USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Women Deliver Conference Focuses Attention to Women’s Health and Rights

During the month of May, IMPACT will be highlighting USAID’s work in Global HealthThis week we will be focusing on Family Planning. 

This week leaders and advocates from nearly 150 countries are gathering in Kuala Lumpur, Malaysia for Women Deliver 2013, one of the largest conferences of the decade focused on the health and wellbeing of girls and women. USAID is proud to participate in Women Deliver 2013 and highlight the Agency’s strong support and dedication to improving the health and status of women and girls across the globe. A number of our technical experts are presenting at the conference on topics covering family planning, maternal, newborn and child health, and other programming that address the needs of women and girls.

With support from USAID, Masreshah delivers reproductive health information and services to households in the Amhara region of Ethiopia. Photo Credit: Pathfinder International

The discussions in Kuala Lumpur are sparking a larger global conversation on how and why we all must work together to improve access to reproductive and maternal health.  Last night, USAID participated in the launch of WomenDeliver+Social Good, a movement that brings together social entrepreneurs and new media connectors around the world with the leaders who are shaping policies and programmes around women’s health and economic empowerment.  Watch USAID’s Health Development Officer, Judy Manning, present at the launch event where she spoke about the development of new contraceptive technologies as a solution to saving women’s and children’s lives.

Coinciding with the Women Deliver conference, USAID is highlighting our work in family planning this week on IMPACT as part of our Global Health blog series this month.  Family planning plays a critical role in meeting our goals of ending preventable child and maternal deaths and creating an AIDS Free Generation, and is crucial to improving people’s lives across the globe.  We know that family planning enables women and couples to choose the timing and spacing of their pregnancies, resulting in incredible health and economic benefits for families.  A USAID analysis found that, by preventing closely spaced births, family planning could save the lives of more than 1.6 million children under five annually.  Satisfying the global unmet need for family planning could reduce maternal deaths by 30 percent. And enabling young women and girls to avoid early pregnancy allows them to stay in school longer, increasing their economic opportunities.

Check back here all week as we highlight the importance of Millennium Development Goal (MDG) 5b, Universal Access to Reproductive Health.  Keep up with USAID’s participation at Women Deliver by following USAID for Global Health on Twitter for live updates and visit our webpage dedicated to the conference.

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

 

PEPFAR: Ten Years of Saving Millions of Lives

Originially appeared on Huffington Post

Ten years ago today, the United States Congress, in a remarkable display of compassion and bipartisanship, passed overwhelmingly legislation that established an historic and transforming global health program now known as PEPFAR— the President’s Emergency Plan for AIDS Relief.

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is in its 10th year of helping HIV and AIDS-infected and -affected populations get access to prevention, care and treatment services. PEPFAR, the largest effort by any nation to combat a single disease, is working to achieve former Secretary of State Clinton’s vision of creating an AIDS-free generation. Photo Credit: EGPAF/James Pursey

At the time that PEPFAR was conceived of and then established during the George W. Bush administration, the world was witnessing first-hand the destruction of an entire generation of individuals in the prime years of their lives and the reversal of remarkable health and development gains, particularly in sub-Saharan Africa and to a lesser extent in other developing nations. Rates of new HIV infections were rising rapidly, and hospitals, communities, and families were often too under-resourced and overwhelmed to cope with the enormity of this burden. At that time in 2003, despite the availability of life-saving antiretroviral therapy (ART) in most countries in the developed world, in southern Africa and other regions of the developing world, an HIV diagnosis meant a virtual death sentence, since few had access to such drugs.

Today, as we mark the 10th anniversary of PEPFAR, the situation has changed dramatically. Plummeting life expectancy rates in much of Africa have been reversed; HIV-infected, but healthy, fathers and mothers who are receiving therapy are able to return to work, care for their families, and spur economic development. Doctors, nurses, and community health workers, who once had little to offer their patients beyond a more dignified death, are delivering life-saving ART to millions of people. AIDS-related mortality has declined by more than 26 percent since its peak in 2005. Where despair once cut a devastating swath through so many communities and countries, hope has been renewed.

With regard to the prevention of HIV infection, globally, in the decade since PEPFAR began, new HIV infections have declined by nearly 19 percent. Between 2009 and 2011, new HIV infections among children, still an important component of the epidemic in many southern African countries and other regions in the developing world, declined by 24 percent globally, compared to a 23 percent decline in the previous six years. Not only is progress happening, but its pace is accelerating.

According to a recent report evaluating PEPFAR by the Institute of Medicine, “PEPFAR has played a transformative role with its contribution to the global response to HIV.” As of the end of September 2012, PEPFAR was directly supporting 5.1 million people on ART — a more than three-fold increase in just the past four years. Last year alone, PEPFAR reached more than 750,000 pregnant women living with HIV with antiretroviral drugs to prevent mother-to-child transmission (PMTCT), allowing an estimated 230,000 babies who would have otherwise been infected to be born without HIV.

