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FrontLines Releases May/June 2013 Issue

Read the latest edition of USAID’s FrontLines to get updates about how the Agency is implementing the Feed the Future initiative. Some highlights:

  • Convincing poachers to leave behind that life for farming is winning converts in Zambia.

    Paul Jean Marc, a member of one of Haiti’s flower growers associations, shows one of the association’s greenhouses filled with chrysanthemums. Photo credit: Feed the Future

  • One of Tajikistan’s newest land rights activists says that she “can’t sit around and watch women being disrespected and mistreated because they don’t know their legal rights or are afraid to fight.” When her farm was nearly stolen from her, USAID helped her fight back.
  • Good grains are translating into good health and good business for a growing number of Senegalese women’s groups.
  • With the recent introduction of greenhouses in Haiti, harvests of broccoli, peppers, tomatoes, leeks, beets, carrots and flowers stand a fighting chance against the region’s punishing weather.

If you want an e-mail reminder in your inbox when the latest issue of FrontLines has been posted online, subscribe here.

Pounds of Prevention – Focus on South Asia Monsoon Flooding

As South Asia approaches the start of monsoon season, let’s take a moment to learn more about these seasonal winds and the rains they bring. In this installment of USAID’s Pounds of Prevention series (PDF), we explore how monsoon rains are both a vital part of life and a potential source of floods. When the hazards a community faces and the underlying causes of disasters are understood and addressed, a community can better withstand negative events. To this end, USAID is supporting a range of activities in Bangladesh, India, Nepal, Pakistan, and Sri Lanka that help keep people safe and minimize damage from potential flooding.

Benjamin Franklin is famous for the adage “an ounce of prevention is worth a pound of cure.” Today, we are faced with great challenges brought about by increasing population and urbanization, a changing climate, and a demonstrated increase in the frequency and severity of natural disasters. To continue to tackle these challenges, what has become clear is this: We need more than an ounce of prevention; we need pounds of prevention!

Photo from Robert Friedman, USAID.

Maryan’s Milk Mustache

During the first week of June, IMPACT will be highlighting the key role of nutrition in Global Health

Three-year-old Maryan is wearing a pretty blue headscarf and a milk mustache.

She is drinking one of the 30 cups of milk that Save the Children provides monthly to each of the nearly 11,000 women and children enrolled in its milk voucher program.

Successive droughts in the country have taken their toll on Wajir, in the northeast region of Kenya. As water sources dried up and crops failed, the livestock that the people have always depended on for their livelihoods perished. Milk became increasingly rare and children began to show signs of hunger.

Three-year-old Maryan drinks milk. Her mother Habiba (left) enrolled her in Save the Children’s milk voucher program when she showed signs of malnutrition. Photo credit: Susan Warner. February 2013

A survey taken in October 2012, found one in four children to be malnourished. To address this, Save the Children launched a nutrition project funded by USAID, which gives the local dairy industry a boost by issuing milk vouchers to those who need it the most. The vouchers, coupled with nutritional supplements, are distributed to malnourished pregnant women, breastfeeding mothers and children under the age of five. The vouchers can be traded for milk at the market, which traders and pastoralists can redeem for money. The cash infusion is slowly rehabilitating the pastoral economy as investments in livestock, fodder and veterinary services increase.

Today Maryan’s milk mustache is framed by cheeks that are round and full, but this wasn’t always so. When she first enrolled in the program a few months ago she was weaker and thinner than her peers. Her upper arm circumference, one of the measures used to determine nutritional status, had shown her to be moderately undernourished. After three months in the program her weight increased by 10%, an astonishing gain, when one factors in an illness that set her back slightly in February.

“The program has helped my child. She is more playful and happier and even though she is not fat, she is quite strong.” says Habiba Osman, Maryan’s mother.

Though Maryan remains somewhat slender, “she has shown great progress in terms of her weight gain,” says Saadia Ibrahim Musa, the community health worker who first treated Maryan at the local health clinic, where Habiba brought her for a screening in October last year.

