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Saving Mothers: A New Initiative to Address Maternal Mortality

This originally appeared on Smart Global Health

“In Zambia, when women have delivered, we say ‘Oh, you have survived.’” This chilling reminder of the impact of maternal mortality in sub-Saharan Africa came from Professor Elwyn Chomba, a Zambian government public health official interviewed by CSIS for a new video about the challenges of maternal mortality and a new initiative to address it.

Pregnancy-related deaths remain an acute problem in many places, despite overall global declines in rates of maternal mortality. Every day, nearly 800 women die from complications in pregnancy or childbirth, and 99 percent of these deaths occur in developing countries. These deaths are largely preventable with interventions and training to prevent or treat complications such as hemorrhage, infection, and obstructed labor, and with increased access to reproductive health services and emergency care.

We traveled to Zambia because it has a disproportionately high rate of maternal mortality – an estimated 440 women dying for every 100,000 live births, which is 20 times higher than the U.S. But Zambia, as well as Uganda, is also the site of a new program, called Saving Mothers, Giving Life (SMGL), designed to reduce maternal mortality by up to 50 percent in selected districts in a year.

SMGL builds on the fact that most maternal deaths result from one or more of three delays: in seeking care, in arriving at a health facility, and in receiving appropriate care. SMGL is working to address those delays by supporting linkages between communities and health facilities through Safe Motherhood Action Groups (SMAGs); by improving communications and transportation in the districts to speed the care and referrals of pregnant women; and by training and hiring health care providers, while improving equipment and standards of care at health facilities.

Although the U.S. government has been a driving force behind SMGL, it is a public-private partnership. The U.S. Agency for International Development leads SMGL for the U.S. Government, in partnership with the President’s Emergency Plan for AIDS Relief (PEPFAR), the Centers for Disease Control and Prevention, the Peace Corps, and the Department of Defense.  The other SMGL partners include the governments of Norway, Zambia, and Uganda, the Merck for Mothers program, the American College of Obstetricians and Gynecologists, and Every Mother Counts.

SMGL has generated excitement, but its implementers know that there is no quick fix for reducing maternal mortality. Accordingly, the initiative faces significant challenges to national scale up and to sustainability, and many experts believe that the changes required will take years – not months — to achieve.

Effectively addressing maternal mortality — in Zambia and elsewhere — will demand ongoing commitment, from national governments and international partners– and investments in community awareness, in improving health facilities and transportation, and in expanding women’s access to health services, including family planning programs. As Professor Chomba said, we want to get to a point where “every woman can look forward to labor, and not say, I may die.”

Conscious Tourism: Plan Your Next Vacation

This year’s Women’s History Month theme is “Women Inspiring Innovation Through Imagination: Celebrating Women in Science, Technology, Engineering and Mathematics”. In observance, USAID is spotlighting innovative women working in these fields.

Fiona Mati from Kenya won a second place prize of $3,000 in USAID and Humanity United’s Tech Challenge for Atrocity Prevention – responding to the challenge to “develop technologies to better identify, spotlight, and deter intentional or unintentional third-party enablers of atrocities”. The second round of the Tech Challenge opened on March 6. Below is an interview with Fiona.

Tell us about your winning idea and your process for developing this concept.

“Conscious Vacations” seeks to deter tourists from visiting countries whose leaders perpetrate crimes against humanity, thus becoming themselves third party enablers. Most travelers remain unaware that their spending could possibly be used as a tool for sponsoring the activities of cruel dictatorships. Conscious Vacations intends to inform potential tourists by sharing data such as the amount of money the government spends on security or defense as opposed to other social sectors such as education and health, incidents of mass atrocities (and other human rights abuses), as well as the amount of government revenues raised from the tourism sector.

Fiona Mati is founder of Yipe!, a resource portal for young Kenyan entrepreneurs. Photo credit: Fiona Mati

To make the concept of Conscious Vacations more vivid to you, imagine for an instant lying on a sun lounger on a pristine beach. Now imagine if you knew that your being in that country enjoying the beach and all the facilities means that the local population will continue to live under the authoritarian rule of a dictator. How would you feel knowing that the dollars you spend are going to buying guns rather than school books or food? Would that beach look as pristine? This is what Conscious Vacations is about: acting as a virtual conscious-barometer to enable tourists to make informed decisions about their next holiday destination.

