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Leveraging Data and Evidence to Drive Decision Making at USAID

A young girl outside a schoolhouse in Ethiopia. / Susan Liebold, USAID

A young girl outside a schoolhouse in Ethiopia. / Susan Liebold, USAID

Over the past five years, USAID has made significant progress in using evaluations and open data to effectively drive budget, policy and management decisions.

Last month, our progress in the areas of evaluation and open data were recognized by both non-governmental and governmental stakeholders: The Federal Invest in What Works Index, released by the bipartisan nonprofit organization Results for America, and the Office of Management and Budget’s Project Open Data Dashboard, both rated USAID highly.

Using Evaluations for Evidence-Based Decision Making

In Results for America’s annual Federal Invest in What Works Index — which describes how key U.S. Government agencies and departments use data and evidence to drive budget, policy and management decisions — USAID ranked second among rated U.S. Government agencies. The Agency performed particularly well in criteria related to use of data, resources dedicated to evaluation, and innovation.

Since the release of USAID’s Evaluation Policy in 2011, the Agency has made an ambitious commitment to invest in evaluation practices that value independent judgement, high-quality methods and evidence-based findings to determine what is and is not working in USAID programs. These evaluations help explain why a program is succeeding or failing, and can provide evidence and recommendations for how best to improve performance.

As a result of this new policy, the number of independent evaluations has increased from an annual average of about 130 to an annual average of about 230. In addition, independent studies have found that the quality and use of USAID evaluations have also improved.

One independent study on use of evaluations at USAID found that 93 percent of evaluations have been used in some capacity, most frequently in project design and implementation as well as strategy and policy formulation.

At the country level, 59 percent of approved Country Development Cooperation Strategies referenced findings from USAID evaluations, and 71 percent of respondents reported that evaluations had been used to design and/or modify a USAID project or activity.

These evaluations have proven invaluable. For example, after USAID shared its evaluation findings with the Government of Ethiopia, the government made HIV testing for highly vulnerable children a priority and revised its National Guidelines for Comprehensive HIV Prevention in 2014

In Mozambique, findings from a USAID impact evaluation of an education program led to the Government of Mozambique’s request to expand the program from 180 schools to an additional 538 schools — improving literacy for 109,021 more students.

A community health worker in Haiti uses mobile technology during her home health care visits. / Ketcia Orilius, USAID

A community health worker in Haiti uses mobile technology during her home health care visits. / Ketcia Orilius, USAID

Expanding Public Access to Data

In the Office of Management and Budget’s Project Open Data Dashboard, the Agency scored highest in all categories and was given “best practice” recognition for having appointed a Chief Data Officer and data stewards throughout the Agency to coordinate its open data work.

Updated quarterly, the Project Open Data Dashboard shows the metrics and progress made by U.S. Government agencies to meet their milestones as they work toward implementation of the Open Data Policy—Managing Information as an Asset directive.

These public acknowledgements validate USAID’s progress in pushing for greater transparency, accountability and evidence following the Open Data Executive Order and other transparency directives from the White House

We are working hard to meet these requirements to contribute to the goal of ensuring that government is transparent, accountable, participatory and collaborative; we believe that it is important to make information resources accessible, discoverable and usable by the public.

USAID’s open data policy provides a framework for systematically collecting Agency-funded data in a central repository, documenting the data to make it easy to locate and use, and making the data available to the general public, while ensuring rigorous protections for privacy and security.

Under this policy last year, the Agency began regularly releasing data about USAID-funded programs to the public for the first time in the organization’s history. Thanks to these efforts, OMB recognized USAID’s open data policy as a “model of best practices.”

The CIO Council, the principal interagency forum on federal agency practices for IT management, has also featured USAID’s forward-leaning open data practices in a case study on innovation. It cites USAID’s progress in including “data submission requirements into its awards,” which has created a steady stream of data to USAID, “which in turn is released to the public.”

We recognize that open data is a powerful tool for collaboration. For example, through a partnership with the National Geospatial Intelligence Agency, USAID’s GeoCenter takes advantage of open data in the form of high-resolution satellite imagery to improve the effectiveness and efficiency of USAID’s development programs.

The satellite imagery serves as a basis for creating new geospatial data in unmapped parts of the world, enhancing USAID’s ability to improve health outcomes, strengthen food security programming and monitor land use change.

Moving Forward

The Agency has made significant progress in establishing a strong framework for open data and evaluation practices, but our work is not yet done.

USAID will continue to build on its evaluation practices, strengthening the capacity of staff and our partners to better integrate evaluative thinking throughout the planning and managing of development programs, as well as expanding tools and partnerships for evaluation.

Additionally, we will continue to refine our transparency policies and practices, emphasizing a responsible approach to data management that balances our commitment to openness with our commitment to mitigating risk in the vulnerable communities we serve.

We will continue to invest in a more robust Development Data Library, designed to provide the general public with timely access to high-quality, USAID-funded data. We remain committed to ensuring that our transparency efforts also include feedback loops, such as the input we are currently seeking on obtaining informed consent in an era of increased data transparency.

Ultimately, we will continue to promote an organizational culture at USAID that emphasizes learning and adapting and that encourages staff to seek out evidence and data to inform decision-making.

ABOUT THE AUTHOR

Negar Akhavi is Acting Director of the Office of Learning, Evaluation and Research in USAID’s Bureau for Policy, Planning and Learning. Brandon Pustejovsky is USAID’s Chief Data Officer.

Leveraging Markets for Global Health

An analyst at the National Quality Control Laboratory in Kenya conducts a test on a pharmaceutical sample. / Tobin Jones, Chemonics

An analyst at the National Quality Control Laboratory in Kenya conducts a test on a pharmaceutical sample. / Tobin Jones, Chemonics

Innovations are critical to help the international development community achieve goals in the fight against malaria, HIV and other global health challenges.

New products, like a household insecticide that kills malaria-carrying mosquitoes in areas where older sprays no longer work, can protect some 50 million people from malaria over four years.

