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Building Back Together: Nepal, One Year Later

USAID recovery and reconstruction projects, like Baliyo Ghar, train construction professionals and homeowners on how to build back safer using local materials and earthquake-resistant best practices. / Laxman Shrestha for USAID/Nepal

USAID recovery and reconstruction projects, like Baliyo Ghar, train construction professionals and homeowners on how to build back safer using local materials and earthquake-resistant best practices. / Laxman Shrestha for USAID/Nepal

Today marks a most solemn occasion — it has been a year since the devastating 7.8 earthquake in Nepal took 9,000 lives and injured 25,000 people. Nepalis lost their homes, their treasured monuments and, in some cases, their livelihoods. The past 12 months have been some of the most difficult Nepal has ever faced.

Since April 25, 2015, Nepal has suffered 445 aftershocks greater than 4.0, and a prolonged border and fuel crisis. There is no doubt Nepal has weathered a very turbulent series of storms.

But the clouds are beginning to clear.

This optimism is born of my firsthand experience working in Rwanda for the last four years. Like Nepal, Rwanda is a landlocked country reliant on its neighbors for access to waterways, fuel and other important imports. Rwanda also suffered a very dark hour in 1994 when it turned on itself.

But through significant reforms, Rwanda has seen sustained economic growth over the last decade, transforming into a knowledge-based, service-oriented economy — making it an increasingly valuable neighbor. The last parliamentary elections saw a majority of the seats taken by female candidates; other development successes, such as rapid poverty reduction and reduced inequality, have set the stage for even more success.

Rwanda’s story offers hope, assuring people that even in the darkest of times, a nation can emerge stronger and more focused on creating the future it wants — vibrant and reflective of people’s hopes and dreams.

To jumpstart recovery in the agriculture sector, USAID is delivering much-needed agricultural tools and supplies to farmers. / Derek Brown for USAID/Nepal

To jumpstart recovery in the agriculture sector, USAID is delivering much-needed agricultural tools and supplies to farmers. / Derek Brown for USAID/Nepal

Immediately after the earthquake, USAID mobilized its partners to provide recovery support. Our health programs are preventing the spread of diseases by ensuring access to clean water and proper hygiene, delivering family planning services and counseling to women, and distributing Vitamin A supplements to 3.2 million under-5 children.

Our education programs helped get children back to school quickly and created safe spaces for them. Our agricultural programs have distributed supplies and other farming tools so that fields and gardens could get replanted. And with the spike in human trafficking, our counter trafficking in persons programs are working to reintegrate women and girls back into their communities.

USAID’s reconstruction investments include our contribution to the World Bank’s Multi-donor Trust Fund, which is supporting an earthquake beneficiary survey and providing cash subsidies for housing. The survey, deployed in all of the 14 most-affected districts, assesses earthquake damage, house by house, informing the Government of Nepal’s National Reconstruction Authority who is in most need of the cash grants.

Another way USAID is supporting Nepal is through training and technical assistance. USAID is funding two housing reconstruction projects, Baliyo Ghar and Sabal, to train more than 13,500 local construction professionals and educate 285,000 affected homeowners on building earthquake-resistant homes over the next five years. These projects will also establish local-level reconstruction technology centers and demonstration homes, and offer vocational trainings.

Finally, USAID is supporting communication and outreach in partnership with the Government of Nepal so that affected households know where to access resources and services and are armed with simple, actionable steps to build back safer.

As we put the past year behind us, it is important to take a step back and acknowledge

everything we accomplished together with the people of Nepal. When disaster struck and before aid arrived, Nepalis picked each other up and supported their families and neighbors with shelter and food.

They define resilience and defy despair. I have only been here two weeks, and yet it is clear these qualities are inherent in the Nepali people. They are the heroes of the past year.

Over the next two weeks, USAID’s mission in Nepal will remember the 9,000 people who perished a year ago today and honor the local heroes who represent the best of Nepal. Follow us on Facebook and Twitter (#RebuildingLives) as we pay tribute to Nepal.

On behalf of the mission, I extend my deepest condolences to those who have experienced loss over the past year, and assure the people of Nepal that we remain a committed partner as we build back together. I’m hopeful for Nepal’s future, and I look forward to serving as USAID Nepal’s new Mission Director.

We stand with you.

ABOUT THE AUTHOR

Peter Malnak is the new Mission Director for USAID/Nepal.

