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Archives for Global Health

Around the World in Videos: How USAID is Helping Curb Child and Maternal Deaths

Mom and baby are doing fine because mom was taught how to perform Kangaroo Mother Care to keep her premature newborn warm. / Molly Ronan, Embrace Global

Mom and baby are doing fine because mom was taught how to perform Kangaroo Mother Care to keep her premature newborn warm. / Molly Ronan, Embrace Global

In 1990, more than 12 million children under the age of 5 died every year because of preventable conditions and diseases. Today, we face a situation considerably less bleak.

But still, far too many children today are being robbed of the chance to lead full, healthy lives. They are being robbed by illnesses we can prevent and treat. And far too many mothers won’t get to hold their newborn in their arms. These women won’t have the chance to raise their families or contribute to their communities.

Over the past six years, the Obama administration has strategically focused our maternal and child health programs in the 24 countries that account for more than 70 percent of child and maternal deaths globally.

By providing expectant mothers with high-quality and respectful care during delivery, resuscitation for newborns, vaccinations, diarrhea treatment and education about the importance of breastfeeding and handwashing, it is estimated we have helped save the lives of nearly 2.5 million children and nearly 200,000 mothers since 2008.

Acting USAID Administrator Alfonso Lenhardt joins Indian Prime Minister Shri Narendra Modi and heads of delegations from around the world at the Call to Action Summit on Aug. 27 in New Delhi, India. / Clay Doherty, USAID

Acting USAID Administrator Alfonso Lenhardt joins Indian Prime Minister Shri Narendra Modi and heads of delegations from around the world at the Call to Action Summit on Aug. 27 in New Delhi, India. / Clay Doherty, USAID

This week in New Delhi, I join health ministers from those priority countries and experts from across the globe for The Call to Action Summit to take stock of progress, share best practices and forge alliances.

Here are snapshots of some of USAID’s efforts around the world.

India

Like all mothers, Satyawati wants the best for her children, including for her newborn son. In a world where motherhood is still a risky endeavour, her story reflects the Indian Government’s new approach to maternal and child survival. With help from her local health worker, Satyawati knows how to best care for her children. She has had them vaccinated, and she practices proper hygiene at home.

Millions more have benefited from India’s recent efforts to reduce maternal and child deaths. In fact, under-5 mortality has dropped from 126 per thousand live births in 1990 to 53 per thousand live births in 2013. The government is using a scorecard to track its progress, providing transparency and accountability.

Malawi

“It’s heartbreaking to not have the equipment you can use on a baby to survive,” said Indira Chikomoni, a nurse at Zomba Central Hospital in Malawi. But with USAID’s support, 27 hospitals throughout Malawi now have access to a device called the Pumani bCPAP, which helps newborn babies breathe until their lungs have fully developed. The device has tripled the survival rate for babies treated for respiratory distress syndrome.

Gloria Mtawila’s son Joshua, who was struggling to breathe at birth, stayed on the machine for a month until eventually he could breathe on his own, and now he is a healthy baby boy.

Ethiopia

Adanech Belay is a proud mother of three, one of millions of rural families that used to live beyond the reach of the health system in Ethiopia. With USAID’s help, the Ethiopian Government has trained more than 38,000 health workers and deployed them around the country. Now, Belay can give birth in a clinic. She knows about vaccines, hygiene and family planning. Health extension workers now form the backbone of Ethiopia’s health care system, empowering families like hers to take charge of their own health. And the efforts are working.

In September 2013, Ethiopia announced it had achieved Millennium Development Goal 4—reducing child mortality by two-thirds by 2015—a full two years ahead of schedule. In 1990, Ethiopia’s under-5 mortality rate was one of the highest in the world at 204 for every 1,000 live births; by 2013, this rate had been slashed to 64 for every 1,000 live births.

Nepal

Until recently, three in 100 Nepali babies died before they were 1 month old, often from infections introduced into the body through the umbilical cord stump. In Nepal, where home delivery is common, a newborn’s umbilical cord has traditionally been cut with dirty household tools, and substances like oil, turmeric or even cow dung were rubbed on the stump to encourage “healing.”

All that is changing now with the support of USAID. With our partner JSI, we’ve helped develop a low-cost antiseptic gel we’re providing to pregnant women free of charge. A network of 50,000 female volunteer health workers are teaching communities how this little tube and new healthy practices can save their babies’ lives.


When a child dies, and when a mother dies giving birth, it is a tragedy for all of us. Because we miss out on everything they might have offered, and because it continues the cycle of extreme poverty that holds the entire world back. Together, we can break that cycle.

The goal of ending preventable child and maternal deaths is within our reach. We will continue Acting on the Call until every mother and child has the chance to lead a full, healthy life.

Q&A: The Legacy of West Africa’s Ebola Crisis

USAID’s Senior Ebola Coordinator Denise Rollins (right), Mission Director John Mark Winfield (second from right) and Bureau of Legislative and Public Affairs staffer Kate Alexander listen as a staff member of DuPort Road Clinic in Paynesville, Liberia speaks to them. / Jonta Williams, USAID

USAID’s Senior Ebola Coordinator Denise Rollins (right), Mission Director John Mark Winfield (second from right) and Bureau of Legislative and Public Affairs staffer Kate Alexander listen as a staff member of DuPort Road Clinic in Paynesville, Liberia speaks to them. / Jonta Williams, USAID

In this Q&A series, we are profiling the experts who have worked tirelessly to stop the spread of the deadly Ebola virus in West Africa and are helping societies rebuild and strengthen health systems in the aftermath of the outbreak.

