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Archives for Health

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

A person wearing a protection suit

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

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

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

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

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

A woman in a red medical vest greets USAID officials

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

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

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

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

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

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

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

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

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

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

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

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

Map of ebola cases in Democratic Republic of Congo

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

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

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


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

The Hidden Costs of Fistula Repair Surgery

Close up portrait of an African woman

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

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

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

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

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

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

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

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

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

A group of African women

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

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

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

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

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

Mothers waiting in a clinic in Nigeria.

Mothers waiting in a clinic in Nigeria. / USAID

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

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

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

Women at Kyenjojo Hospital, Uganda.

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

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

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

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

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


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

How One Simple Solution Has Saved Thousands of Babies

Three women sit on the floor talking

Jharana Kumari Tharu, a community health volunteer in Nepal, visits the home of Syani Tharu, who is eight months pregnant, to counsel her on how a simple tube of chlorhexidine antiseptic gel, applied to her baby’s cut umbilical cord stump, could help prevent infection and even death. / Thomas Cristofoletti for USAID

Every year, an estimated 2.6 million babies die within their first month of life. About 15 percent of these deaths are caused by complications from severe infection – which, in most cases, can be avoided with simple, cost-effective interventions.

Since 2002, USAID and its partners have been working to scale up the use of one life-saving intervention in particular – chlorhexidine, an antiseptic. Chlorhexidine, which comes as either a gel or a liquid, is safe and simple to use, easy to manufacture, and affordable.

Chlorhexidine is commonly used by hospitals to disinfect skin before surgery and to sterilize surgical instruments. In low-resource countries, it can also be used to protect the umbilical stumps of newborns to prevent life-threatening complications from infection.

Some communities see these types of severe infections regularly due to traditional home birthing practices, such as cutting umbilical cords with dirty household tools and then treating the stump with turmeric or even cow dung, and other unsanitary birthing conditions. By comparison, in high-resource countries severe infections occur in less than 1 percent of newborns.

Studies showed that one-time chlorhexidine treatment can lower the risk of severe infection by 68 percent and infant death by 23 percent. Impressed by these results, the Government of Nepal piloted a USAID-supported chlorhexidine program in 2009. Two years later, chlorhexidine was integrated into routine care nationwide with support from Saving Lives at Birth: a Grand Challenge for Development, also co-funded by USAID.

The scale-up program in Nepal is estimated to have saved over 9,600 infant lives since its inception. In less than 10 years, chlorhexidine impressively achieved national coverage.

Today, more than 1.3 million newborns throughout the country have benefited from this simple treatment.

The Government of Nepal has been instrumental in scaling up chlorhexidine. From integrating it into packages that promote maternal and child health, to procuring chlorhexidine tubes and training healthcare workers, the government has been a strong advocate for use of the antiseptic.

The introduction of chlorhexidine in Nepal was further guided by the Chlorhexidine Working Group, a team of representatives from various local and international organizations. Hosted by USAID’s partner PATH, this group was formally established in 2012 to help speed up the scale-up progress.

Typically, decades pass before global health innovations take off in low-and-middle-income countries, according to an analysis by the Bill & Melinda Gates Foundation, Dalberg Global Development Advisors and the Boston Consulting Group. The speed of the chlorhexidine scale-up in Nepal compares favorably to health innovation launches in the United States and other developed countries, which typically take about five years.

So, the question then becomes, how can easy wins from the successful scale-up of a life-saving, low-cost intervention in Nepal be carried over to more countries and across other interventions?

According to a recent report, some factors that contributed to the rapid scale up of chlorhexidine in Nepal and beyond included the ability to produce it locally, extensive market research, policy and advocacy work, and collaboration between government and the private sector.

From the outset of the program in Nepal, the Chlorhexidine Navi Care Program, implemented by John Snow Inc. (JSI), was designed to serve as a “living university” for chlorhexidine scale-up. JSI, USAID and the Government of Nepal carefully documented what was working – and just as importantly, what was not working – to share invaluable lessons.

