USAID Impact Photo Credit: USAID and Partners

Archives for Health

Stopping the Spread of Polio in Central Asia

When my daughter Caitlin cried getting her polio booster, I was able to staunch the flow of her tears by describing the amazing work USAID/Central Asian Republics did in Tajikistan last spring when USAID’s rapid response and advocacy with the host governments and other donors resulted in more than 7 million children getting vaccinated (that’s more than 95 percent of the under-five population).

Caitlin’s response to me was “I’d be happy to give my vaccine to the kids who need it. But what else can I do to help?”  Her innocent comments reflect the spirit of our team as we rolled up our sleeves and mobilized the Tajik Health Ministry and other donors to respond decisively with a series of national immunization campaigns that effectively stopped the spread of the outbreak in six months.

I was reminded of this victory last week when the European Regional Certification Commission for Poliomyelitis Eradication (RCC) announced that Europe will keep its polio-free status.  Last week, in Copenhagen, the RCC said that wild poliovirus transmission had been interrupted.  “No new cases of polio had been reported since September 2010 because countries took effective action.”  That statement is referencing Central Asian countries—for example, Tajikistan—which in 2010 saw its largest polio outbreak in decades.  There were 898 reported cases of acute flaccid paralysis in Central Asia in 2010.  Acute flaccid paralysis is the most common symptom of polio and is one indicator for polio surveillance during an outbreak.

A Tajik mother holds her son while he gets his polio vaccination. Photo Credit: USAID

The RCC acknowledged the contribution and technical support of the World Health Organization Regional Office for Europe, the Global Polio Eradication Initiative partners and the Russian Federation, India, and USAID.  Not only did our work halt this devastating disease, but it also built the foundations of new U.S.-Russia bilateral cooperation on joint efforts to assist with strengthening health systems and surveillance in the region.

Polio has no cure, and only vaccination can prevent it.  But additional funding, coupled with technical assistance and strong advocacy, increases the ability to mount high-quality campaigns and sustain a population’s immunity, which is the best we can do until global eradication is achieved.  The Central Asian Republics have eradicated polio successfully in the past, and serve as an important lesson to stay vigilant and maintain a strong immunization program.

USAID Applauds New White Paper Regarding the Trans-Pacific Partnership and Access to Medicines

Today at Round 8 of the Trans-Pacific Partnership negotiations in Chicago, IL, the Office of the U.S. Trade Representative (USTR) issued a white paper outlining a new strategic initiative entitled “Trade Enhancing Access to Medicines (TEAM).” TEAM is designed to deploy the tools of trade policy to promote trade and reduce obstacles to access to both innovative and generic medicines, while supporting the innovation that is vital to developing new medicines and achieving other medical breakthroughs.

“A cornerstone of the Obama Administration’s global public health strategy has been to focus aid on strengthening entire health systems in developing countries in order to improve public health, including improved access to medicines,” said Ariel Pablos-Mendez, Assistant Administrator for Global Health, U.S. Agency for International Development. “Today’s announcement by the United States Trade Representative confirms the role of trade policy in the Administration’s broader efforts.”

The white paper describes how, under the TEAM approach, the United States proposes to work with partners Australia, Brunei Darussalam, Chile, Malaysia, New Zealand, Peru, Singapore, and Vietnam to achieve the following goals in a TPP agreement:

• Expedite access to innovative and generic medicines through a “TPP access window”
• Enhance legal certainty for manufacturers of generic medicines
• Eliminate tariffs on medicines
• Reduce customs obstacles to medicines
• Curb trade in counterfeit medicines
• Reduce internal barriers to distribution of medicines
• Promote transparency and procedural fairness
• Minimize unnecessary regulatory barriers
• Reaffirm TPP Parties’ commitment to the Doha Declaration on TRIPS and Public Health

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This Week at USAID – September 12, 2011

Administrator Raj Shah participates in a panel discussion about “Leveraging Malaria Platforms to Improve Family Health” during the The Summit to Save Lives, which is presented by the George W. Bush Institute.

Later in the week, Administrator Shah heads to Haiti to meet with USAID Mission staff and to visit an agricultural training center.

The World at 7 Billion People: Deputy Administrator Don Steinberg speaks at the National Geographic Society Headquarters to raise awareness around global population issues related to women and girls.

