Archives for Global Health

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

Posted by Emily Reitenauer on Tuesday, December 1st 2015

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

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

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.

Saving Mothers, Giving Life

Posted by Claudia Morrissey Conlon on Monday, October 19th 2015

The Chikomeni Rural Health Centre in eastern Zambia offers Basic Emergency Obstetrics and Newborn Care services to its clients. / Anne Jennings, Rabin Martin.

For the staff at the Matanda Rural Health Center in northern Zambia, help during emergencies was hard to find. The nearest hospital is 60 kilometers away—40 of them over a rough gravel road. Lacking a cell tower, health center staff would walk or ride 27 kilometers in order to call for an ambulance. Until recently, nurse Esther Kabaye was the center’s only clinician; she treated women in the region when complications arose during pregnancy.

Through Saving Mothers, Giving Life, a public-private partnership launched in 2012, Kabaye began a mentorship program in which she met once a month with a district mentor, developing the necessary skills and knowledge for emergency obstetric and neonatal care.

These efforts were rewarded after only a few months, when Helen, a 35-year-old woman from a nearby village, was brought to the health center in labor. She successfully delivered a healthy baby, but afterwards began bleeding heavily. Kabaye identified the emergency as a postpartum hemorrhage, and promptly performed a bimanual compression of the uterus, saving Helen’s life.

“I am so happy that I am able to effectively handle emergencies and save lives that would have been lost,” Kabaye said. She now teaches other nurses, amplifying the lifesaving impact that she has had on her own community and others nearby.

Stories like Kabaye’s are not uncommon within Saving Mothers, Giving Life districts. USAID is a founding member of the partnership, launched in 2012 by then Secretary of State Hillary Clinton as an innovative, integrated approach to health systems. Saving Mothers, Giving Life seeks to reduce maternal and newborn mortality by increasing the demand for services, facilitating access to lifesaving care, and strengthening health systems at the district level.

The initiative is supported by a range of partners, including the governments of Uganda, Zambia, the United States and Norway; Merck for Mothers; Every Mother Counts; Project C.U.R.E.; and the American College of Obstetricians and Gynecologists.

Target districts in Uganda (left) and Zambia. High levels of success during Phase 1 (June 2012-June 2013) led to the expansion of the program during Phase 2. Mid-Initiative results show even greater improvements in maternal mortality during Phase 2. / Saving Mothers, Giving Life

Initially implemented in four districts each in Uganda and Zambia, Saving Mothers, Giving Life emphasizes adequate and timely care for pregnant women and new mothers. The initiative focuses on three primary delays to lifesaving maternal care: the delay in seeking services, reaching services, and receiving high-quality care. The initiative generated astounding results: The target facilities in both Uganda and Zambia saw a 35 percent drop in maternal mortality in a single year.

Based on such astonishing success, the program was expanded in 2014 to an additional 12 districts in Zambia, and another 6 districts in Uganda. This week, I am excited to share the continued success of the initiative with our 2015 Mid-Initiative Report.

In Uganda, the institutional maternal mortality rate has fallen by 45 percent since the beginning of the initiative. This reflects a 30 percent increase in the rate of delivery in facilities that provide emergency obstetric and newborn care. Such inspiring results are not limited to health facilities, however: Across the target districts as a whole, maternal deaths have decreased by 41 percent—not just among women who delivered in a facility, but among the districts’ entire population

Women queue up for health services at the Chikomeni Rural Health Centre in eastern Zambia. / Anne Jennings, Rabin Martin.

In Uganda’s Kabarole District, District Health Officer Dr. Richard Mugahi faced a challenge. “We had enough midwives and equipment, but mothers were not delivering in facilities,” he says. “They preferred delivering with the support of traditional birth attendants.”

With the support of Saving Mothers, Giving Life, the Kabarole District established a Demand Creation Committee to encourage women to take advantage of family planning services, prenatal care visits, and health facility deliveries. The Kabarole District has also used radio broadcasts to educate communities about the risks of giving birth at home and encourage them to give birth in a facility. The initiative is community-owned, sustainable in the long term, and—most importantly—effective.

The results from Zambia are equally as encouraging. Since the launch of Saving Mothers, Giving Life, institutional maternal mortality has fallen by 53 percent in the target districts. Nearly 90 percent of women are now giving birth in a facility, compared to 63 percent at the outset of the initiative. And the number of women who have received treatment to prevent the spread of HIV/AIDS to their infants has increased by 81 percent.

Mwasemphangwe Zonal Rural Health Centre in Zambia offers Basic Emergency Obstetrics and Newborn Care services to its clients. / Anne Jennings, Rabin Martin.

These results are heartening. They speak to the success of the approach employed through Saving Mothers, Giving Life that revolves around localized, evidence-based interventions. Efforts at the district level strengthen districts’ health systems as a whole, while community-level interventions generate demand for services among women and their families by changing social norms. The initiative is active in two dozen districts across Uganda and Zambia, with expansions underway in additional districts, as well as in Nigeria.

