India
Fighting TB in India, One Lab at a Time
Phil Carroll is the Senior Policy Communications Associate at USAID partner organization PATH. He spent two weeks in India last fall visiting PATH programs related to maternal and child health, tuberculosis, immunizations, and safe water and diarrheal disease. Originally posted at the Global Health Technologies Coalition Blog.
India is a country that changes dramatically from place to place, something I experienced firsthand while on a two week trip there this past fall. One day I was listening in on a mothers’ group meeting in one of the poorest villages in Uttar Pradesh state, and less than 24 hours later I was standing in one of the world’s most technologically advanced airports in Hyderabad—often referred to as the ‘Silicon Valley’ of India. It was during this leg of my journey where I was further convinced of the need for sustained investment in research and development.
Photo: PATH/Gabe Bienczycki
This is significant for a host of reasons. Diagnosing TB on the early side can help get patients on treatment faster, thereby reducing further deterioration of their lungs and other organs and ultimately save their lives. Catching TB early on can also curtail the spread of this incredibly contagious disease to others. India, which has the highest incidence of TB in the world, and 20 percent of the world’s burden, needs these sorts of advancements now more than ever. Currently, the government of India, as part of its National TB program, is only reaching 25 percent of MDR-TB patients with diagnosis. However, by 2013, it is aiming for 100 percent coverage, or around 2 million TB patients.
A Triumph of Coordination: To the Last Case in India and Beyond
Ellyn Ogden delivers a polio vaccine in Kolkata. Photo credit: CORE Group
Ellyn Ogden has coordinated USAID’s polio eradication initiative since 1997 and is a frequent visitor to India.
Western Uttar Pradesh was once seen as the world’s largest reservoir of polio virus. Four districts, namely Moradabad, Bareilly, Rampur and Badaun, were considered the ‘Hot 4’ and for many years, people speculated that the last polio cases would be from these districts. But the skeptics were wrong. The districts pulled together, involved all ministries, not just the health sector, and held everyone accountable for performance. The District Magistrates took charge and became personally involved in solving any obstacles that would crop up. Vacant medical officer positions were filled and progress was monitored closely.
Across India messages travelled the TV and radio airways. Celebrities and sports legends lent their support. Rotarians urged everyone to participate, provided much needed financing, and rolled up their sleeves to help out during the campaigns. CORE and UNICEF Mobilizers spent countless hours answering mothers’ questions, and in some places visited every pregnant woman to sensitize her in advance of the need for immunization. When the baby was born, the mother would then receive a ‘congratulations’ card, an immunization card and education on how to protect the child from a range of diseases. These extraordinary efforts make a difference far beyond polio eradication.
The last polio case in India was in Howarah District of West Bengal. It was not in the ‘Hot 4.’ It was in a child who was never vaccinated against polio in the routine system. It was in an unexpected area, demonstrating the importance of a robust surveillance system. The rapid outbreak response by the West Bengal government has been exceptional. The health team in the area knows how fragile the situation is. Still, far too many families refuse vaccination, there are periodic shortages of the trivalent vaccine used in the routine system, there are vacant medical officer posts, and routine immunization sessions happen once a month rather than the needed once a week in many rural areas.
USAID in the News
Weekly Briefing (1/16/2012 – 1/20/2012)
January 17: The GlobalPost highlighted India’s progress in its fight to end polio and noted that the country recently marked one year since its last confirmed case of polio. The news outlet interviewed Ellyn Ogden, USAID’s worldwide polio eradication coordinator. In the published interview, Ogden discusses India’s achievement and the global outlook to end polio.
January 18: On Wednesday, at the University of Delaware-Wilmington, USAID Administrator Dr. Rajiv Shah joined Senator Chris Coons at an “Opportunity: Africa” Conference. Local media outlets, including The News Journal, the Newark Post, and WDEL-AM covered the event. At the conference, Administrator Shah and Senator Coons highlighted how American businesses, including Delaware-based companies, are developing innovative ways to grow Africa’s economy and open trade markets for U.S. goods.
