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Archives for Extreme Poverty

Family Planning for the World’s Youth Promotes Peace, Health and Prosperity

A mother with her child at the Nhamatanda Health Center in Mozambique. / Arturo Sanabria, Photoshare

With close to 600 million girls growing up in developing countries, achieving global prosperity starts with educating and empowering these young women so they can be healthy, productive members of their communities and become agents of change.

This year’s World Population Day encourages us to “Invest in Teenage Girls.” Voluntary family planning is one tool that can both educate and empower young women worldwide.

Access to voluntary family planning and reproductive health services for everyone, including youth, is vital to the future of our planet. About half of pregnancies among adolescent women in the developing world are unintended, with about 23 million young women wishing to avoid pregnancy, but not using modern contraception. This puts them at high risk of unintended pregnancy.

As we observe World Population Day on July 11, we acknowledge that young people hold the key to determining the future of our planet and to ensuring we meet the Sustainable Development Goals (SDGs)17 goals focused on ending all forms of poverty, achieving social justice for all, and tackling climate change by 2030.

Voluntary family planning is an important intervention that cuts across the five themes of the SDGS: people, planet, prosperity, peace and partnership.

A nurse shows a client an implant rod, and explains how it works during a family planning outreach at a Nairobi informal settlement. / Tobin Jones, Jhpiego

Voluntary family planning affects people. It supports adolescents’ rights to information, and the rights of girls to remain unmarried and childless until they they are ready and desire to bear children.

Family planning saves lives. Today, pregnancy and childbirth are the leading causes of death for adolescent women. By helping young women time and space their pregnancies, family planning helps reduce the number of high-risk pregnancies, and allows women to properly feed, clothe and educate the children they decide to have. Studies show that by 2020, family planning could help avert approximately 7 million under-5 deaths and prevent 450,000 maternal deaths in USAID’s priority countries.

A poster in a Sare Bilaly health hut in the region of Kolda, Senegal. / Amy Fowler, USAID

Family planning impacts the planet. Access to family planning can slow global climate change and improve the health and environment of households and communities worldwide, and research shows that it already has. A 2013 report warns: “poor reproductive health outcomes and population growth exist hand-in-hand with poverty and unsustainable natural resource use.”

Family planning helps reduce poverty and contributes to economic growth and prosperity. Nearly 21 percent of the world’s population—some 1.5 billion people—still live on less than $1.25 per day. By slowing rapid population growth, family planning can help to decrease the sheer number of poor people.

Reducing adolescent fertility can contribute to a “demographic dividend” of rapid economic growth. Having fewer children per family leads to more household savings and increased investments in each child. In Korea and Thailand, governments aligned population policy and family planning services with human capital development policies, particularly girls’ education, to accelerate economic growth.

Voluntary family planning can contribute to peace. Studies show that a large “youth bulge” (defined as a high number of 15- to 29-year-olds) is associated with a high risk of civil conflict. The political impact of fertility decline is measureable: Research shows as a country’s population ages, the probability of attaining and maintaining a liberal democracy is increased.

Worldwide, more than 30 million adolescent women are not in school. Early and unintended pregnancy can be both a cause and a consequence of dropping out of school, so family planning can help women and girls stay in school, become literate, and achieve their educational and employment aspirations. All of these outcomes lead to more peaceful communities and societies.

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Health workers in Mali. / Jane Silcock, USAID

Family planning partnerships at the global and country level will be critical to achieving success as we work toward reaching a grand convergence between the developed and developing world in the next 15 years. As the largest bilateral donor for family planning assistance, USAID has played a crucial role in increasing access to modern contraception. And through our youth policy, USAID strives to integrate youth reproductive and sexual health needs into all of our programs and partnerships.

Young people today will decide our future. We need them to participate in the social, economic, political and cultural life of their communities to eliminate poverty and achieve our collective goals. We also need to recognize the diversity of need and experience of this age group when developing reproductive and sexual health programs and services. As we help youth to succeed, voluntary family planning will be an essential element of our long-term development strategies.

ABOUT THE AUTHOR

Ellen H. Starbird is the director of the Office of Population and Reproductive Health at USAID. Get updates about USAID’s Family Planning work via @USAIDGH.


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Responding to Madagascar’s ‘Silent’ Emergency

With support from Catholic Relief Services, Sisters of Charity provide hot meals to the elderly and children in Tshiombe./Christopher LaFargue, USAID

With support from Catholic Relief Services, Sisters of Charity provide hot meals to the elderly and children in Tshiombe. / Christopher LaFargue, USAID

Because of its slow onset, Southern Africa’s drought may not be headline news. But its impacts are being felt by millions. At least 12.8 million people in Southern Africa will face crisis levels of food insecurity by the end of this year.

Madagascar has been especially hard hit. About 80 percent of the population in the country’s seven southern districts—665,000 people—are in need of emergency food assistance.

I recently traveled to Madagascar with U.S. Ambassador to the United Nations Agencies for Food and Agriculture David Lane. There we met with communities struggling to find enough to eat after three years of consecutive drought made worse by El Niño.

20160519 Tshiombe CRS Community Canteen 1

Soeur Josiane from Sisters of Charity speaks to Dina Esposito about the soup kitchen in Tshiombe. / Christopher LaFargue, USAID

During our trip, we saw visibly malnourished children and adults, including many elderly. In Tshiombe, we spoke with Soeur Immaculata, a nun from Sisters of Charity, who opened up an emergency soup kitchen to provide regular hot meals to children and the elderly. She told us she had not seen so much suffering since the severe droughts of 1992 and 2006.

We also visited Ankilimafaitsy Primary School in Ambovombe, where the U.N. World Food Program is providing children with lunch as part of a school lunch program that feeds almost 300,000 Malagasy children daily. For most of these children, this school lunch is the only food assistance they receive; it has become a vital lifeline in these communities as parents struggle to put food on the table.

