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Archives for Women

The Hidden Costs of Fistula Repair Surgery

Close up portrait of an African woman

Edisa looks forward to her future free of fistula. / Fistula Care Plus

A few months after becoming pregnant with her first child, Edisa’s husband unexpectedly passed away. In need of transportation to reach the closest health facility, and without family nearby, Edisa went into labor at home.

Friends and neighbors contributed money for her transportation to a local hospital, but without enough money for treatment, she labored without medical attention for two days. On Edisa’s third day at the hospital, the staff finally attended her. The child did not survive the prolonged labor.

Edisa returned to her community without a baby, but with a devastating obstetric fistula—an injury caused by prolonged labor and results in a hole between the birth canal and one or more of a woman’s internal organs. The outcome is chronic, uncontrollable leakage of urine and/or feces.

While Edisa was recovering, a neighbor told her that she, too, had the problem of leaking urine after giving birth. She encouraged Edisa to visit Kitovu Hospital, a facility that provides fistula repair surgeries through USAID-supported hospital in Uganda.

Again, Edisa found herself unable to access the care she needed due to financial constraints. Borrowing from friends, Edisa collected enough money for transportation to the hospital located 11 hours away from her home. In Uganda, women can spend up to $25 on one-way transportation costs for two people to a fistula repair facility.

After receiving fistula repair surgery the USAID-supported hospital, Edisa is now completely healed and looking forward to her future. But for the more than 2 million women in sub-Saharan Africa and Asia that are estimated to be living with fistula, the costs of care can be insurmountable, leaving them to go untreated.

Despite increased availability of often free fistula repair in Uganda, women like Edisa can still lack access to this critical treatment.

Because of the factors that can result in an obstetric fistula, including difficulties with transportation to health facilities and lack of quality health services, this injury has a greater impact on women living in poverty. Women living with fistula typically live in impoverished, remote settings with limited access to facilities that provide fistula surgeries.

A group of African women

Women at a USAID-supported fistula repair clinic. / Fistula Care Plus

A recently published USAID-supported research study sought to better understand the barriers women face when seeking fistula care. From June to December 2015, a research team conducted interviews and focus groups in Nigeria and Uganda with women affected by fistula, women’s families and spouses, and fistula care health providers

The study found that women face financial barriers when seeking fistula repair surgery, including loss of income and transportation expenses. In addition to direct medical expenses for fistula care, women also face the costs for food and water during their recovery period at the facility as well as costs to hire child care or employees to manage their businesses.

Pooja Sripad, study co-author and associate at Population Council, says that the research team sought to look at the cost and transport involved in fistula repair “more holistically.” She further explained the research team’s surprise at the wide range of barriers reported and how these barriers limit women’s “own agency to seek treatment.”

Due to the complex nature of fistulas and poor quality of care, women often have to receive multiple surgeries and visit different surgical facilities. That also increases transportation and surgical costs.

Mothers waiting in a clinic in Nigeria.

Mothers waiting in a clinic in Nigeria. / USAID

Dr. Mark Shrime, director of the Center for Global Surgery Evaluation at the Massachusetts Eye and Ear Infirmary and Harvard Medical School, says that the results are “yet another example in a growing body of literature showing that the ‘non-medical’ costs of care—things like transportation, food and lodging—are huge sources of catastrophic expense for surgical patients. Most of our health policies, if they look at financial risk at all and most don’t look only at the risk patients face when getting the surgery itself, but this paper demonstrates how ‘free’ surgery is rarely actually free.”

“The implications are pretty evident,” he added, “to deliver truly equitable, quality surgical care, we need to broaden our definition of ‘health’ to include the financial state we leave patients in after we’re done treating them.”

USAID is using this study to improve care for women with fistula. In Nigeria and Uganda, USAID has piloted a groundbreaking intervention that addresses these barriers and will transform how women like Edisa access care.

Women at Kyenjojo Hospital, Uganda.

Women at Kyenjojo Hospital, Uganda. / Amy Fowler, USAID

After enduring six months of leaking and leg pain, Edisa is taking control of her life, empowering other women to seek treatment through interventions like those provided by USAID that address the central barriers to seeking fistula repair surgery.

Before departing for Kitovu Hospital, women in her village who also suffer from fistula were hesitant to seek treatment. For many women with fistula, the emotional costs of returning home without relief is yet another hidden cost of fistula repair.

“They told me that if I got cured, that they would also come. Now, they will come,” says Edisa.

Since 2004, more than 50,000 fistula repair surgeries have been made possible all over the world through Fistula Care Plus Project and other USAID-supported fistula care projects.


Bianca Devoto is an intern in USAID’s Office of Population & Reproductive Health supporting USAID’s management team for the Fistula Care Plus project.

How One Simple Solution Has Saved Thousands of Babies

Three women sit on the floor talking

Jharana Kumari Tharu, a community health volunteer in Nepal, visits the home of Syani Tharu, who is eight months pregnant, to counsel her on how a simple tube of chlorhexidine antiseptic gel, applied to her baby’s cut umbilical cord stump, could help prevent infection and even death. / Thomas Cristofoletti for USAID

Every year, an estimated 2.6 million babies die within their first month of life. About 15 percent of these deaths are caused by complications from severe infection – which, in most cases, can be avoided with simple, cost-effective interventions.

Since 2002, USAID and its partners have been working to scale up the use of one life-saving intervention in particular – chlorhexidine, an antiseptic. Chlorhexidine, which comes as either a gel or a liquid, is safe and simple to use, easy to manufacture, and affordable.

