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U.S. Opens New Ebola Clinic in Liberia

Liberia is in the midst of a building boom to help control the spread of Ebola. In support of the Liberian Government’s Ebola response strategy, the United States is in the process of constructing 15 Ebola treatment units (ETUs) in this hard-hit nation. Across the country, teams of workers are busy moving dirt, laying concrete, trucking in construction materials, and erecting large white tents.

The first ETU to be built and staffed by the U.S.—in the city of Tubmanburg—started receiving patients on November 18. Now, a second ETU supported by the United States is operational in the city of Kakata, about 45 miles northeast of Monrovia. Built by the organization Save the Children with support from USAID, the ETU is being run by International Medical Corps (IMC), which is also managing another ETU in Bong County, Liberia.

Members of USAID’s Ebola Disaster Assistance Response Team (DART) visited the site on November 22, joining a Liberian delegation that included the Assistant Minister of Health and county health officials. Below is an inside look at the USAID-supported ETU, including those areas that are currently off limits to cameras now that the facility is open to Ebola patients.

11.22.14-Kakata-ETU-sign-photo-credit-Justin-Pendarvis-USAID-OFDA About an hour’s drive northeast of Monrovia, in the heart of Liberia’s rubber cultivation belt, the second Ebola treatment unit (ETU) in Liberia to be constructed and staffed with U.S. Government assistance is now receiving patients. / Justin Pendarvis, USAID/OFDA


The facility was built by Save the Children with USAID providing construction materials, gravel, cots for patients, generators to power the ETU, and other support.  The red fencing separates public areas from Ebola “hot zones.” Photo courtesy: Justin Pendarvis, USAID/OFDA The facility was built by Save the Children with USAID providing construction materials, gravel, cots for patients, generators to power the ETU, and other support. The red fencing separates public areas from Ebola “hot zones.” / Justin Pendarvis, USAID/OFDA


USAID is funding International Medical Corps (IMC) to operate the ETU in Kakata. Here, USAID Disaster Assistance Response Team (DART) Deputy Justin Pendarvis (left) gets a tour from IMC Emergency Response Team Director Sean Casey (right). / Alisha McMichael, USAID/OFDA USAID is funding International Medical Corps (IMC) to operate the ETU in Kakata. Here, USAID Disaster Assistance Response Team (DART) Deputy Justin Pendarvis (left) gets a tour from IMC Emergency Response Team Director Sean Casey (right). / Alisha McMichael, USAID/OFDA


More than 160 people—mostly Liberian national staff—work at the ETU. For the past two weeks, IMC’s medical team received rigorous training on Ebola patient care, safety protocols, and ETU management. Photo courtesy: Alisha McMichael, USAID/OFDA More than 160 people—mostly Liberian national staff—work at the ETU. For the past two weeks, IMC’s medical team received rigorous training on Ebola patient care, safety protocols, and ETU management. / Alisha McMichael, USAID/OFDA


The 88-bed ETU, which opened on November 22, has received a number of patients. Some were discharged after testing negative for Ebola. Photo courtesy: Alisha McMichael, USAID/OFD The 88-bed ETU, which opened on November 22, has received a number of patients. Some were discharged after testing negative for Ebola. / Alisha McMichael, USAID/OFD


NO DETAIL OVERLOOKED: Inside the clinical care areas are electrical outlets where patients can play music or charge their cell phones to keep in touch with their loved ones. USAID provided generators to power the ETU. / IMC NO DETAIL OVERLOOKED: Inside the clinical care areas are electrical outlets where patients can play music or charge their cell phones to keep in touch with their loved ones. USAID provided generators to power the ETU. / IMC

ABOUT THE AUTHOR

The Ebola Disaster Assistance Response Team (DART) is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the U.S. Government, including USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), the U.S. Centers for Disease Control and Prevention (CDC), and the Departments of Defense and Health and Human Services.

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Key Populations Essential to Realize AIDS-Free Generation

Sex worker working on the Phnom Penh riverside. /  Ian Taylor

Sex worker working on the Phnom Penh riverside. / Ian Taylor

As we commemorate World AIDS Day this year, let’s take a moment to remember how far we’ve come, and where we must go. There are currently 35 million people living with HIV worldwide, and 13.6 million of those people are receiving antiretroviral therapy. New HIV infections continue to decline each year, with 2.1 million in 2013, which was 38 percent lower than in 2001. However, over 4,000 people continue to die from AIDS each and every day.

In accordance with the immense toll that HIV and AIDS have taken on the world, the U.S. Government established the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 as the single largest commitment by any nation to combat a single disease. Since then, working closely with many partners, PEPFAR has supported lifesaving antiretroviral therapy for more than 6.7 million men, women and children. As a key implementing agency of PEPFAR, USAID has made significant contributions to this remarkable progress. But, together, we have more work to do to finish the job.

UNAIDS has identified the 90-90-90 targets by 2020. These milestones aim to have 90 percent of people living with HIV know their status, 90 percent of people who know their status receive treatment, and 90 percent of people on HIV treatment having a suppressed viral load so their immune system remains strong and they are no longer infectious. In order to achieve these goals and have a lasting response to this epidemic, we must examine what is required to sustain HIV treatment for decades to come.

