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Moving the Dial on Poverty and Hunger: What are Feed the Future’s High-Level Outcome Targets?

This originally appeared on the Feed the Future blog.

The second Feed the Future progress report is out and is generating a lot of buzz about the initiative’s successes last year.

People are talking about big numbers like:

  • 9 million households benefiting directly from Feed the Future investments
  • More than 7 million farmers applying new technologies or management practices
  • More than 12 million children under five reached by nutrition programs
  • Over $115 million in new private sector investment in the agricultural sector as a result of Feed the Future interventions

With more projects coming online and more USAID Missions and agencies like the Peace Corps and the U.S. African Development Foundation reporting into the Feed the Future Monitoring System in fiscal year 2012, results like these are expected to continue.

These numbers are more than just impressive statistics. They are also critical checkpoints on the road toward achieving Feed the Future’s goal of sustainably reducing poverty and undernutrition. Their placement on this road or “causal pathway” can be seen in the Feed the Future Results Framework (PDF), the conceptual and analytic structure that outlines the initiative’s goals and objectives.

Targets and Targeting

In order to track progress toward our goal, Feed the Future, as a whole, has set aspirational targets of reducing the prevalence of extreme poverty (those that live on less than $1.25 per day) and the prevalence of stunting in children under 5 years of age by 20 percent across all Feed the Future focus countries in the areas in which the initiative works. Individual country-level targets are set against these goals, based on the conditions and context on the ground, and range between 15 to 30 percent in each country, averaging approximately 20 percent overall.

From the beginning, we knew that Feed the Future could not do everything, do it everywhere, and do it well. That’s why Feed the Future prioritizes and concentrates efforts and resources in 19 focus countries where the Rome Principles can be best realized. We’ve further focused our resources within these countries in zones of influence: geographic areas strategically chosen based on need and strong potential for agriculture-led economic growth. Feed the Future tracks reductions in extreme poverty and stunting in these zones through baseline, midterm and final population-based surveys conducted in these areas.

Using Data to Understand

We’re currently tabulating the results of the baseline population-based surveys. The raw survey datasets for Bangladesh and Ghana are already available, with more to come. We’ll conduct midterm population-based surveys in 2015 and final population-based surveys in 2017. Results will be available in 2016 and 2018, respectively.

While real changes in poverty and stunting (the result of chronic undernutrition over time) take time to occur and are, therefore, difficult to measure on a year-to-year basis, independent data does show that poverty rates fell by an average of 5.6 percent across Feed the Future focus countries from 2005 to 2011, and stunting decreased by an average of six percent from 2009 to 2012*. Feed the Future has helped contribute to these trends in the past few years and works to accelerate them in the future. Through population-based household surveys, Feed the Future will be able to show progress in its development hypothesis that agriculture-led growth and a commitment to nutrition can help reduce poverty and hunger.

These surveys also track other data (PDF) critical to understanding Feed the Future’s impact such as women’s empowerment, which we measure through the recently-developed Women’s Empowerment in Agriculture Index; women’s dietary diversity; breastfeeding; minimum acceptable diet; expenditures; and comprehensive household demographic information.

How We Got There

Of course, this is not the only way Feed the Future is looking at high-level, outcome data on reducing poverty and hunger. Feed the Future also seeks to understand what interventions are successful, in what contexts, and why. Those questions are at the front and center of Feed the Future’s robust Learning Agenda.

Through the Learning Agenda, Feed the Future is conducting more than 40 impact evaluations to look at key questions related to the Feed the Future Results Framework. An evaluation currently underway in Uganda is looking at how different approaches to integrate gender work to improve nutritional status and dietary diversity. Another in Cambodia is assessing the impact of extension services on increasing farm productivity, household food availability, and income, as well as how interventions that promote the diversification of the food system impact dietary diversity and nutrition among women and children.

These impact evaluations, paired with annual monitoring results like in our latest progress report, will also help us keep a pulse on our progress toward meeting our “20-20 goals” and help us demonstrate how we are getting there.

The road to food security is a long one, but we are committed to stick to it, learning and sharing as we go.

Learn more about Feed the Future’s progress this Thursday. Check out our event page and tune in on social media via the hashtag #feedthefuture.


