USAID Impact Photo Credit: USAID and Partners

Archives for Cross-Cutting Programs

Bangladesh: Maternal Deaths Decline by 40 Percent in Less Than 10 Years

Bangladesh is on track to meet the 2015 deadline for U.N. Millennium Development Goal 5 (50 percent reduction in maternal deaths).   The Bangladesh Maternal Mortality and Health Service Survey [PDF] jointly funded by the Government of Bangladesh, USAID, Australian Aid (AusAID) and the United Nations Population Fund (UNFPA) found that maternal deaths in Bangladesh fell from 322 per 100,000 in 2001 to 194 in 2010, a 40 percent decline in 9 years.

The decline in direct obstetric deaths is most likely the consequence of better care seeking practices and improved access to and use of higher-level referral care.  The decline in total fertility rate due to the successful family planning program has reduced exposure to high risk pregnancies and has thus prevented a large number of maternal deaths.

USAID’s program in Bangladesh has historically been very strong in family planning through the world’s largest social marketing program for non-clinical contraceptive methods and through the public sector for long-acting permanent methods.  We can confidently say that our long and unwavering investments in family planning have had direct impact in lowering the total fertility rate, and thus the maternal mortality rate, in Bangladesh.  Over the past five years, USAID has also invested in scaling up active management of the third stage of labor to prevent postpartum hemorrhage in the public and NGO sector.

The USAID program has also long invested in promoting and providing antenatal care through the NGO sector which linked women to the health system thus contributing to increased awareness and care-seeking for obstetric complications. USAID and CDC’s long term commitment to the in depth training of local scientists has resulted in the creation of Bangladesh’s premiere research institute, the International Center for Diarrheal Disease and Research, Bangladesh (ICCDDRB) which has the capacity to effectively guide valid and reliable research efforts such as the 2010 Bangladesh Maternal Mortality and Health Care Survey (BMMS).

USAID supported and provided technical leadership in implementation of the 2001 and 2010 BMMS to monitor the performance of the overall maternal health program. Without these two surveys it would not be possible for Bangladesh to monitor its progress towards achieving the MDG 5 goal.

Amanda Glassman, Director of Global Health Policy and a research fellow at the Center for Global Development, wrote “the results are also a good reminder that investments in family planning and girls’ education drive much of maternal health outcomes, and that USAID investment in social marketing of family planning and health seems to be paying off in improved health (see blog post).”

The Bangladesh Ministry of Health and Family Welfare is scaling up emergency obstetric care and active management of the third stage of labor; the Ministry has also recently approved distribution of Misoprostol tablets to all pregnant women shortly after delivery to prevent postpartum hemorrhage. There is also increasing availability of Magnesium Sulphate for management of pre-eclampsia. The predominance of hemorrhage and eclampsia deaths and deaths after delivery indicate a need to strengthen access to treatment for these two conditions, improve referral systems, and improve referral level care.

Every year, USAID provides basic health care services to nearly 20 million Bangladeshis, including provision of low-cost, quality family planning services and maternal and child health care. With USAID and international support, under-five mortality rates have declined by more than 50 percent in Bangladesh since 1990. USAID has trained and mobilized community health workers to provide critical maternal and child health care to supplement broader health interventions and support country-level capacity. Bangladesh already received a country award from the United Nations for significant progress in reaching MDG 4 (reducing child mortality) during the MDG Summit in New York on September 19.

The Government of Bangladesh and the United States jointly rolled out President Obama’s Global Health Initiative in Bangladesh on November 23. GHI in Bangladesh will focus on providing quality services to reduce maternal and child mortality, resuscitate family planning programs, improve nutrition status among children under age five, and strengthen overall health systems over the next five years.

Unleashing the Power of Women and Girls

Women and girls are an extremely powerful force for development. A woman’s economic wellbeing is fundamental to her family, her community, her children, and her children’s children. Women are vital to economic growth, income generation, and security and stability. More than 70 percent of the farmers in Africa are women, often toiling on small plots to grow fruits, vegetables and grains for their families.

They are central to the household economy — they not only grow most of the food, they prepare it and serve it, and keep the house clean and take care of the children. Young girls are responsible for much of the labor families need to survive: tending livestock, carrying water, harvesting crops, watching younger children, and doing chores.

Increasing family incomes, fighting poverty, improving nutrition, and building the skill base needed to sustain development – teachers, doctors, nurses, accountants, engineers – all depend on investing in and providing opportunities for women and girls. When women do earn income, they are more likely than men to spend it on food, education, and health care for their families. They are a huge and growing part of the population in many developing countries: in Nigeria, girls and young woman under 30 years of age account for 35% of the population; in the United States they account for just 20%. And gender equality matters for development: evidence shows that the incidence of poverty tends to be lower and the rate of economic growth higher in countries with greater gender equality.