Chlorhexidine is commonly used by hospitals to disinfect skin before surgery and to sterilize surgical instruments. In low-resource countries, it can also be used to protect the umbilical stumps of newborns to prevent life-threatening complications from infection.

Some communities see these types of severe infections regularly due to traditional home birthing practices, such as cutting umbilical cords with dirty household tools and then treating the stump with turmeric or even cow dung, and other unsanitary birthing conditions. By comparison, in high-resource countries severe infections occur in less than 1 percent of newborns.

Studies showed that one-time chlorhexidine treatment can lower the risk of severe infection by 68 percent and infant death by 23 percent. Impressed by these results, the Government of Nepal piloted a USAID-supported chlorhexidine program in 2009. Two years later, chlorhexidine was integrated into routine care nationwide with support from Saving Lives at Birth: a Grand Challenge for Development, also co-funded by USAID.

The scale-up program in Nepal is estimated to have saved over 9,600 infant lives since its inception. In less than 10 years, chlorhexidine impressively achieved national coverage.

Today, more than 1.3 million newborns throughout the country have benefited from this simple treatment.

The Government of Nepal has been instrumental in scaling up chlorhexidine. From integrating it into packages that promote maternal and child health, to procuring chlorhexidine tubes and training healthcare workers, the government has been a strong advocate for use of the antiseptic.

The introduction of chlorhexidine in Nepal was further guided by the Chlorhexidine Working Group, a team of representatives from various local and international organizations. Hosted by USAID’s partner PATH, this group was formally established in 2012 to help speed up the scale-up progress.

Typically, decades pass before global health innovations take off in low-and-middle-income countries, according to an analysis by the Bill & Melinda Gates Foundation, Dalberg Global Development Advisors and the Boston Consulting Group. The speed of the chlorhexidine scale-up in Nepal compares favorably to health innovation launches in the United States and other developed countries, which typically take about five years.

So, the question then becomes, how can easy wins from the successful scale-up of a life-saving, low-cost intervention in Nepal be carried over to more countries and across other interventions?

According to a recent report, some factors that contributed to the rapid scale up of chlorhexidine in Nepal and beyond included the ability to produce it locally, extensive market research, policy and advocacy work, and collaboration between government and the private sector.

From the outset of the program in Nepal, the Chlorhexidine Navi Care Program, implemented by John Snow Inc. (JSI), was designed to serve as a “living university” for chlorhexidine scale-up. JSI, USAID and the Government of Nepal carefully documented what was working – and just as importantly, what was not working – to share invaluable lessons.

These organizations partnered together to host learning visits for officials from countries interested in introducing and scaling chlorhexidine. All program-related materials were also made publicly available for other countries’ use.

The impact of Nepal’s success reached beyond its borders and paved the way for countries such as Nigeria, Bangladesh, Pakistan and the Democratic Republic of Congo to begin their own journeys to use chlorhexidine to reduce high rates of newborn deaths.

Nigeria, a country with the third-highest number of newborn deaths in the world, has made great strides — from starting chlorhexidine pilot programs in 2013, to developing and implementing a national scale-up strategy and implementation plan by 2016.

As the use of chlorhexidine for preventing newborn deaths continues to grow, the global health community must keep on exploring new ways to introduce and scale up proven life-saving interventions.

The goal? To create a healthier world for generations to come.


Mateo Haddad, Global Health Communications Intern; Bethany Reyes, Data Science Intern.

In Belarus, Women Lead the Way

A woman sits with a microphone in front of a USAID banner

Margot Ellis speaking at Venture Day Minsk 2018. / Imaguru

One thing I’ve learned from working at USAID is no matter what the data says, you need to see what’s happening on the ground, too. This proved to be the case in Belarus, where USAID is transforming the business and social landscapes for women.

Last month, our Belarus Country Office Director Victoria Mitchell Avdiu was asked to speak on a panel about women’s representation in entrepreneurship. Current data suggests that gender equality is relatively high in the country. However, at Victoria’s presentation, the room was unexpectedly packed.

On a Tuesday evening in Minsk, nearly 100 young women came to hear guidance about how they could break through the barriers that too often hold working women back. They wanted to know how to build confidence, where to find mentors, and how to pursue meaningful professional paths when there may be few female role models ahead of them.

A combined image of women speaking into a microphone

Victoria Mitchell Avdiu (right) and crowd during Q&A at a Women in Entrepreneurship event. / Imaguru

Do those questions sound familiar? I imagine every woman reading this, no matter what country they’re from, can relate. I certainly can.

During my career in business, I spent some time working in the automotive industry. Like so many women in male-dominated fields, I assumed that I should hide my skills more traditionally associated with women. I had no one around to tell me otherwise. I quickly realized, though, that those very skills – empathy, observation, cooperation, sensitive communication, humor – were actually some of my strongest assets. My instinct was to build relationships.

I learned that embracing my skills and instincts as a woman offered a new perspective in my workplace and demonstrated that I could be an effective leader.

This is an area where the data and on-the-ground experience perfectly align: numerous studies indicate that the participation of women leads to better development outcomes. It’s the reason that one of USAID’s global objectives is empowering women and girls. We need to make sure women have the support they need to not just be included, but to succeed.

In Belarus, USAID provides strong support for women as they gain new opportunities and work to become leaders. New startups in Belarus’s tech and business fields usually have male-dominated teams, with women making up less than 10 percent. In contrast, at USAID-supported startups, women make up more than 30 percent of the teams. In fact, last year more than half of the beneficiaries of our business finance programs were women.