Yet perhaps even more encouraging is the potential that Saving Mothers, Giving Life has to extend far beyond the borders of Uganda, Zambia and Nigeria. The approach has proven to be successful, and is continuously fine-tuned and developed through extensive monitoring and feedback. The organizing principles employed by Saving Mothers, Giving Life can serve as an example to countries across the globe, who can adapt the model for use in their own communities.

The partnership has brought together the diverse strengths of a variety of organizations, contributing substantially to the mission to end preventable child and maternal deaths within a generation. Saving Mothers, Giving Life has amazed and inspired me over the past two and a half years that I have directed the Secretariat, and I am excited to see what we are able to accomplish in two and a half more.

ABOUT THE AUTHOR

Claudia Morrissey Conlon is USAID’s Senior Maternal and Newborn Health Advisor and the U.S. Government lead for Saving Mothers, Giving Life.

USAID Salutes Nobel Laureates Whose Discoveries Help Fight Malaria, River Blindness, Elephantiasis

Posted by Chris Thomas on Tuesday, October 6th 2015

This year’s Nobel laureates in medicine developed therapies that revolutionized the treatment of some of the most devastating diseases caused by parasites.

On Monday, William Campbell and Satoshi Ōmura were cited for their discovery of the drug Avermectin, the derivatives of which have radically lowered the incidence of river blindness and elephantiasis. And Youyou Tu was rewarded for her research on malaria therapy. USAID relies on these medicines to protect millions of people at risk.

Parasitic worms afflict one-third of the world’s population, causing diseases like river blindness and elephantiasis. Before the development and widespread use of the avermectin-derivative ivermectin, river blindness left whole communities in Africa blind from the disease. Adults would be led around by children holding a stick. Agricultural productivity and development were at a standstill. Decades later, these communities are thriving agricultural centers, and children are in school instead of caring for the blind.

A child leads two individuals blinded by the parasite that causes river blindness through a village. / Bill VanderDecker

USAID’s neglected tropical diseases (NTD) program targets both river blindness and elephantiasis, as well as other diseases. Each year we distribute ivermectin, the drug used to treat river blindness, to more than 25 million people.

Since 2006, USAID has supported the delivery of more than 1 billion preventive drug treatments for NTDs – to almost a half a billion people. The neglected diseases team also manages the largest public-private partnership in USAID’s history, having secured more than $8 billion in drug donations to date. We estimate that for every tax dollar spent by USAID, more than $26 in drugs is donated in-country.

Inspired by a description in a 1,700-year-old Chinese text of the use of sweet wormwood to combat fever, it was Tu who discovered artemisinin. This medicine remains the most effective treatment for malaria today, saving millions of lives.

The parasite responsible for the most lethal human malaria started to resist the drug chloroquine in South America and Southeast Asia in the late 1950s and early 1960s. By the late 1960s, efforts to eradicate malaria had failed and the disease was on the rise.

At that time, Tu turned to traditional herbal medicine to find novel malaria therapies. In China, the qinghaosu plant was used in fever remedies for thousands of years. Tu examined 2,000 recipes for traditional Chinese remedies and discovered one derived from sweet wormwood (Artemisia annua) reduced malaria parasites in the blood.

USAID has been fighting malaria since the 1950s, helping develop the tools relied on today. For example, USAID funded trials showing that mosquito nets, treated with safe insecticide, were effective in significantly reducing child deaths and preventing malaria in pregnancy.

Habiba Suleiman, 29, a district malaria surveillance officer in Zanzibar, naps with her little girl Rahma under a mosquito net. She lives in Tanzania, where up to 80,000 people die from malaria each year. Hariba is working to change that. Read her story on USAID’s storytelling hub. / Morgana Wingard, USAID

The U.S. President’s Malaria Initiative (PMI), launched in 2005, represents the U.S. Government’s bilateral commitment to massively scaling up proven malaria prevention and control efforts. Led by USAID, PMI has advanced game-changing innovations, like insecticide-treated mosquito nets and more effective drugs.

Through PMI, USAID funds operational research to improve uptake and scale of interventions, to preserve intervention effectiveness in the face of both drug and insecticide resistance, and to respond to changes in malaria epidemiology.

More than 6 million deaths have been averted, primarily among children under 5 in sub-Saharan Africa through the expansion of malaria control efforts by affected countries — with the support of PMI and other key partners.

This success would not have been achieved without access to high quality malaria treatments, diagnostics, and tools like bed nets and indoor spraying to kill or repel malaria carrying mosquitoes. Since the initiative began, PMI has purchased more than 318 million quality-assured artemisinin combination therapies, as well as more than 174 million rapid diagnostic tests to support appropriate malaria case management.

The financial and technical contributions of the U.S. Government are a major catalyst in the remarkable progress that has been achieved in many countries to reduce the devastating burden of parasitic worms and malaria. But the work is far from complete.

More than 1 billion people suffer from one or more NTDs. Almost all are poor who live in rural areas and urban slums of low-income countries. Nearly half a million people still die each year from malaria. When children fall ill, students miss school, and adults stop working and are unable to provide for their families.

We admire Campbell, Ōmura and Tu for their inspiration and celebrate their discoveries that helped mankind.

ABOUT THE AUTHOR

Chris Thomas is a communications advisor in the Bureau for Global Health.