India World AIDS Day 2008 / AFP/Narinder Nanu/Getty Images

India World AIDS Day 2008 / AFP/Narinder Nanu/Getty Images

The vision for the next phase of PEPFAR is partnering to deliver an AIDS-free generation with sustainable results.However, a sustainable response to this epidemic requires intensified action to address major ongoing challenges such as health care financing, health systems and new technologies for treatment and prevention. And there is a special need for increased attention to the human rights of key affected populations. These include sex workers, men who have sex with men, transgender persons and persons who inject drugs.

The high vulnerability of key populations to HIV is disturbing. Compared to the general population, sex workers are 14 times more likely to be infected with HIV; men who have sex with men are 19 times more likely to be infected; and the limited data we have on transgender women suggest that they are 49 times more likely to be infected with HIV. Equally unsettling are the global estimates that the number of people living with HIV who inject drugs range from over 1 million to slightly less than 4 million people.

Barriers to essential services prohibit these figures from coming down. Stigma and discrimination, violence, criminalization, bad or ineffective policies, and opposition to civil society engagement present real challenges. One of the most egregious barriers is the lack of acknowledgement by governments and other leaders that key populations even exist and/or are underserved. As I have observed over the years, the most insidious form of oppression is to ignore a people.

Fortunately, that pessimistic view is tempered by the knowledge that these barriers can be overcome. We know from experience that effective programs can reach key populations with high quality, effective services, and that key populations infected with HIV can be linked to the care and treatment services that they desperately need. On Thursday, Dec. 4, we will highlight the importance of key populations in the HIV epidemic at the D.C. launch of USAID’s PEPFAR-funded LINKAGES project.

The U.S. Government’s official theme for World AIDS 2014 is Focus, Partner, Achieve: An AIDS-free Generation. This theme captures the core elements of what is needed to reach this goal, which is outlined in the PEPFAR Blueprint. We must deliver the right thing, in the right place and at the right time. This means focusing on the highest impact interventions, bringing them to scale in key geographic areas and among the most vulnerable populations, including men who have sex with men, sex workers, injecting drug users, and transgender persons.

On this World AIDS Day, nearly 35 years into the epidemic, I am extremely proud of our collective progress. But, while an AIDS-free generation is within our reach, we must not stop until it becomes our reality.

ABOUT THE AUTHOR

David Stanton is the Director of USAID’s Office of HIV/AIDS

Inspiring the Next Generation of Nutrition Leaders in Uganda

Adera facilitating Village Health Team training for community mobilization and SBCC in Ntungamo

Adera facilitating Village Health Team training for community mobilization and SBCC in Ntungamo

Thanksgiving is a time to share a meal with turkey, stuffing and of course pumpkin pie. We spend a lot of time planning our Thanksgiving meal (making sure to include everyone’s favorites) but we probably spend very little time thinking about the nutritional value of the meal. This year, the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project wants to combine the traditional focus on food with a story that will inspire you to consider nutrition as you plan your holiday feast.

Asasira Adera and Carol Noel Agabiirwe would probably have a lot to say about all the desserts we are about to indulge in over the next few days. Both have been working with the SPRING Project as “Nutrition Trainees” in Uganda. This program, developed by SPRING, helps Bachelor of Science in Human Nutrition and Dietetics students at Kyambogo University gain technical experience to ease their transition into the working world. Asasira and Carol were part of the very first group to join SPRING last year.

Carol explains to USAID/Uganda and Feed the Future Team about promoting intake and compliance of iron folate by pregnant women in Kitagata, Sheema district

Carol explains to USAID/Uganda and Feed the Future Team about promoting intake and compliance of iron folate by pregnant women in Kitagata, Sheema district

In Uganda, the rate of stunting in children under age 5 is 38 percent. Stunting limits children’s ability to learn and impacts their future earning potential. Unfortunately, trained nutritionists with strong technical and leadership skills that can improve nutrition behaviors are scarce. Hoping to inspire more young people to become leaders in the field of nutrition, SPRING/Uganda’s internship program focuses on building the knowledge and skills to produce meaningful results. The program requires interns like Adera and Carol to design a work plan, outline specific objectives and produce targeted deliverables due at the end of the training.

Both Adera and Carol used social and behavior change communication (SBCC) strategies to promote nutrition behaviors at the community level. They counseled mothers and fathers with children under age 2 to adopt targeted nutrition behaviors such as exclusive breastfeeding. They provided nutrition services using the nutrition assessment, counseling and supportapproach (NACS), and worked with pharmacies and hospitals to ensure a steady supply of iron folic acid, or IFA, supplements for pregnant women.

Looking back on their experiences, Adera, who worked in the Ntungamo Districtwith district officials, sub county officials, health workers and village health teams, said she was inspired by the strong rapport she built with community members, who, after a year of working together, trusted her and accepted her into their community.

For Carol, being able to translate theory and academic knowledge to real people in the community was an incredibly rewarding experience. She felt more confident in her facilitation and communication skills thanks to the training and support she received through USAID’s SPRING/Uganda.

Having the opportunity to see the impact of their work was a formative experience for both Adera and Carol. SBCC programs for nutrition are challenging, but when new behaviors are formed and lasting improvements in health are made, the payoff is immeasurable. As Adera and Carol were developing their nutrition skills, they were also helping the community to learn and grow.