*Poverty data based on a $1.25/day threshold and obtained from PovCal. Data are either based on recent population-based surveys or World Bank data aggregations for the years 2005 or 2008. Data on stunting is from Demographic and Health Surveys reports or other comparable sources compiled by UNICEF.

USAID in the News

A young female Afghani professional. Photo credit: Daniel Wilkinson, State Department

The Washington Post, Associated Press, Reuters, and BBC among others reported on USAID’s new initiative known as “Promote,” a program to educate, train and empower at least 75,000 women between the ages of 18 to 30 in Afghanistan. In other words, explained USAID Administrator Rajiv Shah, “it is a unique effort to ensure that women are a major part of Afghanistan’s social, economic and political fabric over the next decade, because if they’re not Afghanistan is not likely to be successful.”

The Seattle Times reported on Northern Lights, a local firm that recently finalized an innovative agreement with USAID that’s expected to trigger at least $100 million of new private investment in renewable-energy projects in rural India. Northern Lights partner Jack Swift, believes the project will spark “some really cool projects” in rural India. For example, Swift says, “Many of the cell phone towers are run by diesel — a guy drives out and fills the tank every week. What if those were run by solar?”

The Washington Post recently ran a story in their local section profiling USAID’s Cara Christie and her work on the Agency’s OFDA team during the crisis in the Horn of Africa. For their effort, Christie and the agency’s Horn Drought Humanitarian Response Team are finalists for the 2013 National Security and International Affairs Medal. She is quoted saying, “The U.S. is one of the biggest players in the humanitarian arena. I feel like I have a great job with a big humanitarian hand.”

Sharing Agricultural Success with President Obama

This originally appeared on the Feed the Future blog

When I first got the idea back in 2008 that the women farmers like myself in central Senegal should join together to help one another succeed, I never would have guessed that five years later I would be sharing that story of success with the president of the United States.

On June 28, I found myself before President Barack Obama himself, explaining to him how bringing my producers’ network together with others in the Kaolack region and receiving assistance from a USAID project, part of the Feed the Future initiative helped us help each other, leading to the formation of a federation of some 3,000 producers who last year produced and sold 13,000 tons of corn on 5,000 hectares of land to feed our families and plan for next season.

Nimna Diayaté showed President Obama how technology helps her corn growers federation in Senegal. Photo credit: Zach Taylor, USAID

In our conversation, President Obama explained my story back to make sure he understood: “So you’ve got all these small farmers, and they all came together to better compete with big agribusiness.”

“That’s right,” I told him. “We created a network in the villages and each network worked together as the Saloum Federation of Corn Producers.”

I explained that our larger numbers afforded us better access to credit, with which our federation was able to access modern farm equipment, like the 12 tractors we have today. I pointed to a picture of the tractors on the display at the agricultural technology marketplace prepared for the president, and he asked me if I could drive a tractor myself.

“No, but I want to learn,” I said, knowing he was teasing me. But I really am going to learn.

To meet President Obama was wonderful. He seemed very happy to hear how a U.S. Government project was helping me and the members of our network. He was also very happy to hear that we now have enough good-quality, locally-grown corn for our own consumption and enough left over to sell, and that we are improving the quality of our seeds and equipment for the next growing season.

We want to make all producers in south-central Senegal aware of how we are producing quality corn so that we can be competitive with imports, find business opportunities, and sell our products at good prices.

Going back to before I had ever heard of USAID or Feed the Future, I was planting two hectares of maize a year. With USAID’s support, Feed the Future helped my little group access seasonal bank credit, with which we bought more seed and fertilizer than ever previously possible.

A year later, I planted 13 hectares and my income tripled. The 2011 harvest was a bad one, with a severe drought hitting our region hard. But the quality of the new seed was so good that despite the lack of rain, I still managed to increase my yield to 15 tons and earn close to $5,000 that year.

That money helped the federation qualify for a loan big enough to buy a brand-new tractor worth $35,000. The tractor has helped us prepare more than 350 hectares of land in our area. In 2012, my own cultivation grew to 18 hectares, including three hectares in new high-yielding hybrid varieties.