Around the World in Videos: How USAID is Helping Curb Child and Maternal Deaths

Posted by Alfonso E. Lenhardt on Friday, August 28th 2015

Mom and baby are doing fine because mom was taught how to perform Kangaroo Mother Care to keep her premature newborn warm. / Molly Ronan, Embrace Global

In 1990, more than 12 million children under the age of 5 died every year because of preventable conditions and diseases. Today, we face a situation considerably less bleak.

But still, far too many children today are being robbed of the chance to lead full, healthy lives. They are being robbed by illnesses we can prevent and treat. And far too many mothers won’t get to hold their newborn in their arms. These women won’t have the chance to raise their families or contribute to their communities.

Over the past six years, the Obama administration has strategically focused our maternal and child health programs in the 24 countries that account for more than 70 percent of child and maternal deaths globally.

By providing expectant mothers with high-quality and respectful care during delivery, resuscitation for newborns, vaccinations, diarrhea treatment and education about the importance of breastfeeding and handwashing, it is estimated we have helped save the lives of nearly 2.5 million children and nearly 200,000 mothers since 2008.

Acting USAID Administrator Alfonso Lenhardt joins Indian Prime Minister Shri Narendra Modi and heads of delegations from around the world at the Call to Action Summit on Aug. 27 in New Delhi, India. / Clay Doherty, USAID

This week in New Delhi, I join health ministers from those priority countries and experts from across the globe for The Call to Action Summit to take stock of progress, share best practices and forge alliances.

Here are snapshots of some of USAID’s efforts around the world.

India

Like all mothers, Satyawati wants the best for her children, including for her newborn son. In a world where motherhood is still a risky endeavour, her story reflects the Indian Government’s new approach to maternal and child survival. With help from her local health worker, Satyawati knows how to best care for her children. She has had them vaccinated, and she practices proper hygiene at home.

Millions more have benefited from India’s recent efforts to reduce maternal and child deaths. In fact, under-5 mortality has dropped from 126 per thousand live births in 1990 to 53 per thousand live births in 2013. The government is using a scorecard to track its progress, providing transparency and accountability.

Malawi

“It’s heartbreaking to not have the equipment you can use on a baby to survive,” said Indira Chikomoni, a nurse at Zomba Central Hospital in Malawi. But with USAID’s support, 27 hospitals throughout Malawi now have access to a device called the Pumani bCPAP, which helps newborn babies breathe until their lungs have fully developed. The device has tripled the survival rate for babies treated for respiratory distress syndrome.

Gloria Mtawila’s son Joshua, who was struggling to breathe at birth, stayed on the machine for a month until eventually he could breathe on his own, and now he is a healthy baby boy.

Ethiopia

Adanech Belay is a proud mother of three, one of millions of rural families that used to live beyond the reach of the health system in Ethiopia. With USAID’s help, the Ethiopian Government has trained more than 38,000 health workers and deployed them around the country. Now, Belay can give birth in a clinic. She knows about vaccines, hygiene and family planning. Health extension workers now form the backbone of Ethiopia’s health care system, empowering families like hers to take charge of their own health. And the efforts are working.

In September 2013, Ethiopia announced it had achieved Millennium Development Goal 4—reducing child mortality by two-thirds by 2015—a full two years ahead of schedule. In 1990, Ethiopia’s under-5 mortality rate was one of the highest in the world at 204 for every 1,000 live births; by 2013, this rate had been slashed to 64 for every 1,000 live births.

Nepal

Until recently, three in 100 Nepali babies died before they were 1 month old, often from infections introduced into the body through the umbilical cord stump. In Nepal, where home delivery is common, a newborn’s umbilical cord has traditionally been cut with dirty household tools, and substances like oil, turmeric or even cow dung were rubbed on the stump to encourage “healing.”

All that is changing now with the support of USAID. With our partner JSI, we’ve helped develop a low-cost antiseptic gel we’re providing to pregnant women free of charge. A network of 50,000 female volunteer health workers are teaching communities how this little tube and new healthy practices can save their babies’ lives.

When a child dies, and when a mother dies giving birth, it is a tragedy for all of us. Because we miss out on everything they might have offered, and because it continues the cycle of extreme poverty that holds the entire world back. Together, we can break that cycle.

The goal of ending preventable child and maternal deaths is within our reach. We will continue Acting on the Call until every mother and child has the chance to lead a full, healthy life.

Q&A: The Legacy of West Africa’s Ebola Crisis

Posted by Clara Wagner on Tuesday, August 25th 2015

USAID’s Senior Ebola Coordinator Denise Rollins (right), Mission Director John Mark Winfield (second from right) and Bureau of Legislative and Public Affairs staffer Kate Alexander listen as a staff member of DuPort Road Clinic in Paynesville, Liberia speaks to them. / Jonta Williams, USAID

In this Q&A series, we are profiling the experts who have worked tirelessly to stop the spread of the deadly Ebola virus in West Africa and are helping societies rebuild and strengthen health systems in the aftermath of the outbreak.

