USAID Impact Photo Credit: USAID and Partners

Archives for Global Health

Maximizing the Impact of Public and Private Global Health Commitments

Amanda Makulec is a Monitoring and Evaluation Associate, John Snow Inc.

In a time of international economic uncertainty, it is more important than ever for donor agencies to ensure global health dollars are being spent wisely for maximum health impact.  Investing in maternal and reproductive health programs around the world has supported a one-third reduction in maternal mortality since 1990, and saved the lives of millions. Moving forward, donor agencies are committed to maintaining and continuing that success through new mechanisms for providing basic maternal, newborn, and child health services which leverage both public and private resources and through integrated programs to improve service delivery,  like USAID’s Maternal and Child Health Integrated Program (MCHIP).

One such coordinated effort is the Alliance for Reproductive, Maternal, and Newborn Health (the Alliance), which was born over a year ago to support progress towards MDGs four and five in ten priority countries, including Bangladesh, Ethiopia, India, Indonesia, Kenya, Nepal, Nigeria, Pakistan, Tanzania, and Uganda. Together, these countries account for around 68% of unmet need for family planning globally, 54% of maternal deaths, and 56% of all neonatal mortality. The Alliance’s public sector partners include USAID, the Australian Agency for International Development (AusAID), and the UK Department for International Development (DfID). The Bill and Melinda Gates Foundation contributes its private donor funds and expertise to the core group of partners.

While Alliances and Coalitions seem to spring up often in today’s globally-connected era, this partnership strategically focuses on fostering local country ownership of programs, emphasizing cost-effective spending of donor dollars through improved coordination across agencies, and ensuring it does not create parallel systems for working with countries, providing services, or monitoring and evaluation of its work, instead leveraging existing mechanisms.

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Saving Lives, Improving Health with Simple Act of Handwashing with Soap

Studies show that washing hands with soap is one of the most effective and inexpensive ways to prevent diseases: it can cut deaths from diarrhea by almost half and from acute respiratory infections by a quarter. On Saturday, people across the globe celebrated the fourth annual Global Handwashing Day. Last year, over 200 million people and more than 70,000 schools participated in events and celebrations.

A child washing their hands in Senegal. Photo Credit: Ryan Cherlin/USAID

But handwashing with soap is not an event it is a behavior.  Keeping hands clean is one of the most important steps one can take to avoid getting sick and spreading germs to others. People all over the world wash their hands with water. But washing hands with water alone is significantly less effective than washing hands with soap in terms of removing germs.

Handwashing with soap works by interrupting the transmission of disease. Hands often act as vectors that carry disease-causing pathogens from person to person, either through direct contact or indirectly via surfaces. When not washed with soap, hands that have been in contact with human or animal feces, bodily fluids like nasal excretions, and contaminated foods or water can transport bacteria, viruses and parasites to unwitting hosts.

USAID works in partnership with host countries and to reduce diarrheal disease prevalence and improve child survival through sustainable improvements in three key hygiene behaviors: hand washing with soap, safe excrement disposal, and safe storage and treatment of drinking water at the household level. These health-focused interventions complement community and municipal water supply infrastructure programs by empowering households with the tools to protect their own health.

Creating lasting behavior change and ensuring handwashing with soap becomes a social norm are key components of hygiene and sanitation programs worldwide. 

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Reaching Most-at-Risk Populations with HIV Counseling and Testing in Brazil

Over the summer, I visited Brazil with representatives from USAID’s Caribbean Regional HIV Program.  The Caribbean team was interested in learning about USAID/Brazil’s innovative HIV counseling and testing program, Quero Fazer, which is implemented by the Associação Espaço de Prevenção e Atenção Humanizada (EPAH).

USAID/Brazil Mission Director, Lawrence Hardy, learns about the rapid test procedure from a Ministry of Health employee in Recife, Brazil. Photo Credit: USAID/Brazil

EPAH manages Quero Fazer, a project designed specifically to reach most-at-risk populations (MARPs)—primarily transgenders and men who have sex with men—with HIV prevention and counseling and testing services. We visited Quero Fazer’s mobile clinics in Recife, on the northeastern coast, and in Brasília, the capital. The mobile units provide services at night and in areas where the target populations gather.

We also went to Rio de Janeiro, where Quero Fazer manages a late afternoon to night-time counseling and testing clinic within the office of Arco-Iris, a nongovernmental organization (NGO) that focuses on gay, lesbian, bisexual, and transgender issues.

