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Archives for Health

USAID @ UNGA: Championing Effective Solutions to End Malnutrition in Women and Children

Submitted by Bruce Cogill Ph.D.
Chief, USAID’s Nutrition Division

Administrator Raj Shah joined a historic gathering of the First Ladies of Africa, who convened to declare nutrition as a critical priority for eliminating poverty.

Nutrition is a top priority of both Feed the Future (FTF) and the Global Health Initiative (GHI). To reduce the growing burden of malnutrition, Dr. Shah announced $1 million to expand USAID and Global Alliance to Improve Nutrition (GAIN) efforts to improve heath and nutrition.

“These investments will help vulnerable families improve the health of their children by giving them access to diversified, quality diets and empowering them to make better informed decisions in areas like water, sanitation, and hygiene,” said Dr. Shah.  “All these combined efforts are focused on the critical 1,000 day window of opportunity from pregnancy to the first 2 years of life.”

This partnership was developed because nutrition is the catalyst for improving the lives of millions of people living in extreme poverty, and that failure to meet the nutritional needs of developing children has permanent, irreversible effects.  As the connections between health, economic development and food security become increasingly clear; nutrition is emerging as a central priority.

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USAID @ UNGA: Polio Eradication Efforts Spotlighted During Summit on Reaching the Millennium Development Goals

Submitted by Ellyn Ogden
USAID Worldwide Polio Eradication Coordinator

Today, representatives from partner countries, donors, non-governmental organizations and the private sector met on polio eradication. I represented USAID.

USAID is working closely with the United Nations (U.N) and partner countries to address this outbreak. The global polio eradication effort is at a critical point in time.  Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, the global number of polio cases has reduced by over 99 percent.  Now, polio is endemic in only four countries (India, Pakistan, Nigeria and Afghanistan) compared to 145 countries before the GPEI began.  Furthermore, GPEI’s efforts have mobilized 20 million volunteers around the world, staged mass immunization campaigns, and vaccinated about 2.5 billion children worldwide.  Cases in India and Nigeria are at their lowest ever – an indication that we can not let up on our efforts now.

Still, significant challenges remain. I just returned from an immunization effort in 34 districts of Tajikistan – a country in the midst of its first importation of wild poliovirus in 12 years and the first case in the WHO European Region since it was certified as polio free in 2002. As of September 15, 2010, there are 456 confirmed cases of polio, in Tajikistan – out of 648 total polio cases confirmed worldwide (compared to 1008 for the same time period in 2009). For each confirmed case, there are hundreds of silent infections.

While the outbreak in Tajikistan appears to have peaked, it is important to note that the outbreak is not over and continued immunization campaign and improved routine immunization are urgently necessary. Outbreak response in Tajikistan is continuing, and to minimize the risk and consequences of further international spread, National Immunization Days (NIDs) are being held in neighboring countries, including Uzbekistan, Turkmenistan, Kazakhstan and Kyrgyzstan. This week four additional cases of polio have been confirmed in the Russian Federation, bringing the total number of confirmed polio cases in Russia to 12.  The last four cases were confirmed in two regions of the North Caucasus, Chechnya (3 cases) and Dagestan (one case).  In response, the Ministry of Health and Social Development announced that they plan to launch two rounds of polio immunization campaigns in all regions of the Southern Federal District (which includes the North Caucasus) among children aged 1-5 years old in September, to be followed by nationwide polio immunization campaigns in October – April 2011. The open sharing of information about cases allows for a comprehensive and rapid response with the support of the international community and reduces the chance of further outbreaks.

To eradicate polio, we must eliminate the persistent reservoirs of this disease including insecurity, inconsistent management and ownership by local governments, sub-optimal communication and community mobilization, and reaching newborns, minority and mobile populations. Because of the need to frequently repeat campaigns, there is often a certain fatigue about seeing yet another vaccination team knocking at the door. Yet these proactive house-to-house campaigns are the only proven way to eliminate polio from a country. And with the world being so close to wiping out polio forever, we can’t afford to give up or to settle for “almost.”