Denise Rollins, the senior coordinator of the Africa Ebola Unit, has worked at USAID for 28 years. She rejoined USAID in March after retiring last October because she felt a tremendous commitment to help those in need. She is USAID’s liaison coordinating with other U.S. Government agencies to help West African countries strengthen their ability to respond to future disasters.

What will the legacy of Ebola be in the countries affected by it?

Ebola has changed the lives of those affected by the virus and those who helped fight the disease. Ebola has left behind pain, sadness and death; we cannot keep our heads in the sand knowing what we now know about the disease.

However, as these countries get to and remain at zero, the international community will help build more enduring social and economic systems that will allow the countries to handle not only Ebola, but other infectious diseases, as well. We will once again see progress in health, agriculture, education and the overall economy. While Ebola leaves a legacy of caution and preparedness, it also gives us a future based on hope and resilience.

In July, USAID and other donor partners and governments gathered at the International Ebola Recovery Conference held at the UN. What are your thoughts on the conference?

The conference was a platform for representatives of Guinea, Liberia, Sierra Leone and the Mano River Union to outline their recovery strategies, and for the UN to foster a dialogue between the African countries and the donor community about recovery priorities and expectations.

Donors then pledged an unprecedented $3.4 billion in new funding, with the United States pledging $266 million, in addition to the $1.8 billion already provided for the response efforts. This brings the total pledged for response and recovery to more than $5.2 billion from the donor community.

This was a great step forward in a global call to action that will lead to the creation of more resilient societies in Africa.

What made the Ebola crisis different from past health crises?

The large number of people dying, the rapid spread of the virus, and an initial inability to treat patients made this crisis different. In terms of geography, Ebola reached bustling capitals and heavily populated cities, leading to a faster rate of transmission. Misunderstandings and lack of information about the disease also increased fear and panic, causing some victims to avoid reporting their illness. We have never seen a humanitarian public health crisis quite like this one.

What role has communications played in controlling Ebola?

Denise Rollins retired last October after working at USAID for 28 years, but when asked to return as senior coordinator for the Africa Ebola Unit, she said “yes” without hesitation. “I knew this was the right position for me,” she said. / Ellie Van Houtte, USAID

Due to pre-existing issues with digital and communications infrastructure, it was hard to share information about the disease during the crisis. It was difficult to control the outbreak without accurate and timely information to detect Ebola, trace contacts of people who were infected, organize patients’ transport to treatment centers, and coordinate teams to conduct safe burials. Poor information hampered our ability to understand where the outbreak was occurring.

In Liberia, USAID sent a data logistician to serve on the Disaster Assistance Response Team to develop a better data sharing platform. He helped significantly reduce the time it took to get information from outlying areas to the capital. USAID is working with all three countries on improving data and communication technologies.

We are also strengthening public and private partnerships to bring low-cost Internet and mobile phone service to urban and lower-income, rural settings.

How are we helping to strengthen governance?

USAID is expanding the roles of community groups, NGOs and civil society to manage the effects of Ebola and more effectively work with the government to improve the quality of public services.

Our plan includes help with reopening schools, empowering civil society, and supporting open data policies and using technology for government services and information.

Interest in Ebola has been declining as the situation improves. Why are our response efforts still important?

The focus of the response continues to be ending the Ebola epidemic. While there is Ebola in West Africa, nothing prevents it from entering the United States, so this is a matter of national security.

In terms of the countries themselves, Ebola quickly damaged weak institutions, disrupted vulnerable communities and stymied health systems’ ability to address other infectious diseases or basic health care. We strive to rebuild and strengthen health systems there to enable societies to fend off future threats, while making sure those who’ve experienced setbacks can return to a path of prosperity.

These efforts are core to USAID’s mission to end extreme poverty and promote resilient, democratic societies.

Amid the Ebola crisis, many stories have emerged describing heroic aid efforts and acts of bravery. What stories touched you most?

Access to education and the preservation of arts and culture are important to me, so I was heartened to hear stories of children in Sierra Leone eagerly tuning in to an education radio program; of an American artist who stuck photos of smiling health workers on their protective suits so patients could see who was underneath the mask; of actors, taxi drivers, traditional leaders and musicians working together to raise awareness and stop Ebola.

On the Job at USAID: Meeting An Amazing Global Health Hero

Posted by Margaret McCluskey on Thursday, August 6th 2015

Dr. Suniti Solomon is pictured here in 2008 at the YRG Care Clinic, supported by USAID through the International AIDS Vaccine Initiative, in India. / The Annenberg Foundation

Sometimes, I hear the word “hero,” and I cringe. To me, the bar has to be pretty high to earn that title, so I’m careful to use the word, rather than throw it around thoughtlessly.

On July 28, in Chennai, India, the world that fights HIV lost a true hero – or heroine in this case. The headlines hit the international press: “Dr. Suniti Solomon, who woke India up to HIV threat, dies at 76.”

For the past week, I’ve read some of the many tributes to Dr. Solomon; a favorite was written by Michael Specter, a staff writer at The New Yorker who has written much about the AIDS pandemic.

He recounts an interview with this remarkable physician-scientist-researcher-humanitarian, when she told a story of the tragedy wrought by systemic stigma in the world of HIV and AIDS.