In USAID’s Community Connections Exchange Program, interested Belarusians undergo a rigorous selection process to participate in a short-term exchange to the United States, where they learn about best practices in a variety of professional fields and take part in programs including innovative entrepreneurship, teaching business to youth, and empowering women to resolve community issues. This past year, close to 60 percent of participants were women. In the past decade, over 400 women have benefited from this exchange, gaining new skills from America and returning to become leaders within their home communities in Belarus.

I’m proud of the data coming out of Belarus. But, of course, what often matters most is not just numbers but what’s happening on the ground. That’s why I’m especially proud of who is delivering USAID support in Belarus because we lead by example.

Our Belarus office is unique in that every one of our staff members is a woman – from the director who leads meetings with diplomats and government officials, to the private sector development specialist who supports a better environment for women entrepreneurs, to the administrative assistant who keeps the office organized and helps us accomplish our work.

Regardless of who benefits from USAID’s assistance to Belarus, women have had a hand in that powerful support.

For USAID to fulfill its promise to empower women and girls around the world, we have to look at not just the numbers but also the experience. If Belarus teaches us anything, it’s that women can lead the way.


Margot Ellis is the Senior Deputy Assistant Administrator in USAID’s Bureau for Europe and Eurasia.

Closing the Gender Digital Divide: WomenConnect Challenge Brings 20 Semi-Finalists to DC for Solver Symposium

A woman speaks from a podium

Michelle Bekkering, USAID’s Senior Coordinator for Gender Equality and Women’s Empowerment, speaks at the Solver Symposium where aspiring innovators gathered to network and strengthen ideas to bridge the gender digital divide. Credit: Kevin Koski for USAID

If you are reading this, you are likely doing so on a smartphone, tablet or computer. Today, many of us take for granted how easy it is to stay connected, learn, network or even watch our favorite show, anytime and anywhere. Everything is at our fingertips.

We can take classes online, register our kids for school, make doctor’s appointments, buy groceries and even sell items from the comfort of our homes to destinations all over the world.

Unfortunately, while this is my reality, technology is not readily accessible to millions of women around the world, resulting in a growing gender digital divide.

Almost 2 billion women in low- and middle-income countries still do not own mobile phones. The number of women without access to a computer is even higher.

Barriers such as cost, lack of network coverage, fear on harassment or lack of digital literacy all contribute to the fact that women in developing countries are nearly 25 percent less likely to be online than men—and that number is closer to 50 percent in some countries.

This isn’t just about entertainment or social connections. We need to reduce this divide, so half the world’s population can benefit from life-enhancing information, and commercial networks and financial services which can reduce poverty and drive inclusive economic growth.

At USAID, we are leading efforts to close the gender digital divide and empower women and girls to access and use digital technology to drive improvements in health, and education and economic opportunities for themselves and their families.

Earlier this year, Advisor to the President Ivanka Trump and USAID Administrator Mark Green launched the WomenConnect Challenge to identify and accelerate comprehensive solutions to closing this critical gender digital divide.

The response was amazing. We received more than 500 applications from almost 90 countries in every corner of the world.

This week, we are welcoming the 20 WomenConnect project semi-finalists to Washington, D.C. at a Solver Symposium to hear their ideas for how to bridge this divide. These participants will benefit from the expertise of USAID and our partners in digital solutions as they focus on innovations that can advance women’s access to digital tools in the most underserved regions of the world.

USAID welcomed 20 WomenConnect project semi-finalists to Washington at the Solver Symposium to help them shape proposals for innovative ideas to help bridge the gender digital divide. Credit: Kevin Koski for USAID

The innovative solutions that Solver Symposium participants are proposing will shape the future of women’s empowerment in their respective countries. Their solutions aim to tackle deep-rooted social norms; teach crowdmapping skills; address women’s and girls’ safety on- and off-line; and increase women’s financial knowledge and inclusion through digital financial services and expanded markets.

Participants will learn to make their solutions the strongest possible in hopes of becoming one of 10 finalists that are funded to pilot their projects.

The workshop has another intangible bonus: it provides a platform to build goodwill among the United States and our partners around the world—solvers like these WomenConnect semi-finalists—leading to collective action around some of the world’s toughest problems. It’s about changing the relationship from benefactor and beneficiary, to recognizing we are partners on their development journey to self-reliance. And through WomenConnect, we are poised to get there even faster.

If you would like to join this effort or receive email updates from the WomenConnect team, please visit the WomenConnect Challenge website.


Michelle Bekkering is the USAID Senior Deputy Assistant Administrator of the Economic Growth, Education and Environment Bureau and USAID’s Senior Coordinator for Gender Equality and Women’s Empowerment. Follow her @USAIDMBekkering.

The Time to Make Progress? Right Now.

How USAID and our partners are supporting innovations to save mom’s lives around the globe

A group of women medical practitioners share a smart phone to look at the app

Providers in Liberia using the mobile application Open Development have developed through their SL@B award/ Ilyse Stempler, Open Development

The theme for this year’s International Women’s Day is Press for Progress—a call to action for the global community to come together to demand gender equity.

While women deserve fair treatment in health care throughout their lives, there is no other milestone as poignantly deserving as the moment when a woman becomes a mother. It is a time when she and her baby are most vulnerable and their health outcomes are inextricably linked to each other.

Through Saving Lives at Birth (SL@B), USAID and its partners—the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, the U.K’s Department for International Development and the Korea International Cooperation Agency—support 116 unique innovations spanning new or improved technologies, scientific advancements, improved service delivery models and innovative approaches to empower and create demand for health services. Each addresses a critical challenge during the continuum of care for both mom and baby.

Here’s why our work is so important. Over the last two decades, we have seen a 37 percent reduction in maternal mortality and 40 percent reduction of under 5-mortality globally.

