News/Info: New Information

2005 Highlights

• October/November
• September
• August
• July
• June
• May
• March
• January/February

2004 Highlights

• December
• November
• October
• September
• August
• July
• June
• May
• April

October/November 2005 Highlights

• USAID Preparedness Planning Pays Off in Jordan Bombings
  Fifty-seven people died and scores were injured last week in the coordinated and near simultaneous bombings on the Grand Hyatt, Radisson SAS, and Days Inn hotels in Amman, Jordan. The toll may have been worse if not for the quick response of Jordanian authorities and the orderly evacuation of injured to nearby hospitals where patients underwent triage and provided care. USAID has been assisting the public, private, and military hospital sectors, with the government of Jordan, in a systems improvement exercise that includes emergency response planning.
  
  Through a national program of hospital accreditation, USAID has created more than 900 standards for Jordanian hospitals. The program included developing call-in strategies for essential personnel, creating command centers, developing effective triage procedures for patients, and establishing evacuation plans. The bombings not only forced the hospitals to test those plans but also to realize the importance of having an emergency/disaster response plan in place before such an event occurs.
  
  
• USAID Staff Member Elected Chair of Stop TB Partnership Board
  On November 10, 2005 at the semiannual meeting of the Stop TB Partnership Coordinating Board, Global Health staff member and USAID board representative Irene Koek was elected Board Chair for a two-year term. The Coordinating Board is representative of the Stop TB Partnership, and its 32 members include ministers and vice ministers of health as well as representatives from donor agencies, technical agencies, nongovernmental organizations (NGOs), the research community, the World Health Organization (WHO), the Global Fund secretariat, the World Bank, UNAIDS, the TB patient community, and the private sector. The Stop TB Partnership is a network of 400 organizations, countries, donors, private sector entities, NGOs, and individuals committed to the fight against tuberculosis, which kills nearly 2 million people each year and was recently declared a regional emergency in Africa. The Coordinating Board provides leadership and direction to the Partnership. Recent efforts have focused on the development of the Global Plan to Stop TB (2006-2015), a comprehensive plan for reaching international TB treatment and control targets and for accelerating action for TB control in Africa and Eastern Europe, where rates of multidrug-resistant TB are extremely high.
  
  
• New USAID-Supported Research Shows Infection Prevention Agent Can Reduce Newborn Deaths
  Nearly one-third of neonatal deaths in developing countries are caused by infections and occur within the first few days of birth. As many births still occur at home, USAID has been working to develop approaches to prevent newborn death and treat severe illness in low-resource settings. Soon-to-be-published findings from research supported by USAID and the National Institutes of Health (NIH) suggest that the application of chlorhexidine, an antimicrobial agent, as a vaginal wash, newborn skin cleanser, or newborn cord wash, may be a new tool to prevent newborn death. At the end of October 2005, USAID organized a meeting in conjunction with NIH, the Bill & Melinda Gates Foundation, the Johns Hopkins University Bloomberg School of Public Health, and Save the Children/Saving Newborn Lives. This meeting assembled leading researchers, product developers and manufacturers, regulatory experts, policymakers, and representatives from USAID-supported service delivery projects. The group was charged with 1) assessing the level of evidence for the potential use of chlorhexidine as an infection prevention agent and 2) developing an agenda to expedite research to assess chlorhexidine use while moving forward with program planning, product development, and regulatory approval. USAID's Bureau for Global Health provided funding to help design, set parameters for, and evaluate chlorhexidine research. In the coming months, USAID will be working with the meeting organizers to plan, fund, and implement this research and conduct field trials.
  