The Real Heroes Behind USAID’s Nepal Earthquake Response

Nepal_Rubble

Last year’s earthquake in Nepal claimed the lives of nearly 9,000 people, injured more than 22,000 others, and damaged or destroyed more than 890,000 homes. / Kadish Das Shrestha, USAID

On April 25, a magnitude 7.8 earthquake struck central Nepal—the worst to hit the country in over 80 years. It caused widespread damage across the country, nearly destroyed entire villages, and triggered landslides and avalanches. The earthquake was followed by more than 100 aftershocks, including a magnitude 7.3 trembler on May 12.

I had lived and worked in Nepal for 18 years, establishing very close personal and professional ties during my time there. When I got first word of the earthquake, I immediately felt terror for the people and places I had come to love. Then, I went into response mode.

A medium sized urban search and rescue team made up of 57 members of the Los Angeles County Fire Department and 60,000 pounds of equipment, activated by USAID, board a C-17 Globemaster III at March Air Reserve Base, April 27, 2015. The team is in response to the magnitude 7.8 earthquake and subsequent aftershocks which struck near the city of Kathmandu, Nepal on April 25. The C-17 is assigned to the 337th Airlift Wing, Charleston Air Force Base, S.C. (US Air Force Photos by Master Sgt. Roy A. Santana/Released)

Within hours, USAID’s Disaster Assistance Response Team deployed to Nepal. / U.S. Air Force photos by Master Sgt. Roy A. Santana

Within hours, I was in a U.S. Air Force C-17 on the way to Kathmandu, leading a 136-person Disaster Assistance Response Team (DART) deployed by USAID’s Office of U.S. Foreign Disaster Assistance to coordinate the U.S. government’s response efforts.

Some of our work made front-page news, especially when our urban search-and-rescue teams assisted in two miraculous rescues: the first, a 15-year-old boy who was pulled from the rubble five days after the quake hit. The other involved a 41-year-old woman who was saved from a collapsed building 50 miles east of Kathmandu.

Nepal Rescue

The DART’s urban search-and-rescue teams helped rescue 15-year-old Pemba, five days after the earthquake hit. / Fairfax County Fire and Rescue

But in my opinion, the unsung heroes of this disaster were the Nepalese people, themselves, many of whom were able to play critical roles in their country’s response—all while dealing with a tremendous sense of loss.

More than a thousand people had the ability to save lives in their neighborhoods, communities and villages thanks to training and tools USAID has been providing for more than two decades.

Nepal sits on the boundary of two massive tectonic plates. Previous large-scale earthquakes occurred in 1833 and 1934, and we knew it would only be a matter of time before another catastrophic quake struck.  While we can’t stop earthquakes from happening, we knew we could help people better prepare and respond to disasters.

Bal Krishna 1

USAID’s DART meets with Dr. Vaidya, who implemented a disaster plan in his hospital with the skills he learned from a USAID program. This planning allowed Nepal’s largest medical facility to remain open after the earthquake, helping to save many lives. / USAID

Since 1998, USAID has supported the Program for the Enhancement of Emergency Response. This program helps Nepal’s disaster management agencies organize and conduct trainings on medical first response, collapsed structure search-and-rescue, and hospital preparedness for mass casualties following a disaster.

After taking one of these trainings, Dr. Pradeep Vaidya helped his hospital develop a disaster plan. As a result, Kathmandu’s Tribhuvan Teaching Hospital fastened furniture to the walls, laminated windows, prepositioned supplies, and installed a seismic-resistant blood bank.

These efforts allowed the hospital to stay open right after the earthquake; its doctors treated 700 patients and performed more than 300 surgeries.

CADRE

More than 600 people like Sanam and Kritica put their USAID training into action after the earthquake hit, helping their fellow Nepalese by providing first aid and distributing relief items./ Kadish Das Shrestha, USAID

We’ve also been training communities on basic life support, light search and rescue, dead body management, and best practices on how to respond to multiple casualties through a program called Community Action for Disaster Response, which we support in partnership with the American Red Cross and the Nepal Red Cross Society.

Because of this training, 600 team members deployed to hard-hit areas after the April 25 earthquake to participate in search-and-rescue operations, provide first aid to the injured, and assist with damage assessments and distributions.