Still, those efforts aren’t enough. Progress to reduce newborn deaths has been significantly slower. Today, an estimated 2.6 million stillbirths, 2.7 million neonatal deaths and 303,000 maternal deaths occur globally each year, signaling a major gap in interventions specifically around the time of delivery.

This gap is particularly acute in poor, underserved communities and among women who are disadvantaged.

So how do we address this gap? We have some innovative ideas that have leapfrogged conventional approaches, and are showing success.

With Massachusetts General Hospital (MGH), we are helping tackle the most common cause of maternal morbidity and mortality in developing countries, postpartum hemorrhage (bleeding after birth). With SL@B support, MGH is scaling its next generation uterine balloon tamponade (UBT) system and training curriculum for health care workers who treat uncontrolled postpartum hemorrhage. They have introduced the device in over 550 facilities across Kenya and Sierra Leone and saved over 600 lives, while encouraging interest and use of the UBT in 22 countries.

We are helping the Liberian government engage private health care providers, drive improvements in quality maternal care and empower women by giving them greater choice in where to seek care. In partnership with D-Tree International and Results for Development, SL@B is supporting Washington, D.C.-based Open Development to streamline and automate patient, provider and payer transactions in Liberia through a mobile application.

A newborn baby wears the BEMPU Hypothermia Alert device on its wrist

“At the weekly follow-up, [the mother] came back [to the clinic] and said that the funniest thing had happened—the grandfather had [been alerted via the bracelet that the baby’s temperature was dropping] and started doing kangaroo care. In that region, it’s pretty uncommon for men to be caring for the infant. For me, that was a really powerful moment. Annika Gage from Bempu recalling her interaction with a midwife in Papua New Guinea who had put the bracelet on a premature baby before she left the hospital./ Bempu Health

We are equipping mothers with tools and resources that empower them to seek care for their newborns, like the BEMPU Hypothermia Alert Device. It is a newborn temperature-monitoring wristband that a baby wears and can alert mothers or other caregivers if their newborn’s temperature falls too low. Moms can immediately spring into action with Kangaroo Care, also known as skin-to-skin care and usually between mom and baby. It is a simple, yet effective way of regulating a baby’s heart rate and body temperature to prevent the onset of hypothermia-related complications or death, particularly for low-birth weight and premature babies. This innovation, named one of Time’s Top 25 Inventions of 2017, has not only improved health outcomes for an estimated 10,000 babies, but it is enabling women and their families to practice healthy behaviors in caring for their newborns.

SL@B is grounded in the belief that significant breakthroughs in innovation often come about when new ideas and disciplines are applied to long-entrenched problems. The projects described above are just three examples of how innovations can help us accelerate progress in reducing maternal and newborn mortality and achieving gender equity in health outcomes globally.

Our innovators are a testament to the fact that good ideas can come from anywhere and with strategic partners, support, and determination to save lives, they can create real impact.

Let today serve as a reminder that together, we have the opportunity to close the intervention gaps for pregnant women and their babies and turn insurmountable development challenges into solvable problems. Their futures―and our world —depend on it.

Sofia Stafford is a Program Assistant in the Center for Accelerating Innovation and Impact and helps manage the Saving Lives at Birth Grand Challenge.

Making Education Safe for All

Classmates in the Democratic Republic of Congo celebrate their success after a performance at an event organized to celebrate the International Day of the Girl Child. Photo Credit: Julie Polumbo​

Would you want to participate in class if there was a chance your teacher might hit you if you made a mistake? Could you concentrate on the lesson if your classmates were making fun of your appearance?

For millions of children around the world, violence in schools is a daily reality.

While parents and communities expect schools to be safe and protective environments, research shows that students face high levels of violence, including corporal punishment, bullying, sexual harassment and assault, which is called “school-related gender-based violence.”

This abuse has negative impacts on girls’ and boys’ physical and mental well-being, and also hinders their ability to learn, stay in school and achieve their full potential.

Recent research [PDF, 1.6MB] commissioned by USAID reveals that students who experience bullying have lower test scores in reading, math and science. Additionally, we know that corporal punishment is linked with poor academic performance, low class participation and poor health and  well-being [PDF, 545K].

Adolescent girls are also especially at risk for sexual violence in schools, which can lead to dropping out, pregnancy, HIV/AIDS and early marriage—all factors we know to perpetuate the cycle of poverty.

Evidence also suggests that the cost of education, including school fees, uniforms and books, may stop some poor families from sending their girls to school. Too many schoolgirls, who are keen to continue their education, fall prey to sexual exploitation by older men, exchanging sex for money, food, mobile phones and school fees.

Ending violence in schools is not only the right thing to do, it’s the smart thing to do. We know that educated, employed and civically engaged youth drive economic growth, democracy and prosperity. We know that students who feel supported and safe in their schools learn best. Failing to protect our children can further perpetuate cycles of violence, instability and unrest

This is why USAID couples its investments in teaching children to read with strategies that will keep them safe—including in crisis and conflict environments. A lasting end to school violence requires collaboration with host-country governments and local communities spearheaded by  mothers, fathers, community leaders, teachers and school principals.

African-led institutions, such as the Association for the Development of Education in Africa, help foster policy dialogue between development agencies and local policymakers to share ideas, lessons learned and knowledge on educational reform. The association empowers African ministries of education to directly take on barriers to education, such as school violence.

USAID also partners with African governments to end school-related gender-based violence throughout the continent.

