USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Community-based Approach Prevents HIV in Children and Keeps HIV+ Mothers Healthy in Bondo, Kenya

During the month of May, IMPACT will be highlighting USAID’s work in Global HealthFrom May 18-27 we will be focusing on an AIDS-Free Generation. 

Bondo, Kenya — Babies Gabriel and Mary show the progress that Kenya is making in moving towards an AIDS-free generation.

Beatrice, holding Gabriel, and Grace, with baby Mary, listen as CHW Jane Akoth (right) counsels them on their health choices. Photo Credit: USAID

Although their mothers are HIV-positive, the two babies were born free from the virus that causes AIDS thanks to a team of determined community health workers who recruited their young mothers into a project funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID). The project, carried out by USAID’s flagship Maternal and Child Health Integrated Program (MCHIP), which is led by Jhpiego, connects women to—and keeps them enrolled in—high-quality health care to prevent the transmission of HIV from mother-to-child.

Mothers Beatrice and Grace are grateful they met community health worker Jane Akoth. After recruiting them into the project, Akoth saw both women regularly, through home visits or appointments at the clinic, to ensure that they remained healthy during and after their pregnancies. “After I delivered my baby, Jane advised me on how to take care of my child by exclusive breastfeeding for six months and to continue taking my medication,” adds Grace, the mother of baby Mary. “I want Jane to continue doing what she is doing so that she can help other mothers.”

In Africa, HIV and AIDS affects women and mothers at a greater rate than men, creating a heavy disease burden among families. When parents die of the disease, children are left orphaned or given to the care of relatives who may not have the means to raise them. Pregnant and breastfeeding women who are infected with HIV also run the risk of transmitting the disease to their children but antiretroviral drugs can dramatically reduce the risk of vertical transmission.

The experience of Beatrice and Grace shows that the transmission of this life-threatening virus is indeed preventable. The success of the MCHIP project was due in part to an innovative strategy that was originally developed to improve immunization of children, which links pregnant women to care and keeps them enrolled.

More than 300 community health workers like Jane are working in Bondo District to keep the next generation alive and healthy. Since 2010, coverage through this project has expanded so that women in the most hard to reach areas are being connected to health services. As a result, the percentage of expectant mothers going to all four antenatal care visits increased from 25 percent to 41 percent in two years, and the percentage of HIV-exposed infants who were tested for HIV increased from 27 percent to 78 percent.

We know that follow-up by community health workers is key to saving lives—getting mothers into care, keeping them there, and providing them with the lifesaving medications that they and their children need.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Women’s Involvement in Voluntary Medical Male Circumcision for HIV Prevention

During the month of May, IMPACT will be highlighting USAID’s work in Global HealthFrom May 18-27 we will be focusing on an AIDS-Free Generation. 

Kawango Agot works to scale up voluntary medical male circumcision in Kenya. Photo Credit: USAID

I work as part of a team dedicated to scaling up voluntary medical male circumcision (VMMC) in Kenya. In 2007-2008, clinical trial results confirmed that VMMC has the potential to dramatically reduce men’s risk of acquiring HIV from their female partners. While Kenya and 13 other African countries have made great strides in rolling out VMMC (Kenya has circumcised about 500,000 men since VMMC was endorsed by the World Health Organization as an effective intervention against HIV), there has been a glaring gap that many of us have not paid attention to: how to get women fully on board as stakeholders, guardians, and partners. For all practical purposes, we as VMMC program implementers run our business as if this is solely a man’s affair. We forget that involving female partners is critical to turn this procedure into a successful intervention for HIV prevention.

In 2010, a small, unique group of young women in the lakeside city of Kisumu, Kenya, blew my mind away. One challenge we experience in VMMC programs is finding a way to support men through the six weeks of sexual abstinence recommended after surgery. In my attempt to encourage women to look beyond the usual topics surrounding VMMC (for example, that it reduces their risk of cervical cancer if their male partners are circumcised), and broach more difficult topics, my attention was drawn to some young women who accompanied their husbands/boyfriends for circumcision at one of our VMMC service sites. I called some of the couples for a casual chat, and was amazed at how perceptive they were in making decisions about their health.