As a doctor, mother, wife and particularly humble humanitarian, this was what she railed against; she knew that stigma would be the force that would keep HIV underground, able to do irreparable damage to her beloved India.

Stigma allows HIV to kill like no other force really, and she was determined to spend the last 30 years of her life trying to overcome it.

At USAID, we are seriously fortunate to support a lot of remarkable people trying to find permanent solutions to really big problems like HIV and AIDS. It’s an amazing privilege afforded by the American people to approach these daunting issues that plague our fellow man.

In my three decades of working on the AIDS problem, and eight-plus years working at USAID, no single partner or investigator has affected me like Dr. Suniti Solomon.

As part of the Agency’s portfolio dedicated to finding an HIV vaccine—which one day will be added to the unparalleled efforts of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)—we supported Dr. Solomon’s clinic in educating vulnerable Indians to protect themselves against the virus, get tested and, if it was right for them, volunteer for an HIV vaccine trial.

We were certainly not alone in recognizing Dr. Solomon’s research capacity; she has been awarded many NIH grants which have provided a plethora of noteworthy scientific contributions. I remember being bowled-over the first time I visited and saw the volume of research charts in her clinic at YRG Care, the NGO she started in response to the needs of those who needed care, support, education and information about HIV awareness and prevention in India.

Dr. Suniti Solomon and Margaret McCluskey at the 5K Sunrise Walk for YRG Care in 2010 in Chennai, India. / International AIDS Vaccine Initiative (IAVI), India

How lucky was I, a nurse who’s been at this fight against HIV and AIDS for decades, not only to conduct periodic site visits to Dr. Solomon’s clinic, but once to be seated beside her on a long flight back to Washington, D.C. She had a speaking engagement at the Indian Embassy to discuss her success in helping HIV-positive people become parents of uninfected children.

She shared many memorable stories in that transitory but intimate space. She spoke of taking blood samples of about 100 women awaiting incarceration for prostitution in 1986; six of them were confirmed HIV-positive by a friend’s lab at Johns Hopkins University. That proved despite widespread denial that HIV was a very real problem demanding immediate attention.

That we worked at Chicago’s public hospital, years apart, was incidental, but an engaging source of our conversation—she as a medical resident in pathology, and me as nurse in the Women and Children’s AIDS clinic, before we had much of anything to offer them.

On that flight, I listened intently. We laughed, we cried a bit, as she recently had lost her husband, one of India’s premier cardiovascular surgeons. We shared a lousy airplane meal, we napped a little and really enjoyed one another’s company.

Later, I would nervously cook my first genuine Indian cuisine and serve her on my best china in my dining room. Now, I’m looking back on what an honor it was to have supped with a real hero – to enable the work of a real hero – to be in the presence of a real hero. How lucky we are to be with people who really do make the world a better place.

Now, it is for us to carry on such a legacy and end AIDS.

ABOUT THE AUTHOR

Margaret McCluskey is a Senior Technical Advisor in USAID’s Office of HIV/AIDS working on HIV vaccines. Follow her @m3indc.

Q&A: What A Year Without Polio in Nigeria Means

Posted by Ellyn W. Ogden on Monday, August 3rd 2015

Since 1988, global efforts to eradicate polio have reduced the number of new cases by 99 percent, from 350,000 annually to a few dozen this year — preventing lifelong paralysis in millions of children worldwide.

In the fight to extinguish the disease, a significant milestone was reached on July 24. It has now been one year since the last reported case of wild polio in Nigeria.

Historically, Nigeria has been the main virus reservoir responsible for repeated outbreaks across the world. Just three years ago, the country seemed to be struggling in the battle against polio and recorded more than half of all global cases.

This achievement is the result of a Herculean effort to reach every child multiple times with the polio vaccine — thanks to the legions of volunteers, health workers, community leaders, mobilizers, lab staff, religious and traditional leaders, and millions of others.

However, since the wild polio virus can circulate silently, hiding in raw sewage for more than three years, it is far too soon for Nigeria to be complacent. The risk of undetected transmission remains in Nigeria and other vulnerable areas in and around conflict zones in Africa.

A health worker administers a polio vaccine to a girl in Nigeria. / Courtesy of TSCHIP

What is polio?

Poliomyelitis (polio) is a highly infectious disease caused by the wild polio virus. It spreads through contact with the stool of an infected person and droplets from a sneeze or cough. It invades the nervous system, and can cause paralysis or even death in a matter of hours. For thousands of years, polio was a leading cause of disability, arriving without warning and causing lifelong paralysis.

When will Africa be certified polio-free?

At least two more years must pass without a case of wild polio virus in Africa for the World Health Organization (WHO) to certify the region as polio-free. This will require continued government leadership across the African region, particularly in Nigeria, high quality immunization campaigns, and improved routine immunization, monitoring, and sustained vigilance.

We don’t want any cases of polio to go unnoticed or unreported. If Nigeria sustains high quality campaigns — maintaining population-level coverage (at least 90 percent of people), even in remote and hard-to-reach areas — and continues to improve routine immunizations, the virus will be stopped. Eradicating polio in all of Africa will bring us closer than ever to a world without the disease.