Imagery captured during an aerial survey flight flown by members of Joint Task Force 505, May 7, shows areas affected by an earthquake in outlying villages near Kathmandu, Nepal. The Nepalese government requested the U.S. government’s assistance after a 7.8 magnitude earthquake struck the country April 25. U.S. military services came together to form JTF 505, which works in conjunction with U.S. Agency for International Development and the international community, to provide unique capabilities to assist Nepal. (U.S. Marine Corps photo by MCIPAC Combat Camera Staff Sgt. Jeffrey D. Anderson)

Experts trained by USAID assessed more than 126,000 structures to ensure they were safe after the earthquake. / U.S. Marine Corps photo by MCIPAC Combat Camera Staff Sgt. Jeffrey D. Anderson

Finally, for more than 15 years, we’ve been building a qualified pool of engineers and technical experts through our partnership with the Kathmandu-based National Society for Earthquake Technology.

We trained people on how to conduct seismic risk assessments and develop earthquake preparedness plans. After the earthquake struck, our partner mobilized 400 earthquake damage inspectors and 450 volunteers who surveyed more than 126,000 structures to ensure they were safe.

At the same time, we also trained homeowners and masons on how to make buildings more earthquake resistant—work that still continues to this day.

Nepal_Construction

Homeowners and masons rebuild using seismic-resistant building techniques. / NSET

While the April 25 earthquake caused significant damage, I’m proud that the preparedness investments we put in place prior to the disaster helped save lives. We now have a cadre of earthquake experts in the region with a depth of knowledge to make a difference in their communities. And these experts are grateful.

USAID Bill Berger head shot

After living in Nepal for 18 years, and working to help the country prepare for disasters, USAID’s Bill Berger led the Disaster Assistance Response Team that responded to last year’s earthquake. / Kadish Das Shrestha, USAID

All during my time in Nepal, I had people come up to me and tell me amazing stories of how their training helped them save others. By my calculation, we trained about a thousand Nepalese who then went out as first responders after the earthquake.

These investments must continue. History has shown that another big earthquake will be coming, perhaps even worse than the April 25 disaster. Hopefully, these stories prove that if you equip people with the right tools and training, they can make a real difference.

ABOUT THE AUTHOR

Bill Berger is the Senior Regional Advisor for South Asia for USAID’s Office of U.S. Foreign Disaster Assistance. During the Nepal earthquake response, Berger served as USAID’s Disaster Assistance Response Team Leader.

As the World Focuses on Zika, Malaria Continues its Deadly Toll

When you think about mosquitos these days, one disease likely leaps to mind: Zika.

The media has been sounding the alarm about the virus for months, particularly in Latin America, where health workers are on alert for pregnant women who may have become infected.

But another mosquito-borne disease kills a child every two minutes — and sickens hundreds of millions more, often over and over again: malaria.

In Kenya, Christine Pepela sleeps under an insecticide-treated bed net provided by a local nurse. / Allan Gichigi, MCSP

In Kenya, Christine Pepela sleeps under an insecticide-treated bed net provided by a local nurse. / Allan Gichigi, MCSP

In a rural health center in western Kenya, a 26-year-old woman waits her turn to see the nurse.

Christine Pepela began receiving prenatal care at the Mechimeru Health Centre in Bungoma County when she was four months pregnant.

It was here that she learned she is at risk for malaria — a far more deadly and prevalent mosquito-borne disease than Zika.

Now six months pregnant, Christine meets with Nurse Agnes Nambuya, who gives her an insecticide-treated bed net to sleep under and tells her about sulfadoxine-pyrimethamine, the medication she needs to help prevent malaria in pregnancy.

The risk of malaria faced by Christine and her baby is not new or unique.

In sub-Saharan Africa alone, 10,000 pregnant women will lose their lives to malaria this year, and about 200,000 babies born to mothers who have had just one episode of malaria in pregnancy will die.

In fact, malaria in pregnancy contributes to 8 percent of all stillbirths in the region. Many more babies will be born small or anemic, which can lead to life-threatening consequences, as well as health problems throughout childhood and beyond.

This is exceptionally unfair, as the adverse outcomes associated with malaria in pregnancy are largely preventable.

USAID’s Maternal and Child Survival Program, the President’s Malaria Initiative and other partners are increasing measures to dramatically reduce the number of cases of malaria.

Together, we’re supporting government health ministries to combat malaria in pregnancy through lifesaving and cost-effective tools:

  • Last year, about 900,000 pregnant women received two doses of this intermittent preventive treatment.
Nurse Agnes Nambuya gives Christine sulfadoxine-pyrimethamine drugs to prevent malaria in pregnancy. / Allan Gichigi, MCSP

Nurse Agnes Nambuya gives Christine sulfadoxine-pyrimethamine drugs to prevent malaria in pregnancy. / Allan Gichigi, MCSP

At the foundation of our efforts is ensuring access to high-quality, comprehensive prenatal care, which has proved effective in delivering critical care and counseling to both women and newborns.

It remains a key opportunity for trained health providers to deliver preventive treatment to pregnant women. Health providers can also recognize signs and symptoms of malaria, react swiftly, administer a rapid diagnostic test, and treat accordingly or refer to a higher-level facility.

With Zika virus cases mounting, prenatal care will be more critical than ever.

An estimated 94,000 newborn lives were saved through malaria in pregnancy interventions between 2009 and 2012.

As the world’s attention focuses on a newly emerging threat, we are reminded of the vulnerability of pregnant women to viruses and infections.

This underscores the importance of maternal and newborn health services to ensure all pregnant women receive the comprehensive counseling and care needed before, during and after pregnancy.

To learn more about the global efforts of the Maternal and Child Survival Program to prevent and treat malaria, click here. And to add your voice to the global conversation, join us on Twitter.

ABOUT THE AUTHOR

Elaine Roman is the Malaria Team Lead for USAID’s flagship Maternal and Child Survival Program.

Building Opportunities for Out-of-School Youth in Jordan

Deputy Assistant Administrator Mona Yacoubian watches as youth in Ma’an, Jordan engage in activities during USAID’s Non-Formal Education Program launch event. / Mohammad Maghayda for USAID

Deputy Assistant Administrator Mona Yacoubian watches as youth in Ma’an, Jordan engage in activities during USAID’s Non-Formal Education Program launch event. / Mohammad Maghayda for USAID

Non-formal education serves as a critical bridge for out-of-school youth, connecting them to vocational training or allowing them to re-enter formal education after 10th grade.

In Jordan, this opportunity is much-needed for thousands of young people. At least 21,000 Jordanians ages 12 to 15 are not enrolled in school. In addition, Jordan hosts 80,000 school-aged Syrian refugees who are also out of school.

Youth who do not complete their schooling take the lowest-skilled, lowest-paying jobs and are often exposed to labor exploitation. They may resort to street hustling and suffer from social stigma, labeled as “failures” or “criminals.”

Deputy Assistant Administrator Mona Yacoubian speaks at USAID’s Non-Formal Education Program launch event in Ma’an, Jordan. / Mohammad Maghayda for USAID

Deputy Assistant Administrator Mona Yacoubian speaks at USAID’s Non-Formal Education Program launch event in Ma’an, Jordan. / Mohammad Maghayda for USAID

To help these youth, a new USAID program will expand non-formal education to 28 new school-based centers across Jordan. Together with the Jordanian government and our NGO partner, we will enhance the prospects of vulnerable, out-of-school youth, both Jordanian and Syrian.

Last month, I had the honor of speaking at the launch of our non-formal education program in Ma’an, Jordan. I met with 25 youth from across the governorate, one of the most impoverished areas in the country.

The youth I met at the center told inspiring stories of how the program boosted their confidence and deepened their self-esteem. These young men and women, Jordanian and Syrian, each had an inspiring tale of how their participation in the program and the mentoring they received transformed them.

In one classroom I visited, young men eagerly engaged in an anatomy discussion. In another, gregarious young women laughed and joked as they discussed their friendships and the surrogate family they have become. All were appreciative of the safe space and opportunity to learn in the program.

However, non-formal education is not the only way forward. Jordan’s Ministry of Education is committed to finding pathways to formal education for all out-of-school children. The Ministry will enroll an additional 50,000 Syrian refugee students in school for the 2016-2017 school year — in addition to the 143,000 who are enrolled in the current school year.

Youth participants engage in discussion during USAID’s Non-Formal Education Program launch event in Ma’an, Jordan. / Mohammad Maghayda for USAID

Youth participants engage in discussion during USAID’s Non-Formal Education Program launch event in Ma’an, Jordan. / Mohammad Maghayda for USAID

Later during my trip, I visited Jordanian youth from two leading youth organizations: Al Qantara and Future Makers. They were engaged in a USAID-sponsored youth and civic engagement initiative.

