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Archives for Global Health

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

Posted by  on Friday, April 22nd 2016     

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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Equipping Health Workers to Achieve an AIDS-free Generation

Posted by  on Tuesday, April 5th 2016     
A health worker tests a child for HIV at Eduardo Mondlane Health Center in Chimoio, Manica, Mozambique. / Arturo Sanabria, courtesy of Photoshare

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

I am scared.

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

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

I am afraid.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But what does optimization mean?

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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Ending a Global Epidemic of Tuberculosis in Children

Posted by  on Thursday, March 24th 2016     

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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More Community Health Workers Needed for a Healthier World

Posted by  on Thursday, February 25th 2016     

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

We live in extraordinary times.

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

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

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

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

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

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

Unlocking the potential of community health workers

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

Three thoughts emerge:

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

A framework for community health

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

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

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

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

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

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

It’s a time to be bold

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

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

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

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

ABOUT THE AUTHOR

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

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

Posted by  on Monday, February 22nd 2016     
Ending the HIV/AIDS epidemic can only be achieved with multiple prevention options that meet women’s needs and fit within the context of their lives./Kate Holt/Africa Practice

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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

Posted by  on Friday, January 29th 2016     
A new mother at the Karambo Health Center in Rwanda breastfeeds her newborn baby. Immediate breastfeeding after delivery helps prevent diseases and malnutrition in newborns. / Amy Fowler, USAID

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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

Posted by  on Thursday, December 24th 2015     

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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‘We Are Grateful’: How One Liberian School Has Battled Ebola

Posted by  on Friday, December 18th 2015     
Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

Last month I, along with a multidisciplinary team from USAID and colleagues from the Centers for Disease Control and Prevention and the National Institutes of Health, traveled to Guinea, Sierra Leone and Liberia.

Our objectives were to observe Ebola recovery efforts in each country, assess the progress of USAID’s transition from response to recovery activities on the ground, and get a better understanding of the impact of the disease on the survivors. We met with government officials, international NGOs, civil society organizations, other donors, and a host of ordinary citizens from each country, and visited many project sites.

One of the highlights of our time in Liberia was the visit to Lango Lippaye Elementary, Junior and Senior High School in Kakata, Margibi County, a 50-year-old school with nearly 2,200 students.

In July 2014, as the magnitude of the Ebola outbreak was gaining international attention, Liberian President Ellen Johnson Sirleaf, in an unprecedented move, closed the nation’s 4,500 schools in an effort to stop the spread of the disease. More than 1 million children were forced to stay home for over six months as the country battled the deadliest Ebola outbreak in history.

Over one year later, and after 4,200 deaths, Liberia has made significant strides in defeating the disease and is focused on recovering the development gains achieved prior to the outbreak.

The schools reopened in February as part of the recovery efforts. USAID and our partners at UNICEF worked with the Government of Liberia to ensure that children were able to safely return to school by providing more than 7,000 infection prevention and control kits to schools throughout the country, and training teachers and administrators on how to prevent infection.

The safety kits included buckets, soap, chlorine and cleaning items to help schools reduce the risk of Ebola transmission. USAID also partnered with UNICEF to provide schools with 700,000 learning kits that included chalk, pencils, books, erasers and folders. In addition, we trained teachers and PTA members on how to provide psychosocial support to the students and their families.

The students, teachers and administrators of Lango Lippaye Elementary, Junior and Senior High School welcomed us warmly during our visit. As we alighted from our vehicles, many beaming, cheering students greeted us; virtually all of them showed off their USAID-funded learning kits, holding up blue school bags with the familiar handclasp logo.

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

At the official welcoming ceremony, a student choir filed in singing joyously and full of energy about being grateful for the United States and its citizens for helping Liberia overcome Ebola. What an uplifting moment!

Reflecting on what life was like during the height of the crisis, one high school student told us, “It was very difficult during that period. We did not leave our home. I felt alone. People were afraid to go out.”

Another student added, “I tried to keep up with my courses while the school was closed but it was difficult. I missed my friends.”