The young women described how they discussed VMMC with their partners ahead of going for services – benefits, risks, fears, and interestingly, sexual abstinence. Each one of them narrated how, ahead of time, they agreed on sleeping arrangements that would enable them to observe the 42 days of abstinence. Some separated beds, others separated rooms, some slept on the same bed, but fully clothed, some simply dressed unattractively or avoided bodily contact or seductive talk while others took time off to visit with their families. Many reported to have successfully abstained for the recommended period, and attributed this to the fact that their partners involved them in their decision to be circumcised. As a bonus, most also tested for HIV together.

This experience shows us how crucial women’s participation is in the VMMC process, and how female partners might improve adherence to the post-operative abstinence period. These women deserve praise – ordinary women who have the courage to step out into the extraordinary and claim their space in VMMC, who recognize that their partner’s health is their health too.  To such, I bow in respect… and call on many more to come forward and claim their space in VMMC – it is your right!

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.


More than 30,000 Fistula Repair Surgeries Supported by USAID

During the month of May, IMPACT will be highlighting USAID’s work in Global Health.

On Thursday, May 23, the world will be marking the first-ever International Day to End Obstetric Fistula, as recently designated by the United Nations General Assembly. USAID commemorates this day by celebrating a milestone in global maternal health: Over 30,000 fistula repair surgeries have been performed with U.S. support since 2005. Fistula, a devastating childbirth injury believed to affect millions of women in developing countries, can be surgically repaired up to 90% of the time. Unfortunately, most women who suffer from fistula lack access to a skilled surgeon or fully equipped health center, making treatment and prevention too often out of reach.

Fistula clients in Uganda after receiving treatment. Photo credit: Fistula Care/EngenderHealth

Ten years ago, USAID launched a global effort to both treat and prevent fistula and is today one of the largest funder of such activities worldwide. To date, through initiatives such as the EngenderHealth-led Fistula Care project, and in collaboration with local governments, regional health care organizations, faith-based organizations, and other partners, USAID has supported training and equipment for medical teams in 15 countries at 56 health facilities across Africa and Asia for fistula repair surgery. Efforts to support fistula prevention have been supported by Fistula Care at an additional 43 sites.

Obstetric fistula is an injury caused by prolonged or obstructed labor, when the head of the baby cannot pass safely through the woman’s birth canal. The baby often dies as a result, and the woman is left with an abnormal opening in the birth canal and chronic incontinence.

The hopeful part of the story is that in addition to most cases being reparable, fistula is almost entirely preventable. This is why USAID-supported projects work to improve access to routine and emergency obstetric care and cesarean deliveries for women who experience complications during labor and delivery. Together with skilled attendance at all births and access to voluntary family planning, these efforts can make fistula as rare in the developing world as it is in the United States. USAID works to engage all levels of society to raise awareness about fistula and its underlying causes, including early pregnancy, poverty, and a lack of education and empowerment for women and girls.

As the largest USAID-supported effort to both treat and prevent fistula, EngenderHealth’s Fistula Care project is committed to transform the lives of thousands more women and girls around the world.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

ROADS II Video: Transforming Corridors of Risk into Pathways of Prevention and Hope

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 18-27 we will be focusing on an AIDS-Free Generation. 

Since 2005, the Regional Outreach Addressing AIDS through Development Strategies (ROADS) Project – Phases I and II – funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) East Africa and bilateral missions, has linked communities along transport corridors of east, central and southern Africa with critical HIV and other health services. ROADS is also helping vulnerable men, women and children reduce their vulnerability to HIV by expanding economic opportunities, improving food security, supporting community-based substance abuse counseling and working to protect women and girls from sexual exploitation and abuse. In this video, ROADS II project director Dorothy Muroki describes how the project takes an integrated approach to human development and how it is transforming corridors of risk into pathways of prevention and hope.”

