USAID Assistant Administrator Nancy Lindborg with Darfuri children at the Otash camp for internally displaced persons outside Nyala, South Darfur. Photo is from Doug Arbuckle.
Archives for Sub-Saharan Africa
Two hands clasped together, or one hand alone? This is the choice that southern Sudanese voters will face in less than one week, when they choose either to remain part of a unified Sudan or to secede and form an independent country.
Several democratic milestones have paved the way for Sudan to reach this point: a peace agreement that ended 22 years of civil war, the first national census in 15 years, and the first multi-party elections in 24 years. While these achievements were not without hurdles, the country is nevertheless still on track for its historic referendum on January 9 to 15, 2011.
The next step in the peace process invokes complex and controversial issues: self-determination and government cooperation, the re-integration of soldiers into civilian life, and a decision on the fate of Sudan’s profitable oil fields, just to name a few.
But for the vote to be successful, the smaller, tangible pieces also need to be in place. Poll stations need to be well-equipped and orderly, with the right materials in the right places in the right quantities. And perhaps most importantly, the frontline poll workers need to know how to use the materials to carry off a successful and fair vote.
For established and peaceful democracies, these voting logistics are a given. But in a region that is still recovering from war and that has poor transportation, education, and communication infrastructures, details matter.
In recognition of this fact, on December 23, 2010, USAID and the United Nations delivered polling kits and ballots to assist the official Sudanese commission carrying out the referendum. This delivery followed earlier support to the voter registration process. USAID’s polling kits included critical materials for running a polling site, such as indelible ink, thumbprint pads, ballot box seals, and banners.
The ballots ask voters to place a thumbprint next to their choice—unity or secession, shown in English and Arabic text as well as pictures for voters who may speak one of the country’s more than 125 other languages. In addition, thanks to USAID and its partners in Sudan, over 14,000 poll workers will have been trained in polling and counting procedures by the time the referendum takes place.
USAID’s attention to the details of a successful vote complements its broader activities to support peace, security, and good governance throughout Sudan.
The USAID-supported Horse Riding for Health program engages pony riders and motorcycle riders to transport blood tests, drugs, and supplies to Lesotho‘s remote mountain health clinics.
The system allows people to receive HIV test results sooner, access life-saving drugs, and ensure an uninterrupted supply of medication.
In this photo essay, follow the riders to homes and clinics throughout tiny Lesotho to meet:
Maamohelang Hlaha: An HIV-positive mother of four whose village is inaccessible by vehicles and a three-hour hike from the nearest health clinic
Potso Seoto and Thuso Khanare: Dedicated riders who transport life-saving medicines while supporting their families through a stable job
Dr. Leopold Buhendwa: The Elizabeth Glaser Foundation’s Lesotho country director who works to prevent mother-to-child transmission of HIV
Alice arrives at a health center in Western Province, Kenya, with her nine-month-old baby girl, who has a recurrent fever. Alice suspects malaria, which is endemic in the area. Two hours later, she leaves with malaria medication and a free insecticide-treated bed net. To the casual observer, Alice got what she came for and had her health needs met. She even received a bed net she wasn’t expecting.
But consider what Alice didn’t receive. Had her daughter been weighed, the nurse would have noticed that her growth was faltering because Alice is not yet supplementing her diet with nutritious weaning foods. Her daughter also missed the measles immunization she was due for. Alice was not offered an HIV test, which would have revealed that she is HIV-positive. Finally, no one asked Alice, who has six children and does not want to get pregnant again, if she is using a family planning method or would like information about contraceptives available at the health center. In short, Alice’s immediate need was met, but multiple underlying health needs went undetected by the health center staff.
Alice’s story is unremarkable. Similar scenes play out every day in health care settings around the world. In sub-Saharan Africa, where the burden of HIV, unintended pregnancies, and infant mortality is highest, missed opportunities to meet health care needs, such as those of Alice and her baby, can be deadly.
Fortunately, programs in Kenya and Ethiopia are leading the way in integrating family planning, HIV, and maternal/neonatal and child health (FP/HIV/MNCH) services. In Kenya, the government has made integration of FP and HIV a national policy. USAID/Kenya’s AIDS, Population and Health Integrated Assistance II (APHIA II) project promotes integrated service delivery throughout the country in public, private, and faith-based facilities. Visiting the APHIA II project in Western Province (implemented by PATH), I noted that the Ministry of Health trains nurses and health officers to deliver both FP and HIV services. The project has supported FP/HIV/MNCH integration at 276 health centers and hospitals in Western Province. USAID/Kenya’s new APHIA Plus Project will expand integrated services in 2011.
