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Archives for Global Health

The Hidden Costs of Fistula Repair Surgery

Close up portrait of an African woman

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

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

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

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

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

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

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

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

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

A group of African women

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

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

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

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

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

Mothers waiting in a clinic in Nigeria.

Mothers waiting in a clinic in Nigeria. / USAID

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

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

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

Women at Kyenjojo Hospital, Uganda.

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

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

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

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

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

ABOUT THE AUTHOR

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



How One Simple Solution Has Saved Thousands of Babies

Three women sit on the floor talking

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

Ebola Aftermath: Restoring Trust in Hospitals in Guinea

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About the Author

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

Family Planning for the World’s Youth Promotes Peace, Health and Prosperity

A mother with her child at the Nhamatanda Health Center in Mozambique. / Arturo Sanabria, Photoshare

With close to 600 million girls growing up in developing countries, achieving global prosperity starts with educating and empowering these young women so they can be healthy, productive members of their communities and become agents of change.

This year’s World Population Day encourages us to “Invest in Teenage Girls.” Voluntary family planning is one tool that can both educate and empower young women worldwide.

Access to voluntary family planning and reproductive health services for everyone, including youth, is vital to the future of our planet. About half of pregnancies among adolescent women in the developing world are unintended, with about 23 million young women wishing to avoid pregnancy, but not using modern contraception. This puts them at high risk of unintended pregnancy.

As we observe World Population Day on July 11, we acknowledge that young people hold the key to determining the future of our planet and to ensuring we meet the Sustainable Development Goals (SDGs)17 goals focused on ending all forms of poverty, achieving social justice for all, and tackling climate change by 2030.

Voluntary family planning is an important intervention that cuts across the five themes of the SDGS: people, planet, prosperity, peace and partnership.

A nurse shows a client an implant rod, and explains how it works during a family planning outreach at a Nairobi informal settlement. / Tobin Jones, Jhpiego

Voluntary family planning affects people. It supports adolescents’ rights to information, and the rights of girls to remain unmarried and childless until they they are ready and desire to bear children.

Family planning saves lives. Today, pregnancy and childbirth are the leading causes of death for adolescent women. By helping young women time and space their pregnancies, family planning helps reduce the number of high-risk pregnancies, and allows women to properly feed, clothe and educate the children they decide to have. Studies show that by 2020, family planning could help avert approximately 7 million under-5 deaths and prevent 450,000 maternal deaths in USAID’s priority countries.

A poster in a Sare Bilaly health hut in the region of Kolda, Senegal. / Amy Fowler, USAID

Family planning impacts the planet. Access to family planning can slow global climate change and improve the health and environment of households and communities worldwide, and research shows that it already has. A 2013 report warns: “poor reproductive health outcomes and population growth exist hand-in-hand with poverty and unsustainable natural resource use.”

Family planning helps reduce poverty and contributes to economic growth and prosperity. Nearly 21 percent of the world’s population—some 1.5 billion people—still live on less than $1.25 per day. By slowing rapid population growth, family planning can help to decrease the sheer number of poor people.

Reducing adolescent fertility can contribute to a “demographic dividend” of rapid economic growth. Having fewer children per family leads to more household savings and increased investments in each child. In Korea and Thailand, governments aligned population policy and family planning services with human capital development policies, particularly girls’ education, to accelerate economic growth.

Voluntary family planning can contribute to peace. Studies show that a large “youth bulge” (defined as a high number of 15- to 29-year-olds) is associated with a high risk of civil conflict. The political impact of fertility decline is measureable: Research shows as a country’s population ages, the probability of attaining and maintaining a liberal democracy is increased.

Worldwide, more than 30 million adolescent women are not in school. Early and unintended pregnancy can be both a cause and a consequence of dropping out of school, so family planning can help women and girls stay in school, become literate, and achieve their educational and employment aspirations. All of these outcomes lead to more peaceful communities and societies.

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Health workers in Mali. / Jane Silcock, USAID

Family planning partnerships at the global and country level will be critical to achieving success as we work toward reaching a grand convergence between the developed and developing world in the next 15 years. As the largest bilateral donor for family planning assistance, USAID has played a crucial role in increasing access to modern contraception. And through our youth policy, USAID strives to integrate youth reproductive and sexual health needs into all of our programs and partnerships.

Young people today will decide our future. We need them to participate in the social, economic, political and cultural life of their communities to eliminate poverty and achieve our collective goals. We also need to recognize the diversity of need and experience of this age group when developing reproductive and sexual health programs and services. As we help youth to succeed, voluntary family planning will be an essential element of our long-term development strategies.

ABOUT THE AUTHOR

Ellen H. Starbird is the director of the Office of Population and Reproductive Health at USAID. Get updates about USAID’s Family Planning work via @USAIDGH.


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Ebola’s Second Punch: Hunger

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

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

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

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

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

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

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

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

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

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

Life Before Ebola

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

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

Ebola’s Economic Impact

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

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

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

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

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

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

‘Getting More Life’

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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.
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