The students said they were excited that they were now able to attend school and could pursue their career dreams once again. For some this meant aspiring to be doctors so they could contribute to addressing public health emergencies like Ebola. Being back in school also gave them renewed hope about the future.

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

Children at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia. / Courtney Babcock, USAID

Rosetta Fardolo, the student representative, asserted that USAID is “helping this school develop into a stronger, safer, and more productive environment to teach the next generation of Liberian leaders. We look forward to a long partnership with you as we work to rebuild our school and community post-Ebola.”

Students at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia sing to welcome the visitors. / Courtney Babcock, USAID

Students at the Lango Lippaye Elementary, Junior and Senior High School in Kakata, Liberia sing to welcome the visitors. / Courtney Babcock, USAID

Principal Robert Zaza expressed deep appreciation for the United States, telling us, “We are grateful and blessed even though we lost teachers and parents. Your donations helped our students come back to school and teachers to teach. You gave us those things that make us to be alive today, so we say, thank you.”

He noted that the school had established peer educators and a social club in an effort to fight stigma and discrimination against survivors of Ebola. Addressing survivor care and support are high priorities for USAID and we are developing new approaches to focus on this issue.

We know that there is more to do. Life is still scary and difficult for many Liberians—including schoolchildren and their families. As we support future education programs, we must remain dedicated to easing their concerns about Ebola and reintegrating students who have not yet returned to school. We cannot afford to fail these students now. Their futures depend on it.

ABOUT THE AUTHOR

Denise Rollins is the senior coordinator of the Africa Ebola Unit at USAID.

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Unprecedented Coordination Helped Turn the Tide of an Unprecedented Outbreak

Posted by  on Tuesday, December 15th 2015     
The response to the Ebola outbreak required coordination among a wide, varied array of groups -- and ultimately helped bring the disease under control. / Morgana Wingard/USAID

The response to the Ebola outbreak required coordination among a wide, varied array of groups — and ultimately helped bring the disease under control. / Morgana Wingard/USAID

The international response to the Ebola outbreak was truly unprecedented, combining humanitarian and public health interventions in ways and at a scale that had never been done before. Ultimately, controlling the outbreak required the combined efforts of not only disease experts and national governments, but ordinary citizens, political and religious leaders, community workers, NGOs, U.N. agencies and even militaries.

Writing in the latest edition of Emerging Infectious Diseases , officials from the Liberian Ministry of Health, the U.S. Centers for Disease Control and Prevention (CDC), and the World Health Organization credit the control of the Ebola outbreak in Liberia to six factors: government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves.

At a glance, it is easy to see how all of these factors  are interconnected; the ability to act with urgency, guided by technical experts, and the full participation of communities guided by strong coordination. But, the authors are quick to point out that no single factor explains how the disease was brought under control in Liberia. There is still much to learn about the virus. But here is one thing we do know: the effectiveness of the response depended not on limiting action to what was known at the time, but taking action in spite of the unknown.

The United States played a critical role in the response, ultimately sending more than 3,000 people to West Africa and supporting more than 10,000 civilian responders in Liberia, Sierra Leone and Guinea. / Carol Han/USAID

The United States played a critical role in the response, ultimately sending more than 3,000 people to West Africa and supporting more than 10,000 civilian responders in Liberia, Sierra Leone and Guinea. / Carol Han/USAID

The United States was actively involved in fighting  Ebola from the beginning, sending more than 3,000 people—including aid professionals, public-health specialists, soldiers and logisticians—to Liberia, Sierra Leone and Guinea at the height of the response to support more than 10,000 civilian responders.

The CDC sent teams in March 2014, shortly after the outbreak began. To assist overwhelmed health agencies and local resources, USAID deployed a Disaster Assistance Response Team (DART)—a highly-skilled humanitarian crises response group that August.

Soon after, the U.S. military arrived, bringing speed and scale to the immense logistical effort of training health workers and operating laboratories. The U.S. Public Health Service contributed medical expertise, deploying hundreds of staff to the region to fight the deadly disease.

