US Global Health Policy

U.S. Global Health Policy

Making of Banner for International Day of Persons with Disabilities {Photo Twitpic @UNICCanberra.}Photo Twitpic @UNICCanberra.

On December 3, 2012, the international community commemorated International Day of Persons with Disabilities. About 15 per cent of the global population --- more than one billion people ---  live with some form of disability.

About half are women living with disabilities, many of whom suffer disability-specific gender-based violence.

Malawi mother and children {Photo credit: MSH.}Photo credit: MSH.

I got a call from the resident doctor to come to exam room 6. As soon as I entered the room, I prepared myself. The little girl, 7- or maybe 8-years-old, didn't look well; she was “floppy,” combative, and not entirely aware of where she was or what we were doing to her. She was HIV-positive, and my colleague needed to get an IV line in her arm to test the latest in experimental treatments for kids with HIV– and needed the four of us interns to help hold her still.

It was 1993 during my residency in pediatrics in Cleveland, Ohio. We were at one of the best children’s hospitals in the world; it didn’t matter. The young girl died a few months later.

With the advent of antiretroviral therapy (ART) a few years later, the whole world changed. The world of HIV medicine blossomed; new drugs and drug combinations literally exploded with amazing effect. HIV-positive mothers could give birth to HIV-negative babies, and HIV-positive children and their moms could get treatment.

Democratic Republic of the Congo {Photo credit: MSH.}Photo credit: MSH.

Last night, while in the Democratic Republic of the Congo (DRC) visiting our programs, I attended a US election-eve gathering of mostly Congolese people in Kinshasa. The DRC is one of those “distant nations” President Obama was referring to in his early morning acceptance speech today, where people are, “risking their lives just for… the chance to cast their ballots like we did today.”

Fragile, conflict-ridden nations, such as the DRC, struggle with leadership and governance. Its people have been victims of horrific violence, stunning gender inequality, and some of the worst health conditions in the world. They deserve better.

The United States reelected President Barack Obama to lead not only our country, but also to lead on addressing global health and other global development challenges such as those faced by the DRC.

Management Sciences for Health (MSH), a global non-profit organization dedicated to saving lives and improving health for the poorest and most vulnerable in the world, has long been a partner with the US government, foundations, and other donors, working in more than 140 countries to build stronger and more sustainable health care systems.

A Rwandese woman shows her child's community-based health insurance card. {Photo credit: C. T. Ngoc/MSH.}Photo credit: C. T. Ngoc/MSH.

Eugénie, a widow in Rwanda, farms to provide for her children. In January 2012, she had surgery to remove a tumor, a procedure that would have devastated her family economically if she did not have insurance. Rwanda’s health insurance program is the most successful of its kind in sub-Saharan Africa: it supports the health of more than 90 percent of the population, including the most vulnerable, like Eugénie.

International Day of the Girl: End Child MarriageInternational Day of the Girl: End Child Marriage

My grandmother married at 8 years old; my mother married at age 15.

I often wonder what their lives --- their potential --- would have been, if they were not child brides.

Today, the same pattern is repeated in villages and cities around the world. Every year, nearly ten million girls are forced into marriage before they reach the age of 18 --- with little or no say in the matter.

That’s more than 25,000 girls a day; 19 girls each minute.

These girls are denied the opportunity to fulfill their potential for healthy and productive lives. When they enter marriage, most drop out of school and enter a world where they work from dusk to dawn to provide labor to the households. From their mothers' care they are transferred to the supervision of their husbands and mothers-in-law, who view them as an additional labor source. Pressured to demonstrate their fertility, they get pregnant when they are still children and face the risk of illness or death when they deliver.

And some child brides are as young as eight or nine.

Bolivian nurses. {Photo credit: MSH.}Photo credit: MSH.