  
• USAID Announces $2.5 Million for Polio Eradication in Indonesia in 2006
  During his recent visit to Asia with Health and Human Services Secretary Mike Leavitt, Global Health Assistant Administrator Kent Hill announced USAID plans to commit an additional $2.5 million in 2006 to help eradicate polio in Indonesia, which experienced a sudden resurgence of the disease following an outbreak in April 2005. USAID has committed more than $2 million to support polio surveillance and immunization campaigns in Indonesia since 1996, and USAID-supported teams were instrumental in detecting and responding to the recent outbreak, the first in more than a decade. Since the April 2005 outbreak, the number of polio cases has risen alarmingly, placing Indonesia third on the list of countries with the greatest number of polio cases in the world. The additional funding planned for 2006 will dramatically increase USAID support for surveillance, laboratories, immunization campaigns, and monitoring.

September 2005 Highlights

• First Lady Laura Bush Spoke at a USAID Event Highlighting New Malaria Initiative
  On September 14th, the First Lady of the United States spoke at a USAID event titled Fighting Malaria in Africa: "Taking Action, Building Partnerships." More than 200 dignitaries and public and private sector leaders involved in the fight against malaria joined Mrs. Bush, including USAID Administrator Andrew Natsios, Chairman of the American Red Cross Bonnie McElveen Hunter, Executive Director of the Global Fund Richard Feachem, Director General of the World Health Organization J.W. Lee, UNICEF Executive Director Anne Venemanand, and high-level representatives from Angola, Tanzania and Uganda, for a dinner and to witness the signing of a Declaration to Fight Malaria in these first three target countries, where the disease is a major cause of illness and death.

  The event formally kicked off President Bush's ambitious goal to help free Africa from the death grip of malaria by reducing malaria mortality rates by 50 percent and extending 85 percent coverage in targeted countries in sub-Saharan Africa. The President's Initiative is intended to reach those most in need and the most vulnerable – children under five years old, pregnant women and people living with HIV/AIDS – through preventative measures and treatment. Ultimately in three years, the U.S. will have provided $1.2 billion in additional funding for anti-malaria initiatives in Africa, reaching 650 million people most in need and control malaria in more than 15 of the most affected countries in Africa.

  USAID, the Centers for Disease Control and Prevention (CDC) and other partners identified and negotiated specific country activities in Angola, Tanzania and Uganda to rapidly begin this historic initiative to save lives of those most in need.

• USAID Revolutionizes Africa's Ability to Produce Long-Lasting Mosquito Nets
  USAID, along with NetMark and the Mission in Kenya, is introducing a new way of mass treating long-lasting mosquito nets (LLINs) at the factory level. To be announced at a workshop on September 29, 2005 in Nairobi, this new technology will dramatically improve the supply of LLINs and potentially save millions of lives. Every known net manufacturer in Africa is invited to attend the workshop, including several manufacturers from Asia. The new technology developed binds insecticide to a net so it lasts longer. The first factory using the process, operated by Tana Netting in Thailand, produced the first LLINs using this process on September 15. This technological breakthrough is crucial for the battle against malaria because it’s scalable (net treatment machines come in different sizes to fit specific factory needs) and is easily transferable since it’s added at the end of the factory line.

• USAID Yemen Campaign Immunizes Children Against Polio
  With the Yemeni Ministry of Public Health, PHRplus and the Adventist Development & Relief Agency International, USAID is in the middle of a second round of providing polio vaccinations to children under five. This ongoing polio campaign combats a serious outbreak that's touched nearly every governorate in the country, especially in five governorates with very low coverage or none. The first door-to-door campaign reached more than 57,000 children in June 2005. The children were vaccinated with the monovalent vaccine specifically targeting the wild virus type that's hit Yemen. Yemen currently has the largest number of confirmed cases in the world (more than 360). USAID is working with Yemeni officials to improve immunization coverage, which will now place a greater emphasis on outreach and routine immunizations, health education of women and the use of female vaccinators.