Habiba and Maryan see Saadia regularly now, since they walk to the health clinic, where the supplements and vouchers are distributed, twice weekly. There, Habiba also attends nutrition classes with other Wajir mothers. “We discuss the dangers of malnutrition to a child’s development, the importance of feeding a child a balanced diet, and the importance of handling food in a hygienic manner,” says Saadia.

“Saadia has taught me a lot of things,” says Habina, “I now know to take Maryan to the hospital as soon as I notice something is wrong and how important it is not to share Maryan’s [nutritional] supplements with anyone else in the household as this makes her recovery more difficult.

The changes are visible throughout the community. “The children are happier and more playful now. The mothers are happy as their children now get the milk they couldn’t afford before the project. The traders involved in the project have increased their incomes and their lives are better. Everyone is happy,” says Habiba. “And Maryan loves the milk!”

Learn more about USAID’s efforts to improve nutrition.

Follow USAID (@USAID) on Twitter and use #GHMatters to join in the conversation about global health issues including nutrition.

What I Saw and Learned in Southeast Asia and Why I Left Inspired

This originally appeared on the Clinton Foundation Blog

Over last week, I traveled across Southeast Asia, delivering clean water as part of Procter & Gamble’s Clinton Global Initiative (CGI) commitment in Myanmar, attending the Women Deliver conference in Kuala Lumpur and ending my trip in Cambodia, where I saw how the Clinton Health Access Initiative (CHAI) is working with the government to fight HIV/AIDS and improve health care delivery at the national level through better supply chain management and at the local level in different hospital and clinic settings.

Chelsea Clinton visits a Clinton Health Access Initiative project. Photo credit: Thu Van Dinh

In Myanmar, I helped Naw Phaw Si Hser and her family turn dirty, unsafe water into clean, drinkable water. Procter & Gamble (P&G) first came to the village a couple of months ago and the families, particularly the mothers, all said their children no longer get sick from the water – and that the water tastes better now too! The liter of water that Naw Phaw Si Hser and her family received marked the six billionth liter of clean water from P&G’s CGI commitment. Through their CGI commitment, P&G aims to save one life every hour, every day, every week, every year by delivering more than two billion liters of clean drinking water every year by 2020, preventing cholera, diarrhea and other water-borne illnesses that still too often bring disease and death around the world.

While I was in Myanmar, P&G announced a new partnership with USAID to improve maternal and child health in Myanmar and provide 200 million more liters of clean drinking water over the next two years, furthering its CGI commitment. It is these types of innovations and partnerships that will continue to save millions of lives and fundamentally change health care in developing countries.

Mission Director for USAID Burma, Chris Milligan, greets children in Burma. Photo credit: Thu Van Dinh

After Myanmar, and a trip to Kuala Lumpur for the Women Deliver conference, where I joined leaders and experts to discuss the health of women and girls, my last stop was in Cambodia – a remarkable country and a model in the fight against HIV/AIDS. CHAI began working in the country in 2005, at a time when only 6,000 patients – including 400 children – were receiving the treatment and care they needed. Today, there is close to universal access for antiretroviral (ARV) treatments for adults and children with HIV/AIDS and I am proud that CHAI has been part of drastically changing the treatment equation in Cambodia. CHAI works in part by helping countries like Cambodia access ARVs at affordable prices, because CHAI and its partners have worked with the pharmaceutical industry to increase supply, and with governments to guarantee demand, which has led to a more than 90 percent drop in ARV prices in the developing world since 2002 when CHAI began. Cambodia is one of the first countries in the world to achieve universal access to ARV treatment for both adults and children and one of the first to meet its Millennium Development Goal (MDGs) targets for maternal and child health – truly a leader.