These organizations partnered together to host learning visits for officials from countries interested in introducing and scaling chlorhexidine. All program-related materials were also made publicly available for other countries’ use.

The impact of Nepal’s success reached beyond its borders and paved the way for countries such as Nigeria, Bangladesh, Pakistan and the Democratic Republic of Congo to begin their own journeys to use chlorhexidine to reduce high rates of newborn deaths.

Nigeria, a country with the third-highest number of newborn deaths in the world, has made great strides — from starting chlorhexidine pilot programs in 2013, to developing and implementing a national scale-up strategy and implementation plan by 2016.

As the use of chlorhexidine for preventing newborn deaths continues to grow, the global health community must keep on exploring new ways to introduce and scale up proven life-saving interventions.

The goal? To create a healthier world for generations to come.


Mateo Haddad, Global Health Communications Intern; Bethany Reyes, Data Science Intern.

Witnessing Hope and Health for Kenyan Orphans and Vulnerable Children

An outdoor playground

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

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

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

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

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

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

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

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

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

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

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

Still, there are challenges.

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

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

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

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

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

Exterior of a blue buuilding

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

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

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

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

*Full name withheld to protect privacy.

The Beauty of a Wastewater Treatment Plant

A concrete area with water flowing through it

Before: Wastewater flowed untreated through this neighborhood, increasing the risk of waterborne and airborne diseases. / Center for Urban and Regional Excellence

Most people are familiar with the breathtaking view of the Taj Mahal with its waterways, walking paths and topiary. Of course, this is the perspective from the south, but personally I find that the view from the north is just as moving. From there, you can see the mighty Yamuna river. The poet Rabindranath Tagore once wrote: “The Taj Mahal rises above the banks of the river like a solitary tear suspended on the cheek of time.”

But the Yamuna is not the same river it was when Tagore wrote those words or when Shah Jahan commissioned the Taj Mahal. Nowadays, the Yamuna is one of the most polluted waterways in India, putting communities at risk of contracting cholera, dysentery, typhoid and polio.

I’ve worked as a health and development professional for 22 years and arrived in India a little more than a year ago to be the Mission Director for USAID. If there is one thing my career has taught me, it is to never lose hope that every problem has a solution. That is exactly what people in a slum community in Agra achieved with the help of the local municipal body.

In 2009, this slum community near the Taj Mahal did not have access to sanitation facilities, disposal systems or waste collection. Therefore, 85 percent of residents resorted to open defecation. For the most part, the waste flowed directly into the river, from which residents—and many others—draw their water for drinking and irrigation. Needless to say, this caused high rates of sickness and even death.

The Agra Municipal Corporation — the local governing body for the city — collaborated with a USAID-supported NGO called the Center for Urban and Regional Excellence to reduce the risks of disease. The solution was to construct a wastewater treatment plant that would make the waters flowing by the mausoleum cleaner — and the more than 2,000 people living in this settlement healthier.

The wastewater treatment plant, designed by sanitation experts, was completed in 2011 and does not use polluting chemicals. Instead, it uses natural methods that required a relatively low primary investment, low power consumption and low maintenance demands, making it cost effective to build and operate.

From nearby houses, the treatment plant resembles a picturesque wetland tucked into their neighborhood.

Additionally, the treatment system is designed to channel treated water back into the community’s systems, allowing it to be reused by farmers and for toilets. The result is less water wasted and less wastewater polluting the Yamuna and the local environment.

An area of concrete with a metal grate, with water flowing on either side

After: This wastewater treatment system cleans water and channels it back into the community to be reused by farmers and for toilets. / Center for Urban and Regional Excellence

After construction was complete, USAID trained engineers and community members on the plant’s operation and maintenance. In 2017, the Agra Municipal Corporation took over all operations and committed to ensuring the plant improves residents’ lives for years to come.