A Triumph of Coordination: Eradicating Polio from India
Ellyn Ogden, USAID’s Worldwide Polio Eradication Coordinator, delivers oral polio vaccine to a child in Kolkata, India. Photo credit: CORE Group Polio Project
Ellyn Ogden has coordinated USAID’s polio eradication initiative since 1997 and is a frequent visitor to India.
The news out of India this week marking 12 months with no confirmed case of polio is indeed a landmark event. I have had the good fortune of working with the Pulse Polio Program, as the Polio Eradication Initiative is called here, since 1997, and have seen firsthand the hard work and dedication of the Indian government at the national, state, district, block and panchaiyat levels. Over 2 million health workers, mobilizers, and volunteers have contributed to this success and deserve to be seen as heroes in their communities.
There have been many challenges over the years, not the least of which was figuring out how many children under age five there really are in India. When I participated in my first surveillance review in Bihar, there were no surveillance officers assigned yet and the eradication program was in its infancy. Today, India’s polio eradication program and its surveillance system, the envy of all other polio eradication programs, is often cited as the model to strive for.
With the help of WHO, UNICEF and Rotary international, detailed plans are developed to assure that vaccine reaches every village, data is analyzed and feedback given to constantly improve the work of the teams. Detailed maps help trace the daily route of the vaccination teams. Supervisors provide guidance and quality control. Monitors verify the work of the teams, by checking to see if their fingers are marked and flagging any locations with poor coverage. Sweep teams go back to find missed children. Issues are discussed at evening meetings during the campaigns and corrective action taken immediately. Government accountability and ownership is very visible.
USAID in the News
January 3: Billboard Magazine highlighted USAID’s work to launch a public awareness campaign for the famine in the Horn of Africa. Specifically, the magazine praised USAID’s partnership with MTV to not only “forward the facts,” but auction off items to benefit families in East Africa.
January 2: Over the weekend, Forbes India published a transcript of an interview with USAID Administrator Dr. Rajiv Shah. The interview discusses Feed theFuture and the budget, and took place during Administrator Shah’s trip to India earlier in the month.
December 24: Voice of America reports that the U.S. continues to support the Republic of South Sudan. New efforts are under way to help establish a viable government and lay the groundwork for economic growth. USAID/South Sudan Mission Director Kevin Mullally was quoted, stating that “As the country takes the leadership in its development, we are committed to supporting them in trying to achieve their vision.”
December 22: NPR interviewed Alex Thier, Director of USAID’s Office of Afghanistan and Pakistan, to discuss a promising new survey showing that medical care in Afghanistan has improved dramatically over the past decade.
December 20: USAID’s Chief Innovation Officer, Maura O’Neill, published a post in The Huffington Post’s Impact Blog. In the piece, O’Neill discusses India’s innovative approach to development. She also highlights USAID’s new partnership with the Federation of Indian Chambers of Commerce and Industry (FICCI), one of the largest microfinance organizations in India. The partnership aims to identify and develop cost-effective aid programs that will benefit India as well as the rest of the world.
Crowd Sourcing Development Innovation in India
India has become synonymous with innovation. Inexpensive mHealth applications. The Tata Nano. Low cost eye surgery. These are just a handful of the frugal innovations that India has developed and is now exporting. With a booming social enterprise sector, a number of the world’s leading academics, Nobel Prize winners and thinkers, a vibrant private sector, and world-class NGOs like Pratham, India has been dubbed the innovation hub for the West.
In light of this innovation boom, Administrator Raj Shah challenged us to think about how we could harness the enormous creativity and frugal innovation found in India, and how we could partner to find and scale high-impact development solutions that drive down the cost of development and get results faster—not just for India but for the rest of the developing world, and even here in the United States. USAID has had great success in significantly reducing HIV transmission rates and was within reach of eradicating polio in India. How could we do more of that while thinking globally, not just locally?
