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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.

Innovative HIV-Prevention Product for Women Could Be New Tool in the Fight for an AIDS-Free Gen

Ending the HIV/AIDS epidemic can only be achieved with multiple prevention options that meet women’s needs and fit within the context of their lives./Kate Holt/Africa Practice

Ending the HIV/AIDS epidemic can only be achieved with multiple prevention options that meet women’s needs and fit within the context of their lives./Kate Holt/Africa Practice

HIV/AIDS is the leading cause of death worldwide for women of reproductive age.

Even with marked improvements in HIV treatment, women — especially those ages 15-24 — continue to be at a disproportionately high risk of HIV infection throughout Africa. In fact, in some parts of Africa, young women are more than four times more likely than men to become infected with HIV.

There are structural drivers that directly and indirectly increase women’s HIV risk, including poverty, gender inequality, sexual violence and a lack of education. Many women face unequal access to reproductive health services, including HIV/AIDS education, diagnostic services and treatment programs, putting them at an increased risk of contracting HIV.

Gender norms can also discourage women from asserting control over the timing and circumstances of sex, including negotiating protection against HIV using common prevention methods, such as condoms.

Women need HIV-prevention options that are discreet, do not need their partner’s agreement to use, and that are easy to access and convenient to use.

The Ring Study findings may give new hope to women who need diverse options to protect themselves from HIV and AIDS./ Matthew Willman/Oxfam, Courtesy of Photoshare

The Ring Study findings may give new hope to women who need diverse options to protect themselves from HIV and AIDS./ Matthew Willman/Oxfam, Courtesy of Photoshare

Results released today at the Conference on Retroviruses and Opportunistic Infections in Boston show we are one step closer to having a new prevention tool exclusively for women that fits within the context of their lives.

Through the United States President’s Emergency Plan for AIDS Relief, USAID has invested $25 million in an innovative research trial known as the Ring Study, which was led by the International Partnership for Microbicides.

The Ring Study looked at women’s use of a simple vaginal ring, which is prescribed by a doctor and self-inserted to provide 30 days of continuous, sustained release of the antiretroviral dapivirine. The study found the dapivirine ring helped protect against HIV during vaginal sex among women ages 18 and older.

The monthly dapivirine ring is a longer-acting HIV prevention method specifically designed for women, who bear the greatest burden of the global HIV/AIDS epidemic./ Molly Snell, Courtesy of Photoshare

The monthly dapivirine ring is a longer-acting HIV prevention method specifically designed for women, who bear the greatest burden of the global HIV/AIDS epidemic./ Molly Snell, Courtesy of Photoshare

The Ring Study showed that the monthly dapivirine ring safely reduced HIV infection overall by 31 percent compared to a placebo. Similar results were seen in a sister study, known as ASPIRE. ASPIRE found that the ring safely reduced infection by 27 percent overall. This is the first time that two large clinical trials have yielded statistically significant results in finding that a microbicide can protect against HIV infection.

However, we must recognize that these results are only the starting point for further research. Despite both the Ring and ASPIRE studies showing a statistically significant protective effect against HIV, the dapivirine ring did not reduce infection quite as much as researchers had hoped. While disappointing, we should see this as an opportunity to gain more information in order to create a more effective HIV-prevention product.

To do this, researchers need to look closely at the information collected during the study to figure out why there wasn’t a bigger effect: Was the dapivirine ring itself not as effective in the women in the study? Were women not able to use the product consistently? So far, we know that women who used the ring more had a lower chance of becoming infected with HIV, but we need more information to say for certain.

It is particularly important to understand the influence of consistent use of the dapivirine ring on the study results for younger women. If we look at the Ring Study results broken down by age, women 18-21 years had only a 15 percent reduction in infection, while women older than 21 had a 37 percent reduction.

If younger women, who are at the highest risk of infection, are not able to use the dapivirine ring consistently, we need to understand why and look at whether different marketing, education or additional interventions could improve use and, as a result, decrease their risk of infection.