The U.S. is the largest bilateral donor to the GPEI, contributing over $1.4 billion to date. Polio eradication is also a key part of the Administration’s Global Health Initiative (GHI). In 2009, President Obama announced a U.S. commitment to work with the Organization of the Islamic Conference (OIC) on polio eradication during his speech in Cairo in which he called for a new beginning between the United States and Muslims around the world. Read about USAID’s (PDF)approach to polio eradication. The new 2010-2012 GPEI Strategic Plan, recently endorsed by the World Health Assembly, requires a $2.6 billion budget through 2012, with a $1.3 billion funding gap.

COUNTDOWN TO THE MDGS: WHO Cuts Global Annual Estimate of Maternal Deaths

Submitted by Susan K. Brems Ph.D. Senior Deputy Assistant Administrator, Bureau for Global Health

The World Health Organization said Wednesday that fewer women are now dying each year from complications during pregnancy and childbirth.  A new report found that 358,000 women died during pregnancy or childbirth in 2008, mostly in poor countries of sub-Saharan Africa and South Asia. This represents a 34 percent decline from previous international estimates of greater than 500,000 maternal deaths annually.

USAID welcomed the publication of the WHO,  the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the World Bank.   USAID has been one of the largest donors with sustained investments and programming in both maternal health and family planning.

The Inter-agency methodology estimates 358,000 maternal deaths each year worldwide, close to the 343,000 deaths estimated by the Hogan et al. Institute for Health Metrics (IHME) published in the Lancet in April 2010.  Inter-agency methodology uses nationally representative data and was developed and refined by worldwide experts from UN agencies and major universities in North America and Europe.

The Inter-Agency and IHME estimates of worldwide decline in maternal mortality support USAID’s earlier analyses of DHS data that have shown declines in many countries where governments and donors, including USAID, have had continuous, focused programming on improving health systems that affect maternal care, as well as delivery of high-impact interventions, including family planning and safe delivery care, to prevent and treat the major causes of maternal mortality.

Maternal mortality is still unacceptably high. All partners need to seize the momentum and enhance family planning and maternal health programs to quickly reduce the still unacceptably high toll of preventable maternal deaths. Secretary Clinton challenged USAID to build on existing global health programs and create lasting change. We have made great strides with previous investments, but as Secretary Clinton noted, in many places a woman might be treated for HIV but die in childbirth.

With just five years left to achieve the Millennium Development Goals (MDGs), recent progress presents us with a historic opportunity to achieve lasting reductions in maternal and under-five deaths.

COUNTDOWN TO THE MDG SUMMIT: USAID’s Rajiv Shah: “We Need Results”

As featured in Ministerial Leadership Initiative’s blog

Part two of the 8-part series In the Driver’s Seat: A Series on Country Ownership of Health Programs. Dr. Rajiv Shah was sworn in as the 16th Administrator of the United States Agency for International Development (USAID) on December 31, 2009. He spoke with John Donnelly earlier this month.


Q: What does country ownership mean?

A: I think it primarily means the country owning and defining the set of priorities in terms of what they want to accomplish in the health sector. It will vary country by country and vary based on disease, and it will vary on different country governments and their prioritization of health problems. It’s fundamentally about saying in the last decade that there’s been this huge growth in global health, with a lot of the work being done by NGOs, contract partners, and foundations that sometimes operate outside the dialogue and engagement with the host country. If we are going to achieve progress at a higher level, and ensure that countries sustain these achievements, then we need to make this whole system of donor-supported global health activities fit within a country’s own set of aspirations for global health. We’ve now seen a lot of different models for countries to express their priorities. The ones I prefer are inclusive of civil society and other groups within those countries.

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COUNTDOWN TO THE MDG SUMMIT: Global Investment in Malaria Prevention Could Save 3 Million Lives Over Next Five Years

By Rear Adm. Tim Ziemer, U.S. Global Malaria Coordinator

This morning at the National Press Club, I joined the Roll Back Malaria Partnership (RBM) to launch the third report from the Progress & Impact Series “Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals”.  The report states that the lives of almost three quarters of a million children in 34 African countries are estimated to have been saved in the past 10 years through the use of insecticide treated mosquito nets, indoor residual spraying, and preventive treatment of malaria during pregnancy.  The Lives Saved Tool (or LiST model) provides the first assessment of lives saved based on the level of coverage achieved with currently available malaria prevention tools. The report estimates that an additional 3 million lives could be saved by 2015 if the world continues to increase investment in tackling the disease.