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Building Capacity: Racking Warehouses in Ethiopia

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 18-27 we will be focusing on an AIDS-Free Generation. 

Ethiopia has the second largest population in Africa, and the thirteenth largest in the world. The current population of 84 million is expected to reach 120 million by 2030, and 145 million by 2050. Ethiopia will play a large role in meeting the global goal of putting 15 million people on HIV treatment by 2015 and in helping create an AIDS-free generation. To do so, the population of Ethiopia needs reliable and consistent access to medicine. At present, however, the ability to acquire medicine is limited due to challenges of access, supply, distribution and cost.

The Ethiopian government is undertaking a bold initiative to ensure that medicinal supply and access are available throughout the country. A major challenge is reaching a population whose majority lives in rural areas. Through a series of centralized and regional hubs, this initiative aims to serve thousands of health centers all over the country and overcome the hurdle to reaching patients. Achieving this aim is a complex undertaking, which is becoming increasingly more so as the diversity and volume of medicines regularly expands.

The Supply Chain Management System (SCMS), a project of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) administered by USAID, has stepped in to support this nation-wide initiative. At ten warehouse sites across Ethiopia, the physical warehousing capacity has greatly increased due to the introduction of a warehouse racking system. Warehouse racking allows for vertical storage without damaging stacked products due to weight.

An Ethiopian warehouse, before. Photo credit: SCMS

The racking system enables improved material organization, as products are stored and sorted by rack location. This ensures that short shelf-life products can be located and distributed in a timely manner. It also helps prevent stockouts as regional hubs can respond faster to need requests. Thus, warehouses become more efficient in terms of space utilization, organization and loss-prevention.

Improved warehouse distribution also enhances the ability of warehouses to reduce and prevent product expiry and handle emergency situations, such as product recalls. Furthermore, a better ability to respond to the supply and demand of the population, as well as reduce loss, facilitates for a reduction in product cost.

In Adama, for example, the warehouse capacity was increased by 35 percent, to 880 pallets (the platforms that boxes of commodities sit on for shipping and storage) with the introduction of racking. Organizational improvement is evident, which facilitates for improved cost-efficiency as the products can be stored, located and distributed in a more systematic manner. That, however, is just the beginning.

An Ethiopian warehouse after support from SCMS, USAID and PEPFAR. Photo credit: Jiro Ose, SCMS

The government, with support from PEPFAR and the Global Fund, is constructing ten new – and larger – warehouse facilities to greatly increase warehouse capacity.

SCMS will outfit these new warehouses and expand upon existing facilities. When Adama’s new warehouse is complete, and racked, the pallet capacity will increase from 880 to 5,160. Across the ten sites, the existing pallet capacity of 6,039 will increase to 27,007.

The outfitting of racking in warehouses is only one contribution of many mechanisms that SCMS has provided to enhance and support the Ethiopian government in their aims of providing reliable and consistent access of medicine throughout the country. SCMS is not only meeting the needs of today, but planning for the needs of tomorrow.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Video of the Week: Clean Kumasi: Digital Tools to Transform Urban Waste Management

In the fall of 2012, partnered with Water and Sanitation for the Urban Poor to tackle the issue of open defecation. and WSUP were the recipients of a Development Innovation Ventures  Stage One grant to test a hypothesis that the application of digital tools could effectively change behavior related to the management of human waste.

Building off the lessons learned from rural community-led total sanitation efforts, the team worked to adapt that methodology to an urban context.

The team designed a system that allowed community members to report instances of open defecation by calling them in, in response to signs posted around the neighborhood. This information fed into a database of contacts managed by a community organizer who then called the participants to gather for meetings and clean-ups.

This video shows the and WSUP teams in action – from organizing hackathons in San Francisco to conducting field work in Kumasi, Ghana, live prototyping of the mobile platform and technology, and ultimately to the community gatherings and clean-ups.’s project is supported by the DIV and Gates Foundation WASH for Life Partnership. Read more about the partnership’s new grantees.