Ethiopia’s Ministry of Health also supports integration and strives to offer an HIV test to all clients coming to public sector facilities. Clients are also assessed for family planning needs and offered counseling and FP methods. The government’s Health Extension Program, supported by USAID/Ethiopia, provides FP counseling and contraceptives in the home, HIV and child health counseling, and referral for services. These public sector efforts are complemented by such programs as FHI’s Home and Community-Based Care (HCBC) program (PDF), which strengthens integrated FP and HIV services offered in the community. The HCBC program is working with local iddirs—traditional neighborhood-based burial societies—that now provide mutual aid services to households affected by poverty and illness, including HIV. The iddirs recruit and manage community health volunteers, who provide home-based care and support to those living with HIV and counsel clients about FP and child health.
I observed many different models of FP/HIV/MNCH integration in Kenya and Ethiopia, including intra- and inter-facility referrals and strong linkages between home and community-based programs and health facilities. The type of integration model used is not as important as the fact that health workers in both countries now view clients more holistically and address more than a single health problem in a consultation or home visit.
The integrated programs I visited in Kenya and Ethiopia all report challenges, such as training health care workers in multiple disciplines and struggling to meet the complex needs of clients in crowded facilities, where it is difficult to focus on more than one health issue at a time. But providers are addressing these challenges through training and task shifting, the use of job aids and reporting systems that capture integrated services, and ensuring that contraceptives, HIV test kits, and other necessary commodities are available. The next time Alice visits a facility supported by these programs, odds are she will have more than just one child’s fever addressed.
Ed Scholl serves as AIDSTAR-One Project Director. AIDSTAR-One is funded by USAID’s Office of HIV/AIDS, and provides rapid technical assistance to USAID and U.S. Government country teams to build effective, well-managed, and sustainable HIV and AIDS programs and promotes new leadership in the global campaign against HIV.
Park rangers patrol a wildlife habitat in southern Sudan. Supported by USAID, the Wildlife Conservation Society works to protect the area’s natural resources while creating local jobs and seeking alternatives to unsustainable hunting practices. Photo is from A. Schenk/WCS.
With sharp minds, inquisitive souls, and iron wills, they are an 11-strong group of top-level women scientists in agricultural research with their eyes set on influencing national and regional policy to improve livelihoods in Mozambique and across Africa. Through their work, they are helping to change the face of a continent where women are seldom heard, but are always called on to give and to nurture. They are Mozambique’s scientists in the AWARD program for African Women in Agricultural Research and Development, funded by USAID and the Bill and Melinda Gates Foundation.
Esperanca Chamba, who specializes in natural resources management, is one of 11 women scientists in Mozambique who were selected from among hundreds of applicants from 10 sub-Saharan countries as fellows of the African Women in Agricultural Research and Development (AWARD) project. AWARD was established in 2008 by the Gender & Diversity Program of the Consultative Group on International Agricultural Research, following a three-year pilot program in East Africa. It is a professional development program that strengthens the research and leadership skills of African women in agricultural science, empowering them to contribute more effectively to poverty alleviation and food security in sub-Saharan Africa. The US$15 million, five-year project is funded by the Bill & Melinda Gates Foundation and USAID, with plans to extend to a second phase starting in 2013.
Chamba’s example of a foiled attempt in experimental nutrition finely captures the context of women and agricultural research and development in Africa. “Most of the work in the fields is in women’s hands,” says rural extension officer Claudia Nhatembe, during a break from the sweet potato fields on the rich soils of IIAM’s Umbeluzi Agricultural Station, some 30 km outside the capital, Maputo. “It’s hard work–plowing, sowing and harvesting. For men, it’s mostly handling the plantation’s irrigation systems.”
In Africa, women like Nhatembe carry most of the burden of running the household, raising children, tending to their husbands, fetching water, collecting firewood, cooking and cleaning, and plowing and sowing. They are the pillars of society, yet are commonly ignored. “We give rural women a voice, because through our work, they will also have a voice,” says Carla Menezes, a researcher and Head of Nutrition at IIAM, who is studying alternative feeding options for small ruminants to lower production costs of animal breeding in rural households.
“Scientists are on the cutting edge of solving Africa’s food crisis. But we need to urgently address the gender gap in our scientific community,” says Akinwumi Adesina, Vice President of Policy and Partnerships of the Alliance for a Green Revolution in Africa. “We need more women pursuing careers in agricultural science because women are the face of African farming.”
Research shows that the number of women enrolling in agricultural sciences is steadily increasing, but women researchers tend to drop out as they move up the career ladder. Termed the “leaky pipeline”, this phenomenon is generally attributed to traditional, male-dominated organizational dynamics, in additional to cultural barriers to women’s education and advancement. AWARD seeks to reverse that trend.