Here are three steps we—and other donors—must take to help the people of Madagascar during this “silent,” but devastating emergency:

20160518 Ambovombe WFP School Canteen 3 (1)

Children receive hot meals from the Sisters of Charity soup kitchen supported by Catholic Relief Services in Tshiombe. / Christopher LaFargue, USAID

1. Coordinate support

During my trip, we announced an additional $8 million in food assistance to the Malagasy people, bringing the United States’ total El Niño response in Madagascar to $17 million. But we must work with the government and the donor community to coordinate our assistance. We encourage Madagascar’s national and local officials to assess immediate needs, more proactively mobilize their own response, and more effectively draw global attention to the crisis, mobilize contributions, and facilitate donor planning.

Ready-to-use supplementary food provide children with much needed protein, vitamins and minerals to fight malnutrition./Christopher LaFargue, USAID

Ready-to-use supplementary food provide children with much needed protein, vitamins and minerals to fight malnutrition. / Christopher LaFargue, USAID

2. Plan early for a scaled up emergency and recovery response 

As in the ongoing Ethiopia drought response, early warning is the key to early response. Forecasts indicate that Madagascar’s lean season could begin as early as August rather than October. Children under 5 in this area have unusually high rates of malnutrition. It is urgent that we complement expanded food assistance for families in these southern districts with specialized foods to prevent and treat malnutrition.  

I was particularly impressed by Madagascar’s National Office of Nutrition and its efforts to screen and treat cases of moderate acute malnutrition. We met with well-trained volunteers who were educating young mothers about nutrition. With USAID support, children are being provided with ready-to-use supplementary food. Sustained assistance will be critical in the months ahead to prevent children from sliding into the more serious condition of severe acute malnutrition.

Equally important will be ensuring that families can grow their own food in the next cropping season. A seed distribution plan must get seeds in the hands of farmers by September.

Women farmers in Amboasary tend to a cleared communal vegetable field through a World Food Programme food for assets activity. / Christopher LaFargue, USAID

Women farmers in Amboasary tend to a cleared communal vegetable field through a World Food Programme food for assets activity. / Christopher LaFargue, USAID

3. Continue to invest in resilience

Although the current drought is outpacing the ability of many Malagasy farmers to cope, some farmers have remained self-reliant with our investments. Some of our disaster mitigation efforts include working with farmers to grow more drought-resistant crops like sweet potato and cassava. We are also helping farmers to build assets, access more land near water sources, and improve nearby water points for humans and cattle. Voucher programs help fishermen buy tools and other resources during this drought.

Under a creative arrangement, local farmers are growing corn on large-scale plantations, between rows of sisal (a plant used to make rope and rugs), in exchange for keeping the fields cleared and tended. The farmers keep one-third of what they grow to sell or eat, they reserve a third for seeds for the next season, and another third is sold to the World Food Program for its school lunch program.

The program has especially benefitted women farmers, one of whom told me, “We used to have to take our children out of school when they turned 15. Now they can stay on into high school. Our girls no longer have to ask men for money to buy soap [a local euphemism for prostitution].”

These efforts are making a clear difference as communities cope with drought. We must continue to scale up these investments—and help expand opportunities for populations to make a living during both good and bad times.

The people of Madagascar will inevitably face future climate shocks in addition to the current drought. We can help them to mobilize, plan and build resilience to those shocks to promote security and avert emergencies.

ABOUT THE AUTHOR

Dina Esposito is USAID’s Acting Deputy Assistant Administrator for Democracy, Conflict, and Humanitarian Assistance. @DEsposito_FFP


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The End of Extreme Poverty

Alex Thier, USAID’s Assistant to the Administrator for Policy, Planning and Learning, on the main stage at TEDx Foggy Bottom 2015. / Gregg Rapaport, USAID

Alex Thier, USAID’s Assistant to the Administrator for Policy, Planning and Learning, on the main stage at TEDx Foggy Bottom 2015. / Gregg Rapaport, USAID

The end of extreme poverty is President Obama’s bold vision, central to the mission of USAID.

For as long as humans have existed, so have the travails of poverty.

If you were born in 1980, you had a 50 percent chance of living in destitution — a life without enough food, medicine, education or freedom to live a decent life.

But there is reason to believe in a world of less disparity: In just two decades, we have cut global rates of extreme poverty in half, and we now have the tools to eradicate extreme poverty by 2030.

At a recent TEDx talk, one of our agency’s top experts on poverty policy, Alex Thier, shared USAID’s vision for manifesting this reality.

Thier shared the three critical principles that drive how USAID and its partners collaborate to end extreme poverty: fostering economic growth globally; cultivating transparent, democratic systems of governance; and embracing a “new model for development” that is built on partnerships, local ownership, innovation and a relentless focus on results.

“Ending extreme poverty will be perhaps the greatest accomplishment of our human civilization,” Thier told the audience of 1,500 people who attended TEDx Foggy Bottom in Washington, D.C., last month.

Strong governments are the cornerstone of healthy and resilient societies and one of the key factors to ending extreme poverty.

Thier shared contrasting stories of how good governance — and the lack of it — impacted how two countries rebounded from separate, devastating earthquakes that occurred weeks apart in 2010.

Five years ago, a 7.0 earthquake hit Haiti. It killed 300,000 people. Just weeks later, an earthquake that was 500 times more powerful struck Chile. Yet that earthquake killed 1/500th the number of people. / PPL/USAID

Five years ago, a 7.0 earthquake hit Haiti. It killed 300,000 people. Just weeks later, an earthquake that was 500 times more powerful struck Chile. Yet that earthquake killed 1/500th the number of people. / PPL/USAID

Chile’s government set the right course in advance of the earthquake by preparing for such a disaster, creating and enforcing rigorous building codes that protected its population. The government built institutions and infrastructure while investing in its people.