All this time our network was growing. In 2012, I was elected president of the new federation, which by then had 2,500 members. Now we can negotiate directly with banks, agro-dealers and buyers from the animal feed industry and today can speak for more than 3,000 corn farmers, both women and men, with the Senegalese government and the private sector with which we deal each day. This last season we produced nearly 4,500 tons, 3,000 of which was sold for a profit that will help us increase our yields still more next year.

Like the corn we cultivate, I feel the success of our federation can grow as high as our dreams. For a simple farmer from rural Senegal, to be successful enough to meet the American president shows that big dreams can come true after all.

Learn more about President Obama’s trip to Africa and view an infographic of the agricultural technologies marketplace where Diayaté met Obama.

(Translated from French by Zack Taylor)

Harnessing the Power of Regional Cooperation to Drive Progress in Southeast Asia

It occurs to me that it might be tough to explain why a USAID senior representative would travel to one of the richest countries per capita in the world to talk about development issues. I mull this over as I prepare to meet Deputy Assistant Administrator for Asia, Greg Beck, in the “Abode of Peace,” the small sultanate of Brunei Darussalam on the North Coast of Borneo.

The explanation – which will become clearer in a moment – is that transnational development challenges require multilateral solutions. On July 1, Beck, along with Secretary of State John Kerry, made the journey to tiny Brunei for high-level meetings between the United States and the 10 member countries of the Association of Southeast Asian Nations (ASEAN). USAID’s presence with Secretary Kerry highlights the strong development and diplomacy partnership driving U.S. foreign policy in Asia.

U.S. Secretary of State John Kerry (center) and USAID Assistant Administrator for Asia Greg Beck (right) at the Lower Mekong Initiative Ministerial. Photo credit: William Ng, State Department

While in Brunei, Beck and Kerry participated in the sixth Lower Mekong Initiative (LMI) Ministerial Meeting. The LMI is a partnership between the United States and the five countries of the Lower Mekong River basin (Burma, Cambodia, Laos, Thailand and Vietnam), which share common challenges and opportunities stemming from the river that connects them.

“If people do the wrong things upstream with this river, it can destroy the livelihood of the people downstream,” Secretary Kerry said during the meeting. “It sustains the lives of over 70 million people. …In order to meet these challenges, it is essential that we redouble our efforts to balance the demand for resources with sustainability and to develop cooperative approaches.” [Complete transcript available here.]

“We currently support a number of activities that can assist LMI partner countries in addressing shared water challenges,” Beck said. “For instance, our Water Links program facilitates partnerships among water service providers to expand clean water and sanitation and strengthen climate resilience, as well as address the anticipated impacts of climate change from private power infrastructure development.”

Assistant Administrator for Asia Greg Beck (left) with ASEAN Secretary-General Le Luong Minh. Photo credit: Jennifer Collier Wilson, USAID

USAID engagement alongside State’s diplomatic presence in Southeast Asia is helping to support equitable growth in this dynamic region in the areas of agriculture and food security, connectivity, education, energy security, environment and water, and health. The way we’re doing this, as exemplified by Kerry and Beck’s participation in the Brunei meetings, is by helping to improve communication between countries and encourage regional solutions to the numerous development challenges that impact the entire region.

During the Brunei meetings, I was reminded of the power of regional forums to be catalysts for progress when the foreign minister of Burma – next year’s chair of ASEAN – formally invited the U.S., ASEAN and LMI delegates to next year’s meetings in the Burmese city of Nay Pyi Taw. A few years ago, no one expected that Burma would be in a position to host these annual meetings in 2014. Regional cooperation can be a powerful promoter of positive change.

Demographic and Health Survey Show Positive Results in Haiti

A newly released nationwide health survey of Haiti shows continuing positive trends on key health-care indicators in particular those of Haitian women and children. The latest survey, undertaken by the Haitian Ministry of Public Health and Population, was conducted in 2012 and compares with the prior survey done in 2006. It shows steady improvements among key indicators despite significant health challenges in Haiti due to the 2010 earthquake and cholera outbreak. Of note were improved indicators for child vaccination and malnutrition, infant and child mortality, women’s health and contraception use. The report indicated no increase in HIV prevalence, which remained steady.

Patients get laboratory work done at a USAID-supported health clinic in Ouanaminthe, Haiti on May 15, 2013. Photo credit: Kendra Helmer/USAID

The Morbidity, Mortality, and Service Utilization Survey measures progress and setbacks in health outcomes over the years. The results were announced July 9 by Dr. Florence Guillaume Duperval, Haiti’s Minister of Public Health and Population. The survey has been administered in Haiti five times since 1994.