Ugandan children perform at a two-day conference on gender-based violence hosted with the Ugandan Ministry of Education and Sports. Photo Credit: RTI International/LARA

In Uganda, the Literacy Achievement and Retention Activity works with the Ministry of Education to train teachers, children and communities to recognize, prevent and respond to violence within schools. By creating positive and supportive school climates, Ugandan girls and boys are more likely to participate in class and stay in school, clearing their path to educational achievement and economic success.

With support from the U.S. President’s Emergency Plan for AIDS Relief, USAID works in schools to help adolescent girls become Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) young women. The DREAMS Initiative supports violence prevention programs in schools across 10 sub-Saharan countries where girls are at the highest risk of contracting HIV/AIDS.

Across the continent, we see promising new approaches that help us understand what works to prevent and respond to violence within schools. We all must support more rigorous research and evaluations to build our global evidence base on violence prevention programming and policy.

Read more about this year’s 16 Days of Activism against Gender-based Violence campaign.


Cheryl L. Anderson is the senior deputy assistant administrator in USAID’s Bureau for Africa. She previously served as mission director for USAID’s Southern Africa, Ghana and East Africa Regional missions.

Oley Dibba-Wadda is the director of Human Capital, Youth and Skills Development at the African Development Bank. Dibba-Wadda has also served as the executive secretary for the Association for the Development of Education in Africa and executive director of Forum for African Women Educationalists.

What Does ‘Back to School’ Mean for Children in Crisis and Conflict?

Aisha Mohammed, who fled with her family when Boko Haram attacked her village in Northeast Nigeria was able to continue her education through a non-formal learning center funded by USAID. Erick Gibson/Creative Associates International for USAID

Aisha Mohammed, who fled with her family when Boko Haram attacked her village in Northeast Nigeria was able to continue her education through a non-formal learning center funded by USAID. Erick Gibson/Creative Associates International for USAID

As summer winds down here in the United States, “Back to School” displays with colorful arrays of supplies remind us that students and teachers are preparing for the coming year.

But for many children around the world, going back to school in the traditional sense is elusive.

Each year, conflicts and crises halt or delay the education of 80 million children worldwide. Schools, books and materials are destroyed. Children are forced to leave their homes and communities, often with only the clothes they’re wearing.

In many long-standing conflicts, children spend a significant amount of time out of school. Because the average duration of displacement is 20 years, many children will spend their entire childhood outside of the traditional classroom. The longer they’re out, the less likely they are to ever go back.

However, we know that school is necessary not only for their continued education, but also their emotional and physical protection—and this is critical when their worlds are in chaos.

What ‘Back To School’ Means for Children in South Sudan and Northeast Nigeria

When people are forced from their homes, schools and communities by conflict, USAID partners with development and local organizations to act quickly to help redefine what “school” looks like—ideally so that children are back learning as soon as possible. The conflict or crisis may be ever changing, but USAID seeks to keep learning a constant factor in children’s lives.

Aisha Mohammed (third from left), age 17, and her friends take a break after classes at a USAID-funded non-formal learning center in the capital of Borno State, in Nigeria. Erick Gibson/Creative Associates International for USAID

Aisha Mohammed (third from left), age 17, and her friends take a break after classes at a USAID-funded non-formal learning center in the capital of Borno State, in Nigeria. Erick Gibson/Creative Associates International for USAID

In South Sudan, Nyaradio Gatkuoth and her family fled to a safe haven at the United Nations compound in the capital city of Juba after civil war erupted in 2013—when she was 15 years old. Nearly four years later, conflict continues to disrupt millions of lives in South Sudan.

South Sudan has the world’s highest proportion of out-of-school children, with nearly 70 percent of primary school-aged children missing out on education. Since a political crisis erupted into civil war in 2013, more than 800 schools have closed, and an estimated 900,000 children have abandoned their studies. Today, the formal educational system is still in crisis.

Nyaradio said living in the UN Protection of Civilians site in South Sudan was “like a prison” because she was never able to leave the site. However, she says, attending the Hope Primary School at a site run by UNICEF, and supported by USAID, is a bright spot in her day.

As part of USAID’s Back to Learning initiative, we have supported UNICEF in enrolling more than 430,000 South Sudanese children and adolescents in school, including recently demobilized child soldiers. We have also helped establish more than 950 temporary learning spaces since the civil war began.

Seventeen-year-old Aisha Mohammed grew up in the town of Gwoza, in Northeast Nigeria, and was forced to flee with her family when Boko Haram attacked her village.  Eventually, they settled in the urban center of Maiduguri, which houses hundreds of thousands of Nigerians seeking refuge from the horrors of the ongoing insurgency. As a result, Aisha missed out on formal schooling for nearly two years.

The Boko Haram insurgency has had devastating effects on the education sector in Northeastern Nigeria. UNICEF estimates that nearly 1 million school-aged children have been forced to leave their homes and communities as a result of the ongoing violence.  At the same time, an estimated 3 million children have no access to education across the Northeastern states of Borno, Adamawa and Yobe—those most acutely affected by the insurgency.

Through the Education Crisis Response program, USAID is providing non-formal education in the places where formal schools don’t exist, or where they are too overcrowded to accommodate the influx of children fleeing the insurgency. The curriculum includes basic math and literacy, but is also helping children deal with the emotional effects of what they have experienced. USAID has established more than 1,400 learning centers in Northeast Nigeria, helping 88,000 children like Aisha go back to school.

What ‘Back To School’ Means for USAID During a Conflict or Crisis

USAID is working around the world to expand equitable access to education for children and youth in crisis and conflict-affected environments. For us, “Back to School” during a conflict or crisis means:

  • Providing safe learning opportunities for students and teachers, especially the most vulnerable (such as girls and children with disabilities);
  • Rebuilding education systems, including support to teachers; and
  • Using conflict-sensitive education programs, community engagement and disaster-risk reduction activities to prevent and mitigate future conflict.

