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Archives for Global Health

Listening to Patients: How one Facility Made it easier for Patients on ART to Remain in Care

Posted by  on Friday, December 3rd 2010     

During a site visit with the USAID Health Care Improvement (HCI) Project in Uganda the Quality Improvement team at the Bwera Hospital in the Kasese District showed me data they collected on patients retained from August 2009 to November 2009. They found that only 54 percent of the patients ever started on treatment were still in care. The team leader told me “This is surprising; I thought everybody was here because the clinic is always busy.”

We then discussed ways to improve the situation, and it was decided the health care workers will begin asking patients why they had missed their visits and, more importantly, what they wanted from the clinic so that they wouldn’t miss visits in the future.

My work with the HCI Project supports the Uganda Ministry of Health to implement the Quality of Care Initiative, which aims to improve the quality of HIV services. Over the past ten months, I worked with 14 facilities to ensure that everyone who receives antiretroviral (ARV) medicine remains in care. This entails visiting facilities, such as the one in Kasese, to help them form quality improvement teams, identify areas for improvement, plan improvement projects and measure their performance.

When I returned two months after my initial visit to Bwera Hospital, the team told me that the most common reason for missed appointments was because monthly appointments were hard to keep due to transport problems.  The patients asked for two months worth of ARVs to be dispensed so they could come less often.  The staff listened to their clients and began distributing  a two month supply of ARVs.  They were proud to show me that more patients were now keeping their appointments.

Said one patient:

“Traveling to the hospital for drugs every month was very difficult.  I would lose 2 days of business every month to travel which also affected my health. When I discussed my problem and suggestions with the health workers, they accepted to give me treatment of more than one month. Now I have an obligation to remain adherent to treatment and keep my appointments to continue enjoying this.  My business is not affected anymore and I am able to save money to cater for other things.”

From this experience, I learned that listening to the perspective of patients in health care gives them a sense of relief and satisfaction with care. Health care workers also find the management of patients more fulfilling when the clients are directly involved. Thanks to the American People for making this happen.

Mabel is a Quality Improvement Advisor working with USAID’s Health Care Improvement Project (HCI). HCI is a five-year task order contract issued by USAID to support countries in improving the quality and impact of health services.

Helping Women Avoid HIV Infection and Transmission

Posted by  on Thursday, December 2nd 2010     

HIV-positive and pregnant with her second child, Grace Abalo was like many other women in the developing world- in need of services to prevent her child from contracting HIV. Determined to have her baby born healthy, Grace and her husband joined a USAID-funded family support group at the health center near their home in Uganda.

There Grace learned how to access prevention of mother-to-child transmission (PMTCT) programs and other services that support their health in the long term, as well as strategies for positive living, safe infant feeding, and healthy child care.

“I learned why and how to adhere to cotrimoxazole prophylaxis, what antiretroviral therapy is, and which breastfeeding options would not put my children at risk of being infected,” said Grace.

Armed with knowledge and support, Grace was able to ensure her child stayed HIV negative. She and her husband continued to receive ongoing support through the network of people living with HIV/AIDS, and she has even begun to help other HIV-positive mothers take their children for testing and educates them on breastfeeding options.

With women of childbearing age accounting for more than half of the people living with HIV/AIDS, PMTCT programs are vital to end the HIV/AIDS epidemic. And while these interventions are aimed at women, it is just as important to gain support and participation from their male partners. Like Grace, the support of the men in the life of an HIV-positive woman can make a tremendous difference. With education of men, comes the understanding of the disease, how it’s spread, and how to treat it. This then can result in positive changes in gender, social and cultural norms.

Across the world women just like Grace deserve a chance to have healthy babies. Through the Global Health Initiative, USAID will continue to work to provide every woman with the opportunity to have a healthy child.

50 Weeks to 50 Years at USAID – Week 3: Fighting HIV/AIDS

Posted by  on Thursday, December 2nd 2010     

I had just finished my first year of graduate school at UCLA when the first case of HIV was reported in Los Angeles. Little did I know how that event, happening so close to my school, would affect and influence my professional life. Over the next three decades, HIV/AIDS would play a central role in my USAID career and become a passion and driver of my work.