The previous survey was administered in Haiti between 2005 and 2006; this latest survey was conducted from January 2012 to June 2012. Over 13,000 households participated in the current survey, representing rural and urban areas in all of Haiti’s 10 departments, including camps for people displaced by the January 2010 earthquake. The results were eagerly anticipated by health experts concerned of possible setbacks brought on by the devastating quake, which killed more than 230,000 people and displaced more than 1.5 million.

However, the survey results show that many health outcomes have improved in Haiti. The data collected in the survey show improvements in women’s health, improved nutritional status among the population, and an increase in use of contraceptive methods. Currently, more than two-thirds of pregnant Haitians have made the recommended number of antenatal visits, an increase from 50 percent in 2006; the prevalence of anemia among women has declined from 55 percent in 2000 to 49 percent in 2012; and the use of modern contraceptive methods among married women has increased from 22 percent to 31 percent between 2000 and 2012.

Health data for children also showed positive results. Childhood vaccinations increased from 53 percent in 2006 to 62.5 percent in 2012. With regard to nutrition, the survey showed that 22 percent of children under 5 suffer from chronic malnutrition, a decrease from 29 percent in 2006. The survey also revealed a decrease in acute malnutrition from 10 percent in 2006 to 5 percent in 2012 and a decrease in percent of children underweight from 18 percent to 11 percent.

Childhood mortality has decreased in Haiti over the last 15 years. Survey results show that infant mortality has decreased from 79 to 59 deaths for 1,000 live births. In addition, mortality for children under 5 has also decreased from 112 deaths to 88 deaths per 1,000 live births.

Among other results, the survey revealed that the HIV prevalence among those ages 15-59 have remained the same:  2.7 percent among women and 1.7 percent among men.

USAID is working closely with the Government of Haiti to continue to improve health outcomes for all Haitians. “The information in this survey forces us to continue to work together, to strengthen our interventions and our methods so that progress in the health sector in Haiti is sustained,” said Marc Desjardins, Deputy Chief of Mission of the U.S. Embassy in Port-au-Prince, during the July 9 event.

USAID’s goal is to improve access to health care services and build the Government of Haiti’s capacity to manage and oversee its health programs. Currently, about 50 percent of the population has access to a vast network of USAID-sponsored health facilities throughout the country that provide core health services such as maternal and child health, family planning, and nutrition. In addition, diagnostic and treatment services for tuberculosis and HIV and AIDS services can be accessed at these health facilities. HIV and AIDS services include access to antiretroviral therapy, prevention of mother-to-child transmission, palliative care, and voluntary testing and counseling. USAID programs aim to reduce risky behaviors and maintaining people living with HIV and AIDS on treatment.

Much remains to be done in Haiti. For example, despite high levels of knowledge of family planning, only 35 percent of married women are using any method and 31 percent are using a modern method. However, the positive health trends revealed by this data shows that Haiti continues to move forward despite the earthquake, the ongoing cholera epidemic, and many other challenges that threaten health outcomes. These results are a testament to the hard work and strong commitment of all of those who work to build a better Haiti.

This survey was funded by USAID, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the Global Fund the Global Fund to fight AIDS, Tuberculosis, and Malaria through the United Nations Development Fund (UNDP), and the Canadian International Development Agency (CIDA).

The fifth Morbidity, Mortality, and Service Utilization Survey combined with the Multiple Cluster Indicator Survey (MICS) was conducted by the Haitian Childhood Institute [l’Institut Haïtien de l’Enfance (IHE)] in collaboration with the Haitian Statistical and Information Technology Institute [l’Institut Haïtien de Statistiques et d’Informatique (IHSI)]. This survey was supported by the Ministry of Public Health and Population [Ministère de la Santé Publique et de la Population (MSPP)], benefited from the technical assistance of the Demographic and Health Surveys program (MEASURE DHS), which is implemented by ICF International.

Resources:

  • Read the full DHS report.
  • See photos of USAID’s health-related programs in Haiti.

