USAID Impact Photo Credit: USAID and Partners

Archives for Africa

It’s All In the Evidence: Water Challenge Demonstrates the Power of Doing Development Differently

Five years ago, USAID and the Swedish International Development Cooperation Agency came together at World Water Week in Stockholm, Sweden, to ask a crucial question: How can we grow more food with less water while supporting small farms?

Sustainable agriculture was, and remains, an important part of the answer. According to our Agency’s own findings, agriculture accounts for 70 percent of the world’s fresh water use. By 2025, two-thirds of the world’s population could be without enough fresh water to meet basic needs – such as hygiene, growing food and having enough to drink.

To combat this urgent problem, our two countries, along with the Foreign Ministry of the Kingdom of the Netherlands and the South African Department of Science and Technology, launched an experimental program to provide inventors and innovators working to improve water use in farming with resources and expertise to refine and test their inventions, reach more farmers and develop financially sustainable businesses.

Securing Water For Food: A Grand Challenge for Development (SWFF) — one of USAID’s 10 Grand Challenges — was that program. Two months ago, we returned to World Water Week – a conference teeming with the experts, academics, development practitioners, innovators and governments that could put lessons into practice – to share findings from this effort I helped lead.

I am always asking how do we transform the development enterprise by doing things faster, smarter and better? One way is sharing lessons learned. And, sharing lessons learned is built into the DNA of SWFF.

A panorama of an auditorium, looking from the rear toward the stage

SWFF Innovator in Panel Presentation at 2018 Stockholm World Water Week. / Benjamin Arthur

SWFF has exceeded the expected outcomes envisioned when the program was created. Innovators have reached a combined 6.25 million smallholder farmers, their families and other customers. For every $1,000 of donor funding spent, innovators impacted 267 customers and end users, produced 267 tons of crops, reduced water consumption by more than 810,000 liters, improved water management on 93 hectares of agricultural land, and generated more than $226 in sales. Through the program, many SWFF innovators have become gender champions, implementing strategies that promote the participation and leadership of women by actively looking for ways to design their projects in a gender inclusive way.

USAID’s team hosted a session covering topics such as how to build momentum among innovators, the timing of funding, promoting women’s participation and the importance of local knowledge and context. Innovators supported by SWFF came from across Africa, Asia, the United States and Europe to speak about their challenges and successes.

Two men smiling and laughing

SWFF Innovators Gabrielle Okello, Green Heat and Bacelar Muneme, FutureWater ThirdEye Mozambique at the Unconference in Stockholm. / Benjamin Arthur

Fauzia Hirome, a farmer from Uganda, talked about using the GreenHeat system to turn organic waste into renewable energy. The system has saved Fauzia time and water while helping her grow more crops – all while making enough money to send her kids to school.

And Nompendulo Mgwali came from South Africa, where the Meat Naturally program has helped cattle ranchers adopt sustainable practices, while also helping local women get jobs as eco-rangers. Not only did Nompendulo start making enough money with Meat Naturally to leave a government assistance program, she became a full-time employee of a for-profit company that Meat Naturally played a role in creating.

A woman speaks at a podium

Fauzia Hirome, a farmer from Uganda, shares details at the SWFF panel session at Stockholm World Water Week about how GreenHeat, a SWFF innovation, has impacted her life and economic livelihood. / Benjamin Arthur

While SWFF has wrought many successes, were always trying to improve and learn.

Outside investment provides our innovators with the capital they need to be sustainable and grow, and not all SWFF innovators have been able to get the investment they need to grow to sustainable scale. Additionally, SWFF is focusing on opportunities to involve the private sector in development work. Many companies, from Pepsi to IKEA to H&M, need water to make their products, prompting them to create their own development goals – some even more ambitious than those created by governments.

A man speaks at a podium

Ku McMahan, SWFF Team Lead, provides innovator data and results at the SWFF panel session at Stockholm World Water Week. / Benjamin Arthur

No matter who we work with, SWFF will always focus on improving lives as farmers are now taking what they’ve learned from us and are using it in their daily lives in different ways.


Ku McMahan, is the team lead for Securing Water for Food Grand Challenge for Development, LAB/CDI

Temperature Check: Border Screening of Travelers Key to Stopping Ebola from Spreading

A person wearing a protection suit

A health worker dons personal protective equipment. / Alma Golden, USAID

With confirmation of the Democratic Republic of Congo’s 10th outbreak of the Ebola virus in North Kivu and Ituri provinces, health officials have focused on border screening as a method to identify travelers who could pose a danger to local communities.

Recently, I traveled to the border between the DRC and Uganda with U.S. Centers for Disease Control and Prevention (CDC) Director Dr. Robert Redfield and U.S. Ambassador to Uganda Deborah Malac to see border health screening and surveillance efforts at two key checkpoints.