While the Ring Study’s results have raised many new and important questions, ultimately, the dapivirine ring is the first longer-acting and discreet female-controlled HIV prevention method that has been shown to safely offer protection.

Innovative prevention methods like the dapivirine ring could offer an important additional prevention tool for women unable or unwilling to use other strategies.

If we hope to achieve an AIDS-free generation by 2030, we must continue to invest in products that empower women across the world to protect themselves from HIV.

ABOUT THE AUTHOR

Elizabeth Russell PhD, MSc, is a Senior Advisor for Biomedical Prevention Technologies in the Research Division of the Office of HIV/AIDS. She provides technical assistance for pre-clinical and clinical research projects supported by USAID for new microbicide products.

Healthy Beginnings: New Evidence Cites Breastfeeding’s Health Benefits for Moms, Babies and Economies

A new mother at the Karambo Health Center in Rwanda breastfeeds her newborn baby. Immediate breastfeeding after delivery helps prevent diseases and malnutrition in newborns. / Amy Fowler, USAID

A new mother at the Karambo Health Center in Rwanda breastfeeds her newborn baby. Immediate breastfeeding after delivery helps prevent diseases and malnutrition in newborns. / Amy Fowler, USAID

When it comes to the health of the world’s most vulnerable mothers and children, supporting the practice of a few simple behaviors can be just as beneficial as the most high-tech innovations.

Handwashing with soap helps prevent the spread of communicable diseases. Skin-to-skin contact between mothers and premature babies keeps preemies warm and helps regulate their breathing and heart rate. Having a skilled birth attendant deliver the babies of pregnant women significantly decreases the risk of mortality for both the moms and their babies.

Each of these behaviors has been shown to improve mothers’ and newborns’ health and wellbeing, without requiring new technologies or significant funds.

And new evidence shows one of the most effective of these behaviors is breastfeeding.

In a series published today in The Lancet journal, researchers cite compelling evidence of the benefits afforded by optimal breastfeeding practices, both health-related and economic, for women and children in high- and low-income countries alike.

At USAID, we have already begun to act on the evidence. We concentrate our maternal and child health efforts in 24 priority countries that together account for 70 percent of the world’s maternal and child deaths, and we employ a data-driven approach to maximize our impact through the most effective interventions available.

We’ve identified breastfeeding as one of 10 “Accelerator Behaviors” — the key feature of USAID’s Accelerate project, begun last year to expand the ability of stakeholders in those priority countries to implement high-quality behavioral programming.

And in our Multi-Sectoral Nutrition Strategy, we recommend early initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months, and continued breastfeeding for two years or longer.

This mother in Bakapome, Senegal, a rural village near Thies, knows that breastfeeding doesn’t just benefit infants: it also reduces the risks for breast and ovarian cancers in women. / Jane Silcock, USAID

This mother in Bakapome, Senegal, a rural village near Thies, knows that breastfeeding doesn’t just benefit infants: it also reduces the risks for breast and ovarian cancers in women. / Jane Silcock, USAID

The health benefits are significant. Higher rates of breastfeeding could save more than 820,000 lives — 87 percent of them infants — in low- and middle-income countries each year.

Breastfeeding is also associated with a reduced risk of breast and ovarian cancers for women. At current breastfeeding rates, 20,000 maternal deaths are averted annually. Improved breastfeeding practices could prevent another 20,000 each year.

The new Lancet series also highlights the economic benefits of increasing the number of women who breastfeed. Currently, the cognitive losses associated with not breastfeeding amount to $302 billion globally — including more than $70 billion lost in low- and middle-income countries and $230 billion in high-income countries.

Even a 10 percent increase in breastfeeding rates would translate into hundreds of millions of dollars in healthcare savings through reduced child and maternal mortality and morbidity.

The evidence speaks for itself: Supporting women to practice optimal breastfeeding is a health intervention that we cannot afford to ignore.