One development project isn’t going to make the Yamuna river perfectly clean, but life has improved for these Agra residents living in the shade of the Taj Mahal. The community is no longer one of the many communities whose daily defecation pollutes the surrounding environment, threatening their health and the health of their neighbors. It’s also proof that a wastewater treatment system and its maintenance can be affordable.

What the Agra Municipal Corporation and our NGO partner managed to do with USAID support is impressive. Now, other municipal corporations are following Agra’s model — such as East Delhi and Rourkela. I encourage others to also follow their example.

The Government of India is working to make the entire country clean by 2019 through its Swachh Bharat (Clean India) Mission. At USAID, we are committed to helping in any way we can. Every step taken towards providing people with clean water and access to sanitation facilities is a step in the right direction.



A brick building with a small canal flowing past it, with plants growing alongside the canal

From nearby houses, the treatment plant resembles a picturesque wetland tucked into their neighborhood. / Center for Urban and Regional Excellence



Mark Anthony White is the Mission Director for USAID in India. Follow @usaid_india

Ebola Aftermath: Restoring Trust in Hospitals in Guinea

Fatimata Binta Diallo, an anesthesiologist, inside the office of Dr. Bakayoko Sekou, director of Dubreka Hospital. / Mariama Keita, USAID

Fatimata Binta Diallo, an anesthesiologist, inside the office of Dr. Bakayoko Sekou, director of Dubreka Hospital. / Mariama Keita, USAID

In 2014, Guinea was declared ground zero for the Ebola outbreak, and before it was brought under control in January 2016, there were more than 3,300 confirmed Ebola cases in the country.

During the peak of the rapid spread of the disease, people were afraid to go to the hospital because of low levels of trust in government and poor delivery of health services in general. People were less willing to accept Ebola as real, nor did they embrace social messaging aimed at reinforcing behavior change to save lives.

In the aftermath of the 2014-2016 epidemic and in the face of its reemergence in the Democratic Republic of Congo, USAID is working with partners, communities and policymakers to help Guinea recover and stay resilient. Through a combination of hospital renovations, medical equipment donations and community engagement, we are rebuilding the people’s trust in the healthcare system so they will resume using hospitals and clinics.

Karoline Nyoka, a program officer with Health Communication Capacity Collaborative, greets and interviews patient Salematou Sylla. / Mariama Keita, USAID

Karoline Nyoka, a program officer with Health Communication Capacity Collaborative, greets and interviews patient Salematou Sylla. / Mariama Keita, USAID

Recently, I traveled to the francophone West African country and made my way to Dubreka, a small town of 8,000 people just north of the capital, Conakry. There, I met with Dr. Bakayoko Sekou, director of Dubreka hospital, and we talked about how the Ebola crisis had affected his community.

Prior to the emergence of Ebola, on average there were up to 95 births per month at the hospital. But during the outbreak, the rate dropped to the single digits due to fear of sickness and death associated with hospitals during the outbreak.

Dr. Bakayoko Sekou, director of Dubreka Hospital, takes a group photo with his staff. / Mariama Keita, USAID

Dr. Bakayoko Sekou, director of Dubreka Hospital, takes a group photo with his staff. / Mariama Keita, USAID

However, Dr. Sekou proudly reported that the community is once again using Dubreka hospital to meet their health care needs — he attributed the current rate of 100 births per month to a higher quality of services that the staff now offers.

On my way to meet Dr. Sekou, I noticed the symbolic large Gold Star (Etoile d’Or) signage prominently displayed near the entrance of the health facility, signifying that the Dubreka hospital had passed a months-long accreditation process.

The smile of 26-year old Salematou Sylla brings tears of joy to the health team at Dubreka Hospital who saved her life. / Mariama Keita, USAID

The smile of 26-year old Salematou Sylla brings tears of joy to the health team at Dubreka Hospital who saved her life. / Mariama Keita, USAID

The Gold Star accreditation system is part of a campaign by USAID partner Health Communication Capacity Collaborative, Jhpiego and the Guinea’s Ministry of Health to rebuild people’s trust in the healthcare system and improve the quality of services offered at hospitals.