Through the mobile units and the NGO site, Quero Fazer has forged, with USAID/Brazil’s support, a unique partnership between NGOs and public health programs. In all of its sites, community members serve as peer educators and work to mobilize patients to access the free services. Meanwhile, municipal and state health officers work at the sites to provide the counseling and rapid HIV testing. For patients who test positive, clinic workers make appointments for them at specific clinics and hospitals, where health providers have been trained on working with MARPs. This level of government support is critical to the success of the pilot program, which operates off of minimal funding, and helps to foster expansion and sustainability.

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Public-Private Partnerships Week: “Helping Babies Breathe” Offers Invigorating Possibilities for Newborn Health Worldwide

This blog was originally posted by Lily Kak on January 6, 2011. It is excerpted and updated here in honor of USAID’s Public-Private Partnership Week, Oct.17-21, 2011.

Sixty seconds – that is all it takes to breathe life into a newborn that is gasping for air. This is the golden minute that can mean the difference between life and death for a newborn who is not breathing. Jubaida, a community midwife from Bangladesh, was trained and equipped to act rapidly and appropriately when she heard no cry and felt no breathing just after Baby Shifa was born. Jubaida gently dried and rubbed the baby and, as the family looked on, she used a bag and mask to help Baby Shifa breathe as the hands of the clock ticked by.

Every year, 10 million babies require help to breathe immediately after birth. Such lifesaving care is currently only available for less than one out of four newborns. Scaling up newborn resuscitation is challenging because it requires provider skills, appropriate equipment, and systems strengthening. Challenged by this, USAID searched for a feasible and effective approach to scale up newborn resuscitation and, on June 16, 2010, launched “Helping Babies Breathe,” a Global Development Alliance(GDA) with a diverse group of partners – Laerdal Medical, Save the Children, the American Academy of Pediatrics, the National Institute for Child Health and Development, and USAID.  The partnership combines the private and NGO sector, a professional association, and the US Government.

“The program is focused on the essential steps for helping babies breathe and uses effective educational methods. But to bring true innovation,  also a third factor is required; efficient local implementation. And that is where this GDA has already proved to make a great contribution.”

–          Tore Laerdal, CEO of Laerdal Medical

The Helping Babies Breathe partnership represents a new way of doing business in the field of newborn health and has now become a key USAID strategy to roll out newborn resuscitation and essential newborn care globally.  This partnership is ground-breaking. In just over a year since the launch of the partnership, over 18,000 health providers have been trained in 27 countries. A pilot study in Tanzania reported that HBB reduced asphyxia-related death by over 50 percent among 7,000 newborns.  Rigorous evaluation plans are now being designed in several countries to determine the performance and impact of HBB as it is being scaled out to address the broader international need as part of national newborn programs.

“The GDA concept is powerful; it’s activities in 27 countries has resulted in a wave of activity in other countries, stimulated a review of evidence at WHO, increased participation of new partners, has brought more attention and support for integrating essential newborn care and maternal life saving care education, and has stimulated the development of engineering innovations in life-saving newborn devices.”

–          Dr. William Keenan, AAP

The innovations that have created this significant solution in newborn resuscitation include Laerdal’s low cost, life-like manikin (NeoNatalie) with its easy-to-clean and boilable device to clear the newborn’s airway addressed the global need for a low-cost, resuscitation training simulator.  The American Academy of Pediatrics (AAP) developed the “Helping Babies Breathe” curriculum that simplified the resuscitation action algorithm so that it can be implemented even in peripheral health facilities and communities. These life-saving technologies are available on a not-for profit basis to all 68 Millennium Development Goal countries. Since its inception the partnership has expanded: AAP has pledged to save one million newborns by 2015 and Laerdal has created a spin-off company, Laerdal Global Health, to develop new technologies to address base of the pyramid maternal and child health.

As part of USAID’s 50th Anniversary, the Agency is celebrating Public-Private Partnerships Week October 17-21, 2011 to highlight the mutual benefit that development and business have in establishing public-private partnerships (PPP) and to celebrate the 10th anniversary of the Global Development Alliance (GDA) program.

Visit for continuous updates and new announcements, and to view a live-stream of the October 20th Partnership Forum: The Strategic Value of Connecting Business & Development

Treat the Whole Person: On Mental Health Day, USAID Recognizes the Importance of Mental Health for People Living with HIV

Submitted by: Melissa Sharer AIDSTAR-One Senior Care and Support Officer, John Snow, Inc.