Today’s humanitarian crises are more complex and protracted—like the ones in Northeast Nigeria and South Sudan—and require programs that are responsive, flexible and tailored to the context. These programs help young people thrive despite their circumstances, and contribute to peacebuilding and economic growth in their communities.

Although conflict forced her and her family from their home, Nyaradio has completed grade 8 and is waiting to join secondary school this year. “I want to study up to university. I want to be a journalist one day,” she says.

She also says school makes her happy: “We study, sing, dance and forget about our problems.”

Tanzania’s Young Leaders Bring Innovation to Development Challenges

Abella Paul Bateyunga. /Young Business Leaders of Tanzania

Abella Paul Bateyunga. /Young Business Leaders of Tanzania

In Kiswahili, “bora” means better. Two years ago, Abella Bateyunga, 29, founded the Tanzania Bora Initiative to give y oung Tanzanians a voice, a sense of belonging, and a connection to other youth who want to change their country for the better.

The initiative empowers young Tanzanians through data-driven projects, youth-led television shows on political participation, and training for young girls in computer coding.

The Tanzania Bora Initiative leadership team. / Tanzania Bora Initiative

The Tanzania Bora Initiative leadership team. / Tanzania Bora Initiative

Abella founded the initiative after she returned from two months in the United States on a fellowship with the Young African Leadership Initiative (YALI). Funded by the U.S. State Department and USAID, the fellowship is a huge honor; only 1,000 youth across Africa are chosen each year. YALI fellows get to meet other young rising African leaders in their cohort and are offered opportunities for leadership training at U.S. universities.

Abella Bateyunga with the Tanzania Bora Initiative team. / Michael McCabe, USAID

Abella Bateyunga with the Tanzania Bora Initiative team. / Michael McCabe, USAID

As the 2015 national elections in Tanzania approached, Abella thought about new ways to engage Tanzanian youth to both vote and mobilize peacefully. She also thought of ways to empower youth to use data-based evidence and advocacy to engage local and national leaders on social issues.

Abella’s background as a lawyer and former radio reporter for the BBC in Tanzania positioned her to develop a strategy to engage youth in the election and in data-driven development efforts for employment and youth voice.

Girls in the “She Codes for Change” course. / Tanzania Bora Initiative

Girls in the “She Codes for Change” course. / Tanzania Bora Initiative

Creating Youth Dialogue in Tanzania

Many countries in sub-Saharan Africa  are facing a “ youth bulge ” due to high fertility rates; in Tanzania, over 73 percent of the population is under 30.

“She Codes for Change” provides a safe space for girls to learn coding. /Theirworld, Mticka Almas

“She Codes for Change” provides a safe space for girls to learn coding. /Theirworld, Mticka Almas

In Tanzania and other countries, the government and key civil society partners have developed national plans of action to reduce violence against children and youth that stems from domestic violence and other community violence. In other countries, governments are restricting the ability of civil society organizations to speak out on the rights of minority or excluded groups, including youth who are underrepresented in decision-making.

With support from USAID’s Consortium for Elections and Political Process Strengthening and implementing partner the International Republican Institute, Abella started the Tanzania Bora Initiative with a small budget and a core team of five savvy young social media leaders.

Participants of the Kijana Wajibika (Youth Be Responsible) consortium, which demands youth accountability and participation in civic issues. /Kijana Wajikia and Restless Development Tanzania

Participants of the Kijana Wajibika (Youth Be Responsible) consortium, which demands youth accountability and participation in civic issues. /Kijana Wajikia and Restless Development Tanzania

In just two years, Abella and her team have brought innovation to Tanzanian media and civil society with initiatives like Data Zetu, funded by the U.S. President’s Emergency Plan for AIDs Relief (PEPFAR) in partnership with the Millennium Challenge Corporation to promote data-driven advocacy by youth.

Working with artists and young journalists, Abella helps create dialogue in communities based on evidence and data about what is happening and what works through community solutions. Data Zetu empowers youth to gather data from the local government on services and analyzes it to determine areas in need of improvement.

Participants of the Kijana Wajibika (Youth Be Responsible) consortium, which demands youth accountability and participation in civic issues. /Kijana Wajikia and Restless Development Tanzania

Participants of the Kijana Wajibika (Youth Be Responsible) consortium, which demands youth accountability and participation in civic issues. /Kijana Wajikia and Restless Development Tanzania

Other activities have included engaging pop music groups in Temeke District — one of the largest and poorest areas in southern Dar es Salaam — through its Arts for Change project. Abella and her team work with these musicians to write songs that champion their issues.

Given the rise in violence in Tanzania, Abella partnered with USAID-supported partner Search for Common Ground and others to counter violence in the home and community, as well as violent extremist messaging, through television shows, youth peace festivals and media campaigns.

Kijana Wajibika recognizes youth as an asset who can contribute and lead change. /Kijana Wajikia and Restless Development Tanzania

Kijana Wajibika recognizes youth as an asset who can contribute and lead change. /Kijana Wajikia and Restless Development Tanzania

Abella and the Tanzania Bora Initiative also supported the Kijana Wajibika (Youth Be Responsible) consortium funded along with the Restless Development movement   – for youth to demand accountability and participate in civic issues and learn to use data for decisions. Abella’s TV program creates data ambassadors and trains journalists, particularly young women, to collect data and empower youth on topics related to the national youth agenda: employment, sexual health and education.

Recognizing that youth often don’t know their rights, Abella created the “Know the Constitution” campaign — an online portal which is complemented by a television show called “One Voice” (Sauti Moja) serving as a college competition on rights and the constitution.