USAID is working with national governments, NGOs, the private sector and civil society organizations to generate data and provide insights into the impact that social and behavior change programs can have on saving lives. We work with our partners to then use that data to design and apply effective and innovative behavioral programming.

Throughout the process, we track and measure our programs’ successes and persistent barriers, and provide technical assistance and share lessons across our network of partners — contributing to our goal to reach 38 million women with improved health services by 2020.

When it comes to interventions such as breastfeeding, collecting evidence is a necessary first step. But we must then act on our findings, incorporating the evidence across all levels of our health programs — from the policies of national governments to the daily routines of individual households.

The USAID-funded Suaahara project in Nepal engages young mothers as well as fathers and other men in the family to ensure supportive environments for healthy behaviors, such as breastfeeding, to promote the wellbeing of women and children. / Suaahara Project

The USAID-funded Suaahara project in Nepal engages young mothers as well as fathers and other men in the family to ensure supportive environments for healthy behaviors, such as breastfeeding, to promote the wellbeing of women and children. / Suaahara Project

In Nepal, for instance, USAID began implementing an integrated approach to nutrition in 2012, incorporating community education and personal counseling. Since then, rates of exclusive breastfeeding for the first six months have increased from 46 percent to 69 percent.

The Lancet’s series bolsters our behavior change work and solidifies the evidence base for including breastfeeding as an Accelerator Behavior.

I am encouraged by the successes that USAID has already seen in using these evidence-based approaches to save children’s and mothers’ lives.

Most of all, I am excited about our past, present and future progress towards maternal, newborn, child and adolescent health worldwide, as support for breastfeeding and other lifesaving interventions continues to grow in the global community.

ABOUT THE AUTHOR

Elizabeth Fox is the Director of the Office of Health, Infectious Diseases and Nutrition in USAID’s Bureau for Global Health.

USAID Delivers: Quality Care for Expectant Moms Results in Fewer Stillbirths

Fatima holds her 2-day-old baby, safely and successfully delivered at the USAID-funded Smiling Sun Clinic in Tongi, Bangladesh. / Amy Fowler, USAID

Fatima holds her 2-day-old baby, safely and successfully delivered at the USAID-funded Smiling Sun Clinic in Tongi, Bangladesh. / Amy Fowler, USAID

At the Smiling Sun Clinic in Tongi, Bangladesh, Fatima happily holds her healthy newborn baby, delivered in the facility a short while ago. Fatima chose to deliver in the facility to ensure a healthy outcome, for her first pregnancy had ended in tragedy.

Each year, over 130 million babies are born into the world. For a mother, pregnancy is a time of excitement, and the birth of a baby is a time of joy.

Yet, for millions of others, pregnancy can end in tragedy. Each year, nearly 3 million children die in their first month of life, and an additional 2.6 million women suffer a stillbirth. Fatima was one of them.

Through the support of USAID, she was able to access the care and services she needed to ensure that her next pregnancy had a happier ending: a safe pregnancy, a successful delivery and a healthy baby.

At USAID, we are committed to saving the lives of mothers and children. Our vision is to end preventable child and maternal deaths within one generation. Our efforts to achieve this vision are also helping address the tragedy of preventable stillbirths.

In a new Lancet series of papers on stillbirths published today, more than 200 researchers, investigators and advisors — including myself and my USAID colleague Donna Vivio — have collaborated to report on the problem of stillbirths worldwide.

Skilled birth attendants, like these nurse-midwives at a midwifery education center in Afghanistan’s Bamyan province, are vital for ensuring safe and healthy deliveries for mothers and their babies. USAID has helped train more than half of all midwives currently working in Afghanistan. / USAID Afghanistan

Skilled birth attendants, like these nurse-midwives at a midwifery education center in Afghanistan’s Bamyan province, are vital for ensuring safe and healthy deliveries for mothers and their babies. USAID has helped train more than half of all midwives currently working in Afghanistan. / USAID Afghanistan

Unavoidable stillbirths, which are caused by congenital abnormalities, account for only 7.4 percent of all stillbirths in the world. The rest are largely preventable. In fact, nearly half of all stillbirths — 1.3 million each year — occur during labor and delivery.

