USAID Impact Photo Credit: USAID and Partners

Archives for Health

Mapping for Informed Decision Making in Rwanda

Mapping and Geographic Information System (GIS) have long been used in Rwanda for sectors such as agriculture and economic growth. The need for these innovative tools and skills, however, are just now being recognized in other fields, including health. As a monitoring and evaluation expert, I have seen how useful geography and maps can be to monitor and improve programs, and I was interested to learn more about how they were being used and enhanced in the field.

For four days, I joined 18 public health professionals at a GIS training in Kigali, Rwanda, organized by MEASURE Evaluation and Monitoring and Evaluation Management Systems (MEMS) and supported by USAID in collaboration with National AIDS Control Commission (CNLS ). The participants represented many local Rwandan organizations such as MEMS, the Ministry of Health, the Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics (TRAC Plus), and National University of Rwanda’s School of Public Health.

Andrew Inglis and training participants use qGIS and local data to produce maps that can be used for monitoring HIV programs. Photo Credit: Kristen Wares/USAID"

GIS is a unique tool that allows people to interact with their data. Rather than comparing data in charts or graphs, mapping data through geography allows data users to identify essential trends and associations that may not be apparent in other formats. By building local capacity in GIS, we are expanding “evidence-based decision making” for high quality and strategic health programs.

There was a lot of enthusiasm during the training about GIS. The training provided an excellent forum for the participants to talk about innovative ways they are already using the GIS tool. Participants discussed plans to create  new programs that would allow for better ownership and monitoring, to improve supply chain management, and to integrate services, all things that will support and enhance the projects that USAID and its partners are implementing.

MEASURE Evaluation trainers, Andrew Inglis and Clara Burgert, introduced the concept of GIS maps and their ability to link to a database that is capable of capturing, storing, querying, analyzing, displaying and outputting data. In addition to teaching concepts such as how to interpret maps and how to effectively use spatial data, the training provided participants an excellent opportunity to gain practical experience.

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How a Simple Memo Protected Mothers and Children from Malaria

Megan Fotheringham, Public Health Advisor, President’s Malaria Initiative

In the developing world, pregnancy is a dangerous time for women. In sub-Saharan Africa, malaria poses a major threat to the health of pregnant women and their developing babies; each year nearly 32 million pregnant women are at risk from this deadly disease. The dangers, which occur when malaria parasites infect the placenta, are serious and include maternal anemia, miscarriage, stillbirth, and low birth weight in newborns. The cost in lives and resources as a result of malaria infection places a heavy burden on families and national health systems.

Thankfully there is a solution. Women can reduce their risk of infection by taking an antimalarial drug as preventive treatment: intermittent preventative treatment for pregnant women or IPTp. For full protection, pregnant women take at least two doses of the treatment during pregnancy. In Africa, IPTp is widely available and usually given during routine antenatal care visits across the region. Despite this fact, IPTp rates are still surprisingly low.

The Kenyan government’s Division of Malaria Control recently found an innovative and simple way to respond to this problem and subsequently increased the percentage of women taking IPTp. In the Gem District of western Kenya, where only 7 percent of pregnant women received the recommended two doses of IPTp, the Government of Kenya teamed up with researchers from the Kenya Medical Research Institute and the U.S. Centers for Disease Control and Prevention to improve the use of IPTp.

With funding from the U.S. President’s Malaria Initiative, the researchers discovered one of the reasons for low compliance with recommended use was that health workers were confused about when to give IPTp. According to the official guidelines, pregnant women should only be given IPTp in their second trimester but the doses should be given at least 30 days apart. This is complicated by the fact that many women are not sure how far along they are in their pregnancy. In addition, a mother’s HIV status is also a factor in treatment protocol.

To address this confusion, the Government of Kenya piloted a simple approach.  They sent an official memorandum to all government health facilities located in the Gem District and followed up with supervisory visits. The memo clearly listed five key messages about IPTp and instructed health workers to comply with these simplified guidelines. To reinforce their message, officials made half-day visits to all facilities providing antenatal care services in Gem. To support the importance of this simplified approach, the same memo was re-sent six months later.