We didn’t have to look further than Lalitesh Katragadda, who is an Indian citizen who earned his robotics PhD at Carnegie Mellon. Lalitesh joined Google when it was a start-up, and then returned to India to both grow the engineering talent base and search for inexpensive ways to solve some of the world’s most troubling development challenges. With a group of volunteers he came up with a way to get the world to map its neighborhoods. The Pakistanis used the new Google Map Maker during the devastating floods last year to locate 800,000 people. They told Lalitesh that the maps helped them save an estimated 250,000 flood victims’ lives, all with a crowd sourcing tool. This is an inexpensive solution at scale. This is what is sorely needed.
Today USAID is announcing a partnership with the Federation of Indian Chambers of Commerce and Industry (FICCI); one of the largest microfinance organizations in India, Basix; and an Indian venture operation, Infinity Innovation Fund. The focus is to source and scale development solutions being developed and tested in India that will benefit vulnerable populations across the country and the rest of the world.
The Millennium Alliance: An India-US Innovation Partnership for Global Development will raise $50 million in seed capital, grants, loans, guarantees, and technical support for base of the pyramid solutions. The Alliance will be modeled on USAID’s Development Innovation Ventures to deliver maximum development impact by focusing on cost-effective solutions, rigorous testing and evaluation, and transition to scale via public and private pathways. USAID has committed $7.5 million to help launch the partnership with the Indian businesses matching it.
We knew FICCI was the right partner when we saw on the Boardroom entry wall a picture of Mahatma Gandhi and quote from his FICCI address in 1927, which read, “The industry should regard themselves as trustees of the poor.” Dr. Rajiv Kumar, Secretary General of FICCI embodies that motto- smart business and caring about those currently left behind.
Together we are eager to create a new, transformational relationship with India that marries USAID’s continuing and sustained efforts to make American taxpayer dollars go further and India’s potential as a global innovation laboratory to lift up the world’s poor.
Administrator Shah Receives Award for Indian Diaspora
Diaspora can make a difference. That’s the reasoning behind India’s Pravasi Bharatiya Samman Award—the most prestigious civilian award given by the President of India to successful Indian diaspora who have enhanced India’s prestige around the world.
Administrator Shah (wearing the award) with his wife, Shivam Mallick Shah, and Ambassador Meera Shankar with her husband Ajay Shankar. Photo Credit: USAID
USAID’s Administrator, Rajiv Shah, was recently honored as an Indian-American who is making a difference when he was presented with the above-mentioned award at a reception at the residence of Indian Ambassador Meera Shankar. Dr. Shah is one of 15 people, of Indian descent, from around the world to receive the award.
In his acceptance speech, Dr. Shah stated, “This award has particular significance to me, because it symbolizes two of the most important values in development work: partnership and service.”
Although he was born and raised in suburban Detroit, Dr. Shah’s parents hailed from India, and his Indian heritage has influenced his path in life. He still recalls the shock of seeing the deep human suffering in slums of Mumbai while on a family trip to India as a small boy. Years later, as a medical student, he went back to India and volunteered in a poor community in South India, where impoverished students in a one-room schoolhouse looked for inspiration to three portraits on their classroom wall—Mahatma Gandhi, Jawaharlal Nehru, and USAID’s founder John F. Kennedy.
At the original award ceremony in New Delhi in February, which the Administrator was unable to attend, the President of India, Smt. Pratibha Devisingh Patil called on the Indian diaspora to participate in building a better life for India’s disadvantaged.
And in his speech last night, Dr. Shah echoed the importance of drawing on the talents and skills of the diaspora community to help meet development challenges: “As someone who walks between both of these worlds—the halls of government and the Indian diaspora community—I appreciate the critical role diaspora communities have to play in expanding economic opportunity, increasing access to services, advocating for peace, and consolidating democratic gains.”
