USAID Impact Photo Credit: USAID and Partners

Archives for Health

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.

Contraceptive Technologies Offer New Options

The introduction of the contraceptive Depo-Provera in Uniject is suitable for delivery by community health workers and even for self-injection. Photo Credit:PATH/Patrick McKern

It is well-documented that contraception has multiple individual, national and global health and development benefits, including reductions in maternal and child mortality and maternal to child transmission of HIV, and increased opportunities for women in the workforce and global economy.  World Contraception Day, commemorated every year on September 26, highlights the growing need for improved access and awareness of modern contraception.

Seven out of 10 women in Sub-Saharan Africa, South Central Asia and Southeast Asia who want to avoid pregnancy but are not using modern contraceptives report the  major reasons they don’t use contraception include: concerns about health risks and side effects (23%), infrequent sex (21%), being  postpartum or breastfeeding (17%), and opposition of their partner (10%).  In other words, the currently available methods do not, necessarily, meet their needs.  It is imperative that we continue to work to develop innovative technologies, both adaptive technologies that improve current methods and totally new methods to ensure women and men use and have access to a wide range of modern contraceptive methods.

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Malaria Takes Stage at the Social Good Summit in NYC

As featured on MCHIP

Throughout the first two days of the Social Good Summit, hosted by Mashable, the UN Foundation, 92Y, and Ericsson, malaria has been making headlines. The disease is ripe for its time in the limelight. Preventable through simple, cost effective solutions and the recent subject of a high profile study validating the effectiveness of bednet use, malaria is a daily challenge in the lives of millions who live in malaria endemic areas, but has also become a global challenge due to the increase in travel across country borders.

Yesterday at the Summit, USAID Administrator Raj Shah highlighted expanding on the rapid reduction in child malaria deaths as one of three key action items for the Agency to reduce child mortality by up to one-half. Today, Mandy Moore and Randy Zuckerberg took the stage in the closing session to talk about Nothing But Nets, and Rear. Adm. Tim Ziemer, U.S. Global Malaria Coordinator, came by 92Y to see the presentation.

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Because No Mother Should Die Giving Life; Every Child Deserves a Healthy Start

Last night, the Saving Lives at Birth partnership announced three award nominations for transition-to-scale grants that have the potential to save the lives of mothers and newborns in rural areas of the developing world at the time of birth. We couldn’t be more excited about the announcement.

The award nominees – a mobile technology initiative in Ghana, an HIV and syphilis testing device in Rwanda and a treatment to prevent newborn infections in Nepal – have provided the most compelling evidence that their innovative and promising solutions are ready to be tested on much larger platforms.

USAID Administrator Raj Shah made the announcement at the high-level Every Woman, Every Child reception hosted by Ray Chambers, the UN Secretary-General’s Special Envoy for Malaria and MDG Advocate. These $2 million grants will be implemented over four years.  The partners – USAID, the Government of the Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and The World Bank – all congratulated the nominees for their ongoing efforts to reduce maternal and newborn deaths in rural areas of the world and encouraged them to keep going.

JSI, Columbia University, and Grameen Foundation – the latest Saving Lives nominees – are all eager to advance their work.

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Collective Action to Advance the Health of Women and Newborns

Global maternal mortality has dropped by one third since 1990, but still every day an estimated 1,000 women lose their life in childbirth.  For the past year, USAID, the UK Department for International Development, Australian Agency for International Development and the Bill and Melinda Gates Foundation have worked in partnership to accelerate progress in improving maternal and child health.  Launched at last year’s UN General Assembly Summit on the Millennium Development Goals, the Alliance for Reproductive, Maternal, and Newborn Health has supported the UN Secretary-General’s Every Woman, Every Child effort.

As director of USAID’s Office of Population and Reproductive Health, I’ve seen firsthand how this unique partnership has enhanced our efforts to improve the lives of women and children in the countries we work.  Through shared planning and funding, coordinated implementation, joint problem-solving, and joint learning, we’ve seen results that have far exceeded what any one organization could have achieved on its own.  For example, in Ethiopia, more women will have access to contraceptive implants and the government will save an estimated $2 million per year because Alliance partners worked with manufacturers to reduce the price of reproductive health commodities.

And in Pakistan, Alliance members helped increase the number of trained community midwives from 2,795 in 2010 to 7,764 in 2011, promising to reduce maternal and newborn death rates.  These are just examples from two of the ten countries in which the Alliance is focused on in its first year.

What makes the Alliance partnership different is that it brings added value, not added work, through smarter application of resources.  Through our joint efforts, by 2015, the Alliance aims to contribute to:

  • 100 million additional users of modern methods of family planning to reduce unmet need.
  • 67 million more women giving birth with the help of skilled attendants to reduce the maternal mortality ratio.
  • 80 million more infants exclusively breastfed through the first six months of life to reduce newborn mortality.

You can learn more about the Alliance’s work over the past year and our achievements in a one year progress report (pdf, 2.3mb) submitted this week to the UN Secretary-General’s Every Woman, Every Child effort.  In the coming year, the Alliance intends to expand to include additional partners and countries.

Delivering Quality, Affordable and Equitable Care to Improve Health

The U.N. High Level Meeting on Prevention and Control of Non-communicable Diseases marks only the second time in history the UN has held a special meeting on a health issue: the first was for HIV/AIDS in 2001.

Non-communicable diseases (NCDs) represent an urgent and growing global public health concern. In 2008, NCDs — diseases such as cardiovascular disease, respiratory disease, cancer and diabetes — claimed the lives of more than 39 million people, according to the World Health Organization (WHO). And we know that the majority of poor people, the bottom billion, bear most of this burden in lower- and middle-income countries.