“We need good collaboration to make sure that women are equal partners with men farmers all the way through the process,” U.S. Secretary of State, Hillary Clinton, said recently in Nairobi. “The AWARD program is a great example. It supports women scientists working to improve farming here in Africa and to fight hunger and poverty. And we need women represented in our laboratories, as well as in our fields.”
Recent studies indicate that the majority of those who produce, process, and market Africa’s food are women, but only one in four agricultural researchers is female. A study by AWARD and the Agricultural Science and Technology Indicators on “Women’s Participation in Agricultural Research and Higher Education”, which looked at key trends in sub-Saharan Africa, found that the overall proportion of female professional agricultural and higher education staff increased from 18 percent in 2000/01 to 24 percent in 2007/08. On a national basis, female staffing levels were particularly low in Ethiopia, Togo, Niger and Burkina Faso, whereas in Botswana, Mozambique and South Africa levels were high. However, the benchmarking survey—which was conducted in 125 agricultural research and higher education agencies in 15 sub-Saharan countries—showed that only 14 percent of the management positions were held by women.
“Only with the full involvement and leadership of women in agriculture will Africa succeed in its quest for food security and prosperity,” says Vicki Wilde, Director of AWARD and the CGIAR Gender & Diversity Program. “There is no time to lose.”
Mozambique, a former Portuguese colony in southeastern Africa, is a member of the Commonwealth and the only non-English speaking country represented in AWARD. With a population of 20 million, it was ranked 22nd out of 134 countries in the Gender Gap Index for 2010. Although the country scores poorly in terms of educational attainment (123rd), it boasts a good female-to-male ratio in terms of economic participation and opportunity. Analysts say there is an increasing trend in women’s contribution to economic growth, although there is a lowering contribution in sectors like agriculture, where there are more women but incomes are lowest.
“We know the people who matter most aren’t the financiers or the agriculture ministers or the assistance workers and partners. They are the women farmers who are the untapped solution to this problem,” says USAID Administrator Rajiv Shah. “We’re working to ensure that women get equal access to services and support, such as financial services that preferentially target women and extension services delivered by female workers. To make this happen, we are investing in women producer networks and expanding fellowship programs, such as the AWARD program.”
The 11 Mozambican fellows cover a broad range of agricultural sciences, from forestry management to agro-economics and veterinary medicine, including animal production, reproduction, and nutrition. “I am inquisitive by nature. I feel enraptured by the process of looking at a problem, imagining solutions, and seeking the adequate answer,” says Paula Pimentel, a senior researcher at IIAM, who is currently studying gender relations in goat-breeding families in the remote district of Chicualacuala, about 500 km from Maputo.
What drives all these women is a focus on pro-poor, community-oriented research objectives, and an awareness of the need to combine traditional knowledge with modern methods as a fundamental contribution to scientific advancements. “Learning from local techniques should always be the starting point,” says Anabela Manhiça, Senior Researcher and Head of the Technology Transfer Department at IIAM. “Rural producers have abundant knowledge. It’s always best to learn what they are doing, how they are doing it, and then add the new technology. It doesn’t work when you try to introduce something completely new.”
“These outstanding Mozambicans debunk the myth in some science circles that qualified African women researchers ‘aren’t out there’—that they don’t exist in significant numbers,” says Wilde. “Qualified women scientists are out there. These women prove it.”
The work of USAID has been far-reaching and long-standing as evidenced by this photo of a Peace Corps volunteer working in the ORT center funded by USAID. In the mid 1970’s Joan Wadelton, a Peace Corps Volunteer from Princeton, New Jersey, holds one of the children she helps at a maternal and child health center in Niger. The center is operated by ORT, a voluntary agency, and the Nigerienne Ministry of Health, is financed by USAID. Photo is from USAID.
You may not know that the leading killers of children in the poorest countries are diarrhea and pneumonia. You almost certainly don’t know that your contributions can help save the lives of 4 million children – many because of the introduction of two new vaccines to protect against those diseases.
Last week, I was in Rwanda, helping the Global Alliance for Vaccines and Immunization plan the introduction of vaccines for rotavirus and pneumococcal diseases, major causes of diarrhea and pneumonia. With your support as well as corporations, foundations, and countries rich and poor, GAVI, will save the lives of 4 million children in the next five years.
That sounds ambitious, but it’s very doable – and you’re a big part of the reason. With your help, GAVI supported childhood immunization in poor countries over the last 10 years, saving the lives of 5.4 million children, and shielding millions more from the long-term effects of illness on growth and development.
The U.S. has been a leader in immunization, but we can’t do it alone. Working with and through groups like GAVI helps ensure that other donor countries, companies and foundations, as well as developing countries themselves, all contribute their share: a global solution to a global problem. In addition to the U.S., fourteen other countries and the European Union are donors, and The Bill & Melinda Gates Foundation is also a generous supporter.