They discussed the challenges they face in their communities, their aspirations, and creative approaches to meeting these challenges. They spoke eloquently about the need for recreational facilities, more English language instruction, and a desire for more adult mentoring their lives.  

They also expressed deep frustration at the stereotypes often raised about socially conservative governorate, Ma’an: “terrorists,” “trouble-makers,” “extremists.” Most powerfully, they spoke passionately about a way forward, brimming with positive ideas and energy — perhaps the most powerful refutation of those ill-conceived labels.

I came away from my trip inspired by the hope and dynamism embodied in these young people. Their energy and desire to succeed are a potent reminder of the promise of Jordan’s youth and the power of USAID’s partnership with the Jordanian people.

ABOUT THE AUTHOR

Mona Yacoubian is the Deputy Assistant Administrator for the Middle East Bureau at USAID.

USAID Continues to Deliver on Aid Transparency

An Afghan pupil reads a poem to her classmates at a girls school in Kabul. / Patrick Baz, AFP

An Afghan pupil reads a poem to her classmates at a girls school in Kabul. / Patrick Baz, AFP

Being transparent about how we spend U.S. foreign aid is necessary for effective and accountable development.

It benefits governments, civil society, citizens and donors alike. That’s why at a high-level forum in Busan, Korea in 2011, the United States joined others in voluntarily agreeing to publish timely, comprehensive and forward-looking information on development cooperation resources.

The United States became a member of the Open Government Partnership, a consortium of over 60 countries “committed to making their governments more open, accountable, and responsive to citizens.”

At USAID, we are delivering on that commitment.

After the Busan forum, USAID created a working group to produce a cost management plan to improve its reporting to the International Aid Transparency Initiative (IATI) — which developed a standard for publishing foreign assistance spending data, allowing for comparison across publishers.

We are doing more reporting and sharing foreign assistance financial data at foreignassistance.gov and in the IATI standard. We have doubled-down on strengthening the quality of our data, and are pushing hard to use it to drive evidence-based development that delivers the best results possible for people around the world.

The 2016 U.S. Aid Transparency Review, released today by Publish What You Fund, a United Kingdom-based NGO advocating for greater aid transparency, ranks USAID 19 out of 46 of the world’s major donor organizations.

It recognizes that we have made improvements since the last index; however, we feel that USAID’s “fair” rating does not fully reflect our commitment and progress since 2011.

We were pleased to release our new report, “Strengthening Evidence-Based Development: Five Years of Better Evaluation Practice at USAID ” last month. The report reflects our commitment to strong evaluation practices — including sharing data and results on the Development Experience Clearinghouse — and ways we’ve improved since 2011.

To help inform the U.S. Government’s aid transparency agenda, USAID also conducted three aid transparency country pilot studies in Zambia (May 2014), Ghana (June 2014), and Bangladesh (September 2014).

The country pilots assessed the demand for and relevance of information that the U.S. Government is making available, as well as the capacity of different groups to use it.

USAID’s Cost Management Plan, released in July of last year, is proving to be an effective roadmap for us to continue making progress to improve data quality and reach maximum compliance in reporting to IATI.

For example, we have added 21 more fields to our quarterly reporting to increase our IATI compliance. We are also improving our internal reporting systems with the Development Information Solution, which is currently in development.

In addition to updating IATI compliance, the Agency has created Foreign Aid Explorer for better ease and use of aid information and is doing more work on geocoding and open data efforts.

We share Publish What You Fund’s perspective that aid transparency is fundamental to achieve development results.

Getting exactly to where we want to be on aid transparency is a marathon, not a sprint, and we’re not there yet. We are proud of efforts to date and remain fully committed to continuing to make significant progress on aid transparency.

ABOUT THE AUTHOR

Wade Warren is the Assistant to the Administrator for USAID’s Bureau for Policy, Planning and Learning.

Strengthening Grassroots Democracy in Libya

Libya's Constitutional Drafting Assembly members and media professionals participate in a press conference to discuss the constitutional development process and key constitutional issues.

Libya’s Constitutional Drafting Assembly members and media professionals participate in a press conference to discuss the constitutional development process and key constitutional issues.

For 40 years in Libya, Muammar Gaddafi pitted community against community and tribe against tribe to prevent any organized revolt.