As deputy director of the Health and Nutrition Office in the 1990s, I helped oversee the HIV/AIDS division’s work and program. But HIV/AIDS was only a disease I read about and discussed. It took my Foreign Service posting in Zambia in 1998 for HIV/AIDS to become real.

One in five Zambians was HIV positive, and because the epidemic had been underway for 15 years, illness and death were at an all time peak. Our home was on the road to the city cemetery, and long funeral processions were daily occurrences.

It was during my first year there that I personally experienced the devastating death of one of my staff from AIDS. It changed our entire office and we were inspired to do all we could to ensure others did not face the same fate. It was those five years in Zambia, at the heart of the HIV/AIDS epidemic, which convinced me of the importance of prevention—especially reaching the next generation with effective messages.

Reading the predictions for the next HIV/AIDS wave to hit key Asian countries, I was motivated to share what I learned in southern Africa with this region.

With my five-year assignment to India, I was witness to the large scale expansion of the Indian response to high risk groups and key geographic areas. We focused the majority of our efforts on building the local capacity of the government and civil society to ensure sustainability.

The scale of this effort was enormous given that most Indian states’ populations are greater than those of many countries.

I am now back in Washington, leading the HIV/AIDS Office in the Bureau for Global Health. This is a very important time as the second phase of the President’s Emergency Plan for AIDS Relief (PEPFAR) is being implemented with a greater focus on sustainability and country ownership. And with President Obama’s Global Health Initiative underway, USAID is working with our U.S. Government partner agencies to improve integration among our programs.

We have made tremendous progress over these some 30 years—PEPFAR is currently supporting over 3.2 million people on lifesaving antiretroviral (ARV) drugs, and with USG support in fiscal year 2010 alone more than 114,000 infants were born HIV-free.  Through partnerships with more than 30 countries, PEPFAR  directly supported 11 million people with care and support and provided nearly 33 million people with HIV counseling a testing.

It has also been an exciting time for prevention with the results of the USAID-funded CAPRISA trial proving a microbicide could help prevent HIV transmission. This was met with enthusiasm by the HIV/AIDS community, and Administrator Shah is supportive of an aggressive way forward to advance microbicides from proof of concept to impact in the field to slow transmission of HIV.

So on this World AIDS Day and in the coming year, we should all honor the 33.3 million people who are currently living with HIV and the millions more who have died from this epidemic, and recommit ourselves to do all we can to address the personal tragedy caused by HIV/AIDS.

A Brief History of USAID’s Role in HIV/AIDS

•         1986: USAID officially begins HIV/AIDS programs in the developing world. This is only two years after HIV, the virus that causes AIDS, was isolated and identified.

•         1988: USAID’s Demographic and Health Survey begins collecting data on HIV.

•         1993: USAID is a founding member of the International HIV/AIDS Alliance

•         1998: USAID launches the IMPACT program for HIV prevention and care.

•         2000: USAID launched Regional HIV/AIDS Program for Southern Africa.

•         2001: USAID officially launches the Office of HIV/AIDS within the Bureau for Global Health.

•         2001: USAID begins partnership with the International AIDS Vaccine Initiative.

•         1998: USAID launches the IMPACT program for HIV prevention and care.

•         2000: USAID launched Regional HIV/AIDS Program for Southern Africa.

•         2001: USAID officially launches the Office of HIV/AIDS within the Bureau for Global Health.

•         2001: USAID begins partnership with the International AIDS Vaccine Initiative.

•         2003: The U.S. President’s Emergency Plan for AIDS Relief is announced

•         2005: PEPFAR, in conjunction with USAID, launched the Supply Chain Management System Project

•         2008: The $48 billion Lantos-Hyde reauthorization bill on HIV/AIDS, TB, and malaria is signed into law

•         2009: The President’s Global Health Initiative is announced

•         2010: the CAPRISA 004 trial provides the first ever proof of concept that a microbicide can prevent HIV transmission

Fighting HIV With Circumcision

Posted by  on Wednesday, December 1st 2010     

This originally appeared on Zeke Emanuel’s Africa Diaries. This is Part Six.