August 2005 Highlights

• Rapid Assessment Teams Take Shape; Possible Spraying and Net Distribution Prospects in Angola
  USAID in conjunction with the Centers for Disease Control and Prevention (CDC) and the World Health Organization's Regional Office for Africa (WHO/AFRO) conducted rapid assessments in Angola from August 8-18, 2005, Uganda from August 1-10 and Tanzania around this same time. The assessment team in Angola conducted a needs assessment in addition to collecting baseline and planning information for an environmental assessment for the planned indoor residual spraying activities that may occur between October and December (spraying season).
  
  USAID's Bureau for Global Health (GH) and Africa Bureau (AFR) are working closely to aggressively focus on immediate actions, such as planning the nationwide campaign to distribute long-lasting insecticide-treated nets (LLINs) in Angola in conjunction with a planned measles vaccination campaign in June 2006.
  
  On June 30, 2005, President Bush challenged the world to reduce the burden of malaria dramatically as a major killer of children in sub-Saharan Africa, and pledged to increase funding of malaria prevention and treatment by more than $1.2 billion over five years. The goal of this effort is reduce malaria deaths by 50 percent in each of the target countries after three years of full implementation.
  
  To launch this initiative, the United States will significantly expand resources for malaria in Angola, Tanzania and Uganda beginning in 2006, and will expand to at least four more highly endemic African countries in 2007, and at least five more in 2008. By 2010, the U.S. Government will provide an additional $500 million per year for malaria prevention and treatment. This effort will eventually cover more than 175 million people in 15 or more of the most affected African countries.
  
  
• USAID Increases Assistance to Battle TB-HIV Co-Infection Ravaging Africa
  Every year close to two million people die of tuberculosis (TB) worldwide and over 30 percent of them are in Africa. Africa is suffering more deaths from TB than in past years, more than doubling from about 200,000 in 1990 to 539,000 in 2003. The factor behind this tragic anomaly is HIV/AIDS and the devastating effects of the deadly dynamic of co-infection.
  
  USAID is the leading bilateral donor in TB supporting the global expansion and strengthening of the directly observed treatment, short-course (DOTS) strategy for TB control. USAID currently supports programs to expand and strengthen DOTS in 11 African countries (USAID assists DOTS programs in Angola, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Nigeria, South Africa, Uganda, Malawi, Senegal and Sudan).
  
  USAID assistance supports the provision of lab supplies and equipment, training all cadres of health workers and engaging communities about TB care. USAID is also strengthening coordination of HIV care and DOTS programs so that TB patients are tested for HIV. In addition, HIV patients are screened for TB and then treated if needed.
  
  This year USAID is beginning new assistance to the national TB programs in Mozambique, Namibia, Tanzania and Zambia. As all four are focus countries for The President's Emergency Plan for AIDS Relief, the new TB resources will be used to strengthen DOTS programs and will complement funding on TB and HIV co-infection.
  
  USAID is also partnering with the private sector to improve diagnostic capacity and to increase access to quality TB treatment. Over 40 Public-Private Mix (PPM) DOTS pilot projects are underway in 14 countries worldwide, including several countries in Africa. These projects include individual private providers, as well as local NGOs and others. Treatment success rates in the PPM pilots are at or above the global target of 85 percent in most pilot sites.
  
  
• New Study on Pricing and Revenue Retention Policies Key for Combating Malaria
  USAID's Bureau for Global Health (GH), Partners for Health Reformplus and others initiated a multi-partner assessment on pricing guidance, revenue retention, trade, import and commercial distribution policies that ensure rapid, appropriate availability of needed supplies (drugs, spraying equipment and long-lasting insecticide-treated nets, or LLINs). The study will be essential to ensure the success of President Bush's bold initiative to fight malaria across Africa. U.S. funding should be additional and not substitute for existing funds, to ensure that all vulnerable populations are reached, especially those in the poorest quintile.
  
  The USAID study in Benin indicated that the price of insecticide treated nets (ITNs) in the same health facility varied according to which agency had financed the nets. In some cases, a proportion of the revenues collected were retained at the facility level. It was noted that different financing mechanisms and multiple systems could cause confusion for both health workers and consumers.
  