A woman voting in the 2005  Liberian elections. Photo Credit:©2010 Benjamin Spatz

And yet women and girls face huge systematic disadvantages and hurdles that undermine their own progress, and the progress of their families, communities, and countries. According to the path-breaking report Girls Count, girls and women are less educated, less healthy, and less free than their male counterparts. Many are forced to marry at a young age and are extraordinarily vulnerable to HIV, sexual violence, and physical exploitation. They typically cannot own land, get credit, or even apply for many jobs. Between one-quarter and one-half of girls become mothers before age 18, and 70% of the people in the world living in poverty are women and girls.

I’ve seen first-hand the power of creating opportunities for girls and women. As a Peace Corps teacher in an all-girls school in the tiny village of Leulumoega in Samoa, I saw how girls with a basic high school education could get good jobs, help provide for their families, and become leaders in their communities.

I’ve met young women working in garment factories in Indonesia and data-entry centers in Ghana that speak about the empowerment that comes from earning their own incomes, and how they are able to wait longer to be married, have fewer children, and take better care of their families. And I’ve seen close up how, when given the opportunity, a woman president – Ellen Johnson Sirleaf of Liberia – can lead her country from the brink of ruin at the end of a terrible civil war and regain peace, stability, credibility, and the beginnings of economic growth and vibrant democracy.

We can and must do better to support women and girls. That’s why through President Obama’s Feed the Future Initiative we are focusing on investments that provide new opportunities for women farmers and help improve nutrition for their families. That’s why our microfinance and SME programs emphasize creating new opportunities for women to earn incomes to support their families. That’s why the Quadrennial Diplomacy and Development Review and USAID Forward puts a huge emphasis on investing in women and girls, and incorporates gender equality into our core aid effectiveness principles. We know that to accelerate development and build strong, stable and well-governed societies, we must unleash the power of girls and women.

Administrator Shah Delivers a TED Talk on Leveraging Science and Technology in Development

Administrator Rajiv Shah delivering a TED Talk in Long Beach. Photo Credit: Dan Shine/USAIIn the world of science and technology, we crave for the new and the different.  Innovation is described as applied invention sometimes, but true innovation creates an emotion when you’re exposed to it.  It’s a combination of fascination and an urgent instinct to share what you’ve just experienced with others.

I just finished day one of the annual TED conference in Long Beach, and amongst the sharing of breakthroughs in quantum mechanics, the relationship between policy and emotion, and a virtual choir, the audience got a chance to hear from USAID Administrator Raj Shah.

He described how we are changing the way USAID approaches aid, highlighting innovations in healthcare delivery, mobile banking, and the prevention of HIV transmission.  He focused on how important leveraging these science and technology game-changers has become, and provided a strong vision for the future.

This is a tough crowd.  TED prides itself on showing us things not seen before.  From us, they saw USAID’s innovative vision and Raj’s passion, and from all the conversations and excitement that ignited following his talk, it’s clear they were intently excited and inspired about what they saw.  Just as importantly, millions more will have access to that vision when his talk makes it’s way to www.ted.com.

Addressing the World’s Greatest Development Challenges

As a career Foreign Service Officer, I’ve seen many international frameworks that try to address some of the world’s greatest development challenges. It’s a tricky balance to strike—ensuring the inclusion of viewpoints from the international partners we depend on, but not losing the needed focus at the expense of broad buy-in.

Susan Reichle, Assistant to the Administrator for USAID’s Bureau of Policy, Planning and Learning (far left) speaks at the Center for Strategic and International Studies. Photo credit: USAID

The Organization for Economic Co-operation and Development (OECD) recently released statebuilding guidance that achieves this fine balance. This guidance will help shape and improve the international community’s engagement with fragile states.

Over the past two years, USAID has been deeply involved in the development of this guidance. USAID worked closely with other OECD members to stress the important role that legitimacy plays in making governance more effective and less fragile. This idea was outlined in USAID’s 2005 “Fragile States Strategy” where concrete examples of what it means to be “legitimate” and “effective” were developed. USAID also helped the OECD to more clearly define the significance of gender roles and relations and place these at the core of how we improve state effectiveness

Yesterday, I had the opportunity to comment on the statebuilding guidance at a panel discussion hosted by the Center for Strategic and International Studies (CSIS). After presentations from the OECD’s Stephen Groff and CSIS’s Mark Quarterman, I became even more convinced that the guidance offers a critical framework to address fragile states, one that helps us avoid conflicting signals and wasted time when every minute counts.