Dr. Emanuel, from the White House Office of Management and Budget, blogged extensively during a recent two-week trip through Africa.  In this installment he discusses the potential for using male circumcision to prevent HIV transmission.

Three separate randomized trials have shown that male circumcision is among the most effective interventions against HIV/AIDS, reducing transmission by about 60 percent. This is a huge impact. As one AIDS researcher has said to me, if we had a vaccine that effective, we would be sparing no effort to distribute and administer it.  But widespread deployment of male circumcision has not yet occurred.

He goes on to address issues of manpower, facilities, cost, and cultural barriers. Learn more and read the complete post at The New Republic.

USAID at Forefront of HIV Prevention

Posted by  on Wednesday, December 1st 2010     

On Monday, I convened a meeting to determine the next steps following the success of the CAPRISA trial, which showed the world that a microbicide could help prevent HIV transmission in women. Together with both public and private sector colleagues, we defined a way forward over the next two years to expedite licensure and prepare for the introductory phase of the gel or other ARV-based microbicides. I will also convene an additional meeting  of technical experts in the field to discuss how to aggressively roll out microbicide treatments to those most in need.  We have a shared responsibility to build on the successes achieved to date by making smart investments that will ultimately save more lives in the future.

Pic of the Week: Commemorating 2010 World AIDS Day

Posted by  on Wednesday, December 1st 2010     

Woman and boy in MozambiqueEighty percent of Mozambique‘s people live in villages and must walk on an average 12 kilometers to reach a health clinic. Here, a woman and her daughter hold the anti-AIDS medicine that keeps them alive. They worried that neighbors would see the medicine and know they had the disease. Photo is from Ben Barber/USAID.

Giving Girls a Chance Against HIV/AIDS

Posted by  on Wednesday, December 1st 2010     

In Malawi, Chimwemwe Banda was abandoned by her parents when she was a young girl; she and her sister were left to take care of themselves. Without money to pay for basic needs or tuition, Chimwemwe was forced to drop out of school. In hopes of improving her situation, like many girls in Malawi, she entered into an early marriage— Chimwemwe was only 15 years old on her wedding day.  Soon after she married, Chimwemwe realized that life was not going to get better just because she had a husband.

Chimwemwe Banda is one of the many girls who has benefited from a Go Girls! community intervention. Photo Credit: Hilary M. Schwandt/AFP

Early marriage, along with behaviors such as transactional and intergenerational sex, contributes to girls’ vulnerability to HIV. Chimwemwe is just one of the 600 million girls living in poverty who are at increased risk of contracting HIV/AIDS. Similarly, girls who are orphans, early school leavers, socially marginalized, and/or migrants have a heightened vulnerability to the virus. Worldwide, women and girls bear the brunt of the HIV/AIDS epidemic; according to the World Health Organization, AIDS is the leading cause of death among women aged 15-44 worldwide.

Socio-economic factors like poverty, along with gender norms such as expectations around early marriage, can lead to increased vulnerabilities that discourage girls from asserting control over the timing and circumstances of sex, including negotiating protection against HIV and other sexually transmitted infections (STIs).

Most interventions to date have focused on individual-level behavioral change without sufficient consideration of the structural factors that fuel the epidemic. USAID is working to address this imbalance through the Go Girls! Initiative.

In fact, it was Go Girls! that stepped in to help Chimwemwe. With their assistance Chimwemwe dissolved her marriage. Her village developed a community mobilization team that recognized the detrimental effects of early marriage on girls, and advocated delaying marriage as a strategy for maintaining girls’ health and encouraging their educational pursuits.