The hours and days surrounding childbirth are the times when women and babies are most vulnerable, and high-quality care at these times has the greatest potential to reduce maternal and newborn mortality and stillbirths.

Another way to reduce these unnecessary deaths is through family planning. Empowering and educating women and girls helps families choose the number, timing and spacing of their pregnancies, translating into improved birth outcomes for both mothers and their babies.

In fact, quality care for pregnant women before and during childbirth — coupled with optimally-timed pregnancies — would prevent most stillbirths, as well as most preventable maternal and newborn deaths.

During pregnancy, adequate nutrition and quality prenatal care, including treatment for maternal infections, keep women healthy and increase the likelihood of a healthy newborn. These measures have also been shown to improve child development outcomes, thereby yielding a quadruple return on investment.

A network of 300 Smiling Sun clinics throughout Bangladesh, supported by USAID, provides essential services to individuals and communities across the country. / Amy Fowler, USAID

A network of 300 Smiling Sun clinics throughout Bangladesh, supported by USAID, provides essential services to individuals and communities across the country. / Amy Fowler, USAID

In Bangladesh, USAID works to provide these vital services to the most vulnerable populations of women and children. We support a network of Smiling Sun Clinics that are active throughout the country.

The Smiling Sun Clinic in Tongi serves a population of some 94,000 individuals, providing prenatal and postnatal care, immunizations, and family planning services. Now in its 19th year of operation, the clinic provides services free of charge to the poorest of the poor through funds paid by other clients, ensuring the clinic’s sustainability. And it was this clinic in Tongi that changed Fatima’s life.

After losing her first child, Fatima resolved to seek care from the Smiling Sun Clinic during her next pregnancy. She delivered in the facility, open 24 hours a day for delivery services, in the presence of skilled birth attendants.

Gift Usami Ava, pregnant with her third child, receives prenatal care at the Ugep General Hospital in Nigeria’s Cross River State. Quality prenatal care during pregnancy helps reduce stillbirths and improves maternal and newborn health. / Amy Fowler, USAID

Gift Usami Ava, pregnant with her third child, receives prenatal care at the Ugep General Hospital in Nigeria’s Cross River State. Quality prenatal care during pregnancy helps reduce stillbirths and improves maternal and newborn health. / Amy Fowler, USAID

Fatima’s story had a happy ending, and her baby was delivered safe and healthy. We believe all women should have that chance.

Pregnancy and motherhood ought to be a time for celebration rather than for mourning. We have set ambitious targets to save the lives of babies, children and mothers worldwide, and we are confident that, with the support of strong global and local communities, we will be able to achieve them.

ABOUT THE AUTHOR

Katie Taylor is the deputy child and maternal survival coordinator at USAID and the deputy assistant administrator for the Bureau for Global Health.

All in Good Faith: Partnering with Malawian Ministries for Maternal Health

In USAID’s—and the world’s—goal of ending preventable child and maternal deaths, the faith sector is a powerful partner.

Close to 90 percent of the world’s people adhere to some religious belief, and in rural areas in many of the developing countries in which we work, health care is provided by religious organizations. Faith-based organizations like the Christian Health Association of Malawi (CHAM) reach deep into the community, and bring a unique set of skills, experience and contributions to the development arena.

They play a pivotal role in improving the quality, accessibility and respectfulness of maternal and child health services—and in promoting the demand for these services. Many faith-inspired groups are enthusiastic supporters and invaluable allies in our efforts to save the lives of mothers and children.

