Fragile States

Fragile States (including Afghanistan, Democratic Republic of Congo, Haiti, Liberia and South Sudan)

Ryan Cherlin, USAID, wrote this blog after a recent visit to Haiti. This blog post was originally posted on USAID's IMPACT Blog.

A woman holds one of the USAID hygiene kits at a Cholera Treatment Center on Thursday, Oct. 28, in Verrettes in the Artibonite department of Haiti. The center, run by USAID partner International Medical Corps, opened earlier this week.

 

When a Haitian says, Dí¨yí¨  mí²n gen  mí²n, they mean to say, as you solve one problem there is always another that must also be solved.

Driving through the densely populated city of Port-au-Prince I wondered how many times this old proverb was the subject of conversation this past year.

In the months following the earthquake in early January 2010, Haitians endured the devastating effects of hurricane Tomas, political instability and violence stemming from a presidential election, and a cholera epidemic.

Dr. Florence Guillaume, Deputy Chief of Party for MSH's Santé pour le Développement et la Stabilité d'Haíïti (SDSH) Project reflects on the year since the Haiti earthquake last January 12 in this video.

SDSH is a USAID-funded health project in Haiti supporting decentralization, strengthening public-sector capacity in service delivery, and supporting local nongovernmental organization service delivery.

Prior to January 12, 2010, Management Sciences for Health’s Leadership, Management and Sustainability Program was working with Haiti’s Ministry of Public Health and Population to build capacity in several areas:  family planning and reproductive health; commodity management and security; coordinating HIV & AIDS awareness and community mobilization activities; and leadership development.

But after the terrible earthquake of one year ago, we who normally promote leadership in the health sector were faced with our own leadership challenges:  how to continue to lead and manage our program effectively during an ongoing crisis, and most importantly, how to ensure continued help to those who rely on LMS support. Our immediate priority:  dealing with the collapse and destruction of our office.  For months, we worked out of large tent constructed next to the LMS warehouse, a reminder everyday that many of those we were serving had been forced to move into temporary shelters.  

Haiti, One Year On: Realizing Country Ownership in a Fragile State

Tuesday, January 11, 2011, 3:00-5:00 p.m., B-340, Rayburn House Office Building, Capitol Hill
This Washington DC event will be webcast live. You can tune in and join the discussion, below, starting at 3:00 p.m.

Dr. Florence Duperval Guillaume, MSH’s Deputy Chief of Party and Technical Director, Santé pour le Développement et la Stabilité d’Haíïti, will be discussant at this Oxfam America-hosted policy discussion to examine aid effectiveness in Haiti within the context of country ownership. Other speakers will include:

January 12, 2011 marks the one year anniversary of the earthquake that devastated Port-au-Prince, Haiti. I have the good fortune of visiting MSH’s USAID-funded SDSH (Santé pour le Développement et la Stabilité d’Haíïti) project team in Port-au-Prince this week, and I traveled out into the city to see the devastation the earthquake caused.

Rubble and dust in Haiti a year after the earthquake.

It has been a catastrophic year for Haitians. The Haitians themselves say this, a people who are used to dealing with poverty, combined with yearly hurricanes, and near constant political instability. However, one thing has been made clear to me in the past few days that I have been on this island: Life Goes On.

Health Workers in Southern Sudan

A few weeks ago, I had the opportunity to visit Southern Sudan. For over five decades, Southern Sudan endured civil war, unrest, and several waves of forced displacement and refugees. The infrastructure of nearly every sector was mostly destroyed throughout the region. It is a classic fragile state situation.

Since the Comprehensive Peace Agreement was signed five years ago, the Government of Southern Sudan, donors, international organizations, nongovernmental organizations, private organizations, and, most importantly, health workers are coming together to rebuild a shattered health system.

Now the global community focuses attention on Southern Sudan as they prepare for a Referendum vote to decide if they will officially break away from Northern Sudan to become an independent state. The vote is scheduled to begin January 9, 2011.

Kitchen Garden Produce & Afghan Boy

The carefully irrigated and shaded kitchen garden provided welcome splashes of different shades of green against the surrounding dry brown soil and rocks. We congratulated Shukria, a community health worker (CHW), on the lush vegetables and ripening fruits as we entered her home.

Shukria explained that the gardens that she and other women were growing started with the community-based growth monitoring program through the Family Health Action Groups. The growth monitoring is successfully identifying children under two who were not gaining enough weight or were undernourished. She and other mothers spent time counseling the mothers of the identified underweight children.

At the First Global Symposium on Health Systems Research in Montreux, Switzerland in November, Dr. Yogesh Rajkotia, of USAID Rwanda, moderated a panel discussion noting that Performance-Based Financing (PBF) is an effective health systems strengthening strategy. The presentations were made on behalf of the Rwandan Ministry of Health with the guidance of Dr. Agnes Binagwaho, Permanent Secretary.

In 2000, Rwanda’s health system was perceived as weak: there were human resources shortages, especially in rural areas; poor quality of services; and a high morbidity/mortality rate of women and children. Since 2001, Rwanda has committed itself to better health and to pushing for achievement of the Millennium Development Goals (MDG) by 2015.

PBF is a powerful means for increasing the quantity and quality of health services by providing incentives to health providers to improve performance. A PBF program typically includes performance-based grants or contracts. Health clinics and their staff are rewarded for reaching or exceeding health indicators.

Female community health worker teaching mothers to improve hygiene and preventing diarrhea in their homes through regular hand washing.

Many children in Afghanistan die each year of easily preventable diseases; nearly 25% of those deaths are due to diarrhea. However, it is not only the fatal cases of severe diarrhea that are imperative to address. Between a quarter and a half of mothers of children less than five years old report their child had diarrhea in the two weeks prior to questioning. These frequent cases of diarrhea are among the main causes of under nutrition, which delays development and is implicated in over half of all childhood deaths.

One of the most effective ways of preventing diarrhea is to improve hygiene in the home, especially through regular hand washing with soap before preparing and eating food, after using the toilet or handling a child’s feces.

Danielle Brown is the Program Coordinator of the Leadership, Management and Sustainability (LMS) project in Haiti. She worked with our teams in Haiti from October 24 – November 14.

River Crossers at Rivií¨re des Barres

 

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