Additionally, the statebuilding guidance reinforces many of the reforms we’re focused on through USAID Forward. It emphasizes the importance of evaluation, the imperative of working with local partners, and the opportunity of employing technologies like geographic information systems (GIS) to better connect and adapt our programs to changing conditions in the countries in which we work, especially in fragile states.

The statebuilding guidance also complements our broader U.S. foreign policy goals as outlined through the Presidential Policy Directive on Global Development (PPD) and the Quadrennial Diplomacy & Development Review (QDDR). As called for in the PPD, the guidance promotes a modern aid architecture in support of common objectives, and applies a unique approach and division of labor when working in conflict affected countries. Furthermore, the guidance contributes to the development of “standing guidance and an international operational response framework to provide crisis and conflict prevention and response,” called for in the QDDR.

I am pleased with the OECD’s timely work and proud that USAID was able to play an active role in its formulation.

USAID’s Battleground: Expanding Access and Strengthening Health Systems

Administrator Shah: “Our experience with GHI has made it clear: our largest opportunities to improve human health do not lie in optimizing services to the 20% of people in the developing world currently reached by health systems; they lie in extending our reach to the 80% who lack access to health facilities. That is where the success of everything I’ve discussed today will be determined.  That is our battleground.  And I am proud to say: that is where USAID will lead the fight.”

Today, in a packed auditorium at NIH, Administrator Shah outlined a global health agenda around five transformational goals.  Dr. Shah believes that we can achieve the following by 2016: save the lives of over 3 million children; prevent more than 12 million HIV infections, avert 700,000 malaria deaths, ensure nearly 200,000 pregnant women can safely give birth, prevent 54 million unintended pregnancies, and cure 2.4 million people infected with TB.  To achieve these ambitious goals, he emphasized the need to strengthen health systems by empowering community health workers and midwives by equipping them with better diagnostics and treatments.

As part of the President’s Global Health Initiative, USAID helps countries integrate their health systems across WHO’s six health system “building blocks” (human resources; medical supplies, vaccines, and technology; health financing; information; leadership and governance; and service delivery) and within their national infrastructure.  Recent activities included: strengthening health care financing in Armenia, Azerbaijan, Georgia, and Senegal through the use of national health accounts; helping nine countries implement human resource information systems; and instituting performance assessments to raise standards for HIV services in six Central American countries.

Engaging Presidential Management Fellows at USAID

Dr.  Shah recently met with a group of 75 Presidential Management Fellows (PMFs) and PMF alumni at USAID. The discussion focused on engaging the dynamic PMF community in the reforms associated with USAID Forward.

Presidential Management Fellow Class of 2008. Photo Credit: Harry Edwards/USAID

Notable guests at this event included Deborah Kennedy, the Director of Human Resources, and Ambassador Barry Wells, the Director of the Office of Civil Rights and Diversity. Deputy Assistant Administrators Mark Lopes and Barbara Feinstein, who started their careers as PMFs, were also in attendance. These senior leaders from across the agency offered advice and wisdom to the PMFs at USAID.

The Presidential Management Fellowship program is a prestigious two-year government fellowship that places recent graduate students in USG federal agencies. The PMF Program was established in 1977 to attract outstanding citizen-scholars to Federal service from a variety of academic disciplines and career paths who have an interest and commitment to excellence in the leadership and management of public policies and programs. The PMF Program is competitive and designed with a narrow focus: developing a cadre of government leaders. By drawing graduate students with a variety of backgrounds, the PMF Program provides a continuing source of trained men and women to meet the future challenges of public service. Students use this two-year fellowship as a stepping stone to highly visible and respected leadership positions in the Federal Government.

USAID, along with the State Department, is one of the most sought-after placements for PMFs, and PMFs at the agency are grateful for the opportunity to work here. The PMF community at USAID is a vibrant and dynamic group of young professionals and staff who are eager to be more deeply involved as leaders in agency reforms, such as those associated with USAID Forward.

Dr. Shah told the PMFs that we are at a unique point in time in the agency. He encouraged PMFs to be the voice of results-oriented thinking and learning, particularly around key USAID initiatives such as Feed the Future, Climate Change, and Global Health. As he said, “You can be the symbols of how we work in the future.” This was the first time Dr. Shah had met with the large PMF community at USAID, and he expressed an appreciation for the program as a tool for recruiting and retaining talent.

Many PMFs were inspired by Dr. Shah’s words: “You can be a part of the most significant transformation of a major bureaucracy in the most important area of how we as Americans express our values in the world.”

USAID’s Evaluation Policy: Setting the Standard

By: Ruth Levine, Deputy Assistant Administrator, Bureau of Policy, Planning and Learning

In a major address today, Dr. Shah will announce USAID’s new evaluation policy, evidence of the renewed emphasis the Agency is placing on evaluation, measuring and documenting program achievements and shortcomings, and generating data on what works to drive decision-making.