The idea came to me after reading an article that quoted Burma’s Aung San Suu Kyi speaking in 1999 during the military junta’s rule. At the time a debate was raging among pro-democracy activists on whether to press the international community to boycott the country’s tourism. Her words spoke volumes to me when she said: “Burma will be here for many years, so tell your friends to visit us later. Visiting now is tantamount to condoning the regime.”

What are some of the challenges you have faced as a woman working in the field of science and technology?

Coming from Kenya, I have to say that the tech ecosystem is very supportive of women, so I can’t attribute my gender as presenting any obstacles. This has been the case particularly in the past five years with the growth of mobile phone use and the widespread adoption of mobile money systems such as M-Pesa, which has encouraged many women to venture into the tech space.

How can organizations encourage more women to enter the field of science and technology and nurture this talent?

Kenya’s accommodating technology ecosystem is mainly urban-based, and it would be great if organizations would work on enabling rural women to access the same opportunities. It’s also important to continue encouraging more girls to pursue careers in science and technology. Judging from local university enrollments in science, technology, engineering, and mathematics (STEM) courses, women by and large remain in the minority.

Learn more about the Tech Challenge.

Fiona Mati is the founder of Yipe!, a resource portal for young Kenyan entrepreneurs.

CITES Met in Bangkok To Protect At-Risk Plants and Wildlife

This originally appeared on Dipnote.

CITES (the Convention on International Trade in Endangered Species of Wild Fauna and Floramet in Bangkok, and we are thrilled to be part of the 177 member governments for these important discussions. CITES is one of the largest international conservation agreements, and helps ensure that the international trade of wild plants and animals does not threaten their survival.

This trade — both legal and illegal — is worth billions of dollars each year. Because the trade crosses borders, regulation requires international cooperation. CITES facilitates this cooperation and protects more than 30,000 animals and plants.

Hundreds of millions of plants and animals are traded every year, ranging from living creatures to products derived from them. While the plight of elephants, tigers, rhinos, and other great animals get a lot of the attention, it’s important not to forget the thousands of other plant and animal species that have been threatened by human exploitation — sometimes to the point of extinction. Even for the many traded species that are not endangered, we still want to be proactive and ensure their protection for the future.

At Embassy Bangkok, illegal trafficking of wildlife and plants is an ongoing priority. Working through USAID, we partnered with the FREELAND Foundation to produce the iThink campaign to increase public awareness of how individuals can make a difference. USAID Asia has invested $16 million over the last decade to combat wildlife trafficking, and the State Department’s Bureau of International Narcotics and Law Enforcement Affairs has sponsored a series of law enforcement training courses for the region’s customs and wildlife crime authorities. On a local level and with our CITES partners, we look forward to progress.

Celebrating the One-Year Anniversary of the Women’s Empowerment in Agriculture Index

This originally appeared on the Feed the Future Blog

Last March, Feed the Future launched a tool to measure women’s empowerment in agriculture—the first of its kind.

The Women’s Empowerment in Agriculture Index—developed by USAID, the International Food Policy Research Institute (IFPRI), and the Oxford Poverty and Human Development Initiative (OPHI)—tracks women’s engagement in agriculture in five areas: production, resources, income, leadership, and time use. Unlike any other tool, it also measures women’s empowerment relative to men within their households, providing a more robust understanding of gender dynamics within households and communities.

The Women’s Empowerment in Agriculture Index (or WEAI) makes empowerment a solid and quantifiable concept Feed the Future and partners can work toward. It also helps us improve the way we do our development work. We’re using the tool to systematically assess and improve our food security programs in regard to women’s empowerment and gender equality.

Azaratu Fushieni walks through her soy field. She has benefited from the assistance of a Feed the Future project, which helped her improve her agricultural practices and use better inputs. Photo credit: Elisa Walton, USAID

We asked Emily Hogue, the acting team leader for monitoring and evaluation in the Bureau for Food Security at USAID, to reflect on the one-year anniversary of this innovative tool, which she helped create.

