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More Community Health Workers Needed for a Healthier World

Editor’s note: This blog originally appeared as a longer article on the Wilton Park conference website.


We live in extraordinary times.

In 1960, more than 22 percent of all children in developing countries — one out of every five — died before the age of 5. Today, we are within reach of ending preventable child deaths

Across developing countries, when compared with 50 years ago, people are living longer, more people are educated, there are fewer wars, and there is an unprecedented drop in both the number and rates of people living in extreme poverty.

At the same time, Ebola and Zika are drastic reminders of our human frailty and the need for vigilance and responsiveness — in all countries, and at all levels of care, down to every community, every family. The survival and safety of the women and children of the world require us to find ways to link families and communities to the knowledge, behaviors and treatments that can help them survive, thrive and transform the world they live in.

Enter community health workers. For years, they have been vital in strengthening maternal and child health, preventing the spread of infectious diseases, and promoting sanitary behaviors. They will play a critical role in helping us achieve the Sustainable Development Goals.

Community health workers play an important role in USAID’s efforts to end preventable child and maternal deaths. / MCHIP/MCSP

Community health workers play an important role in USAID’s efforts to end preventable child and maternal deaths. / MCHIP/MCSP

Unlocking the potential of community health workers

Seeking to unlock the potential of community health workforces in post-Ebola Africa, 50 development practitioners, thinkers, experts and funders gathered two weeks ago in Wilton Park in England. Ministry and NGO practitioners presented models developed and being improved in several countries.

Three thoughts emerge:

  • Inspiring models of community health workforces already exist – which smart, experienced people are striving to make even better through policy improvements, strengthening supervision, leveraging technology and introducing long-term domestic financing.
  • There is not yet a simple, systematic way of sharing good practices across countries; we need to be able to compare solutions that could be replicated and scaled faster, smarter or more affordably.
  • We have not yet cracked the nut of financing. There is an urgent need for national governments and development partners to substantially increase investment in community health workers as part of integrated health care systems. We need financing solutions to be shared, adopted and adapted, as well as spur thinking on new ones.

A framework for community health

My colleagues and I shared the first version of a Community Health Framework with participants to jumpstart a “common language” on community health.

This first framework highlights some laudable models and tools; it’s simple to navigate and understand. It acts as an interactive learning tool to help practitioners and ministries better appreciate why we should care about community health, how to approach community health, and where to find successful examples.

The framework also offers a way of acting in a common ecosystem. In order to be successful, any country — whatever its circumstances — should follow a five-step process: identify target health outcomes, understand the existing system, analyze barriers, develop or strengthen programs and ensure oversight, monitoring and evaluation.

We urge our colleagues to consider leveraging this common language in their own work, so we can begin to find commonalities and ways to better scale and replicate.

In Senegal, community health workers provide essential services at local health posts and promote healthy activities within their communities. / Jane Silcock, USAID

In Senegal, community health workers provide essential services at local health posts and promote healthy activities within their communities. / Jane Silcock, USAID

It’s a time to be bold

This was the warning we heard at Wilton Park: “The acute crisis of Ebola may be over, but sustained crisis and emergency still exist.”

We cannot afford not to invest in community health workforce development. Strong political will and leadership, smart investment and coordinated planning are just a few of the critical components. The private sector has much to offer — both in terms of investment and bringing strong business models for sustainable solutions.

This is the time to be bold and to be practical. Two weeks ago, we set out broad principles to achieve strong community health workforce development. As we closed the conference, I felt inspired by the commitment and passion shared by those in the room

As one of our colleagues said, “It is not easy; it requires collaboration and determination, but we know what needs to be done — now let’s go and do it.”

ABOUT THE AUTHOR

Katie Taylor is USAID’s Child and Maternal Survival Coordinator and Deputy Assistant Administrator in the Bureau for Global Health.

Innovative HIV-Prevention Product for Women Could Be New Tool in the Fight for an AIDS-Free Gen

Ending the HIV/AIDS epidemic can only be achieved with multiple prevention options that meet women’s needs and fit within the context of their lives./Kate Holt/Africa Practice

Ending the HIV/AIDS epidemic can only be achieved with multiple prevention options that meet women’s needs and fit within the context of their lives./Kate Holt/Africa Practice

HIV/AIDS is the leading cause of death worldwide for women of reproductive age.

Even with marked improvements in HIV treatment, women — especially those ages 15-24 — continue to be at a disproportionately high risk of HIV infection throughout Africa. In fact, in some parts of Africa, young women are more than four times more likely than men to become infected with HIV.

There are structural drivers that directly and indirectly increase women’s HIV risk, including poverty, gender inequality, sexual violence and a lack of education. Many women face unequal access to reproductive health services, including HIV/AIDS education, diagnostic services and treatment programs, putting them at an increased risk of contracting HIV.

Gender norms can also discourage women from asserting control over the timing and circumstances of sex, including negotiating protection against HIV using common prevention methods, such as condoms.

Women need HIV-prevention options that are discreet, do not need their partner’s agreement to use, and that are easy to access and convenient to use.

The Ring Study findings may give new hope to women who need diverse options to protect themselves from HIV and AIDS./ Matthew Willman/Oxfam, Courtesy of Photoshare

The Ring Study findings may give new hope to women who need diverse options to protect themselves from HIV and AIDS./ Matthew Willman/Oxfam, Courtesy of Photoshare

Results released today at the Conference on Retroviruses and Opportunistic Infections in Boston show we are one step closer to having a new prevention tool exclusively for women that fits within the context of their lives.

Through the United States President’s Emergency Plan for AIDS Relief, USAID has invested $25 million in an innovative research trial known as the Ring Study, which was led by the International Partnership for Microbicides.