The Results

A year after the first memo was sent, a second survey was conducted with a sample of women who recently gave birth: 43 percent of these women had received the recommended two doses of IPTp, a dramatic increase in usage.  As a result the Kenyan government is now repeating the process of disseminating the memo and following up with supervisory visits in all other districts in Kenya where IPTp is policy.

This simple approach, if replicated, could help improve IPTp coverage elsewhere in Africa, where use of IPTp is government policy. This is just one example of the new approaches the President’s Malaria Initiative is supporting to improve program implementation and malaria control across Africa. These approaches are driving forward progress through simple and cost effective processes to save the lives of those who are most vulnerable to malaria – pregnant women and young children.

Do you have other examples of simple, effective solutions that could improve the delivery of health services? We invite you to provide your comments and suggestions below.

World Population Day: Why seven billion matters

By Scott Radloff, Director of the Office of Population and Reproductive Health

This October 31st the UN has projected that the world population will reach 7 billion.  In my lifetime, the world population has passed the 3, 4, 5, and 6 billion milestones.  During that time the world has become much more interconnected and great advances have been made to help people across the globe live healthier and longer lives.

Today, on World Population Day, as we anticipate the arrival of the seven billionth human being on earth, I’d like to pose the question: what more must we do to ensure the health, nutritional, and educational needs of all seven billion are met?

One place to start is by meeting the reproductive health needs of the more than 215 million women in the world who would like to postpone or stop having children but are not using modern contraception.  Investing in family planning translates to lower maternal and child mortality, reduced need for abortion, and it improves women’s opportunities and family well-being.  A USAID-supported study in Bangladesh (PDF,147kb) found that families who received reproductive health services experienced health benefits in addition to larger incomes, greater accumulation of wealth, higher levels of education, and improved access to water.

As we look forward to the next 60 years, it is certain that the world population will increase to 8 billion.  Beyond that the world’s population might stabilize at around 8 billion by the end of the century or could reach upwards of 16 billion, according to the UN projections.  The future course of population growth depends on our current and continued investment in and commitment to voluntary family planning programs, as well as investments in child survival and girls’ education.


In it to Save Lives: Scaling Up Voluntary Medical Male Circumcision for HIV Prevention for Maximum Public Health Impact

Emmanuel Njeuhmeli is the Senior Biomedical Prevention Advisor in the USAID Office of HIV/AIDS.

“Male circumcision can be done anywhere, and if you don’t believe me, I’ll prove it to you during this meeting.”

These were my last words during my first presentation at the 2011 PEPFAR Annual Meeting in Johannesburg this past May. Needless to say, there were a lot of raised eyebrows, a few laughs and a couple of questions as to whether I had a male circumcision tent set up in one of the breakout rooms.

But no – the goal, of course, was not to perform a medical procedure on my USG colleagues. It was to heighten their understanding of a cost saving and effective form of HIV prevention that, despite the science and clinical findings, still does not get the recognition and broad support it should.

Soon after the World Health Organization released findings from three randomized trials that showed  male circumcision prevents 60% of new HIV infections in men who have heterosexual sex, countries in Eastern and Southern Africa  with technical and financial support of PEPFAR, BMGF, WHO, UNAIDS began scaling up efforts around voluntary medical male circumcision (VMMC).

PEPFAR, through USAID, CDC, DOD, Peace Corps, and NIH, has continually supported country governments in their VMMC efforts. Kenya’s program is one worth noting. In two short years, the national program has reached 66 percent of its VMMC goals. This means – based on USAID and UNAIDS estimates that Kenya is on its way to averting 47,000 adult HIV infections between 2009 and 2025, and can save $247 million along the way. This is no small feat.

Now, working to support other countries in Africa, such as Swaziland – which is scaling up VMMC services through the Soka Uncobe, an accelerated saturation initiative – we are confident VMMC has the potential to avert more than 4 million adult HIV infections in Eastern and Southern Africa in the next 16 years.

That is what PEPFAR is all about: making smart investments to save more lives.

After our meetings, I felt my colleagues were more inclined to return home and explain VMMC to their country governments in a compelling and effective way. They saw the value of VMMC as a critical HIV prevention tool – one that can be done in a safe medical environment and rolled out on a wide scale in almost any community.

