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Q&A: How We Are Working To Rid Mozambique of A Blinding Disease

A community drug distributor provides a young mother with the appropriate dose of the trachoma-fighting drug Zithromax as part of a mass drug administration in Mozambique. / RTI International

A community drug distributor provides a young mother with the appropriate dose of the trachoma-fighting drug Zithromax as part of a mass drug administration in Mozambique. / RTI International

In Mozambique, almost 7 million people are at risk of losing their sight from trachoma, an eye infection that is the world’s leading cause of blindness.

A devastating disease that often strikes poor communities, trachoma is fueled by crowded living conditions and limited access to clean water and proper sanitation.

USAID has supported Mozambique’s government to fight trachoma since 2012. Thanks to the efforts over the past year of the ENVISION project, a collaboration between Mozambique’s Ministry of Health, USAID and other international partners, 1 million people in Mozambique are no longer at risk of contracting the eye infection.

The goal of the project is to eliminate the blinding disease within Mozambique’s borders by 2020.

With such an ambitious timeline, the manager of the project Sharone Backers discusses progress, challenges, partnerships, and what work is left.

What are the consequences of trachoma?

If left untreated, trachoma causes eyelids to turn inward and painfully scrape the cornea. Children can’t function in school, and adults become unable to care for their families and work their crops as the constant itching and unbearable pain worsens.

Eventually, blindness takes over, and lives and futures are changed irreversibly.

Is treatment reaching those who need it?

This year, more than 3.5 million people in five provinces of Mozambique are expected to be treated through mass drug administration. This will be a huge accomplishment largely due to partnership between our country office and the International Trachoma Initiative, which is delivering the trachoma-fighting antibiotic Zithromax.

A child in Mozambique receives an oral solution of Zithromax as part of a national campaign to eliminate trachoma by 2020. USAID supports the campaign through its Neglected Tropical Diseases program. / RTI International

A child in Mozambique receives an oral solution of Zithromax as part of a national campaign to eliminate trachoma by 2020. USAID supports the campaign through its Neglected Tropical Diseases program. / RTI International

Last year, at least 80 percent of those who were eligible received treatment in almost all of the targeted districts, and about half were women.

Women play a powerful role in gathering their families together; they are usually the ones taking children for vaccinations, but they are often the last ones receiving health care themselves. It’s heartening to see women receiving this treatment, so they can in turn benefit and nurture their families.

How do you assess where treatment is most needed?

Mozambique’s Ministry of Health tracked cases of trachoma across the country, mapping where disease rates were high enough to require mass treatment. ENVISION and others provided support — a lot of dialogue was needed, as much was at stake in getting it right.

It’s an enormous task to provide treatment to everyone – but having a clear and accurate picture of trachoma rates is a crucial first step.

ENVISION supported mass drug administrations for trachoma in 10 districts of Niassa province in 2013. These have grown each year since then, and are now conducted in all provinces where trachoma affects at least 10 percent of the population.

What lessons have we learned from our success in fighting trachoma in Mozambique?

Strong engagement with communities, at all levels, is crucial. Conversations with community leaders, before mass treatments begin, ensure they understand these campaigns and will encourage people to participate. High levels of illiteracy mean that posters are sometimes not the best option; however, community radio messages are more far-reaching.

After every mass treatment, ENVISION and the Ministry of Health began reflecting on what needs to be improved.

Distributing antibiotics only gets us so far. Other solutions to fight trachoma include ensuring facial cleanliness, making environmental improvements — such as access to clean toilets, and sometimes providing medical interventions like surgery.

We’ve learned that we must leverage our resources and partnerships to support a full strategy that include those components.

For instance, with support from the Queen Elizabeth Diamond Jubilee Trust, we are working with partners to increase trichiasis surgeries in four provinces.

We are also engaging with NGOs working in the water, sanitation and hygiene sector and the Ministry of Health to incorporate facial cleanliness messages and environmental improvements into programs and policies. We’re particularly proud of a recent partnership with WaterAid to improve access to safe water sources and sanitation.

So what’s next?

It’s amazing to think about how far we’ve come in such a short amount of time: Already, mass treatment is no longer needed in Niassa, Mozambique’s largest and most remote province, since rates of trachoma there have dipped to less than 5 percent.

Current trends tell us that active trachoma levels could fall significantly across the entire country by 2018. This means mass treatment will stop, and we will monitor districts for the next three years to evaluate whether further treatment is needed. We are very excited that this phase may be around the corner.

The trachoma-fighting community in Mozambique has faced its fair share of challenges, but commitment from all involved – from the government to the communities themselves – has kept progress moving.