The Ring Study looked at women’s use of a simple vaginal ring, which is prescribed by a doctor and self-inserted to provide 30 days of continuous, sustained release of the antiretroviral dapivirine. The study found the dapivirine ring helped protect against HIV during vaginal sex among women ages 18 and older.

The monthly dapivirine ring is a longer-acting HIV prevention method specifically designed for women, who bear the greatest burden of the global HIV/AIDS epidemic./ Molly Snell, Courtesy of Photoshare

The monthly dapivirine ring is a longer-acting HIV prevention method specifically designed for women, who bear the greatest burden of the global HIV/AIDS epidemic./ Molly Snell, Courtesy of Photoshare

The Ring Study showed that the monthly dapivirine ring safely reduced HIV infection overall by 31 percent compared to a placebo. Similar results were seen in a sister study, known as ASPIRE. ASPIRE found that the ring safely reduced infection by 27 percent overall. This is the first time that two large clinical trials have yielded statistically significant results in finding that a microbicide can protect against HIV infection.

However, we must recognize that these results are only the starting point for further research. Despite both the Ring and ASPIRE studies showing a statistically significant protective effect against HIV, the dapivirine ring did not reduce infection quite as much as researchers had hoped. While disappointing, we should see this as an opportunity to gain more information in order to create a more effective HIV-prevention product.

To do this, researchers need to look closely at the information collected during the study to figure out why there wasn’t a bigger effect: Was the dapivirine ring itself not as effective in the women in the study? Were women not able to use the product consistently? So far, we know that women who used the ring more had a lower chance of becoming infected with HIV, but we need more information to say for certain.

It is particularly important to understand the influence of consistent use of the dapivirine ring on the study results for younger women. If we look at the Ring Study results broken down by age, women 18-21 years had only a 15 percent reduction in infection, while women older than 21 had a 37 percent reduction.

If younger women, who are at the highest risk of infection, are not able to use the dapivirine ring consistently, we need to understand why and look at whether different marketing, education or additional interventions could improve use and, as a result, decrease their risk of infection.

While the Ring Study’s results have raised many new and important questions, ultimately, the dapivirine ring is the first longer-acting and discreet female-controlled HIV prevention method that has been shown to safely offer protection.

Innovative prevention methods like the dapivirine ring could offer an important additional prevention tool for women unable or unwilling to use other strategies.

If we hope to achieve an AIDS-free generation by 2030, we must continue to invest in products that empower women across the world to protect themselves from HIV.

ABOUT THE AUTHOR

Elizabeth Russell PhD, MSc, is a Senior Advisor for Biomedical Prevention Technologies in the Research Division of the Office of HIV/AIDS. She provides technical assistance for pre-clinical and clinical research projects supported by USAID for new microbicide products.

When The Sweet Potato Goes Viral: A New Approach to Nutrition Programming in Northern Ghana

Women prepare a highly nutritious meal from the orange-fleshed sweet potato, a vitamin A-rich crop introduced in Northern Ghana. / USAID/Ghana

Women prepare a highly nutritious meal from the orange-fleshed sweet potato, a vitamin A-rich crop introduced in Northern Ghana. / USAID/Ghana

Before last year’s harvest, most people living in the northern region of Ghana had never seen an orange-fleshed sweet potato. Now, this brightly colored vegetable may be on its way to becoming the region’s most popular crop.

This variety of potato was recently introduced to communities in Northern Ghana through a USAID project to counter Vitamin A deficiency — a condition that compromises the immune system and can lead to blindness. Last year, 439 women in 17 districts learned how to cultivate orange-fleshed sweet potatoes for the first time.

The villagers lovingly call the new crop Alafie Wuljo,” which means “healthy potato” in the local language of Dagbani. At one community’s first harvest celebration, the head of the project Philippe LeMay recalls how government officials and community leaders came to learn how to use the new crop in the kitchen.

Project beneficiaries, like the couple above, have benefited from a multi-sectoral approach that includes providing agricultural and nutritional training, providing animals for farm use, improving WASH infrastructure, introducing farmers to markets, and more. / USAID/Ghana

Project beneficiaries, like the couple above, have benefited from a multi-sectoral approach that includes providing agricultural and nutritional training, providing animals for farm use, improving WASH infrastructure, introducing farmers to markets, and more. / USAID/Ghana

There were several cooking demonstrations, but the sweet potato fries were a hit among schoolchildren. “Now everyone wants to grow orange-fleshed sweet potatoes,” said LeMay.

But encouraging farmers to plant nutritious crops is just one of several strategies employed by this project to address malnutrition in northern Ghana. Besides agriculture, we are also working on improving livelihoods; governance; nutrition; and water, sanitation and hygiene (WASH). These sectors are interrelated and help to achieve common goals.

The project introduces new and more nutritious crops to farmers and helps them boost yields through improved farming techniques. It also links farmers to markets, helps community members create village savings and loans associations, works to improve water and sanitation infrastructure, and promotes better hygiene.

Ghana is one of the first countries to put USAID’s Multi-Sectoral Nutrition Strategy into action. The fresh approach, which will guide our work through 2025, cuts across several development areas, resulting in programs that are more cost-effective and deliver greater impact around the world.

The strength of USAID programs in more than 100 countries provides a large delivery platform for scaling up nutrition services. Just scaling up nutrition-specific interventions to 90 percent coverage will generate a ratio in which every dollar invested yields a $16 rate of return.

At a regional Global Learning and Evidence Exchange workshop in Accra, Ghana last month, project representatives shared their experiences, explaining how they overcame the challenges of coordinating across different development sectors. In some countries, technical offices such as agriculture, nutrition and WASH aren’t used to working together. LeMay thinks the transition went smoothly in Ghana in part because the various technical offices are housed within the same government structure.