Memory Mponda (right), Priscilla Ziyaye and Pacharo Kumwenda, USAID-supported students training to become nurse-midwives, stand outside the Kangaroo Mother Care ward at the Chonde Health Center. / Grace Soko, Christian Health Association of Malawi

Memory Mponda (right), Priscilla Ziyaye and Pacharo Kumwenda, USAID-supported students training to become nurse-midwives, stand outside the Kangaroo Mother Care ward at the Chonde Health Center. / Grace Soko, Christian Health Association of Malawi

Take the Ndirande Health Center in the city of Blantyre, Malawi, where 15 students from St. Joseph’s College of Nursing and Midwifery work alongside clinical staff to check the vital signs and collect the histories of women who have come to give birth. They assist during the deliveries, and administer necessary care when emergency situations arise.

Recent visitors to the hospital have been pleased that their waiting time has been reduced, as the students, organized into teams, quickly and efficiently check people in and get them the care that they need. As the only public health facility in a district of more than 300,000 people, there is never a dull moment at Ndirande.

On the other side of Blantyre, at the Chilomoni Health Center, 19 of their classmates perform similar duties. Both facilities see upwards of 300 deliveries a month; at Ndirande, that number sometimes approaches 450. On average, 10 or more women come to each facility to give birth each and every day.

For the nursing students at St. Joseph’s, the challenges and experiences that they face at the health facilities are an invaluable learning tool. And for the clinical staff, the extra hands on deck provide much-needed assistance throughout the busy days. At Chilomoni, the hospital’s staff is more than doubled by the addition of the students.

St. Joseph’s is one of 12 constituent training colleges funded in part by USAID and operated by CHAM. Established in 1966, CHAM is an ecumenical organization overseen by the Episcopal Conference of Malawi and the Malawi Council of Churches, and provides administrative and technical support to the health care services of member units across the country.

With 175 member health facilities, CHAM reaches more than 4 million Malawians with health services—37 percent of all care provided in Malawi, and second only to the Ministry of Health. Through training programs like those at St. Joseph’s, students are able to become nurse midwife technicians, medical clinicians, laboratory technicians and psychiatric nurses.

This training helps students bring knowledge and experience to Malawian communities—and is an important step towards ending preventable newborn, child and maternal deaths.

Chimwemwe (“Joy” in the local Chichewa language), a community health worker in Malawi, meets with an HIV-positive pregnant woman at her home in Lilongwe through the USAID-funded Tingathe program, which works closely with the Ministry of Health. / Chris Cox, Baylor College of Medicine Children’s Foundation.

Chimwemwe (“Joy” in the local Chichewa language), a community health worker in Malawi, meets with an HIV-positive pregnant woman at her home in Lilongwe through the USAID-funded Tingathe program, which works closely with the Ministry of Health. / Chris Cox, Baylor College of Medicine Children’s Foundation.

In the 2014 Acting on the Call report, USAID laid out a framework for using proven, high-impact interventions and data-driven investments to improve health outcomes in 24 priority countries for maternal and child health, saving the lives of 15 million children and 600,000 thousand mothers through 2020.

In Malawi, a scale-up of key interventions could save more than 25,000 newborns and 5,000 mothers—lives that we know how to save, but that will likely be lost if we do not act.

Already, our efforts are yielding results and translating into lives saved. The 2015 report shows that Malawi is on track or has exceeded the year’s target for improving key interventions, such as the percentage of live births occurring in a health facility or being overseen by a skilled birth attendant, or the percentage of households with at least two insecticide-treated bed nets. But more rapid progress is needed in pregnant women receiving antenatal care and in women and children having access to clean water.

Our collaboration in Malawi with CHAM is one of many ways we are leveraging strategic partnerships, promoting country ownership and building the capacity of local communities. The holiday season reminds us how vital these partnerships are—now, and all throughout the year.

As the students at St. Joseph’s graduate next year, we will be there applauding them for their hard work, wishing them future success, and welcoming in the next class of students to begin their training.

ABOUT THE AUTHOR

Katie Taylor is the deputy Child and Maternal Survival Coordinator and a deputy assistant administrator for the Bureau for Global Health at USAID.
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