Folow @DIVatUSAID  on Twitter and join the conversation with #DIVWash.

#AskAg Twitter Chat: Intersection of HIV and AIDS & Food Security

Do you wonder how we can improve food security for HIV-affected households? Do you ask yourself how activities in the agriculture sector and for improving economic growth can play a role in helping these vulnerable populations? Well, then please join us on Thursday, May 23 from 12-1:30 pm EDT for an #AskAg Twitter Chat on the “Intersection of HIV and AIDS & Food Security.” The chat is sponsored through the Feed the Future initiative and hosted by Agrilinks, USAID Office of HIV/AIDS, and the Livelihoods and Food Security Technical Assistance (LIFT) project as part of Global Health Month at USAID.

The chat will feature tweets from:

  • Meaghan Murphy (@MurphyMeaghan) — Food Security and Livelihoods Specialist, FHI 360
  • Kirsten Weeks (@klweeks) — Global Lead, Health, Nutrition & Livelihoods, DAI
  • Jason Wolfe (@jasonmwolfe) — Senior Household Economic Strengthening Advisor, USAID’s Office of HIV/AIDS

So why is this topic worth tweeting about?  Here are some key issues to keep in mind:

  • The relationship between HIV and AIDS and livelihood/food insecurity is bi-directional: HIV and AIDS can increase the vulnerability of households and communities to livelihood and food insecurity, while livelihood and food insecurity can also increase the risk of a person becoming infected with HIV.
  • HIV and AIDS can impact all aspects of a household’s livelihood, including directly affecting its income generation and productivity due to compromised health of people living with HIV (PLHIV), increased care costs associated with the chronic illness, stigma, and even death of affected household members. These reduced livelihoods opportunities can have direct impacts on household food access and ultimately the diet quality and quantity of individuals in the household.
  • The increased nutritional needs of PLHIV and the toll that HIV takes on the body complicate and further make food utilization and proper nutrition critical elements of the HIV and AIDS and food security discussion.
  • Vulnerable households with insecure livelihoods and food access, often resort to unsustainable coping behaviors that may include those that can put them at great risk for contracting HIV.

How to participate:

Agrilinks is an activity of the U.S. Government’s Feed the Future initiative, led by USAID’s Bureau for Food Security.

Living Positively: The Importance of Pediatric HIV Disclosure

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 18-27 we will be focusing on an AIDS-Free Generation. 

As a public health practitioner and as a physician, I have seen the challenges that pediatric HIV brings to communities and to families. But I have also seen first-hand the positive, transformative effect that disclosing an HIV status can have. One case from my medical practice stands out as an example:

A grandmother brought in her seven-year-old grandchild, who had been orphaned by AIDS, for emergent care. At the clinic, we discovered that the child was HIV-positive, and we provided the grandmother with medication and dosing instructions. Not long after, the grandmother and her grandchild returned to the clinic. Because she did not know she was HIV-positive, the child was beginning to rebel against taking her medication and was getting very sick again. After careful consideration, it became clear to me, as her physician, and to her grandmother, that it was time to disclose her HIV status to her to help this child become adherent to her medications. Through a collaborative process, the child’s grandmother and I were able to help her understand that she had an illness and that it was very important to take medication so that she would continue to feel good. It was through this process of disclosure that the child was able to begin living positively.                         

Statistics from the World Health Organization show that across the world there are approximately 1.3 million children under the age of 15 living with HIV. These children will need anti-retroviral therapy and medical care for their entire lives to stay healthy. There’s a conflicting factor, though—many of these kids don’t even know they have HIV.

Children and adolescents knowing their HIV status is important for the global goal of “getting to zero.” Some studies show that pediatric HIV disclosure at a younger age decreases mortality due to HIV by half among adolescents. Other studies show that disclosure can increase medication adherence by 20 percent. These positive results highlight the importance of pediatric disclosure for living longer, healthier lives.

Disclosure can also play an important role in the psycho-social development of children living with HIV. Early disclosure may decrease anxiety and depression in kids, and make them feel more normal. Overall, disclosure holds great benefits for a child’s ability to engage and maintain medical treatment.