The northern region of Ghana has developed at a much slower pace than the rest of the country because of its remote location, limited resources, sparse population and inhospitable climate. More than a third of children under 5 in these districts suffer from stunted growth, a result of poor nutrition.

With this project — implemented by the Government of Ghana with technical support from Global Communities — we aim to reach about 300,000 people by targeting the region’s most vulnerable population — women of reproductive age with at least one child under 5 in households identified by their communities as the poorest of the poor. The project is supporting Feed the Future’s goals of decreasing child stunting by 20 percent and doubling the incomes of vulnerable households in the north.

A woman grows leafy green vegetables for consumption with resource-conserving and yield-boosting techniques introduced by a USAID project. /USAID/Ghana

A woman grows leafy green vegetables for consumption with resource-conserving and yield-boosting techniques introduced by a USAID project. /USAID/Ghana

Through an innovative government-to-government approach, USAID and local government officials from the Northern Regional Coordinating Council are working together to plan how best to respond to the needs of the most vulnerable households.

To build the capacity of local governments to implement these plans, the project provides training, technical assistance and tools. Notably, this is one of only a handful of USAID efforts that engage governments at the sub-regional levels to support local solutions.

The result has been more capable and responsive local governments. “We have been proud to see how the Government of Ghana has demonstrated leadership and initiative in taking additional steps to promote this work for the long term,” said USAID/Ghana Mission Director Andrew Karas.

District Assemblies participating in the USAID project have organized trainings to communities, teaching them the importance of  building latrines to their health. The latrines keep water clean, preventing diseases like diarrhea that lead to undernutrition.

“My children and I used to defecate outside because we did not have a toilet in our home,” said 31-year-old Ama Nuzaara, who lives in West Gonja District. After several latrines were built by community members, people started to connect the dots.

“I now understand the links between poor sanitation, diarrheal diseases and nutrition,” says Nuzaara. “I also make sure that my children wash their hands with soap and water after they use the toilet. I do this for my family’s health and well being.”

Karas said that this multi-sectoral collaboration is already paying dividends. “We have repaired dozens of boreholes [holes through which people can access uncontaminated water] and established community water and sanitation committees. We are training farmers to grow new, more nutritious vegetables and helping women access markets and boost their incomes.”

Each of the project’s integrated activities increases the resilience of vulnerable people to the inevitable shocks inherent to living in northern Ghana. “The multi-sectoral approach amplifies the effectiveness of [the project’s] activities,” says Yunus Abdulai, another project official.

By strengthening local capacity, the project is working to build sustainability across all sectors of development.

ABOUT THE AUTHOR

Lindsey Spanner is the communications point of contact for the USAID Nutrition Team at the Global Health Bureau in Washington, DC. Celia Zeilberger is the Senior Development Outreach and Communications Specialist at the USAID Mission in Ghana.

Sharing the Land: Using Mapping Technology to Resolve Disputes

In my country, the Democratic Republic of the Congo, land is the lifeblood of the population: It nourishes people, allowing them to prosper and grow. However, ineffective management of this land has also led to conflict and violence.

Today’s technologies offer an opportunity for citizens to be better tenants of the land.

As the project manager for the Sharing the Land initiative, I work with a team to help local communities improve the way they manage land ownership and address disputes. GPS data gathered from satellites is one tool that we’ve introduced to solve land-based conflicts. We also use household surveys to gather information on conflict, a family’s assets or demographics.

Once the team has plotted this information on interactive maps using Geographic Information Systems (GIS), anyone with internet access can visualize and better understand land ownership in the city of Beni in North Kivu province. Our goal is to have these interactive maps up and running from both a public website and the Christian Bilingual University of Congo library.

The city of Beni in North Kivu, Democratic Republic of the Congo. / Christina Mukongoma

The city of Beni in North Kivu, Democratic Republic of the Congo. / Christina Mukongoma

The Makings of Conflict

Land conflict has a long history in eastern Congo. In the late 19th century, King Leopold of Belgium’s tyrannous rule disregarded the authority of existing leaders and claimed vacant land for his own use, laying the foundation for the development of two overlapping systems of land management. Even after his reign, tension remained between land controlled by customary authorities and land controlled by the state, which only grew worse in the early 1970s when new land laws were introduced.

To this day, this issue has never been fully resolved. Weak laws and poor land management continue to hinder economic development and urban planning in my city, Beni.

Growing up in Ituri in the Orientale province of northeast Congo, my family and I experienced inexplicable torture. The summary execution of civilians, the abuse of human rights, and the destruction of property by armed groups divided my city.

Knowing this violence in my community was preventable inspired me to take action. As a student at the Christian Bilingual University of Congo, I found others who were seeking community-based solutions to conflict.

Sharing the Land Project Manager Archip Lobo (far right) with team member Ali (center) in Beni, Democratic Republic of the Congo. / Christina Mukongoma

Sharing the Land Project Manager Archip Lobo (far right) with team member Ali (center) in Beni, Democratic Republic of the Congo. / Christina Mukongoma

The Start of Something Good

In 2014, several protests over existing land management practices in Beni prompted my university’s Integrated Research Institute to learn more about land conflict in the city. Together, we began to plan.

First, we came up with the idea of using GIS software to map land parcels, creating layers to track the differences in state ownership and historical ownership. The immediate benefit of this would be twofold: It would help clarify the land purchasing process, while also giving the land authority a better platform for managing land ownership data.

Before we could put our plan into action, the Sharing the Land project needed support. Our team won a Transformative Solutions Grant from the Center on Conflict and Development (ConDev) at Texas A&M University last year, financing the first phase of our land mapping initiative.

ConDev is part of the U.S. Global Development Lab’s Higher Education Solutions Network, which unites seven universities applying science, technology and innovation to address development needs.