Denise Rollins, the senior coordinator of the Africa Ebola Unit, has worked at USAID for 28 years. She rejoined USAID in March after retiring last October because she felt a tremendous commitment to help those in need. She is USAID’s liaison coordinating with other U.S. Government agencies to help West African countries strengthen their ability to respond to future disasters.

What will the legacy of Ebola be in the countries affected by it?

Ebola has changed the lives of those affected by the virus and those who helped fight the disease. Ebola has left behind pain, sadness and death; we cannot keep our heads in the sand knowing what we now know about the disease.

However, as these countries get to and remain at zero, the international community will help build more enduring social and economic systems that will allow the countries to handle not only Ebola, but other infectious diseases, as well. We will once again see progress in health, agriculture, education and the overall economy. While Ebola leaves a legacy of caution and preparedness, it also gives us a future based on hope and resilience.

In July, USAID and other donor partners and governments gathered at the International Ebola Recovery Conference held at the UN. What are your thoughts on the conference?

The conference was a platform for representatives of Guinea, Liberia, Sierra Leone and the Mano River Union to outline their recovery strategies, and for the UN to foster a dialogue between the African countries and the donor community about recovery priorities and expectations.

Donors then pledged an unprecedented $3.4 billion in new funding, with the United States pledging $266 million, in addition to the $1.8 billion already provided for the response efforts. This brings the total pledged for response and recovery to more than $5.2 billion from the donor community.

This was a great step forward in a global call to action that will lead to the creation of more resilient societies in Africa.

What made the Ebola crisis different from past health crises?

The large number of people dying, the rapid spread of the virus, and an initial inability to treat patients made this crisis different. In terms of geography, Ebola reached bustling capitals and heavily populated cities, leading to a faster rate of transmission. Misunderstandings and lack of information about the disease also increased fear and panic, causing some victims to avoid reporting their illness. We have never seen a humanitarian public health crisis quite like this one.

What role has communications played in controlling Ebola?

Denise Rollins retired last October after working at USAID for 28 years, but when asked to return as senior coordinator for the Africa Ebola Unit, she said “yes” without hesitation. “I knew this was the right position for me,” she said. / Ellie Van Houtte, USAID

Denise Rollins retired last October after working at USAID for 28 years, but when asked to return as senior coordinator for the Africa Ebola Unit, she said “yes” without hesitation. “I knew this was the right position for me,” she said. / Ellie Van Houtte, USAID

Due to pre-existing issues with digital and communications infrastructure, it was hard to share information about the disease during the crisis. It was difficult to control the outbreak without accurate and timely information to detect Ebola, trace contacts of people who were infected, organize patients’ transport to treatment centers, and coordinate teams to conduct safe burials. Poor information hampered our ability to understand where the outbreak was occurring.

In Liberia, USAID sent a data logistician to serve on the Disaster Assistance Response Team to develop a better data sharing platform. He helped significantly reduce the time it took to get information from outlying areas to the capital. USAID is working with all three countries on improving data and communication technologies.

We are also strengthening public and private partnerships to bring low-cost Internet and mobile phone service to urban and lower-income, rural settings.

How are we helping to strengthen governance?

USAID is expanding the roles of community groups, NGOs and civil society to manage the effects of Ebola and more effectively work with the government to improve the quality of public services.

Our plan includes help with reopening schools, empowering civil society, and supporting open data policies and using technology for government services and information.

Interest in Ebola has been declining as the situation improves. Why are our response efforts still important?

The focus of the response continues to be ending the Ebola epidemic. While there is Ebola in West Africa, nothing prevents it from entering the United States, so this is a matter of national security.

In terms of the countries themselves, Ebola quickly damaged weak institutions, disrupted vulnerable communities and stymied health systems’ ability to address other infectious diseases or basic health care. We strive to rebuild and strengthen health systems there to enable societies to fend off future threats, while making sure those who’ve experienced setbacks can return to a path of prosperity.

These efforts are core to USAID’s mission to end extreme poverty and promote resilient, democratic societies.

Amid the Ebola crisis, many stories have emerged describing heroic aid efforts and acts of bravery. What stories touched you most?

Access to education and the preservation of arts and culture are important to me, so I was heartened to hear stories of children in Sierra Leone eagerly tuning in to an education radio program; of an American artist who stuck photos of smiling health workers on their protective suits so patients could see who was underneath the mask; of actors, taxi drivers, traditional leaders and musicians working together to raise awareness and stop Ebola.

Empowering Youth: Expanding Access to Reproductive Health

Youth face unique economic and social barriers to receiving family planning services, limiting their ability to make healthy choices about their reproductive health. USAID is committed to making youth’s aspirations a reality by expanding access to these services. / Neil Brandvold, USAID

Youth face unique economic and social barriers to receiving family planning services, limiting their ability to make healthy choices about their reproductive health. USAID is committed to making youth’s aspirations a reality by expanding access to these services. / Neil Brandvold, USAID

Like millions of women around the world, I want to help my children pursue the lives they dream of having. I want my younger child, a teenage girl, to have the same opportunities as the older one, a boy. I hope both of them will be treated fairly, regardless of their gender, as they acquire an education. I want them to develop the confidence to accomplish anything they strive for, and have every opportunity open to them.

As young adults, I want them to understand the importance of family planning so they are empowered to make good decisions. I hope they will wait to have a child until the time is right. If and when they decide to start families, I want them to be able to choose both the number of children they have and the timing and spacing of my grandchildren.

In my visits to USAID’s country programs, I’ve spoken with women across the globe — from Ethiopia to India — who want the same. What I want for my son and daughter are things that all young people deserve. Advancing youth’s access and understanding of family planning is not a “be all and end all” solution to poverty, inequity and poor health, but it’s still critical to ensuring healthy and fulfilling lives.