With support from our partners, I am sure we can eliminate this blinding disease and classify Mozambique as a trachoma-free country.

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Record Population Displacement Shows Needs are Rising

One in three Syrian children, born after the conflict began, have never known a life without war, insecurity or displacement. A new report reveals Syria has the second-largest number of internally displaced people in the world, due to conflict and violence. / Louai Beshara, AFP

One in three Syrian children, born after the conflict began, have never known a life without war, insecurity or displacement. A new report reveals Syria has the second-largest number of internally displaced people in the world, due to conflict and violence. / Louai Beshara, AFP

While the Syria crisis has been going on for more than five years, it wasn’t until the lifeless body of a 3-year-old toddler washed up on the shores of a Turkish beach last September that the plight of the Syrian people made headlines again and struck a nerve with the general public.

His story — and that of the 12 other refugees who drowned with him — is part of a greater humanitarian tragedy unfolding worldwide.

Syria’s crisis has become the most pressing humanitarian emergency of our time. Since the conflict began, hundreds of thousands of Syrian refugees have crossed international borders, risking their lives to reach the safety of Europe.

But this doesn’t represent even half of the people fleeing the violence. Inside the war-torn country, 6.5 million people are internally displaced, meaning they were forced to flee their homes but stayed within their country’s borders.

Worldwide the picture is clear: Conflicts like the Syria crisis have changed the pattern of humanitarian needs, which are growing at an astronomical rate.

According to a new report released by the Internal Displacement Monitoring Centre, 40 million people globally were internally displaced due to conflict and violence by the end of 2015 — the highest figure ever recorded. More than 21 percent, or 8.6 million people, were newly displaced in the last year alone.

In 2015, 8.6 million people were newly displaced due to conflict and violence, and 19.2 million more people were displaced due to disasters. / Internal Displacement Monitoring Centre

In 2015, 8.6 million people were newly displaced due to conflict and violence, and 19.2 million more people were displaced due to disasters. / Internal Displacement Monitoring Centre

Most of these displacements occurred in the Middle East and North Africa, where fighting in Yemen, Syria and Iraq contributed to more people being displaced in this region than in all other regions in the world combined.

In addition to conflict, natural disasters contributed to record-breaking global population displacement, with storms, flooding and last year’s Nepal earthquake accounting for millions more people being uprooted from their homes and communities.

USAID’s Office of U.S. Foreign Disaster Assistance responds to an average of 65 disasters in 50 countries every year, working to ensure that humanitarian aid reaches internally displaced people (IDPs) around the world.

Globally, there are twice as many IDPs as there are refugees. But since IDPs remain in their country and don’t cross international borders, they do not receive the same protection provided to refugees by international law.

To make matters worse, in some of the world’s most dangerous and insecure regions, humanitarian organizations are not given access to deliver critical aid to the people most in need.

Despite these obstacles, USAID disaster experts are working with dedicated humanitarian partners to deliver much needed food, safe drinking water, emergency health care and shelter to IDPs.

We also support activities that protect the most vulnerable — like women, children and elderly people — as well as programs that help address the physical and emotional trauma endured before, during or after a crisis.

In 2015, 8.6 million people were newly displaced due to conflict and violence, and 19.2 million more people were displaced due to disasters. / Internal Displacement Monitoring Centre

In 2015, 8.6 million people were newly displaced due to conflict and violence, and 19.2 million more people were displaced due to disasters. / Internal Displacement Monitoring Centre

But the reality is that the humanitarian system is straining under the weight of today’s multiple and complex global challenges — from conflicts that won’t end to the widespread displacement they fuel.

That’s why the U.S. is seizing the unique opportunity that the World Humanitarian Summit presents to re-affirm our commitment to international humanitarian law, strengthen the international humanitarian system, and improve coherence between humanitarian and development assistance.

It’s an opportunity for us to work collectively with our partners and other countries, bringing all of our expertise to bear, to ensure that we can meet 21st century challenges. This is a significant and long-term task, but one which many agree is long overdue.

Today’s unparalleled challenges require new and innovative solutions. The United States is prepared to roll up its sleeves to figure out ways to better support our partners while continuing to serve the growing number of people who are in need of humanitarian assistance worldwide.

This month’s World Humanitarian Summit presents an opportunity for the international community to come together to form innovative solutions to help those most in need. / Michael Gebremedhin, USAID

This month’s World Humanitarian Summit presents an opportunity for the international community to come together to form innovative solutions to help those most in need. / Michael Gebremedhin, USAID

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Delivering Life-Saving HIV/AIDS Drugs Around the World

Laboratory systems and commodities are a critical component of USAID’s global health supply chain and integral to achieving an AIDS-­free generation. / SCMS

Laboratory systems and commodities are a critical component of USAID’s global health supply chain and integral to achieving an AIDS-­free generation. / SCMS

As the warm Haitian sun comes up, Chantal leaves her four children behind to get her HIV treatment, traveling for three hours in the back of a crowded jeep.