Now, Cambodia is uniquely placed to be one of the first countries to eliminate new pediatric HIV infections, and through collaborative partnerships, I have no doubt Cambodia will be able to reach its goal. Last Thursday, I joined the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) where they announced, in partnership with CHAI and the government of Cambodia, the Cambodia Strategy 3.0, which aims to reduce HIV transmission between mothers and children to less than five percent by 2015 and less than two percent by 2020, while simultaneously reducing HIV-related mortality among children. The three ultimate goals of Cambodia Strategy 3.0 are no HIV/AIDS deaths, no new infections, and no stigma. Goals we all can and should get behind.

In Phnom Penh, I met with women and children who have benefited from the country’s Prevention of Mother to Child Transmission (PMTCT) programs, and saw first-hand how their country’s health system has transformed their lives. I saw the technologies, treatment, and direct impact that CHAI is having in this community and communities across the country. Outside Phnom Penh, I met Basil, a little boy my father first met in 2006 when he was a baby and his body was ravaged by AIDS and tuberculosis. Today, he is healthy, in school and as rambunctious as any child should be. I am grateful and proud that CHAI can play a part in the Cambodian government’s efforts to ensure there will be more children with stories like Basil’s in Cambodia’s future.

From reducing the prevalence of HIV/AIDS to providing clean drinking water to rural communities, these programs are examples of how, when corporations, NGOs, governments, and people work together, incredible strides can be made to challenges that were once thought intractable. These achievements give me hope that other countries will be able to replicate these models and provide similar health care access to individuals – and that, in my lifetime, we’ll achieve an AIDS-free generation and eliminate mortality caused by unclean water.

Facing History: Education’s Role in Transitional Justice

Karen Murphy is International Director for Facing History and Ourselves, an international educational and professional development NGO. Photo credit: Facing History and Ourselves

In April, I presented alongside USAID education experts as part of the Agency’s Transitional Justice speaker series about the role of education in transitional justice. Transitional justice initiatives aim to address the legacies of widespread, systematic human rights violations, crimes committed by government or officially-backed entities or in the context of armed conflict. Unlike the more commonly discussed traditional transitional justice processes–prosecutions, truth commissions, reparations and other economic and institutional reforms–education is too often neglected. In authoritarian and divided societies with identity-based conflicts, education has quite often been used as an instrument of inequality and division and as a medium for spreading myths and misinformation, as occurred in Rwanda. Yet, we are slow to apply the same kind of rigorous reforms to this sector that we would do for the judiciary, military and police.

There are many interventions that can be made from the level of laws and policies that guide departments of education, to those which inform schools, to interventions in classrooms themselves. For example, USAID supports an education project in Bosnia and Herzegovina to build trust and partnership among students from different ethnic groups, and improve the capacity of teachers, school management and policy makers in implementing intercultural education. One of USAID’s goals in its Education Strategy (PDF) is improving equitable access to education for 15 million learners by 2015 in crisis and conflict environments, focusing on the most vulnerable such as displaced populations, ethnic minorities and war-affected youth.

History curriculum is crucially important within these contexts and is often left untackled because it is so potentially divisive and challenging. But not talking about the violent past and its legacies or addressing the transition and its effects in the classroom does not make them go away–silence can increase the tensions around the conflict and deepen the misunderstandings and misperceptions that groups have about each other (and themselves).

One of the most significant features of education within this context is that it offers a multigenerational opportunity, possibly the only sector with this kind of reach. Adult teachers and department of education representatives are themselves citizens who may have been actors during the conflict as well as witnesses and victims. They often need to wrestle with the violent past and its legacies, and the myths and misinformation in which they are perhaps invested, before they teach and discuss these things with students.

Students represent a new generation of citizens. Northern Ireland’s adolescents were all born after “the troubles.” South Africa’s adolescents are the “born free” generation. While these young people escaped the mass violence of their conflicts, they also missed the critical interventions that marked the transition to peace. Young people are inheriting not just societies that have experienced war and mass violence but the transitions themselves, their legacies and the legacies of the remedies. School is a critical place where new generations can and should learn about their societies, the conflicts and the human behavior that animated them, as well as the people who inspired peace.