Haiti did not. When the earthquake struck the island, the most vulnerable population — those living in extreme poverty in poorly constructed buildings of densely populated ghettos — experienced the loss of not only their homes, but thousands of their lives.

“What’s particularly tragic is that it’s avoidable,” he said. “It’s not theory or fate. It’s not about geography or natural resources. It’s about the choices that governments and their societies make every day.”

Cultivating more resilient, democratic societies like the one in Chile is just one of the ways that USAID is working to make Obama’s vision of ending extreme poverty a reality. With our international partners, we are well on our way to solving one of humanity’s greatest challenges.

ABOUT THE AUTHORS

Hope Bryer is the Communications Team Lead for USAID’s Bureau for Policy, Planning and Learning.

Historic Donor Agreement: More Money Where It Is Needed Most

In Barisal Sadar, Bangladesh, Ayub Ali serves his community by producing quality fingerlings (young fish), which is a key factor for local fish farming. As part of the USAID-Aquaculture project, he learns about modern method of aquaculture through training. This knowledge and support has made him a successful entrepreneur. / World Fish, A. W. M. Anisuzzaman

In Barisal Sadar, Bangladesh, Ayub Ali serves his community by producing quality fingerlings (young fish). As part of the USAID-Aquaculture project, he learns about modern method of aquaculture through training. / World Fish, A. W. M. Anisuzzaman

This year, 2015, will be seminal in setting not only bold new goals – like ending extreme poverty – but also in making bold reforms that change the way things get done.

As donors, one of our primary concerns is to use our taxpayers dollars as effectively and efficiently as possible in order to leverage significant change. That means attracting other forms of capital (public, private, social, multilateral – you name it) and directing those resources to where they can best have the sort of transformative development impact that we all want.

At December’s High-Level Meeting of the Organization for Economic Cooperation and Development’s Development Assistance Committee (OECD-DAC) in Paris, we advocated for and achieved important policy and structural changes to how donors allocate resources and report those numbers. These changes will impact the future of Official Development Assistance (ODA) — the international definition of foreign aid that is used to track donors’ foreign aid commitments.

First, 29 DAC members agreed to “allocate more of total ODA to countries most in need,” including low-income countries, the least-developed countries (LDCs), small island developing states, landlocked developing countries, and fragile and conflict-affected states.

We believe this policy is critical. The countries that can least afford to self-finance are the same ones lagging behind on the eradication of extreme poverty and the basic human development needs that form the foundation of the Millennium Development Goals.

Second, we created a fairer, more transparent, and better targeted system for development-focused lending. Three integral changes include:

  • Creating a fairer accounting system. Previously, donors got equal credit for grants and qualifying loans¹ – even though the loans needed to be repaid.  Under the new rules, only the grants and a portion of loans (known as the “Grant Element”) will count as Official Development Assistance (ODA). The United States only provides assistance in the form of grants.
  • Directing money to the most needy. The formula for deciding what counts as ODA now rewards donors who lend money to least-developed countries – i.e., those who can least afford commercial terms or self-financing.
  • Increasing transparency. During the meeting, members agreed to publish all ODA statistics more regularly, with frequent reviews and updates.
A worker at Muya Ethiopia weaves fabric that will become clothing and accessories sold on store shelves thousands of miles away. From 2005 to 2014, with support from USAID, Muya expanded from seven to 400 full-time employees and now sells 90 percent of its products overseas. / IESC, Steve Dorst

A worker at Muya Ethiopia weaves fabric that will become clothing and accessories sold on store shelves thousands of miles away. From 2005 to 2014, with support from USAID, Muya expanded from seven to 400 full-time employees and now sells 90 percent of its products overseas. / IESC, Steve Dorst

In order to unlock more development funding for the least-developed countries, the changes also endorse focusing on work with the private sector in support of the New Model of Development. These changes will also bring transparency to development transactions and encourage donors to send money to the neediest countries. They could not come at a more perfect time.

This year, the Millennium Development Goals will expire and the world will come together to decide on a new set of post-2015 sustainable development goals. These new benchmarks are likely to redefine USAID’s target of ending extreme poverty–a mission that will rely heavily on effective financial policies. Thanks to the lending reforms and support from other donor countries, USAID is in a strong position to move forward in tackling the development of countries most in need.

We can provide support to boost the economies of low-income countries to minimize poverty, but this renewed emphasis on countries most in need, including LDCs, small island developing states, landlocked developing countries, and fragile and conflict-affected states, stands to make an even greater difference.

This summer, donor countries and recipients will have a chance to further refine their approach to these issues at the third International Conference on Financing for Development in Addis Ababa, Ethiopia in order to achieve the next set of global development goals.

Currently, we are poised to bring significant changes to global development. With this early success in agreeing to changes in the recording of ODA loans and a renewed focus on countries most in need, large steps have been taken to help us realize an end to extreme poverty.


¹To be counted, loans had to be concessional in character and convey a grant element of at least 25 percent (calculated at a rate of discount of 10 per cent), a formula that has grown very out of date. Click here for more information.

ABOUT THE AUTHOR

Alex Thier is USAID Assistant to the Administrator for Policy, Planning and Learning. Follow him @Thieristan

In National Security Strategy, Key Role for Development

Fazal Wahid, 66, a bee farmer in Pakistan’s turbulent SWAT region is now able to sustain his family because of assistance from a USAID program. The economy in Pakistan’s Swat Region was devastated by  militants and devastating floods. / USAID, Pakistan

Fazal Wahid, 66, a bee farmer in Pakistan’s turbulent SWAT region is now able to sustain his family because of assistance from a USAID program. The economy in Pakistan’s Swat Region was devastated by militants and devastating floods. / USAID, Pakistan

The 2015 National Security Strategy (NSS), released today by President Obama, makes a powerful argument about how central development is to our national security and prosperity.