In May 2014, Kyambogo University and SPRING/Uganda signed a memorandum of understanding to continue their partnership to support new nutritionists with training. A group of six new nutrition trainees just joined SPRING/Uganda this June. Now, it is Adera’s and Carol’s turn to share their knowledge and lessons learned with the new group.

Make sure to follow SPRING/Uganda for updates from communities learning about and improving their nutrition behaviors.

Happy Thanksgiving from SPRING!

ABOUT THE AUTHORS

Asasira Adera is a Nutrition Trainee working with SPRING/Uganda
Carol Noel Agabiirwe is a Nutrition Trainee working with SPRING/Uganda
Alexis Strader is a Knowledge Management Program Officer at John Snow Inc. (JSI) based in Washington, D.C.

The Economic Case for LGBT Equality Worldwide

Dr. Claire Lucas, USAID’s senior adviser on partnerships, addresses the audience at the launch of the joint Williams Institute-USAID report on LGBT inclusion and economic development. Seated, left to right: Carla Koppell, chief strategy officer, USAID; M.V. Lee Badgett, report author and research director, Williams Institute; and Brad Sears, executive director, Williams Institute. Photo credit: Matthew Corso/USAID

Claire Lucas, USAID’s senior adviser on partnerships, addresses the audience at the launch of the joint Williams Institute-USAID report on LGBT inclusion and economic development. Seated, left to right: Carla Koppell, chief strategy officer, USAID; M.V. Lee Badgett, report author and research director, Williams Institute; and Brad Sears, executive director, Williams Institute. / Matthew Corso/USAID

What if there was hard-and-fast evidence that discriminatory laws and actions against lesbian, gay, bisexual and transgender (LGBT) individuals hurt economic prosperity in emerging markets and developing countries?

Last week, I was proud to join in the launch of a groundbreaking report published by the Williams Institute as part of USAID’s LGBT Global Development Partnership that undertakes this empirical analysis. The underlying study found that human rights and economic prosperity are intertwined and that greater inclusion of LGBT people in emerging economies, at both the micro and macro levels, is positively associated with a country’s economic development.

Across 39 emerging economies and other selected countries, the study found substantial evidence that LGBT people are limited in their freedoms in ways that also create economic hardships.

The study uses, for the first time, the Global Index on Legal Recognition of Homosexual Orientation, which establishes categories of legal recognition and protection for lesbians and gay men, as well as a provisional index on transgender rights that was created specifically for the report. The index identifies eight types of laws that indicate a country’s level of legal recognition of LGBT people. It includes legalizing consensual acts between same-sex adults, providing protections against discrimination in employment or the provision of goods and services, and legal recognition of same-sex couples or the legal ability of couples to adopt children. The index allows for a numerical value to be assigned to each country in the study based on the number of laws currently enacted that provide either basic protections or address family recognition and adoption rights.

Based on this index, the study was able to show that one additional legal right in the index is associated with approximately a $320 in per capita GDP, or about 3 percent of the average in the sample countries, and a higher human development index value. For instance, Kenya has a score of zero, as it does not provide any legal protections for LGBT people and has a per capita income of $1,318. In contrast, Argentina has a score of seven and a per capita income of $13,323.

This positive correlation is significant because it allows us to put a price tag on discrimination. Based on the models and anecdotal evidence, we can see that countries that discriminate against LGBT people are pushing entire groups of people out of the formal economy and reducing the economic gains they would otherwise enjoy if they were allowed to be productive members of society.

So what does this mean for development and the LGBT community?

This research has potentially powerful ramifications for the way USAID works, for the donor community, for business leaders, for policymakers in emerging markets, and even for the U.S. taxpayer and legislators.

By linking stigma and discrimination against LGBT individuals to a country’s economic well-being, the issue of bigotry is not just felt and understood by those who are LGBT, but by anyone who cares about that country’s economic growth.

In April, Marco Andrés Jaramillo—an entrepreneur and CEO of EgoCity, an online and print magazine in Medellín, Colombia—joined 60 LGBT Colombians for #ActivatingLGBT, an entrepreneur training hosted by USAID partner, the National Gay & Lesbian Chamber of Commerce of the United States, and the Colombian LGBT Chamber of Commerce.

The training, held in Barranquilla, coached innovative LGBT entrepreneurs on how to create and sustain economically viable businesses, conduct trade with international partners, and make use of inclusive procurement policies. With new skills and connections, his business is booming.

Today, Jaramillo is turning his business from a small, niche magazine focused on his local community into one serving major multinational clients throughout Latin America and Europe. In the past year alone, business has grown by roughly a quarter.

Entrepreneurs like Jaramillo are engines of growth for their communities, countries and continents. Far too often, LGBT individuals around the world are excluded from contributing to their economy because of who they are. The fact is simple: Economic growth depends on a healthy, inclusive workforce, and people can’t work if they are routinely excluded from schools, jobs and health care or subject to other harms such as violence and police abuse.

ABOUT THE AUTHOR

Claire Lucas is a Senior Adviser in the U.S. Global Development Lab focused on partnerships.

Building Ebola Treatment Units to Foster Hope, Healing in Liberia

Liberian Vice President Joseph Boakai, middle, gets a tour of the U.S.-built Tubmanburg Ebola treatment unit from USAID partner International Organization for Migration, which will be running the facility / Carol Han, USAID/OFDA

Liberian Vice President Joseph Boakai, middle, gets a tour of the U.S.-built Tubmanburg Ebola treatment unit from USAID partner International Organization for Migration, which will be running the facility / Carol Han, USAID/OFDA

In the Bomi Hills northwest of Monrovia, in an area that used to be the region’s iron and diamond mining center, it’s hard to miss the new “precious resource” that has become critical to Liberia’s fight against Ebola.