Admiral Ziemer hands out a bednet at a distribution site. Photo Credit: USAID/Global Health

The results in global malaria prevention and control are encouraging, but, as we have seen before, this progress is fragile and can be easily reversed.  As we expand and consolidate these gains, it is vitally important to ensure that our efforts not only maintain momentum, but also continue to adapt to emerging challenges such as drug and insecticide resistance. That’s why a key imperative in the United States’ Strategy for meeting the MDGs is to leverage innovation as a powerful catalyst for development.

The U.S. Government’s commitment to fight malaria is a key component of our nation’s foreign assistance strategy and the Administration’s Global Health Initiative to expand the promise of good health that is the foundation of stronger and more stable families, communities, and societies.  On behalf of the American people, the U.S. Government has taken extraordinary steps to curb the spread of this preventable and curable disease.  Working with national governments and other donors, the President’s Malaria Initiative (PMI), led by USAID and implemented together with the Centers for Disease Control and Prevention, reached more than 50 million people in the past year with highly effective malaria prevention or treatment measures in 15 focus countries in Africa.

Education + Health = Opportunity

Submitted by Wendy Coursen

This is Education Week at USAID. We work across the globe from Dhaka to Dakar; and Kabul to Kinshasa to promote development and save lives by helping people and societies recover from disaster, escape poverty, and improve health and education.  All efforts are conducted on behalf of the American people – reflecting the care and generosity of our nation that people across the globe admire and respect.

Throughout our nearly 50-year history, USAID has developed robust education programs that have increased literacy, built local capacity to deliver basic education services, encouraged workforce development, and developed generations of leaders through scholarships and access to higher education. On a fundamental level, education empowers societies: It leads to opportunities for economic growth, promotes civic engagement and good governance, and supports (PDF)sustainable democracy.  In the development community, we often say the same about the benefits of ; in fact, education and health not only complement, but depend on each other for maximum impact.

Community Health Worker

A community health worker in Nemba, Rwanda, teaches a health education class to women. USAID, with partner Jhpiego, has trained 800 community health workers in Rwanda. Credit: Jhpeigo

For disease prevention and treatment, the communities we serve often need access to commodities like bed nets , antiretroviral drugs, and safe water.  They also need the tools and access to information about critical health concerns and what to do about them. Women who participate in literacy programs have better knowledge of health and family planning and are more likely to adopt preventive health measures or seek medical help for themselves and their children. Family planning also enables women to stay in school longer, which contributes to improved maternal and child survival and increased ability for parents to raise healthy, well-nourished children.  Healthy children, we know, are more likely to learn, more likely to thrive throughout their lives and contribute to their communities as adults.  Early and sustained investments in health and education – for men, women, and children — are truly investments for life.

In the late 1990s, USAID was instrumental in bringing the educational children’s series Sesame Street to South Africa. The country has been significantly impacted by the HIV/AIDS epidemic, and in 2002, the show introduced Kami, the world’s first HIV-positive Muppet. Through Kami, age-appropriate HIV/AIDS messages reach millions of children, parents, caregivers, and educators. Her message is also helping to reduce the fear of stigma that prevents many from seeking treatment.

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USAID-World Bank Debate Series Opens Important Dialogue on HIV Prevention in Africa

Submitted by: Bureau for Global Health

Do discordant couples, or those in which only one partner is HIV-positive, really contribute a majority of new HIV infections?  Should interventions to address discordant couples receive a majority of funding? As the global response to HIV and AIDS evolves, fostering an open dialogue about what approaches work best is essential to mounting an effective response to the global pandemic. To achieve this, the Office of HIV/AIDS at USAID and the World Bank’s Global HIV/AIDS Program are co-sponsoring a debate series to examine emerging and sometimes controversial issues in HIV prevention. The latest debate, held August 26, at the World Bank headquarters in D.C. with webcast participants from over 20 countries, examined the role of HIV counseling and testing among couples in which only one of the two partners has HIV.