One key driver of this progress is the development and implementation of a combination prevention program. Just as it became clear that multiple HIV medicines, when used in concert, more effectively control replication of the virus in the body, it was shown that multiple prevention interventions, when implemented together, can more effectively reduce new HIV infections at the population level. This evolution in our thinking and approach to preventing HIV infection has reflected scientific innovation together with practical implementation. Landmark scientific advances, coupled with lessons learned from a decade of implementing programs under PEPFAR, have given us the tools, knowledge, and experience needed to achieve an AIDS-free generation.

Recent statistics show that the promise of an AIDS-free generation is truly within our reach, as President Obama powerfully articulated in his State of the Union address earlier this year. More countries than ever before have reached, or surpassed, the programmatic tipping points in their HIV epidemics — the point at which the annual increase in adult patients receiving treatment exceeds the number of annual new adult HIV infections. Reaching this tipping point is a key indication that a country is on the path to achieving an AIDS-free generation — and the more countries that achieve this goal, the closer we will be to ending the HIV/AIDS pandemic.

While PEPFAR is certainly the largest and most successful foreign health assistance program in history, it is clear that the United States cannot be alone in this endeavor… Other partners, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, to which the U.S. is the largest contributor, multilateral organizations, the private sector, civil society, and host countries must all share in the responsibility. And, as PEPFAR enters its second decade, countries with a high burden of HIV disease must assume greater ownership for addressing the health needs of their own people by building strong and sustainable health systems.

PEPFAR represents the very best of America — the extraordinary generosity and compassion of the American people. Through PEPFAR, we are helping to deliver a better future to millions around the globe. Although much remains to be done in the future, the 10th anniversary of PEPFAR is something to celebrate now.

Ambassador Eric Goosby is the U.S. Global AIDS Coordinator and head of the State Department’s Office of Global Health Diplomacy. Dr. Anthony Fauci is the Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

Follow Ambassador Eric Goosby, MD on Twitter:www.twitter.com/@PEPFAR

 

Remembering and Learning from Those We Have Lost to AIDS

Last week, I joined non-governmental organization (NGO), community, and health care leaders at a ceremony held to honor those whom we have lost to AIDS in Tajikistan and throughout the world.  This year in Dushanbe, the International AIDS Memorial Day ceremony was conducted for the second time at a public City Health Center, rather than at an NGO or AIDS Center, marking a growing acceptance by front-line health care workers of the key populations at higher risk who come to their facility for services. The ceremony was a time to mark the many steps Tajikistan has made in the fight against AIDS, but it was also a time to remember the suffering and loss experienced by many and to call on the community for greater acceptance and support of those in need.

Health care workers and community members honor the lives lost to AIDS in Tajikistan. Photo Credit: USAID

Since 1991, over 800 people in Tajikistan have died due to AIDS-related illnesses. As pointed out by Sevar Rahimovna Kamilova, a brave woman who leads an HIV-focused NGO here in Tajikistan, “Those lost to AIDS come from all genders, ages, religions, social strata, and professions.” Ms. Kamilova also shared that in Tajikistan now, almost 5,000 people are officially registered as HIV-positive. Of these, less than a third receive anti-retroviral therapy. Pulod Jamolov, director of a local NGO that supports people who inject drugs, movingly described why so few HIV-positive individuals are tested and receive treatment. “Discrimination and stigma directed at HIV-positive people result in a reluctance to do anything that would make their status known – including discussing risks with health care workers when they have medical needs, seeking out an AIDS Center to get tested, or receiving the free treatment offered by the government through support from the Global Fund to Fight AIDS, Tuberculosis, and Malaria.” This fear, combined with ignorance of available options, means that many people will die who don’t have to.

Yesterday’s ceremony brought home to me yet again the importance of the work that USAID, PEPFAR, and its partners are doing to reduce stigma and discrimination in Central Asia and to support key populations to access testing and treatment. As the event came to a close, the crowd kneeled as they were led in prayer by a local imam. I looked out at the many white-clad medical workers in the crowd – each braving the noonday heat to honor a group of people that, perhaps just years ago, they would have disdained. International AIDS Memorial Day is indeed a sad day, but it is also a day of hope, courage, and possibility.

Task Shifting to End Preventable Maternal/Child Death in Kenya and Zambia

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

A mother and her baby. Photo Credit: USAID

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

Bondo, Kenya — Babies Gabriel and Mary show the progress that Kenya is making in moving towards an AIDS-free generation. 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. [AE1]

 

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.

 

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, IDEO.org partnered with Water and Sanitation for the Urban Poor to tackle the issue of open defecation. IDEO.org 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 IDEO.org 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.

IDEO.org’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.

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