  Therefore, pricing and revenue retention policies on ITNs and other malaria interventions should be developed to promote desired consumer and provider behavior. As the initiative moves forward, donor policies must not undermine local health system strengthening efforts, and speedy implementation must not bypass current innovative and successful delivery approaches. Monitoring and evaluation activities already planned will play a key role in ensuring the success of this broad, important initiative as it expands across Africa.
  
  
• USAID Point-of-Use Water Treatment Expands to Nine Countries, Prevents Cholera Outbreak
  For the world's 1.1 billion people without access to safe water Point-of-use (POU) treatment of household water has emerged as a key intervention for preventing childhood diarrhea and death and offers the promise of clean drinking water. Contaminated water, unsanitary living conditions, water shortages and consequent poor hygiene kills two million children each year, but beyond deaths, place an enormous burden on health and nutritional status, health systems, economic growth, and the environment. But through comprehensive hygiene improvement programs with multiple interventions, diarrheal disease prevalence in young children can be reduced by roughly a third to a half.
  
  From research to implementation, USAID's Bureau for Global Health with regional bureaus and missions have expanded or launched country-level "point-of-use" treatment of household water in nine countries and in emergency distribution settings in Pakistan, Haiti, Ethiopia and Afghanistan.
  
  USAID partnered with Procter & Gamble to expand use of its "PuR" water purification product in commercial, social marketing, and emergency distribution settings in Pakistan, Haiti and Ethiopia. Unlike simple chlorination, PuR can turn even muddy water into safe, drinkable water within minutes. Also, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), USAID missions in six countries are using adaptations of the Safe Water System, which includes POU chlorination, inexpensive safe water containers, and hygiene practices related to water storage and use.
  
  In July 2005, USAID with Population Services International (PSI) responded to a cholera outbreak in Kabul, Afghanistan by distributing a home water purification solution, Clorin – a safe water solution (SWS) used to disinfect water at the point of use by inactivating microbial pathogens that cause diarrhea.
  
  The campaign, partnered with the Afghan Ministry of Public Health with support from UNICEF, began in an area with the poorest access to potable water. USAID with PSI also distributed specially designed 20-liter water vessels to encourage correct storage by schools and families at risk of cholera. By the end of July more than 6,000 families received the SWS and more than 500 vessels were distributed to schools, providing access to clean water to over 29,000 pupils. Less than 40 percent of Afghan families have access to safe water and diarrheal disease is the country's leading killer of children under five.

July 2005 Highlights

• Report on Health Related Research and Development at USAID Details Work, Receives Tribute
  At the request of Congress, USAID’s Office of Health, Infectious Diseases and Nutrition (HIDN) provided a report describing its role in the health research, development, and application cycle and its efforts to coordinate research and development activities with other agencies. The House Appropriations Subcommittee on Foreign Operations noted its appreciation for the report in this year’s Foreign Operations Bill. The report titled Health Related Research and Development Activities at USAID [PDF, 2.8MB], noted that from 2002 to 2004 USAID invested 6 to 7 percent of its total health-related budget in research and development. This percentage represented approximately $112 million in 2002, $123 million in 2003, and $155 million in 2004.

  In 2004, the largest amount of research funds were spent on HIV/AIDS-related research, followed in descending order by research on family planning and reproductive health, research on infectious diseases, and research on child survival and maternal health, including polio and micronutrients.

  The results of USAID-supported research have had significant public health impacts, starting with Oral Rehydration Salts (ORS), now used in about 85 percent of child diarrhea cases in almost half the world’s children under 5. The results of vitamin A research now save approximately 1 million preschool aged children a year. The impact of zinc, another USAID research product, on decreasing child mortality could be as or more significant than Vitamin A. By 2004, 2.5 billion autodisable syringes and 900 million vaccine vial monitors, both results of USAID-supported research, had been sold or distributed worldwide. USAID-funded research has also resulted in food fortification programs, making fortified sugar, cooking oil and flours available to the majorities of the population of many countries.

• President’s Initiative on Malaria Moving Rapidly Forward
  USAID is playing a leading role in President Bush’s initiative to fight malaria in Africa, which was announced June 30, 2005. USAID has organized and conducted planning meetings with the Centers for Disease Control and Prevention (CDC), the U.S. Department of Health and Human Services (HHS) and the State Department to coordinate efforts for this interagency initiative.

  USAID is spearheading the President’s initiative. Beginning in three countries – Angola, Tanzania, and Uganda – USAID’s Bureau for Global Health (GH), with help from the Africa Bureau (AFR), has produced a detailed action and implementation plan to ensure rapid action on the ground well in advance of FY 2006 funding. To ensure rapid results, the both bureaus are already working on mechanisms for procurement of long-lasting insecticide-treated nets, artemisinin-based combination therapy and indoor residual spraying.

  A combined USAID/CDC team will conduct rapid field assessments in each of the three countries in August and begin the country strategic planning process. In addition, the two USAID bureaus, along with CDC, have begun negotiating a Global Development Alliance partnership with the American Red Cross, UNICEF, and a private corporation, tentatively named as ExxonMobil, to provide long-lasting nets to most of the target population in Angola, coinciding with a planned measles vaccination campaign.

June 2005 Highlights

• Serious Polio Outbreak that Began Last Year in Nigeria Spreads to Indonesia
  Indonesia, the world’s fourth most populous country – and polio-free since 1995 – identified its first polio case in Girijaya village near Sukabumi in May. In response, USAID surveillance officers conducted an outbreak investigation with the World Health Organization (WHO) and the Indonesian Ministry of Health (MoH). The investigation confirmed an additional eight cases of polio in neighboring villages during a three-week period. USAID, with the WHO and MoH, conducted an immediate outbreak response campaign, immunizing children under 5 in the province of West Java and confirmed that the strain was imported from Africa and previously identified in Kano, Nigeria. A follow-up campaign to vaccinate several million children across the provinces of West Java, Banten and the city of Jakarta is planned for May 31 and June 28, 2005.
  
  
  Since 1998, USAID has funded Indonesia’s disease surveillance system. This investment was critical in detecting the first outbreak in a decade. USAID has contributed an additional $200,000 for these campaigns, on top of the $500,000 already allocated for surveillance. In addition to conducting initial assessments in all of the affected districts and helping the Ministry of Health assess the quality and planning of the response, USAID’s Global Polio Eradication Coordinator met personally with many of the affected children during the outbreak response.
  
  
• More than 130 Attend Global Health "Hot Topics and Technical Update" Meeting to Improve Coordination and Policy Understanding
  More than 130 people from 22 countries attended a one-day Global Health "Hot Topics and Technical Update" meeting in Washington, D.C., May 31, 2005, to review USAID policies and technical guidance, and improve networking and communication among USAID and implementing partners. The meeting was sponsored by the Bureau for Global Health (GH) in coordination with the Regional Bureaus. Attendees included chiefs of party and senior technical advisors from implementing partners on health projects, as well as representatives from USAID Missions, GH and regional bureau technical staff. Through technical update sessions led by USAID/GH, agency-wide guidance on state-of-the-art topics including HIV/AIDS, prevention and control of malaria, maternal and child health, and repositioning family planning were disseminated. The meeting also featured an update session on the USAID Fragile State Strategy presented by the USAID Bureau for Policy and Program Coordination (PPC). Since the event coincided with a major international health meeting, GH supported no invitational travel expenses of the attendees.
  