Four stark white tents gleam in the sun, the most prominent part of the new Ebola treatment unit (ETU) in Tubmanburg, which is the first ETU to be built and staffed by the United States in Liberia.

Liberian Army Capt. Glee Dilliard Dada led a team of Liberian soldiers who worked closely with the U.S. military to build the facility. Despite the rain, heat and construction setbacks, the Ebola treatment unit was built in 35 days / Carol Han, USAID/OFDA

Liberian Army Capt. Glee Dilliard Dada led a team of Liberian soldiers who worked closely with the U.S. military to build the facility. Despite the rain, heat and construction setbacks, the Ebola treatment unit was built in 35 days / Carol Han, USAID/OFDA

Construction on the 2-acre site was overseen by the U.S. Defense Department in close partnership with the Armed Forces of Liberia. More than 60 people had to overcome the rain, heat, poor roads and supply shortages to build the site in 35 days, completing the ETU earlier this month.

“Especially in this time of national crisis, it has been rewarding to be out here and assisting,” said Armed Forces of Liberia Capt. Glee Dilliard Dada, who supervised the Liberian military construction crew. “I am very overwhelmed with a lot of pride. In a month’s time we did all of this.”

The Ebola treatment unit (ETU) in Tubmanburg is the first ETU to be built and staffed by the United States in Liberia / Carol Han, USAID/OFDA

The Ebola treatment unit (ETU) in Tubmanburg is the first ETU to be built and staffed by the United States in Liberia / Carol Han, USAID/OFDA

USAID Disaster Assistance Response Team leader Bill Berger called the ETU an extraordinary effort, saying, “It took strong partnership to build this ETU. It will also take strong partnership to provide care to patients.”

USAID partner the International Organization of Migration, or IOM, has stepped forward to manage the ETU under the leadership of the Liberian Ministry of Health and Social Welfare. For the past two weeks, IOM’s medical team—made up of local and international health care workers—received rigorous training on Ebola patient care, safety protocols and ETU management.

Within the 2-acre site is a changing area where local and international staff with the International Organization for Migration will be donning googles and other protective equipment to care for patients. / Carol Han, USAID/OFDA

Within the 2-acre site is a changing area where local and international staff with the International Organization for Migration will be donning goggles and other protective equipment to care for patients. / Carol Han, USAID/OFDA

More than 120 members of IOM’s team are now prepared to care for patients. Tejanie Golafaley, a local resident and Ebola survivor, is especially eager to speak to patients at the ETU about his experience beating the disease.

“When I got Ebola, people didn’t want to come around me. I was stigmatized by Ebola,” Golafaley said. “The best thing I can do is talk to [patients] …. I’m going to tell them I’m a survivor. I want to give them hope.”

Tejanie Golafaley, an Ebola survivor, saw it as his personal mission to work at the USAID-supported Ebola treatment unit in Tubmanburg. “I want to explain my story to patients [so that] they can start to take courage.” / Carol Han, USAID/OFDA

Tejanie Golafaley, an Ebola survivor, saw it as his personal mission to work at the USAID-supported Ebola treatment unit in Tubmanburg. “I want to explain my story to patients [so that] they can start to take courage.” / Carol Han, USAID/OFDA

ABOUT THE AUTHOR

Carol Han is the Press Officer for USAID’s Ebola Disaster Assistance Response Team [DART], which is overseeing the U.S. Ebola response efforts in West Africa. The DART includes staff from across the government, including USAID’s Office of U.S. Foreign Disaster Assistance, the U.S. Centers for Disease Control and Prevention, and the Departments of Defense and Health and Human Services.

5 Million Child Slaves, One Nobel Peace Laureate

It is not often that I am personally asked a favor by a Nobel Peace Prize Laureate.

In late September 2014, I ran into a much-esteemed colleague, Kailash Satyarthi, a human rights activist from India who has been at the forefront of the global movement to end child slavery and exploitative child labor since 1980, when he founded the Bachpan Bachao Andolan (Save the Childhood Movement). Kailash asked me to do what I could to support a new campaign he would be launching.

On this Universal Children’s Day, Kailash and many of the world’s leading human rights organizations are launching a campaign—End Child Slavery—to target some of the world’s most vulnerable and exploited children, including the estimated 5.5 million child slaves around the world. The campaign is looking for 5.5 million signatures in five days—one for each of the estimated child slaves.

Why 5 million signatures in five days? The campaign organizers believe that many people are not aware of the extent of slavery in the world today. In fact, according to a recent report by the International Labour Organization (ILO), slave labor generates higher annual profits today than even some of the biggest legitimate global industries. It has recently been estimated that the total profit obtained from the use of forced labor in the private economy worldwide amounts to $150 billion per year.

Children carry bricks in Nepal. Credit: Navesh Chitrakar

Children carry bricks in Nepal. / Navesh Chitrakar

In addition to the enslaved children, an estimated 115 million children, aged 5-17, work in hazardous child labor—dangerous conditions in sectors as diverse as agriculture, mining, construction, manufacturing, service industries, hotels, bars, restaurants and domestic service. Worldwide, the ILO estimates that some 22,000 children are killed at work every year. The numbers of those injured or made ill because of their work are not known.