Our partnership with ConDev has helped us collect information from both high-tech sources and community members. We first tried using an unmanned aerial vehicle to capture high-resolution aerial imagery, but later switched to a method using GIS and GPS technology, community organizing, and networking to create a base map of Beni.

We also gathered land ownership information from the records of the customary chiefs and state technical services, as well as through household surveys we conducted with landowners and tenants in the Masiani neighborhood.

Using QGIS and ArcGIS software, we’re not only mapping roads, streams and buildings but also conducting advanced data analysis that incorporates demographic and household information from the surrounding area.

A Sharing the Land team member uses a GPS device to collect data points for mapping Beni’s Masiani neighborhood. / Christina Mukongoma

A Sharing the Land team member uses a GPS device to collect data points for mapping Beni’s Masiani neighborhood. / Christina Mukongoma

To successfully change land management, we are sharing our data with policy makers, mediators, and the public to help resolve arguments over land and prevent future conflicts.

A series of workshops and radio programs that we hosted last spring brought together community leaders, government-associated technical professionals, civil society organization representatives, lawyers and young people. We formed focus groups to better understand the causes and consequences of land conflict.

Support from ConDev and USAID set us on the path to achieving our ultimate goal:  formalizing our database and becoming the go-to resource for land information in eastern Congo.

To date we have mapped a total of 531 land parcels and documented 29 cases of conflict in our database, but our work is not yet finished.

In early 2016, we plan to partner with UN-Habitat to provide land administration training to government officials in North Kivu, South Kivu and Orientale provinces in an effort to strengthen urban planning.

I hope that these future leaders of the DRC will not become bad managers of the state, or agents of further violence and crime in our communities, but rather agents of change.

Sharing the Land Project Manager Archip Lobo (second from left) poses with other Integrated Research Institute members. / Christina Mukongoma

Sharing the Land Project Manager Archip Lobo (second from left) poses with other Integrated Research Institute members. / Christina Mukongoma

ABOUT THE AUTHOR

Archip Lobo is the project manager for Sharing the Land. He graduated from the Christian Bilingual University of Congo in 2014, where he worked on research to better understand problems in the community and propose solutions.

Healthy Beginnings: New Evidence Cites Breastfeeding’s Health Benefits for Moms, Babies and Economies

A new mother at the Karambo Health Center in Rwanda breastfeeds her newborn baby. Immediate breastfeeding after delivery helps prevent diseases and malnutrition in newborns. / Amy Fowler, USAID

A new mother at the Karambo Health Center in Rwanda breastfeeds her newborn baby. Immediate breastfeeding after delivery helps prevent diseases and malnutrition in newborns. / Amy Fowler, USAID

When it comes to the health of the world’s most vulnerable mothers and children, supporting the practice of a few simple behaviors can be just as beneficial as the most high-tech innovations.

Handwashing with soap helps prevent the spread of communicable diseases. Skin-to-skin contact between mothers and premature babies keeps preemies warm and helps regulate their breathing and heart rate. Having a skilled birth attendant deliver the babies of pregnant women significantly decreases the risk of mortality for both the moms and their babies.

Each of these behaviors has been shown to improve mothers’ and newborns’ health and wellbeing, without requiring new technologies or significant funds.

And new evidence shows one of the most effective of these behaviors is breastfeeding.

In a series published today in The Lancet journal, researchers cite compelling evidence of the benefits afforded by optimal breastfeeding practices, both health-related and economic, for women and children in high- and low-income countries alike.

At USAID, we have already begun to act on the evidence. We concentrate our maternal and child health efforts in 24 priority countries that together account for 70 percent of the world’s maternal and child deaths, and we employ a data-driven approach to maximize our impact through the most effective interventions available.

We’ve identified breastfeeding as one of 10 “Accelerator Behaviors” — the key feature of USAID’s Accelerate project, begun last year to expand the ability of stakeholders in those priority countries to implement high-quality behavioral programming.

And in our Multi-Sectoral Nutrition Strategy, we recommend early initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months, and continued breastfeeding for two years or longer.

This mother in Bakapome, Senegal, a rural village near Thies, knows that breastfeeding doesn’t just benefit infants: it also reduces the risks for breast and ovarian cancers in women. / Jane Silcock, USAID

This mother in Bakapome, Senegal, a rural village near Thies, knows that breastfeeding doesn’t just benefit infants: it also reduces the risks for breast and ovarian cancers in women. / Jane Silcock, USAID

The health benefits are significant. Higher rates of breastfeeding could save more than 820,000 lives — 87 percent of them infants — in low- and middle-income countries each year.

Breastfeeding is also associated with a reduced risk of breast and ovarian cancers for women. At current breastfeeding rates, 20,000 maternal deaths are averted annually. Improved breastfeeding practices could prevent another 20,000 each year.

The new Lancet series also highlights the economic benefits of increasing the number of women who breastfeed. Currently, the cognitive losses associated with not breastfeeding amount to $302 billion globally — including more than $70 billion lost in low- and middle-income countries and $230 billion in high-income countries.

Even a 10 percent increase in breastfeeding rates would translate into hundreds of millions of dollars in healthcare savings through reduced child and maternal mortality and morbidity.

The evidence speaks for itself: Supporting women to practice optimal breastfeeding is a health intervention that we cannot afford to ignore.

USAID is working with national governments, NGOs, the private sector and civil society organizations to generate data and provide insights into the impact that social and behavior change programs can have on saving lives. We work with our partners to then use that data to design and apply effective and innovative behavioral programming.

Throughout the process, we track and measure our programs’ successes and persistent barriers, and provide technical assistance and share lessons across our network of partners — contributing to our goal to reach 38 million women with improved health services by 2020.