When will the world be polio-free?

Polio will be stopped — but we need continued political will, quality immunization campaigns, stronger routine immunization, and active disease surveillance to make that happen. The world will be declared polio-free three years after the last polio case is identified.

What is USAID’s role in the global polio eradication effort?

The global effort to eradicate polio is spearheaded by Rotary International, the Centers for Disease Control and Prevention (CDC), WHO, UNICEF and the Bill and Melinda Gates Foundation.

USAID has played a critical role raising the importance of cross-border coordination, communication and the need for more women vaccinators. In fact, by working with local community organizations, women’s groups and self-help groups, the messages have gone well beyond polio to address other immunizations, water and sanitation, breastfeeding and handwashing.

Supported by USAID, countries are monitoring for cases in formal health facilities and in communities, providing the data to verify that immunization efforts are working. Increasingly, this network of disease surveillance officers is also searching for cases of other preventable diseases and working at the front lines during any disease outbreak or natural disaster. Our steady financial support and technical leadership has contributed to this success and laid the foundation for a lasting legacy.

How important are vaccines to global health?

Vaccines are one of the best buys in public health and global development — the cheapest, most lasting measure we have to save a child’s life. Vaccines protect us from 25 diseases, such as measles, whooping cough, polio and meningitis, and avert an estimated 2 to 3 million deaths each year.

Working closely with host country governments, ministries of health and finance, and in-country and global partners, USAID is bringing its financial, technical and diplomatic efforts to support country immunization programs and reach all children with critical safe vaccines.

ABOUT THE AUTHOR

Ellyn W. Ogden is the Worldwide Polio Eradication Coordinator for USAID and a Senior Technical Advisor for Health and Child Survival. She is responsible for the Agency’s polio eradication program and related immunization and disease control efforts in over 25 countries in Africa, South Asia and the Near East.

Sustainable Finance Key to Health Equity

Posted by Dr. Ariel Pablos-Méndez on Thursday, July 16th 2015

A newborn in Nigeria. USAID is intensifying efforts to develop, test and scale up simple, low-cost approaches to preventing newborn deaths in lower-income countries. / Amy Fowler, USAID

The world faces an alarming shortfall of funding needed to transform global health. If the world is to end preventable child, adolescent and maternal deaths, we need new forms of development finance to close a $33.3 billion annual funding gap.

A new financing platform announced this week at the Conference on Financing for Development in Addis Ababa, Ethiopia aims to do just that. The Global Financing Facility (GFF) is a country-driven financing partnership to accelerate efforts to end preventable maternal, newborn, child and adolescent deaths by 2030.

The launch of the financing platform brings together $12 billion from public and private partners, both domestic and international, to scale up national strategies in four countries particularly in need: the Democratic Republic of the Congo (DRC), Ethiopia, Kenya, and Tanzania.

Their five-year strategies include life-saving interventions based on evidence of what works best that will be expanded to reach those that are most in need.

Why is this financing platform important?

Donor resources alone are not sufficient to reach our targets and meet the Sustainable Development Goals. We need innovative approaches to financing, with increased domestic commitment from countries and regional development banks, as well as more involvement from the private sector. Our core intent is to support countries as they work to provide for the health of their own citizens, and help them along the pathway to sustainable financing.

How is this different from business as usual?

As a financing mechanism, the GFF is an example of how to use official development assistance to catalyze additional private sector funding. The GFF is partnering with the World Bank to raise money from capital markets for countries with significant funding gaps for child, adolescent and maternal survival.

Every $1 invested into the GFF is expected to mobilize between $3 and $5 from the private capital markets. The investments in the GFF are designed to help countries transition to self-financing for maternal and child survival programs.

Who is contributing money?

USAID is investing $50 million, subject to Congressional approval, into the financing platform at the country level to scale up national strategies to end child and maternal deaths in the DRC, Ethiopia, Kenya, and Tanzania.

Other donors include Canada, Japan, multilateral organizations, host governments, civil society, and the private sector.

Is it working?

Tanzania is one example of the increased focus on women and children that the GFF can help bring about in country. By blending some of our grant funding through the GFF, we have enabled the Government of Tanzania to significantly increase financing for women’s and children’s survival and health.

A mother in Rwanda with her newborn daughter. Investing in survival & health can lead to greater individual and national productivity and growth. / Amy Fowler, USAID

Why just these four countries?

Over the next five years, the ultimate goal for the global facility is to support 62 high-burden low- and lower-middle income countries through the GFF. The DRC, Ethiopia, Kenya, and Tanzania are part of the first wave of countries. Results from these nations will inform the best way forward for any continued U.S. government funding of the GFF.

The next group of eight countries eligible to benefit from the global trust fund will be Bangladesh, Cameroon, India, Liberia, Mozambique, Nigeria, Senegal and Uganda.

Why invest in global health?

In low-income countries, child mortality is 15 times higher than in high-income countries, and maternal mortality almost 30 times higher. Despite remarkable progress across global health, the brutal fact is the world’s poorest people still pay the most for things like clean water and basic health services.