The brand and the quality associated with it was widely promoted through a mass-media campaign on radio, TV, on billboards, and at community events. Dr. Sekou

cited the Gold Star accreditation as one of his greatest achievements.

He also attributed the accreditation to USAID support in renovating the pediatrics and maternity section of Dubreka hospital, which included adding ramps, repairing the roof, installing ceiling fans and air conditioners in delivery rooms and operating rooms, and fixing the building’s plumbing.

Basic supplies and amenities like protective gloves and air conditioning are rare in hospitals in the developing world. Fatimata Binta Diallo, an anesthesiologist who visited Dr. Sekou’s office during our meeting, told us she vividly remembered a patient who was completely surprised by doctors’ use of protective gloves. Another patient being prepared for surgery had shouted to her, “Madame Diallo, wait, don’t put me to sleep yet. I feel like I am in paradise with this cool air.”

The services that the hospital provides are life-saving, but they only work if people trust that the hospitals are safe to use. Dr. Sekou told me the story of 26-year old Salematou Sylla, who came to the hospital in need of an emergency C-section. Although she lost her unborn child and underwent three major surgeries, she survived.

“Salematou entered into the hospital unable to pay for her medical fees and was in need of emergency caesarean section due to a shattered womb,” Dr. Sekou told me. “Many times, healthcare workers pull resources together from their own pocket to support the financial health care needs of patients like Salematou.”

Dr. Sekou then offered to introduce her to me. We walked into what appeared to be an outpatient section, where I saw a young, thin and fragile-looking woman sitting in a chair. Our presence brought a smile to her face. I had to fight back tears as I watched Dr. Sekou embrace Salematou as he would his own biological daughter.

Her survival is a huge success, as maternal and neonatal mortality rates in Guinea are some of the highest in the West African region. At USAID, we remain committed to re-establishing trust and restoring confidence in the health care system to prevent another global health humanitarian crisis.

As Ebola recovery interventions come to an end in the region, USAID has renovated 16 health facilities, and we expect to renovate another 20 by the end of this year. This translates into more success stories like Salematou’s as the citizens of Guinea get access to quality health care.

About the Author

Mariama Keita is a Communication and Partnership Advisor in USAID’s Africa Bureau, Office of Sustainable Development working on Ebola Recovery programs in West Africa. Follow her @mariamakeita

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.


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.


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.


Ebola’s Second Punch: Hunger

Fudia Lansana is back at work on her farm in Sierra Leone after the Ebola outbreak kept her home without food for her family. / Michael Stulman, CRS

Fudia Lansana is back at work on her farm in Sierra Leone after the Ebola outbreak kept her home without food for her family. / Michael Stulman, CRS

Fudia Lansana once felt that nothing could be as terrifying as becoming one of more than 14,000 people infected with Ebola in Sierra Leone. But as her household of nine went from eating three meals a day to two, and then from two to one, Fudia realized she was facing something just as scary: hunger.

Under normal circumstances, Fudia would walk a few miles from her village to work on her farm with friends and family, but these were far from normal times. The government—in an effort to stop the spread of Ebola—restricted movement and prohibited public gatherings.

Approximately 45 people wait to receive cash transfers during a Catholic Relief Services distribution in Konia village, Kanema district, in Sierra Leone. / Michael Stulman, CRS

Approximately 45 people wait to receive cash transfers during a Catholic Relief Services distribution in Konia village, Kanema district, in Sierra Leone. / Michael Stulman, CRS

“Farming is our source of survival, but things were locked down during the Ebola era,” says Fudia. “We couldn’t reach the farm, so having enough food was very difficult.”

Fudia survived for months on savings and borrowed money. But even now that the Ebola outbreak is over, she and other farmers still feel its effects. Their farms are overwhelmed by weeds after months of neglect. It will be a while before they can prepare the land, plant new crops and collect the harvest to replenish their depleted food stocks.