Drs. Susan Allen and Elizabeth Marum presented several sets of data to support the proposition. According to Dr. Allen’s work in Rwanda and Zambia, a majority of new infections were the result of transmission within co-habiting or married couples. Drs. Allen and Marum additionally argued that couples testing and counseling was an evidence-based and cost-effective intervention, which should be scaled up to prevent large numbers of new infections.

On the contrary, Drs. Gray and Halperin provided data opposing the proposition. For instance, in Rakai, Uganda, intra couple transmission within known HIV discordant couples contributed approximately 30 percent of new infections.  Among other arguments, Dr. Halperin stated that a majority of new infections cannot logically emerge from long-term stable couples in countries where marriage and cohabitation rates are low.  Drs. Gray and Halperin concluded that a majority of new infections emerge from multiple and concurrent partnering practices and therefore that a majority of prevention funding should not be utilized for addressing sero-discordance among long-term stable partnerships.

These and other points of views made for a lively discussion that will hopefully improve our understanding about what drives HIV epidemics in Southern Africa.

Save the date of October 18, 2010, for the fourth debate in this series that will examine concurrent sexual partnerships.

Visit the Office of HIV/AIDS AIDSTAR-One HIV Prevention Knowledge Base to access resources about HIV Prevention for Serodiscordant Couples drawing on epidemiologic and demographic data.

Saving Mothers and Newborns in Afghanistan

Submitted by the USAID Maternal and Child Health Integrated Project (MCHIP)

Every 27 minutes, a woman in Afghanistan dies from complications due to pregnancy or birth. Across the country, midwives are the frontline health care providers working day and night to save these women. Educated with USAID support, Sadiqa Husseini, 24, is among the more than 2,000 new midwives who are helping to significantly reduce Afghanistan’s maternal mortality rate, which is among the highest in the world. Sadiqa was featured in a recent BBC audio slideshow on a day in the life of an Afghan midwife. The piece is a moving portrayal that demonstrates how USAID contributes to empowering women, rebuilding essential networks of skilled health care providers, improving health care services for women and families, reducing deaths of mothers and newborns, and strengthening communities.

Sadiqa had wanted to become a midwife ever since her sister nearly bled to death giving birth to her first child. At the time, Sadiqa and other family members relied on traditional means and home remedies to try to stop the bleeding. Ultimately, Sadiqa’s sister had to be taken to a hospital some 20 kilometers away. She and her newborn daughter survived, but Sadiqa’s sister never fully recovered and had no more children. The experience had a profound impact on Sadiqa.

“When I saw this happen in my own family, I wanted to become a midwife,” Sadiqa said. “I didn’t want other women to suffer like my sister and her family.”

Najiba Fazzay, a 35-year-old Community Health Worker (far right), gives a talk on maternal health care to expectant mothers in the village of Aquachanoy near Jawjzan, Afghanistan. USAID-funded programs have helped train 8,500 community health workers in Afghanistan. CREDIT: Jhpiego

USAID’s Health Services Support Project, in partnership with the Afghan Ministry of Health, allowed Sadiqa to realize her ambition. Through the project, accredited midwifery schools have been established in nearly every province of Afghanistan. These schools, assisted by USAID with partner organization Jhpiego, provide essential training for midwives like Sadiqa, helping increase the number of trained midwives to more than 2,000 (from about 450) since the fall of the Taliban.

Local health committees are involved in identifying and selecting candidates, a unique aspect of the program that builds support for midwives who return to their communities to work. Villages and communities have directly benefited from the increase in midwives: The number of Afghan health centers that are staffed with more than one midwife has increased from 10 percent (2002) to 61 percent (2009) since USAID began focusing on maternal and child health in Afghanistan in 2003.

