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Archives for Global Health

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.

ABOUT THE AUTHOR

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

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

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

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

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

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

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

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

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

What are the consequences of trachoma?

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

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

Is treatment reaching those who need it?

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

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

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

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

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

How do you assess where treatment is most needed?

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

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

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

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

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

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

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

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

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

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

So what’s next?

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

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

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

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

ABOUT THE AUTHOR

Delivering Life-Saving HIV/AIDS Drugs Around the World

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

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

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

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

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

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

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

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

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

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

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

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

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

As a result, the Supply Chain Management System project

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

Leveraging Markets for Global Health

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

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

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

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

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

But inventing these new products is not enough.

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

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

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

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

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

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

Unrolling New Insecticide Sprays

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

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

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

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

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

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

Marketing Low-Dose HIV Treatment

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

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

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

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

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

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

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

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

This post is part of the #MarketsMatter blog series.

ABOUT THE AUTHOR

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

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

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


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

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

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

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

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

Investing in a Healthy Future

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

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

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

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

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

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

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

The Need for Political Commitment

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

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

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

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

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

World Immunization Week 2016: Closing the Gap

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

Equipping Health Workers to Achieve an AIDS-free Generation

A health worker tests a child for HIV at Eduardo Mondlane Health Center in Chimoio, Manica, Mozambique. / Arturo Sanabria, courtesy of Photoshare

A health worker tests a child for HIV at Eduardo Mondlane Health Center in Chimoio, Manica, Mozambique. / Arturo Sanabria, courtesy of Photoshare

I am scared.

I think I have the disease that everyone talks about. Other women warned me to be careful with my clients. My mind is buzzing with questions.

Where do I go to get help? Will people see me if I go to a clinic to get tested? What happens if I am positive? Will I die? Will I have to stop working?

I am afraid.

Jamilah, a sex worker in Kenya, is afraid of finding out her HIV status because of stigma and fear of living with the disease. She is unsure of how to get help and what will happen after she is tested.

In Bangladesh, a BRAC community health worker enrolls an expecting couple in the MAMA program so that they will receive informational SMS or Voice Messages during pregnancy and for the first year of life. / Cassandra Mickish, CCP/Courtesy of Photoshare

In Bangladesh, a BRAC community health worker enrolls an expecting couple in the
MAMA program so that they will receive informational SMS or Voice Messages during pregnancy and for the first year of life. / Cassandra Mickish, CCP/Courtesy of Photoshare

But a community health worker, Mariam, who is also a sex worker living with HIV, connects people in her community to the nearby HIV clinic.

Mariam meets with Jamilah and listens to her questions. She calms Jamilah’s fears. She sits with Jamilah at the clinic as she nervously waits to find out her status.

Through rapid testing at the clinic, Jamilah finds out she is positive. While the news is overwhelming and frightening, Jamilah is able to receive counseling and initiation of treatment from a nurse on the same day. The nurse teaches Jamilah how to manage her HIV for the rest of her life, including preventing transmission to partners and during pregnancy.

Feeling less afraid and supported by the community health worker and nurse she interacted with, Jamilah is empowered to face her HIV-positive status. Because she had a positive experience, Jamilah will return to the clinic regularly to monitor the disease.

A community care worker from Turntable Trust provides HIV counseling and testing service to a local woman at her home in South Africa as part of the national effort aimed at getting 15 million South Africans to know their HIV status. / JHHESA, CCP/Courtesy of Photoshare

A community care worker from Turntable Trust provides HIV counseling and testing service to a local woman at her home in South Africa as part of the national effort aimed at getting 15 million South Africans to know their HIV status. / JHHESA, CCP/Courtesy of Photoshare

Through the support of health workers, Jamilah is confident that she can live with HIV.

Community and facility health workers, like those in Jamilah’s story, are the backbone of health systems. They connect people to clinical services, provide emotional support, perform diagnostic tests, advise and counsel, and combat stigma by providing critical services to patients who need it most.