Author Justin Pendarvis first traveled to the region in July 2014 and helped stand up USAID's Disaster Assistance Response Team to coordinate the response. / Morgana Wingard/USAID

Author Justin Pendarvis first traveled to the region in July 2014 and helped stand up USAID’s Disaster Assistance Response Team to coordinate the response. / Morgana Wingard/USAID

I first arrived in Guinea in early July 2014, visiting each of the affected countries to observe and gauge the growing outbreak, understand the coordination at play for the response and identify key challenges. I helped stand up our DART , with staff deployed in each the three affected countries and eventually to Mali, Nigeria, Senegal and Ghana.

Coordinating efforts among various U.S. Government agencies—as well as host governments, NGOs, other responding governments, local communities and the United Nations—was a heavy lift. Even as support rapidly scaled up, there was still no playbook on how to respond .

USAID coordinated with many partners that were doing jobs that they had never done before. For example, we worked with Global Communitie s (known best for its emergency shelter work) to support safe burials across all of Liberia, and UNICEF to develop tools for community-led social mobilization. We worked with the International Medical Corps and the International Organization for Migration on running Ebola treatment units.

Through Mercy Corps, we partnered with more than 70 local organizations to reach 2 million Liberians with life-saving information to protect themselves and their communities from infection. Through the International Rescue Committee and Action Contre la Faim, we ensured that the Liberian Ministry of Health had the necessary support to link together investigation teams, ambulances and burial teams, treatment facilities and community-led actions—linkages that were critical to stopping the explosive outbreak in densely populated urban Monrovia.

Because of our work in Liberia and other affected countries, local health systems are increasingly poised to maintain control and prevent future large-scale outbreaks themselves. / Morgana Wingard/USAID

Because of our work in Liberia and other affected countries, local health systems are increasingly poised to maintain control and prevent future large-scale outbreaks themselves. / Morgana Wingard/USAID

All in all, USAID worked with dozens of partners, the majority of whom remain in the region, committed to working alongside their national counterparts to safeguard against new outbreaks and restore routine health and social services. And throughout the response, the DART worked closely with national and international agencies to ensure that all the resources brought to bear by the United States were aligned with a common strategic plan, minimizing the burdens on national counterparts so they could be more responsive to their own leadership and ultimately to those affected.

Safe burial teams were a critical component to controlling the outbreak in Liberia. / Morgana Wingard/USAID

Safe burial teams were a critical component to controlling the outbreak in Liberia. / Morgana Wingard/USAID

Our work has made a difference. While there have been a handful of cases reported in the region, national systems and local health actors are now increasingly poised and ready to take the immediate steps necessary to maintain control and prevent future large-scale outbreaks. And new treatments and vaccines are being tested that may dramatically reduce mortality and prevent new infections.

With so few cases in the region now, it can be easy to forget that a much larger humanitarian catastrophe was averted. By some estimates, hundreds of thousands of lives have been saved. And despite the fact there were no days off on the DART, I am proud of the assistance we supported and grateful for the opportunity to have served alongside so many brave men and women on the epidemiological frontlines of an extraordinary response.

ABOUT THE AUTHOR

Justin Pendarvis is a public health advisor with USAID’s Office of U.S. Foreign Disaster Assistance.

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From the Household Hearth to Global Health: Creating a Healthier Planet Starts with a Cookstove

Posted by  on Tuesday, December 8th 2015     

Each year, in the days leading up to holiday gatherings across the United States, stoves and ovens put in a lot of hours.

Many are used to cook turkeys; some roast more than one. Stovetops steam green beans, simmer gravies, and cook cranberries down to a sauce.

Now, imagine a different scene. Instead of a kitchen filled with the aromas of a holiday meal, imagine a kitchen filled with black smoke that stings the eyes and itches the back of the throat. An open fire of kindling and cow dung burns in the center of the room, and clouds of smoke billow steadily forth to hang thick, heavy and hazy in the air.