Creating Opportunity in Nepal through Education for Income Generation Project

For eighteen-year-old Sitara Bano Bagban, living in the rural village of Karamohana, Banke District in Mid-Western Nepal, educational opportunities were very limited. Extreme poverty along with conservative cultural beliefs, that require male family members accompany females outside the home, as well as extreme poverty had prevented her from getting a formal education. This is not uncommon in rural Nepal where families often depend on their children to stay at home and work to augment income. Since married women are sent to live in their in-laws’ homes, parents traditionally give priority to educating boys who will stay in their parents’ house.

Those without an education in Nepal have few options. Without the ability to read and write they  are less likely to use government services or send their children to school. Also, their ability to find gainful employment or own and operate successful businesses is hampered by the fact that they are not able to do basic mathematics, leaving them vulnerable to being cheated in the market because they are unable to count money.

During EIG’s entrepreneurial literacy course, Sitara learned how to read and write, and how to use a calculator. She also learned about proper nutrition, peace-building, and how to access loans, credits, and other government services. Photo credit: Winrock International

Everything changed for Sitara when her parents allowed her to enroll in USAID’s Education for Income Generation (EIG) project, which provides income generation training as well as basic literacy training to underserved groups. Because her brother also began to attend EIG’s entrepreneurial literacy class and agricultural training, her parents agreed that she could participate because she would have someone to accompany her.

The EIG Project, which is implemented by Winrock International, has trained 74,000 disadvantaged youth (78% of whom are women) to increase their income through employment and agricultural production. EIG uses a market-driven approach consisting of four basic activities: a nine-month entrepreneurial literacy course; demand-driven vocational training tied to job placement; high-value agricultural training linked to markets; and scholarships for people from low castes (dalits) for professional certificates that lead to employment.

After attending EIG’s entrepreneurial literacy class and agriculture training, Sitara and her family increased their productivity and income by producing higher quality vegetables in their family farm. Photo credit: Winrock International

During the class, Sitara learned how to read and write and how to use a calculator. She learned proper health and nutrition practices, peacebuilding skills, and how to access loans and other government services. In addition to literacy, Sitara enrolled in EIG’s agriculture production training where she learned how to produce off-season, high-value vegetables including nursery development, integrated pest management (IPM), micro-irrigation technology (MIT), and post-harvest handling. As a result, Sitara convinced her parents that MIT could increase their farm’s productivity. Because she was able to attend this training her family decided to install a small well and pump and which have allowed them to grow fresh vegetables for their home and to sell in the market. Sitara’s income has increased significantly and Sitara has even been able to save  a little money at the local saving and credit cooperative.

Sitara’s story is just one example of the impact this type of training has had on thousands of disadvantaged youths. These programs prepare young people to be more involved in their governments in a positive way, to get jobs that improve their country’s economy, and to ensure a better and brighter for future youth.

Photo of the Week: Learning How to Read

 

In the second grade, students learn to read through new learning techniques at USAID-supported Kakila Primary School in the Democratic Republic of the Congo. Photo is from Alain Mukeba USAID/DRC.

 

“Come Back at Night and You Will Understand”

Rajiv Shah serves as Administrator at USAID

This plain-spoken answer—from a father who lived in a village without access to electricity—came in response to the question: What is life like without electrical power?

For most of the world, electricity allows business to flourish, students to study, and clinics to run long after the sun goes down. But for 600 million Africans, these opportunities simply don’t exist.

As a result, a sick child in Nigeria is unable to take antibiotics because the medication has to be refrigerated. A farmer in northern Ghana purchases a cell phone to connect himself with the world, but every other day he has to walk to the nearest electrified village and pay to charge the phone—a waste of time and money.

These difficulties are repeated on a large scale across the continent. Nearly half of all businesses try to cope with frequent power outages by using expensive stand-alone diesel generators that also pollute the environment. These stop-gap measures are no basis on which to build a modern economy.

In order to shape a brighter future, we cannot rely on donors alone. African countries must have transparent, accountable, and streamlined systems that attract private investors and developers. To help shape this environment, the United States, together with African governments and the international business community, is kicking off an initiative to bring more reliable, clean power to Africa. Announced by President Obama in Cape Town, Power Africa will create the conditions needed for long-term investments in energy infrastructure – generators, transmission lines and distribution systems. In ten years, we’ll bring 10,000 megawatts on line – and bring power to millions of African homes and businesses.

