office of HIV/AIDS within the Bureau for Global Health.

•         2001: USAID begins partnership with the International AIDS Vaccine Initiative.

•         2003: The U.S. President’s Emergency Plan for AIDS Relief is announced

•         2005: PEPFAR, in conjunction with USAID, launched the Supply Chain Management System Project

•         2008: The $48 billion Lantos-Hyde reauthorization bill on HIV/AIDS, TB, and malaria is signed into law

•         2009: The President’s Global Health Initiative is announced

•         2010: the CAPRISA 004 trial provides the first ever proof of concept that a microbicide can prevent HIV transmission

Pic of the Week: Commemorating 2010 World AIDS Day

Woman and boy in MozambiqueEighty percent of Mozambique‘s people live in villages and must walk on an average 12 kilometers to reach a health clinic. Here, a woman and her daughter hold the anti-AIDS medicine that keeps them alive. They worried that neighbors would see the medicine and know they had the disease. Photo is from Ben Barber/USAID.

The Story Behind the Statistics: Victims of Rape in Benin Find Justice

The Statistics: In Benin, more than 75 percent of women are victims of violence, and 44 percent are sexually abused.

The Story: Déborah and her husband Djobo live in the village of Guiguiso in northern Benin. On the night of September 9, 2009, three men assaulted the couple while they slept. Djobo was left bleeding and unconscious and Déborah was raped. After Djobo regained consciousness, he alerted the village. The coordinator of a USAID project, which aims to reduce violence against women and girls in all of Benin’s 77 municipalities, promptly informed the police commissioner and project facilitator in nearby Bassila. With the help of the entire population of Guiguiso, the three men were tracked down and taken into custody before sunrise.

Déborah and Djobo sought medical attention from the Bassila hospital and, with medical certificates in hand, they went to the police commissioner. After hearing the accused, the victims, and the witnesses, the commissioner presented the case to the prosecutor. Today, the three accused men await trial from jail.

In Benin, more than 75 percent of women are victims of violence, and 44 percent are sexually abused. Since 2007, USAID has helped to not only promote greater recognition and acceptance of women’s rights in Benin but also get more women victims of violence to seek help from the Benin Government’s Social Service Centers and the justice system.

“The injury we suffered as a result of this gang rape may pass with time,” Déborah said weeks after the assault, “but I dare not imagine what life would be like had we not received help from USAID, all the way from the hospital, the police station, and down to the prosecutor’s office to press charges.”

From November 2007 to September 2010, the U.S. Government has assisted in 2,782 cases of physical and sexual violence of which 996 reached the Courts of First Instance. This is nearly seven times the number planned for the life of the project, as it is very difficult for Beninese women to press charges against the men who abused them.

“Before,” a Beninese judge said, “we would attempt to resolve cases of gender-based violence ‘amicably’ and out-of-court. This is no longer the case because of USAID programs which help the victims understand and pursue their cases in the court system; and mounting pressure from the media, which act as essential partners in the cause of justice for women.”

The 16 Days Campaign to End Violence Against Women:

From 25 November to 10 December, USAID will post a blog every day to bring much needed attention to the reality of millions of women around the world who are victims of violence and abuse.  Our blog posts will focus on the root causes of violence and individual stories of women and girls who lived through it.

Follow us on Twitter. When you see us tweet something interesting, retweet it!

Become a fan of our USAID for Global Health Facebook page and feel free to share stories, photos, and videos that demonstrate your support for women’s rights!

Up Close and Personal With Our Global Health

I recently traveled to Senegal, Ethiopia, and Mozambique to visit a wide range of global health programs supported by USAID and other U.S. Government Agencies including the Centers for Disease Control, Department of Defense, and the Peace Corps.

My colleague, Zeke Emanuel, from the White House Office of Management and Budget, blogged extensively during this two-week trip about President Obama’s Global Health Initiative.  This whole-of-government effort encourages a more integrated approach to global health — building upon historic efforts under the Bush Administration through PEPFAR and PMI with a renewed focus on child and maternal health, TB and other diseases.  It also strengthens health systems to ultimately save more lives.

Is funding for global health a never-ending waste of money in which billions are spent but nothing gets better? Or are we being selfish and grossly unethical, because we are unwilling to spend a few hundred dollars more per year in order to save a life of a poor person half way around the world?

These are tough questions, and Zeke addresses them in his first blog entry, now featured at The New Republic.

Democratic Republic of Congo Joins Malaria Initiative

On Tuesday, November 16th, the Democratic Republic of Congo (DRC) became the 16th focus country of the President’s Malaria Initiative (PMI) and one of the most important. DRC is the second largest and third most populated country in Sub-Saharan Africa. Nearly 95 percent of the population – some 69 million people – live in malaria endemic areas and suffer nearly 30 million cases of this treatable and preventable disease. Malaria accounts for nearly half of the deaths of the 620,000 children in DRC who die before their fifth birthday.