The success of USAID-funded projects in Afghanistan has also led to the training of 8,500 community health workers and the formation of a professional midwife’s association, which includes 1,600 members. The impact of this expanded force of maternal health specialists is reflected in the increasing number of Afghan women who give birth with skilled care, a key intervention to reducing maternal and newborn deaths. According to the most recently available data, deliveries assisted by a skilled birth attendant in Afghanistan increased from 8 percent in 2003 to 19 percent in 2006.

USAID Strengthens Malaria Control Efforts in Africa

Submitted by Elissa Jensen

Thanks to a little teamwork, efforts toward sustainable malaria control in Africa just received a boost.  Indoor residual spraying (IRS), a mainstay of malaria eradication efforts for decades, has typically involved oversight by health specialists trained in IRS application.  But the intervention also requires input from environmental experts, who have historically been overlooked in IRS operations.

This summer, with USAID support under the President’s Malaria Initiative (PMI), environmental experts from across Africa participated in a workshop in Kisumu, Kenya, to review and refine best practices to support health teams in providing oversight and management of IRS.  The workshop was the first of its kind to introduce such an integrated approach.

In addition to discussing the development of environmental assessments and proper waste disposal, participants addressed the challenges associated with proper implementation of IRS considering real-life constraints, such as scarcity of water and lack of infrastructure.

With their training, participants will increasingly work alongside counterparts from the health sector to provide oversight of environmental components of IRS operations, thereby strengthening local and regional capacity for sustainable malaria control.  Soon after the workshop, in fact, two of the participants conducted environmental inspections and provided technical assistance in new spray areas in Zambia and Ethiopia.

USAID is proud to contribute to PMI, which has provided IRS to nearly 7 million houses and protected 27 million people through spray campaigns since 2006.

Delivering Hope: One Pill At a Time

Submitted by: Jessica DiRocco

It’s shocking what two little pills can do for someone living with HIV/AIDS. Antiretroviral (ARV) drugs have been a lifesaving advance in the treatment of HIV/AIDS because they limit the virus’ power to weaken the immune system. A stronger immune system means stronger individuals. Instead of sickness and immediate death, HIV becomes a manageable disease. Mothers can continue to take care of their children, husbands can continue to support their families, and children can continue to attend school. All because of two little pills. The USG, through PEPFAR, has already put almost 2.5 million people on treatment worldwide, with plans to support four million people by 2015.

To assist in reaching this goal, USAID focuses on activities that directly and indirectly support the provision of antiretroviral therapy. USAID’s comprehensive AntiRetroViral program includes: increasing access to ARVs and other medications, improving the physical infrastructure of laboratories and facilities, ensuring a consistent supply of quality drugs and commodities, building the personal capacity for health care workers to manage antiretroviral therapy programs, nutritional supplementation programs, and provide psychosocial support of patients before and throughout treatment.

The transformation of most of the people on ARVs is nothing short of amazing. After only a couple moths of ARV treatment, many individuals who were bedridden and facing death, became strong advocates armed with huge smiles and their powerful stories. In fact, several studies have begun to support the idea that people living with HIV may achieve near-normal life-expectancies through the simple act of taking their ARV drugs every day.

These remarkable results have been captured over the years through words, photos, and videos.

In 2007, the Global Fund teamed with Magnum Photos to create Access to Life– a series of photo essays which documented the impact of antiretroviral treatment on the lives of individuals around the world.

Just this year, (RED) worked with HBO to create The Lazarus Effect, a film which illustrates the transformative effect of ARV treatment through the stories of HIV-positive individuals in Zambia. USAID staff received a special screening of the film only a short time after it premiered on HBO, with representatives from (RED) present to show their support of USAID and PEPFAR work.

Most recently, the Topsy Foundation, which receives funding from Right to Care, a USAID and PEPFAR partner based in South Africa, created a short video on Selinah, a woman living with AIDS in South Africa, who experienced the disease effects of the disease being reversed over a three month period with the help of ARVs. The Topsy Foundation even won the Cannes Gold Lion award for the video at the 57th Cannes Lions International Advertising Festival.

USAID stays committed to the goals of PEPFAR and the Global Health Initiative to put more than four million people on treatment. USAID programs will continue to work so people like Selinah can maintain a healthy life.

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