Assistant to the Administrator Susan Reichle talks about USAID’s progress towards implementing President Obama’s Policy Directive on Global Development at a town hall hosted by the Modernizing Foreign Assistance Network.

Miriam’s Success in Changing Lives in her Community

When she was only 14 years old, Miriam was the primary caretaker of her family. Like many other girls in her situation in Guyana, Miriam turned to commercial sex work to provide for her family.

As a female sex worker (FSW), Miriam put herself at risk of HIV/AIDS and sexually transmitted infections. In Guyana, FSWs have an HIV prevalence rate of 16.6%; still, only 35% of FSWs surveyed knew two ways to prevent sexual transmission of HIV. In order to reach this population with education, prevention, care and treatment services the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), through USAID, funds several community based intervention programs.

At 15 years old, Miriam gave birth and soon found herself in an abusive relationship. She suffered through years of abuse until she left with her children and moved to a large city. Once again, she was on the streets trying to make a living.

In 2006, Miriam was reached through Keep the Light On, a project targeting sex workers implemented by Comforting Hearts, a USAID-supported NGO located in New Amsterdam. Through training and education, Miriam became a peer educator.

She said, “Being involved as a volunteer with Comforting Hearts benefited me greatly. In addition to reaching out to my peers, my own life was also changed, because of the knowledge I acquired which helped me to change my risky behaviors.”

Miriam reached out to sex workers and their clients and shared HIV/AIDS information with them.  She was also trained to provide care to people living with HIV, through the Home Based Care program, and provided bedside care to HIV positive people at the New Amsterdam Hospital. Miriam later became a member of the Caribbean Network of Sex Workers and president of the Caribbean Sex Work Coalition.

On a return visit to her hometown, Kwakwani, in 2008, with her greater insights on HIV/AIDS and her experience as a sex worker, she quickly assessed the plight within her childhood community.  Poverty was still rife; the sex trade, with many unsafe sexual practices, was more pronounced than ever in this small mining community.

To respond to these challenges, she decided to start a community-based organization, ONE LOVE, to educate commercial sex workers on HIV prevention.  The organization trains peer educators from the mining areas within Kwakwani and reaches sex workers and their clients with appropriate HIV prevention messages, condoms and HIV testing and counseling.  The organization also provides economic empowerment activities, which allowed some of the women to leave sex work.

ONE LOVE, through Mariam’s leadership and passion, is one of the newest recipients of USAID funding through PEPFAR, and is testimony to the fact that one person, based on her own experiences, can make a difference in the lives of others.

Miriam concludes, “Now I am living my dream of reaching the population that I was once a part of; many lives have been saved and many lives have been changed, all because of my work. This is very precious to me.”

New Program Educates Health Sector Executives in Kenya

Kate Steger, MA, MPH is a Communications and Knowledge Exchange Coordinator for the Kenya Leadership, Management and Sustainability Program at Management Sciences for Health

Earlier this year, USAID supported the launch of the Leading High-Performing Healthcare Organizations program (LeHHO) for senior health leaders in Kenya.  Offered at Nairobi’s Strathmore Business School, the program is the result of a successful partnership between Strathmore and USAID’s Leadership, Management and Sustainability (LMS) project in Kenya.

Kenyatta National Hospital Chief Nurse Philomena Maina (center) receives her LeHHO certificate from Strathmore Business School Dean Edward Mungai (left) and Academic Director Joan Mansour of MSH (right). Photo Credit: MSH

A leadership development specialist from Management Sciences for Health, which implements the LMS project, worked with Strathmore Business School faculty to integrate key components of leadership development for the health sector with Strathmore’s business education model. The result: an ongoing six-month course that combines executive health systems education with applied leadership training, offered exclusively to the health sector’s most senior leaders.

Program participants expand the depth and breadth of their knowledge with modules on the healthcare environment, improving organizational performance, healthcare systems management, and managing change. At the same time, they are asked to choose a specific current challenge in their organization and set a goal for overcoming that challenge. At the recent graduation ceremony for the first cohort, participants boasted accomplishments that promise to have widespread and lasting effects on the health of Kenyans.

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This Week at USAID – September 6, 2011

After a hiatus, we will be continuing the “This Week at USAID” series on the first day of the work week.