At its core, Power Africa represents a new model for development that is beginning to define the way we work around the world. Like the New Alliance for Food Security and Nutrition and the Call to Action in Child Survival, Power Africa harnesses public-private partnerships and demands greater accountability from our partners to deliver incredible results.

On his trip to Africa, the President recognized the profound potential of this new model. “[Power Africa] is representative of my new approach when it comes to development,” President Obama explained in Tanzania. “I believe the purpose of development should be to build capacity and to help other countries actually stand on their own feet… Instead of perpetual aid, development has to fuel investment and economic growth so that assistance is no longer necessary.”

Through Power Africa, we will help create incentives and reduce risk for American investors in Africa, while working with African governments to modernize inefficient old networks and establish fair and transparent partnerships with the private sector. We will also be working with businesses themselves – American, African, and others. Investment specialists will analyze barriers to investment and then work with all parties to remove those roadblocks.

Once the first Power Africa projects succeed in bringing electrical power to African communities, the impact of those examples will encourage other ventures to follow in their footsteps. Electricity provides the countless opportunities and freedoms that define development.  It will take a great deal of commitment and patience to solve this problem, but today we know it can be solved.

Resource:

Follow @USAIDAfrica on Twitter to learn about our global development work in the continent!

Youth Empowerment is Key to President Obama’s Vision for Africa’s Future

Throughout his recent trip to Africa, President Obama returned again and again to the theme of economic opportunity and empowerment: building the capacity of people and institutions to lead their countries forward. Central to his vision is the critical role that African youth must play in the region’s social and economic transformation. The USAID-funded Youth:Work program is already at work to make this a reality.

In partnership with the International Youth Foundation (IYF), the Youth:Work project is working in eight countries in Sub-Saharan Africa to assess the needs and aspirations of young people, the hurdles they face in seeking employment, and the opportunities that can help them improve their lives and prospects. This holistic mapping exercise, called Youth:Map, is developed through interviews with business, community, government, and youth leaders. The resulting assessments consolidate critical evidence and expand our knowledge about youth issues in Africa that will help the private sector and governments alike to make smart, targeted investments in the years ahead.

Group of African young adults. Photo credit: USAID

In fact, this comprehensive information gathering has already become the basis for designing and implementing innovative pilot programs to specifically address the issues raised through the studies. One consistent theme from all Youth:Map studies is that Africa’s young people do not have access to the life skills and vocational training they need to get good jobs or start their own businesses. USAID and IYF are addressing this deficit in a number of ways.

In Uganda, for example, a 6-month internship program has been launched to help young people join the labor market and contribute to the country’s broader economic development. “This is the kind of program that we need to ensure that Uganda’s youth have real opportunities to achieve their dreams and build their futures,” said Commissioner Kyateka F. Mondo of Uganda’s Ministry of Gender, Labour and Social Development, at the program’s launch.

In Tanzania, orphans and vulnerable youth are gaining access to education and job training opportunities through the Tanzania Youth Scholars program, which offers educational scholarships and livelihood training.

Passport to Success®, a global life and employability skills curricula that has been translated into 18 different languages, is improving the employment prospects of young people in Senegal, Zimbabwe, and Mozambique. Build Your Business, an entry-level curricula for young people interested in starting their own micro-businesses, developed by IYF in collaboration with Microsoft, is being used to teach entrepreneurship and life skills to young people in Liberia and Uganda.

USAID and IYF are also joining forces to respond to another significant assessment finding – that young people feel marginalized and seek a greater voice in society. Two regional youth leadership institutes are opening in Senegal and Uganda to ensure more African youth become strong, innovative, and confident leaders in their communities.

In his speech in Johannesburg, President Obama declared that Africa’s young people “are going to determine the future” of their countries. While significant challenges lie ahead, USAID is working with IYF and many others to help build the kind of infrastructure and enabling environment needed to ensure Africa’s youth can fully realize this vision of hope.