The border between Uganda and DRC is porous. Several times a week, small-scale traders, mostly women, ferry goods and food across the border by bicycle, cart or on their heads. In addition to traders, local farmers, merchants, business people and refugees move through the area.

At Busunga, a border crossing in western Uganda, the shallow Lamia River acts as a physical barrier between the two countries. People wade across the river by foot, while others do laundry, wash their motorbikes and take baths in the river that flows from the nearby Rwenzori Mountain Range. On market days there, Wednesdays in Uganda, almost 500 people are screened for Ebola.

A woman in a red medical vest greets USAID officials

USAID Senior Deputy Assistant Administrator for Global Health Alma Golden receives information about Ebola at a border crossing between the Democratic Republic of Congo and Uganda. / Courtesy Photo

There are another 16 informal crossing points nearby. At the busiest border crossing point, Mpwonde to the south, more than 12,500 travelers pass through each day. And on Tuesdays and Fridays, which are market days at Mpwonde, there can be a fivefold increase in travelers and shoppers.

Early identification, confirmation and isolation of possible Ebola cases is critical for stopping the outbreak as early as possible. Ugandan Red Cross Society volunteers are screening travelers at all border crossings. Volunteers have been trained on the signs and symptoms of Ebola and are equipped with tools for screening.

Health screening procedures include hand washing with chlorinated water and soap, and a temperature check of travelers using a thermoscan thermometer that can detect a fever in seconds. Those who are screened are given simple, illustrated brochures that provide information about the symptoms of Ebola and how to prevent the spread of the virus.

People with Ebola can have symptoms similar to those with malaria and other endemic infectious diseases, including typhoid and Rift Valley fever. Ebola spreads from an infected sick person to others when there is direct contact with bodily fluids.

Travelers suspected to have Ebola symptoms are referred to Bwera hospital for further assessment; ambulances are available to transport individuals with symptoms to an isolation unit until tests are completed. Health workers have been given protective gloves, gowns, masks and other equipment provided by WHO to reduce the chances of contact with the Ebola virus.

Border screening is just one important element of the complex response to this crisis.

In Uganda’s neighbor, the Democratic Republic of the Congo, the U.S. Government, through USAID, is supporting core interventions to control the spread of Ebola, including: disease surveillance, contact-tracing, triage and isolation, and case management in Ebola treatment units; the prevention and control of infection; diagnostic laboratory support; community engagement; risk communication; interventions in water, sanitation and hygiene; and safe and dignified burial activities.

In DRC, through trusted messengers, community leaders and radio, communities are quickly learning how to protect themselves by learning the basics of the disease, how it is transmitted and what they can do to prevent it, care for and transport the sick, and to safely bury the dead. A targeted vaccination campaign is underway and is initially following a ring vaccination protocol: vaccines are being given to frontline health-care workers and response teams, contacts of confirmed cases, and contacts of those contacts.

The U.S. Government is also providing expertise and supplies. CDC and USAID have deployed over a dozen technical experts to the region in support the response. And USAID supported the World Health Organization (WHO) to send 20,000 personal protection equipment kits (including full body coveralls, heavy duty gloves, and goggles) and 50,000 universal care kits (surgical masks, face shields and gloves, and disinfection materials) to support response efforts in the DRC provinces affected by Ebola.

The Congolese and Ugandans have demonstrated a strong capacity to manage outbreaks. However, never before has Ebola struck in an area quite like this one. The region suffers from chronic insecurity due to local militia groups, and is under a long-term humanitarian crisis, which limits international and national responders from fully deploying disease control measures.

USAID has a long history of engagement in the health sector in the DRC, having worked to improve maternal and child health, immunizations, HIV diagnosis and treatment, and the prevention and management of malaria and tuberculosis.

Map of ebola cases in Democratic Republic of Congo

Map shows the Ebola outbreak in the Democratic Republic of the Congo as of Sept. 5, 2018. Latest figures from the World Health Organization indicate deaths have risen to 92, and confirmed or probable cases are now at 137.

The clinics, health workers, laboratories and health systems supported through USAID funding in both Uganda and the DRC provide the backbone of the response to the current outbreak. The DRC national laboratory, with supports from USAID and other donors, rapidly sequenced the virus, and provided critical laboratory capacity in the field to diagnose the disease at the site of the outbreak. The Ministry of Health is providing essential leadership, coordinating the response in the provinces and nationally.

My visit to the DRC and Uganda was enlightening. I am impressed by the dedication, determination and skill of our partners in the ministries of health and the countless epidemiologists, clinicians, logisticians, social mobilizers, vaccinators and volunteers working to stop the outbreak.


Alma Golden is Senior Deputy Assistant Administrator for Global Health at USAID.