AIDSTAR-One is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government (USG) country teams to build effective, well-managed, and sustainable HIV and AIDS programs, and promotes new leadership in the global campaign against HIV.

“First we need ARVs, second is Duong Sinh TuNa, third is psychosocial support,” said an HIV-positive female client at an HIV clinic in Van Don, Vietnam. Her spontaneous response to a question about the needs of people living with HIV (PLHIV) includes a double dose of mental health care and support. Duong Sinh TuNa is a rhythmic poem recited during relaxation and stretching exercises hosted at the clinic she attends. It reads in part: “Breathe, meditate, relax, exercise, think positively…Healthy minds and clearer thinking help recovery.”

This client knows what she’s talking about. An individual’s well-being underpins everything she or he does. Emotional health facilitates opportunities to form relationships, to love, to work, allowing a person to continue making choices that support good physical health. The World Health Organization defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community,” a definition that should inform all programs and policies targeting individuals living with HIV.

Mental health services are thus critical to a continuum-of-care approach for people living with HIV (PLHIV).  A recent meta-analysis looking at depression and adherence shows a consistent relationship between depression and HIV treatment non-adherence (Gonzalez et al. 2011). Estimated rates of depression among PLHIV soar as high as 72 percent in resource-constrained countries (Adewuya et al. 2007), which threatens the consistent use of the antiretroviral therapy (ART) that keeps them alive.

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Picture of the Week: A Social Pharmacy in Paraguay

A woman in Paraguay at a social pharmacy. Photo Credit: Laura Alvarez, USAID/Paraguay.

A woman in Carmen del Paraná, a small town in rural Paraguay works at a social pharmacy program at the local hospital. This program implemented by local health councils with technical assistance from USAID/Paraguay helps pharmacies keep prices for medicine affordable for low-income communities who do not normally have access to medical supplies and often cannot afford regular prices of basic medicines. Money for the pharmacies is channeled through a revolving fund managed by the local health councils in each community, in coordination with the municipal and departmental governments and the departmental health council.

Darfuri Woman Working for USAID Inspires Community

Story submitted by Millennium Relief and Development Services/Partner Aid International

When Ikhlas was a young girl in El Fasher, North Darfur, her life took a tragic turn when she contracted polio. The disease has been nearly eradicated worldwide following the advent of safe and effective childhood vaccinations, but in a few pockets of the world, poor access to health care means that children become disabled or die from preventable causes.

Throughout her life, Ikhlas has battled others’ misguided perceptions that because she is disabled, she is unable to hold a normal job or do anything of value. Although she was an active member of the Darfur Disability Society, people only focused on her handicap when she interviewed for jobs.

In 2010, Ikhlas interviewed with USAID partner Millennium Relief and Development Services/Partner Aid International (MRDS/PAI) in North Darfur to become the supervisor of rural clinics. Many MRDS/PAI staff were concerned that she would not be able to travel to villages or would be a burden to others during field trips, but some saw in Ikhlas a spark with great potential. Ikhlas’ first assignment was to help start a new clinic in Grawid Besham, a village with no health care services within 20 kilometers. Ikhlas organized a village health committee to oversee the work of the clinic, involving all relevant government organizations.

Ikhlas spent several months traveling to rugged rural areas, working with the community to remodel the clinic and to build residential facilities for medical, monitoring, and support staff.  After months of hard work mobilizing the community and government agencies into action, the clinic opened in 2010 and the community celebrated the arrival of health care services to the village.

With USAID support, the clinic in Grawid Besham is providing health care for up to 8,000 rural Darfuris. Ikhlas is now helping to prevent other children from contracting a disease that has created so many challenges in her own life. Grawid Besham is the first of four clinics that Ikhlas has helped USAID and its partners open in the area.

“I am really fortunate to show that I am able to work in spite of my disability,” Ikhlas said. “The stigma is still very high in people thinking disabled people can’t do anything. So I thank God, my family—for giving me permission to work outside of town—and I thank my employers for not seeing only the outside and my inability but encouraging me to show my abilities. To me, this is real partnership and it has changed my life and I hope the lives of many others not only in health care but also in their attitude towards other people living with disabilities.”

Local Health Support Builds Better Lives for Mothers and Babies

As we headed out for a health-focused field trip in Timor-Leste’s central highlands, we were treated to almost all the geographical delights of the country.  Along the coast road, the dry season winds were whipping up the sea into the biggest waves I’d seen since I arrived in Timor-Leste.  As we turned inland, the brown fields among the rising hills attested to the end of the harvest.  Driving ever higher—along narrower and narrower roads—the altitude brought back the green of forests.