Transition is multi-generational if we truly want security, stability, peaceful coexistence, and democracy. South Africa’s “born free” generation, for instance, need to feel deeply committed to the strength of transition, to seeing it through, to protecting the rule of law, a commitment to human rights and a vision of the future that is inclusive.

MCHIP’s Respectful Maternity Care Toolkit Promotes Positive Attitudes in the Care of Women and Newborns

Abuse and disrespect during maternity care has been documented and observed globally. In response, USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) is launching the Respectful Maternity Care (RMC) Toolkit. This package of materials is designed to provide clinicians, trainers, managers and other stakeholders involved in the provision of maternity care with the tools necessary to begin implementing RMC in their area of work or influence. This toolkit contains program learning documents, such as: surveys and briefs on country experiences; training materials; tools to assess and improve RMC within programs and services; job aids; and a resource list.

Women who chose to give birth at home without a skilled health care provider, as well as their newborns, are more likely to suffer complications and die. In less developed countries, there may be many reasons women chose not to give birth in a health facility, such as distance, and lack of transport or money to pay for health services. However, all too often a lack of respectful care from frontline health workers—such as doctors and midwives—cause women and their families to distrust the health care system and opt for more risky homebirths, with unskilled traditional birth attendants (TBAs). Women often choose to deliver with TBAs not only because their services cost less, but also because they provide RMC and follow up care, and are trusted and known within their communities.

Mozambican mother holds her newborn. Photo credit: Jhpiego

Multiple factors may contribute to disrespect and abuse within healthcare services. Health systems may be underequipped, and healthcare workers may be overwhelmed due to inadequate pay, lack of infrastructure, or insufficient staff and supplies. An attitude of disrespect for clients and patients may permeate the healthcare system, and healthcare workers may not receive any guidance or supportive supervision related to RMC or their work in general.

The goal of this toolkit is to empower frontline health workers to provide RMC, allowing women and their families to experience better maternity care and to choose to deliver with a skilled provider at home or, preferably, in a health facility. The ultimate impact of more women using skilled birth services during child birth will be reduced newborn and maternal deaths.

RMC in Mozambique                                    
 “Giving birth is such a special time for a woman, but it is also filled with stress and fear,” said MCHIP Senior Technical Advisor Veronica Reis. She often wondered during her more than 20 years of clinical practice in Brazil why ensuring women’s comfort and preferences during childbirth was almost never discussed at medical school: “Most of the training in medical school was technically focused, about diagnostic treatment and clinical procedures.”

Therefore, Dr. Reis was pleased to hear about a movement known as Humanization of Childbirth, which centers on putting women and their families at the center of care, especially during childbirth. This movement began in Brazil and has increasingly gained prominence in Latin America and elsewhere. Grounded in respect for human rights, this movement has evolved into what is known as Respectful Maternity Care, which promotes the idea of the client as a person with values and expectations that should be respected during the provision of health care.

Therefore, when asked in 2003 to help promote RMC at the Ministry of Health’s National Maternal Health Program in Brazil, Veronica jumped at the chance, convinced this was a worthwhile initiative that was long overdue. There she learned that the presence of a companion at birth, usually a family member or loved one, is an important part of RMC. She was amazed that in all the hospitals where she had worked, policies never permitted family members to accompany the woman in labor; they were always forced to stay outside and/or not be present. Nor did policies allow women to make many other choices in their care, including the right to choose their birth position.

Importantly, Veronica was able to take the skills and knowledge she developed in RMC and successfully help apply them in Mozambique, where she supported USAID’s Jhpiego-led maternal and newborn health program (ACCESS) starting in 2006.  At a large stakeholders meeting in 2007, attendees learned that one important reason women were not giving birth in hospitals—and therefore more often suffering from complications of and dying in childbirth—was fear of not being treated well.  “Women were afraid of being treated badly and dying alone in the hospital,” Veronica explained.