The figure of 5.5 million children in forced labor is a conservative estimate, with governments identifying only a small fraction of all victims and bringing few perpetrators to justice.

Child worker in India. / Global March Against Child Labor

Child worker in India. / Global March Against Child Labor

Still, the child labor movement is a development success story. In the late 1990s, the estimated number of children in various forms of child labor was nearly 250 million. Today, that figure has dropped to 168 million. The decline has particularly benefited girls as total child labor among girls has fallen by 40 percent since 2000, compared to a drop of 25 percent for boys.

However, millions of the hardest-to-reach children still remain in slavery.

USAID is working to address this problem. Through our Counter-Trafficking in Persons programming, we have supported grassroots organizations working to prevent all forms of human trafficking in over 68 countries and regional missions during the past decade. For example, in Albania, USAID is partnering with the Government of Albania and NetHope on a new app that will target at-risk youth to prevent human trafficking.

Two weeks after I ran into Kailash, he was awarded the Nobel Peace Prize—along with Malala Youssef—for his 34-year career as a child labor activist, during which he has freed tens of thousands of young Indians. As a grassroots activist, he has led the rescue of over 78,500 child slaves and developed a successful model for their education and rehabilitation.

I first met Kailash in 1998 when I joined the ambitious social movement he launched to eradicate child labor globally, the Global March Against Child Labor. With support from USAID and the U.S. Department of Labor, we worked together to document child labor around the world in photos and a film titled Stolen Childhoods, which shared child laborers’ stories in their own words.

In Kenya, where we filmed USAID programs with the Solidarity Center to educate former child coffee pickers, Kailash and our team also had the privilege of working with another passionate activist, Wangari Maathai. She helped our film team document the stories of street children in Kenya in 2002 and 2003. She subsequently became the first African woman awarded the Nobel Peace Prize in 2004 for her contribution to sustainable development, democracy and peace.

During the next five days, there is something each of us individually can do to express our concern for the children who remain victims of slavery today. The End Child Slavery campaign site provides resources and suggested actions. The U.S. Child Labor Coalition also provides important links and resources, and serves as a convening point for U.S. Government agencies and civil society organizations to share information. We can also be proud of our work at USAID, which will continue, in collaboration with other governments and stakeholders, to protect children’s rights around the world.

ABOUT THE AUTHOR

Bama Athreya is a Labor and Employment Rights Specialist at the USAID Center of Excellence on Democracy, Human Rights and Governance

The Power of Toilets, Simple Medicines, and Strong Policies to Stop Diarrhea

Children outside of the health center in Kampong Thom province in Cambodia, where oral re-hydration therapy is provided to children who have diarrhea. PATH/Heng Chivoan

Children outside of the health center in Kampong Thom province in Cambodia, where oral re-hydration therapy is provided to children who have diarrhea. / PATH/Heng Chivoan

More than 2.5 billion people still do not have access to a toilet. As we #CelebratetheToilet on this World Toilet Day, we should remember that universal access to toilets is one of the many necessary steps to ending preventable death.

Day in and day out, I’m reminded of the power of innovation to save the lives of women and children. Often,we forget how successful low-cost innovations and solutions—and the policies that support them—have been in advancing health progress. Like the toilet.

It might seem like an odd thing to celebrate, but the invention of the toilet has been a critical contribution to modern-day public health. Access to toilets, safe water, vaccines and simple interventions like oral rehydration solution (ORS) and zinc have the power to stop deadly diarrhea and save lives. But like all health innovations and interventions, toilets need more champions and complementary policies to reach their full lifesaving potential.

 Children and their families attend community health education sessions in Kampong Cham Province. Diarrheal disease is a leading infectious killer of children under 5 years old. PATH/Heng Chivoan

Children and their families attend community health education sessions in Kampong Cham Province. Diarrheal disease is a leading infectious killer of children under 5 years old. / PATH/Heng Chivoan

Around the globe, local leaders and advocates are playing a critical role in bringing innovations, interventions and policy together to accelerate health gains within their countries. It was heartening to see India’s new prime minister, Narendra Modi, embracing innovative thinking and advocacy to solve the health problems caused by open defecation. As a result, he has the country talking about toilets. Diarrheal disease is devastating in India—as well as other parts of Asia and Africa—where it is one of the leading causes of death among children under the age of 5.

India is not the only country making progress in the fight against deadly diarrhea. Another example is in the Mekong Delta, where my organization, PATH, has helped policymakers in Vietnam and Cambodia evaluate and refocus their policy efforts to stop diarrheal disease—a leading killer of children in their region as well.

About 10 years ago, when new formulations of ORS and zinc, the two cornerstone interventions for severe diarrhea, were recommended for widespread use by the World Health Organization (WHO) and UNICEF, it became clear that the diarrheal disease policies needed to be updated in both Vietnam and Cambodia. Unfortunately, making these updates was not a government priority at the time. Local health workers, NGO advocates and scientists knew more needed to be done to prioritize diarrheal disease so that lifesaving medicines could reach the children dying in their local communities.