The launch of PMI was held in Mbuji Mayi, capital city of East Kasai. Admiral Timothy Ziemer, U.S. Global Malaria Coordinator, U.S. Ambassador to DRC James Entwistle, and USAID Mission Director Stephen Haykin joined thousands of Congolese for the public launch of the program, which included distributing long-lasting insecticide-treated nets (LLINs) and preventive malaria treatment to pregnant women. Next year, PMI will procure 2 million LLINs to support the universal coverage strategy in Katanga Province, which is part of the National Malaria Control Program’s (NMCP) five-year strategic plan for universal coverage. PMI will procure another 645,000 LLINs for routine distribution in 112 health zones in the four provinces where USAID works, which will be part of the NMCP’s distribution plan for 2009-2014.

With its large population, geographic size, and heavy burden of malaria, the DRC presents a major challenge to reducing morbidity and mortality attributable to malaria in Africa. As with other PMI focus countries, the goal of PMI in the DRC will be to expand malaria control efforts to reach large areas of the country, achieving a 50 percent reduction in malaria burden by targeting those most vulnerable to malaria – children under the age of five and pregnant women. PMI will work with the NMCP to provide LLINs and antimalarial drugs, help strengthen health systems, and integrate malaria control and prevention activities with other health programs in 112 health zones in the four target provinces. PMI will also help identify and fill gaps in other malaria interventions in close collaboration with other partners, including donors, civil society organizations, faith-based groups, and the private sector.

Malaria prevention and treatment is a core component of the U.S. Government’s development policy and the Administration’s Global Health Initiative (GHI). Rather than attack diseases individually, GHI focuses on tying health programs together, creating an integrated and coordinated system of care. For example, PMI is expanding efforts to support health systems strengthening and to integrate with USAID’s maternal and child health (MCH) programs and the President’s Emergency Plan for HIV/AIDS Relief (PEPFAR). Given that malaria control is essentially a maternal and child health program, PMI has been working to ensure that all its activities at the health facility level are integrated with the MCH program.

The Global Health Initiative and the President’s Malaria Initiative share a common focus on women — improving their health status benefits women, as well as their families and communities. By expanding women’s access to care, increasing the focus on women’s health outcomes, and incorporating women’s perspectives into health systems, the GHI and PMI will impact women, their children, and their families.

The United States Government has supported malaria control in DRC during the past 10 years as a key component of the health program supported by USAID in almost half of the country, including Katanga, South Kivu and East and West Kasai provinces. During the past two years, the DRC has conducted mass distribution of LLINs in Kinshasa, Equateur, Orientale and Maniema provinces. Similar campaigns are planned in Katanga and East and West Kasai in the near future. These life-saving bed nets are also being provided for routine distribution through antenatal and child health clinics. As a result of these programs, since 2008, nearly 30 million LLINS have been brought into the country by the government of the DRC and the donor community.

Voter Registration Begins for Sudan Referendum

Voter registration began today in Sudan for the landmark referendum on self-determination for southern Sudan, which is scheduled to begin January 9. The referendum—a key provision of the 2005 Comprehensive Peace Agreement (PDF) that ended 22 years of war between northern and southern Sudan—will allow the people of southern Sudan to choose either to remain part of a unified Sudan or to secede and form an independent nation.

USAID is playing a key role in supporting this historic referendum process, including the purchase and delivery of voter registration books, cards, and training manuals that are now in use, conducting voter education to inform voters about the process, helping domestic organizations to observe the process, and supporting independent international observation of the process.


Slideshow of Voter Registration from Sudan

More than 5.4 million southern Sudanese are eligible to register, and there are nearly 3,000 registration centers in Sudan that will register voters through December 1. Registration of eligible voters is taking place in Sudan as well as eight other countries that have large populations of southern Sudanese—Australia, Canada, Egypt, Ethiopia, Kenya, Uganda, the United Kingdom, and the United States. Three American cities are hosting voter registration: Phoenix, Arizona; Omaha, Nebraska; and the Washington, DC, metro area.

Introducing the NGO Sustainability Index for Sub-Saharan Africa

Whether acting as advocates, watchdogs, or service providers, it is widely recognized that Non-Governmental Organizations (NGOs) play a crucial role in countries across sub-Saharan Africa.

However, their ability to make a true impact depends not only upon their own organizational capacity and financial viability, but also upon such external factors as their country’s legal framework, communications, and other sectoral infrastructure.

USAID is now giving users an easy way to understand the opportunities and the threats facing NGOs across the region with our roll-out of the NGO Sustainability Index for Sub-Saharan Africa (PDF).

The Index measures NGO sustainability using a methodology that employs seven “dimensions”. These include legal environment, organizational capacity, financial viability, advocacy, service provision, infrastructure, and public image.

By combining numerical scores with narrative justifications, the Index offers a useful description of the state of the NGO sector in 19 countries in Sub-Saharan Africa.

Mirroring the long-established Central and Eastern Europe and Eurasia NGO Sustainability Index, this first edition of the Africa NGOSI will provide a benchmark for observing trends across sub-Saharan Africa as well as between

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