1. How is Feed the Future currently using the Women’s Empowerment in Agriculture Index?

We’re using the WEAI to track changes in women’s empowerment that occur as a direct or indirect result of Feed the Future programs. There’s a couple of different ways we do that. First, in our focus countries, we’re monitoring changes within the targeted geographic regions where Feed the Future works to track the contribution our food security programs make to women’s empowerment. Second, we’re collecting WEAI data within our impact evaluations on specific activities to learn more about the approaches we’re using and how effective they are. This helps us understand and assess how different approaches impact women and men and identify which program approaches are showing the most promise so we can expand their use.

2. What’s happened over the past year with the Women’s Empowerment in Agriculture Index? What’s new?

In 2012, we collected data for the WEAI through population-based surveys in 16 of the 19 Feed the Future focus countries, alongside other Feed the Future indicators. We’re collecting data in the additional three focus countries in early 2013. This has allowed us to calculate baseline values for the WEAI so we can measure change from these baselines in future years. USAID and partners are also analyzing the large amount of data collected in the surveys to learn more about the relationships between empowerment, poverty, and nutrition, as well as relationships between WEAI indicators. Through our analyses, we’re also exploring how to further refine the tool to make it as practical and broadly useful as possible.

The WEAI team (USAID, IFPRI, and OPHI) produced a number of materials over the past year to support use of the tool, such as a brochure (PDF), a video, a webinar, and a discussion paper (PDF). So far, we’ve trained more than 600 people on how to use the tool—and that doesn’t include the number of people who have viewed our webinar training.

USAID is also funding the WEAI Resource Center at IFPRI, which offers assistance to users on fine-tuning the questionnaire for new contexts, tabulating and analyzing data, and interpreting the WEAI data to inform program design. Through IFPRI, WEAI partners selected four dissertation grants, funded by USAID, for research related to the WEAI. This research is helping build evidence on how women’s empowerment relates to other development outcomes, such as improved nutrition.

We’re excited to roll out a new instructional guide this week, published by IFPRI, that provides detailed information to users on how to use the WEAI questionnaire, analyze the WEAI data, and use the findings of the WEAI to inform program design.

3. How are you using the WEAI to improve the way Feed the Future works?

We created the WEAI as a monitoring and evaluation (M&E) tool to track the effects of our programs over time, but one of the most exciting uses of the WEAI has been as a diagnostic tool to identify constraints women face in the agriculture sector. Because the WEAI examines several dimensions and uses direct measures of empowerment rather than proxies, it can identify specific obstacles to women’s advancement in agriculture, such as limited access to credit or limited involvement in leadership roles. Once we identify those constraints, we tailor our programs to address them.

We’re currently examining WEAI baseline data to better understand the primary constraints and how our programs are addressing them. Then, we use the WEAI to track change over time in those specific areas, along with all five dimensions. We’re closely tracking how our programs impact equality and empowerment so we can strengthen and replicate practices that work well and reorient programs that aren’t working.

4. What has been the development community’s response to the WEAI?

Many development partners have expressed interest in using the WEAI for tracking their own programs.  Several international organizations like the International Fund for Agricultural Development, non-governmental organizations like CARE International, and a number of universities are planning to use or are already using the tool for program monitoring and research.

The WEAI team is developing tools and guidance to help our partners use and replicate the WEAI beyond Feed the Future’s focus countries and the targeted regions we work in. With the help of our development partners, we believe we can greatly increase the potential for learning through the WEAI. What started as a fairly modest effort to develop a monitoring tool for Feed the Future has greatly exceeded our expectations and provided the development community with a robust and accessible instrument to tackle one of the most complicated development challenges.

5. What’s next for the WEAI in its second year?

Now that we have a tremendous amount of data on the WEAI, most of our focus for 2013 is on analyzing and learning more about the context of empowerment in the areas where we work, as well as how the WEAI is working as a tool. The WEAI Resource Center and M&E partners are helping us conduct analyses to make this learning happen.

In 2013, we will also be designing and collecting baselines for a few impact evaluations of Feed the Future activities that use the WEAI. The WEAI team has many other materials in the works, so stay tuned in the coming months for baseline reports and a few case studies interpreting the results of the WEAI in our baselines. We’d also love to hear from others about how they are using and learning from the WEAI, so please let us know* about any work you will be doing in 2013 related to the WEAI.

While just a first step to improve learning and programming in this critical area, the WEAI signifies the commitment of the U.S. Government to prioritize empowerment as an essential development outcome that we will measure and strive to achieve.

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.

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