Our biggest global challenges: improving global health security; addressing inequality; confronting climate change; countering authoritarian regimes and extremism; and ending conflict all require successful humanitarian and development responses.

USAID’s mission to end extreme poverty and promote resilient, democratic societies is right at the center of this strategy.

It states:

“We have an historic opportunity to end extreme poverty within a generation and put our societies on a path of shared and sustained prosperity. In so doing, we will foster export markets for U.S. businesses, improve investment opportunities, and decrease the need for costly military interventions.”

The new NSS comes at a seminal moment for international development, as the world comes together in 2015 to create new goals for development, for climate, and figures out how to get them done.

Employees assemble tablets at the Surtab Factory in Port au Prince, Haiti. Surtab, which was established in 2013 with funding from USAID, has been a huge boost to the technology sector in Haiti, creating a highly skilled local workforce through training programs and on-site instruction. The company's tablets are used in social programs in education, health care and agriculture. / David Rochkind, USAID

Employees assemble tablets at the Surtab Factory in Port au Prince, Haiti. Surtab, which was established in 2013 with funding from USAID, has been a huge boost to the technology sector in Haiti, creating a highly skilled local workforce through training programs and on-site instruction. The company’s tablets are used in social programs in education, health care and agriculture. / David Rochkind, USAID

Strong and sustainable American leadership is the central theme of the strategy. In it, President Obama calls for the United States to play “a leading role in defining the international community’s post-2015 agenda for eliminating extreme poverty and promoting sustainable development.”

USAID is delivering on this pledge through efforts with our civil society partners, at the United Nations, and in the 80 countries around the world where we practice what we preach.

Development is a whole-of-government and whole-of-society approach. The challenges we face, and ambitions we harbor, require this. Our New Model for Development ties together the need for local ownership and good governance with big public private partnerships that deliver big results.

The strategy doubles down on this by calling for us to “use our leadership to promote a model of financing that leverages billions in investment from the private sector and draws on America’s scientific, technological, and entrepreneurial strengths to take to scale proven solutions in partnership with governments, business, and civil society.”

In the West Bank, girls are thriving in the classroom. Since 2000, USAID has constructed nearly 3,000 classrooms and renovated 2,700 more--allowing many schools to cut class size and eliminate the need for students to learn in shifts. / Bobby Neptune, USAID

In the West Bank, girls are thriving in the classroom. Since 2000, USAID has constructed nearly 3,000 classrooms and renovated 2,700 more–allowing many schools to cut class size and eliminate the need for students to learn in shifts. / Bobby Neptune, USAID

In 2010, President Obama said that USAID must be the world’s premier development agency. This is needed to bring the historic changes to women and girls, people burdened by hunger and disease, and those struggling for freedom that our values and our national security require. The 2015 NSS reflects an Agency transformed.

The development voice is strong, and we are delivering on ambitious goals like lifting 7 million farmers out of extreme poverty, getting 100 million children reading, and driving infant and maternal mortality to record lows.

“We embrace our exceptional role and responsibilities at a time when our unique contributions and capabilities are needed most, and when the choices we make today can mean greater security and prosperity for our Nation for decades to come.”

USAID’s work has never been more central to this goal.

ABOUT THE AUTHOR

Alex Thier is USAID Assistant to the Administrator for Policy, Planning and Learning. Follow him @Thieristan

Disruptive Innovations Bringing Nepal Closer to Ending Extreme Poverty

Nurses apply chlorhexidine to the umbilical cord of a newborn at Nepalganj Medical College & Teaching Hospital. USAID is helping Nepal bring the life-saving antiseptic gel to villages, communities and health centers across the country. / Thomas Cristofoletti for USAID

Nurses apply chlorhexidine to the umbilical cord of a newborn at Nepalganj Medical College & Teaching Hospital. USAID is helping Nepal bring the life-saving antiseptic gel to villages, communities and health centers across the country. / Thomas Cristofoletti for USAID

In the maternity ward of a USAID-supported hospital in Dhulikhel, a town on the eastern rim of the Kathmandu Valley in Nepal, I watched a nurse apply a disinfectant gel to the umbilical cord of a newborn baby. That tube of the antiseptic chlorhexidine — worth under 15 cents — has been shown in a randomized control trial, to reduce neonatal mortality by a remarkable 34 percent in Nepal.

All around the country, more than 50,000 female community health volunteers  are sharing this innovation and saving thousands of lives in the process.

Thanks to simultaneous advances in health, education, nutrition and access to energy, Nepal stands at the edge of its prosperity. On the path to overcoming the remnants of internal conflict and transitioning to democracy, the Nepalese have cut extreme poverty by 50 percentage points in the last two decades.

Gita, a female community health worker, visits a pregnant woman and her family to show them how to use the chlorhexidine antiseptic gel and how to apply it to the umbilical cords of newborns.   / Thomas Cristofoletti for USAID

Gita, a female community health worker, visits a pregnant woman and her family to show them how to use the chlorhexidine antiseptic gel and how to apply it to the umbilical cords of newborns. / Thomas Cristofoletti for USAID

Innovative programming like chlorhexidine application is growing more common in Nepal and around the world. USAID is also supporting creative community-based approaches to countering human trafficking, including a novel effort to criminalize organ sales that has won landmark court cases, setting new precedent in Nepalese law for holding traffickers accountable.

Suaahara, a comprehensive nutrition program  that translates to “good nutrition,” teaches skills for nutrient-rich backyard vegetable farming, raising poultry, improving sanitation and hygiene, and controlling pests through demonstration farms and new mothers’ discussion groups.