When it comes to interventions such as breastfeeding, collecting evidence is a necessary first step. But we must then act on our findings, incorporating the evidence across all levels of our health programs — from the policies of national governments to the daily routines of individual households.

The USAID-funded Suaahara project in Nepal engages young mothers as well as fathers and other men in the family to ensure supportive environments for healthy behaviors, such as breastfeeding, to promote the wellbeing of women and children. / Suaahara Project

The USAID-funded Suaahara project in Nepal engages young mothers as well as fathers and other men in the family to ensure supportive environments for healthy behaviors, such as breastfeeding, to promote the wellbeing of women and children. / Suaahara Project

In Nepal, for instance, USAID began implementing an integrated approach to nutrition in 2012, incorporating community education and personal counseling. Since then, rates of exclusive breastfeeding for the first six months have increased from 46 percent to 69 percent.

The Lancet’s series bolsters our behavior change work and solidifies the evidence base for including breastfeeding as an Accelerator Behavior.

I am encouraged by the successes that USAID has already seen in using these evidence-based approaches to save children’s and mothers’ lives.

Most of all, I am excited about our past, present and future progress towards maternal, newborn, child and adolescent health worldwide, as support for breastfeeding and other lifesaving interventions continues to grow in the global community.

ABOUT THE AUTHOR

Elizabeth Fox is the Director of the Office of Health, Infectious Diseases and Nutrition in USAID’s Bureau for Global Health.

Young Entrepreneurs Develop Startups in Serbia

The room was full of energy and promise. Huddled around computers, young adults worked in teams in a bright, open-concept, collaborative environment resembling a startup, creating innovative apps and IT platforms.

This is Serbia’s ICT Hub, a business incubator in Belgrade for information and communications technology (ICT) entrepreneurs.

Last fall, I visited the ICT Hub — a partner project of USAID, DNA Communications and Orion Telekom – to learn more about economic opportunities for young adults in Serbia, a country where the unemployment rate for this population is about 50 percent.  However, jobs in ICT are growing for people entering the workforce.

So far, over 60 young Serbians have participated in the ICT Hub’s intensive training for developing entrepreneurship skills and business strategies, and many more have engaged in monthly lectures open to the general public on strategy, leadership and tech entrepreneurship.

The ICT Hub provides a space available 24/7 where teams can collaborate, receive mentorship support from local business executives, have access to business and legal resources, and develop programs and applications specific to the IT sector.

As a young communications professional and an ICT aficionado, I was delighted to discover a general sentiment of optimism and hope when I spoke to my fellow ICT-enthusiast peers at the Hub about their various apps and innovations.

First, I met ICT Hub Project Director Kosta Andrić, who emphasized that the goal of the Hub is to build the potential for tech entrepreneurship while changing the mindset of young adults and the work culture within the country.

Young adults who first come to the Hub often fear failure, but through the program, they learn to take chances and innovate. Not all ideas and products may succeed, but the skills developed through the hub are transferrable to future ventures.

Kosta introduced me Milan Brindić, 26, co-creator of Bincode Entertainment, a gaming studio that produces mobile games. Milan enrolled in the ICT Hub’s program after an initial investment from a Bulgarian accelerator, a business incubator that provided mentorship and support for his startup. His team now has a space to work on the game as well as support from the hub’s extensive network of contacts, and a pathway for fulfilling his dream of publishing his game.

“Life in Serbia is hard for a young person … but, despite that, every person must follow his dream,” Milan said.  “The ICT Hub is very useful to me and helps me the most with networking…every tenant helps each other, so we are like family.”

Integrating communication and technology, Milan’s passion for gaming has a regional twist; his role-playing mobile game apps are based on Slavic mythology.

“We are inspired by all the other great role-play games in the world,” he said. “Each team member is in love with this genre of games. But one important fact — everyone knows what Greek mythology is, but we are inspired by Slavic mythology, and we want to educate our players about Slavic mythology and about Slavs.”

Milan Brindić, 26, co-creator of Bincode Entertainment, collaborates with team members at the ICT Hub. / Laura Jagla, USAID

Milan Brindić, 26, co-creator of Bincode Entertainment, collaborates with team members at the ICT Hub. / Laura Jagla, USAID

A creative path for many

Since the ICT Hub opened in fall 2014, several products developed have been quite successful. Some participants have created mobile games, such as extreme sports game Longboard Mapp, which has more than 15,000 users. ICT Hub participant Vuk Nikolić, creator of TruckTrack, a management software for the trucking industry, was connected to U.S. venture capital seed fund 500 Startups, which invested money and expertise in Nikolić’s software and team. Now, TruckTrack’s team has expanded, and the platform has over 2,000 companies registered.

Other teams are just getting their start, though they are enthusiastic about their potential. Nemanja Stefanovic, 25, creator of HireApp – an application connecting youth and others with part-time jobs – remarked that the creative space and mentorship offered by the hub contributed to his success

HireApp creator Nemanja Stefanovic and team member (left). New ICT Hub participants Vanja Belić, Stevan Janković, and Vuk Spplajković (right). / Laura Jagla, USAID

HireApp creator Nemanja Stefanovic and team member (left). New ICT Hub participants Vanja Belić, Stevan Janković, and Vuk Spplajković (right). / Laura Jagla, USAID

Investing in the future

The next ICT Hub session of pitching to potential investors will take place this spring. Hope lingered in the air as participants worked in a flurry to innovate.

After meeting with the young entrepreneurs at the Hub, I can summarize the experience in one word: possibilities.

In the words of Milan Brindić, “In the next five to 10 years, I see myself running a gaming company in San Francisco, focused on game design and experience. I am making awesome games… So, my dream is… I don’t have any dream, I am living it already!”