People have been a big part of that success as well. GAVI has had strong, high-level leadership – the Rwanda meeting marked the last for Mary Robinson, the former president of Ireland who served as chair of GAVI’s board, who deserves thanks for her advocacy. Norway has been a global leader in the fight to immunize children in the poorest countries, and its former health minister, Dagfinn Hoybraten, took over as chair – underlining Norway’s continuing commitment.
U.S. leadership isn’t just a matter of money. The expertise of people at USAID has been crucial as well. Since the ‘70s, USAID professionals have worked with partners across the globe to confront the challenge of vaccine-preventable diseases and help immunize children in remote parts of the world. Working with an efficient partner like GAVI that mobilizes resources from other countries, foundations and companies multiplies the impact of U.S. expertise, as well as dollars.
GAVI is a model for the new approach the U.S. is taking through the Global Health Initiative: an innovation approach, a public-private partnership seeking innovative sources of finance for vaccines for poor countries, investing in children, with a clear focus on measurable results. GAVI is a true partnership, accomplishing more than any nation could do on its own, and doing it efficiently, with a small staff.
As the U.S. expands the life-saving impact of our global health assistance through the Global Health Initiative announced by President Obama, our support for immunization will continue, because it is one of the most cost-effective ways to save lives and promote health. Reaching children with this simple, affordable intervention is one of the smartest investments in global health – and the right thing to do. And we can do it in a way that builds national systems, so they won’t need help forever.
These times demand that we provide more health for the money we invest in global health. Despite the success of immunization programs, vaccine-preventable diseases are still estimated to cause more than 2 million deaths every year.
We will help because compassion is a fundamental American value — and so is efficiency in using the resources we have, innovation to make those resources go further, and realism to know we can’t do it all by ourselves. Working with and through GAVI, we have changed the future of millions of children and families. That’s effective, efficient realistic compassion, and it’s worth doing more.
Mwanawina Rural Health Center is located approximately 80 kilometers from Mongu, the capital of Zambia’s Western province. Each year, during the rainy season, the facility becomes inaccessible by motor vehicles.
To get drugs and medical supplies to the health center, the District Health Office hires an ox cart—the only reliable transport through the flooded plains between December and June. The journey takes no less than six hours.
With its expertise in logistics, particularly in challenging environments, the USAID | DELIVER PROJECT is partnering with Zambia’s Ministry of Health (MOH) to help bring drugs and medical supplies to patients by strengthening the supply chain.
In the Western province, the project trains health center staff in logistics and provides technical guidance and mentorship to MOH staff in provinces and districts, and at individual health centers.
The project is also enhancing the computerized systems in all hospitals and major health centers to include important logistics information. The new information will help improve systems performance and increase commodity security in the province.
Last week we reported on the successful and peaceful close of voter registration in Sudan for January’s referendum on southern independence. In another promising development, this month Blue Nile state began popular consultations, a political process guaranteed by the 2005 Comprehensive Peace Agreement (CPA) that ended Sudan’s violent, 22-year civil war. Located on the north-south border, Blue Nile was on the frontlines of the war, and the state’s people had mixed loyalties—some aligned with the north and others with the south.
While the CPA stipulated that southern Sudan would vote on whether or not to secede from the north, it also determined that Blue Nile and Southern Kordofan states are part of the north. The agreement further required public hearings in the two states to determine the will of the citizens—whether they felt the peace agreement adequately met their aspirations. If not, additional negotiations would proceed between the states’ democratically elected state legislatures and the central government. Popular consultations are significant because they provide a unique opportunity to instill civic participation into Sudan’s public life, empowering citizens to understand their rights and responsibilities and make their opinions heard.
In Blue Nile, the process began with pilot citizen hearings in Damazin and Roseires December 12-13, where 876 citizens registered to attend, and nearly 300 of those expressed their opinions. Participation among women was strong. The Chair of the Commission encouraged women to come forward and minorities to speak in their own language, providing a positive sign that the state’s diversity will be reflected in the consultations. Over 100 similar meetings supported by USAID will be held across Blue Nile by January.
In Southern Kordofan, popular consultations cannot begin until after state elections are held next year.
USAID has been helping Blue Nile and Southern Kordofan prepare for the popular consultations since 2008—providing logistical support, organizing civic education campaigns to inform citizens about the process, and taking community leaders on study tours to Indonesia and Kenya, which have conducted processes similar to popular consultations. Many citizens have incorrectly believed that the process includes a vote on secession, like the southern referendum, which highlights the importance of civic education so that citizens understand the process and their rights.
For further analysis on the importance of the popular consultation process, read this special report from the United States Institute for Peace.
For more information on USAID’s work in Sudan: