USAID

A team of experts from WHO, UNICEF, UNFPA, and World Bank recently published a report on maternal mortality entitled “Trends in Maternal Mortality: 1990 to 2008" (PDF).

The document reports some fantastic news about a public health indicator that has until recently refused to budge. That indicator is the maternal mortality ratio, the number of maternal deaths per 100,000 live births. The improvement between 1990 and 2008 is significant and promising.

The part of the report that received much less coverage relates to HIV and its strong, adverse effect on maternal mortality. The authors estimate that in 2008 there were 42,000 deaths due to HIV & AIDS among pregnant women and approximately half of those were maternal deaths. In absence of HIV we would have had 337,000 maternal deaths in 2008 instead of 358,000.

Reeling from Shock

Estama Murat, Director of the Drouin Methodist School, cautiously hopes to reopen: “This obviously will not come easy," he says, "because we have many children still sick and other pupils have fled the village.”

Drouin is in Grande Saline, where the cholera virus was first discovered in the Artibonite department last week. The population of 17,000 is still in shock. Many of them left for the chief town of Gonaives, Mr. Murat explains, or toward Saint-Marc in the Lower Artibonite region.

The Santé pour le Développement et la Stabilité d’Haíïti (SDSH), led by MSH, funded by USAID, has been supporting the Drouin health center for the past three years, to deliver a package of primary health services in maternal and child health and family planning. Through the USAID-funded project, MSH also supports a network of community health workers and traditional birth attendants for community outreach activities, ensuring that the services reach the people in need.

A volunteer nun tending to a chld at the Drouin health centerOn Tuesday and Wednesday, Dr. Serge Conille, the HIV/AIDS technical Advisor of the USAID-funded SDSH project led by Management Sciences for Health, and designated lead of the project's emergency cholera task force, and I visited project-supported health facilities in the epicenter of the epidemic in the lower Artibonite Department (Province).

We drove into the cholera zone over a dirt track through a flat plain of fields, green, but neglected. The road ran parallel to what appeared to be a wide canal, the dikes on either side uneven and crumbling. Later, I found out that this was the Artibonite river, source of the epidemic. It was constrained and channeled some 25 years ago as part of a “whole valley development plan” which included promotion of rice cultivation. The rice is largely gone and the dikes are frequently overrun by the river which floods the surrounding countryside isolating some villages, sometimes for long periods of time.

The Management Sciences for Health Haiti staff continues to work tirelessly alongside local partners to mitigate the cholera outbreak. A sample of today’s work is outlined below.

On Saturday, October 23, a four-member group from the Santé pour le Développement et la Stabilité (SDSH) project, led by MSH’s Dr. Patrick Dimanche, conducted an initial on-the-ground assessment and provided support for five local NGO partners---Service and Development Agency (SADA) in Mattheux/West Department, Saint-Paul Health Center in Montrouis/West Department, Pierre Payen Health Center in Pierre Payen/Lower Artibonite Department, Hospital Albert Schweitzer/Lower Artibonite Department, and Claire Heureuse Community Hospital/Upper Artibonite Department---that have cared for over a third of the 2,364 cases reported thus far. Ninety-eight of the reported 208 deaths have occurred in four of these five health facilities.

The three USAID-funded projects managed by MSH in Haiti---SDSH, Leadership, Management, and Sustainability (LMS), and the Supply Chain Management System (SCMS) project---are working together to deliver emergency commodities including bed sheets, towels, adult diapers, disposable gloves, oral rehydration salts, IV solution, water treatment tablets, and soap.

Yesterday the Direction of Civil Protection and Disaster in Haiti confirmed a cholera outbreak in two departments (districts) of the country resulting in 1,498 cases managed in health facilities and 135 cholera related deaths.

The USAID-funded, MSH-led Santé pour le Développement et la Stabilité d’Haíïti (SDSH) project is working closely with Haiti’s Ministry of Health and other local and international partners to coordinate a community-level response to the cholera outbreak.

SDSH is mobilizing its established network of over 4,000 community-based health workers to reach Haiti’s largely rural population. The project is working with local and international vendors to procure oral rehydration solutions, a critical component of first aid for diarrheal disease.

For more details reported by SDSH on the ground, see our press release from earlier today.

With sometimes impenetrable terrain and limited infrastructure, Yemen presents a very challenging environment for delivering health services to rural areas. Basic health services do not reach most women; rural areas lack health facilities; and Yemen’s conservative cultures do not allow women to receive health services from men, or to freely come and go from their home.

In Yemen, through a pilot program, the Extending Service Delivery (ESD) Project supported the Basic Health Services (BHS) Project to assist midwives with setting up private practices in rural communities where facilities did not exist or were too far away. Midwives are generally respected in Yemen communities and, most husbands allow their wives to visit the midwives in their homes.

On Friday, June 18th  USAID Administrator, Dr. Rajiv Shah spoke at the National Press Club in Washington, DC about the role USAID must play in the future of development. “President Obama and Secretary Clinton have made it my mission to remake USAID into the world’s premier development agency, to meet the security and development needs of the 21st Century,” said Dr. Shah.  In his presentation he laid out four elements for action to revitalize USAID

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