Yet too often, youth are underserved by family planning programs and reproductive health education, including HIV prevention. HIV and pregnancy-related complications are the major causes of death among youth worldwide. In many countries where USAID works, high levels of childbearing and an unmet need for contraception among adolescents are concerns.

Youth are not a homogenous population; their needs vary depending on their circumstances. In some areas, where there are social norms encouraging childbearing to prove fertility, married youth have a high unmet need for family planning. Young people outside urban areas are often overlooked by family planning programs and must travel long distances to find such services.

Why should we care? Expanding access to reproductive health services and information is vital to reducing inequality. When girls understand the importance of healthy timing and spacing, and when men and boys are engaged in family planning efforts, we are closer to achieving gender equality. Men and women’s equal investment in reproductive health strengthens families and improves the economic wellbeing of communities.

Maimouna Ba, the operator of a small reproductive health clinic in Senegal, explains the female condom to a university student. Local efforts of community members like Maimouna helps empower youth to make smart decisions about their reproductive health. / Benjamin Bynum

Maimouna Ba, the operator of a small reproductive health clinic in Senegal, explains the female condom to a university student. Local efforts of community members like Maimouna helps empower youth to make smart decisions about their reproductive health. / Benjamin Bynum

Making access available

USAID’s Office of Population and Reproductive Health has prioritized youth, and the Agency as a whole is taking action to reach this underserved group.

USAID’s global flagship for strengthening family planning and reproductive health service delivery, Evidence 2 Action, is meeting the needs of young people by identifying, adopting and scaling evidence-based practices on a country-by-country basis. Similarly, USAID’s first dedicated cross-sectoral youth development project, YouthPower, aims to increase youth engagement in development and achieve positive outcomes across multiple sectors, including reproductive health.

USAID works with numerous partners to empower youth. In Senegal, a small reproductive health clinic, supported by USAID since 2012, provides services and counseling to university students in a safe and confidential setting. In Ukraine, a local NGO with its genesis in a former USAID-funded project called Together for Health mobilizes local youth to raise awareness of family planning and reproductive health issues, while dispelling common myths and misconceptions regarding contraception.

Youth account for more than 30 percent of the population in many developing countries. To harness the immense potential of the world’s young people, the global community must increase efforts to meaningfully involve youth in the decisions that impact their lives.

When we support young people’s aspirations and engage them in the global conversation on family planning, they better understand the importance of delaying the age when they have their first child and spacing pregnancies.

This not only will improve health outcomes, but will enable girls to remain in school, get jobs and meaningfully participate within their communities. Expanding educational and livelihood opportunities strengthens countries’ economies, while ending the cycle of poverty and making the world a better place.

ABOUT THE AUTHOR

Ellen Starbird is the director of the Office of Population and Reproductive Health at USAID.

On the Job at USAID: Meeting An Amazing Global Health Hero

Dr. Suniti Solomon is pictured here in 2008 at the YRG Care Clinic, supported by USAID through the International AIDS Vaccine Initiative, in India. / The Annenberg Foundation

Dr. Suniti Solomon is pictured here in 2008 at the YRG Care Clinic, supported by USAID through the International AIDS Vaccine Initiative, in India. / The Annenberg Foundation

Sometimes, I hear the word “hero,” and I cringe. To me, the bar has to be pretty high to earn that title, so I’m careful to use the word, rather than throw it around thoughtlessly.

On July 28, in Chennai, India, the world that fights HIV lost a true hero – or heroine in this case. The headlines hit the international press: “Dr. Suniti Solomon, who woke India up to HIV threat, dies at 76.”

For the past week, I’ve read some of the many tributes to Dr. Solomon; a favorite was written by Michael Specter, a staff writer at The New Yorker who has written much about the AIDS pandemic.

He recounts an interview with this remarkable physician-scientist-researcher-humanitarian, when she told a story of the tragedy wrought by systemic stigma in the world of HIV and AIDS.

As a doctor, mother, wife and particularly humble humanitarian, this was what she railed against; she knew that stigma would be the force that would keep HIV underground, able to do irreparable damage to her beloved India.

Stigma allows HIV to kill like no other force really, and she was determined to spend the last 30 years of her life trying to overcome it.

At USAID, we are seriously fortunate to support a lot of remarkable people trying to find permanent solutions to really big problems like HIV and AIDS. It’s an amazing privilege afforded by the American people to approach these daunting issues that plague our fellow man.

In my three decades of working on the AIDS problem, and eight-plus years working at USAID, no single partner or investigator has affected me like Dr. Suniti Solomon.

As part of the Agency’s portfolio dedicated to finding an HIV vaccine—which one day will be added to the unparalleled efforts of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)—we supported Dr. Solomon’s clinic in educating vulnerable Indians to protect themselves against the virus, get tested and, if it was right for them, volunteer for an HIV vaccine trial.

We were certainly not alone in recognizing Dr. Solomon’s research capacity; she has been awarded many NIH grants which have provided a plethora of noteworthy scientific contributions. I remember being bowled-over the first time I visited and saw the volume of research charts in her clinic at YRG Care, the NGO she started in response to the needs of those who needed care, support, education and information about HIV awareness and prevention in India.