Thursday, September 8th is International Literacy Day. The Center for Universal Education at Brookings, the Education for All-Fast Track Initiative, and USAID will mark the day by hosting a series of panel discussions on how a range of education stakeholders are addressing the challenge of improving literacy, particularly at lower primary levels, to help fulfill the promise of quality education for all.

Stephen Haykin will be sworn-in as USAID Mission Director to Georgia.

Raja Jandhyala, USAID’s Deputy Assistant Administrator for the Bureau for Africa, will testify before the U.S. House Subcommittee on Africa, Global Health, and Human Rights on the long-term needs in East Africa.

Alex Their, USAID’s Assistant to the Administrator and Director of the Office of Afghanistan and Pakistan Affairs, will testify before U.S. Senate Committee on Foreign Relations on development programs in Afghanistan.

On the Road with SCMS, Part 2: In Ethiopia, capacity building helps a health center manage its supply of HIV/AIDS commodities

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.

The Fital Health Center is located about 135 kilometers north of Ethiopia’s capital, Addis Ababa, in a beautiful agricultural region of small villages of thatched roof huts and fields of dark, rich soil.  HIV prevalence is low here.  Although the center tests about 1,000 people a month, the center has only 37 patients on treatment, three of whom are children.

The health center has a small but well organized store room filled with medical supplies, including adult anti-retroviral medicines and HIV test kits provided by the Global Fund and pediatric antiretroviral drugs (ARVs) and laboratory supplies procured by SCMS with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID.  The store room also serves as a distribution point for nine other smaller health centers in the area.

In Ethiopia, a PEPFAR implementing partner picks up a shipment of HIV test kits from SCMS’s local distribution center. Photo credit: David Fombot

As recently as 2009, the health center struggled to manage its relatively small number of medicines and other supplies. Staff here told me they faced challenges with drugs expiring and experienced stockouts of drugs and other supplies as well.

As part of a national capacity building program, SCMS has provided training and ongoing supportive supervision visits with key staff here and at 198 sites like it to strengthen the health center’s processes, including reporting and ordering to the regional warehouse hub, management of its medical supplies and distribution to other sites. Staff here showed me examples of the forms they fill out and use to report data—including consumption of commodities and current stock on hand—to the regional warehouse staff, who then enter the information in a national internet-based system developed by SCMS to support Ethiopia’s Pharmaceutical Fund and Supply Agency (PFSA) and international donors plan their funding and procurement of HIV/AIDS commodities.  They also showed me a number of other forms, including ones they use to manage their inventory and others used to process and track orders from the other sites they serve. SCMS prints and distributes many of the forms sites like this use to manage their HIV/AIDS medicines and supplies.

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Securing Health for the Sake of Security

Colonel Mbaye Khary Dieng of the Senegalese Armed Forces made one point very clear: “This is a global security issue.”

One thing you can count on in Senegal is rolling power outages. In fact, that’s how our meeting with the Colonel began. What we learned about the Senegalese Armed Forces’ approach to national security, however, was less expected.

Colonel Dieng enrolled as a cadet at age the age of 11 in 1965. Now, forty-six years later, he commands a team of military personnel that includes an Obstetrician-Gynecologist , a biologist, a pharmacist, a psychiatrist, a social worker and a medical school dean.

Senegal has largely been spared the devastating economic and health effects caused by HIV. In this small, westernmost African nation, only 0.7 percent of the general population (12.5 million) has tested positive for the disease. Interestingly, according to a 2005 Combined Behavioral Surveillance Survey, the prevalence rate in the military was also 0.7 percent – the same as in the general population.

“The reason this country enjoys such a low rate of HIV,” Colonel Dieng explains, “is because we were not afraid to recognize this as a major problem from the very beginning.”

He recalls that commanding officers, as far back as 1978, openly talked about safe sex and encouraged the use of condoms. So when scientists discovered how HIV is transmitted in the mid-1980s, this message became even more important as a preventative measure. Realizing the need to do more to protect his troops, Colonel Dieng expanded the role of the military to include sites that specifically address the prevention of mother-to-child-transmission of HIV, provide voluntary counseling and testing, laboratory services, training centers for health professionals and psychological support. To reach more people, many of these services are brought directly into communities.

