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Where the Rubber Hits the Road: Evidence Informing Impact for Global Health

This blog is part of the Global Health Research & Development Blog Series.

Like strands of human DNA, the genetic underpinnings of life, research and evidence are so closely intertwined they cannot be separated. Whether testing the efficacy of an HIV vaccine or the marketing strategy of a new contraceptive technology, quality research, careful methodology and rigorous analysis are fundamental for acquiring evidence useful in decision-making. As outlined in USAID’s Report to Congress: Health-Related Research and Development Strategy, the Agency supports a range of research activities, including both ‘upstream’ product research and ‘downstream’ implementation research. Along this continuum, USAID places a strong emphasis on evidence for informing development policies, practice and strategy.

As global health products are developed, we need evidence to demonstrate their effectiveness in developing country settings. For example, despite the fact that effective treatments exist for pneumonia, over 1.2 million children die each year from the disease. In the last few years, USAID has supported studies in Pakistan investigating the effectiveness of community-based treatment of severe pneumonia. Results from these studies have shown that oral antibiotics administered at home are as effective as injectable antibiotics administered in a hospital setting. This evidence prompted a 2012 revision of the WHO guidelines on outpatient management of severe pneumonia.

A community health worker in rural Ethiopia tests a boy for malaria. Photo credit: Bonnie Gillespie, Photoshare

Beyond effectiveness studies, like the one conducted in Pakistan, we need studies that focus on the implementation and adoption of public health interventions, also known as implementation science. USAID’s 2012 Global Health Strategic Framework: Better Health for Development iterates a commitment to implementation research and the “scale-up of evidence-based, equitable, inclusive, and locally adapted health solutions.” USAID is meeting this challenge in multiple ways; some examples include:

  • To increase understanding of the ‘what’ and ‘how’ of implementation research, USAID in partnership with Johns Hopkins University and George Washington University, has launched an open-access peer-reviewed journal called Global Health: Science & Practice;
  • To accelerate product development and the introduction of new technologies, USAID has initiated the Center for Accelerating Innovation and Impact (CII), which engages key experts to identify state-of-the-art ‘best practices’ around product marketing, introduction, and scale;
  • To expand knowledge of interventions that have “high impact,” the Bureau for Global Health has developed several High-Impact Practices (HIPs) in family planning; maternal, newborn, and child health; nutrition; and health systems strengthening. For example High-Impact Practices in family planning are best practices that, when scaled up and institutionalized, will maximize investments in a comprehensive family planning strategy.

Since 2011, USAID and partners have hosted three evidence summits addressing critical challenges in global health. Not an ordinary conference, an evidence summit is an organized process that convenes leading scholars and health practitioners to review the latest research and provide evidence- based guidance for improved health performance, an understanding of knowledge gaps, and research agenda recommendations. These summits have addressed: Protecting Children Outside of Family Care, Enhancing Provision and Use of Maternal Health Services through Financial Incentives, and Enhancing Community Health Worker Performance. A fourth evidence summit on Behavior Change Communication for Child Survival will be held later this year.

The local adaptation of health solutions is where the rubber meets the road. Each developing country is characterized by its own unique population, culture, health challenges and infrastructure. To enable the development of local solutions to local problems, USAID is supporting the Partnerships for Enhanced Engagement in Research (PEER) Health program. PEER Health is a capacity-building program which provides research grants to developing country investigators in partnership with National Institutes of Health researchers focused on addressing local health challenges. 

Asking the right question, at the right time, in the right way, is not easy. As global health moves into the 21st century, more complex health challenges, including non-communicable diseases, the integration of health services, and the strengthening of health systems, present themselves. Solid evidence based on rigorous research is an indispensable ingredient for the successful introduction and scale of health products and services. As the 2012 health research report to Congress attests, USAID remains committed to pursuing an evidence-based agenda in global health.

