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Ending a Global Epidemic of Tuberculosis in Children

“When my daughter got sick, I took her to a clinic in my neighborhood. They gave her cough syrup for seven days. I thought she was getting better, but it was apparent that she was still ill. After another examination, they referred her to St. Paul Hospital in Addis Ababa where they put her on oxygen and started taking blood sample after sample and injection after injection for a month. Her condition did not get better so they gave her another medicine. The doctors then decided to take blood from her back…only then did they know it was tuberculosis.” Atsede Tefera

Atsede Tefera with her daughter, Nigist, who was diagnosed with tuberculosis at a hospital in Addis Ababa, Ethiopia. / MSH Ethiopia

Atsede Tefera with her daughter, Nigist, who was diagnosed with tuberculosis at a hospital in Addis Ababa, Ethiopia. / MSH Ethiopia

Atsede Tefera, photographed above, recalls three months of long delays in the diagnosis of tuberculosis for her daughter Nigist, who was eventually able to start treatment for the disease.

Tuberculosis (TB) kills more people each year than any other infectious disease, causing over 1.5 million deaths globally in 2014 alone. More than a quarter of cases are in Africa, the region with the highest burden of TB disease relative to population.

Children are among the most vulnerable, and all too often children with TB remain in the shadows, undiagnosed, uncounted and untreated. Today, more than 53 million children worldwide are infected with TB, and more than 400 die each day from this preventable and curable disease.

This global childhood TB epidemic is serious, yet historically neglected. Some children get TB at the same time as other chronic illnesses, such as malnutrition, making it even more lethal. However, TB is preventable through prompt diagnosis and treatment.

TB is an airborne disease, which is passed between people with symptoms by coughing or sneezing. TB often spreads in communities where people are living in close proximity to each other, putting those living in poor socio-economic conditions particularly at risk.

Children living with a parent who is diagnosed with TB should be systematically screened for infection. They should either be put on prophylaxis treatment, or if they start to cough, those cases should be identified early on. / MSH Uganda

Children living with a parent who is diagnosed with TB should be systematically screened for infection. They should either be put on prophylaxis treatment, or if they start to cough, those cases should be identified early on. / MSH Uganda

In recent years, progress has been made to combat childhood TB. The emergence of policies and guidelines across the Africa region that incorporate childhood TB, coupled with innovative treatment and child-friendly medicine, have moved us closer to tackling one of the oldest and most persistent diseases in the world.

However, a new analysis released today on World Tuberculosis Day, shows that in African countries, a persistent divide between policy and practice threatens to impede progress gained for addressing childhood TB across the region.

The analysis, a collaboration between USAID and its African Strategies for Health project, presents the landscape of childhood TB programming in 12 countries in Africa, and suggests three focus areas critical for moving the dial on this intractable issue:

  1. Strengthen the capacity of health workers to identify and diagnose children infected with TB. For children, the first contact with the health sector at a primary health care or maternal and child health clinic is an important opportunity to identify TB symptoms early and refer for treatment. Symptoms such as a persistent cough, loss of appetite and high fevers must be recognized by all providers as possible signs of TB. Health workers at all levels of the health system must be empowered to take appropriate action, such as referral for treatment and follow-up.
  2. Implement active case finding strategies for early identification of child TB. Delays in diagnosing TB and initiating appropriate treatment are often long, particularly where access to health care is poor. Systematically identifying children who have come into contact with a person with active TB, as well as screening children with HIV and those who are malnourished, are critical steps to identify sick children.
  3. Ensure adequate care closer to home. Health systems must be strengthened to guarantee a regular supply of diagnostic tools and child-friendly medicines at all levels where sick children may access care. Clear guidance on the optimal interaction and links between service delivery platforms including maternal and child health, HIV, and nutrition programs is vital.

No child should die from TB, which is preventable and curable. We have the policies, guidelines, medicines, and health service delivery platforms needed to make this vision a reality. The time to apply these instruments – to end preventable child deaths due to TB – is now.

Join the conversation on World Tuberculosis Day by following #WorldTBDay, #UnitetoEndTB, and #LouderThanTB.

ABOUT THE AUTHOR

Keri Lijinsky is the HIV/AIDS and TB Advisor at USAID’s Bureau for Africa. This blog is co-authored with Rudi Thetard, Project Director for USAID’s African Strategies for Health project.