ICT Hub is a model that could be replicated in other countries to promote entrepreneurship, leadership development, and increased economic opportunity.

Possibilities, indeed.

ABOUT THE AUTHOR

Laura Jagla is a Communications Specialist in USAID’s Bureau for Economic Growth, Education and Environment.

USAID Delivers: Quality Care for Expectant Moms Results in Fewer Stillbirths

Fatima holds her 2-day-old baby, safely and successfully delivered at the USAID-funded Smiling Sun Clinic in Tongi, Bangladesh. / Amy Fowler, USAID

Fatima holds her 2-day-old baby, safely and successfully delivered at the USAID-funded Smiling Sun Clinic in Tongi, Bangladesh. / Amy Fowler, USAID

At the Smiling Sun Clinic in Tongi, Bangladesh, Fatima happily holds her healthy newborn baby, delivered in the facility a short while ago. Fatima chose to deliver in the facility to ensure a healthy outcome, for her first pregnancy had ended in tragedy.

Each year, over 130 million babies are born into the world. For a mother, pregnancy is a time of excitement, and the birth of a baby is a time of joy.

Yet, for millions of others, pregnancy can end in tragedy. Each year, nearly 3 million children die in their first month of life, and an additional 2.6 million women suffer a stillbirth. Fatima was one of them.

Through the support of USAID, she was able to access the care and services she needed to ensure that her next pregnancy had a happier ending: a safe pregnancy, a successful delivery and a healthy baby.

At USAID, we are committed to saving the lives of mothers and children. Our vision is to end preventable child and maternal deaths within one generation. Our efforts to achieve this vision are also helping address the tragedy of preventable stillbirths.

In a new Lancet series of papers on stillbirths published today, more than 200 researchers, investigators and advisors — including myself and my USAID colleague Donna Vivio — have collaborated to report on the problem of stillbirths worldwide.

Skilled birth attendants, like these nurse-midwives at a midwifery education center in Afghanistan’s Bamyan province, are vital for ensuring safe and healthy deliveries for mothers and their babies. USAID has helped train more than half of all midwives currently working in Afghanistan. / USAID Afghanistan

Skilled birth attendants, like these nurse-midwives at a midwifery education center in Afghanistan’s Bamyan province, are vital for ensuring safe and healthy deliveries for mothers and their babies. USAID has helped train more than half of all midwives currently working in Afghanistan. / USAID Afghanistan

Unavoidable stillbirths, which are caused by congenital abnormalities, account for only 7.4 percent of all stillbirths in the world. The rest are largely preventable. In fact, nearly half of all stillbirths — 1.3 million each year — occur during labor and delivery.

The hours and days surrounding childbirth are the times when women and babies are most vulnerable, and high-quality care at these times has the greatest potential to reduce maternal and newborn mortality and stillbirths.

Another way to reduce these unnecessary deaths is through family planning. Empowering and educating women and girls helps families choose the number, timing and spacing of their pregnancies, translating into improved birth outcomes for both mothers and their babies.

In fact, quality care for pregnant women before and during childbirth — coupled with optimally-timed pregnancies — would prevent most stillbirths, as well as most preventable maternal and newborn deaths.

During pregnancy, adequate nutrition and quality prenatal care, including treatment for maternal infections, keep women healthy and increase the likelihood of a healthy newborn. These measures have also been shown to improve child development outcomes, thereby yielding a quadruple return on investment.

A network of 300 Smiling Sun clinics throughout Bangladesh, supported by USAID, provides essential services to individuals and communities across the country. / Amy Fowler, USAID

A network of 300 Smiling Sun clinics throughout Bangladesh, supported by USAID, provides essential services to individuals and communities across the country. / Amy Fowler, USAID

In Bangladesh, USAID works to provide these vital services to the most vulnerable populations of women and children. We support a network of Smiling Sun Clinics that are active throughout the country.

The Smiling Sun Clinic in Tongi serves a population of some 94,000 individuals, providing prenatal and postnatal care, immunizations, and family planning services. Now in its 19th year of operation, the clinic provides services free of charge to the poorest of the poor through funds paid by other clients, ensuring the clinic’s sustainability. And it was this clinic in Tongi that changed Fatima’s life.

After losing her first child, Fatima resolved to seek care from the Smiling Sun Clinic during her next pregnancy. She delivered in the facility, open 24 hours a day for delivery services, in the presence of skilled birth attendants.

Gift Usami Ava, pregnant with her third child, receives prenatal care at the Ugep General Hospital in Nigeria’s Cross River State. Quality prenatal care during pregnancy helps reduce stillbirths and improves maternal and newborn health. / Amy Fowler, USAID

Gift Usami Ava, pregnant with her third child, receives prenatal care at the Ugep General Hospital in Nigeria’s Cross River State. Quality prenatal care during pregnancy helps reduce stillbirths and improves maternal and newborn health. / Amy Fowler, USAID

Fatima’s story had a happy ending, and her baby was delivered safe and healthy. We believe all women should have that chance.

Pregnancy and motherhood ought to be a time for celebration rather than for mourning. We have set ambitious targets to save the lives of babies, children and mothers worldwide, and we are confident that, with the support of strong global and local communities, we will be able to achieve them.

ABOUT THE AUTHOR

Katie Taylor is the deputy child and maternal survival coordinator at USAID and the deputy assistant administrator for the Bureau for Global Health.

Loans in Bangladesh: Stories of Change

Somer Ali, Bashir Gazi and Shahinur Rahman have several things in common.  They live in Bangladesh, they work in the agricultural sector, and they’ve all struggled with the lack of available credit.

In Bangladesh, banks are often reluctant to lend money to poorer borrowers in the agricultural sector — where nearly half of the population earns its income — preferring to restrict their business to more financially stable clients.  However, this practice excludes most farmers from a vital source of credit, and prevents them from expanding or making the investments necessary to break out of poverty and build better lives.