About the International Youth Foundation
The International Youth Foundation (IYF) invests in the extraordinary potential of young people. Founded in 1990, IYF builds and maintains a worldwide community of businesses, governments, and civil-society organizations committed to empowering youth to be healthy, productive, and engaged citizens. IYF programs are catalysts of change that help young people obtain a quality education, gain employability skills, make healthy choices, and improve their communities. To learn more visit www.iyfnet.org

A Roadside Attraction in Djibouti: Community and Condoms at the SafeTStop

Whether on foot, camel, dhow, containership, tanker, or truck—traders have likely criss-crossed Djibouti and its waters for as long as there has been trade. Today, the Port of Djibouti, one of Africa’s busiest, lies at the nexus of major shipping routes between Asia, Africa, and Europe.

From Djibouti, most goods travel inland by trailer-truck: some 800 Ethiopian truckers arrive every day. After offloading coffee, cotton, beans and other commodities from Ethiopia, truckers wait 4 to 6 days to reload with imported electronics, spare parts, construction materials, food aid and much else.

This range of activity makes a small community, virtually unknown outside Djibouti, both important and vulnerable. It’s called PK-12 for “Point Kilometre 12″ in French, the official language. Meaning that it’s 12 km from Djibouti town, the capital and site of the port. PK-12 looks like the mother of all truckstops. Colorful vehicles lie like flattened dominoes as far as the eye can see—thousands of them.

Thanks to a public-private partnership between USAID, the Government of the Republic of Djibouti, FHI 360, and Dubai Ports World, the little container-hut at PK-12 will be replaced by a larger center.The new SafeTStop will feature testing and treatment on the premises, so clients will have a one-stop-shop for recreation plus HIV and other health services. Photo credit: Dubai Ports World

Understandably, drivers with several days on their hands also ferry back and forth another invisible item. About 25 percent are thought to be HIV-positive. The number of HIV-positive young women and men from the community is not known, and the stigma is too strong for even the boldest to disclose their status.

As late as 2004, HIV was a taboo subject, along with condoms. Voluntary testing did not exist. A lot of young women in this small roadside settlement were not only getting pregnant out of wedlock, they were also dying. If someone got a positive diagnosis—usually by showing up at a hospital with TB or another disease—they often took their own life.

“I got involved in HIV education because I used to lie awake at night worrying about my two daughters,” says Zahra Daher.  “They were very young then, but what would happen later? There’s so little opportunity here except sex work.  It seemed like a death sentence.”

Zahra and I, along with three bearded imams and several peer counselors, are talking on the second floor of a little building made, fittingly, from one transport container atop another. This center for recreation and HIV education is a “SafeTStop”—one in a network of 52 in communities along the main highways of East Africa. The SafeTStops are part of the ROADS II program funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID and implemented by FHI 360.

Zahra Daher and Hussein Houmed, founders of the PK-12 SafeTStop. Photo credit: Carole Douglis, USAID/East Africa

A decade ago, before the SafeTStop existed, Daher and others here were chased, stoned, and accused of infecting people simply for talking about HIV. In 2004, Daher assembled a concerned women’s association. Hussein Houmed put together a youth association. Together, they sought support and funding. By 2005, they received both from PEPFAR through USAID/Djibouti.

The clerics—initially far from enthusiastic—were invited to join the initial training. They did, and today they preach prevention at community mosques. “Our target,” says Houmed, “was to inspire people to go for voluntary counseling and testing, so if they’re positive they start taking ARVs [antri-retroviral drugs] if needed. That way they can stay healthy and are also unlikely to pass the virus on.”

Peer counselors roam the local bars and restaurants, befriending people in Arabic, Afar, Somali, or Amharic, distributing condoms, and encouraging truckers and community members alike to be tested.

“The progress is very visible,” says Daher. “Before, no one mentioned the disease. Today we see people talking about it. We see people easily asking for condoms, going for testing, then going back for the results. People who are positive approaching us for advice. And undesired pregnancies are much rarer than they were.”

Thanks to a public-private partnership between USAID, the Government of the Republic of Djibouti, FHI 360, and Dubai Ports World, which operates the port of Djibouti, the little container-hut at PK-12 will be replaced by a larger center nearby. The new SafeTStop will feature testing and treatment on the premises, so clients will have a one-stop-shop for recreation, plus HIV and other health services.

“I’m taking this opportunity to thank American taxpayers and the Ambassador,” said Houmed after our interview. “Long life to the U.S. and the Government of Djibouti, who have made this partnership possible.”

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