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Empowering Women Through a Simple Purse

Imagine giving birth without the help of sterile tools, a doctor, nurse or midwife. This is the experience of nearly half of women giving birth in low-income countries — and many are at high risk of infection. With limited access to antibiotics, these infections often prove fatal.

One woman is trying to change that.  

Zubaida Bai, founder and CEO of ayzh, speaking at USAID's Partnering to End Extreme Poverty and Achieve the Global Goals event. / USAID

Zubaida Bai, founder and CEO of ayzh, speaking at USAID’s Partnering to End Extreme Poverty and Achieve the Global Goals event. / USAID

Zubaida Bai is the co-founder of ayzh, an organization providing women’s health resources to underserved women globally.  The venture’s first product is a clean birthing kit that includes all the items recommended by the World Health Organization to prevent infection at birth.

Infections at birth affect more than 6 million women annually. Even worse, poor hygiene and sanitation during birth is directly linked to the preventable deaths of more than 1 million women and newborns each year.

In celebrating International Women’s Day earlier this month, we recognize women like Zubaida who are revolutionizing their field and making history with their achievements. With the support of USAID and other organizations, Zubaida’s work establishing ayzh has saved the lives of women and newborns on a global scale.

Zubaida posing with the clean birthing kit. / Ayzh

Zubaida posing with the clean birthing kit. / Ayzh

This is her story: After earning her engineering degree, Zubaida Bai decided to go back to India to serve the women she had seen suffer her whole life from health and financial hardship.

She worked in India for four years developing technology appropriate for low-resource settings, before she decided to spin off on her own. Both Zubaida and her husband Habib were passionate about helping women, so they started looking for opportunities to design for this underserved population.

On a field visit to a rural village, Zubaida discovered that some midwives used a sickle — normally used for cutting grass — to cut the umbilical cord. This was an “aha” moment for her.

Reflecting on the infection she contracted when her first child was born in one of the best facilities in India, she thought, “If I had everything and had to suffer an infection, what would women in these villages be facing?” This is the moment that launched Zubaida into a whole new world of maternal health.

“It made me very determined to make my childhood dream come true – to improve the lives of women,” she said in a blog for TED.

In 2007, Zubaida and her husband participated in MIT’s International Development Design Summit, a program that brings together people from across the globe to collaborate and build projects that address issues faced by the world’s poorest communities.  The program exposes participants to practical design for development.

Zubaida and other IDDS participants in morning circle, the way that summits start their days with team building exercises, announcements, and appreciations. / IDIN

Zubaida and other IDDS participants in morning circle, the way that summits start their days with team building exercises, announcements, and appreciations. / IDIN

After studying how to best succeed in markets in developing countries, Zubaida founded ayzh in 2009 and a year later launched the clean birth kit. She called it “janma,” which means “birth” in Sanskrit. The $3 purse comes with six items to ensure a safe and sterile delivery at half the cost of comparable birth kits.

Ayzh hires local Indian women to assemble the packages, allowing them to develop a stable income. Since 2010, about 250,000 kits have been sold in India, Afghanistan, Gambia, Laos, Ghana, Malawi, Nigeria, Zambia, and Haiti — reaching 500,000 mothers and babies.

Ayzh plans to reach 6 million women over the next five years, improving maternal health and breaking the cycle of poverty one woman at a time.

With support from USAID’s Higher Education Solutions Network (HESN) through MIT’s International Development Innovation Network, ayzh is developing a similar kit for newborns. It will provide the tools necessary to make transitions for new mothers and their babies as smooth and healthy as possible.  

Through HESN, USAID is empowering entrepreneurs and researchers at universities so that people like Zubaida can get the funding and mentoring they need to jump start their ventures.

Zubaida Bai and ayzh intern Kelly Brennan iterating on potential impact metrics they can use when communicating with their stakeholders during a workshop in Chennai, India. / Kyle Munn, SEAD

Zubaida Bai and ayzh intern Kelly Brennan iterating on potential impact metrics they can use when communicating with their stakeholders during a workshop in Chennai, India. / Kyle Munn, SEAD

Last year, ayzh was selected to be a part of a cohort of innovators at the Social Entrepreneurship Accelerator at Duke  — another HESN partner — to receive mentorship and capacity building to expand their global reach and impact. The Evidence Lab at Duke is providing support to ayzh to find the best ways to measure and communicate its impact.

With the support of USAID and other organizations, we hope this venture and others like it will continue to improve the health of women around the world.

ABOUT THE AUTHOR

Danielle Somers is a communications analyst for the U.S. Global Development Lab’s Higher Education Solutions Network (HESN). Emily Jablonski is a virtual intern for HESN and student at the University of Michigan.

More Community Health Workers Needed for a Healthier World

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


We live in extraordinary times.