Amplifying citizens’ voices through data. /Data Zetu

Amplifying citizens’ voices through data. /Data Zetu

Tanzania Bora Initiative-led activities under Data Zetu. TBI/Data Zetu

Tanzania Bora Initiative-led activities under Data Zetu. TBI/Data Zetu

Abella also recognizes the importance of skills-based opportunities for youth who want to make a difference. That was the impetus behind starting She Codes for Change in partnership with Apps and Girls . The program trains girls from each region on digital literacy and computer  coding.

“Creating mobile apps on issues that concern girls has a transformative effect on their opportunities,” said Abella. “The girls have developed apps on female genital mutilation prevention, bus fares, fashion and rights.”

Abella Paul Bateyunga was chosen by USAID partner IREX as a Young African Leadership Initiative fellow in 2014. / Courtesy of Abella Bateyunga

Abella Paul Bateyunga was chosen by USAID partner IREX as a Young African Leadership Initiative fellow in 2014. / Courtesy of Abella Bateyunga

Abella describes her vision for how international development organizations such as USAID can best approach engaging youth as partners in development:

“Youth bring three key tools to the development field: Innovative ideas, a wicked broad knowledge of how to mobilize networks via media (especially new media) and record numbers of youth in Tanzania and around the world. We aren’t the hope of tomorrow, we are changing things today.”

The Power of Radio in the Fight for Girls’ Education in Malawi

Marshall Dyton, the editor-in-chief of Malawi's first online Muslim publication during a live broadcast on Kumakomo Radio. / IREX

Marshall Dyton, the editor-in-chief of Malawi’s first online Muslim publication during a live broadcast on Kumakomo Radio. / IREX

Most people in Malawi  rely on radio as their primary source of news and information, as 85 percent of the population do not have access to television or newspapers.

Marshall Dyton
 is no stranger to this fact — he recognizes radio’s power and its critical role in educating and informing rural communities across the country, including his own in Mangochi District in eastern Malawi.

As a Mandela Washington Fellow
— chosen as part of the Young African Leaders Initiative (YALI) program in 2015 — and editor-in-chief of Malawi’s first online Muslim publication, Marshall first produced radio broadcasts during an internship at the Kumakomo Community Radio Station in Zimbabwe, which he secured with support from USAID. There, he led a team of a dozen volunteers to produce content.

After completing the internship, Marshall decided to put his newfound skills to use to engage communities about a plight sweeping Malawi — the negative impact of child marriage on education for women and girls.

This is an issue that Marshall understood personally — his mother was one of the few women who went to school in his community, despite a culture that prioritizes the education of men and boys.

Marriam Larry (left), from Wumi Wumo Foundation and part of the second cohort of USAID's Regional Leadership Centers, and Halima Twabi (right), from Malawi Girls and a 2016 Mandela Washington Fellow. / IREX

Marriam Larry (left), from Wumi Wumo Foundation and part of the second cohort of USAID’s Regional Leadership Centers, and Halima Twabi (right), from Malawi Girls and a 2016 Mandela Washington Fellow. / IREX

Shedding Light on a Dark Subject

According to UNICEF, Malawi has the 11th-highest child marriage rate in the world, with nearly one in two girls married before the age of 18. Human rights activists have long argued that child marriage is a barrier to education particularly for girls, making them vulnerable to cycles of poverty and violence.

Bashir Amin, of the Malawi Broadcasting Corporation, the state-owned radio station. / IREX

Bashir Amin, of the Malawi Broadcasting Corporation, the state-owned radio station. / IREX

Early this year, the Malawian government voted to amend the constitution to remove a provision that allowed children to marry at 15. Now, marriage before the age of 18 is illegal, but challenges remain.

To join the fight against child marriage and other issues that affect women and girls in marginalized communities, Marshall wanted to engage directly with communities to create change. Inspired by his time at the Kumakomo Radio, he organized a radio talk show that brought together chiefs, religious leaders, girls, women and men to confront child marriage and discuss the importance of education for girls.

Florence Mwitha, a recent graduate, representing girls during a live broadcast of Kumakomo Radio (left) and Twaina Sanudi, an activist advocate of Muslim girls’ rights (right). / IREX

Florence Mwitha, a recent graduate, representing girls during a live broadcaston Radio Islam (left) and Twaina Sanudi, an activist advocate of Muslim girls’ rights (right). / IREX

The show was a collaboration across the YALI and Mandela Washington Fellows networks, and with Regional Leadership Center participants — young leaders between 18 and 35 enrolled in USAID-supported leadership training programs in sub-Saharan Africa — who took turns at the microphone during the live show.

Previously, issues around child marriage, women’s education and the status of women were rarely discussed, and they remain largely taboo. Marshall’s goal was to take the discussion to the national stage.

A Malawian schoolgirl reads out loud to her class. USAID is working to improve reading skills in primary school students and create safe spaces for girls to learn. / Amos Gumulira, Feed the Children

A Malawian schoolgirl reads out loud to her class. USAID is working to improve reading skills in primary school students and create safe spaces for girls to learn. / Amos Gumulira, Feed the Children

“With radio we spent less but achieved more,” Marshall said.

The show was broadcast live for two hours and reached an estimated 3 million listeners on national radio. The aim was to increase awareness within Muslim communities in Malawi about education, the misinterpretation of religious text, and why communities must confront embedded cultural values that lead to child marriage.