Immediate relief has come in the form of cash transfers distributed by Catholic Relief Services with support from USAID’s Office of Food for Peace. The monthly $30 distributions target nearly 24,000 people in Kenema district, which has one of the highest rates of extreme poverty and chronic malnutrition in Sierra Leone.

The cash distributions are a bridge to get farmers over the next 10 months. They help farmers make ends meet until markets and food production recover and income-earning opportunities increase.

Life Before Ebola

Before the Ebola outbreak, Sierra Leone was still feeling the effects of a brutal decade-long civil war that ended in 2002. More than 60 percent of the population lived on less than $1.25 a day, according to the United Nations Development Program, and life expectancy was 48.

“Life was difficult then too,” says Battu Koroma, the breadwinner for her household of eight. “Since I lost my husband during the war, things were hard. But then during the outbreak, I could not farm or visit my family. I would take loans from people. I would give away my clothes just for a cup of rice.”

Ebola’s Economic Impact

“If you didn’t have money saved, you couldn’t afford to buy food,” explains Fudia. “During the Ebola outbreak, I was surviving on plain rice.”

Children from over 4,000 vulnerable families could eat three healthy meals a day after their parents used cash transfers from Catholic Relief Services to invest in their farms and buy food. / Michael Stulman, CRS

Children from over 4,000 vulnerable families could eat three healthy meals a day after their parents used cash transfers from Catholic Relief Services to invest in their farms and buy food. / Michael Stulman, CRS

She buys the rice, fish and fruit at markets in her village. Fudia and others who received cash distributions were encouraged to buy locally produced food, which ensures the money supports local merchants and stays in the community. This helps local markets to recover from the shock of Ebola and helps community-based food producers and buyers to get back on their feet.

“Everyone is benefitting from this, including local businesses,” Fudia says. “When the money isn’t there in the community, businesses can’t sell, so they don’t make money.”

Cash distributions also mean people have the flexibility to purchase what’s most important for their family. For example, they are able to buy a variety of nutritious foods at the market or seeds to restart their farm.

‘Getting More Life’

Fudia chose to invest her first $30 installment in her farm.

“I have been able to hire people to help prepare my land for planting seeds and to increase the size,” she says. “This will change our lives.”

Fudia also likes the educational components of the food assistance program. “I’ve learned about nutrition and health care,” she says. “I can take care of my family, improve my farm and eat well.”

Like Catholic Relief Services’s work in more than 100 countries around the world, supporting families like Fudia’s is helping improve and advance human life.

“Food brings life,” she says. “And with this money, I’m getting more life.”

USAID, through its Food for Peace program, partners with seven NGOs, including Catholic Relief Services, across Liberia, Guinea and Sierra Leone to address acute food insecurity. The program uses a cash-based approach that restores household purchasing power, promotes the recovery of market function and trade, and supports agricultural production.

Since the onset of the Ebola crisis in 2014, Food for Peace has reached more than 1.3 million people with emergency food assistance. The program continues to help thousands of families like Fudia’s to meet their food needs, while simultaneously helping local food producers, markets and countries recover from the food security impacts of Ebola.


Michael Stulman is the regional information officer for West and Central Africa at Catholic Relief Services (CRS).  Follow him @MichaelStulman

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.


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


Resilient Health Systems Can Prevent and Contain Pandemics

Capt. John Whiteside of the U.S. Public Health Service dons Personal Protective Equipment as he prepares for a new potential Ebola case at the Monrovia Medical Unit in Liberia. USAID led and coordinated the U.S. Government's relief efforts in West Africa for the Ebola response. / Neil Brandvold, USAID

Capt. John Whiteside of the U.S. Public Health Service dons Personal Protective Equipment as he prepares for a new potential Ebola case at the Monrovia Medical Unit in Liberia. USAID led and coordinated the U.S. Government’s relief efforts in West Africa for the Ebola response. / Neil Brandvold, USAID

Resilience is one of those buzzwords that every so often captures the hearts and minds of development practitioners. The importance of this particular term, though, becomes all too clear as the world faces an increasing number of humanitarian crises, including outbreaks that can turn into pandemics.