Latrine in Cambodia. 2.5 billion people-- 1 in 3 worldwide-- lack access to a toilet, and open defecation is a major culprit behind the tragic number of diarrhea –related deaths. PATH/Anne Aumell

Latrine in Cambodia. One in three people worldwide–or 2.5 billion–lack access to a toilet, and open defecation is a major culprit behind the tragic number of diarrhea–related deaths. PATH/Anne Aumell

Using our unique advocacy model, PATH worked with these local champions to help them assemble a compelling case to present to the ministries of health in each country, which included a package of strong evidence based on the WHO’s global policy recommendations, more effective treatments, the high burden of disease, and support among communities and potential partners. This informed the governments’ policies and compelled action to increase access to ORS and zinc, better equipping health workers to deal with the scope of the diarrheal disease problem in both countries.

As the global health community, including USAID, works to end preventable maternal and child deaths in a generation, country leadership and collaboration for stronger advocacy is key. At PATH, we are always gratified to help local communities and technical experts take action to achieve policy improvements that will save lives.

Students learn healthy hygiene habits and help maintain school toilets in the GIZ Regional Fit for School Programme in Cambodia. Photo credit: Ivan Sarenas

Students learn healthy hygiene habits and help maintain school toilets in the GIZ Regional Fit for School Programme in Cambodia. / Ivan Sarenas

I am confident that we can continue to expand toilet use, improve water and sanitation, and advance diarrheal disease policies around the world if we equip and empower more local leaders and experts to be champions of health innovations, interventions and policies. Together, we can bring the basic essentials of our everyday lives to the rest of the world.

ABOUT THE AUTHOR

Steve Davis is President and CEO of PATH, an international NGO working to drive transformative innovation to save lives.

One Year Later—the Road to Resilience After Typhoon Haiyan

The United States is providing more than $47 million in humanitarian aid to help the people of the Philippines in the wake of Typhoon Haiyan. This photo was taken in hard-hit Tacloban, Nov. 18, 2013. At least 200,000 people affected by Typhoon Haiyan in the Philippine city of Tacloban and six surrounding districts are now receiving clean water for cooking and drinking, as the first water treatment plant came back to full operating capacity /  IOM/J. Lowry

The United States is providing more than $47 million in humanitarian aid to help the people of the Philippines in the wake of Typhoon Haiyan. This photo was taken in hard-hit Tacloban, Nov. 18, 2013. At least 200,000 people affected by Typhoon Haiyan in the Philippine city of Tacloban and six surrounding districts are now receiving clean water for cooking and drinking, as the first water treatment plant came back to full operating capacity / IOM/J. Lowry

This week a year ago, I was in the Philippines, flying with the USAID Disaster Assistance Response Team in a C-130 to Tacloban in the wake of Typhoon Haiyan (known locally as Yolanda). The strongest storm in recorded history, Haiyan hit on Nov. 8, killing more than 6,000 people, displacing 4.1 million, and affecting 16 million in total—about 14 percent of the country’s total population. Flying into Tacloban, I saw a flattened landscape littered with what looked like matchsticks—the splintered remains of homes, businesses and millions of coconut trees. The damage was immense.

The Philippine Government estimates the typhoon caused $12.7 billion in losses. More than a million homes were damaged or destroyed, and 33 million coconut trees, a source of income for many Filipinos, were wiped out. As the average growth span of a coconut tree is 12 years, the storm essentially wiped out a decade of livelihoods for many Filipino families.

USAID Assistant Administrator Nancy Lindborg greets a man at the Tacloban airport who is set to board a flight to Manila, Nov. 19, 2013 / USAID

USAID Assistant Administrator Nancy Lindborg greets a man at the Tacloban airport who is set to board a flight to Manila, Nov. 19, 2013 / USAID

While we have seen enormous progress by the Philippines to build back better, including plans to move 1 million people away from the coast, many of the 4 million people displaced by the storm are still living in temporary shelters. The Philippines continues to lose up to $5 billion, or 2 percent of its gross domestic product, each year to recurring natural disasters.

The Philippines’ steady but tough recovery one year after Haiyan underscores the importance of investing in resilience—of helping people, communities, countries and systems survive and recover from acute shocks and stresses.

Far from being an isolated incident, Haiyan is part of a litany of natural disasters that are coming faster and harder each year thanks to climate change. Research suggests that, as our oceans become warmer, the severity of storms will inevitably increase. The number of reported disasters has already nearly tripled since 1980, and the cost of those disasters is up 300 percent, to $200 billion every year.

As Haiyan illustrates, when disaster strikes, the most vulnerable populations are the hardest hit, often without a chance to recover before the next shock hits them. Many of the communities affected by Haiyan already had poor infrastructure, which was devastated by the storm.

We know that droughts, typhoons and other disasters will continue to happen. By investing in resilience, USAID has pledged to help the world’s most vulnerable get ahead of these recurring shocks. We have changed the way we do business to help communities adapt, mitigate and manage the risks that will inevitably come. These efforts include bringing our humanitarian and development teams together to integrate, layer and sequence our relief and development resources around the shared aim of reducing persistent emergencies by addressing underlying vulnerabilities.

Caption: Boxes of relief kits from USAID sit outside the heavily damaged Tacloban airport, Nov. 19, 2013 / IOM/J. Lowry

Boxes of relief kits from USAID sit outside the heavily damaged Tacloban airport, Nov. 19, 2013 / IOM/J. Lowry

Climate change adaptation is critical to mitigating the impact of disasters like Haiyan, and USAID is investing in these efforts. We are part of the Urban Climate Change Resilience Trust Fund, a $140 million partnership with the Department for International Development and the Rockefeller Foundation targeting infrastructure projects in Asian cities. We also launched the Pacific American Climate Fund, a $24 million program that provides grants to help communities adapt to the impacts of climate change.