This week marks World Health Worker Week. As we thank the world’s health workers, it is also important to recognize the invaluable role they will play in the coming years as we look to achieving the Sustainable Development Goals (SDGs). Health workers will be a driving force towards achieving at least nine of the 17 SDGs.

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A community health worker examines a child in Malawi. / SC4CCM/JSI/Courtesy of Photoshare

Health workers go beyond providing patient care; they also act as agents of socioeconomic development, leading countries to advance education and employment opportunities, especially for women, and increase the productivity of the population.

To keep a robust health workforce, systems and policies must be created to have health workers in the right places at the right time with the right support. Currently, the World Health Organization (WHO) is finalizing its Global Strategy on Human Resources for Health, which focuses in part on optimizing the existing health workforce.

Here at USAID, we are establishing programs in alignment with this strategy, focusing on optimizing health workers’ service delivery in order to reach an AIDS-free generation.

The global community is currently transitioning to new HIV treatment guidelines, known as Test and START, which will require a significant amount of support from health workers to be implemented.

These guidelines recommend starting antiretroviral therapy as soon as a person is diagnosed with HIV instead of waiting until the person gets sick from the disease. This means an additional 37 million people living with HIV are now eligible for this treatment. Expanding coverage is critical to achieving the 90-90-90 goals of the Joint United Nations Programme for HIV/AIDS.

Since most areas with high rates of HIV face health worker shortages, there is an urgency to evaluate the impact of health workers and how we train the existing workforce so they can better connect people with life-saving care and treatment for HIV.

The bottom line is that if we want to achieve an AIDS-free generation, a key component will be to better optimize the available workforce for HIV/AIDS services.

But what does optimization mean?

It means being creative and efficient about the way we use health workers based in hospitals, health clinics and communities to make HIV service delivery effective and sustainable.

It means investigating how community health workers, like Mariam, can be more effectively trained and distributed across communities and in healthcare facilities to support outreach and testing.

It means figuring out how to be more effective in administering antiretrovirals at all points of care, such as communities, health clinics and hospitals.

It means improving the quality of training for laboratory workforces and creating efficient lab systems to support health workers in scaling up viral load testing.

It means examining the skill mix of doctors, nurses, midwives, and community-based health workers to meet the needs of all patients, including adolescent girls and other key populations.

As we celebrate health workers this week and honor their important role in creating healthy, resilient and productive societies, we must direct our focus and investment to overcoming key barriers so we can maximize their impact.

Jamilah and millions of others living with HIV and AIDS are counting on us.

ABOUT THE AUTHOR

Shayanne Martin, Diana Frymus and Kim Rogers are members of the Health Workforce Team in the Office of HIV/AIDS at USAID. Follow them on Twitter at @ShayanneMartin and @DianaFrymus.

Ending a Global Epidemic of Tuberculosis in Children

“When my daughter got sick, I took her to a clinic in my neighborhood. They gave her cough syrup for seven days. I thought she was getting better, but it was apparent that she was still ill. After another examination, they referred her to St. Paul Hospital in Addis Ababa where they put her on oxygen and started taking blood sample after sample and injection after injection for a month. Her condition did not get better so they gave her another medicine. The doctors then decided to take blood from her back…only then did they know it was tuberculosis.” Atsede Tefera

Atsede Tefera with her daughter, Nigist, who was diagnosed with tuberculosis at a hospital in Addis Ababa, Ethiopia. / MSH Ethiopia

Atsede Tefera with her daughter, Nigist, who was diagnosed with tuberculosis at a hospital in Addis Ababa, Ethiopia. / MSH Ethiopia

Atsede Tefera, photographed above, recalls three months of long delays in the diagnosis of tuberculosis for her daughter Nigist, who was eventually able to start treatment for the disease.