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

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

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

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

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

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

Unlocking the potential of community health workers

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

Three thoughts emerge:

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

A framework for community health

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

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

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

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

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

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

It’s a time to be bold

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

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

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

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

ABOUT THE AUTHOR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ABOUT THE AUTHOR

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

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

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.

Unprecedented Coordination Helped Turn the Tide of an Unprecedented Outbreak

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.

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

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.

Why Right Now is the Right Time to Act Faster to Stop Unnecessary HIV/AIDS Deaths

Emily with two employees of Project Concern International (PCI) and her youth group members, celebrating the youths' graduation from PCI's Entrepreneurial and Business Skills Training in Botswana. / Project Concern International

Emily with two employees of Project Concern International (PCI) and her youth group members, celebrating the youths’ graduation from PCI’s Entrepreneurial and Business Skills Training in Botswana. / Project Concern International

“Dineo! DINEO! Diiiiiny!”

I hear my Setswana name being called, but I can’t concentrate on that right now. I’m busy biting my tongue as I begin the familiar routine of mentally reminding myself to relax.

This is not a new experience for me as a Peace Corps volunteer in Botswana—closing my eyes and counting to 10 as I wait in line in a cramped grocery store while a cashier, in a comically unhurried manner, takes her sweet time ringing up customers’ items, moving at the speed of a sleepy-eyed cat that’s spent its day dozing in the sun. This seems to be the default speed in my village.

Thankfully, my lack of response did not deter my caller. I’m shaken out of my irritability by Masego, a shining star in the youth group that I manage. Before I can greet her, she’s excitedly speaking in a hushed tone:

“Dineo! I was calling! I want to tell you! Mpho got tested. She’s positive.”

Mpho is another member of my youth group. Masego should absolutely not be telling people, including me, Mpho’s* status. Before I can even speak on this, though, Masego nonchalantly adds:

“She says she won’t take the drugs when they ask.”

What? “Why?”

Masego shrugs. “Ga ke itse.” I don’t know. “She says she’ll take muthi.”

Muthi. Traditional medicine.

Well. That did not improve my mood.

Not only is that one of the last things an HIV/AIDS volunteer wants to hear, but it also scared me. Five weeks before, another youth that I had worked with, Pako, passed away. He was born with HIV and had been living with the virus until he was 21—the age he stopped his antiretroviral therapy because he didn’t want his new roommates to see and deduce that he was HIV positive.

Emily distributing condoms to youth group members after a lively condom demonstration in Botswana. / Thabo Lentswe

Emily distributing condoms to youth group members after a lively condom demonstration in Botswana. / Thabo Lentswe

This once healthy young man deteriorated before us, eventually dying, unnecessarily, all the while denying that he was HIV positive to his friends and denying that he had stopped taking his treatment to his family.

Twenty years ago, in Botswana and in many other parts of the world, an end like Pako’s was often inevitable for people diagnosed with HIV. That is no longer the case. More people than ever before are living with HIV. And by living, I mean living; they’re healthy—working, studying, caring for their children, playing soccer, hanging with friends, living.

How you ask? Antiretroviral therapy.

Now, more people than ever before have access to lifesaving medication. This monumental achievement is the direct result of the work of USAID, the President’s Emergency Plan for AIDS Relief (PEPFAR), international partners, partner countries and civil society.

But here’s the thing: In order for antiretroviral therapy to work, people have to actually start taking it. And once they start taking it, they must adhere to it. Completely.

Emily with four youth group members in Botswana. / Project Concern International

Emily with four youth group members in Botswana. / Project Concern International

This is why the Joint United Nations Programme for HIV/AIDS, as part of its 90-90-90 targets, is striving to get 90 percent of all people living with HIV on sustained antiretroviral therapy by 2020 in order to end the HIV epidemic by 2030. USAID and PEPFAR have established new targets to aggressively scale up treatment in order to reach this goal.

This goal cannot be accomplished, though, if people, like Mpho, do not start the treatment.

Right now.

This goal cannot be accomplished if people, like Pako, do not stay on the treatment.

Right now.

This goal cannot be accomplished if the international community, including beneficiaries, does not act urgently.

Right now.

We are closer than we have ever been to reaching an AIDS-free generation. This can’t be done, though, if international agencies, civil society, partner countries and beneficiaries move at the same languid pace as the cashier in that cramped, scorching grocery store in my village in Botswana.

In order to control the HIV epidemic, save lives and get people on sustained treatment, we need to move now, together, with a sense of urgency and purpose. This is the time to push. This is the time to work. The time to act is now.

*Names have been changed throughout to protect individuals’ identities.

ABOUT THE AUTHOR

Emily Reitenauer is a program assistant on the Gender Team for the Technical Leadership and Research Division in the Office of HIV/AIDS in USAID’s Global Health Bureau. She spent three years (2012-2015) serving as a Peace Corps volunteer performing HIV/AIDS work in Botswana.
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