E. Callie Raulfs-Wang is a Research Advisor for USAID Center for Accelerating Innovation and Impact.

Read other posts in the Global Health Research & Development Blog Series:

Mark Feierstein Launches #AskUSAID Expert Hour series on Twitter

On Friday, March 8, Assistant Administrator for Latin America and the Caribbean, Mark Feierstein, took part in our first-ever #AskUSAID Expert Hour on Twitter. He answered questions from the Twitterverse on USAID’s work in the region. Questions touched on a variety of topics including: mobile technology, innovation, and mobile money. Check out this Storify feed that highlights the Expert Hour with Mark Feierstein.

USAID will hold #AskUSAID Expert Hour on Twitter monthly. Join us to learn about our work! Photo credit: USAID

#AskUSAID Expert Hour will be held on a monthly basis on Twitter, and anyone interested in international development is invited to ask our assistant administrators, and others, about our work in various regions and current projects and programs.

Follow USAID (@USAID) to join the next Expert Hour chat! Have a question for us? Use the hashtag #AskUSAID.

Help Shape USAID Policy on Sustainable Urban Living

The world is rapidly urbanizing. Every day, 80,000 people move into cities, and urban areas are expected to gain 1.4 billion people between 2011 and 2030. By 2030, it is projected that over 60 percent of the world’s populations will live in cities.

This unprecedented urban growth is mainly taking place in less developed countries, where urban populations are most vulnerable to natural disasters, suffer disproportionately from infectious diseases, and are most likely to live in slums without basic services like clean water and sanitation.

USAID’s program, “Sembrando Escuelas”, built over 100 schools in Panama City. School children dash to their classrooms in their newly inaugurated school. June 2012. Photo Credit: USAID/Panama

USAID’s forthcoming Sustainable Urban Services Policy (PDF) reflects the Agency’s commitment to address the complex development challenges of urban environments. The policy will present new approaches and principles to help missions support country-led, sustainable urban services maximizes development impacts, leverages financial sustainability, and enhances geographic focus and selectivity.

The policy will set out a core set of development principles to support sustainable urban services. These include:

  • Ensuring political and financial stability;
  • Advancing accountable, pro-poor service delivery models;
  • Fostering market orientation and public-private collaboration; and
  • Supporting municipal resilience.

On Friday, March 8, USAID released a draft of the policy for review for public comment, especially by external stakeholders and the broader public. This is the first time that we have solicited input on a draft policy from the external community. We hope that by being more transparent and reaching out to the vast wealth of knowledge and experience outside of USAID, we can craft a richer and more effective policy.

The draft policy is available for download, which also has a link to the online survey that asks for comments on the draft. You can also access the online survey. The survey will be up through March 26, 2012. The feedback received will be incorporated, as appropriate, into the final version of the policy.

Improved urban service delivery is the key to responding to the challenges posed by an increasingly urbanized world. We look forward to your feedback on this draft policy and to working together to ensure that USAID can help countries respond to those challenges.

First @StateDept Tweetup Spotlights International Women of Courage

This originally appeared on DipNote

On March 8, Secretary of State John Kerry honored nine extraordinary women with the Secretary of State’s International Women of Courage Award, which recognizes women around the world who have shown exceptional leadership in advocating for women’s rights and empowerment, often at great personal risk.

On March 8, 2013, nine women received the International Women of Courage Award from Secretary John Kerry, for their service in women's rights and empowerment. Photo credit: State Department

Since the 2007, the U.S. Secretary of State has recognized 66 women from 44 countries with this award, and the annual ceremony has become an occasion that encourages all of us who work at the U.S. Department of State. One of the reasons the ceremony inspires us is the powerful stories these women have to tell. We want to share their stories and spotlight their achievements, and the use of social media is a vital way we can achieve that goal. So, we could not have been more pleased that today’s ceremony also marked the U.S. Department of State’s first Tweet-up, an in-person gathering of individuals from our online communities.