But, to reach our ultimate target – the decision makers and communities in country – we knew we had to go beyond the presentations. So, with the help of AIDSTAR One, we teamed up with Lisa Russell, an award-winning filmmaker, to create In It to Save Lives: Scaling Up Voluntary Medical Male Circumcision for HIV Prevention for Maximum Public Health Impact.

The film examines the expansion of male circumcision as an HIV prevention intervention and tells the story of how governments and communities in Kenya and Swaziland have embraced VMMC in their countries. The goal of the film is to show that VMMC services can be replicated and expanded to reach the critical mass needed for maximum public health impact.

Now, 30 years into the epidemic, there are roughly 34 million currently living with HIV/AIDS, with another 7,000 new HIV infections each day. With numbers like these, it’s more important than ever to focus on reaching those most in need with prevention, treatment, care and support messages and programs.

Through a variety of prevention interventions, including VMMC, we hope to turn the tide of the HIV epidemic.

Watch the video and download additional resources at AIDSTAR-One.

Mobile Clinics in India Take to the Road: Bringing HIV Testing and Counseling and STI Services to Those Most at Risk

Ed Scholl, AIDSTAR-One Project Director, 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.

Sanjay takes his lunch break on his construction job near the city of Nagpur in the state of Maharashtra, India.  He migrated here in search of work from his home in the northern state of Madhya Pradesh.  He’s 23 and single and hopes to earn enough to get married, start a family, and help his parents back home.

During his break, Sanjay (not his real name) decides to visit the big van parked near the construction site, where an outreach worker told him he can get free HIV and sexually transmitted infection (STI) testing.  He’s curious and a bit concerned about his HIV status, since he knows that visiting sex workers back in town, as he and his fellow workers occasionally do, puts him at risk for HIV.  He enters the van and is greeted by the counselor, who explains how HIV and STIs are transmitted and what he can do to avoid them. Sanjay then gives his consent for an HIV test.  The counselor shares some pamphlets that give him additional information about HIV and STI prevention.  Before she leaves, she demonstrates how to use a condom and offers him some.

Next, he visits the doctor, who goes through a checklist of STI symptoms and provides a physical exam.  Finally, he goes to the lab, where blood is drawn. He is told to come back for the results in four hours.  At the end of his shift, he returns to the van and the counselor tells him, much to his relief, that he is HIV-negative and does not have an STI.  She reminds him how he can stay healthy and avoid HIV and STIs and answers all of his additional questions.

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30 Years of HIV/AIDS: A USAID Historical Perspective

On June 5, 1981, the Morbidity and Mortality Weekly Report reported that five seemingly healthy young gay men were diagnosed with an infection that would typically affect only individuals with substantial damage to their immune system. As similar cases cropped up, national and international attention soared, and the scientific and public health community mobilized to ascertain the scope and root of this anomaly. Eventually, the causal factor was given the name AIDS.

This month marks 30 years since the first cases of AIDS were reported in the United States. After scientists identified and isolated HIV, and confirmed it caused AIDS, the U.S. Agency for International Development (USAID) began its HIV/AIDS development program. Starting in 1986, USAID’s work in this field has been ambitious and cutting edge, showcasing the best of American scientific ingenuity and demonstrating core American values.

In the 1980s and 1990s, we launched prevention, care and treatment programs through our missions around the world using approaches that fit within the social context of each country and targeted the most vulnerable populations. The proliferation of the disease across sub-Saharan Africa prompted us to intensify our focus on this region. In 2000, USAID convened the first agency-sponsored international meeting on male circumcision and HIV prevention. We also began some of the first prevention of mother-to-child transmission programs with the Elizabeth Glaser Pediatric AIDS Foundation.

We quickly realized fighting this disease would require more than just new medication and care. In 2001, we forged a partnership with the International AIDS Vaccine Initiative (IAVI) to invest in research and development for an effective vaccine. To date, IAVI has made a number of groundbreaking discoveries, including several potent new antibodies to HIV, adding more vitality to this game-changing effort. In the same year, USAID commenced three pilot trials of antiretroviral treatment in Kenya, Rwanda, and Ghana.