A focused effort to improve early-grade reading is supporting the Ministry of Education’s School Sector Reform Plan by strengthening curricula and training teachers, school committee members, parents and technical support staff in more than 27,000 Early Childhood Education Development centers across the country. Just a 10 percent increase in the share of students with basic literacy skills can boost a country’s economic growth by 0.3 percentage points, while laying the foundation for their later learning.

We need these kinds of disruptive innovations to help bend the curve toward increased child survival, better access to justice, lower malnutrition, greater literacy and skills, and, ultimately, the end of extreme poverty. Solutions like these will drive broader development progress and elevate our efforts to realize transformative change, and now, 2015, is the time to do it.

This year will be a pivotal year for international development. In Addis Ababa this summer, leaders will come together at the third Financing for Development conference to agree on a new compact for global partnership.

In the fall at the U.N. General Assembly in New York, heads of states will ratify a post-2015 development agenda, a universal, more comprehensive, more ambitious follow-on to the Millennium Development Goals, outlining a vision for the next 15 years of development progress. And in Paris next December, member states will adopt a new agreement to combat global warming at the 21st Conference of Parties to the U.N. Framework Convention on Climate Change.

Substantial challenges lie ahead for Nepal. Tensions from the recent conflict remain, simmering below the surface. The government has set a January 2015 deadline to approve a constitution – after a failed attempt in 2012 – to be followed by local elections, which haven’t been held in 16 years. And a quarter of Nepal’s population still lives on less than $1.25 a day.

Based on current projections, Nepal is likely to eradicate extreme poverty before 2030. If Nepal can navigate the pitfalls ahead, it is well-positioned to see long-term, sustainable growth by developing its immense hydropower potential, exploiting its unparalleled tourist draw, and producing goods and services for the growing middle class on its doorstep – the belt from eastern Pakistan through northern India to Bangladesh that constitutes the most densely populated area on earth.

A worker for Lomus Pharmaceutical packs tubes of a chlorhexidine antiseptic gel that is one of Nepal’s great innovations and success stories in global health. The gel, when applied to the cut umbilical cord stumps of newborns, instead of traditional substances like oil, curry powder or ash, can reduce the risk of infant death by up to a third.  / Thomas Cristofoletti for USAID

A worker for Lomus Pharmaceutical packs tubes of a chlorhexidine antiseptic gel that is one of Nepal’s great innovations and success stories in global health. The gel, when applied to the cut umbilical cord stumps of newborns, instead of traditional substances like oil, curry powder or ash, can reduce the risk of infant death by up to a third. / Thomas Cristofoletti for USAID

While the solution to a vexing challenge like neonatal mortality may seem as simple as applying a bit of antiseptic ointment at the right time, this breakthrough came only after a dedicated and concerted effort to hammer away at the problem. USAID worked in partnership with academic researchers, government service providers, community extension workers, private-sector drug manufacturers and others to rigorously pilot, test and scale the Chlorhexidine project.

One particular obstacle, for instance, was that in much of Nepal mothers traditionally rub substances like cooking oil, ash, or even cow dung, on their babies’ umbilical stumps. For widespread adoption to be viable, USAID and its partners had to develop a gel that could be applied similarly to traditional salves, and spend as much effort on behavior change and institutional strengthening as on the technology.

By focusing our efforts on disruptive innovations such as Nepal’s successful chlorhexidine project and using the U.S. Global Development Lab to design, test and scale similar interventions around the world, USAID will help bend the curve towards the end of extreme poverty.

ABOUT THE AUTHOR

Alex Thier is the Assistant to the Administrator in the Bureau for Policy, Planning and Learning. He tweets from @Thieristan

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Ending Extreme Poverty in Asia through Universal Health Coverage

A woman in the Philippines receives a tetanus shot during a pre-natal visit. / HealthPRO

A woman in the Philippines receives a tetanus shot during a pre-natal visit. / HealthPRO

The 2010 World Health Report on Health Systems Financing and the unanimous endorsement of Universal Health Coverage (UHC) by the United Nations in 2012 have paved the way for rich and poor countries alike to take a closer, more critical look at how raise resources and improve access to health services, particularly for the poor. Asia is home to 3.9 billion people and accounts for a third of the global economy. Despite the region’s robust economic growth, almost two thirds of those in extreme poverty still live in Asia.

While there are many paths that a country can choose to get out of poverty, mobilizing domestic resources towards the health sector – in the form of Universal Health Coverage policies that seek to increase access to services especially for the poor – is a sound and sustainable investment that can lead to great economic returns. These reforms that empower the poor are critical because poor health and health shocks are leading causes of chronic poverty and impoverishment.

An Indonesian patient awaits further instructions during a check-up. / USAID

An Indonesian patient awaits further instructions during a check-up. / USAID

Rapidly growing Asian countries, Bangladesh, Indonesia, Thailand, and Vietnam have shown that improving health indicators and reducing extreme poverty are clearly linked. Declines in infant and child mortality rates in these countries preceded periods of strong and sustained economic growth.

Clearly, an agenda to end extreme poverty must include UHC goals.

Ill health prevents the poor from climbing out of poverty and can impoverish the near poor. When a household member falls ill, this can mean diminished labor productivity. In addition, households often make catastrophic financial outlays paid for by selling their assets, reducing their consumption, dipping into their savings, or borrowing at high interest rates for seeking health care.

High rates of out-of-pocket spending, a highly regressive way of financing health systems, create financial barriers to accessing health care., This financing represents 36 percent and 61 percent of the total health spending in developing East Asia and Pacific and South Asia regions, respectively.

Pupils in Vietnam's Bac Giang Province take part in a USAID deworming project . /  Richard Nyberg, USAID)

Pupils in Vietnam’s Bac Giang Province take part in a USAID deworming project . / Richard Nyberg, USAID)

UHC reforms come in different shapes and sizes. Some common characteristics include improving revenue collection mechanisms so that they are fair and affordable;, helping people move away from paying for health services out of pocket and toward prepayment and risk pooling; improving value for money with strategic purchasing;, and targeting the poor through subsidies.