In the aftermath of Haiyan, our humanitarian assistance of over $90 million helped the Philippines not only bounce back, but rebuild livelihoods and build up stronger systems to weather future shocks. Our Office of U.S. Foreign Disaster Assistance deployed people before the storm hit so we were prepared to provide immediate assistance to help save lives. We quickly turned our cash assistance programs into cash-for-work and cash-for-training activities, including emergency employment programs that engaged 118,000 people in essential reconstruction efforts to clear debris, repair more than 1,500 kilometers of roads, and restore services in 560 schools, 220 rural health care centers and more than 30 hospitals.

We also provided skills training and micro-enterprise and small business support to the most vulnerable populations, particularly small-scale coconut farmers.USAID joined together with Procter & Gamble and Coca-Cola to help revive economic activity and livelihoods in Leyte, the province worst hit by the typhoon. These efforts helped restore damaged or destroyed sari-sari stores (small community stores) in public markets, and jump-start business by providing store owners access to micro-financing loans.

And we continue to seek the best ideas for building resilience in advance of a crisis. USAID joined forces with the Rockefeller Foundation and Swedish International Development Cooperation Agency earlier this fall to launch the Global Resilience Partnership, which aims to catalyze innovation and scale what is already working in resilience efforts by bringing in new actors, including the private sector and academia. With an initial investment of $150 million from the three partners, the Partnership will help to drive evidence-based investments that enable cities, communities and households to better manage and adapt to inevitable shocks.

The Partnership’s first activity is the Global Resilience Challenge, a call for the creation of teams from all sectors to come together to produce locally driven, high-impact solutions to resilience challenges (application deadline: Nov. 30). Our focus will be in the Sahel, the Horn of Africa, and South and Southeast Asia—areas with high resilience needs.

Through the Partnership, we seek to create a community of practice to strengthen resilience globally. In the face of shocks and stresses caused by epidemics, fragility and our planet’s changing climate, we need all-in ideas and solutions. The Partnership is an important effort to learn from disasters like Haiyan, build preparedness for the future, and help the world’s most vulnerable get on a solid path toward development.

ABOUT THE AUTHOR

Nancy Lindborg is the USAID Assistant Administrator for the Bureau for Democracy, Conflict and Humanitarian Assistance. Follow here @nancylindborg

Recapturing Growth in Ebola-Stricken West Africa

With funding and support from USAID, construction crews work quickly to build a new Ebola treatment unit in Monrovia, Liberia, in front of the former Ministry of Defense building, Oct. 1, 2014

With funding and support from USAID, construction crews work quickly to build a new Ebola treatment unit in Monrovia, Liberia, in front of the former Ministry of Defense building, Oct. 1, 2014 / Morgana Wingard

Unlike a civil war or natural disaster, an epidemic does not destroy property. But it sharply increases the cost of doing business, with powerful effects on employment and investment.

This is happening in Guinea, Liberia and Sierra Leone where the secondary impacts of the Ebola crisis have been seen in terms of shuttered businesses and closed schools. But just as economies can stall during an epidemic, we also know what expedites their recovery—a robust business climate that encourages private sector investment.

New Ebola cases continue to be recorded in Guinea, Liberia and Sierra Leone, but as health workers have begun to contain the epidemic, we are already turning our attention, in partnership with host governments, to the task of restoring business activity in these countries. Liberia and Sierra Leone had been growing strongly before the crisis, driven largely by foreign direct investment in the mining sector; Guinea’s growth was weaker but had been expected to increase in 2014. All three economies have contracted sharply in the latter half of 2014, with full-year gross domestic products now expected to be at or below 2013 levels.

A first look at a 25-bed critical care hospital—staffed by U.S. medical professionals—in Harbel, Liberia, that will treat all Ebola health care workers in the country, Oct. 15, 2014

A first look at a 25-bed critical care hospital—staffed by U.S. medical professionals—in Harbel, Liberia, that will treat all Ebola health care workers in the country, Oct. 15, 2014 / Morgana Wingard

Public and private investment plans have been scaled back, suggesting that slow growth will linger through 2015 even if the epidemic is contained early in the year. This is actually not driven primarily by the loss of labor to sickness and health care, but rather by what economic epidemiologists call “social distancing”—when people avoid interacting with each other in order to avoid a perceived risk of viral transmission.

The benefits to workers, firms and farms to restoring normal economic activity can provide a powerful counterbalance to the effects of social distancing, suggesting that capacity utilization, employment and income will rebound as the epidemic is contained.  But tomorrow’s economy depends on today’s investment. The pace of economic recovery will therefore depend crucially on how private-sector firms view the evolving business environment.

Containing the outbreak will do much to restore that environment, but firms across the size spectrum—including potential new entrants—will be wary of their exposure to health-related losses even as the overall health system is strengthened. Reforms that enhance the quality of regulation and reduce the costs of doing business are therefore crucial components of the recovery effort.