Since the end of her marriage, Chimwemwe returned to school. She now leads a happier life and enjoys going to school everyday. “I feel good about being back in school,” she said. “If I had the opportunity to advise other girls, I would tell them not to marry early but to continue schooling because school is good. I am working hard at school every day so that I may have a brighter future.”

The 16 Days Campaign to End Violence Against Women: From 25 November to 10 December, USAID will post a blog each day that aims to prove a single point: The human race cannot progress when half of the world population lives without the same rights and respect afforded to its male counterpart. If you are moved by what you read and want to share, we’ve made it easy for you. Click here to find out how.

World AIDS Day 2010

On World AIDS Day, we commit to build upon our successes and continue to make smart investments that will ultimately save and improve millions of lives.  Join us this week as we highlight some of our successes and share stories of those helped by our programs.

If you’d like to learn more about the Go Girls! program, including how to access free copies of the Go Girls! program materials, contact ghcommunicationsteam@usaid.gov

 

Promoting Evidence and Action for Respectful Care at Birth

Posted by  on Tuesday, November 30th 2010     

Exciting. Moving. Powerful.

These words are often used to describe childbirth. It can be a time of wonder and joy.

In many places, however, the experience is described differently: Humiliating. Frightening. Abusive.

Throughout the world, women are abused in subtle and overt ways during childbirth, which is also a time of intense vulnerability. The abuse – or anticipation of it — can be so extreme, in fact, that it often prevents women from seeking lifesaving care.

“Some female nurses rough you up to an extent that you can tell her to let you deliver alone. You are in pain, and all she does is give you a harsh and rude approach. That is why I don’t go to the hospital to deliver because I am not used to somebody who roughs me up,” says woman interviewed in Kenya.

While much focus has been placed on overcoming financial and geographic obstacles to connecting women with lifesaving care during childbirth, little attention has been paid to documenting and tacking significant barriers posed by disrespect and abuse of women in facilities.

A new USAID-funded report, “Exploring Evidence and Action for Respectful Care at Birth,” presents evidence of abuse of women during childbirth and documents the negative impact on women’s use of skilled care. USAID funds grants to develop and evaluate interventions addressing disrespect and abuse in childbirth, and will support future efforts to further document, confront, and tackle abuse during childbirth.

A recent report found that 34 percent fewer women die each year from complications during pregnancy and childbirth than previous international estimates suggested. Access to quality care is critical in maintaining this trend.

USAID programs support facility-based maternal health care and community mobilization approaches to ensure women’s access to appropriate care and safe delivery is not restricted.

Through the Global Health Initiative, USAID will continue to support efforts to ensure that women have access to appropriate care and safe delivery is not restricted. When women are able to access needed quality health services and protect themselves from the many health risks they face, long-term social and economic progress can be achieved.

The 16 Days Campaign to End Violence Against Women: From 25 November to 10 December, USAID will post a blog each day that aims to prove a single point: The human race cannot progress when half of the world population lives without the same rights and respect afforded to its male counterpart. If you are moved by what you read and want to share, we’ve made it easy for you. Click here to find out how.

Follow us on Twitter. When you see us tweet something interesting, retweet it!

Become a fan of our USAID for Global Health Facebook page and feel free to share stories, photos, and videos that demonstrate your support for women’s rights!

The Straight Facts: The Plight of Women

Posted by  on Tuesday, November 30th 2010     

Women around the globe should be celebrated for their extraordinary contributions in all areas of society – as professionals, as bread-winners, as caregivers and caretakers.

16 Days of Activism Against Gender Violence Graphic

But we must also focus on the stark reality that women suffer disproportionately from poor access to health services, discrimination, the effects of war, and, at times, victimization by harmful traditions.  It is important to keep in mind that behind every statistic listed below, there is a heartbreaking story to be told.