We were headed through the district of Ermera to the “sub-village” of Hatugeo, tucked just below the peak of Timor-Leste’s highest mountain.  This district has some of the country’s worst health indictors:

  • Infant mortality is 70 babies per 1,000 births, far higher than the national average of 45/1,000, and higher than in neighboring Indonesia (34/1,000).
  • Only 3 percent of mothers deliver their babies in a health care facility, compared with 22 percent across the country.
  • A higher percentage of children show signs of malnourishment and illness than in the rest of Timor-Leste.

Why is that?  I’ve been told there are four main reasons (and I suppose that there are more).  First, the district is very mountainous; second, there are few roads; third, there is a shortage of professional health staff; and fourth, this district is known for its festivals and parties—people spend what little money they have on these, not on nutrition and health, so says the Deputy Director of the District Health Service Florindo De Araujo.  This is a big problem, and Mr. De Araujo and his staff are wracking their brains to figure out what to do about it.

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Seeking a Sustainable Solution for HIV Funding in Kenya

In March 2011, the Kenyan National AIDS Control Council prepared a Cabinet memorandum that outlines ways to raise funds for HIV programming.  Through innovative solutions, Kenya is looking for sustainable ways to combat the AIDS epidemic in country.

The memo is based on a recommendation from the USAID-funded Health Systems 20/20’s HIV/AIDS Program Sustainability Tool (HAPSAT) assessment.

Two government staff who helped prepare the memo tell us how it will help Kenya’s 1.5 million citizens living with HIV.

Regina Ombam, head of strategy for Kenya National AIDS Control Council (NACC), leads planning, implementation and evaluation of HIV programs. As part of the Cabinet memo initiative, she managed the process of gathering relevant health financing data on behalf of the director of NACC. Ms. Ombam holds master’s degrees in economics and public administration.


Irene Mukui is the antiretroviral therapy (ART) program manager for the National AIDS and STI Control Programme. She oversees the provision of ART and other associated care (i.e., nutrition, TB/HIV integration, etc.) for both children and adults in Kenya. Dr. Mukiu was a member of the technical working group that developed the Cabinet memo. She is a licensed medical doctor.


HS20/20: What does the Cabinet memorandum propose to raise funds for HIV programming?


RO: The Cabinet memo proposes that the Ministry of Finance create a HIV/AIDS Trust Fund that would support scaling up prevention, treatment, care and support in Kenya. If approved, the government would contribute 1% of its annual revenue to the fund. In addition, the fund would receive contributions from partners and the private sector through initiatives such as airtime and airline levies, levies on remittances from abroad, corporate and NGO donations, the national lottery system, and leveraging unclaimed financial assets (i.e., monies that are dormant or abandoned often as a result of death, name change, or relocation). The Ministry of State for Special Programmes, the Ministry of Public Health and Sanitation, and the Ministry for Medical Services would implement HIV programming supported by the fund.

IM: The Cabinet memo aims to establish long-term, sustainable financing through the existing National Health Insurance Fund and increase government funding to meet the Abuja target of allocating 15% of the annual budget to health.

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Photo Essay: Community Volunteers Help Women Suffering from Fistula in Guinea

The volunteers make their way to the next family in Faloboa village. Sometimes the volunteers encounter village women who have suffered with fistulas for many years without any access to medical help. USAID’s program is able to support these women with diagnosis and treatment. Photo Credit: Elizabeth Fakan, USAID/Guinea

The average Guinean woman will have six children during her lifetime, but due to the lack of obstetric care, many develop fistula, a painful injury that is especially traumatic due to the stigma associated with it. During obstructed labor, a baby’s head may be pressed against his mother’s pelvic bone, cutting off circulation to tissue in the area and literally creating a hole or “fistula” in her bladder or rectum. Aside from the physical pain, many also suffer psychological trauma, as they are often shunned by their families and communities due to the foul smell resulting from their injuries. The internationally renowned Hamlin Fistula Foundation says that although this condition was eradicated in the United States over a century ago, more than 2 million women in developing countries still suffer from it today.

USAID is helping more than 1,500 women in Guinea access treatment for fistula and working with communities-women and men, secular and religious leaders-to understand, prevent, and treat fistula while better supporting those who have suffered from it. In addition, USAID is strengthening the national health system by training doctors, nurses, and midwives in fistula prevention and care.

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