Dr. Suniti Solomon and Margaret McCluskey at the 5K Sunrise Walk for YRG Care in 2010 in Chennai, India. / International AIDS Vaccine Initiative (IAVI), India

Dr. Suniti Solomon and Margaret McCluskey at the 5K Sunrise Walk for YRG Care in 2010 in Chennai, India. / International AIDS Vaccine Initiative (IAVI), India

How lucky was I, a nurse who’s been at this fight against HIV and AIDS for decades, not only to conduct periodic site visits to Dr. Solomon’s clinic, but once to be seated beside her on a long flight back to Washington, D.C. She had a speaking engagement at the Indian Embassy to discuss her success in helping HIV-positive people become parents of uninfected children.

She shared many memorable stories in that transitory but intimate space. She spoke of taking blood samples of about 100 women awaiting incarceration for prostitution in 1986; six of them were confirmed HIV-positive by a friend’s lab at Johns Hopkins University. That proved despite widespread denial that HIV was a very real problem demanding immediate attention.

That we worked at Chicago’s public hospital, years apart, was incidental, but an engaging source of our conversation—she as a medical resident in pathology, and me as nurse in the Women and Children’s AIDS clinic, before we had much of anything to offer them.

On that flight, I listened intently. We laughed, we cried a bit, as she recently had lost her husband, one of India’s premier cardiovascular surgeons. We shared a lousy airplane meal, we napped a little and really enjoyed one another’s company.

Later, I would nervously cook my first genuine Indian cuisine and serve her on my best china in my dining room. Now, I’m looking back on what an honor it was to have supped with a real hero – to enable the work of a real hero – to be in the presence of a real hero. How lucky we are to be with people who really do make the world a better place.

Now, it is for us to carry on such a legacy and end AIDS.

ABOUT THE AUTHOR

Margaret McCluskey is a Senior Technical Advisor in USAID’s Office of HIV/AIDS working on HIV vaccines. Follow her @m3indc.

Q&A: What A Year Without Polio in Nigeria Means

Since 1988, global efforts to eradicate polio have reduced the number of new cases by 99 percent, from 350,000 annually to a few dozen this year — preventing lifelong paralysis in millions of children worldwide.

In the fight to extinguish the disease, a significant milestone was reached on July 24. It has now been one year since the last reported case of wild polio in Nigeria.

Historically, Nigeria has been the main virus reservoir responsible for repeated outbreaks across the world. Just three years ago, the country seemed to be struggling in the battle against polio and recorded more than half of all global cases.

This achievement is the result of a Herculean effort to reach every child multiple times with the polio vaccine — thanks to the legions of volunteers, health workers, community leaders, mobilizers, lab staff, religious and traditional leaders, and millions of others.

However, since the wild polio virus can circulate silently, hiding in raw sewage for more than three years, it is far too soon for Nigeria to be complacent. The risk of undetected transmission remains in Nigeria and other vulnerable areas in and around conflict zones in Africa.

A health worker administers a polio vaccine to a girl in Nigeria. / Courtesy of TSCHIP

A health worker administers a polio vaccine to a girl in Nigeria. / Courtesy of TSCHIP

What is polio?

Poliomyelitis (polio) is a highly infectious disease caused by the wild polio virus. It spreads through contact with the stool of an infected person and droplets from a sneeze or cough. It invades the nervous system, and can cause paralysis or even death in a matter of hours. For thousands of years, polio was a leading cause of disability, arriving without warning and causing lifelong paralysis.

When will Africa be certified polio-free?

At least two more years must pass without a case of wild polio virus in Africa for the World Health Organization (WHO) to certify the region as polio-free. This will require continued government leadership across the African region, particularly in Nigeria, high quality immunization campaigns, and improved routine immunization, monitoring, and sustained vigilance.

We don’t want any cases of polio to go unnoticed or unreported. If Nigeria sustains high quality campaigns — maintaining population-level coverage (at least 90 percent of people), even in remote and hard-to-reach areas — and continues to improve routine immunizations, the virus will be stopped. Eradicating polio in all of Africa will bring us closer than ever to a world without the disease.

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When will the world be polio-free?

Polio will be stopped — but we need continued political will, quality immunization campaigns, stronger routine immunization, and active disease surveillance to make that happen. The world will be declared polio-free three years after the last polio case is identified.

What is USAID’s role in the global polio eradication effort?

The global effort to eradicate polio is spearheaded by Rotary International, the Centers for Disease Control and Prevention (CDC), WHO, UNICEF and the Bill and Melinda Gates Foundation.

USAID has played a critical role raising the importance of cross-border coordination, communication and the need for more women vaccinators. In fact, by working with local community organizations, women’s groups and self-help groups, the messages have gone well beyond polio to address other immunizations, water and sanitation, breastfeeding and handwashing.

Supported by USAID, countries are monitoring for cases in formal health facilities and in communities, providing the data to verify that immunization efforts are working. Increasingly, this network of disease surveillance officers is also searching for cases of other preventable diseases and working at the front lines during any disease outbreak or natural disaster. Our steady financial support and technical leadership has contributed to this success and laid the foundation for a lasting legacy.

How important are vaccines to global health?

Vaccines are one of the best buys in public health and global development — the cheapest, most lasting measure we have to save a child’s life. Vaccines protect us from 25 diseases, such as measles, whooping cough, polio and meningitis, and avert an estimated 2 to 3 million deaths each year.

Working closely with host country governments, ministries of health and finance, and in-country and global partners, USAID is bringing its financial, technical and diplomatic efforts to support country immunization programs and reach all children with critical safe vaccines.

ABOUT THE AUTHOR

Ellyn W. Ogden is the Worldwide Polio Eradication Coordinator for USAID and a Senior Technical Advisor for Health and Child Survival. She is responsible for the Agency’s polio eradication program and related immunization and disease control efforts in over 25 countries in Africa, South Asia and the Near East.

Sustainable Finance Key to Health Equity

A newborn in Nigeria. USAID is intensifying efforts to develop, test and scale up simple, low-cost approaches to preventing newborn deaths in lower-income countries. / Amy Fowler, USAID

A newborn in Nigeria. USAID is intensifying efforts to develop, test and scale up simple, low-cost approaches to preventing newborn deaths in lower-income countries. / Amy Fowler, USAID

The world faces an alarming shortfall of funding needed to transform global health. If the world is to end preventable child, adolescent and maternal deaths, we need new forms of development finance to close a $33.3 billion annual funding gap.

A new financing platform announced this week at the Conference on Financing for Development in Addis Ababa, Ethiopia aims to do just that. The Global Financing Facility (GFF) is a country-driven financing partnership to accelerate efforts to end preventable maternal, newborn, child and adolescent deaths by 2030.

The launch of the financing platform brings together $12 billion from public and private partners, both domestic and international, to scale up national strategies in four countries particularly in need: the Democratic Republic of the Congo (DRC), Ethiopia, Kenya, and Tanzania.

Their five-year strategies include life-saving interventions based on evidence of what works best that will be expanded to reach those that are most in need.

Why is this financing platform important?

Donor resources alone are not sufficient to reach our targets and meet the Sustainable Development Goals. We need innovative approaches to financing, with increased domestic commitment from countries and regional development banks, as well as more involvement from the private sector. Our core intent is to support countries as they work to provide for the health of their own citizens, and help them along the pathway to sustainable financing.

How is this different from business as usual?

As a financing mechanism, the GFF is an example of how to use official development assistance to catalyze additional private sector funding. The GFF is partnering with the World Bank to raise money from capital markets for countries with significant funding gaps for child, adolescent and maternal survival.

Every $1 invested into the GFF is expected to mobilize between $3 and $5 from the private capital markets. The investments in the GFF are designed to help countries transition to self-financing for maternal and child survival programs.

Who is contributing money?

USAID is investing $50 million, subject to Congressional approval, into the financing platform at the country level to scale up national strategies to end child and maternal deaths in the DRC, Ethiopia, Kenya, and Tanzania.

Other donors include Canada, Japan, multilateral organizations, host governments, civil society, and the private sector.

Is it working?

Tanzania is one example of the increased focus on women and children that the GFF can help bring about in country. By blending some of our grant funding through the GFF, we have enabled the Government of Tanzania to significantly increase financing for women’s and children’s survival and health.

A mother in Rwanda with her ​newborn ​daughter. Investing in survival & health can lead to greater individual and national productivity and growth. / Amy Fowler, USAID

A mother in Rwanda with her ​newborn ​daughter. Investing in survival & health can lead to greater individual and national productivity and growth. / Amy Fowler, USAID

Why just these four countries?

Over the next five years, the ultimate goal for the global facility is to support 62 high-burden low- and lower-middle income countries through the GFF. The DRC, Ethiopia, Kenya, and Tanzania are part of the first wave of countries. Results from these nations will inform the best way forward for any continued U.S. government funding of the GFF.

The next group of eight countries eligible to benefit from the global trust fund will be Bangladesh, Cameroon, India, Liberia, Mozambique, Nigeria, Senegal and Uganda.

Why invest in global health?

In low-income countries, child mortality is 15 times higher than in high-income countries, and maternal mortality almost 30 times higher. Despite remarkable progress across global health, the brutal fact is the world’s poorest people still pay the most for things like clean water and basic health services.

There is substantial evidence on the “health-to-wealth” pathway, and how investing in survival and health can lead to greater individual and national productivity and growth. Increasing access to health services — especially for the poor – is a sound and sustainable investment that can command great economic returns. To put it simply, people who are healthy are more productive at work.

We have a clear and conclusive case to invest in health. Now we must summon the will to mobilize domestic resources and activate creative co-financing approaches that will transform societies.

ABOUT THE AUTHOR

Dr. Ariel Pablos-Méndez was appointed by President Barack Obama to lead the Global Health Bureau at USAID. He is also the Agency’s child and maternal survival coordinator.

Q&A: How Technology is Transforming Ebola Response Efforts

In a new Q&A series, we are profiling the experts who have worked tirelessly to stop the spread of the deadly Ebola virus in West Africa and are helping societies rebuild and strengthen health systems in the aftermath of the outbreak.

Eric King holds up a handprint to echo the wall of handprints from Ebola survivors at the Bong County Treatment Unit in Liberia.  Eric King worked to coordinate the flow of data for the international humanitarian response in Liberia for two months last Winter. / Ellie Van Houtte, USAID

Eric King holds up a handprint to echo the wall of handprints from Ebola survivors at the Bong County Treatment Unit in Liberia. Eric King worked to coordinate the flow of data for the international humanitarian response in Liberia for two months last Winter. / Ellie Van Houtte, USAID

Eric King, an innovation specialist with the Digital Development Team in the Global Development Lab, worked on USAID’s Disaster Assistance Response Team (DART) in Liberia for two months in 2015, working to coordinate the flow of critical data. He came to USAID in September 2013 with a doctorate in Planetary Physics. Follow him @eric_m_king.

What innovations have been developed to combat Ebola?

Almost every aspect of the Ebola response has been innovative. We have never before fought a disease this deadly on this kind of scale. Response teams have had to educate remote communities, meticulously seek out new Ebola cases, provide new facilities for isolating and treating patients, safely bury infected bodies while observing local customs, and all on a massive scale and with no time to lose.

All of these efforts are critical to preventing further spread of the disease. To be successful, trust and solidarity must be created between responders and the communities they work in. Those relationships are fostered by weaving strong communication lines – including feedback loops – into the response network, often helped by harnessing existing technologies like radio and mobile phones.

How will the role that science and technology played in this response affect the way we approach future emergencies?

Among the technological tools that have amplified the Ebola response, arguably none has been more helpful than the mobile phone.

A decade ago, a small percentage of West Africans had access to cellphones. Now, mobile phones allow us to connect those in need with those who can help. Families of the sick can call emergency Ebola hotlines, social mobilizers can share tips for community engagement, individuals can resolve Ebola rumors by texting local radio stations, health workers can be paid electronically, and clinics can flag when they’re low on supplies.

The unique communications needs of the Ebola response have tested and ultimately strengthened the connections between all the many people and organizations that come together in times of emergency.

Technology is a key component of  managing information on the Ebola virus. A local dispatcher records 115 Ebola hotline responses at a community health office in Guinea, above left. Contract tracers also use mobile phones in the field to collect data for reporting, above right. / Eric King, USAID

Technology is a key component of managing information on the Ebola virus. A local dispatcher records 115 Ebola hotline responses at a community health office in Guinea, above left. Contract tracers also use mobile phones in the field to collect data for reporting, above right. / Eric King, USAID

In a crisis, efficiently managing the flow of information is key. How did USAID rapidly get things to where they were needed?

USAID’s logistics professionals have decades of experience managing supply chains in complex emergencies, ensuring that critical commodities like food, water, and medical supplies are available to those who need them, and they’re really good at it. Similarly, we recognize the importance of ensuring that actionable information is available when and where it’s needed.

For example, ambulance teams need to know where to find the sick as soon as they show symptoms so they can be quickly isolated and treated. Contact tracing teams need to know where to find those who have recently been in contact with confirmed Ebola patients so they can monitor them for symptoms. Food distribution teams need to know where to find at-risk households who have volunteered to stay at home to protect their neighbors so that they can deliver necessary supplies.

During the Ebola response, USAID deployed an information management advisor to work with local government and partners to coordinate the flow of information throughout the response network. These efforts are often amplified by integrating proven digital technologies and mobile data tools.

As a member of an Ebola case investigation team in Liberia, Justina M. Morris interviews people who may have been in contact new patients to control and monitor the disease. Information gathering is an important component of USAID’s Ebola fighting strategy. / Neil Brandvold, USAID

As a member of an Ebola case investigation team in Liberia, Justina M. Morris interviews people who may have been in contact new patients to control and monitor the disease. Information gathering is an important component of USAID’s Ebola fighting strategy. / Neil Brandvold, USAID

USAID believes in tapping the ingenuity of nontraditional sources. How did this play a role in the Ebola response?

USAID launched the Ebola Grand Challenge, the first-ever open innovation platform for a disaster response. Through the challenge, anyone anywhere could offer a solution for how to better fight Ebola. We received more than 1,500 applications from individuals and organizations from all over the world, many of whom had never worked with USAID. From all of these diverse, creative ideas, 15 innovations have been selected to receive support.

The porous nature of borders can make tracking and containing Ebola difficult. How did the international community work to counter this?

When Liberian President Ellen Johnson Sirleaf announced in February that the country’s land borders were reopening, response organizations worked with the Liberian government to quickly develop and deploy a set of best practices for border health security.

This involved two major components: border screening and community surveillance. People passing through official border crossings are screened for signs of Ebola in order to identify, isolate, test, and treat those who may be infected.

This is a vital first step, but we also recognize that there will inevitably be travellers that cross the border unofficially. So, we’ve also brought communities near the borders into the formal surveillance process — effectively crowdsourcing an Ebola alert system.

Furthermore, communities on either side of the border are working together to make sure that communication channels are available to alert one another.

Amid the Ebola crisis, many stories have emerged describing heroic aid efforts and acts of bravery. What stories touched you most?

I’ve found inspiration in the selfless dedication of the medical professionals who put themselves at risk and extreme discomfort to treat those in need. Working in full protective equipment in sweltering heat and humidity, they have been tirelessly and skillfully fighting to save as many lives as they can.

In some treatment units, some of the Ebola patients themselves began helping to provide care for the other patients who were suffering most. And some Ebola survivors, now immune, have organized themselves to work with health professionals to provide care to those in need. It inspires me to see such compassion and solidarity emerge from this unprecedented tragedy.

ABOUT THE AUTHOR

Clara Wagner was an intern for USAID’s Bureau of Legislative and Public Affairs working on content and public engagement.

Ebola Doesn’t Disappear at Zero and Neither Will We

Senior Ebola Coordinator Denise Rollins, Associate Administrator Eric Postel, and National Security Council Senior Advisor Chris Kirchhoff listen as a staff member from the International Organization for Migration provides a tour of a mock-Ebola treatment unit in Freetown, Sierra Leone. / Kate Alexander, USAID

Senior Ebola Coordinator Denise Rollins, Associate Administrator Eric Postel, and National Security Council Senior Advisor Chris Kirchhoff listen as a staff member from the International Organization for Migration provides a tour of a mock-Ebola treatment unit in Freetown, Sierra Leone. / Kate Alexander, USAID

Imagine being in a house with 15 family members, and watching them all gradually die from Ebola.

This was Gibril Kamara’s reality.

Last month in Sierra Leone, Gibril shared his harrowing ordeal with our visiting team from Washington, D.C. As the senior coordinator of USAID’s Africa Ebola Unit, I was traveling with USAID Associate Administrator Eric Postel and others in Liberia, Sierra Leone and Guinea — the three countries most affected by Ebola — to see USAID’s efforts on the ground, meet with officials, and hear from communities.

We met Gibril and three other Ebola survivors at the International Organization for Migration’s Ebola healthcare training center in Freetown. They told us their stories of resilience amid a devastating public health crisis.

Gibril recounted how at first his family members thought the symptoms they exhibited could have been caused by any number of diseases. However, Gibril knew the telltale signs of Ebola.

He pleaded with his family to go to a medical facility, but the patriarch of the family refused to allow them to leave. While the fear of stigma permeated the air, the patriarch insisted everyone stay at home and not seek outside help.

First, one sister died, then another, then uncles and aunts, and finally the patriarch himself.

Gibril decided he would not be next.

On the brink of succumbing to Ebola himself, Gibril made his way in a taxi to a hospital for medical care. With proper Ebola treatment and care, Gibril survived.

Although Liberia reached zero Ebola cases just days before my arrival in country, Sierra Leone and Guinea continue to see new cases weekly, and stories like Gibril’s are still common.

Through the Disaster Assistance Response Team (DART), USAID continues to work alongside partners in all three countries  to fight the spread of the disease. After hearing Gibril’s story, I stood in the middle of an Ebola command center in Freetown and was awestruck by the vast number of people, computers and teams needed to respond to the Ebola outbreak. The extensive coordination required to contain and defeat the disease is daunting.

From the surveillance teams and the social mobilization groups who go door to door identifying people with fever, to the ambulance drivers, health care workers and safe burial teams, everyone must work in lockstep.

Such a complicated effort is not easy in the best of circumstances, but in three of the poorest countries in the world, where the  people without electricity outnumber those that have it, effective coordination is a challenge. I doff my hat to the thousands of U.S. and local staff and volunteers who continue to work tirelessly.

Students of Infection Prevention and Control and Midwifery Training programs greet the USAID delegation in Kindia, Guinea.  / Kate Alexander, USAID

Students of Infection Prevention and Control and Midwifery Training programs greet the USAID delegation in Kindia, Guinea. / Kate Alexander, USAID

Since August 2014, USAID has converged an unprecedented array of people, equipment, financing and other resources to these Ebola-affected countries.

Thanks to the international community and local partners, we are easing the burdens of the citizens of these countries. As we work together to fight Ebola and lessen the secondary impacts of the outbreak, we are serving as an example of worldwide collaboration at its best.

Getting to zero Ebola cases is critical and  the  goal for USAID is helping these countries end the epidemic, get back on track, and be  better prepared to stop any future outbreaks before they become epidemics.

Weak health care systems suffered major setbacks during the Ebola outbreak, but now USAID is helping improve the ability to detect threats early, and respond rapidly and effectively to prevent the spread of Ebola and other viruses across borders.

In addition to support rebuilding and strengthening healthcare systems, we are also helping reopen schools and stimulate local food production.

Gibril’s world was turned upside down when he lost his entire family. However — like so many other Ebola survivors — Gibril was resilient.

Resilience is such an overused word, but it captures the spirit, commitment and dedication of the citizens of Liberia, Sierra Leone and Guinea to get back on their feet after this devastating public health crisis.

Many survivors, like Gibril and the others I spoke with at the National Ebola Training Academy, now volunteer their time as trainers, health care workers and social mobilizers — helping other patients recover from their battles with the virus, while spreading awareness about Ebola prevention.

In turn, USAID will continue to support the people of West Africa. Ebola doesn’t disappear at zero, and neither will our fight to keep Ebola away.

ABOUT THE AUTHOR

Denise Rollins is the senior coordinator of the Africa Ebola Unit at USAID.

Q&A: How Changing Behaviors is Helping Stop Ebola’s Spread in West Africa

In a new Q&A series, we are profiling the experts who have worked tirelessly to stop the spread of the deadly Ebola virus in West Africa and are helping societies rebuild and strengthen health systems in the aftermath of the outbreak.

Kama Garrison is a senior public health advisor for USAID’s Neglected Tropical Disease Program. ​For the Ebola response effort, she has been working on social mobilization with other agencies and partners.

What is social and behavior change communication (SBCC) and what role has it played in the Ebola response?

SBCC is the use of communication strategies — mass media, community-level activities, face-to-face communication and technologies — to influence behaviors that affect people’s health.

Within the context of Ebola, SBCC is critical to ending the epidemic. Ebola is an easily preventable disease; changing a few key behaviors can stop the virus from spreading further. And while health facilities and health care workers are absolutely essential in responding to an Ebola outbreak, the behaviors of individuals, families and communities are key to stopping it entirely.

Kama Garrison holds up the silhouette of a hand, echoing the wall of handprints from Ebola survivors at the Bong County Treatment Unit in Liberia. / Ellie Van Houtte, USAID

Kama Garrison holds up the silhouette of a hand, echoing the wall of handprints from Ebola survivors at the Bong County Treatment Unit in Liberia. / Ellie Van Houtte, USAID

But SBCC isn’t just about telling people about Ebola, warning them to stop touching those who are sick or discouraging them from using traditional burial practices. It’s about carefully understanding a community’s cultural, religious and social beliefs so we can deliver meaningful, relevant and respectful messages and interventions.

Early on in the Ebola crisis, some fear-based messages made people feel powerless, hopeless and unable to act. Effective SBCC must be founded in the target population’s belief in their own ability to succeed; we seek to develop interventions that instill hope. Now, successful SBCC interventions have been developed to engage and better educate communities about Ebola.

Why is it critical to employ social and behavior change communication in a response like this?