Although the process of pediatric disclosure is important for a child’s health, it is also complex. Many children who are HIV-positive live with other family members who are also positive. This makes disclosure very sensitive and personal. Disclosure also makes a child’s role in his or her own treatment important, and not all children are ready for this kind of responsibility. For these reasons, disclosure must be tailored to children’s own understanding of their illness and its impact on their life.

The AIDSTAR-One Pediatric and Youth Disclosure Materials (examples below) are designed to help tailor the disclosure process to a child’s specific needs. They are intended to be interactive and to encourage discussion among the child, his or her caregivers, and health professionals. The color booklets and accompanying cue cards are easy-to-read, and suited for children of varying ages. They will be printed in French, Portuguese, and Xhosa.

HIV programs can also use these materials as guidelines for establishing HIV disclosure interventions for their own populations. The materials can be used by health care workers, parents, caregivers and children together, throughout the disclosure process to ensure disclosure is completed appropriately and supportively. Just like the seven-year-old grandchild and her grandmother, all children and their caregivers deserve an appropriate disclosure experience; these materials will help other children with disclosure and encourage them to live longer, healthier lives.

Illustration explaining the importance of medication for children ages 2-6 from AIDSTAR-One’s “Booklet 1: How to Keep Healthy." Photo credit: AIDSTAR-One

Explaining HIV transmission to children 6-12 years of age in AIDSTAR-One’s “Booklet 2: Knowing about Myself.” Photo credit: AIDSTAR-One

“Booklet 3: Living a Life of Health” is AIDSTAR-One’s disclosure materials geared towards children over the age of 9. Photo credit: AIDSTAR-One

AIDSTAR-One is funded by PEPFAR through USAID’s Office of HIV/AIDS. The project provides technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

USAID and Merck Put Skin in the Health Finance Game

This originally appeared on the Devex Blog.

The U.S. Agency for International Development and pharmaceutical giant Merck have joined other donors and companies in a massive ramp-up of an existing public health financing program built to help countries that need health supplies get more bang for their buck.

The Pledge Guarantee for Health (PGH), a loan insurance program for health commodities, is emerging from a pilot phase, which supporters say showed that the program can work to get health supplies where they are needed most, faster and in larger quantities.

Early on, the PGH showed promise when it helped UNICEF deliver bed nets to Zambia months faster than usual, staving off a feared malaria outbreak during the rainy season.

USAID Administrator Rajiv Shah. Photo by: Center for Strategic and International Studies/CC BY-NC-SA

USAID Administrator Rajiv Shah announced on Thursday that the agency and the Swedish International Development Cooperation Agency will commit $50 million to insure 50 percent of any loan that commercial banks issue to PGH over the next five years. The guarantee doubles the amount of funding that PGH can leverage from $50 to $100 million and signals a strong vote of confidence in the two-year-old program.

Merck and the public health product developer Vestergaard-Frandsen also pledged to provide discounted health products purchased through PGH, so the loans will carry even more weight in the health commodities market.

The companies will lower pricing so that the average savings on health commodities will offset the average costs of financing the loans to purchase them.

“This announcement builds on our efforts to partner with the private sector to help end preventable child death within a generation,” Shah said in a statement.

He added: “USAID’s partnership with PGH will help make this promise a reality by ensuring that people around the world — especially mothers and their children — have access to life-saving vaccines, bed nets, and other supplies that are delivered more quickly, cheaply, and broadly than ever before.”

‘Major leap forward’ for PGH

The pledge was first assembled two years ago by the United Nations Foundation and partners including the Bill & Melinda Gates Foundation and USAID.

In this next phase, UNF will continue to support the program, but will no longer have a financial stake in any loan guarantees.

PGH allows third-party guarantors to guarantee rapid bank loans so that recipient countries, or the NGOs that they select, can purchase and distribute antibiotics, vaccines, contraceptives, bed nets and other life-saving treatments six-to-eight months faster than if they did so through traditional donor funding channels. This fast-track process aims to address the problems of stock shortages and higher costs associated with slower supply deliveries.