Tuberculosis (TB) kills more people each year than any other infectious disease, causing over 1.5 million deaths globally in 2014 alone. More than a quarter of cases are in Africa, the region with the highest burden of TB disease relative to population.

Children are among the most vulnerable, and all too often children with TB remain in the shadows, undiagnosed, uncounted and untreated. Today, more than 53 million children worldwide are infected with TB, and more than 400 die each day from this preventable and curable disease.

This global childhood TB epidemic is serious, yet historically neglected. Some children get TB at the same time as other chronic illnesses, such as malnutrition, making it even more lethal. However, TB is preventable through prompt diagnosis and treatment.

TB is an airborne disease, which is passed between people with symptoms by coughing or sneezing. TB often spreads in communities where people are living in close proximity to each other, putting those living in poor socio-economic conditions particularly at risk.

Children living with a parent who is diagnosed with TB should be systematically screened for infection. They should either be put on prophylaxis treatment, or if they start to cough, those cases should be identified early on. / MSH Uganda

Children living with a parent who is diagnosed with TB should be systematically screened for infection. They should either be put on prophylaxis treatment, or if they start to cough, those cases should be identified early on. / MSH Uganda

In recent years, progress has been made to combat childhood TB. The emergence of policies and guidelines across the Africa region that incorporate childhood TB, coupled with innovative treatment and child-friendly medicine, have moved us closer to tackling one of the oldest and most persistent diseases in the world.

However, a new analysis released today on World Tuberculosis Day, shows that in African countries, a persistent divide between policy and practice threatens to impede progress gained for addressing childhood TB across the region.

The analysis, a collaboration between USAID and its African Strategies for Health project, presents the landscape of childhood TB programming in 12 countries in Africa, and suggests three focus areas critical for moving the dial on this intractable issue:

  1. Strengthen the capacity of health workers to identify and diagnose children infected with TB. For children, the first contact with the health sector at a primary health care or maternal and child health clinic is an important opportunity to identify TB symptoms early and refer for treatment. Symptoms such as a persistent cough, loss of appetite and high fevers must be recognized by all providers as possible signs of TB. Health workers at all levels of the health system must be empowered to take appropriate action, such as referral for treatment and follow-up.
  2. Implement active case finding strategies for early identification of child TB. Delays in diagnosing TB and initiating appropriate treatment are often long, particularly where access to health care is poor. Systematically identifying children who have come into contact with a person with active TB, as well as screening children with HIV and those who are malnourished, are critical steps to identify sick children.
  3. Ensure adequate care closer to home. Health systems must be strengthened to guarantee a regular supply of diagnostic tools and child-friendly medicines at all levels where sick children may access care. Clear guidance on the optimal interaction and links between service delivery platforms including maternal and child health, HIV, and nutrition programs is vital.

No child should die from TB, which is preventable and curable. We have the policies, guidelines, medicines, and health service delivery platforms needed to make this vision a reality. The time to apply these instruments – to end preventable child deaths due to TB – is now.

Join the conversation on World Tuberculosis Day by following #WorldTBDay, #UnitetoEndTB, and #LouderThanTB.

ABOUT THE AUTHOR

Keri Lijinsky is the HIV/AIDS and TB Advisor at USAID’s Bureau for Africa. This blog is co-authored with Rudi Thetard, Project Director for USAID’s African Strategies for Health project.

Empowering Women Through a Simple Purse

Imagine giving birth without the help of sterile tools, a doctor, nurse or midwife. This is the experience of nearly half of women giving birth in low-income countries — and many are at high risk of infection. With limited access to antibiotics, these infections often prove fatal.

One woman is trying to change that.  

Zubaida Bai, founder and CEO of ayzh, speaking at USAID's Partnering to End Extreme Poverty and Achieve the Global Goals event. / USAID

Zubaida Bai, founder and CEO of ayzh, speaking at USAID’s Partnering to End Extreme Poverty and Achieve the Global Goals event. / USAID

Zubaida Bai is the co-founder of ayzh, an organization providing women’s health resources to underserved women globally.  The venture’s first product is a clean birthing kit that includes all the items recommended by the World Health Organization to prevent infection at birth.