As the world’s epidemiology evolves, preventing NCDs will help to prolong life expectancy, reduce disability and extend opportunity. A healthier lifestyle delivers the biggest dividend.

The Agency’s significant investments in health systems strengthening (pdf, 3.15mb) underpin the foundation for integrated, country-led NCD prevention and control programs.

This means our current programs are building the foundation upon which future NCD efforts can be based. The same approaches that strengthen health workforces, ensure reliable supplies of vaccines and contraceptives, collect and analyze health information, and promote more effective governance, can also be adapted and applied to addressing NCDs.

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USAID Renews Commitment to Finding a Viable HIV Vaccine

Having worked in the HIV/AIDS realm for many years, I’ve gotten my share of questions on when I think an effective vaccine will finally be discovered and the world will bear witness to an AIDS free generation. Some wonder why, after 30 years, our path towards finding a cure for HIV—a virus that has taken the lives of more than 25 million people around the globe since it first surfaced—remains complex and plagued with so many challenges. Others are just plain frustrated with what they feel has become a fictional idea.

What people often forget is that vaccines for diseases that have been eliminated—such as polio and smallpox—have taken, in many cases, decades to develop. Discovering an effective vaccine, especially one for a virus that is so tricky and where the body has no naturally protective response, takes enormous dedication, persistence and research.

Dedication, persistence and research: all qualities in which USAID is well-versed and has a longstanding history. Since the early years of the epidemic, USAID was steadfast in supporting initiatives dedicated to prevention and finding a cure for HIV/AIDS. This is just as true today as it was 30 years ago. The Agency, just this month, renewed its commitment to the InternationalAIDSVaccineInitiative (IAVI), a longtime partner and leading research NGO whose mission is to discover and make accessible a preventive AIDS vaccine.

In partnership with IAVI, USAID will continue to be a global thought leader and leading voice on the importance of the discovery of an effective vaccine for HIV/AIDS. USAID has made it a priority to continue supporting leading organizations dedicated to working in this area. To date, USAID-supported IAVI studies have led to the discovery of the first of now several powerful, broadly neutralizing antibodies capable of blocking HIV, which were isolated from an African donor.  IAVI has also developed novel vectors that show great promise in pre-clinical stages.

I am also pleased to see IAVI expand its partnerships with other U.S. Government agencies, such as its collaboration on the National Institute of Health’s HIV Vaccine Trials Network (HVTW). IAVI has also built capacity in countries, such as in Kenya where the Kenya AIDS Vaccine Initiative is currently a model for developing country research institutions, capable of rigorously and ethically evaluating AIDS vaccine candidates and playing a crucial role in the global quest for the vaccine.

Investing in science, technology and innovation is imperative to be strategic and cost effective in our fight against AIDS. New technologies can dramatically improve health and development outcomes, resulting in pivotal progress toward preventing new infections in the developing world, where the burden of HIV is most painfully felt. New biomedical prevention tools are of critical importance in this battle – particularly that of a safe and effective HIV vaccine. We must continue to build our arsenal of biomedical prevention tools, given the game-changing impact they can have both on global health outcomes and overall economic development.

I am delighted that our work with partners, like IAVI, will continue as we strive to find an effective vaccine – a tool that is essential in our fight against HIV/AIDS.

On the Road with SCMS, Part 3: In South Africa, a provincial depot’s dream team mobilizes to support scale up of HIV/AIDS care and treatment

In this three part series, Jay Heavner, Director of Knowledge Sharing and Communication at Supply Chain Management System (SCMS), highlights his experiences visiting three countries in Africa to observe SCMS project sites.

In March, Diane Reynolds, Supply Chain Management System (SCMS)’s country director in South Africa,wrote about President’s Emergency Plan for AIDS Relief (PEPFAR) and USAID’s partnership with the government of South Africa to help bring down the price of antiretroviral drugs (ARVs) in that country. ThisBridging Fund program has been a game-changer for South Africa as it rapidly scales up HIV/AIDS treatment, so I jumped at the opportunity to visit the country and see first-hand the impact of this innovative initiative.

One of the most memorable experiences of my recent trip was a site visit to the KwaZulu-Natal Provincial Pharmaceutical Supply Depot near Durban. Although one of ten provincial depots, it stores and distributes an impressive 32 percent of the country’s lifesaving ARVs to 28 hospitals and 600 clinics in the province.  Before arriving, I heard about the depot’s dream team who worked wonders to accommodate a large influx of ARVs in a warehouse that was already stretched to capacity.

A hand-operated fork lift helps navigate tight warehouse spaces.Photo Credit: Desiree Swart

To understand their achievement, consider the following:

  • The depot was designed 27 years ago to serve a population a fraction of the current one and before the first case of AIDS was reported in South Africa.
  • Most ARV regimens in South Africa still use three separate pills in combination rather than have patients take one pill containing three different medicines (fixed-dose combination).
  • More than 500 pallets of ARVs were occupying 27 percent of the total space in the depot the day I visited, meaning that the staff are managing all other public health commodities in roughly three quarters of the space they used to have available.
  • The ARV stock turns at the hub are almost weekly; monthly stock turns at any warehouse would be considered an accomplishment.

The team who runs the depot is a passionate bunch.  When I asked how they pulled off such an amazing feat, one replied, “Each person here is a perfectionist. We are the people who have to do it. The implications of not doing it are too great.”

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