Empowering Women Through a Simple Purse

Imagine giving birth without the help of sterile tools, a doctor, nurse or midwife. This is the experience of nearly half of women giving birth in low-income countries — and many are at high risk of infection. With limited access to antibiotics, these infections often prove fatal.

One woman is trying to change that.  

Zubaida Bai, founder and CEO of ayzh, speaking at USAID's Partnering to End Extreme Poverty and Achieve the Global Goals event. / USAID

Zubaida Bai, founder and CEO of ayzh, speaking at USAID’s Partnering to End Extreme Poverty and Achieve the Global Goals event. / USAID

Zubaida Bai is the co-founder of ayzh, an organization providing women’s health resources to underserved women globally.  The venture’s first product is a clean birthing kit that includes all the items recommended by the World Health Organization to prevent infection at birth.

Infections at birth affect more than 6 million women annually. Even worse, poor hygiene and sanitation during birth is directly linked to the preventable deaths of more than 1 million women and newborns each year.

In celebrating International Women’s Day earlier this month, we recognize women like Zubaida who are revolutionizing their field and making history with their achievements. With the support of USAID and other organizations, Zubaida’s work establishing ayzh has saved the lives of women and newborns on a global scale.

Zubaida posing with the clean birthing kit. / Ayzh

Zubaida posing with the clean birthing kit. / Ayzh

This is her story: After earning her engineering degree, Zubaida Bai decided to go back to India to serve the women she had seen suffer her whole life from health and financial hardship.

She worked in India for four years developing technology appropriate for low-resource settings, before she decided to spin off on her own. Both Zubaida and her husband Habib were passionate about helping women, so they started looking for opportunities to design for this underserved population.

On a field visit to a rural village, Zubaida discovered that some midwives used a sickle — normally used for cutting grass — to cut the umbilical cord. This was an “aha” moment for her.

Reflecting on the infection she contracted when her first child was born in one of the best facilities in India, she thought, “If I had everything and had to suffer an infection, what would women in these villages be facing?” This is the moment that launched Zubaida into a whole new world of maternal health.

“It made me very determined to make my childhood dream come true – to improve the lives of women,” she said in a blog for TED.

In 2007, Zubaida and her husband participated in MIT’s International Development Design Summit, a program that brings together people from across the globe to collaborate and build projects that address issues faced by the world’s poorest communities.  The program exposes participants to practical design for development.

Zubaida and other IDDS participants in morning circle, the way that summits start their days with team building exercises, announcements, and appreciations. / IDIN

Zubaida and other IDDS participants in morning circle, the way that summits start their days with team building exercises, announcements, and appreciations. / IDIN

After studying how to best succeed in markets in developing countries, Zubaida founded ayzh in 2009 and a year later launched the clean birth kit. She called it “janma,” which means “birth” in Sanskrit. The $3 purse comes with six items to ensure a safe and sterile delivery at half the cost of comparable birth kits.

Ayzh hires local Indian women to assemble the packages, allowing them to develop a stable income. Since 2010, about 250,000 kits have been sold in India, Afghanistan, Gambia, Laos, Ghana, Malawi, Nigeria, Zambia, and Haiti — reaching 500,000 mothers and babies.

Ayzh plans to reach 6 million women over the next five years, improving maternal health and breaking the cycle of poverty one woman at a time.

With support from USAID’s Higher Education Solutions Network (HESN) through MIT’s International Development Innovation Network, ayzh is developing a similar kit for newborns. It will provide the tools necessary to make transitions for new mothers and their babies as smooth and healthy as possible.  

Through HESN, USAID is empowering entrepreneurs and researchers at universities so that people like Zubaida can get the funding and mentoring they need to jump start their ventures.

Zubaida Bai and ayzh intern Kelly Brennan iterating on potential impact metrics they can use when communicating with their stakeholders during a workshop in Chennai, India. / Kyle Munn, SEAD

Zubaida Bai and ayzh intern Kelly Brennan iterating on potential impact metrics they can use when communicating with their stakeholders during a workshop in Chennai, India. / Kyle Munn, SEAD

Last year, ayzh was selected to be a part of a cohort of innovators at the Social Entrepreneurship Accelerator at Duke  — another HESN partner — to receive mentorship and capacity building to expand their global reach and impact. The Evidence Lab at Duke is providing support to ayzh to find the best ways to measure and communicate its impact.