Local bank and USAID staff with Somer Ali near his rice milling operation. / USAID Bangladesh

Local bank and USAID staff with Somer Ali near his rice milling operation. / USAID Bangladesh

Fortunately, Somer, Bashir and Shahinur also share something else in common. All three are transforming their lives because they gained access to loans through USAID’s Development Credit Authority.

Somer Ali has been running a rice mill and dairy business for the past eight years.  He has 30 employees and a stable livelihood, but because he could not get a loan from a bank, he was never able to buy the land he farmed. Instead, he rented the land month by month.

Bashir Gazi earns an income by raising 8,000 chickens in a single story chicken coop.  Although Bashir is proud of his brood, he dreams of expanding his business. He approached a bank for a loan, but was turned away. Bashir had never received a loan before and did not have a credit history. Without a credit history, banks perceived him as a high-risk borrower.

 Bashir Gazi’s new three story poultry building financed through a DCA-supported loan. / Christine Ryan, USAID

Bashir Gazi’s new three story poultry building
financed through a DCA-supported loan. / Christine Ryan, USAID

Even for Shahinur Rahman, who employs 21 people on his carp farm, banks were unwilling to open up their purse strings to offer a loan. After 16 years in operation, Rahman’s business was not only well-established, but also expanding. Many other promising small entrepreneurs like Rahman also face closed doors from banks.

Opening doors to credit

That’s where USAID comes in. Partnering with Bangladeshi banks, USAID encourages local banks to make loans and financing more available to poor farmers.

Thanks to those efforts, Somer has been able to purchase the land where his rice mill and dairy business are. He now no longer needs to worry about the instability of renting, and hopes to receive a larger loan to continue expanding his business. Shahinur, too, received his first loan to grow his carp farm.

 Shahinur Rahman with his award from the local government for the quality of his fish. / Christine Ryan, USAID

Shahinur Rahman with his award
from the local government for the quality of his fish. / Christine Ryan, USAID

Bashir shares a similar story. Thanks to USAID’s partnership with his local bank, he’s expanding his chicken business by more than 500 percent. He will soon have the capacity to house 45,000 chickens. This exponential business growth means a major boost in revenue, and for Bashir, it’s just the beginning.

Somer, Bashir and Shahinur are three of 239 agricultural workers in Bangladesh who gained access to financing through USAID’s partnerships with local banks since 2013. Each of these 239 individuals has their own story — their own families, hardships, ambitions and passions. But their stories have a common thread: one of the creation of possibilities where there once were none.

Through our partnerships with local Bangladeshi banks, we’ve mobilized $8 million in credit since 2003 — for every dollar that we’ve spent, $15 of private sector financing has been made available for lending. And USAID’s work in Bangladesh is only a small part of the picture. Since 1999, USAID’s Development Credit Authority program has mobilized $4.3 billion across 75 countries in support of development objectives.

Each loan granted offers new opportunities, and gives minds room to dream. And for every agricultural worker like Somer, Bashir and Shahinur that are empowered through access to finance, we are one step closer to a better, more prosperous world.

ABOUT THE AUTHOR

Megan Phelps provides communications support to USAID’s Development Credit Authority.

Could Sri Lanka’s 2015 Elections Signal a New Era of Democracy?

Sri Lankans line up to cast their vote during the country’s presidential election in January 2015. / USAID

Sri Lankans line up to cast their vote during the country’s presidential election in January 2015. / USAID

Sri Lanka held two elections this year that were markedly different from those in the past. Why? Nobody could predict the outcome. It was a true victory for democracy.

In the election for president in January, Sri Lankan citizens succeeded in making their voices heard, voting for an unconventional choice—a candidate who did not belong to any established political party. In August, parliamentary elections led to a coalition government instead of a majority party holding power.

The news media framed the outcomes as a signal that citizens were voting against a history of nepotism, corruption and abuse of power. Turnout was high—at about 82 percent and 78 percent, respectively. International and domestic election monitors praised the elections as some of the most transparent and credible in the Asian region.

A changing political landscape

But it hasn’t always been like this. In past elections here, we’ve seen violence, vote rigging and mudslinging. This year, we were impressed with how well organized the Sri Lankan election officials were and the level of planning and professionalism that made these elections a success.

Sri Lanka has come a long way. USAID has supported this small island nation off the southern tip of India by investing in its economy, society and institutions since 1956. The cornerstone of our work this year has been supporting free and fair elections and a democratic transition.

Domestic election monitors at a polling booth during 2009 elections in Sri Lanka / USAID

Domestic election monitors at a polling booth during 2009 elections in Sri Lanka / USAID

Our work has included training and deploying 15,000 election observers to oversee polls, providing mail-in ballots, establishing counting centers, and conducting workshops on electoral laws, financial management, and how to take security precautions and report elections violence at polls.

During the parliamentary elections, we noticed how USAID-trained election monitors worked with polling officials and the police to immediately stop a political candidate from campaigning at a polling station on Election Day—a violation of electoral law. They took him away from the crowd of voters and brought the situation under control so well and amicably that no one seemed to notice.

The election monitors also paid close attention to the dynamics in each of the voting districts. For example, in a district close to Colombo, they noticed a tense atmosphere—small groups of people were whispering to each other as they watched vehicles and passersby suspiciously. Keeping close watch, the election monitors asked police to be on hand in case of trouble.

USAID has also supported the design and printing of an election observation handbook, a trilingual guidebook on the electoral process, and a braille pamphlet on the electoral process for the visually impaired. We’ve supported voter education, helping vulnerable families register to vote and obtain necessary identification documents.

