USAID

Issakha Diallo, MD, MPH, DrPH

Part six of the blog series: Spotlight on Global Health Initiative Plus Countries Amid grave health statistics, the Global Health Initiative (GHI) brings hope of a healthier future in Mali.

Mali is one of the ten poorest countries in the world, ranking 173 out of 175 countries on the 2007 Human Development index of the United Nations Development Program (UNDP). Mali has highest percentage of people living on less than a dollar a day.  And, Mali has some of the worst demographic indicators in the sub-Saharan region: a population growth rate of 2.6%, a 6.6 fertility rate (the highest in the sub-Saharan Africa after Niger, at 6.8), and a birth rate of 49.8 per 1,000. The population is very young, with more than 50% of Malians under 15 years old and 17% under 5 years old.

MSH CEO, Jonathan Quick, MD, MPH moderates panel on AIDS, Human Rights, and Vulnerable Populations (Ben Greenberg/MSH)

Human rights are no longer considered peripheral to the AIDS response. Human rights are an essential tool of public health. 80% of countries explicitly acknowledge or address human rights in their national AIDS strategies. However, 80 countries still have punitive laws against people with HIV which pose significant challenges to the AIDS response

In the past decade, there have been some major developments in the HIV epidemic. New cases have decreased, 5 million people are now on treatment, and people are discussing the importance of human rights in relation to the disease. However, 33 million people are infected and only one-third of those in need of treatment are receiving it.

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.

Women Nurses at Results Presentation in Aswan, Egypt

In Aswan, Egypt’s sunniest southern city located about one and a half hours by plane from Cairo, the Nile is at its most striking. Tropical plants grow along the edges of the flowing river, and the amber desert and granite rocks surround orchards of palm trees.

I was honored to be present in Aswan during one of Management Sciences for Health’s most important events; the results presentation of the Leadership Development Program (LDP), funded by the US Agency for International Development (USAID) as part of the Improving the Performance of Nurses in Upper Egypt (IPN) project in the Aswan governorate.

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.

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.

Annie Likhutu, shown right, receiving volunteer HIV counseling and testing services from Word Alive’s HTC volunteer, Charles Sapala.

Three months ago, Annie Likhutu, a mother of six, came to Migowi Health Center in Phalombe, Malawi to receive voluntary HIV counseling and testing (VCT); now, she is back at the health center and ready to be tested for a second time.“It is very important to know your status, it is no good waiting until you get sick,” she said.

Annie initially learned of the importance of testing through a radio advertisement from Word Alive Ministries International (WAMI), which is aired regularly and encourages listeners to go to health centers for VCT.

Although Annie takes pride in knowing her status and encourages others in her village to do so, her husband refuses to go for testing. This motivates Annie to continue returning to confirm her negative status.

There have been a collection of high-profile and well attended mobile health (mHealth) “summits” held around the world in the past few years, including last month’s second annual mHealth Summit in Washington, D.C. (headlined by Bill Gates and Ted Turner), but the really interesting conversations are happening on the African continent. While large providers in the “developed world” are talking about the need for business plans and analysis, the debate in Kenya and Nigeria and Ghana is on how country-based leadership can scale up proven programs, develop sustainability, and provide practical and integrated models for cooperation between the government, mobile service providers, the medical community and the private sector.

Last year, the mHealth Alliance and the National Institute of Health (NIH) sponsored their first mobile health (mHealth) “Summit,” at the Ronald Reagan building in Washington, DC. The location was telling: it is the home of the US Agency for International Development (USAID). This year’s mHealth Summit has nearly doubled in size, moved its location to the Convention Center, and is being keynoted by Bill Gates and Ted Turner. It is safe to say that mHealth is certainly a topic de jour. The problem is that the big names---the global mobile phone network providers, manufacturers, pharma companies, and global consulting firms---are all jumping on the bandwagon, but they are late to the game. And the conversations in the plenary sessions highlight the fact that there’s a huge disconnect between the global companies and the on-the-ground implementers.

Blog post also appeared on Global Health Magazine.

PEPFAR Fellow in the field

As the country with the second highest maternal mortality rate in the world, outranked only by India, Nigeria loses one in every 18 women during child-birth. The country also has one of the highest infant mortality rates in the world, one of the lowest life expectancy rates---estimated at 47 years---and the second largest population of people living with HIV & AIDS, with only 30% of people eligible for anti-retroviral treatment able to access these life-saving drugs.

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