She bumps over unpaved roads to her monthly visit for antiretrovirals, one that she has been doing routinely for several years to keep her disease at bay.

Her children don’t know that she is HIV positive, and she doesn’t want to tell them. She makes this long trip over rough and ragged terrain to preserve her privacy and escape the possibility of stigma, still prevalent in Haitian society.

Hours later, she finally arrives at the Hôpital Immaculée Conception and waits her turn at the pharmacy to see the dispenser for her medicine. This local hospital’s pharmacy is consistently stocked with life-saving antiretroviral drugs as a result of the USAID-led Supply Chain Management System project under the President’s Emergency Plan for AIDS Relief (PEPFAR).

“I’m confident that my medicine will be here,” says Chantal, “When I come, I always find it.”

Since 2005, the supply chain project has been procuring and delivering drugs, laboratory supplies and reagents to hospitals and clinics like Hôpital Immaculée Conception all over the world.

The global health supply chain works to get life-saving HIV/AIDS commodities to even the most rural places around the world. / Jean Jacques Augustin, SCMS

The global health supply chain works to get life-saving HIV/AIDS commodities to even the most rural places around the world. / Jean Jacques Augustin, SCMS

With support from PEPFAR, USAID established the supply chain project to provide a reliable, cost-effective and secure supply of products for HIV/AIDS programs in PEPFAR-supported countries. The supply chain project is to-date the largest ever public health supply chain in the world, and leverages the collective power of many different partnerships, both private and public, to deliver critical products to fight the HIV/AIDS epidemic.

Through this project, USAID focused on saving lives by aggressively scaling up treatment access, promoting country ownership, and investing in sustainable country health systems to make real and lasting progress toward achieving universal access to lifesaving HIV and AIDS products.

For 10 years, the supply chain project has been driving improvements in public health systems. These efforts — in coordination with the efforts of many donors, partners and individuals around the world — are driving toward the ultimate goal: an AIDS-free generation.

As a result, the Supply Chain Management System project

  • Delivered $2.4 billion of life-saving commodities, including antiretrovirals, essential medicines and laboratory commodities
  • Directly procured a majority of the lifesaving antiretroviral drugs used to treat 5.7 million people in developing countries
  • Negotiated a dramatic drop in the cost of drugs to treat a single HIV/AIDS patient to $110 per year
  • Saved hundreds of millions of dollars through the procurement of generic antiretrovirals
  • Delivered 239 million HIV tests to high-prevalence countries, so that millions of people around the world could know their status
  • Saved more than $176 million in shipping costs over the last 10 years
  • Supported local partners in 25 countries to build capacity and country ownership of supply chain management
Chantal, an HIV-­positive woman, waits for her monthly supply of antiretroviral medication at the Hôpital Immaculée Conception in Haiti. / Jean Jacques Augustin, SCMS

Chantal, an HIV-­positive woman, waits for her monthly supply of antiretroviral medication at the Hôpital Immaculée Conception in Haiti. / Jean Jacques Augustin, SCMS

There is no doubt the supply chain project has made an incredible impact on the lives of millions of people around the world, like Chantal. For the last decade, on behalf of the U.S Government, this project has successfully operated the largest public health supply chain in the world.

As a result, patients know their status and are getting the treatment they need. Mothers can care for children born without the virus. HIV-positive parents can go to work and provide for their families.

As the supply chain project draws to a close, a new phase of the U.S. Government’s Global Health Supply Chain Strategy begins under the Procurement and Supply Management project.

Looking forward, the challenge of the Procurement and Supply Management project is to build upon the successes of the supply chain project. In an effort to control the HIV/AIDS epidemic, the new project will rapidly scale up prevention, treatment and care, while harnessing innovations and efficiencies to shape best practices in supply chain management in Africa and elsewhere.

Doing so will require ongoing investments in preventing and treating HIV/AIDS, as well as continued support for national supply chains.

USAID’s vision to take advantage of supply chain innovation to make an impact on eliminating the burden of HIV and AIDS worldwide will serve as a critical foundation to achieving the goal of an AIDS-free generation.

USAID’s global health supply chains promote country ownership of public health programs and create sustainable country health systems. / Ulf Newmark, SCMS

USAID’s global health supply chains promote country ownership of public health programs and create sustainable country health systems. / Ulf Newmark, SCMS

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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.
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