There is substantial evidence on the “health-to-wealth” pathway, and how investing in survival and health can lead to greater individual and national productivity and growth. Increasing access to health services — especially for the poor – is a sound and sustainable investment that can command great economic returns. To put it simply, people who are healthy are more productive at work.

We have a clear and conclusive case to invest in health. Now we must summon the will to mobilize domestic resources and activate creative co-financing approaches that will transform societies.

ABOUT THE AUTHOR

Dr. Ariel Pablos-Méndez was appointed by President Barack Obama to lead the Global Health Bureau at USAID. He is also the Agency’s child and maternal survival coordinator.

Q&A: How Technology is Transforming Ebola Response Efforts

Posted by Clara Wagner on Tuesday, June 30th 2015

In a new Q&A series, we are profiling the experts who have worked tirelessly to stop the spread of the deadly Ebola virus in West Africa and are helping societies rebuild and strengthen health systems in the aftermath of the outbreak.

Eric King holds up a handprint to echo the wall of handprints from Ebola survivors at the Bong County Treatment Unit in Liberia. Eric King worked to coordinate the flow of data for the international humanitarian response in Liberia for two months last Winter. / Ellie Van Houtte, USAID

Eric King, an innovation specialist with the Digital Development Team in the Global Development Lab, worked on USAID’s Disaster Assistance Response Team (DART) in Liberia for two months in 2015, working to coordinate the flow of critical data. He came to USAID in September 2013 with a doctorate in Planetary Physics. Follow him @eric_m_king.

What innovations have been developed to combat Ebola?

Almost every aspect of the Ebola response has been innovative. We have never before fought a disease this deadly on this kind of scale. Response teams have had to educate remote communities, meticulously seek out new Ebola cases, provide new facilities for isolating and treating patients, safely bury infected bodies while observing local customs, and all on a massive scale and with no time to lose.

All of these efforts are critical to preventing further spread of the disease. To be successful, trust and solidarity must be created between responders and the communities they work in. Those relationships are fostered by weaving strong communication lines – including feedback loops – into the response network, often helped by harnessing existing technologies like radio and mobile phones.

How will the role that science and technology played in this response affect the way we approach future emergencies?

Among the technological tools that have amplified the Ebola response, arguably none has been more helpful than the mobile phone.

A decade ago, a small percentage of West Africans had access to cellphones. Now, mobile phones allow us to connect those in need with those who can help. Families of the sick can call emergency Ebola hotlines, social mobilizers can share tips for community engagement, individuals can resolve Ebola rumors by texting local radio stations, health workers can be paid electronically, and clinics can flag when they’re low on supplies.

The unique communications needs of the Ebola response have tested and ultimately strengthened the connections between all the many people and organizations that come together in times of emergency.

Technology is a key component of managing information on the Ebola virus. A local dispatcher records 115 Ebola hotline responses at a community health office in Guinea, above left. Contract tracers also use mobile phones in the field to collect data for reporting, above right. / Eric King, USAID

In a crisis, efficiently managing the flow of information is key. How did USAID rapidly get things to where they were needed?

USAID’s logistics professionals have decades of experience managing supply chains in complex emergencies, ensuring that critical commodities like food, water, and medical supplies are available to those who need them, and they’re really good at it. Similarly, we recognize the importance of ensuring that actionable information is available when and where it’s needed.

For example, ambulance teams need to know where to find the sick as soon as they show symptoms so they can be quickly isolated and treated. Contact tracing teams need to know where to find those who have recently been in contact with confirmed Ebola patients so they can monitor them for symptoms. Food distribution teams need to know where to find at-risk households who have volunteered to stay at home to protect their neighbors so that they can deliver necessary supplies.

During the Ebola response, USAID deployed an information management advisor to work with local government and partners to coordinate the flow of information throughout the response network. These efforts are often amplified by integrating proven digital technologies and mobile data tools.

As a member of an Ebola case investigation team in Liberia, Justina M. Morris interviews people who may have been in contact new patients to control and monitor the disease. Information gathering is an important component of USAID’s Ebola fighting strategy. / Neil Brandvold, USAID

USAID believes in tapping the ingenuity of nontraditional sources. How did this play a role in the Ebola response?

USAID launched the Ebola Grand Challenge, the first-ever open innovation platform for a disaster response. Through the challenge, anyone anywhere could offer a solution for how to better fight Ebola. We received more than 1,500 applications from individuals and organizations from all over the world, many of whom had never worked with USAID. From all of these diverse, creative ideas, 15 innovations have been selected to receive support.

The porous nature of borders can make tracking and containing Ebola difficult. How did the international community work to counter this?

When Liberian President Ellen Johnson Sirleaf announced in February that the country’s land borders were reopening, response organizations worked with the Liberian government to quickly develop and deploy a set of best practices for border health security.

This involved two major components: border screening and community surveillance. People passing through official border crossings are screened for signs of Ebola in order to identify, isolate, test, and treat those who may be infected.

This is a vital first step, but we also recognize that there will inevitably be travellers that cross the border unofficially. So, we’ve also brought communities near the borders into the formal surveillance process — effectively crowdsourcing an Ebola alert system.