Eight of the State Department’s Twitter followers attended today’s ceremony and met Secretary of State John Kerry, Teresa Heinz Kerry, and special guest, First Lady Michelle Obama. The Tweet-up participants included graduate students, a kindergarten teacher, an astrophysicist, and advocates for women’s rights — a remarkable group in and of themselves.

During the event, one of the participants, Paul, tweeted, “Thanks for having us! It’s an honor to help spread the important message of women’s rights to the globe.” Another participant, Catherine, tweeted, “For a girl from a small country town this is amazing beyond words and I am so grateful.”

We were grateful to have had the chance to engage with our online community offline, in what was the first of what we hope will be many opportunities for our followers. Stay tuned to @StateDept for information on future events, and contribute to the conversation on International Women’s Day by using the hashtags #IWOC and #IWD.

Video of the Week: Administrator Shah’s Remarks for Global Child Nutrition Dinner

Administrator Shah offered remarks for the Global Child Nutrition Dinner held at the Ronald Reagan Building in Washington, D.C. on March 4, 2013. The dinner was part of the 10th annual ‘A Possible Dream Gala’, and this year, Arlene Mitchell, Deputy Director of Agricultural Development at the Bill & Melinda Gates Foundation, was the guest of honor. Hosted by the Global Child Nutrition Foundation whose aim is to end childhood hunger, proceeds from the event enable the Foundation to provide technical assistance to countries so they can develop and expand school feeding programs.

USAID In the News

This week Administrator Raj Shah visited India and Burma. The Press Trust of India reported on USAID’s announcement to extend “two of its flagship projects for child survival in India”. The renewed commitment of the two nations through the USAID, “aims to end all preventable child deaths and to strengthen India’s Call to Action on Child Survival and Development.” The agency “resumed work in Burma ” in November, after Washington suspended most sanctions against the country,” according to the AP. “Since then, USAID has committed $171 million to health, food security, democracy, human rights and rule of law programs.”

Dr. Rajiv Shah, USAID Administrator, spoke of USAID's commitment to engaging with civil society groups in Burma to support reforms. March 7, 2013. Photo credit: Richard Nyberg/USAID

In an interview with Reuters, Administrator Shah exclaimed the international community is slowly rethinking its policies toward Burma in light of the government’s decision to implement a number of reforms. He noted, “Everything we do is geared toward making these reforms sustainable and more durable, and if there’s backtracking, we will not continue to expand our efforts.”

The Yemen Times reports, “During the revolution, armed militias and government forces used hundreds of children’s schools as barracks and firing points” and they left many Yemeni schools “in complete disrepair, some destroyed entirely. Now, nearly two years later, 380 of those schools have been repaired, ” thanks to a number of organizations including USAID.

Round-the-Clock Aid for a Syrian Baby

In January 2013, a mortar shell struck an apartment in Dar’a Governorate.  A mother in an adjoining apartment grabbed her 7-month old son Dia’a* and ran to check for survivors.

Just as she discovered her brother was killed in the attack, another mortar shell hit the building—this time killing one of her other sons.  The explosion also ruptured a water heater, blasting scalding water on Dia’a’s face and right arm.

Seven-month-old Dia'a* sustained burns to his face and arm after a shell hit his house, causing a nearby water heater to burst water onto him. Photo credit: USAID NGO Partner

Dia’a was rushed to a nearby Syrian government-run medical clinic, where many believe that women and children can safely receive care. After Dia’a received basic aid, a worker at the clinic discreetly warned the mother that they should leave before she and her son were both killed.

The family fled to the Jordanian border and were received by Jordanian border guards, who transported them to Za’atri refugee camp. During the trip, Dia’a contracted a severe infection, which needed to heal before further he could receive treatment.

Every four hours, a medical team at a U.S.-funded clinic is changing the dressings on Dia’a’s burns. As soon as the infection is gone, doctors at the clinic will perform a skin graft.  Doctors expect Dia’a will make a full recovery, despite the scars from his burns.