Since the fall of Gaddafi’s authoritarian regime five years ago, a bruising battle over Libya’s national governance continues to test national leaders. The country has experienced ongoing damaging political divisions — even as national surveys continue to show the vast majority of Libyans seek a unified Libya with democratic governance.

Only five years ago, there were no municipal governments in Libya at all. Now, newly elected municipal officials are working to fill the governance vacuum that existed at the national level.

What’s unfolding now in the dry, southern desert city of Sabha highlights how Libyans are developing institutions at the local level and how the fate of the more than 6 million Libyans is evolving.

USAID supports consensus building for the national dialogue, constitution drafting and governing process in Libya.

USAID supports consensus building for the national dialogue, constitution drafting and governing process in Libya.

A grassroots Libyan democracy emerges

In Sabha, the opening of a community center has enabled citizens to engage in the decision-making processes.

The city’s mayor, Hamed al-Khayalee, describes the center as a neutral and accessible space for honest conversations between residents and local government leaders, nurturing the legitimacy of the local institutions.

The community center has also been the site for training the municipal council on public relations to better enable councilors to inform the public, further increasing transparency and credibility.

This center is just one of the many ways that USAID is working to improve Libyan governance and build community cohesion.     

USAID has been in Libya since 2011 training newly elected leaders, facilitating input of Libyans into the constitutional drafting process, and strengthening elections.

Woven through each of these activities is a concerted effort to bring Libyans from all walks of life together — often for the first time — over issues of mutual interest.  In this way, stereotypes are broken down and Libyan cohesion can be forged.  

In another example, late last year we brought together 12 women municipal councilors representing the districts of Tripoli, Zawiya, Jabal al Gharbi, Benghazi and Wadi al Shati.

Our goals were to build the technical skills of these local government officials, get a sense of what needs exist for female councilors, and set a foundation for the establishment of a Women’s Municipal Councilor Association.

The women leaders discussed the principles of local governance, public service delivery, and the responsibilities of municipal councilors.  

A participant of a gender and elections workshop engages men and women in discussion.

A participant of a gender and elections workshop engages men and women in discussion.

An End to Authoritarianism

Libyans want a legitimate and effective democracy in which individuals can live with freedom, dignity and opportunity. This is easy to agree upon.

But real threats to unity exist from within Libya’s different factions, and especially in the form of extremist violence, foreign fighters and Da’esh.

After generations of central government authoritarianism, these municipal officials represent a bridge from the past to a unified future — even as they build bridges to the east, south and the west of Libya.

Five years after the overthrow of Gaddafi’s regime, Libya continues to struggle over competing interests that have had a disastrous impact on its people.

USAID supports the brave Libyan men and women who agree that authoritarianism should not rise again, that the Government of National Accord and the Libyan-led, UN-facilitated Libyan Political Agreement is the only viable solution to the country’s political and security crisis.

Effective institutions encourage stability, and only through the genuine inclusion of all groups will there be Libyan prosperity.

ABOUT THE AUTHOR

Jed Meline is the USAID Senior Development Advisor for Libya.

Equipping Health Workers to Achieve an AIDS-free Generation

A health worker tests a child for HIV at Eduardo Mondlane Health Center in Chimoio, Manica, Mozambique. / Arturo Sanabria, courtesy of Photoshare

A health worker tests a child for HIV at Eduardo Mondlane Health Center in Chimoio, Manica, Mozambique. / Arturo Sanabria, courtesy of Photoshare

I am scared.

I think I have the disease that everyone talks about. Other women warned me to be careful with my clients. My mind is buzzing with questions.

Where do I go to get help? Will people see me if I go to a clinic to get tested? What happens if I am positive? Will I die? Will I have to stop working?

I am afraid.

Jamilah, a sex worker in Kenya, is afraid of finding out her HIV status because of stigma and fear of living with the disease. She is unsure of how to get help and what will happen after she is tested.

In Bangladesh, a BRAC community health worker enrolls an expecting couple in the MAMA program so that they will receive informational SMS or Voice Messages during pregnancy and for the first year of life. / Cassandra Mickish, CCP/Courtesy of Photoshare

In Bangladesh, a BRAC community health worker enrolls an expecting couple in the
MAMA program so that they will receive informational SMS or Voice Messages during pregnancy and for the first year of life. / Cassandra Mickish, CCP/Courtesy of Photoshare

But a community health worker, Mariam, who is also a sex worker living with HIV, connects people in her community to the nearby HIV clinic.