  
• Vitamin A Supplementation Program in Tanzania Costs Only $0.22 Per Child
  The results of a USAID cost analysis study of the national, twice a year vitamin A supplementation program in Tanzania showed the delivery of vitamin A at a mere $0.22 per child receiving a supplement. These findings dispel a widely held belief that twice-yearly vitamin A supplementation is a high cost, unsustainable short-term solution. The study followed the same methodology applied in analyzing the supplementation programs in Ghana and Zambia. Costs were broken down into three broad categories: program-specific costs, personnel costs and capital costs. These annual program specific costs -- those incurred exclusively for the delivery of the vitamin A -- demonstrate that vitamin A supplementation in Tanzania is highly cost effective and thereby the twice-yearly vitamin A supplementation program should receive priority and be viewed as a long-term approach to be maintained and strengthened. The study was conducted with personnel from MOST, the Agency’s Micronutrient Program.
  
  
• USAID Plans Health Assistance Transition in Liberia Using Fragile State Strategy
  From April 5-7, 2005, representatives from the USAID Bureau of Global Health, the Africa Bureau, the West Africa Regional Program, and the Office of U.S. Foreign Disaster Assistance helped the Agency's Liberia Mission develop a framework for harmonized U.S. health assistance to Liberia, and plan an effective transition from humanitarian to health development assistance. The goals were to coordinate health programs across the USAID Mission, USAID Bureaus and the U.S. Department of State’s Bureau for Population, Refugees and Migration, and to incorporate USAID’s new thinking on fragile states and conflict mitigation into health activities in Liberia. USAID used this forum to introduce the Agency’s new Fragile State Strategy and to develop principles of transition from relief to development. The recommendations from this workshop, especially related to joint planning and implementation of humanitarian and development assistance, will become models for health assistance in other fragile states.

May 2005 Highlights

• Administrator Andrew Natsios Receives 2005 Rotary International Polio Eradication Champion Award
  On Wednesday, May 11, 2005, USAID Administrator Andrew Natsios received the 2005 Rotary International Polio Eradication Champion Award at a ceremony in the U.S. Capitol. Rotary cited USAID’s work under his leadership that provided vital support for the synchronized polio immunization campaigns in 23 west and central African countries in 2004 and 2005, including critical work to reach children in the previously inaccessible areas of Darfur, Sudan and northern Nigeria. In Southeast Asia, USAID grants supported immunization activities that impacted over 200 million children in 2004. This award has previously gone primarily to presidents or prime ministers. Director of the Centers for Disease Control and Prevention Julie Geberding was also honored at the ceremony. Members of Congress who attended the event included Representatives Ralph Regula (R-OH), Mark Kirk (R-IL), Roger Wicker (R-MS), Janice Schakowsky (D-IL), Donna Christensen (D-VI) and Senator Russ Feingold (D-WI).
  
  
• Increasing Access to Financing for Private Health Practitioners in Uganda
  USAID-sponsored seminar in April, more than 100 Ugandan doctors, midwives, and dentists in private practice learned about access to financing for expanding their capacity to deliver high-quality health services. The seminar is part of USAID’s work with the Uganda Private Medical Practitioners Association (UPMPA), the Uganda Private Midwives Association (UPMA), and a local training institution called Enterprise Uganda to institutionalize training in business skills for private health care providers.

  At the seminar, local financial institutions discussed leasing and credit products and explained processes and requirements for accessing financing. A doctor and a midwife also described how they used financing in conjunction with newly acquired business management skills to expand their practices. The seminar used a variety of advertising techniques to recruit attendees, who heard about the seminar on a local radio talk show, through radio announcements, from Short Message Service (SMS) text messages sent to the mobile phones of members of medical associations, and by word of mouth.