The Hidden Costs of Fistula Repair Surgery

Close up portrait of an African woman

Edisa looks forward to her future free of fistula. / Fistula Care Plus

A few months after becoming pregnant with her first child, Edisa’s husband unexpectedly passed away. In need of transportation to reach the closest health facility, and without family nearby, Edisa went into labor at home.

Friends and neighbors contributed money for her transportation to a local hospital, but without enough money for treatment, she labored without medical attention for two days. On Edisa’s third day at the hospital, the staff finally attended her. The child did not survive the prolonged labor.

Edisa returned to her community without a baby, but with a devastating obstetric fistula—an injury caused by prolonged labor and results in a hole between the birth canal and one or more of a woman’s internal organs. The outcome is chronic, uncontrollable leakage of urine and/or feces.

While Edisa was recovering, a neighbor told her that she, too, had the problem of leaking urine after giving birth. She encouraged Edisa to visit Kitovu Hospital, a facility that provides fistula repair surgeries through USAID-supported hospital in Uganda.

Again, Edisa found herself unable to access the care she needed due to financial constraints. Borrowing from friends, Edisa collected enough money for transportation to the hospital located 11 hours away from her home. In Uganda, women can spend up to $25 on one-way transportation costs for two people to a fistula repair facility.

After receiving fistula repair surgery the USAID-supported hospital, Edisa is now completely healed and looking forward to her future. But for the more than 2 million women in sub-Saharan Africa and Asia that are estimated to be living with fistula, the costs of care can be insurmountable, leaving them to go untreated.

Despite increased availability of often free fistula repair in Uganda, women like Edisa can still lack access to this critical treatment.

Because of the factors that can result in an obstetric fistula, including difficulties with transportation to health facilities and lack of quality health services, this injury has a greater impact on women living in poverty. Women living with fistula typically live in impoverished, remote settings with limited access to facilities that provide fistula surgeries.

A group of African women

Women at a USAID-supported fistula repair clinic. / Fistula Care Plus

A recently published USAID-supported research study sought to better understand the barriers women face when seeking fistula care. From June to December 2015, a research team conducted interviews and focus groups in Nigeria and Uganda with women affected by fistula, women’s families and spouses, and fistula care health providers

The study found that women face financial barriers when seeking fistula repair surgery, including loss of income and transportation expenses. In addition to direct medical expenses for fistula care, women also face the costs for food and water during their recovery period at the facility as well as costs to hire child care or employees to manage their businesses.

Pooja Sripad, study co-author and associate at Population Council, says that the research team sought to look at the cost and transport involved in fistula repair “more holistically.” She further explained the research team’s surprise at the wide range of barriers reported and how these barriers limit women’s “own agency to seek treatment.”

Due to the complex nature of fistulas and poor quality of care, women often have to receive multiple surgeries and visit different surgical facilities. That also increases transportation and surgical costs.

Mothers waiting in a clinic in Nigeria.

Mothers waiting in a clinic in Nigeria. / USAID

Dr. Mark Shrime, director of the Center for Global Surgery Evaluation at the Massachusetts Eye and Ear Infirmary and Harvard Medical School, says that the results are “yet another example in a growing body of literature showing that the ‘non-medical’ costs of care—things like transportation, food and lodging—are huge sources of catastrophic expense for surgical patients. Most of our health policies, if they look at financial risk at all and most don’t look only at the risk patients face when getting the surgery itself, but this paper demonstrates how ‘free’ surgery is rarely actually free.”

“The implications are pretty evident,” he added, “to deliver truly equitable, quality surgical care, we need to broaden our definition of ‘health’ to include the financial state we leave patients in after we’re done treating them.”

USAID is using this study to improve care for women with fistula. In Nigeria and Uganda, USAID has piloted a groundbreaking intervention that addresses these barriers and will transform how women like Edisa access care.

Women at Kyenjojo Hospital, Uganda.

Women at Kyenjojo Hospital, Uganda. / Amy Fowler, USAID

After enduring six months of leaking and leg pain, Edisa is taking control of her life, empowering other women to seek treatment through interventions like those provided by USAID that address the central barriers to seeking fistula repair surgery.

Before departing for Kitovu Hospital, women in her village who also suffer from fistula were hesitant to seek treatment. For many women with fistula, the emotional costs of returning home without relief is yet another hidden cost of fistula repair.

“They told me that if I got cured, that they would also come. Now, they will come,” says Edisa.

Since 2004, more than 50,000 fistula repair surgeries have been made possible all over the world through Fistula Care Plus Project and other USAID-supported fistula care projects.


Bianca Devoto is an intern in USAID’s Office of Population & Reproductive Health supporting USAID’s management team for the Fistula Care Plus project.