With continued advocacy by Veronica and her colleagues, the Minister began to prioritize RMC through on-going health programs, most notably through MCHIP’s Model Maternity Initiative (MMI), starting in 2009.  This initiative, carried out in the largest 34 hospitals in the country, supports birthing practices that recognize women’s preferences and needs.  Not only are these hospitals continually evaluated on the quality of care they provide, but also on their ability to provide RMC. Some RMC behaviors include: respect for beliefs, traditions and culture; the right to information and privacy; the choice of a companion during birth; freedom of movement and position; keeping mother and baby together after birth; and the prevention of violence and disrespectful care.

Thanks in large part to strong commitment from the country’s key decision makers and local communities, and with financial backing from USAID through MCHIP, RMC is becoming more widespread in Mozambique. The influence of RMC can be seen increasingly in training institutions, professional associations, and civil society. In fact, the MOH, with the support of USAID and other partners, has now scaled up RMC to more than 80 facilities, and is working to scale up the MMI to more than 122 health facilities by 2014. Significantly, this figure covers about half of all facility births in the country. The MOH and its partners are taking action so that women won’t have to fear that they will be treated poorly during one of the most beautiful—and challenging—times of their lives.

The Toolkit includes:

  • “RMC: Country Experiences” survey offering an RMC overview from 19 countries
  • RMC Program Review Instrument to be used for country-level RMC self-assessment
  • “RMC: General Concepts and Considerations” presentation for guidance on the promotion of RMC
  • Learning Resource Package for RMC with all materials needed to conduct a one-day RMC workshop for clinicians
  • Operational Standards for RMC for antenatal care, childbirth care and postnatal care, which establish objective guidance to gauge health care workers’ clinical performance promoting RMC
  • Resource List for RMC with related references and links
  • Program Briefs detailing examples of RMC being implemented at the field level
  • Monitoring Indicators for RMC to measure the success of RMC interventions
  • Job Aids to serve as on-the-job reminders of the importance of maintaining RMC

Follow USAID Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Photo of the Week: Nutrient-Rich Crops for Kenyan Children

During the first week of June, IMPACT will be highlighting the role of nutrition in Global Health

In Kenya, the U.S. Government, through Feed the Future, is working with whole families to improve food security and childhood nutrition by helping farmers introduce nutrient-rich crops to their farms and teaching families new recipes full of vitamins and minerals needed to ensure healthy growth. Photo Credit: Fintrac Inc.

Learn more about USAID’s efforts to improve nutrition.

Follow USAID (@USAID) on Twitter and use #GHMatters to join in the conversation about global health issues including nutrition.

Proof that the U.S. Government, NGOs and Activists are Working Together on Nutrition

During the first week of June, IMPACT will be highlighting the role of nutrition in Global Health

This originally appeared on the ONE Campaign blog

This morning, USAID Administrator Raj Shah joined a Google+ Hangout – a group video chat – with ONE’s U.S. Executive Director Tom Hart and a group of ONE members and agriculture policy experts from Feed the Future, GAIN, Thousand Days and Future Fortified.

USAID Administrator Raj Shah with ONE’s U.S. Executive Director Tom Hart. Photo credit: ONE.org

Tom gave Administrator Shah a fat stack of 100,336 petition signatures from ONE members across the US. Their ask? End chronic malnutrition for 25 million children by 2016. Administrator Shah heard them loud and clear, with two ONE members, George Houk and Vanessa Avila, as witnesses and representatives of our U.S. membership.

One of the highlights of the Hangout was hearing Administrator Shah talk about how global food security is in fact in America’s best interest.

“We know that this [nutrition] is an issue that touches on the economic prospects of countries that will be our trading partners in the future, it touches on our national security in places ranging from Afghanistan to Somalia, where far too many children die of core underlying malnutrition, and most importantly, we know it just touches on our moral consciouness because we cannot live in 2013 knowing that hundreds of millions of children go hungry and that that hunger prevents them from learning in school, from fighting disease, from surviving a simple bout of diarrhea or pneumonia and of building a better future for themselves,” he said.