For nearly 3 billion people around the world, this is not a sign that the casserole has caught fire in the oven. Rather, it’s a daily part of life.

More than 40 percent of the world’s population relies on solid fuels such as wood, coal, dung, charcoal and crop residues for everyday cooking. And in the clouds of thick smoke that such fuels produce, threats to environmental and human health converge.

Cleaner Technologies for Safer Homes

In Uganda, biomass fuel sources are used for nearly all household cooking needs. Open biomass fires release harmful particles into the air, and household air pollution is estimated to cause 20,000 premature deaths in Uganda each year.

A community organizer in Uganda demonstrates the use of the TLUD stove to a local group. / Kendra Williams, URC

A community organizer in Uganda demonstrates the use of the TLUD stove to a local group. / Kendra Williams, URC

To address this, USAID’s Translating Research into Action (TRAction) Project is researching the drivers and barriers for the household adoption and sustained use of cleaner cooking technologies.

A Top-Lit UpDraft (TLUD) stove was selected for the TRAction behavior change initiative in Uganda. The new stove burns wood more efficiently, emitting less ash and particulate residue than open fires. Local artisans produce and repair the stoves and leaders encourage adoption of the stove, promoting community ownership of the intervention.

A Global Concern

USAID is a founding member of the Global Alliance for Clean Cookstoves. The Alliance and its partners hope to disseminate 100 million cookstoves by 2020.

An investment in clean cookstoves is an investment in human health. Exposure to household air pollution accounts for 4.3 million deaths worldwide each year. Exposure to household air pollution is the leading risk factor for pneumonia, the second-leading cause of child mortality.

The linkages to the environment are also well-established. Solid fuel dependency for household fires contributes to climate change through the emission of gases and particles such as carbon dioxide, methane, and black and brown carbon. Unsustainable wood harvesting can lead to deforestation, reducing the uptake of carbon by plant matter and exacerbating soil erosion, waterway pollution, and altered vector-borne disease patterns.

Teresia Oloitai of Tanzania installs a chimney stove in her home to reduce the intake of smoke and carbon dioxide during household cooking. / Morgana Wingard, USAID

Teresia Oloitai of Tanzania installs a chimney stove in her home to reduce the intake of smoke and carbon dioxide during household cooking. / Morgana Wingard, USAID

Clean cookstoves are also an investment in women’s empowerment, as the burden of collecting biomass fuel often falls on women and girls — at the expense of other productive opportunities. New cookstoves also improve the health of women and children, who spend much of their time at home near the hearth.

Improving the health of communities through the expansion of sustainable fuel sources is one of the many ways in which climate change considerations both affect and are affected by efforts to improve global health. And as our understanding of the full impacts of climate change on the planet come to light, the connections to global health continue to grow.

The Talks in Paris: Envisioning a Healthy World

Recently, the WHO concluded that climate change is the greatest threat to global health in the 21st century. Its effects on human health are myriad. Air pollution accounts for 7 million deaths each year, and outbreaks of infectious diseases are expected to increase as weather patterns shift. Natural disasters and political instability — both linked to climate change — disrupt primary health services, and displaced populations are put at a heightened risk of illness and infection due to poor nutrition and a lack of vaccinations, medications, clean water and sanitation.

When each of these effects of climate change on human health, both direct and indirect, are taken into account, the number of people affected reaches into the billions.

Through a variety of efforts, USAID and others have contributed to the significant global progress over the past half century in reducing mortality rates and improving health and quality of life. There is undoubtedly much work left to be done — yet neglecting the issue of climate change could undermine the past 50 years of progress in global health.

The conversations at this week and next’s COP21 conference in Paris must take into account the full implications of our changing climate — not only for the health of our planet, but for the health of our fellow human beings. And as world leaders gather round the conference tables in Paris, our team will continue to help families gather round cleaner, safer cookstoves. Global health depends on both.

ABOUT THE AUTHOR

Benjamin Rost works on communications within the Global Health Bureau.

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