Infections at birth affect more than 6 million women annually. Even worse, poor hygiene and sanitation during birth is directly linked to the preventable deaths of more than 1 million women and newborns each year.

In celebrating International Women’s Day earlier this month, we recognize women like Zubaida who are revolutionizing their field and making history with their achievements. With the support of USAID and other organizations, Zubaida’s work establishing ayzh has saved the lives of women and newborns on a global scale.

Zubaida posing with the clean birthing kit. / Ayzh

Zubaida posing with the clean birthing kit. / Ayzh

This is her story: After earning her engineering degree, Zubaida Bai decided to go back to India to serve the women she had seen suffer her whole life from health and financial hardship.

She worked in India for four years developing technology appropriate for low-resource settings, before she decided to spin off on her own. Both Zubaida and her husband Habib were passionate about helping women, so they started looking for opportunities to design for this underserved population.

On a field visit to a rural village, Zubaida discovered that some midwives used a sickle — normally used for cutting grass — to cut the umbilical cord. This was an “aha” moment for her.

Reflecting on the infection she contracted when her first child was born in one of the best facilities in India, she thought, “If I had everything and had to suffer an infection, what would women in these villages be facing?” This is the moment that launched Zubaida into a whole new world of maternal health.

“It made me very determined to make my childhood dream come true – to improve the lives of women,” she said in a blog for TED.

In 2007, Zubaida and her husband participated in MIT’s International Development Design Summit, a program that brings together people from across the globe to collaborate and build projects that address issues faced by the world’s poorest communities.  The program exposes participants to practical design for development.

Zubaida and other IDDS participants in morning circle, the way that summits start their days with team building exercises, announcements, and appreciations. / IDIN

Zubaida and other IDDS participants in morning circle, the way that summits start their days with team building exercises, announcements, and appreciations. / IDIN

After studying how to best succeed in markets in developing countries, Zubaida founded ayzh in 2009 and a year later launched the clean birth kit. She called it “janma,” which means “birth” in Sanskrit. The $3 purse comes with six items to ensure a safe and sterile delivery at half the cost of comparable birth kits.

Ayzh hires local Indian women to assemble the packages, allowing them to develop a stable income. Since 2010, about 250,000 kits have been sold in India, Afghanistan, Gambia, Laos, Ghana, Malawi, Nigeria, Zambia, and Haiti — reaching 500,000 mothers and babies.

Ayzh plans to reach 6 million women over the next five years, improving maternal health and breaking the cycle of poverty one woman at a time.

With support from USAID’s Higher Education Solutions Network (HESN) through MIT’s International Development Innovation Network, ayzh is developing a similar kit for newborns. It will provide the tools necessary to make transitions for new mothers and their babies as smooth and healthy as possible.  

Through HESN, USAID is empowering entrepreneurs and researchers at universities so that people like Zubaida can get the funding and mentoring they need to jump start their ventures.

Zubaida Bai and ayzh intern Kelly Brennan iterating on potential impact metrics they can use when communicating with their stakeholders during a workshop in Chennai, India. / Kyle Munn, SEAD

Zubaida Bai and ayzh intern Kelly Brennan iterating on potential impact metrics they can use when communicating with their stakeholders during a workshop in Chennai, India. / Kyle Munn, SEAD

Last year, ayzh was selected to be a part of a cohort of innovators at the Social Entrepreneurship Accelerator at Duke  — another HESN partner — to receive mentorship and capacity building to expand their global reach and impact. The Evidence Lab at Duke is providing support to ayzh to find the best ways to measure and communicate its impact.

With the support of USAID and other organizations, we hope this venture and others like it will continue to improve the health of women around the world.