As a result, more than 85 percent of the Armed Forces have voluntarily been tested for HIV. More than 16,000 soldiers and family members, as well as 5,000 national police benefit from the services offered by the Colonel’s team. He maintains this level of care by working closely with national health officials and an international community of donors, including the US Government through the Department of Defense HIV/AIDS Prevention Program, that provide funding and technical support to the cause.

“The Colonel understands that sowing the seeds for long-term stability requires examining the root causes of instability,” says Assistant Administrator for Global Health at USAID, Dr. Ariel Pablos-Mendez. “There’s no question that poor health affects the military’s ability to protect the country. His efforts have been critical to preventing the spread of HIV.”

The Senegalese Armed Forces also operate peacekeeping missions in 15 countries across Africa, Middle East and the Caribbean. For a variety of reasons, including poor education, sexual violence or broken health systems, the rates of HIV are typically much higher in countries experiencing conflict.

The Colonel reflected on the fact that soldiers posted abroad often engage in riskier behavior because social barriers are removed; they have expendable money; and sometimes, on a cause of loneliness, they seek companionship. The information and services provided by the Colonel’s team—which are supported and reinforced by the hierarchy within the Armed Forces—increases the likelihood that Senegal can continue its peacekeeping missions with less risk to the health of troops and the people of Senegal.

“I have 10 men in a brigade on our northern border,” says Colonel Dieng, “if five of them were sick, how can we protect the border?” To drive home his point, the Colonel added, “What if 60-80 percent of the soldiers were HIV positive, how would we protect this country?”

On the road with SCMS, Part One: In Nigeria, PEPFAR partners pool procurement of life-saving commodities

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.

On a documentation tour of Nigeria earlier this month, I visited sites in four states plus the capital, Abuja, to document the progress of SCMS and find out how well the country is doing in managing its public health medicines and other supplies.  The tour was a study in contrasts: One state boasts a central medical store that is ISO Certified and has a computerized system that helps manage inventory and orders.  Nearby, a private hospital has a small, well organized and air-conditioned room dedicated to the storage of AIDS medicines.  On the other hand, in a neighboring state, the central medical store lacks even basic equipment.  Its dedicated staff, after a recent SCMS training in warehouse management, is taking a first step to improve their operations by requesting wooden pallets to reduce the risk of water damage to boxes that currently sit on the floor.

In Nigeria, a PEPFAR implementing partner picks up a shipment of HIV test kits from SCMS’s local distribution center Photo credit: David Fombot

A highlight of my trip was a visit to the warehouse in Abuja that was built with private funds to support coordinated “pooled” procurement by some 20 President’s Emergency Plan for AIDS Relief (PEPFAR) implementing partners (IPs).  Operated in a partnership between RTT, a South Africa-based company (also an SCMS team member organization), and MDS, a Nigerian company based in Lagos, the facility is a fully equipped pharmaceutical compliant warehouse.   The day I visited, the loading dock was a hub of activity.  Several IPs – Institute of Human Virology, Nigeria, Partners for Development and Vanderbilt/Friends in Global Health and AXIOS—were picking up their bi-monthly supply of HIV test kits.

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International Youth Day: Meeting the Reproductive Health Needs of Youth

I first came to D.C. in 1994, the year of the International Conference on Population and Development in Cairo, which marked a milestone in the field of population and reproductive health.  The conference set a turning point as the world agreed that population is not about numbers but about people and their rights.  It also solidified my commitment to youth, health and development which began when I served as a Peace Corps Volunteer working with youth in Ghana.  Today I am the youth advisor for USAID’s Office of Population and Reproductive Health.

Personal photo of Cate while serving as a Peace Corps Volunteer in Ghana circa 1994. Photo Credit: Cate Lane/USAID

More than half of the world’s population is under age 25.  I believe meeting the reproductive health needs for today’s young people is vital in ensuring future generations are able to lead healthy and dignified lives.  When girls are able to delay first pregnancy, they are more likely to obtain an education and end the cycle of poverty.  The United Nations proclaimed the past year commencing on August 12, 2010 as the International Year of Youth.  As the year comes to an end on International Youth Day, let us continue to stress the need for investment in programs that reach out to youth.

Listen to more of my thoughts on youth and development in this audio podcast by the Population Reference Bureau:

Involving Youth in Development Programming: Interview With Cate Lane, USAID by PopulationReferenceBureau

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