After handing off the petition signatures, the conversation turned to our agriculture policy experts, Tjada McKenna, Deputy Coordinator for Development at Feed the Future, and Lucy Sullivan, Executive Director of 1,000 Days, and guest foodie activist, Chef Candice Kumai, a nutrition champion for Future Fortified. Adrianna Logalbo from GAIN moderated a lively discussion on the importance of agriculture, some of the successes and progress the world has made on nutrition, and how everyday citizens can get more involved.

Watch the full Google+ Hangout here:

Administrator Shah will be off to the pre-G8 Summit event, Nutrition for Growth, next week, with your petition signatures in hand. Stay tuned to ONE.org for updates on this important and critical event.

Learn more about USAID’s work on improving nutrition

Follow USAID (@USAID) on Twitter and use #GHMatters to join in the conversation.

Video of the Week: The Powerful Women of Kenya Fortified

During the first week of June, IMPACT will be highlighting the role of nutrition in Global Health

In 2012, as East Africa recovered from record drought, we called on the Future Fortified community to help invest in good nutrition in Kenya. And thanks to them, we achieved our goal and right now we are reaching over 20,000 children in southern Kenya with home nutrition packets – small packets filled with the essential nutrients children need to live, grow and learn.

Kenya Fortified is possible because of an incredible network of powerful, local women — community leaders, health workers and mothers — working together to help nourish the future.

Follow USAID (@USAID) on Twitter and use #GHMatters to join in the conversation.

This is not an endorsement of Future Fortified and individuals must make their own choices. 

Women Deliver: Bold Visions for Women’s and Girls’ Health and Rights

Robert Clay serves as deputy assistant to the administrator for Global Health. Photo credit: Robert Clay

I’ve just returned from an inspiring and thought-provoking week in Kuala Lumpur, Malaysia where leaders and advocates from 149 countries gathered for the Women Deliver 2013 conference. My USAID colleagues and I were proud to participate in one of the decade’s largest conferences on the health and rights of girls and women.

One of the most memorable parts of the week for me was speaking on a panel at the Ministerial Forum with Yemurai Nyoni, a youth representative from Zimbabwe. He was a strong and articulate voice for youth and urged that young people be included in program design and implementation of youth-focused programs. It’s people like Yemurai that give us hope for the future. And with 1.8 billion youth in the world today, it is vital that we listen and include them in our development work.

Women Deliver served as a pivotal opportunity to renew commitment to meeting the needs of girls and women across the globe. USAID places women and girls at the center of our global health programs because we know improving women’s and girl’s health is critically important to almost every area of human development and progress. We’re helping countries acquire the resources they need to improve health outcomes through strengthened health systems and integrated services. This week in Kuala Lumpur I discussed the bold visions we have for our future to end preventable child and maternal deaths and create an AIDS Free Generation. Bold visions inspire action, and action paves the way for progress.

Over the past decade, we’ve seen wonderful success in reductions of maternal and child deaths and improved access to family planning. But despite all the good we have done, millions around the globe still do not receive the reproductive, maternal, newborn, and child health services they need. Every year 6.9 million children die of preventable causes and 287,000 women lose their life in pregnancy or childbirth. Some 222 million women who want to avoid pregnancy are not using a modern method of family planning.  Closing this access gap to family planning information and services would reduce maternal deaths by 30 percent and could save the lives of 1.6 million children annually (PDF).

After a week of renewed commitments, sharing lessons learned, and listening to those pioneering the way forward on women’s health and rights, I feel inspired to do my part in leading USAID to achieve our global health goals and improve women’s and girl’s health and rights across the globe.

Learn more about USAID’s work at Women Deliver and share with us your thoughts below.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

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