Dr. Shah also highlighted examples of USAID’s successful partnership with India, such as halving HIV prevalence in Tamil Nadu and reducing electricity losses in Bangalore. And he underscored India’s important role as a model for development and as a donor itself, noting the potential—with the help of diaspora and other partners—for expanding these achievements throughout India and around the world.
Dr. Shah also stressed that USAID is changing its relationship with India from that of donor-recipient to a new strategic partnership, working hand in hand with the Indian government and private sector on initiatives that will harness technologies and innovations of both countries to address global challenges.
For more information on USAID’s work in India, please visit the USAID/India mission website.
Mobile Clinics in India Take to the Road: Bringing HIV Testing and Counseling and STI Services to Those Most at Risk
Ed Scholl, AIDSTAR-One Project Director, John Snow, Inc. AIDSTAR-One is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government (USG) country teams to build effective, well-managed, and sustainable HIV and AIDS programs, and promotes new leadership in the global campaign against HIV.
Sanjay takes his lunch break on his construction job near the city of Nagpur in the state of Maharashtra, India. He migrated here in search of work from his home in the northern state of Madhya Pradesh. He’s 23 and single and hopes to earn enough to get married, start a family, and help his parents back home.
Mobile clinic in the Nagpur District of Maharashtra, India Photo credit: Ed Scholl/JSI
During his break, Sanjay (not his real name) decides to visit the big van parked near the construction site, where an outreach worker told him he can get free HIV and sexually transmitted infection (STI) testing. He’s curious and a bit concerned about his HIV status, since he knows that visiting sex workers back in town, as he and his fellow workers occasionally do, puts him at risk for HIV. He enters the van and is greeted by the counselor, who explains how HIV and STIs are transmitted and what he can do to avoid them. Sanjay then gives his consent for an HIV test. The counselor shares some pamphlets that give him additional information about HIV and STI prevention. Before she leaves, she demonstrates how to use a condom and offers him some.
Next, he visits the doctor, who goes through a checklist of STI symptoms and provides a physical exam. Finally, he goes to the lab, where blood is drawn. He is told to come back for the results in four hours. At the end of his shift, he returns to the van and the counselor tells him, much to his relief, that he is HIV-negative and does not have an STI. She reminds him how he can stay healthy and avoid HIV and STIs and answers all of his additional questions.
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Accidental Empowerment
By: Anju Malhotra, Vice President of Innovation at The International Center for Research on Women (ICRW)
Women are on the move in New Delhi, and in an entirely new way: on the Metro. I couldn’t help but notice them during my last trip to India a few weeks ago. Women filled the first car of every train — by law designated exclusively for them — and were scattered throughout the co-ed cars. They were of all ages, and from all walks of life: young teens in their jeans; moms in saris with one child in their arm and another at their hand; middle-aged women from North Delhi covered in burqas; and working women dressed professionally and in a hurry. Seeing this, I realized that the Indian government’s latest large-scale infrastructure project has become an innovation that is unintentionally, but most definitely empowering women.
Anju Malhotra is the vice president for research, innovation and impact at the International Center for Research on Women (ICRW). Malhotra was a featured speaker at the Elliott School of International Affairs Roundtable Discussion on “Implementing the Quadrennial Diplomacy and Development Review” on April 14, 2011. Photo Credit: ICRW
The new mode of transportation was meant to bring Delhi into the 21st century for the Commonwealth Games and to connect the burgeoning, diverse, rambling metropolis. While there was no thought of empowering women in the planners’ minds, in its design and roll out, this innovation has met the needs of women, satisfying a latent demand for fast, clean, safe, affordable transportation. For too long, urban Indian women have faced disadvantages when it comes to transportation: They walk, while men ride motorcycles. They are groped on packed minibuses. They fear for their safety in taxis. The Metro is attractive to women because it’s opening new worlds and opportunities for them by connecting them to school, jobs, friends, shops and tourism in ways they hadn’t been before. And in a growing economy, women – just like men – need to be going places.