Dia’a’s mother expressed gratefulness for the care her son is receiving at the U.S.-funded medical clinic and also thanked the Jordanian government for assisting her family and countless other Syrians in their time of need.

In total, the United States is providing nearly $385 million to help the innocent children, women, and men affected by the crisis in Syria. U.S. humanitarian aid includes emergency medical care and medical supplies, food aid, and winterization and other relief supplies that will help more than 2.4 million people in Syria, as well as the more than 1 million who have fled to the safety of neighboring countries.

*Name changed to protect identity

A Time for Action and Working Together to Improve Women’s Lives

This past week I traveled to India and Burma to meet with leaders of the private sector, civil society, and government who are charting their nations’ bright and prosperous futures. In Mumbai, I had the opportunity to sit down with a group of courageous women advocates to discuss gender-based violence. It was especially meaningful to have this conversation leading up to International Women’s Day, particularly because this year’s theme is A Promise is a Promise: Time for Action to End Violence against Women. It was only recently that thousands of young men and women took to the streets in India to protest the tragic death of a 23-year-old physiotherapy intern who was the victim of a brutal gang rape in Delhi.

At our meeting, we discussed the opportunity to shift ingrained social and cultural practices that perpetuate sexual violence among women, girls, and boys and the importance of educating India’s future generations. We also talked about the need for better data, stronger laws, and expanded services to both prevent and respond to gender-based violence.

I was honored to inform them that the young woman known worldwide as “Nirbhaya” (Fearless) would be honored posthumously by First Lady Michelle Obama and Secretary of State John Kerry at the Department of State’s Women of Courage Awards event this year.

In 2012 alone, Dr. Aye Aye Mu, who is part of USAID’s SUN Quality Health clinics in Burma, conducted over 5,000 reproductive health consultations, diagnosed and treated 107 pneumonia cases, diagnosed and treated 243 tuberculosis cases with a treatment success rate of over 80 percent. Photo credit: Richard Nyberg, USAID

A few days later, I had the opportunity to meet Dr. Aye Aye Mu, who has been practicing medicine in Burma since 1977. It quickly became clear that the Doctor and I share the same vision for development—beginning with the community level and drawing on the strengths of both private sector and civil society. Dr. Aye Aye Mu is part of a network of active health providers that is supported by our Agency and covers 217 of Burma’s 324 townships.

Through an innovative approach called “social franchising,” Dr. Aye Aye Mu helps encourage doctors running their own private clinics to improve the scope, quality, and accessibility of their services by joining the franchise called the SUN Quality Health Clinics. Started by our long-standing partner Population Services International in Myanmar, this network provides affordable, quality health care services nationwide.

Today, this network is contributing in remarkable ways to USAID’s ambitious yet achievable goal of ending preventable child death and improving the lives of women and children. In 2012 alone, Dr. Aye Aye Mu conducted over 5,000 reproductive health consultations, diagnosed and treated 107 pneumonia cases, and diagnosed and treated 243 tuberculosis cases with a treatment success rate of over 80 percent. By leveraging the local private sector to deliver health commodities and better quality, affordable health care services, she receives quality birth spacing products and anti-malarial drugs at subsidized prices and passes the savings to those who need it them most.

Our Agency is working hard to save lives, especially among children. Building upon the Child Survival Call to Action, USAID is introducing a global public private partnership, Survive and Thrive, which will be linked to local partnerships to increase coverage of high impact and high quality interventions delivered by midwives to women and newborns wherever births occur.  Working closely with our partners, these efforts will help improve the quality of maternal and newborn health by linking Burmese health care providers at the community level to their peers from American professional associations.

From India to Burma, these efforts advance the aspirations of the first-ever United States Strategy to Prevent and Respond to Gender-Based Violence Globally, which was released this past year. The strategy pledges to improve coordination across U.S. government agencies to improve the quality of our programming and strengthen our impact.  In a world where rates of gender-based violence show no signs of abating, it is increasingly important that we work together to improve women’s lives.