Furthermore, communities on either side of the border are working together to make sure that communication channels are available to alert one another.

Amid the Ebola crisis, many stories have emerged describing heroic aid efforts and acts of bravery. What stories touched you most?

I’ve found inspiration in the selfless dedication of the medical professionals who put themselves at risk and extreme discomfort to treat those in need. Working in full protective equipment in sweltering heat and humidity, they have been tirelessly and skillfully fighting to save as many lives as they can.

In some treatment units, some of the Ebola patients themselves began helping to provide care for the other patients who were suffering most. And some Ebola survivors, now immune, have organized themselves to work with health professionals to provide care to those in need. It inspires me to see such compassion and solidarity emerge from this unprecedented tragedy.

ABOUT THE AUTHOR

Clara Wagner was an intern for USAID’s Bureau of Legislative and Public Affairs working on content and public engagement.

Ebola Doesn’t Disappear at Zero and Neither Will We

Posted by Denise Rollins on Thursday, June 18th 2015

Senior Ebola Coordinator Denise Rollins, Associate Administrator Eric Postel, and National Security Council Senior Advisor Chris Kirchhoff listen as a staff member from the International Organization for Migration provides a tour of a mock-Ebola treatment unit in Freetown, Sierra Leone. / Kate Alexander, USAID

Imagine being in a house with 15 family members, and watching them all gradually die from Ebola.

This was Gibril Kamara’s reality.

Last month in Sierra Leone, Gibril shared his harrowing ordeal with our visiting team from Washington, D.C. As the senior coordinator of USAID’s Africa Ebola Unit, I was traveling with USAID Associate Administrator Eric Postel and others in Liberia, Sierra Leone and Guinea — the three countries most affected by Ebola — to see USAID’s efforts on the ground, meet with officials, and hear from communities.

We met Gibril and three other Ebola survivors at the International Organization for Migration’s Ebola healthcare training center in Freetown. They told us their stories of resilience amid a devastating public health crisis.

Gibril recounted how at first his family members thought the symptoms they exhibited could have been caused by any number of diseases. However, Gibril knew the telltale signs of Ebola.

He pleaded with his family to go to a medical facility, but the patriarch of the family refused to allow them to leave. While the fear of stigma permeated the air, the patriarch insisted everyone stay at home and not seek outside help.

First, one sister died, then another, then uncles and aunts, and finally the patriarch himself.

Gibril decided he would not be next.

On the brink of succumbing to Ebola himself, Gibril made his way in a taxi to a hospital for medical care. With proper Ebola treatment and care, Gibril survived.

Although Liberia reached zero Ebola cases just days before my arrival in country, Sierra Leone and Guinea continue to see new cases weekly, and stories like Gibril’s are still common.

Through the Disaster Assistance Response Team (DART), USAID continues to work alongside partners in all three countries to fight the spread of the disease. After hearing Gibril’s story, I stood in the middle of an Ebola command center in Freetown and was awestruck by the vast number of people, computers and teams needed to respond to the Ebola outbreak. The extensive coordination required to contain and defeat the disease is daunting.

From the surveillance teams and the social mobilization groups who go door to door identifying people with fever, to the ambulance drivers, health care workers and safe burial teams, everyone must work in lockstep.

Such a complicated effort is not easy in the best of circumstances, but in three of the poorest countries in the world, where the people without electricity outnumber those that have it, effective coordination is a challenge. I doff my hat to the thousands of U.S. and local staff and volunteers who continue to work tirelessly.

Students of Infection Prevention and Control and Midwifery Training programs greet the USAID delegation in Kindia, Guinea. / Kate Alexander, USAID

Since August 2014, USAID has converged an unprecedented array of people, equipment, financing and other resources to these Ebola-affected countries.

Thanks to the international community and local partners, we are easing the burdens of the citizens of these countries. As we work together to fight Ebola and lessen the secondary impacts of the outbreak, we are serving as an example of worldwide collaboration at its best.

Getting to zero Ebola cases is critical and the goal for USAID is helping these countries end the epidemic, get back on track, and be better prepared to stop any future outbreaks before they become epidemics.

Weak health care systems suffered major setbacks during the Ebola outbreak, but now USAID is helping improve the ability to detect threats early, and respond rapidly and effectively to prevent the spread of Ebola and other viruses across borders.

In addition to support rebuilding and strengthening healthcare systems, we are also helping reopen schools and stimulate local food production.

Gibril’s world was turned upside down when he lost his entire family. However — like so many other Ebola survivors — Gibril was resilient.

Resilience is such an overused word, but it captures the spirit, commitment and dedication of the citizens of Liberia, Sierra Leone and Guinea to get back on their feet after this devastating public health crisis.

Many survivors, like Gibril and the others I spoke with at the National Ebola Training Academy, now volunteer their time as trainers, health care workers and social mobilizers — helping other patients recover from their battles with the virus, while spreading awareness about Ebola prevention.

In turn, USAID will continue to support the people of West Africa. Ebola doesn’t disappear at zero, and neither will our fight to keep Ebola away.

ABOUT THE AUTHOR

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

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