The policy marks a significant change from current practice, yet builds on the Agency’s long and innovative history with evaluation.  It seeks to redress the decline in the quantity and quality of USAID’s recent evaluation practice.

And it is my pleasure to offer you a sneak peek. Key points include:

1.       Defining impact evaluation and performance evaluation and requiring at least one performance evaluation for each major program and any untested and innovative interventions, and encouraging impact evaluation for each major development objective in a country program, especially for new or untested approaches and interventions:

2.       Calling for evaluation to be integrated into programs when they are designed;

3.       Requiring sufficient resources be dedicated to evaluation, estimated at approximately three percent of total program dollars;

4.       Requiring that evaluations use methods, whether qualitative or quantitative, that generate the highest quality evidence linked to the evaluation questions and that can reasonably be expected to be reproducible, yielding similar findings if applied by a different team of qualified evaluators;

5.       Building local capacity by including local evaluators on evaluation teams and supporting partner government and civil society capacity to undertake evaluations; and

6.       Insisting on transparency of findings with the presumption of full and active disclosure barring principled and rare exceptions.

This policy – which you will find here – sets a new standard for evaluation practice. Thank you to those who informed its development. Watch this space for updates on how the Agency implements its renewed commitment to evaluation.

Secretary Clinton Holds Town Hall Meeting at USAID on the QDDR

On Friday, Secretary Clinton and USAID Administrator Rajiv Shah spoke on the First Quadrennial Diplomacy and Development Review (QDDR), “Leading Through Civilian Power,” at a town hall meeting at the U.S. Agency for International Development (USAID). Here is the webcast in case you missed it.

Leading Through Civilian Power

After months of effort and meaningful discussions, today I was happy to join Secretary Clinton to unveil the first ever Quadrennial Diplomacy and Development Review (QDDR) at a State Department town hall.

Complementing the Presidential Policy Directive on development that was released earlier this year, the QDDR helps make real the commitment the Secretary has shown to creating a modern, efficient diplomatic and development architecture.

For USAID, the QDDR provides an opportunity for this Agency to demonstrate its capabilities, elevating the role development plays in our nation’s foreign policy while empowering us to be inclusive leaders. It affirms USAID mission directors as the top development advisers in U.S. embassies and grants USAID the hiring authority to attract and recruit top talent. It also recognizes USAID as the lead agency in charge of President Obama’s chief development initiative, Feed the Future, and positions us to lead the Global Health Initiative by the end of FY 2012.

Critically, the QDDR endorses the suite of reforms we began earlier this year—USAID Forward—recognizing this Agency’s need to develop new systems and capacities to deliver against these new opportunities. We will continue to streamline our work and cut red-tape, transforming our Agency into a modern, efficient development enterprise. But we also must renew our engagement with our interagency partners in a spirit of inclusive leadership and cooperation, and focus thoughtfully, aggressively, and primarily on delivering results for those we serve.

We should keep in mind that in the end, success for this Agency and the people we serve will not be delivered in a directive or a document, no matter how powerful or carefully crafted. Our success will be determined by the hard work and enlightened leadership we show. The QDDR has provided us a blueprint to effectively channel our efforts, but it is only as powerful as we make it.

Celebrating International Volunteer Day

USAID has partnered with the American people to leverage the skills of professional volunteers in meeting pressing development challenges in health, food security, climate change, economic growth and education.  In celebration of International Volunteer Day, we are proud to highlight a few of the great volunteers supported by the USAID’s Volunteers for Prosperity program who volunteer their time and skills to meet some of these development challenges.

In 1985, The United Nations General Assembly established International Volunteer Day with the hopes of highlighting the tremendous contributions that volunteers make worldwide.  Since then, governments, the UN system and civil society organizations have joined together around the world to celebrate the work of volunteers on December 5th.   This year, the UN Volunteers program has made volunteering for one or more of the Millennium Development Goals its theme.

The Volunteers for Prosperity program is focused on encouraging international voluntary service by highly skilled American professionals and partnering with U.S. based NGOs who have active volunteer programs abroad.   The Volunteers for Prosperity Service Incentive program supports skilled volunteers through a competitive matching grants process.    We are partnering with the IBM Corporation to launch an International Corporate Volunteer Program which intends to expand the number of companies and volunteers assisting in developing countries. Additionally, the Volunteers for Prosperity website serves as a clearing house whereby volunteers and volunteer organizations can connect.   To find out more about the program visit the new Volunteers for Prosperity website at www.volunteersforprosperity.gov.

Volunteers can have a profound impact on development and we are committed to finding innovative ways to incorporate the use of volunteer resources into the design and implementation of development programming.

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