Pick-up trucks-turned-ambulances drive hours through dirt roads in Bong County, Liberia, to collect patients, Oct. 9, 2014

Pick-up trucks-turned-ambulances drive hours through dirt roads in Bong County, Liberia, to collect patients, Oct. 9, 2014 / Morgana Wingard

The World Bank’s newly released business-climate survey of 189 economies—Doing Business 2015:Going Beyond Efficiency—highlighted sub-Saharan Africa as home to five of the 10 top reformers, four of which are in West Africa. “Doing business” reforms are changes in the procedure, time or cost of conducting business in a country, such as reducing the time it takes to get a construction permit or the number of approvals required to open a business. USAID has supported the Doing Business project since its inception in 2004.

Several of the highlighted business reforms from this year’s top reformers in West Africa (Benin, Cote d’Ivoire, Senegal and Togo) were the result of coordinated harmonization efforts led by the Council of Ministers of the Organization for Harmonization of Business Law in Africa. These efforts encouraged  business-friendly innovations throughout the region such as one-stop shops for registering a business, easier land registry and transfer processes, and improved credit information systems—including in the countries most affected by the outbreak.

Liberia and Sierra Leone took the impressive step of establishing public credit registries in the past year, making it easier to get credit in these countries. The resolve demonstrated by member governments in setting a regional reform agenda and implementing meaningful changes for business also bodes well for increased regional trade, which USAID supports through its regional Trade Hubs in West, East and Southern Africa.

USAID has been working with many of the reformers highlighted in this year’s report and will continue to partner with governments in the region as they tackle both the immediate challenges and the secondary effects of Ebola. Better regulatory environments, supported by governments taking the right steps to attract both domestic and foreign investment, will help these countries recover and prosper in the future.

ABOUT THE AUTHOR

Stephen O’Connell is the Chief Economist for USAID

“Being LGBT” in Asia

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Thomas White, deputy director, Governance and Vulnerable Populations Office, Regional Development Mission Asia, USAID

This month marks the release of the eighth series of comprehensive country reports under USAID’s “Being LGBT in Asia” initiative, a partnership with the United Nations Development Programme (UNDP) begun in 2012. The initiative seeks to learn about, meet and engage lesbian, gay, bisexual and transgender (LGBT) people across Asia, developing a better understanding of their lives as well as recommendations for further development assistance activities.

Conducted through national dialogues and interviews among LGBT communities—including over 650 LGBT people and 220 LGBT organizations—the initiative highlights the Asian LGBT experience and raises awareness about USAID’s LGBT rights and development policies.

Taken collectively, the reports highlight important trends and lessons about LGBT life. On the promising side, Vietnam has seen sweeping changes in the acknowledgement of LGBT rights in recent years, including dozens of television shows and interviews in the media with LGBT people, culminating in a parliamentary vote on same-sex marriage earlier this year, although the measure did not pass. Thailand is genuinely friendly in many ways, and openly welcomes LGBT tourists. But LGBT people in Thailand face strong pressure to be “good citizens” and put family concerns before their own, a pressure that is similar in Cambodia.

The Philippines paints a mixed picture with high levels of basic social tolerance and acceptance, and even LGBT political parties. At the same time, there is widespread friction with the Catholic Church and the country’s Muslim communities. Other countries face deeper challenges. Basic social acceptance of LGBT people is lacking in most of Indonesia; if you are LGBT in Aceh province, the courts prescribe whipping, caning and egregious fines. Ultranationalist gangs have taken to violent repression of LGBT people in Mongolia. In China , being LGBT is deeply challenging with the country’s cultural focus on family and, in some cases, LGBT people marry and have children against their will to fulfill social requirements.

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To mark the global celebration of the International Day against Homophobia and Transphobia (IDAHO), the United Nations Development Programme and USAID held a series of events to highlight the plight of LGBT people in the Philippines May 12-16, 2014, as part of the “Being LGBT in Asia” initiative. This is part of the ongoing exhibit at the RCBC Galleria Plaza in Makati, Metro Manila, Philippines / Being LGBT in Asia

Nepal is widely lauded for a 2007 Supreme Court ruling that annulled laws containing discrimination against sexual minorities, but being LGBT in Nepal is truly difficult because of the country’s poverty, continuing political crisis and powerfully entrenched patriarchal values. Brunei, Burma, Malaysia and Singapore continue to criminalize LGBT status, a position the United States opposes.

“Being LGBT in Asia” country reports are now available for Cambodia, China, Indonesia, Mongolia, Nepal, the Philippines, Thailand and Vietnam, and reports are in both English and the associated local language.

In addition to country-level reports, USAID reached out to LGBT communities across Asia using social media, websites and crowd-sourced videos.  USAID also recently released its LGBT Vision for Action, a strong stand on developing an inclusive environment for all LGBT people.

Since the beginning of the initiative, U.S. ambassadors across Asia have held receptions to reach out to and recognize LGBT people. More recently, “Being LGBT in Asia” has garnered broader support that includes the White House, U.N. Secretary General Ban Ki-moon and UNDP Administrator Helen Clark.

As President Barack Obama has said: “The struggle to end discrimination against lesbian, gay, bisexual and transgender (LGBT) persons is a global challenge, and one that is central to the United States’ commitment to promoting human rights.”

ABOUT THE AUTHOR

Thomas White, Deputy Director, Governance and Vulnerable Populations Office, Regional Development Mission Asia (RDMA), USAID

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