ABOUT THE AUTHOR

Danielle Somers is a communications analyst for the U.S. Global Development Lab’s Higher Education Solutions Network (HESN). Emily Jablonski is a virtual intern for HESN and student at the University of Michigan.

More Community Health Workers Needed for a Healthier World

Editor’s note: This blog originally appeared as a longer article on the Wilton Park conference website.


We live in extraordinary times.

In 1960, more than 22 percent of all children in developing countries — one out of every five — died before the age of 5. Today, we are within reach of ending preventable child deaths

Across developing countries, when compared with 50 years ago, people are living longer, more people are educated, there are fewer wars, and there is an unprecedented drop in both the number and rates of people living in extreme poverty.

At the same time, Ebola and Zika are drastic reminders of our human frailty and the need for vigilance and responsiveness — in all countries, and at all levels of care, down to every community, every family. The survival and safety of the women and children of the world require us to find ways to link families and communities to the knowledge, behaviors and treatments that can help them survive, thrive and transform the world they live in.

Enter community health workers. For years, they have been vital in strengthening maternal and child health, preventing the spread of infectious diseases, and promoting sanitary behaviors. They will play a critical role in helping us achieve the Sustainable Development Goals.

Community health workers play an important role in USAID’s efforts to end preventable child and maternal deaths. / MCHIP/MCSP

Community health workers play an important role in USAID’s efforts to end preventable child and maternal deaths. / MCHIP/MCSP

Unlocking the potential of community health workers

Seeking to unlock the potential of community health workforces in post-Ebola Africa, 50 development practitioners, thinkers, experts and funders gathered two weeks ago in Wilton Park in England. Ministry and NGO practitioners presented models developed and being improved in several countries.

Three thoughts emerge:

  • Inspiring models of community health workforces already exist – which smart, experienced people are striving to make even better through policy improvements, strengthening supervision, leveraging technology and introducing long-term domestic financing.
  • There is not yet a simple, systematic way of sharing good practices across countries; we need to be able to compare solutions that could be replicated and scaled faster, smarter or more affordably.
  • We have not yet cracked the nut of financing. There is an urgent need for national governments and development partners to substantially increase investment in community health workers as part of integrated health care systems. We need financing solutions to be shared, adopted and adapted, as well as spur thinking on new ones.

A framework for community health

My colleagues and I shared the first version of a Community Health Framework with participants to jumpstart a “common language” on community health.

This first framework highlights some laudable models and tools; it’s simple to navigate and understand. It acts as an interactive learning tool to help practitioners and ministries better appreciate why we should care about community health, how to approach community health, and where to find successful examples.

The framework also offers a way of acting in a common ecosystem. In order to be successful, any country — whatever its circumstances — should follow a five-step process: identify target health outcomes, understand the existing system, analyze barriers, develop or strengthen programs and ensure oversight, monitoring and evaluation.

We urge our colleagues to consider leveraging this common language in their own work, so we can begin to find commonalities and ways to better scale and replicate.

In Senegal, community health workers provide essential services at local health posts and promote healthy activities within their communities. / Jane Silcock, USAID

In Senegal, community health workers provide essential services at local health posts and promote healthy activities within their communities. / Jane Silcock, USAID

It’s a time to be bold

This was the warning we heard at Wilton Park: “The acute crisis of Ebola may be over, but sustained crisis and emergency still exist.”

We cannot afford not to invest in community health workforce development. Strong political will and leadership, smart investment and coordinated planning are just a few of the critical components. The private sector has much to offer — both in terms of investment and bringing strong business models for sustainable solutions.

This is the time to be bold and to be practical. Two weeks ago, we set out broad principles to achieve strong community health workforce development. As we closed the conference, I felt inspired by the commitment and passion shared by those in the room

As one of our colleagues said, “It is not easy; it requires collaboration and determination, but we know what needs to be done — now let’s go and do it.”

ABOUT THE AUTHOR

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