The unintentional outcomes that Metro is providing women offer important lessons for the U.S. government’s new approach to development outlined in its inaugural Quadrennial Diplomacy and Development Review (QDDR). The QDDR provides concrete steps to promote innovation and technology in USAID’s work to achieve development outcomes. It also calls for a focus on gender equality and elevated investments in women and girls as a way to “maximize results across the board.”
The Delhi Metro is a striking example of how to double the impact of our foreign assistance dollars – in this case, an investment in a 21st century technology also is helping to foster equity between India’s women and men. The Metro is empowering women – even though it was not built with them in mind. It illustrates why it is important to consider big, innovative technologies – such as infrastructure projects – as a way to empower women. No longer can investments in women be small side bars or clunky add-ons to the development agenda.
And imagine what technology and infrastructure investments could do if they considered women from the beginning, not accidentally as an afterthought, but as a key demographic and half of the consumer base. Imagine. We would be able to not only create more women on the move, but new technologies, new products, new consumers, new markets, and new ideas.
Anju Malhotra is the vice president for research, innovation and impact at the International Center for Research on Women (ICRW). Malhotra was a featured speaker at the Elliott School of International Affairs Roundtable Discussion on “Implementing the Quadrennial Diplomacy and Development Review” on April 14, 2011.
The International Center for Research on Women (ICRW) works to make women in developing countries an integral part of alleviating global poverty. ICRW’s research evidence identifies women’s contributions as well as the obstacles that prevent them from being economically strong and able to fully participate in society. ICRW translates these insights into a path of action that honors women’s human rights, ensures gender equality and creates the conditions in which all women can thrive. Visit www.icrw.org
Actress Lucy Liu: “Fight Human Trafficking by Nurturing Women and Girls”
Lucy Liu on field visit with UNICEF in 2008 to Cote d’Ivoire. Photo credit: U.S. Fund for UNICEF.In the past several years I’ve met with girls and women who have survived brutal treatment as sex trafficking victims, and have been involved with several documentaries about their struggle to survive and give back.
In the past several years I’ve met with girls and women who have survived brutal treatment as sex trafficking victims, and have been involved with several documentaries about their struggle to survive and give back.
Meena Haseena was nine when she was kidnapped from her home in Bihar, India, and taken to a brothel where she was beaten and raped for twelve years. When she ran away to get help from the police, they returned her to the brothel, asking only that she be spared beatings. (New York Times columnist, Nicholas Kristof, chronicled her story in his book with Sheryl WuDunn, “Half the Sky: Turning Oppression Into Opportunity for Women Worldwide.”)
This is human trafficking, a lucrative and growing transnational crime that brings in roughly $32 billion per year[1] internationally. Of those profits, $28 billion[2] are made from commercial sexual exploitation, which characterizes 79% of identified trafficking cases.[3] The victims are predominantly female.
As the United States Government takes this week to consider crime and violence perpetrated specifically against women, we must think of the circumstances that lead to girls and women like Meena being trafficked into captivity and viciously raped of their rights. In the brothel, Meena wasn’t allowed condoms, and so she bore a daughter and son in captivity. They were taken away from her and raised as slaves. When Meena learned that she might be killed, she managed to escape, but it took her 14 years to rescue her first child, a daughter, from the brothel.
The organization Apne Aap Women Worldwide ultimately helped rescue Meena’s daughter from the brothel and then started a boarding school in Bihar to protect and educate girls. In school, girls are not as at risk for being kidnapped. This is success. There are many organizations working to address child trafficking, and their solutions deserve attention.
UNICEF, for example, established anti-trafficking committees in three districts of India and trained police on relevant Indian laws that protect the rights of potential trafficking victims.[4] They learned that police and state authorities provide models for their communities by enforcing laws against the exploitation of women and girls. In those districts, if a girl goes to the police to report being trafficked into a brothel, we can only hope that the police won’t send her back, but instead, shut down the brothel.