And lower-dose antiretroviral medications could dramatically lower HIV treatments costs, while shrinking pill size and reducing side effects.

But inventing these new products is not enough.

Efficient markets need to motivate suppliers to manufacture, wholesalers to distribute, and retailers to sell.

Donors, national governments, advocates and other global health stakeholders can play an important role in identifying and seizing market-shaping opportunities to maximize market forces for global health goals.

“With so many breakthroughs, we’re spoiled in the HIV world, and there is a groundswell of support for these new drugs,” said Francois Venter, the deputy executive director of the South African research organization Wits Reproductive Health and HIV Institute, which is overseeing a critical clinical trial for new antiretrovirals.

“But these products won’t deliver themselves, and we need everyone working together to succeed,” he said.

A member of a local malaria control team in Ethiopia gets ready to apply indoor residual spray. Brant Stewart, RTI/Courtesy of PMI

A member of a local malaria control team in Ethiopia gets ready to apply indoor residual spray. Brant Stewart, RTI/Courtesy of PMI

Unrolling New Insecticide Sprays

In February, UNITAID and Innovative Vector Control Consortium launched a market-shaping partnership with the President’s Malaria Initiative (PMI), USAID’s Center for Accelerating Innovation and Impact, PATH, Abt Associates and the Global Fund to stimulate development of and facilitate access to new insecticides for malaria control.

The $65 million Next Generation Indoor Residual Spray Project uses a co-payment program to lower the cost of novel, long-lasting residual sprays while strengthening demand forecasting and fostering competition to keep prices affordable over the long term.

By supporting the use of these new sprays in 13 African countries, PMI and the Indoor Spray Project protect communities from malaria where older insecticides are largely ineffective due to increasing resistance in mosquitoes.

At the same time, broader use of new sprays expands the market and builds a business case for prospective suppliers.

A malaria control team heads out to a rural village in Kenya to provide indoor residual spray services. / Brant Stewart, RTI/Courtesy of PMI

A malaria control team heads out to a rural village in Kenya to provide indoor residual spray services. / Brant Stewart, RTI/Courtesy of PMI

Marketing Low-Dose HIV Treatment

In the HIV space, treatment programs have long used antiretroviral therapy, but transitioning to new drugs will still require a complex rollout: registering new products, training providers on new regimens, and phasing out older drugs.

Each of these steps compounds uncertainty around the size and timing of demand, and this uncertainty hampers the ability of suppliers to invest in adequate production for low-income markets.

Given these challenges, global health experts need to be proactive in analyzing how to encourage a competitive market that meets demand at affordable and sustainable prices.

To further this effort, the U.S. President’s Emergency Plan for AIDS Relief, USAID’s Office of HIV and AIDS and the Center for Accelerating Innovation and Impact are supporting the OPTIMIZE project, which is charged with bringing new antiretroviral drugs to market.

Led by the Wits Reproductive Health and HIV Institute, this innovative consortium brings together an unusually diverse set of partners to draw on expertise in clinical research, market access, and advocate engagement.

Collaboration is a cornerstone of any market-shaping intervention, and the OPTIMIZE consortium will work with partners on reducing manufacturing costs, accelerating product registrations in developing countries, and facilitating production planning with more demand visibility.

From insecticide sprays to new HIV treatments, USAID’s Center for Accelerating Innovation and Impact leverages USAID’s financing, technical expertise and convening power to shape markets where needed.

For these and other health areas, we hope to forge partnerships on both the demand and supply side to help inefficient markets operate more effectively, get better value for money for our investments, and — most importantly — accelerate access to lifesaving innovations and health impact.

This post is part of the #MarketsMatter blog series.

ABOUT THE AUTHOR

Wendy Taylor is the director of USAID’s Center for Accelerating Innovation and Impact, and Amy Lin is a senior market access advisor at the center. Follow them at @wtaylor1 and @amyhlin.

5 Things USAID’s Land Office Has Learned about Impact Evaluations

Laida Phiri proudly displays her customary land certificate on her parcel of land in eastern Zambia. USAID is conducting a randomized control trial impact evaluation to measure the effect of securing property rights on the adoption of climate-smart agricultural practices. / Jeremy Green, The Cloudburst Group

Laida Phiri proudly displays her customary land certificate on her parcel of land in eastern Zambia. USAID is conducting a randomized control trial impact evaluation to measure the effect of securing property rights on the adoption of climate-smart agricultural practices. / Jeremy Green, The Cloudburst Group

At an event marking five years since the release of USAID’s Evaluation Policy, USAID Administrator Gayle Smith noted, “Development is aspirational, but it’s also a discipline.” I couldn’t agree more.

As a researcher and practitioner, I approach development with a scientist’s eye: I draw on the best available evidence and carefully measure the impact of our programs to better serve our beneficiaries and maximize our limited funds. Together, let’s examine how USAID’s Land Office is learning from our experience and investing in rigorous impact evaluations in partnership with local stakeholders.

But aren’t impact evaluations difficult and expensive? Don’t they take years to show results? Is it ethical to “withhold” benefits from people in order to run a scientific experiment? I hear these questions often. For the past three years, I have managed a portfolio of eight land and resource governance impact evaluations across sub-Saharan Africa. Here are some common misconceptions and lessons I have learned from one impact evaluation in Zambia:

In eastern Zambia, community members water plants at a nursery that is part of a USAID-supported agroforestry program. USAID is conducting a rigorous impact evaluation to determine whether clarifying and certifying customary land rights in this community will lead to farmers planting more fertilizer trees. / Jeremy Green, The Cloudburst Group

In eastern Zambia, community members water plants at a nursery that is part of a USAID-supported agroforestry program. USAID is conducting a rigorous impact evaluation to determine whether clarifying and certifying customary land rights in this community will lead to farmers planting more fertilizer trees. / Jeremy Green, The Cloudburst Group

Myth #1: Impact evaluations are too expensive.

Although impact evaluations do cost more than the typical performance evaluation, when you consider that a rigorous impact evaluation could significantly improve the results of a $15 million project and also inform USAID’s global portfolio and the sector at large, then investing $500,000 to $1 million on a land sector impact evaluation becomes more cost-effective in the long run.

There are also cost savings that start at the baseline — even before the program starts. In Zambia, our program implementer used the baseline evaluation data to develop village summaries with statistics on landholdings, population, livelihoods and land conflicts. These village summaries helped staff better understand the local context and how to target their assistance — essentially, the evaluation baseline provided a detailed needs assessment.

Myth #2: Impact evaluations take too long.

It is true that from baseline to endline, traditional impact evaluations often take years to complete. In my sector, changes in governance happen slowly, but we can actually already learn a lot from the baseline, even before the program starts.

We are using our baseline data in Zambia to test our underlying program assumptions in real time. For example, we found that despite not having documentation of their land rights, farmers feel their rights are fairly secure from expropriation. We also find farmers tend to invest less in labor-intensive practices, like live fencing, on fields where they feel their rights are less secure. We are sharing these findings with our colleagues and partners and using them to adapt our theories of change.

Myth #3: Randomization isn’t realistic.

Impact evaluations compare two groups over time: one that gets the intervention (treatment) and another that does not (control). USAID uses a number of impact evaluation designs to identify these groups; while randomized control trials are the most rigorous, there are other options as well. In 2013, I stood before four chiefs in eastern Zambia to explain impact evaluations and why USAID wanted their permission to use a “lottery” to decide which villages we would support.

I knew this was going to be a tough sell, but the chiefs agreed that randomized selection was the fairest way to select who receives benefits from our limited resources. Randomization doesn’t work for everything, but it can work, even with complex governance programs.

Myth #4: Impact evaluations aren’t fair.

Last month, I met with those same four chiefs in Zambia to review our progress. They are eager to register land rights in the control villages because they think this helps reduce land conflicts. While this is an outcome we hope to achieve, we do not yet have conclusive evidence that conflicts have been reduced, or that it was our program that led to this effect. To truly help, we must first understand that our approach works before we scale up, and the chiefs agreed to wait until 2018, after the endline, to work in the control villages.

Myth #5: USAID can’t be involved in evaluating our own programs.

Independent evaluations increase accountability and avoid bias. But USAID staff (and our implementing partners) can (and should!) be involved to leverage the diverse expertise necessary for a good impact evaluation design.

At USAID, we also need to facilitate coordination across programming and evaluation. When implementation and evaluation objectives do not align, we (USAID) need to help find the best solution. When our impact evaluation in Zambia reached an impasse on the right level (chiefdom/ village/ household) for randomizing land registration, I helped reach consensus that it should be at the village level, since village headmen traditionally allocate land rights.

This kind of coordination and technical guidance requires more work than “outsourcing” the evaluation, but it also helps ensure we find the right balance between learning and implementation and that we maximize the effectiveness of our programs over time.

I hope this post has sparked some ideas and encourage you to consider how you can help build a more rigorous evidence base on what works in your discipline.

ABOUT THE AUTHOR

M. Mercedes Stickler is the senior land governance and evaluation advisor in USAID’s Office of Land and helps USAID design more effective land programs and evaluations. Follow her @mmstickler.

Using Mobile Phones to Alert Households Waiting for ‘NextDrop’ of Water

Although nearly half of the world’s population now has water piped into their homes and there have been significant improvements to water access in recent decades, many people living in urban areas of developing countries still do not have easy access to this most basic resource. And even where pipes do reach the urban poor, water sometimes does not.

NextDrop’s real-time data and messaging system uses SMS to inform subscribers about when they'll be receiving water, when there’s a delay, when pipe damage is likely to affect them, and when someone in the community has updates to share. / NextDrop

NextDrop’s real-time data and messaging system uses SMS to inform subscribers about when they’ll be receiving water, when there’s a delay, when pipe damage is likely to affect them, and when someone in the community has updates to share. / NextDrop

“Literally, people wait around their house until the water comes on,” said Anu Sridharan, a founder of a social enterprise called NextDrop. “We’ve met people who’ve missed weddings, funerals and meetings.”

If customers miss a water supply window, then they may have to wait two to 10 days for their next chance. Unreliable water supply is a serious impediment to health and economic development. In India, 250 million people rely on unreliable water systems.

Sridharan created the phone-based program NextDrop to notify people when water will be available. In 2010, NextDrop won the Big Ideas@Berkeley contest, allowing Sridharan — a University of California-Berkeley civil engineering graduate — and her team of fellow UC Berkeley graduates to begin acting on their vision.

The service has reached 75,000 registered users in Bangalore, India. Now, the Development Impact Lab at Berkeley, with USAID funding from the U.S. Global Development Lab’s Higher Education Solutions Network, is evaluating the effects of the text message-based notification system. The evaluation has reached 1,500 households so far.

This May, Big Ideas celebrates its 10 year anniversary at UC Berkeley. Since its founding in 2006, the year-long contest has provided funding, support and encouragement to interdisciplinary teams of students who have innovative solutions for addressing global challenges.

Big Ideas is an example of how a university can be a catalyst for high-impact social innovation and research in international development, helping achieve an end to extreme poverty. The story of Big Ideas winner NextDrop demonstrates how a project that began on a college campus is now building evidence to reach scale.

Emily Kumpel, representing the NextDrop team, accepts an award in 2011 to scale up the team’s pilot study in Hubli-Dharwad. / Big Ideas Contest

Emily Kumpel, representing the NextDrop team, accepts an award in 2011 to scale up the team’s pilot study in Hubli-Dharwad. / Big Ideas Contest

From Classroom Idea to Reality

The seed funding that Sridharan and her team won from the Big Ideas Contest helped them to develop their simple but innovative idea: using text messages and crowd-sourced information to alert residents one hour before water will be heading down municipal pipes and into their homes.

NextDrop’s system involves collecting water flow information from valvemen — the individuals responsible for opening and closing the valves controlling water flow into particular districts — and notifying NextDrop customers.

This allows households not only to have accurate and timely information but also enables water utilities to access real-time information about the status of their systems.

The student team partnered with an NGO in Hubli, India for a pilot study of 200 households. Preliminary results were positive and the group was able to continue and refine their technology.

With funding from the Gates Foundation, the Clinton Global Initiative University, and the Knight Foundation, they began scaling their services beyond Hubli to the Indian cities of Bangalore and Mysore.

Building an Evidence Base for Scale

The evaluation of the rollout of NextDrop’s services will demonstrate whether receiving text message notifications of when water is flowing improves a family’s quality of life, so they don’t have to spend as much time waiting — time that could’ve been spent working or at school.

Each year, a household in India loses an estimated seven days waiting for intermittent water. NextDrop seeks to reduce consumers' coping costs in developing countries. / NextDrop

Each year, a household in India loses an estimated seven days waiting for intermittent water. NextDrop seeks to reduce consumers’ coping costs in developing countries. / NextDrop

The research team is also using survey data from the household impact evaluation to assess the accuracy of valvemen reports to NextDrop. The end goal is to provide NextDrop and the utility with a low-cost system for verifying and adjusting data provided by the valvemen, so that the utility has more accurate information about water flows to be able to manage limited water supplies.  

If NextDrop’s services are shown to be valuable in Bangalore, they will be able to scale their approach across other major cities in developing countries.

From early stage funding and support through the Big Ideas contest to evidence-based decision making and scale-up through the Development Impact Lab, projects like NextDrop have shown how the university has become a powerful space for inspiring, launching, developing and scaling big ideas.

As Phillip Denny, director of Big Ideas shares, “University-based programs like Big Ideas provide the perfect ecosystem for early-stage entrepreneurs by providing the resources, funding and ultimately the validation that allows ideas like NextDrop to thrive.”

ABOUT THE AUTHOR

Anh-Thi Le is the Program Coordinator at Blum Center for Developing Economies at the University of California-Berkeley. Follow her @_AnhThi.

Improving Microenterprise through Open Data

Fishing businesses such as this one are an example of USAID microenterprise activities that have provided Afro-Colombian and indigenous groups in Colombia with economic security. / Courtesy of ACDI/VOCA

Fishing businesses such as this one are an example of USAID microenterprise activities that have provided Afro-Colombian and indigenous groups in Colombia with economic security. / Courtesy of ACDI/VOCA

In rural and remote parts of northern Colombia, fertile land remains untouched and violence runs rampant. The “curse of resources” in the north has fueled illicit crop cultivation and violence between illegally armed groups, while the isolated south has suffered from little governance or infrastructure.

To find ways to counter the economic hardship that violence and conflict create in Latin America and the Caribbean, about 100 people from 50 organizations gathered last year for a hackathon organized by USAID. Determined to improve the governance and economic state of these countries, hackathon members from data, policy and technical backgrounds developed eight projects.

Sitting among regional and policy experts were representatives from two data-focused USAID groups: Economic Analysis and Data Services, which facilitates USAID’s access to and analysis of development data and information, and the Development Experience Clearinghouse, an online repository of USAID-funded technical and project documents spanning over 50 years.

Colombians make panela, a form of sugar typical in Latin American countries and a source of income for many Afro-Colombian and indigenous groups. / David Osorio, ACDI/VOCA

Colombians make panela, a form of sugar typical in Latin American countries and a source of income for many Afro-Colombian and indigenous groups. / David Osorio, ACDI/VOCA

As data experts, questions of how USAID could leverage its wealth of data to benefit the growing number of projects in this region of the world were at the forefront of each group’s agenda.

In a brainstorming session, the groups conceived of a plan to integrate their data into an interactive portal, called the Microenterprise Results Reporting Portal, to visualize microenterprise information.

Microenterprise consists of efforts to support and deliver financial services to the poor that are cost effective and financially sustainable. These projects vary from agricultural development, to microfinance loans and more. USAID believes that when citizens are thriving in a strong economy, crime and violence drop.

The newly designed portal provides a clearer picture of the projects that are eliminating crime and violence, strengthening governments and restoring the livelihood of individuals in countries like Colombia.

The Microenterprise Results Reporting Portal includes an online map that contextualizes microenterprise information at the project level by location, year and sector. The portal houses a full view of each project from its initial startup cost to the monitoring and evaluation efforts.

These projects include 41 USAID microenterprise investments around the world, such as water irrigation projects in Rwanda and business development programs for women in Afghanistan. It will eventually include more investments, linking nearly 200,000 downloadable technical and project documents.

The collaboration of these two data-focused USAID groups presents an opportunity for the Agency to use open data to set project performance goals, analyze project impacts over time, and view the effectiveness of projects by location. By meeting our open data goals, we can become more efficient and effective in decision making and monitoring and evaluation of projects.

Above all, this collaboration marks a step toward bridging USAID’s institutional knowledge to bureaus and offices that can harness this information to inform policy decisions.

The portal is only one of the many successes originating from last year’s hackathon. Hopefully, future hackathons will be equally fruitful in helping USAID improve its work around the world.

ABOUT THE AUTHOR

Hayley Samu is the Communications Coordinator for USAID Economic Analysis and Data Services at DevTech Systems, Inc.

Saving Lives Today, Saving Costs Tomorrow: Why USAID Invests in Immunization

A longer version of this blog was originally posted on DipNote.


With one in five children worldwide not receiving essential vaccines, achieving equitable vaccination coverage rates is a global priority. This World Immunization Week, the global community rallies together to “close the gap.”

At USAID, our goal is to save the lives of 15 million children and 600,000 women by 2020. To achieve this ambitious target, we’re supporting interventions with the greatest potential.

The bottom line is we know that vaccines work: They save lives and money. The challenge is ensuring that every child, everywhere, receives the vaccines that he or she needs to grow up healthy, while also being protected from malnutrition, malaria and other potential killers.

Ketcia Orilius, a USAID-supported health worker in Robin, Haiti, gives 3-month-old Orelus vaccines to protect against multiple childhood illnesses. / David Rochkind, USAID

Ketcia Orilius, a USAID-supported health worker in Robin, Haiti, gives 3-month-old Orelus vaccines to protect against multiple childhood illnesses. / David Rochkind, USAID

Investing in a Healthy Future

If vaccines were stocks, investors would be scrambling to buy up shares.

That’s because vaccines have been shown to yield a 16-fold return on investment — the amount of money generated or saved relative to the amount invested — when looking at averted health care costs alone.

When that analysis was expanded to a full-income approach, which goes beyond averted health care costs and additionally takes into account the value associated with people living longer, healthier lives, vaccines were found to yield net returns at 44 times the initial costs.

But you don’t need to be a financial analyst to appreciate the value of vaccines. Globally, child mortality rates have been reduced by more than half since 1990, thanks in part to increases in vaccination coverage. And each and every day, vaccines continue to save the lives of children around the globe. And when it comes to efficiency and “bang for the buck,” few interventions are able to rival immunization.

A young boy receives an oral polio vaccine in Port-au-Prince, Haiti. The incidence of polio has fallen by more than 99 percent over the past three decades. / Kendra Helmer, USAID

A young boy receives an oral polio vaccine in Port-au-Prince, Haiti. The incidence of polio has fallen by more than 99 percent over the past three decades. / Kendra Helmer, USAID

Polio, for instance, is now closer than ever before to being eradicated. Before 1988, there were 350,000 cases of polio annually across 125 countries. That year marked the launch of the Global Polio Eradication Initiative, and in 2015 — less than 30 years later — there were just 74 cases of wild polio virus, limited to two countries.

The Need for Political Commitment

Each and every year, 130 million newborns need to be immunized, or we risk losing the gains that we have made. We  must also ensure that the world’s 650 million children under age 5 have received their full course of recommended vaccines.

At the Ministerial Conference on Immunization in Africa in Addis Ababa, Ethiopia, earlier this year, I was inspired by the participation and enthusiasm of the ministers present. Ministers of health and finance — both vital to sustainable programming — from countries across the continent convened to sign a Ministerial Declaration on universal access to immunization’s foundational role for health and development across Africa.

Surrounding this conference, these ministers were highly engaged and vocal in both formal and informal settings. Ngozi Okonjo-Iweala, the new Chair of Gavi, the Vaccine Alliance, led an animated discussion on financial sustainability and the need to mobilize domestic finances. Other ministers emphasized integration, from embedding immunization in universal health care to thinking strategically about the “polio legacy.”

At the USAID-supported Smiling Sun Clinic in Tongi, Bangladesh, Raja brings her infant in for a measles vaccine. / Amy Fowler, USAID

At the USAID-supported Smiling Sun Clinic in Tongi, Bangladesh, Raja brings her infant in for a measles vaccine. / Amy Fowler, USAID

World Immunization Week 2016: Closing the Gap

At USAID, our immunization work is centered on a comprehensive approach that views immunization as a crucial part of a strong health system, rather than as a stand-alone activity. We support the goals of the Global Vaccine Action Plan and work with countries to strengthen national immunization programs in order to meet these targets.

Through our work with Gavi, the Vaccine Alliance, USAID supports global efforts to expand immunization coverage for children living in the world’s poorest countries, with a specific emphasis on increasing equitable use of new and underutilized vaccines.

It is crucial that the immunization programs and policies that we help build are there to stay. Gavi was founded with the objective of making affordable, life-saving vaccines available to countries that otherwise could not pay for them, but as countries’ economies grow, long-term support must come from the countries themselves.

Sustainability is vital to ensuring that we achieve high levels of immunization coverage — and that they stay high, long after the transition from Gavi support.

USAID’s work helps ensure that health workers have the capacity to deliver safe and effective vaccines in a timely manner. Many vaccines must be kept cold to remain effective, which is why we work to improve “cold-chain” capacity. We collaborate with country governments to develop sound immunization policies, strategies and guidelines.

These are not easy tasks, and they require the commitment of individuals at all levels — from international governing bodies to the health workers who deliver the vaccines themselves.

Yet I have faith that we, working together with our partners in countries across the globe, will be able to build strong immunization systems that will keep children alive and healthy for years to come.

ABOUT THE AUTHOR

Katie Taylor serves as USAID’s Deputy Child and Maternal Survival Coordinator and a Deputy Assistant Administrator in the Bureau for Global Health.

Facing Climate Change, Leaders Take A Step Toward A Healthier World

“Today, thanks to strong, principled, American leadership, that’s the world that we’ll leave to our children — a world that is safer and more secure, more prosperous, and more free.  And that is our most important mission in our short time here on this Earth.”

-President Barack Obama, Statement on the Paris Climate Agreement, December 12, 2015

In Senegal’s Tambacounda region, farmers face a growing risk of droughts and floods as familiar rain patterns change. Building stone bunds protects rice fields from silting and improves production. / Carla De Gregorio

In Senegal’s Tambacounda region, farmers face a growing risk of droughts and floods as familiar rain patterns change. Building stone bunds protects rice fields from silting and improves production. / Carla De Gregorio

On Friday, leaders from around the globe took an important step to ensure a safer, more secure and more prosperous world for our children.

Representatives of about 170 countries came to New York to sign the Paris Climate Agreement, marking a shared commitment to curb climate pollution and build resilience to climate change.