Mariam meets with Jamilah and listens to her questions. She calms Jamilah’s fears. She sits with Jamilah at the clinic as she nervously waits to find out her status.

Through rapid testing at the clinic, Jamilah finds out she is positive. While the news is overwhelming and frightening, Jamilah is able to receive counseling and initiation of treatment from a nurse on the same day. The nurse teaches Jamilah how to manage her HIV for the rest of her life, including preventing transmission to partners and during pregnancy.

Feeling less afraid and supported by the community health worker and nurse she interacted with, Jamilah is empowered to face her HIV-positive status. Because she had a positive experience, Jamilah will return to the clinic regularly to monitor the disease.

A community care worker from Turntable Trust provides HIV counseling and testing service to a local woman at her home in South Africa as part of the national effort aimed at getting 15 million South Africans to know their HIV status. / JHHESA, CCP/Courtesy of Photoshare

A community care worker from Turntable Trust provides HIV counseling and testing service to a local woman at her home in South Africa as part of the national effort aimed at getting 15 million South Africans to know their HIV status. / JHHESA, CCP/Courtesy of Photoshare

Through the support of health workers, Jamilah is confident that she can live with HIV.

Community and facility health workers, like those in Jamilah’s story, are the backbone of health systems. They connect people to clinical services, provide emotional support, perform diagnostic tests, advise and counsel, and combat stigma by providing critical services to patients who need it most.

This week marks World Health Worker Week. As we thank the world’s health workers, it is also important to recognize the invaluable role they will play in the coming years as we look to achieving the Sustainable Development Goals (SDGs). Health workers will be a driving force towards achieving at least nine of the 17 SDGs.

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A community health worker examines a child in Malawi. / SC4CCM/JSI/Courtesy of Photoshare

Health workers go beyond providing patient care; they also act as agents of socioeconomic development, leading countries to advance education and employment opportunities, especially for women, and increase the productivity of the population.

To keep a robust health workforce, systems and policies must be created to have health workers in the right places at the right time with the right support. Currently, the World Health Organization (WHO) is finalizing its Global Strategy on Human Resources for Health, which focuses in part on optimizing the existing health workforce.

Here at USAID, we are establishing programs in alignment with this strategy, focusing on optimizing health workers’ service delivery in order to reach an AIDS-free generation.

The global community is currently transitioning to new HIV treatment guidelines, known as Test and START, which will require a significant amount of support from health workers to be implemented.

These guidelines recommend starting antiretroviral therapy as soon as a person is diagnosed with HIV instead of waiting until the person gets sick from the disease. This means an additional 37 million people living with HIV are now eligible for this treatment. Expanding coverage is critical to achieving the 90-90-90 goals of the Joint United Nations Programme for HIV/AIDS.

Since most areas with high rates of HIV face health worker shortages, there is an urgency to evaluate the impact of health workers and how we train the existing workforce so they can better connect people with life-saving care and treatment for HIV.

The bottom line is that if we want to achieve an AIDS-free generation, a key component will be to better optimize the available workforce for HIV/AIDS services.

But what does optimization mean?

It means being creative and efficient about the way we use health workers based in hospitals, health clinics and communities to make HIV service delivery effective and sustainable.

It means investigating how community health workers, like Mariam, can be more effectively trained and distributed across communities and in healthcare facilities to support outreach and testing.

It means figuring out how to be more effective in administering antiretrovirals at all points of care, such as communities, health clinics and hospitals.

It means improving the quality of training for laboratory workforces and creating efficient lab systems to support health workers in scaling up viral load testing.

It means examining the skill mix of doctors, nurses, midwives, and community-based health workers to meet the needs of all patients, including adolescent girls and other key populations.

As we celebrate health workers this week and honor their important role in creating healthy, resilient and productive societies, we must direct our focus and investment to overcoming key barriers so we can maximize their impact.

Jamilah and millions of others living with HIV and AIDS are counting on us.

ABOUT THE AUTHOR

Shayanne Martin, Diana Frymus and Kim Rogers are members of the Health Workforce Team in the Office of HIV/AIDS at USAID. Follow them on Twitter at @ShayanneMartin and @DianaFrymus.

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.
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