With the support of USAID and other organizations, we hope this venture and others like it will continue to improve the health of women around the world.

ABOUT THE AUTHOR

Danielle Somers is a communications analyst for the U.S. Global Development Lab’s Higher Education Solutions Network (HESN). Emily Jablonski is a virtual intern for HESN and student at the University of Michigan.

Adapting to Climate Change: How USAID is connecting cities to find solutions

Sitting around a conference table in Somerville, Massachusetts, many heads nodded. “Yes,” these bobbing heads seemed to say, “We have that problem, too. Yes — we, too, are being affected.”

As Oscar Montes, director of the Municipal Office of Environment, discussed the increasing storms, worsening floods and shrinking coastline that his city La Ceiba, Honduras was experiencing due to climate change, he clicked through a number of photos.

Mothers carrying children on their shoulders through flooded streets. Shopkeepers using buckets to empty their markets of water in vain. Satellite images of an eroded coastline. Photos of houses crumbling into the sea.

Coastal cities like La Ceiba, which is home to a quarter of a million people, have always been vulnerable, but the effects of a changing climate are accelerating these threats.

You might not think that Somerville and La Ceiba have much in common, but after sitting in on a few hours of conversation between these two cities’ officials, it was abundantly evident they face similar problems, and they can help each other find solutions.

This is the key theory behind USAID’s support to the CityLinks program, implemented by the International City/County Management Association, which partners cities to share best practices for adapting to climate change.

Oliver Sellers-Garcia, director of Somerville’s Sustainability and Environment Office, points out aspects of Somerville to Oscar Montes, director of La Ceiba’s Environment Office. / Nancy Leahy Martin, USAID

Oliver Sellers-Garcia, director of Somerville’s Sustainability and Environment Office, points out aspects of Somerville to Oscar Montes, director of La Ceiba’s Environment Office. / Nancy Leahy Martin, USAID

Across the conference table, Oliver Sellers-Garcia, director of Somerville’s Office of Sustainability and Environment, translated Oscar’s presentation for his colleagues, adding his own commentary throughout.

“Oscar says that the hardest hit parts of La Ceiba are those in the urban center, where most of the population lives in the flood zone. When there are flash floods from the nearby rivers and streams, the neighborhood groups notify the city. Guys, this is something we can actually learn from La Ceiba and start doing here.”

Later in the day, Somerville’s director of Capital Projects and Planning, Rob King, showed Oscar how the city is adapting to increased rainfall.

As in many cities in the United States, storms overwhelm Somerville’s sewer system, which collects both sewage and stormwater runoff. When there is too much water for the city’s treatment plant to handle, both runoff and raw sewage get dumped into local bodies of water.

“We can put holding tanks underground to temporarily capture the stormwater that would otherwise flood our city’s sewage system, but that’s expensive,” Rob said. “We can create plant- and grass-filled medians in the roadways and direct runoff there, but that means less room for pedestrians, cars, bicyclists…”

There are no easy answers, and Oscar knows this all too well. In La Ceiba, the wastewater treatment facility’s pumps fail every time there’s a storm, spewing raw sewage into the ocean. With more storms expected in La Ceiba due to climate change, the city is trying to find affordable solutions to prevent this from happening.

Rob King, Somerville’s director of Capital Projects and Planning, discusses Somerville’s waste water treatment program with La Ceiba’s Oscar Montes. / Nancy Leahy Martin, USAID

Rob King, Somerville’s director of Capital Projects and Planning, discusses Somerville’s waste water treatment program with La Ceiba’s Oscar Montes. / Nancy Leahy Martin, USAID

More than half the world’s population lives in cities, and that number is growing at unprecedented rates. The urban poor are especially vulnerable to the effects of climate change, living in unsafe housing and in areas most prone to flooding.

By partnering cities facing similar challenges, USAID helps them to increase their resilience, protect their citizens and prepare for a changing climate.

ABOUT THE AUTHOR

Nancy Leahy Martin is an Urban Advisor in USAID’s Engineering and Urban Division. Follow her at @LeahyNancy.

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.
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