Rice farmers in one of Vietnam’s poorest districts are using new climate-resilient rice strains and growing practices that are dramatically increasing yields while curbing greenhouse gas emissions and increasing resilience to climate impacts. Here, farmers learn to spot pests and diseases in their plants. / Phuong Nguyen

Rice farmers in one of Vietnam’s poorest districts are using new climate-resilient rice strains and growing practices that are dramatically increasing yields while curbing greenhouse gas emissions and increasing resilience to climate impacts. Here, farmers learn to spot pests and diseases in their plants. / Phuong Nguyen

This historic agreement, reached in December 2015, is the culmination of years of hard work, tireless persistence and bold foresight on the part of world leaders. They should be commended for looking beyond immediate concerns to invest in our future.

But now the real work starts.

Vulnerable communities face a host of risks with changing weather patterns that can lead to more frequent and severe storms, as well as longer droughts.

The U.S. Government will be there to help when disaster strikes, just as we were in the Philippines after Typhoon Haiyan in 2013 and in Nepal after the devastating earthquake last year – and today the U.S. is leading the response to severe drought in Ethiopia. Reaching out to people in times of urgent need is one of the greatest expressions of American values.

Preparing for Extreme Weather

Whether slow-creeping droughts or sudden floods and storms, we need to get better at anticipating and preparing for risks. The international development community can help by working with countries to build the core capabilities needed to withstand some of these shocks.

At USAID, we use important new tools to help communities plan for a future of heightened risk, taking early action when we can to keep events from becoming catastrophic in the first place.

Technical experts from Indonesia’s power utility, PLN, and government officials from Indonesia’s Ministry of Energy and Mineral Resources visit a Maui wind farm to learn how Hawaii is using smart policies and regulations to attract private investment and spur clean energy development. / Sarah Fretwell

Technical experts from Indonesia’s power utility, PLN, and government officials from Indonesia’s Ministry of Energy and Mineral Resources visit a Maui wind farm to learn how Hawaii is using smart policies and regulations to attract private investment and spur clean energy development. / Sarah Fretwell

For instance, we help more than 30 countries tap NASA satellite data to better predict and prepare for extreme events.  In many communities, we are looking at how essential crops would perform under warmer conditions while simultaneously exploring varieties of crops that are more resilient.

In Jamaica, which is facing record drought, we developed a seasonal drought forecast tailored to farmers. And it is paying off: Jamaican farmers who acted on what they learned through the forecast have lost only half of what other farmers lost.

Similar forecasts – and other climate tools – are now being replicated around the world. In fact, right now, there are at least 5.3 million people who are using climate data and technologies to make better decisions.

Another way to curb the risks posed by climate change is to invest in healthy forests and clean energy.

Healthy landscapes enhance livelihoods and provide billions of people with food. They also increase resilience to dangerous weather. And investing in clean energy is a smart move for countries looking for a flexible and increasingly affordable way to diversify their energy resources, while extending energy to people who need it.

That’s why USAID works to support countries that want to make these smart investments in the health of their economies – and the health of our planet.

We have helped entrepreneurs in Asia attract millions of dollars of investment in clean energy projects. And through Power Africa, we help countries expand renewable energy production, on and off the power grid, to ensure clean electricity reaches those who most need it.

In total, USAID’s clean energy support has helped more than a dozen countries add 50,000 megawatts of renewable energy capacity since 2010 – enough to electrify 13 million American homes.

With the signed Paris Agreement in place, USAID is renewing its commitment to empower people and communities to take bold action to invest in the future. We all share a responsibility to help build a safer, healthier world.

ABOUT THE AUTHOR

Gayle Smith is USAID’s Administrator. Follow her @GayleSmith.

Building Back Together: Nepal, One Year Later

USAID recovery and reconstruction projects, like Baliyo Ghar, train construction professionals and homeowners on how to build back safer using local materials and earthquake-resistant best practices. / Laxman Shrestha for USAID/Nepal

USAID recovery and reconstruction projects, like Baliyo Ghar, train construction professionals and homeowners on how to build back safer using local materials and earthquake-resistant best practices. / Laxman Shrestha for USAID/Nepal

Today marks a most solemn occasion — it has been a year since the devastating 7.8 earthquake in Nepal took 9,000 lives and injured 25,000 people. Nepalis lost their homes, their treasured monuments and, in some cases, their livelihoods. The past 12 months have been some of the most difficult Nepal has ever faced.

Since April 25, 2015, Nepal has suffered 445 aftershocks greater than 4.0, and a prolonged border and fuel crisis. There is no doubt Nepal has weathered a very turbulent series of storms.

But the clouds are beginning to clear.

This optimism is born of my firsthand experience working in Rwanda for the last four years. Like Nepal, Rwanda is a landlocked country reliant on its neighbors for access to waterways, fuel and other important imports. Rwanda also suffered a very dark hour in 1994 when it turned on itself.

But through significant reforms, Rwanda has seen sustained economic growth over the last decade, transforming into a knowledge-based, service-oriented economy — making it an increasingly valuable neighbor. The last parliamentary elections saw a majority of the seats taken by female candidates; other development successes, such as rapid poverty reduction and reduced inequality, have set the stage for even more success.

Rwanda’s story offers hope, assuring people that even in the darkest of times, a nation can emerge stronger and more focused on creating the future it wants — vibrant and reflective of people’s hopes and dreams.

To jumpstart recovery in the agriculture sector, USAID is delivering much-needed agricultural tools and supplies to farmers. / Derek Brown for USAID/Nepal

To jumpstart recovery in the agriculture sector, USAID is delivering much-needed agricultural tools and supplies to farmers. / Derek Brown for USAID/Nepal

Immediately after the earthquake, USAID mobilized its partners to provide recovery support. Our health programs are preventing the spread of diseases by ensuring access to clean water and proper hygiene, delivering family planning services and counseling to women, and distributing Vitamin A supplements to 3.2 million under-5 children.

Our education programs helped get children back to school quickly and created safe spaces for them. Our agricultural programs have distributed supplies and other farming tools so that fields and gardens could get replanted. And with the spike in human trafficking, our counter trafficking in persons programs are working to reintegrate women and girls back into their communities.

USAID’s reconstruction investments include our contribution to the World Bank’s Multi-donor Trust Fund, which is supporting an earthquake beneficiary survey and providing cash subsidies for housing. The survey, deployed in all of the 14 most-affected districts, assesses earthquake damage, house by house, informing the Government of Nepal’s National Reconstruction Authority who is in most need of the cash grants.

Another way USAID is supporting Nepal is through training and technical assistance. USAID is funding two housing reconstruction projects, Baliyo Ghar and Sabal, to train more than 13,500 local construction professionals and educate 285,000 affected homeowners on building earthquake-resistant homes over the next five years. These projects will also establish local-level reconstruction technology centers and demonstration homes, and offer vocational trainings.

Finally, USAID is supporting communication and outreach in partnership with the Government of Nepal so that affected households know where to access resources and services and are armed with simple, actionable steps to build back safer.

As we put the past year behind us, it is important to take a step back and acknowledge

everything we accomplished together with the people of Nepal. When disaster struck and before aid arrived, Nepalis picked each other up and supported their families and neighbors with shelter and food.

They define resilience and defy despair. I have only been here two weeks, and yet it is clear these qualities are inherent in the Nepali people. They are the heroes of the past year.

Over the next two weeks, USAID’s mission in Nepal will remember the 9,000 people who perished a year ago today and honor the local heroes who represent the best of Nepal. Follow us on Facebook and Twitter (#RebuildingLives) as we pay tribute to Nepal.

On behalf of the mission, I extend my deepest condolences to those who have experienced loss over the past year, and assure the people of Nepal that we remain a committed partner as we build back together. I’m hopeful for Nepal’s future, and I look forward to serving as USAID Nepal’s new Mission Director.

We stand with you.

ABOUT THE AUTHOR

Peter Malnak is the new Mission Director for USAID/Nepal.

The Real Heroes Behind USAID’s Nepal Earthquake Response

Nepal_Rubble

Last year’s earthquake in Nepal claimed the lives of nearly 9,000 people, injured more than 22,000 others, and damaged or destroyed more than 890,000 homes. / Kadish Das Shrestha, USAID

On April 25, a magnitude 7.8 earthquake struck central Nepal—the worst to hit the country in over 80 years. It caused widespread damage across the country, nearly destroyed entire villages, and triggered landslides and avalanches. The earthquake was followed by more than 100 aftershocks, including a magnitude 7.3 trembler on May 12.

I had lived and worked in Nepal for 18 years, establishing very close personal and professional ties during my time there. When I got first word of the earthquake, I immediately felt terror for the people and places I had come to love. Then, I went into response mode.

A medium sized urban search and rescue team made up of 57 members of the Los Angeles County Fire Department and 60,000 pounds of equipment, activated by USAID, board a C-17 Globemaster III at March Air Reserve Base, April 27, 2015. The team is in response to the magnitude 7.8 earthquake and subsequent aftershocks which struck near the city of Kathmandu, Nepal on April 25. The C-17 is assigned to the 337th Airlift Wing, Charleston Air Force Base, S.C. (US Air Force Photos by Master Sgt. Roy A. Santana/Released)

Within hours, USAID’s Disaster Assistance Response Team deployed to Nepal. / U.S. Air Force photos by Master Sgt. Roy A. Santana

Within hours, I was in a U.S. Air Force C-17 on the way to Kathmandu, leading a 136-person Disaster Assistance Response Team (DART) deployed by USAID’s Office of U.S. Foreign Disaster Assistance to coordinate the U.S. government’s response efforts.

Some of our work made front-page news, especially when our urban search-and-rescue teams assisted in two miraculous rescues: the first, a 15-year-old boy who was pulled from the rubble five days after the quake hit. The other involved a 41-year-old woman who was saved from a collapsed building 50 miles east of Kathmandu.

Nepal Rescue

The DART’s urban search-and-rescue teams helped rescue 15-year-old Pemba, five days after the earthquake hit. / Fairfax County Fire and Rescue

But in my opinion, the unsung heroes of this disaster were the Nepalese people, themselves, many of whom were able to play critical roles in their country’s response—all while dealing with a tremendous sense of loss.

More than a thousand people had the ability to save lives in their neighborhoods, communities and villages thanks to training and tools USAID has been providing for more than two decades.

Nepal sits on the boundary of two massive tectonic plates. Previous large-scale earthquakes occurred in 1833 and 1934, and we knew it would only be a matter of time before another catastrophic quake struck.  While we can’t stop earthquakes from happening, we knew we could help people better prepare and respond to disasters.

Bal Krishna 1

USAID’s DART meets with Dr. Vaidya, who implemented a disaster plan in his hospital with the skills he learned from a USAID program. This planning allowed Nepal’s largest medical facility to remain open after the earthquake, helping to save many lives. / USAID

Since 1998, USAID has supported the Program for the Enhancement of Emergency Response. This program helps Nepal’s disaster management agencies organize and conduct trainings on medical first response, collapsed structure search-and-rescue, and hospital preparedness for mass casualties following a disaster.

After taking one of these trainings, Dr. Pradeep Vaidya helped his hospital develop a disaster plan. As a result, Kathmandu’s Tribhuvan Teaching Hospital fastened furniture to the walls, laminated windows, prepositioned supplies, and installed a seismic-resistant blood bank.

These efforts allowed the hospital to stay open right after the earthquake; its doctors treated 700 patients and performed more than 300 surgeries.

CADRE

More than 600 people like Sanam and Kritica put their USAID training into action after the earthquake hit, helping their fellow Nepalese by providing first aid and distributing relief items./ Kadish Das Shrestha, USAID

We’ve also been training communities on basic life support, light search and rescue, dead body management, and best practices on how to respond to multiple casualties through a program called Community Action for Disaster Response, which we support in partnership with the American Red Cross and the Nepal Red Cross Society.

Because of this training, 600 team members deployed to hard-hit areas after the April 25 earthquake to participate in search-and-rescue operations, provide first aid to the injured, and assist with damage assessments and distributions.

Imagery captured during an aerial survey flight flown by members of Joint Task Force 505, May 7, shows areas affected by an earthquake in outlying villages near Kathmandu, Nepal. The Nepalese government requested the U.S. government’s assistance after a 7.8 magnitude earthquake struck the country April 25. U.S. military services came together to form JTF 505, which works in conjunction with U.S. Agency for International Development and the international community, to provide unique capabilities to assist Nepal. (U.S. Marine Corps photo by MCIPAC Combat Camera Staff Sgt. Jeffrey D. Anderson)

Experts trained by USAID assessed more than 126,000 structures to ensure they were safe after the earthquake. / U.S. Marine Corps photo by MCIPAC Combat Camera Staff Sgt. Jeffrey D. Anderson

Finally, for more than 15 years, we’ve been building a qualified pool of engineers and technical experts through our partnership with the Kathmandu-based National Society for Earthquake Technology.

We trained people on how to conduct seismic risk assessments and develop earthquake preparedness plans. After the earthquake struck, our partner mobilized 400 earthquake damage inspectors and 450 volunteers who surveyed more than 126,000 structures to ensure they were safe.

At the same time, we also trained homeowners and masons on how to make buildings more earthquake resistant—work that still continues to this day.

Nepal_Construction

Homeowners and masons rebuild using seismic-resistant building techniques. / NSET

While the April 25 earthquake caused significant damage, I’m proud that the preparedness investments we put in place prior to the disaster helped save lives. We now have a cadre of earthquake experts in the region with a depth of knowledge to make a difference in their communities. And these experts are grateful.

USAID Bill Berger head shot

After living in Nepal for 18 years, and working to help the country prepare for disasters, USAID’s Bill Berger led the Disaster Assistance Response Team that responded to last year’s earthquake. / Kadish Das Shrestha, USAID

All during my time in Nepal, I had people come up to me and tell me amazing stories of how their training helped them save others. By my calculation, we trained about a thousand Nepalese who then went out as first responders after the earthquake.

These investments must continue. History has shown that another big earthquake will be coming, perhaps even worse than the April 25 disaster. Hopefully, these stories prove that if you equip people with the right tools and training, they can make a real difference.

ABOUT THE AUTHOR

Bill Berger is the Senior Regional Advisor for South Asia for USAID’s Office of U.S. Foreign Disaster Assistance. During the Nepal earthquake response, Berger served as USAID’s Disaster Assistance Response Team Leader.

As the World Focuses on Zika, Malaria Continues its Deadly Toll

When you think about mosquitos these days, one disease likely leaps to mind: Zika.

The media has been sounding the alarm about the virus for months, particularly in Latin America, where health workers are on alert for pregnant women who may have become infected.

But another mosquito-borne disease kills a child every two minutes — and sickens hundreds of millions more, often over and over again: malaria.

In Kenya, Christine Pepela sleeps under an insecticide-treated bed net provided by a local nurse. / Allan Gichigi, MCSP

In Kenya, Christine Pepela sleeps under an insecticide-treated bed net provided by a local nurse. / Allan Gichigi, MCSP

In a rural health center in western Kenya, a 26-year-old woman waits her turn to see the nurse.

Christine Pepela began receiving prenatal care at the Mechimeru Health Centre in Bungoma County when she was four months pregnant.

It was here that she learned she is at risk for malaria — a far more deadly and prevalent mosquito-borne disease than Zika.

Now six months pregnant, Christine meets with Nurse Agnes Nambuya, who gives her an insecticide-treated bed net to sleep under and tells her about sulfadoxine-pyrimethamine, the medication she needs to help prevent malaria in pregnancy.

The risk of malaria faced by Christine and her baby is not new or unique.

In sub-Saharan Africa alone, 10,000 pregnant women will lose their lives to malaria this year, and about 200,000 babies born to mothers who have had just one episode of malaria in pregnancy will die.

In fact, malaria in pregnancy contributes to 8 percent of all stillbirths in the region. Many more babies will be born small or anemic, which can lead to life-threatening consequences, as well as health problems throughout childhood and beyond.

This is exceptionally unfair, as the adverse outcomes associated with malaria in pregnancy are largely preventable.

USAID’s Maternal and Child Survival Program, the President’s Malaria Initiative and other partners are increasing measures to dramatically reduce the number of cases of malaria.

Together, we’re supporting government health ministries to combat malaria in pregnancy through lifesaving and cost-effective tools:

  • Last year, about 900,000 pregnant women received two doses of this intermittent preventive treatment.
Nurse Agnes Nambuya gives Christine sulfadoxine-pyrimethamine drugs to prevent malaria in pregnancy. / Allan Gichigi, MCSP

Nurse Agnes Nambuya gives Christine sulfadoxine-pyrimethamine drugs to prevent malaria in pregnancy. / Allan Gichigi, MCSP

At the foundation of our efforts is ensuring access to high-quality, comprehensive prenatal care, which has proved effective in delivering critical care and counseling to both women and newborns.

It remains a key opportunity for trained health providers to deliver preventive treatment to pregnant women. Health providers can also recognize signs and symptoms of malaria, react swiftly, administer a rapid diagnostic test, and treat accordingly or refer to a higher-level facility.

With Zika virus cases mounting, prenatal care will be more critical than ever.

An estimated 94,000 newborn lives were saved through malaria in pregnancy interventions between 2009 and 2012.

As the world’s attention focuses on a newly emerging threat, we are reminded of the vulnerability of pregnant women to viruses and infections.

This underscores the importance of maternal and newborn health services to ensure all pregnant women receive the comprehensive counseling and care needed before, during and after pregnancy.

To learn more about the global efforts of the Maternal and Child Survival Program to prevent and treat malaria, click here. And to add your voice to the global conversation, join us on Twitter.

ABOUT THE AUTHOR

Elaine Roman is the Malaria Team Lead for USAID’s flagship Maternal and Child Survival Program.

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