In 2003, President Bush announced an unprecedented initiative to ramp up the U.S. Government’s commitment to HIV/AIDS in the developing world. Today, the President’s Emergency Plan for AIDS Relief (PEPFAR) continues to be the largest bilateral AIDS program in the world, touching millions of lives through prevention, care, and treatment. Through our global network of missions and partners, USAID currently implements more than half of all PEPFAR programs.

Through PEPFAR, USAID has contributed to saving lives through a variety of voluntary prevention interventions, counseling, testing and care programs. Today, more than 3.2 million people receive lifesaving treatment through the support of the American people.

Building on the strength of PEPFAR  and other successful US global health initiatives, USAID is working at an interagency level to ensure President Obama’s Global Health Initiative replicates and amplifies the success of our HIV/AIDS programs through a continued focus on health system strengthening and investments in innovation. Our award-winning Supply Chain Management System project has provided more than $750 million in HIV/AIDS commodities and saved $700 million by pooling procurements of generic AIDS drugs. We also funded the CAPRISA 004 Trial, which was completed last summer and provided the first-ever proof of concept that a microbicide can reduce risk of transmission from men to women.

Our work is far from done. We have a shared responsibility as a global partner to save lives by focusing on smart investments. The generosity of the American people has made sustained progress against this deadly disease possible. Closing the chapter on HIV/AIDS will require a steadfast focus on remaining gaps and challenges as we chart the way forward.

The Other Half of the Family Planning Equation

As Father’s Day approaches I look back to when my wife and I first decided to have children. We married fairly late, both in our early 30s, so we planned to have our first child just a couple years after we married. It was an exciting time; much thought went into planning our family. We are now proud parents of two healthy and happy girls. It’s normal in the U.S. for both men and women to play an active role in planning their families; however, in much of the developing world that is not the case.

Involving men in international family planning programs is an uphill battle. There is a lack of information among men on the importance of delaying first birth, of spacing births, and of avoiding high parity births for the health of the woman and the child. Family planning saves lives and improves maternal and child health. In the developing world, an estimated 90 percent of infants whose mothers die after childbirth will die by their first birthday.

Men play an essential role as they are the gatekeepers in many countries to what women can and cannot do: whether women can use contraception or whether family resources should go to pay for other methods. A number of USAID’s programs address gender issues, focusing on improving male participation in family planning.

We are making progress. Twenty years ago in Kenya, 10 percent of women who were not using or planning to use family planning said that their husband’s disapproval of family planning was the main reason. Today, this percentage has been reduced to 6 percent. Meanwhile, countries like Nigeria have 10 percent of these women attributing non-use of family planning to husband’s disapproval. So while we have seen improvements, there is still much work to be done.

Educating men on the importance of family planning and birth spacing is only part of the equation. There should also be a greater emphasis on male methods, including condoms and vasectomy.

The challenge is many men around the world don’t have good health seeking behavior so we must get creative in our opportunities to reach men. For example, now that there is incontrovertible evidence that male circumcision significantly reduces acquisition of HIV by men, there are male circumcision programs for adult men blossoming all over sub-Saharan Africa. We should make sure there are no missed opportunities to speak to men about other health issues, including planning for their families.

This Sunday, as we celebrate fathers everywhere, let us not forget that men’s participation in planning for their families will result in better health and improved lives.

Photo blog: If countries lead will donors follow?

Originally posted on the Ministerial Leadership for Global Health (MLI) Blog

All five MLI countries were represented Thursday afternoon at the MLI event, “If Countries Lead Will Donors Follow?” at the Global Health Council’s annual conference in Washington, D.C. Delegates spoke on a panel moderated by John Donnelly in The Ambassador Room, sharing stories about how country leadership has advanced health outcomes in their countries.

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The Health Professional Crisis: A Personal Perspective

Phetogo Phoi, Lab Logistics Advisor, Supply Chain Management System (SCMS)

Botswana, like many countries, struggles with a limited amount of health workers, especially personnel qualified in the area of lab management.  In Botswana, this challenge is compounded by a limited number of graduate and undergraduate health programs. Professional courses, especially in the health area, are not offered here. Like many, I went abroad to the United States and the United Kingdom for my undergraduate and graduate degrees.