This past week has been an incredible experience. Even as we advance gender equality and women’s empowerment worldwide, it is important to remember on this International Women’s Day that women and girls are not just victims. They are leaders, change-agents, and innovators, courageously improving lives and expanding opportunities around the world for individuals, families, and communities.  As our policies and initiatives gain traction and implementation gains speed, we will work beside them to ensure our aspirations translate into concrete results around the world.

Shoulder to Shoulder: Delivering Real Results for Women and Girls

Working to promote gender equality and women’s empowerment around the world can be a challenge. There are difficult days when you wonder if your efforts are having a real impact on the lives of women and girls facing violence, deprivation, discrimination and disempowerment on a daily basis.  But when you have the opportunity to meet individuals fighting to create a better life for themselves, their families, and their communities, it makes it all worthwhile. Yesterday was one of those days.

Yesterday USAID was proud to host the International Women of Courage awardees. These remarkable women put themselves at risk every day to make a difference not only for themselves but for women and girls everywhere.

USAID staff host International Women of Courage Awardees. Back row, from left: Fartuun Adan, Somalia; Summer Lopez, USAID; Franklin Moore, USAID; Beth Hogan, USAID; Ambassador Donald Steinberg, USAID; Kathleen Campbell, USAID; Amber Ussery, USAID; Front row, from left: Dr. Josephine Odumakin, Nigeria; Roberta Mahoney, USAID; Julieta Castellanos, Honduras; Sarah Mendelson, USAID; Malalai Bahaduri, Afghanistan; Yelena Milashena, Russia, Key Freeman, USAID. Photo credit: Pat Adams, USAID

In Nigeria, Dr. Josephine Odumakin has spent the past 20 years handling over 2,000 cases of violations of women’s rights, including cases of extrajudicial practices committed by government security agencies against women.

Fartuun Adan is a true human rights activist in Somalia.  She champions women’s rights, peace-building, and the rehabilitation of child soldiers. In 2010-2011, Ms. Adan initiated a program to support survivors of gender-based violence in Somalia’s internally displaced persons camps and launched the first sexual violence hotline and rape crisis center in Mogadishu.

In Russia, Yelena Milashena is an investigative reporter for one of the few remaining independent Russian newspapers. She has distinguished herself for her cutting-edge, hard-hitting journalism covering the terrorist seizure of a school in Beslan, the seizure of the Dubrovka theater in Moscow, human rights abuses in the North Caucasus, and corruption in the Russian Federal Narcotics Control Agency. Most recently, Ms. Milashina has reported on the vote-rigging and abuses by government officials during the December 2011 elections.

Malalai Bahaduri is an Afghan National Interdiction Unit instructor committed to the professional development of the Counter Narcotics Police – Afghanistan (CNP-A). As the first female member of the NIU, First Sergeant Bahaduri reminds us that Afghan women can lead in very high level technical positions. Through her integral role as an instructor at NIU, she focuses on efforts to target the most significant drug trafficking networks, collect evidence, and arrest and prosecute Afghan drug traffickers in accordance with Afghan law.

Julieta Castellanos is an advocate who has played a central role in efforts to overcome enormous challenges afflicting Honduras, including rule of law, anticorruption, and promoting citizen security. She was instrumental in forming an umbrella organization for more than 400 organizations that has given civil society a more powerful voice and an unprecedented ability to engage with the government. Ms. Castellanos has also pressed relentlessly for systemic reform of the country’s dysfunctional police and justice sector institutions.

For their efforts, these courageous women have endured threats, detainment, and violence.  Some of them have been shunned by their families and communities, or lost livelihoods and loved ones. Still, they press on.  It is for these women and the millions like them that we work every day to expand opportunities and improve the lives of women and girls around the world.