With the new commitments from USAID and Merck, the pledge is poised to take a major leap forward, supporters say.

“By joining in this partnership with PGH, our company will help to provide developing countries and local health workers with improved faster access to our life-saving medicines and vaccines,” Merck President for Global Human Health Adam Schechter said in the joint statement with the USAID chief.

Schechter echoed Shah’s call for more public-private partnerships to jump-start the final push towards lagging Millennium Development Goals (MDGs). According to USAID public health officials, ending preventable child death is one goal where innovative financing and risk-sharing between government agencies and the private sector can remove road blocks and save lives.

“While the financial mechanisms may be complex, the goal of PGH is simple: to quickly and effectively reduce deaths from easily preventable diseases,” noted UNF President & CEO Kathy Calvin.

With more partners sharing more risk than ever before, there will be no shortage of scrutiny as to whether or not the pledge pays off.

Happy Baby, Happy Mama: Private Sector Partnership Gets Results with Vouchers

During the month of May, IMPACT will be highlighting USAID’s work in Global Health. Below features the important role of mothers and partnerships in Global Health.

When Scovia Ketusiime was 24 years old and five months pregnant with her second child she made a purchase that might have saved her life, the life of her baby, and that of her 18-month-old: she bought a voucher. The voucher cost $1.20 and entitled her to four antenatal care visits, a safe delivery including transport to a larger facility if needed, and a postnatal care visit.

Scovia lives in an area of Uganda with one of the highest maternal mortality rates in the country. While 88 percent of wealthy women have a skilled attendant at delivery, fewer than half of poor pregnant women deliver in the presence of a skilled attendant. To achieve the goal of reduced maternal mortality, Millennium Development Goal 5 (MDG 5), we need to increase the proportion of women who deliver with skilled attendants, and ultimately, we want every woman to deliver with a skilled provider. A critical step toward achieving this goal is partnership with the private sector.

Scovia Ketusiime holds a Healthy Baby voucher. Photo credit: SHOPS

When Scovia heard about the Healthy Baby voucher on the radio, she wasn’t thinking MDGs or partnerships. She was thinking safe delivery. Her first baby was born at home with the aid of a traditional birth attendant after three antenatal care visits at a local public facility. While her first delivery experience wasn’t bad, this time she wanted to ensure that, “in case of any complications, I can get good care.” She talked it over with her husband, and decided to buy a voucher. Happy with her decision, Scovia said that the price was affordable and that even if it had cost twice as much, she would have found a way to purchase a voucher.

The Healthy Baby voucher program is implemented by the USAID-funded Strengthening Health Outcomes through the Private Sector project in partnership with Marie Stopes Uganda. The program, supported by the Saving Mothers, Giving Life initiative, works with private facilities to ensure high quality service and with community-based voucher distributors to provide information to recipients.

The Healthy Baby voucher program set out to address the dual objective of increasing access to comprehensive obstetric care for the poor in private facilities and improving and maintaining the quality of obstetric care within the private sector. It achieved remarkable results.

Nine months after the program began, more than 10,000 vouchers had been sold. Almost 6,000 babies have been delivered to women using the vouchers to access safe delivery with a skilled birth attendant in a facility. More than 2,000 women used the vouchers for postnatal care, which included family planning counseling.

We know that when a mother dies, her children are less likely to survive. We know that two-thirds of all maternal deaths take place during the 24-hour period of labor and delivery. We know that poorer women lack access to quality obstetric care, and we know the private sector can help bridge the gap. This program shows that coupling private sector providers with low-cost vouchers can contribute to improved maternal health.

The program sounded good to Scovia. It sounded good to her husband, too. He is the one who takes her to the Kagame Maternity Home on his motorbike.

Follow USAID for Global Health (@USAIDGH) on Twitter and use #GHMatters to join in the conversation.

Page 17 of 48:« First« 14 15 16 17 18 19 20 »Last »