Human behavior plays an important role in the spread of infectious diseases such as Ebola. Therefore, understanding the influence of behavior on the spread of disease can be the key to stopping disease transmission. Even if a new medical technology such as a vaccine is developed, people still have to trust that vaccine and choose to receive it – so addressing behavior is at the core of disease prevention and outbreak response.

But the motivations behind why people do what they do are complicated. People are complicated — our behaviors reflect our personal experiences, education, cultural/religious beliefs, community etc. SBCC seeks to understand these motivations. By using methods from psychology, anthropology, marketing and behavioral economics, we collect information and data about target populations to design suitable interventions that address the specific needs, beliefs and practices of the target populations.

Ebola survivors in Liberia leave their handprints on a wall of the Bong County Ebola Treatment Unit - the facility that saved their lives. / Adam Parr, USAID

Ebola survivors in Liberia leave their handprints on a wall of the Bong County Ebola Treatment Unit – the facility that saved their lives. / Adam Parr, USAID

What previous experiences with social and behavior change communication informed our Ebola response? How do you think those lessons that Ebola taught us will be relevant to future crisis responses?

In the past, I worked on SBCC and risk management for crises like the Avian Influenza and the 2009 H1N1/Swine Flu pandemic.

I’ve seen that large-scale outbreaks aren’t inevitable — that by working on preventative behaviors we can minimize the emergence of diseases and by strengthening response capacity, we can quickly contain them if they do emerge. But it isn’t easy. Food preferences, economics, and cultural and religious practices all contribute to the risks associated with emerging diseases. Those are difficult behaviors to address.

If prioritized, though, we can draw from proven solutions and make the necessary investments to prevent diseases such as Ebola from turning into regional or global epidemics.

What’s the next steps with these efforts?

The three affected countries aren’t out of the woods yet; there will be a continued focus on Ebola to end the epidemic in the region. Even after the end of this Ebola crisis, there will be a great need to rebuild trust in the health system so that children are immunized, women get appropriate maternal care, malaria is addressed, etc. SBCC is key to that trust building.

The Ebola outbreak has caused much pain and suffering.  However, in the midst of the crisis many heroic stories have emerged. What has touched you the most?

Ebola has created thousands of orphans — they are the ultimate tragedy of this crisis. In that tragedy, heroes emerge every day, from families that take in extended relatives to single individuals who adopt orphaned children. Those are the stories that touch me.

ABOUT THE AUTHOR

Clara Wagner was an intern for USAID’s Bureau of Legislative and Public Affairs working on content and public engagement.

Fighting Ebola with Information

Youth-turned-social mobilizers in Liberia learn how to use social media tools on their cell phones to stay connected while spreading awareness about Ebola prevention in communities. / Eric King, USAID

Youth-turned-social mobilizers in Liberia learn how to use social media tools on their cell phones to stay connected while spreading awareness about Ebola prevention in communities. / Eric King, USAID

A room full of young people with heads buried in their phones is not an unfamiliar sight. In fact, this was the scene in rural Margibi County, Liberia, during a training of youth-turned-social mobilizers in late February.

The audience members weren’t distracted, though — they were following the trainer’s instructions. To foster culturally adaptive community engagement in the fight against Ebola, USAID-funded training events like these are teaching social mobilizers how to use social media tools like WhatsApp and SMS-based U-report to stay connected while they’re out in the communities, educating people about how to protect themselves from the disease.

“This is enhancing coordination, it’s cost effective, and the young people find it exciting to work with,” said Jzohn Alexander Nyahn, Jr., executive director of nongovernmental organization (NGO) CHESS Liberia.

Outsmarting the deadly Ebola virus requires that communities and response organizations work together. A key component of the USAID-led U.S. Ebola response strategy in Liberia — where they have now reached zero cases — has been arming community members and responders with the information they need to prevent Ebola transmission.

For example, at-risk communities need to know the facts about Ebola and how to prevent its spread. Rapid response teams need to know where to find suspected cases as soon as they show symptoms. Health ministries need to know which public health facilities are not yet equipped to isolate and treat infected individuals.

But these types of data originate in thousands of different places with thousands of different people, and we must get the right information into the hands of thousands more who can take action. Fast moving collective action on such a massive scale is a serious challenge.

By weaving well-placed feedback loops into human response networks, USAID, the U.S. Centers for Disease Control and Prevention (CDC), the governments of the affected countries, and private and NGO partners have coordinated efforts to prevent, detect and treat the disease. And, in many cases, mobile phones provide the key link to connect those who have life-saving information with those who need it.

The growing ubiquity of mobile phones in the developing world is unlocking tremendous opportunities to amplify humanitarian response efforts. Liberia, for example, which is one of the world’s poorest countries, has seen an explosion in its mobile market in recent years; phone ownership rates skyrocketed from 4 percent to 60 percent in just the last decade.

In the Ebola response, information and communication technologies like mobile phones empower local and international humanitarian responders to save lives by tightening the feedback loops between those who need help and those who can offer it.

Here are a few examples of how:
Adaptive Media Crowdsourced Community Engagement Ebola Hotlines Connected Healthcare Real-time Risk Mapping
This Ebola outbreak has mobilized one of the largest public health crisis responses in history. Although it is the hard work and sacrifices of frontline responders and the people of West Africa, and not technology, that will ultimately defeat the disease, transformative technologies like mobile phones empower us to act together to get to zero cases.

ABOUT THE AUTHOR

Eric King is an Innovation Specialist with the U.S. Global Development Lab’s Digital Development Team, who joined the USG DART in Liberia for several weeks. Follow him @eric_m_king.
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