USAID will train over 3,300 women in Haiti to manage natural resources and better invest in crops that can generate income and stabilize hillsides as part of our Feed the Future initiative.  It’s why I’m proud that over 140,000 women in Pakistan are increasing their income by 30-40% as part of our Entrepreneurs, Firms, and Baluchistan Agriculture projects.

In Afghanistan, our Women In Transition (WIT) program provides educated young women with enhanced technical and leadership skills to facilitate entry and advancement into mid- and high-level positions in government, the private sector and civil society over the next five years. We’re also launching a public-private partnership with Chevron South Africa and Anglo-American to support a gender-based microfinance program called Intervention with Microfinance for AIDS and Gender Equity (IMAGE). The program combines microfinance with a gender and HIV training curriculum to improve women’s financial independence, reduce vulnerability to HIV and gender-based violence, and foster wider community mobilization.

In Bangladesh, we’re launching a pilot project to test multi sector approaches to child marriage prevention with a focus will be community sensitization, involving local religious authorities, media, local NGO and civil authorities. We’re also expanding our efforts in the Democratic Republic of Congo to raise community awareness about gender-based violence (GBV) and support survivors, granting them increased access to medical and psycho-social care, legal assistance, and income generating activities.

These brave individuals, dedicated partners, and determined civil society organizations are delivering real results for women around the world.  We are proud to stand shoulder-to-shoulder with them.

USAID and CISCO to Establish Networking Academies in Burma

Last week in Burma, USAID hosted a technology delegation with the top American companies in the industry, including Cisco, Intel, Microsoft, Hewlett Packard and Google. With extremely low Internet and mobile coverage in-country and the government’s determination to create a more transparent and efficient governance, we were on the hunt for partnership opportunities to make a speedy transition.

Burma’s Minister of Communications, Information Technology called the delegation the ‘ICT Dream Team’ and outlined specific ways in which we could be helpful. He told us how pleased he was that these companies were committed to both the economic and social development of their country. Too often others seemed to only care about the former.

Maura O’Neill, Chief Innovation Officer,l at 2013 Mobile World Congress. Photo credit: Visa

We knew that in order for everyone in the country to benefit from a digital economy and for the government to develop the know-how to navigate the technology, Internet was key. Fortunately the companies involved in the tech delegation have experience developing and rolling out projects in digital literacy and business skill training in other countries on a massive scale. One of those companies is Cisco.

USAID has a long history with Cisco on public-private partnerships and they too had recently established operations in-country. Together, we have successfully developed and managed alliances in more than 70 countries. These partnerships range from focused projects where USAID and Cisco address development needs in one community by providing Information and Communication Technology (ICT) solutions, to large multi-partner alliances that have both broad and deep impact across a region or country, with the common goal of enabling human capacity-building and workforce development.

Drawing upon this established global partnership, Cisco committed to working with USAID to establish two Networking Academies in Burma within the next several months. Cisco Networking Academies are the flagship of Cisco’s social investment programs worldwide. They have established over 10,000 Networking Academies in 165 countries, helping individuals build ICT skills and prepare for industry-recognized certifications and entry-level ICT careers in virtually every type of industry. Over the next four to six weeks, Cisco will identify the location and donate lab equipment to support the launch of the Networking Academies.

This is just the beginning. USAID has long-standing relationships with the major global technology companies with track record of advancing development outcomes while aligning with core business interests.  The technology companies bring deep expertise, leading-edge technology products and platforms, and extensive experience in leveraging their core business and technology capabilities to advance outcomes ranging from strengthening governance and transparency, advancing education and fostering entrepreneurship and economic growth.

We know that broad-based economic growth is essential to long-term development. That is why USAID has adopted a model for development that seeks to achieve development goals more sustainably and at scale through high-impact and innovative partnerships.  With this in mind, we are building public private partnerships with U.S. businesses, university networks and civil society, linking them to development projects and encouraging the Burmese people to invest in their own development. Transition must come from within and USAID is committed to working alongside the people of Burma in building a path to prosperity.

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