Witnessing Hope and Health for Kenyan Orphans and Vulnerable Children

An outdoor playground

Among its many features, COGRI’s sister facility, Nyumbani, includes a playground for children who are at risk, or vulnerable to, HIV.

We were late. Very late. Morning meetings ran over, office tasks required urgent attention and Nairobi’s infamous traffic led to a delayed arrival at the nondescript metal gate outside the clinic in Kawangware, an informal settlement in need of social amenities.

As we hastened our pace to the small administration office, the staff graciously ignored our tardiness and warmly welcomed us to the Lea Toto Clinic operated by the Children of God Relief Institute (COGRI), a non-profit organization dedicated to caring for children and adolescents who have been orphaned from, or are vulnerable to, HIV, and who live in six of Nairobi’s poorest informal settlements. Lea Toto means “to bring up the child” in Kiswahili.

Upon arrival, our hosts handed us a summary on the history of Lea Toto and the Kawangware facility’s impressive pediatric and adolescent accomplishments supported by USAID through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR.

PEPFAR funding helps COGRI staff manage the facility and evaluate the project’s aim—to deliver high quality, high impact pediatric and adolescent HIV care.

Soon an elderly and vivacious Irish nun walked in and quickly introduced herself as Sister Mary Owens, the executive director of COGRI. Sister Mary provided an impassioned explanation of the holistic care COGRI has provided for hundreds of young Kenyans over the past 25-plus years, including: psychosocial support groups, referrals for child victims of gender-based violence, case management, schooling, housing and medical care.

A woman stands outside, next to a carved sign in the middle of a fountain surrounded by rocks.

Sister Mary Owens, COGRI’s Executive Director, has devoted her life to caring for children and adolescents who have been orphaned from, or are vulnerable to, HIV.

Embedded in her introduction was deep hope and advocacy: advocacy for children receiving the medical treatment they need and deserve, and hope that one day soon no Kenyan child will be infected with HIV in utero or during breastfeeding.

There are an estimated 1.6 million people in Kenya living with HIV, of which 120,000 are children ranging from infants up to 14 years old, according to the 2016 estimates from UNAIDS.

Kawangware clinic’s sole physician, Dr. Caroline*, told us that of the 377 children and adolescents who were currently receiving HIV care at the facility, 73 percent have achieved viral suppression, which happens when a patient is correctly taking an adequate treatment regimen. That percentage is notably higher than Kenya’s current average pediatric viral suppression rate of 65 percent and is attributed to USAID’s ongoing commitment to eliminate HIV in Kenya.

Still, there are challenges.

A few children here are not yet virally suppressed due to barriers that far too many children and adolescents face: food insecurity resulting in difficulty tolerating HIV treatment, absence of a consistent caregiver to administer the necessary daily medication and provide support and accountability, and lack of transport fare, making it nearly impossible to return to collect medications.

There are no easy solutions. Nonetheless, the Kawangware staff persist in trying to find ways to better support their patients, to ensure each child and adolescent achieves a healthy, happy life.

One of these young people was only 12 years old when he was brought to Lea Toto by his grandmother. He was in declining health with no improvement in sight, a state common among children and adolescents living with untreated HIV.

Upon arrival to Lea Toto, the young man was immediately initiated on ART. His treatment, coupled with strong psychosocial support including peer mentoring, enabled him to regain health and confidence. Through COGRI’s unwavering dedication to this patient’s health and education, the now 23-year-old young man proudly holds a certificate in graphic and web design and has successfully started his own shoe business.

Kawangware also operates Nyumbani, a sister facility that is home to COGRI’s state-of-the-art laboratory and is one of a select number of sites in Kenya performing HIV drug-resistance testing. The lab also provides fee-based laboratory services to external facilities for both HIV- and non-HIV-related conditions to fund its operations.

Exterior of a blue buuilding

COGRI’s sister facility, Nyumbani, is dedicated to caring for children and adolescents who have been orphaned from, or are vulnerable to, HIV.

It was easy to forget the dire situations many COGRI beneficiaries face as we wandered through the immaculate grounds and observed the contagious joy coming from several young children as they were laughing, playing and learning.

It was during our Nyumbani visit that Sister Mary shared stories from the early 1990s, a time when the only HIV medications available were inconsistent drug donations from overseas, necessitating numerous medication regimen changes for each child.

While the piecemeal approach was far from today’s standard of care, the children were receiving treatment that many people living with HIV in Africa did not have access to at that time. The devotion of Sister Mary and the Kawangware and Nyumbani clinic staff, coupled with the tremendous progress made thus far through USAID and PEPFAR support, brings Kenya closer to halting the HIV pediatric epidemic, granting a brighter future for all Kenyan children.

*Full name withheld to protect privacy.