In the absence of a comprehensive health education infrastructure, the technical assistance provided by President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID to enhance the skills of the health workforce plays a critical role in strengthening the health sector. In the area of lab logistics, lab commodity management ensures that tests and other supplies are available when a doctor or nurse needs them. This field of study is often the furthest thing from a laboratory scientist or pharmacist’s mind when they enter the workforce.

In my work as a Lab Logistics Advisor for the Supply Chain ManagementSystem (SCMS), a project under PEPFAR and administered by USAID, I train health workers, mainly lab personnel, on laboratory commodity logistics management. One thing I’ve learned:  lab supplies are critical to health programs. Someone will visit a clinic and be tested for HIV. If they test positive, based on their CD4 count, they are placed on lifesaving treatment. Health workers then monitor the patient’s treatment regimen and most importantly, their health.

If a lab isn’t properly tracking its inventory, there is an opportunity for stockouts of test kits, which could lead to very sick people going without treatment because they never learned their status.  By learning to better manage their inventory of medicines, test kits and laboratory supplies, health workers can ensure their facilities are well stocked and the products they need are available for patient diagnosis and treatment.

I’m working with laboratory staff to help them implement the systems they didn’t learn about in their university studies or other pre-service trainings. I try to focus staff on addressing challenges and identifying how the system should look. Systems are more important than some may think. Without a system, there are many challenges in managing a health facility. But even with all the complaints and finger pointing, there was no structured system to resolve challenges.

Every day, I see the difference PEPFAR and USAID and the Centers for Disease Control and Prevention are making in this area.  I used to visit one of the facilities we work with, and it was a painful sight to find everything so mixed up. Pharmacists and laboratory officers were unable to find the supplies they needed or were unable to use them before they expired. Now, I go to facilities where I’ve trained people and just smile to see so much changing.

There is still much to do. Change doesn’t happen overnight, but I believe that with more investment in training and technical assistance we can help build a public health workforce we can all be proud of.

Renewed Commitment to Global Vaccines and Immunizations Will Save Lives

Originally posted on the White House Blog

During a time when we all – including the federal government – need to live within our means and find places to cut spending, any investments made by your government need to meet the test of whether it is an effective and efficient use of taxpayer dollars.

Immunizing children from preventable diseases meets that test. As USAID Administrator Raj Shah announced in London on Monday, by making a multi-year commitment to the Global Alliance for Vaccines and Immunizations (GAVI), the US is able to get the most from our investment – leveraging a pledge of $450 million over three years more than eight-fold into billions of dollars in commitments from other donors, including the UK, the Gates Foundation, Norway and others.

Together, these commitments will help save the lives of 4 million children over the next five years, by getting more vaccines to more children and by helping to ensure the quantities of vaccines needed to lower the prices for new vaccines such as those that protect against pneumonia and diarrhea, the world’s two most potent childhood killers. All in all, we will be able to immunize more than 250 million children and prevent more than four million premature deaths.

Investments in vaccines are one of the best and most cost-effective life-saving investments for the world’s children, which is why we’ve made tough choices and trade-offs within our current global health portfolio to make this commitment.  As Administrator Shah said: “In this fiscal climate, a multi-year pledge is an extremely difficult commitment to make. But we have made tough reallocations across our portfolio in order to make that commitment because only a multi-year pledge will ensure the highest possible return for every taxpayer dollar.

Not only will our commitment inspire the generosity of other donors, it will help drive economies of scale that lower the cost of vaccines, allowing us to save even more lives. Just last week, GAVI reached an agreement with GlaxoSmithKline to cut the cost of the rotavirus vaccine by 67%. That kind of reduction is only possible with the guaranteed demand a multi-year pledge provides.”

In the lead up to GAVI’s conference, the White House received thousands of phone calls, emails, and signed petitions calling for continued U.S. support for GAVI.  The ONE Campaign issued a statement of support following our announcement, including praise from Bono who noted the President was “in it to win it.”

The U.S. has played a lead role in GAVI since its inception, and is a world leader in support of every aspect of the vaccines value chain, including research, development, vaccine affordability, delivery systems, and policy coordination.

Gayle Smith is Special Assistant to the President and Senior Director for Development and Democracy for the National Security Staff
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