New direction for elections

During the August elections, the law appeared to be enforced equitably, irrespective of the wealth and status of candidates and voters, and election violations were addressed quickly. Invalid votes were low compared to previous years.

Thanks to newly enforced election regulations, government institutions and the state media took a more neutral stance, showing less bias to the ruling party, a common practice in the past. Government institutions were mandated to remove political billboards and posters and reduce the number of rallies and people who canvassed homes.

And in the weeks leading up to the elections, more Sri Lankans stayed informed by hearing from political candidates directly on social media platforms instead of depending only on the traditional news media.

The nation and the region can learn from the practices of the 2015 elections. We fervently hope to see these practices in future elections.

ABOUT THE AUTHORS

Anil Liyanage and Angelina Hermon are Foreign Service Nationals working with USAID in Sri Lanka.

Passanna Gunasekera, a Program and Outreach Specialist working with USAID in Sri Lanka, contributed to this blog.

All in Good Faith: Partnering with Malawian Ministries for Maternal Health

In USAID’s—and the world’s—goal of ending preventable child and maternal deaths, the faith sector is a powerful partner.

Close to 90 percent of the world’s people adhere to some religious belief, and in rural areas in many of the developing countries in which we work, health care is provided by religious organizations. Faith-based organizations like the Christian Health Association of Malawi (CHAM) reach deep into the community, and bring a unique set of skills, experience and contributions to the development arena.

They play a pivotal role in improving the quality, accessibility and respectfulness of maternal and child health services—and in promoting the demand for these services. Many faith-inspired groups are enthusiastic supporters and invaluable allies in our efforts to save the lives of mothers and children.

Memory Mponda (right), Priscilla Ziyaye and Pacharo Kumwenda, USAID-supported students training to become nurse-midwives, stand outside the Kangaroo Mother Care ward at the Chonde Health Center. / Grace Soko, Christian Health Association of Malawi

Memory Mponda (right), Priscilla Ziyaye and Pacharo Kumwenda, USAID-supported students training to become nurse-midwives, stand outside the Kangaroo Mother Care ward at the Chonde Health Center. / Grace Soko, Christian Health Association of Malawi

Take the Ndirande Health Center in the city of Blantyre, Malawi, where 15 students from St. Joseph’s College of Nursing and Midwifery work alongside clinical staff to check the vital signs and collect the histories of women who have come to give birth. They assist during the deliveries, and administer necessary care when emergency situations arise.

Recent visitors to the hospital have been pleased that their waiting time has been reduced, as the students, organized into teams, quickly and efficiently check people in and get them the care that they need. As the only public health facility in a district of more than 300,000 people, there is never a dull moment at Ndirande.

On the other side of Blantyre, at the Chilomoni Health Center, 19 of their classmates perform similar duties. Both facilities see upwards of 300 deliveries a month; at Ndirande, that number sometimes approaches 450. On average, 10 or more women come to each facility to give birth each and every day.

For the nursing students at St. Joseph’s, the challenges and experiences that they face at the health facilities are an invaluable learning tool. And for the clinical staff, the extra hands on deck provide much-needed assistance throughout the busy days. At Chilomoni, the hospital’s staff is more than doubled by the addition of the students.

St. Joseph’s is one of 12 constituent training colleges funded in part by USAID and operated by CHAM. Established in 1966, CHAM is an ecumenical organization overseen by the Episcopal Conference of Malawi and the Malawi Council of Churches, and provides administrative and technical support to the health care services of member units across the country.

With 175 member health facilities, CHAM reaches more than 4 million Malawians with health services—37 percent of all care provided in Malawi, and second only to the Ministry of Health. Through training programs like those at St. Joseph’s, students are able to become nurse midwife technicians, medical clinicians, laboratory technicians and psychiatric nurses.

This training helps students bring knowledge and experience to Malawian communities—and is an important step towards ending preventable newborn, child and maternal deaths.

Chimwemwe (“Joy” in the local Chichewa language), a community health worker in Malawi, meets with an HIV-positive pregnant woman at her home in Lilongwe through the USAID-funded Tingathe program, which works closely with the Ministry of Health. / Chris Cox, Baylor College of Medicine Children’s Foundation.

Chimwemwe (“Joy” in the local Chichewa language), a community health worker in Malawi, meets with an HIV-positive pregnant woman at her home in Lilongwe through the USAID-funded Tingathe program, which works closely with the Ministry of Health. / Chris Cox, Baylor College of Medicine Children’s Foundation.

In the 2014 Acting on the Call report, USAID laid out a framework for using proven, high-impact interventions and data-driven investments to improve health outcomes in 24 priority countries for maternal and child health, saving the lives of 15 million children and 600,000 thousand mothers through 2020.

In Malawi, a scale-up of key interventions could save more than 25,000 newborns and 5,000 mothers—lives that we know how to save, but that will likely be lost if we do not act.

Already, our efforts are yielding results and translating into lives saved. The 2015 report shows that Malawi is on track or has exceeded the year’s target for improving key interventions, such as the percentage of live births occurring in a health facility or being overseen by a skilled birth attendant, or the percentage of households with at least two insecticide-treated bed nets. But more rapid progress is needed in pregnant women receiving antenatal care and in women and children having access to clean water.

Our collaboration in Malawi with CHAM is one of many ways we are leveraging strategic partnerships, promoting country ownership and building the capacity of local communities. The holiday season reminds us how vital these partnerships are—now, and all throughout the year.

As the students at St. Joseph’s graduate next year, we will be there applauding them for their hard work, wishing them future success, and welcoming in the next class of students to begin their training.

ABOUT THE AUTHOR

Katie Taylor is the deputy Child and Maternal Survival Coordinator and a deputy assistant administrator for the Bureau for Global Health at USAID.
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