Marshall Dyton during the Mandela Washington Fellowship Presidential Summit in 2015 in Washington, D.C. / IREX

Marshall Dyton during the Mandela Washington Fellowship Presidential Summit in 2015 in Washington, D.C. / IREX

“Radio allows for debates and discussions to be open and transparent, and can be a critical tool for building consensus among communities and citizens,” Marshall said.

The talk show was organized under the Girl Child Education Movement, an initiative that Marshall founded to help girls in his community access education in rural Malawi. Broadcast on Malawi’s only Islamic radio station, Radio Islam, the event was designed to reach Malawi’s Muslim communities, who are vulnerable to discrimination given their religious and cultural background, Marshall said.

Creating Change Through Community Inclusion

As a result of the talk show, the Muslim Association of Malawi, who attended the event, agreed to open new offices in rural areas where communities can access up-to-date information about education and scholarship opportunities for girls.

Girl power in Chipoka, Malawi. /Amber Lucero-Dwyer

Girl power in Chipoka, Malawi. /Amber Lucero-Dwyer

Inspired by the success of his radio show, Marshall’s dream is to start a community radio station that is run by youth from diverse religious backgrounds. He believes that one way to tackle challenges facing marginalized communities and women in Malawi is to discuss these issues in an open forum.

Like in Malawi, USAID supports programs in over 30 countries to strengthen journalistic professionalism for individuals such as Marshall, establish media management skills and promote free media.

About the Author

Neetha Tangirala is a Senior Program Officer at IREX.

Raising Goats (and Confidence) in Uganda

Women share highly nutritious goat milk from their own livestock with their children to improve and diversify their diets. / ACDI/VOCA

Women share highly nutritious goat milk from their own livestock with their children to improve and diversify their diets. / ACDI/VOCA

One key to women’s empowerment is self-confidence. When a woman truly realizes her worth and can publicly act on that confidence, the world changes for her.

One woman living in the Karamoja region of Uganda—where tradition dictates much in the lives of men and women—had little confidence in her own abilities, that is until she was offered an opportunity to generate income for herself through USAID’s Resiliency through Wealth, Agriculture, and Nutrition in Karamoja Project.

When Joyce Owalinga first married, her husband Sagal managed the family’s money, choosing when and how to spend it. “My husband controlled all the money, and when he went away for long periods of time for work, my children and I had very little food. We would sometimes go to bed hungry.”

Despite economic disempowerment, Joyce, like many women in her village, is responsible for feeding her family. To come up with the money, she collected and sold firewood and charcoal and did odd jobs for others, yet she still failed to scrape together enough for her family’s basic needs. “I couldn’t even afford salt and flour, and I had nothing to call my own.”

To empower women as income earners in their communities—and strengthen food security in Karamoja while diversifying livelihoods for rural families—USAID partnered with ACDI/VOCA and Welthungerhilfe to introduce a hardy breed of goat—Galla, or “milk queens” into the region.

Livestock owner and her family show off their “Milk Queen” goat. / ACDI/VOCA

Livestock owner and her family show off their “Milk Queen” goat. / ACDI/VOCA

The project’s unique approach organized 211 women’s livestock groups, comprised of about 10 women each and initially consulted  with village elders to determine how to best counter expectations of traditional roles and to secure support, as men typically care for livestock and keep the money from sales.

After attending a training to learn how to care for the goats, Joyce received five of her own.  She and other group members attended additional trainings on health management and how to build shelters for the animals. The  goats began to thrive under their care.  

As the women demonstrated their herding skills, gender norms in communities began to change little by little. When Joyce went into the village to sell her goats’ milk, she was able to keep the proceeds and reinvest in the business. After the group took part in animal care training sessions, Joyce confidently spoke to others about how to trim a goat’s hooves. As she spoke, Sagal listened carefully to learn more about the intricacies of animal care.

A recent assessment of this project revealed that 65 percent of community members now recognize livestock group members as new leaders in their communities. And, perhaps not surprisingly, 61 percent of members reported improved marriage dynamics as a result of owning the goats. This holds true for Joyce and Sagal. He quietly mentioned that he now holds more respect for Joyce and intends to give her the first calf born this season.

Lokibeyia Livestock Group Chairwoman Rachel Akol herds one of her many goats.

Lokibeyia Livestock Group Chairwoman Rachel Akol herds one of her many goats.

Now chairwoman of her livestock group, Joyce has successfully increased her stock of goats from 5 to 15. She recently made the decision to sell one of her goats and used the profits to start her own business.

“Now, I have something that I can call my own,” she proudly noted. “As chairperson of my group, I can also now speak with confidence. The other women and community members respect and listen to me, and my husband now respects me.”

As Joyce and other group members grow more confident, they are leading by example and teaching their children how to spot health problems in goats. By involving a new generation in this activity, children now understand that both men and women can own and take care of livestock, fostering gender equality within the children’s minds.

This project represents lasting, sustainable change in Karamoja—a catalyst tool for empowerment that is ushering in a new way of looking at the world.

Food security, economic empowerment and gender equality must all be seen as crucial elements to community resilience, and the project is making strides to ensure that communities in Karamoja value all of these.

Gender equality and women’s empowerment are a core pillar of sustainable development, and USAID currently supports gender programming in more than 80 countries. For societies to thrive, women and girls must have access to education, economic resources, healthcare, and technology.

To achieve USAID’s mission of ending extreme poverty and promoting the development of resilient, democratic societies, programs seek to ensure inclusivity, strengthen the voices of the marginalized and vulnerable, and help women and girls reach their full potential.


Mark Mitchell is the deputy chief of party for the USAID Resiliency through Wealth, Agriculture, and Nutrition in Karamoja project. Paul Guenette is ACDI/VOCA’s chief communications officer.
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