Many of these reforms across Asia have increased access and utilization of health care, provided financial protection, as well as improved health care outcomes.

Countries such as China and Bangladesh successfully piloted schemes. In Bangladesh, the pilot voucher program to improve maternal and child health successfully increased pre-and post-natal care and facility-based deliveries, while reducing out-of-pocket spending and the costs of these services, and decreasing neonatal mortality rates by a third to almost half in home-based interventions. Bangladesh has adopted UHC as a national policy goal and USAID is providing assistance to support implementation of their health financing strategy.

Vietnam and Indonesia have reached partial coverage of their populations by around two thirds, and have recently taken additional steps to expand their coverage.

Analysis of various UHC schemes in Vietnam (public voluntary health insurance, social insurance and the health care fund for the poor) showed that they had improved financial protection – significantly decreasing spending for the beneficiary insured and providing evidence of positive impacts on their nutrition indicators. And in January of this year, Indonesia set out on the path towards UHC with the goal of covering its entire population of 250 million people by 2019.

The dynamic economic environment in fast-growing Asia means that the role of donors like USAID and the development assistance architecture will need to evolve as well.

Individual countries and the region at large will need to grapple with growing migrant populations and the need for portable schemes that ensure access for migrant labor populations across porous borders. A large and growing informal sector, individuals not covered by the labor and social security provisions, will continue to test how countries communicate expanded coverage to remote and often marginalized communities. Equally as important will be the question of how to finance and address the changing mix of population health needs arising from demographic trends and the emergence of non-communicable diseases.

As many of the developing countries in Asia continue to grow, they will have sufficient resources to afford a basic package of health services for their entire population; however, governments tend to under-invest in their health sector relative to their economic potential.

As a result, oftentimes as countries grow wealthier, public health systems fall further behind.

In Asia and globally, growing domestic resources represent a critical window of opportunity where countries must have the vision and courage to strategically direct this increased wealth towards the health sector so that development dollars are crowded out.

By financing policies that focus on increasing equity and access to quality essential health services – the aim of universal health coverage – countries will be taking concrete steps towards the bold vision of ending extreme poverty.

ABOUT THE AUTHOR

Kristina Yarrow is a Senior Health Technical Specialist in the Asia Bureau, backstopping technical areas specific to health systems strengthening and research such as health financing, UHC, and implementation research.

Caroline Ly is a Health Economist in the Bureau for Global Health’s Office of Health Systems.

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South Sudan: The Threat of Worsening Hunger

Residents of Bor County receive sorghum, oil, and lentils in exchange for road construction work they completed as part of the Catholic Relief Services led Jonglei Food Security Program, in Jonglei, South Sudan.  / CRS

Residents of Bor County receive sorghum, oil, and lentils in exchange for road construction work they completed as part of the Catholic Relief Services led Jonglei Food Security Program, in Jonglei, South Sudan. / CRS

A few weeks ago, my office instructed a vessel carrying 21,000 tons of American-grown sorghum destined to serve hungry people in South Sudan to divert from its Djibouti destination and discharge its cargo in Port Sudan instead. That vessel arrived and offloaded last week.

While the food was originally destined to travel for weeks by road from Djibouti to Gambella, Ethiopia, and then be airlifted or air-dropped into remote areas of South Sudan, a recent agreement between Sudan and South Sudan brings the possibility of a more hopeful scenario.

After almost a year of negotiation, the U.N. World Food Program secured agreement from both governments, as well as opposition groups in South Sudan, to facilitate safe passage of this grain to hungry people in South Sudan.  Saving both time and expense, it will be trucked or shipped by barge across the border from Sudan to South Sudan to meet immediate food needs and be pre-positioned in remote areas for use in the coming months.  If the two governments follow through on their commitments, the opening of this corridor will help to stave off hunger in a new country, whose hopes for growth and prosperity were dashed by ruinous fighting between the government and armed opposition groups one year ago.

Mary Ngok, 31, a farmer in Bor County receives sorghum, oil, and lentils in exchange for road construction work they completed as part of the Catholic Relief Services led Jonglei Food Security Program, JFSP, in Jonglei, South Sudan. / Sara A. Fajardo/Catholic Relief Services

Mary Ngok, 31, a farmer in Bor County receives sorghum, oil, and lentils in exchange for road construction work they completed as part of the Catholic Relief Services led Jonglei Food Security Program, JFSP, in Jonglei, South Sudan. / Sara A. Fajardo/Catholic Relief Services

South Sudan is the most food-insecure place in the world. Six months ago, after visiting, I laid out five key actions that USAID was taking to avert hunger and famine in South Sudan. One of them was to draw on the Bill Emerson Humanitarian Trust (BEHT), a seldom-used fund that USAID taps when unanticipated global needs outstrip food aid budgets, to procure additional food for South Sudan. Thanks to this trust, 50,000 tons of U.S. food – including the 21,000 tons recently offloaded in Port Sudan, are being used to respond to the hunger crisis in South Sudan.

The scale-up has enabled emergency care for more than 76,000 children suffering from severe acute malnutrition, and humanitarian workers have reached roughly 3.5 million vulnerable and displaced people with aid since January. Throughout 2014, conflict and bad weather forced the international community to rely on expensive airlift operations to move food and other supplies into remote areas of the country – operations that are roughly 8 times more costly than serving people by road. While extraordinarily costly in terms of expense, lifesaving aid has helped avert famine – for now.

The question is, what happens next?

Will the United States’ BEHT food make it safely to its intended destination, as planned? Will people already worn down by a year of war be reached with lifesaving aid and recovery support? Or will renewed fighting move South Sudan into a deeper downward spiral?

Sadly, the dry season, which typically lasts from December to April, is not only a time for recovery but has in past years also been a time for renewed conflict. Already we have reports that fighting has begun anew, adding to the suffering experienced by the nearly 1.9 million displaced people.

The international community is already overstretched due to the scale and gravity of the crisis and other humanitarian emergencies worldwide. The United States has provided more than $720 million in response to the crisis, including more than $339 million for food and nutrition assistance alone.

The future of South Sudan is in the hands of the combatants. This humanitarian crisis is man-made, as will be its resolution. The best way to avert a future famine is for the combatants to stop fighting, so that ordinary South Sudanese people can plant crops, markets can reopen and communities can begin to recover.

ABOUT THE AUTHOR

Dina Esposito is the Director of USAID’s Office of Food for Peace

A ‘Daily’ Struggle for Human Rights

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Today, in honor of International Human Rights Day and the 66th anniversary of the Universal Declaration of Human Rights, USAID joins the world  in standing with all those who struggle for the realization and protection of their human rights. We believe that promoting human rights is closely linked to advancing long-term, sustainable development, and that these rights are instrumental to attaining other goals such as economic growth and democracy and addressing underlying grievances that cause instability and conflict.

While USAID’s global mission is to end extreme poverty and promote resilient, democratic societies, inextricably linked to this mission, is the protection and promotion of universally accepted human rights for all persons where we work.

Following the Rwanda genocide in 1994, issues of reconciliation remain a concern for maintaining peace into the future. USAID's Reconciliation and Reintegration programs provided trauma counseling and space for dialogue that allowed Elaine to forgive Alexis (both pictured) for killing her family members. They now have rebuilt their lives in the same community.  / Carol Storey

Following the Rwanda genocide in 1994, issues of reconciliation remain a concern for maintaining peace into the future. USAID’s Reconciliation and Reintegration programs provided trauma counseling and space for dialogue that allowed Elaine to forgive Alexis (both pictured) for killing her family members. They now have rebuilt their lives in the same community. / Carol Storey

Ending poverty is not feasible if people are denied the right to work, or are not paid fairly for their labor or are unable to secure housing, land, and property or lack access to health care.  Building well-functioning democratic societies requires respect for fundamental rights and freedoms of assembly, association, expression, information, political participation, and a fair trial.

Everyone should have the right to non-discrimination and protection against arbitrary arrest and detention, torture and inhumane treatment, and forced labor and slavery.

USAID’s human rights programming is grounded not only in core democratic principles and values of the United States of America, including the four freedoms articulated by President Franklin D. Roosevelt in 1941 (of speech, of worship, from want, and from fear), but also in the clear and timeless framework of the United Nations Declaration of Human Rights.   This includes:

  • Article 2.  Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.  In countries and regions such as Cameroon, Nicaragua, Bosnia, South East Asia, Kazakhstan, Vietnam, Zambia, and Jordan, USAID is supporting the education, advocacy and sensitization work of local activists and human rights organizations who are breaking down the barriers of many forms of discrimination. USAID’s recently launched Lesbian, Gay, Bisexual, and Transgender (LGBT) Vision for Action specifically highlights our commitment to promoting and protecting the rights of sexual and gender minorities.
Training of Human Rights Monitors, part of USAID’s Human Rights in Action Program, Chernihiv, Ukraine. / USAID/Ukraine

Training of Human Rights Monitors, part of USAID’s Human Rights in Action Program, Chernihiv, Ukraine. / USAID/Ukraine

  • Article 3. Everyone has the right to life, liberty and security of person.  USAID is assisting human rights defenders and national human rights institutions in Ukraine, Burundi, Zimbabwe, and Mali, among many other countries, to document, investigate, and report on the severest forms of violations of this internationally enshrined right to life. USAID also supports the protection of human rights defenders  and the victims and survivors of human rights violations.
Youth from the municipality of Caucasia (Bajo Cauca Antioqueño), Colombia, participating in the first intercollegiate human rights competition “Human Rights: A Strategy to Educate.” This initiative, carried out by Corporación Jurídica Colombia Humana with USAID’s Human Rights Program support, sought to promote a human rights culture at schools through a human rights competition that evaluates knowledge acquired during the project duration. Photo Credit: Jairo  Martínez, Corporación para el Desarrollo Social del Bajo Cauca, partner with USAID’s Human Rights Program

Youth from the municipality of Caucasia (Bajo Cauca Antioqueño), Colombia, participating in the first intercollegiate human rights competition “Human Rights: A Strategy to Educate.” This initiative, carried out by Corporación Jurídica Colombia Humana with USAID’s Human Rights Program support, sought to promote a human rights culture at schools through a human rights competition that evaluates knowledge acquired during the project duration. / Jairo Martínez, Corporación para el Desarrollo Social del Bajo Cauca, partner with USAID’s Human Rights Program

  • Article 4. No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms. As millions of people around the world continue to be exploited in the modern day slave trade or human trafficking, USAID set forth a new vision to counter-trafficking in persons (C-TIP) through an agency-wide C-TIP Policy with key programming objectives that include integrating C-TIP activities in development projects across sectors from health to economic growth.  USAID is responding to human trafficking trends in Bangladesh, Cambodia, and Nepal by supporting programs that foster legal labor recruitment practices and safe migration. We also work to ensure that its own employees, partners, and procurement practices are not in any way facilitating human trafficking, by diligently enforcing the agency’s C-TIP Code of Conduct. New partnerships are being cultivated with the private sector since ending human trafficking is everyone’s business.
Nusrat Bibi, an acid burn survivor, takes photographs during a field trip for the photography workshop in Pakistan. Nusrat received photography training from Acid Survivors Foundation (ASF) under the USAID Gender Equity Program, which supports women’s rights as human rights and works to empower women, especially those who are survivors of gender-based violence. As part of a rehabilitation process that includes developing new skills, ASF trained nine acid attack survivors. The photographic work of these survivors was featured in three different exhibitions in Islamabad. / Diego Sanchez.

Nusrat Bibi, an acid burn survivor, takes photographs during a field trip for the photography workshop in Pakistan. Nusrat received photography training from Acid Survivors Foundation (ASF) under the USAID Gender Equity Program, which supports women’s rights as human rights and works to empower women, especially those who are survivors of gender-based violence. As part of a rehabilitation process that includes developing new skills, ASF trained nine acid attack survivors. The photographic work of these survivors was featured in three different exhibitions in Islamabad. / Diego Sanchez.

  • Article 10.  Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal in the determination of his [or her] rights and obligations and of any criminal charge against him [or her]. USAID provides Rule of Law assistance to more than 40 countries around the world, including Bosnia, Burma, Cote d’Ivoire, and Indonesia in order to strengthen the administration of justice and promote independent, accountable, and efficient judicial systems.
Vu Lieu, LGBT Advocate, participated in the Vietnam National Dialogue as part of the “Being LGBT in Asia” Initiative.  The dialogue convened LGBT persons from around Vietnam to share lived experiences and discuss legal and socio-economical challenges they face and propose solutions. / Information Communication and Sharing, Vietnam

Vu Lieu, LGBT Advocate, participated in the Vietnam National Dialogue as part of the “Being LGBT in Asia” Initiative. The dialogue convened LGBT persons from around Vietnam to share lived experiences and discuss legal and socio-economical challenges they face and propose solutions. / Information Communication and Sharing, Vietnam

  • Article 19. Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers. In Central African Republic, USAID is supporting local journalists, radio and press outlets to ensure critical and accurate information and peacebuilding programming is reaching those communities severely affected by the crisis.
  • Article 25.1. Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.  In Angola, USAID has empowered communities affected and threatened by forced evictions and demolitions through capacity strengthening activities and legal assistance and assisting the government in compiling a database of those in need of housing.

Today, we support the global efforts to expand human rights and the fundamental liberties contained in the Universal Declaration of Human Rights, which reminds us that “the inherent dignity and…the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.” It is equally a foundation of development.

ABOUT THE AUTHOR

Nicole Widdersheim is Human Rights Advisor for USAID’s Center for Democracy, Human Rights and Governance

Politically Smart Development

Mid September’s Frontiers in Development conference hosted by USAID was a celebration and a reflection. It celebrated halving global extreme poverty between 1990 and 2010 and reflected on the next big goal: eliminating extreme poverty by 2030. It’s an admirable aim but the next mile will be even harder. Growth, especially in China, which lifted 680 million people out of poverty between 1981 and 2010, played a pivotal role in the gains of the past few decades. Today, extreme poverty is increasingly concentrated in fragile states, with weak governments. And with the link between growth and falling poverty broken in many countries, governments will need to fix it.

Appearing at the USAID Frontiers in Development conference last week, AGI’s patron Tony Blair discussed with Raj Shah the nexus between politics and ending extreme poverty.

Appearing at the USAID Frontiers in Development conference last week, AGI’s patron Tony Blair discussed with Raj Shah the nexus between politics and ending extreme poverty. / USAID


As Francis Fukuyama haswritten in the Wall Street Journal, effective government provides “personal security, shared economic growth and the basic public services (especially education, health care and infrastructure) that are needed to achieve individual opportunity.” And without those things, zero extreme poverty won’t happen. So how can we build effective government? We need to start by providing support that’s “politically smart and locally led,” in the words of David Booth and Sue Unsworth, leading governance experts.

This isn’t always easy to do. It requires flexible funding and adapting approaches as you go, which isn’t always possible for major development agencies. One positive example from our work here at the Tony Blair Africa Governance Initiative (AGI) is found in Rwanda. In 2011, only 16 percent of the population had access to electricity, and, lacking capacity and expertise, the government was struggling to get big power projects off the ground.

President Paul Kagame decided Rwanda should focus all government capacity building on four key areas, including energy. From there, the government, with support from AGI, set up a capacity building program that brought in international experts to work with young Rwandan counterparts across the energy sector. This approach meets the twin goals of delivery and capacity building at the same time. The results are starting to show. There’ll be a boost of 230MW to Rwanda’s grid in the coming years – enough to power tens of thousands of households and small businesses. And these gains look likely to be sustainable – local staff are already taking over from many of the external experts.

The political and the local have been essential to the program’s success. President Kagame has kept the government focused on implementation and the government designed the initiative in a “locally problem driven” way, in Matt Andrews’ words – around a cadre of young Rwandan professionals. AGI’s role as partner has been to help set up systems that work “with the grain.”

The lesson for those of us who work on development is to identify what political leaders really care about and “give them politically realistic advice,” as Tony Blair told USAID Administrator Raj Shah at the Frontiers in Development conference, because they set the real priorities of government.

The U.S. Government’s Power Africa initiative is a great example. The focus of the program is right because energy is an issue that’s high on the agenda of many African leaders as well as being central to economic development. And USAID’s approach is smart because, as well as providing access to capital and technical expertise, it aims to help leaders identify politically feasible routes to manage reforms – something AGI will support through a group of senior former government, energy industry and investment figures. This is important because the politics around things like putting in place the right legislation and setting up effective, independent regulators can be tricky.

The good news is this isn’t groundbreaking. “We need to recognize that development is fundamentally a political process, not a technical one,” wrote Raj Shah in the Frontiers in Development publication. Or as Tony Blair puts it ‘if you miss the politics, you miss the point.’ So the political leader and the development leader seem to agree. If we miss the politics we may miss the chance to end extreme poverty.

ABOUT THE AUTHOR

Dan Hymowitz is Head of Insight and Learning for the Tony Blair Africa Governance Initiative

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