  • More than 530,000 women die in childbirth every year – tragically, the vast majority of these deaths are avoidable with simple and cost-effective health interventions.
  • More than 100 million women in the developing world, about 17 percent of all married women would prefer to postpone their next pregnancy or not have any more children but are not using a modern method of contraception.
  • It is estimated that up to 100,000 maternal deaths could be avoided each year if women who did not want children used effective contraception.
  • One harmful outcome of unintended pregnancy is abortion – an estimated 18 million abortions take place each year in the developing world, contributing to high rates of death and injury.
  • In sub-Saharan Africa, approximately 58 percent of all people living with HIV are female. In some countries, girls between the ages of 15 and 19 have three to six times higher HIV prevalence than boys their age.
  • More than 80,000 women suffer complications during pregnancy including obstetric fistula.  The consequences of this condition, when untreated, are life shattering.  Many times the child dies, and the mother has lifelong reproductive and urinary complications.  But it can be prevented through expanded access to modern methods of family planning, raising the age of marriage and can be treated with proper medical attention.
  • An estimated 52 million girls under the age of 18 years of age are married off by their families each year.  Likewise, several hundreds of thousands of girls and women are trafficked every year as illegal workers and/or forced into prostitution.
  • An estimated 100 million to 140 million women and girls undergo female genital mutilation/cutting each year and thousands more are at risk.

Despite these startling statistics we know that women around the world have an undying spirit, are surmounting obstacles, and are committed to making their lives, their families, and their communities better.  President Obama stated, “…we must also recommit ourselves more broadly to ensuring that our daughters have the same rights and opportunities as our sons: the chance to attain a world-class education; to have fulfilling careers in any industry; to be treated fairly and paid equally for their work; and to have no limits on their dreams.  That is what I want for women everywhere.”

The 16 Days Campaign to End Violence Against Women: From 25 November to 10 December, USAID will post a blog each day that aims to prove a single point: The human race cannot progress when half of the world population lives without the same rights and respect afforded to its male counterpart. If you are moved by what you read and want to share, we’ve made it easy for you. Click here to find out how.

The Freakonomics of “The Girl Effect”

Posted by  on Monday, November 29th 2010     

What would happen if you applied economic theory in an unconventional way to try and understand how a girl might change the course of humanity?

At my desk one morning, I watched Nike’s “The Girl Effect” campaign videos on YouTube hoping to find inspiration for new Impact blog topics. The videos instantly reminded me of Steven Levitt and Stephen Dubner’s award-winning book, Freakonomics. The collaboration between a leading economist and the author/journalist explores the application of economic theory to diverse and seemingly unrelated topics. Most know it as the butterfly effect, or chaos theory, where small changes in an initial condition can produce large variations in future outcomes of a dynamic system.

It dawned on me, the incredible synergies between the campaign, the book, and the work we do here at USAID.  It put into perspective the reason we ensure all of our programs are women-centered.

There’s no denying the abundance of gender inequality around the world, particularly in developing nations. There is no denying the billions of dollars in lost productivity due to the fact that millions of women are denied the right to education and the ability to work outside the home. Women’s rights are more than just a moral imperative; they are the key to progress.

So how might a girl change the course of humanity?

Assume this initial condition: A 13 year old girl stands at a crossroads with two choices before her: school or child marriage. The problem is it’s not usually a choice.

Married, she is more likely to die from childbirth at an early age; she is more susceptible to sexually transmitted diseases; she is more prone to become a victim of partner violence; she never receives an education; and she is unable to contribute to society in a way that has a larger social impact and helps to push the human race forward.

With an education she marries later in life—to someone she chooses. She decides the timing of her children and is in a position to make decisions about her own health. She invests money in her children’s health and education, and is able to contribute to society in a meaningful way. Other people recognize her value and contributions, and begin to understand that all girls have value.

Multiply that scenario by the 600 million girls in the developing world and it’s easy to comprehend how a small change in an initial condition is capable of determining the course of humanity. That is powerful.

The 16 Days Campaign to End Violence Against Women: From 25 November to 10 December, USAID will post a blog each day that aims to prove a single point: The human race cannot progress when half of the world population lives without the same rights and respect afforded to its male counterpart. If you are moved by what you read and want to share, we’ve made it easy for you. Click here to find out how.

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