Building local capacity is a pillar of the United States Agency for International Development's USAID Forward reforms. This post is one example of how USAID worked through Management Sciences for Health (MSH) to build, nurture, and support a local development stakeholder that is still thriving today. The story was written by global health writer John Donnelly, and first appeared in MSH’s book Go to the People in 2011. Cross-posted on Modernize Aid in the Modernizing Foreign Assistance Network (MFAN) blog field feedback series.

Girl from Uganda. {Photo credit: MSH.}Photo credit: MSH.

The press statement title caught my attention: “Members Continue Efforts to Protect Rights of Women in Developing Countries.”

With piqued interest, I read on:

Congresswoman Betty McCollum and Aaron Schock have once again introduced legislation to stem the devastating impact of child marriage on young girls in developing countries.  The McCollum-Schock International Protecting Girls by Preventing Child Marriage Act, House Resolution (H.R.) 6087, promotes and protects the rights of girls in the developing world.

I was pleased to learn that H.R. 6087 establishes a strategy to prevent child marriage and promote the empowerment of girls.  The legislation also integrates the issue of preventing child marriage into existing US development programs, and requires that relevant agencies collect and make available data on the rates of child marriage and its impact on meeting key development goals.

While global health and policy efforts to protect young girls from early or forced marriage are increasing, millions of girls are forced into early marriage every year. Pictured: four Senegalese girls. {Photo credit: S. Galdos/MSH.}Photo credit: S. Galdos/MSH.

If you think that child marriage is not an issue in the twenty-first century, think again.  In developing countries, 82 million girls who are now ages 10 to 17 will be married before their 18th birthday. Over the past decade, 58 million girls in developing countries -- one in three -- have been married under the age of 18; 15 million -- one in nine -- were married by age 15.

These girls are often married against their will, despite national laws that prohibit marriage until the age of 18, and numerous international declarations, conventions, and global conferences that “guarantee” the rights of girls, like the Universal Declaration of Human Rights.

Senate Passes Preventing Child Marriage Act

Child marriage is increasingly becoming a hot topic within the realm of global health -- and influencing U.S. domestic and global policy.

The International Protecting Girls by Preventing Child Marriage Act (S. 414) -- reintroduced in the U.S. Congress in February 2011 --- passed on the Senate floor by way of voice vote on May 24, 2012. (The bill also passed the Senate unanimously in December 2010.)

5thBDay badge in white background.5thBDay badge in white background.

Every child deserves a fifth birthday. It seems simple enough. But for many children in the world — especially in countries with the highest burden of child mortality, such as India, Nigeria, Democratic Republic of the Congo (DRC), Pakistan and Ethiopia — preventable deaths will claim their lives, before they reach the age of five.

Today, USAID launched an ongoing child survival awareness campaign, called, “Every Child Deserves a 5th Birthday.”

The “5th Birthday” campaign kicked off with a briefing event at Kaiser Family Foundation, featuring USAID Administrator Dr. Rajiv Shah and other experts. Dr. Shah and colleagues stressed that reducing the burden of child mortality is critical to our future as a global community.

While the global community has made great strides reducing child mortality, inequality in child mortality remains: several regions and countries continue to shoulder the greatest burden and loss of life.

Speakers at the Inaugural Conference on Global Health, Gender and Human Rights. {Photo credit: PAHO/WHO.}Photo credit: PAHO/WHO.

Health is a human right and should not be denied based on any factor, including gender, ethnicity, or socioeconomic status.

On March 21 and 22, 2012, law students, global health professionals, and human rights experts gathered at the Inaugural Conference on Global Health, Gender and Human Rights at American University to discuss tackling global health issues from a human rights perspective.

Co-hosted by the American University Washington College of Law, the Pan American Health Organization (PAHO), and the Royal Norwegian Embassy in Guatemala, the two-day conference focused on six crucial topics: disabilities, women's and adolescent girls’ health, gender identities, older persons, access to medicines, and tobacco control.

Speakers and participants articulated the important role gender and human rights play in the promotion of health around the world.

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