Did you know, for instance, that every year, up to 500,000 people die from the flu? And in years when pandemic flu occurs, millions of people can lose their lives. The 1918 pandemic flu is a good case in point, as it infected up to 40 percent of the populations of some countries and killed up to 100 million people.

As a result of global warming, more pathogens with pandemic potential continue to emerge, many of which originate in animals (zoonotic). They include Ebola, H5N1 avian flu, H7N9 avian flu, HIV/AIDS, and two kinds of coronavirus: severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS).

In this scenario, resilience is about detecting potential pandemic threats, and then mitigating and containing them. This concept came to the forefront during the 2014 Ebola outbreak when already stretched and under-resourced health systems in West Africa were confronted with a surge of patients, a contagious virus, overall lack of preparedness and minimal resources.

A technician swabs the throat of a duck at Bangkok’s Klongtoey Market during an avian influenza survey. / Richard Nyberg, USAID

A technician swabs the throat of a duck at Bangkok’s Klongtoey Market during an avian influenza survey. / Richard Nyberg, USAID

And to be fair, Ebola caught us by surprise also in North America where health personnel initially felt inadequately trained and hospitals struggled to put in place a rapid plan of action.

The point is that resilience in the health sector is not static but rather an ongoing and evolving state of affairs. Much of the work that USAID does in the global health space is focused on strengthening health systems, so they perform well and are resilient.

Well-performing health systems provide sustained, equitable access to essential services for all without financial hardship. They are better able to bounce back when adversity strikes; are prepared to detect and respond to emerging disease threats; are able to adapt to adverse conditions; address a wide range of health challenges; and offer innovative solutions by leveraging diverse skills and views.

USAID invests in health system strengthening by partnering with countries to better manage financial resources, to ensure the right health workers and medicines are available where and when needed, and to inform and strengthen governance for effective service delivery.

And, yes, we all know that pathogens do not wait patiently in line to get their passport stamped. Contagious diseases will continue to threaten humanity because of the globalized nature of the world we live in and the impact of climate change.

Our work on emerging pandemic threats is meant to prevent, or at the very least, to contain a humanitarian crisis and minimize the impact of disease outbreaks on human health and the economic and social stability of countries. We do this by building the capacity of countries to prevent the emergence of new zoonotic diseases, to detect them early and to control them in a timely and effective manner.

Health innovations can strengthen health systems and save lives during a disease outbreak by quickly leveraging collective expertise and delivering practical and cost-effective solutions. Last year, USAID in partnership with the White House Office of Science and Technology Policy, the U.S. Centers for Disease Control and Prevention, and the Department of Defense launched Fighting Ebola: A Grand Challenge for Development.

The initiative was to help frontline workers provide better care and stop the spread of Ebola in West Africa. Global innovators generated close to 1,500 ideas. Half of the funded innovations are either in use or available for purchase today.

This past April, the Agency launched the Combating Zika and Future Threats Grand Challenge. Through this effort, the Agency will invest up to $30 million in groundbreaking innovations and interventions that enhance our ability to prevent, detect and respond to the Zika virus and other future infectious disease outbreaks—in both the short and long-term.

This latest Grand Challenge specifically calls for solutions that improve and enhance vector control (methods that eliminate the transmission of pathogens from animals to humans), personal and household protection, surveillance, diagnostics and community engagement.

We are also enhancing preparedness and response by creating university networks across the U.S., Africa and Southeast Asia to train graduates in a variety of sectors and disciplines.

As the world becomes increasingly connected, we must ensure that health professionals are able to address the complex, multi-sectoral disease detection, response, prevention, and control challenges in their countries and regions.

In this context, resilience is about helping other countries be more well-rounded and prepared to create a safer, healthier world for all.


Irene Koek is the Acting Deputy Assistant Administrator for USAID’s Bureau for Global Health.
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