• USAID Responds to Marburg Outbreak in Angola
  USAID’s Bureau for Global Health, along with the Bureau for Democracy, Conflict and Humanitarian Assistance, and the Bureau for Africa, are responding to a Marburg Viral Hemorrhagic Fever (VHF) outbreak in Angola that has killed 194 people in several weeks. Seven provinces are affected, all concentrated in the northwestern part of the country. To successfully contain the spread of the virus, prevent further infection, and provide quality treatment and care to all infected individuals, USAID is working with the Centers for Disease Control (CDC) and the Angolan Ministry of Health, (MINSA) allocating $525,000 to establish a field laboratory at the National Institute for Public Health. This lab has the capability of detecting viral RNA and antigens in clinical specimens and can test for evidence of recent or past infection in persons that have recovered from Marburg virus infections. USAID support will also mobilize additional epidemiologists, ship laboratory equipment and personal protective equipment, and provide local logistical support, and specimen shipment. MINSA and its partners (CDC, WHO, UNICEF, and Medecins Sans Frontieres) have created a National Technical Commission to combat the outbreak. The Marburg VHF outbreak was formally declared on March 24, 2005.

• USAID Plans Health Assistance Transition in Liberia Using Fragile State Strategy
  From April 5-7, 2005, representatives from the USAID Bureau of Global Health, the Africa Bureau, the West Africa Regional Program, and the Office of U.S. Foreign Disaster Assistance helped the Agency's Liberia Mission develop a framework for harmonized U.S. health assistance to Liberia, and plan an effective transition from humanitarian to health development assistance. The goals were to coordinate health programs across the USAID Mission, USAID Bureaus and the U.S. Department of State’s Bureau for Population, Refugees and Migration, and to incorporate USAID’s new thinking on fragile states and conflict mitigation into health activities in Liberia. USAID used this forum to introduce the Agency’s new Fragile State Strategy and to develop principles of transition from relief to development. The recommendations from this workshop, especially related to joint planning and implementation of humanitarian and development assistance, will become models for health assistance in other fragile states.

• Dramatic Improvements in Maternal Health in Egypt
  This month, more than 500 people gathered in Cairo to review the improvements in access to and quality of maternal and child health services in Egypt. Over the past 10 years, Egypt has witnessed a dramatic decline in the number of maternal deaths. The Maternal Mortality Ratio (MMR) was reduced from 174 maternal deaths per 100,000 live births in 1992-93 to 67.6 per 100,000 live births in 2004. The Safe Motherhood Program and USAID’s Healthy Mother/Healthy Child Project, implemented with the Ministry of Health and Population in Egypt, with the technical assistance of John Snow, Inc. were showcased as leading the improvements to the quality, effectiveness, and utilization of health services.

  Representatives from bilateral and multilateral donors and non-governmental, faith-based and international organizations; undersecretaries and health providers from Egyptian governorates and general and district hospitals; university professors; and clinical supervisors joined USAID technical staff in this review of program successes and discussion of remaining challenges to health in Egypt.

March 2005 Highlights

• USAID Staffer Speaks at Georgetown University on World Health Day
  Dr. Clydette Powell of USAID's Bureau for Global Health spoke at Georgetown University to students and staffers to commemorate World Health Day, April 7, 2005. Vanessa LaVallee, Assistant to Georgetown University President John J. DeGioia, welcomed Dr. Powell and noted that Georgetown is proud to have Administrator Natsios as an alumnus, as well as a prior speaker at Commencement. Dr. Powell spoke with students about USAID’s role in developing countries; USAID’s support of the President’s Emergency Plan for AIDS Relief, outlining the Agency’s key role in responding to the global HIV/AIDS pandemic; and Agency coordination with other U.S. Government institutions to fight the epidemic. She also described the initiative to prevent transmission of HIV, including approaches through abstinence and behavior change in youth, as well as the prevention of mother-to-child HIV transmission. Dr. Powell also used the time to describe some of USAID’s career paths in public health and medicine available.
  
  
• Eritrea’s Malaria Cases Fall 85 Percent
  Eritrea's National Malaria Control Program (NMCP) reported the number of malaria cases in Eritrea has fallen by 85 percent over the past five years due in part to the increased use of insecticide treated bednets (ITNs). Indoor residual spraying with DDT in high-risk areas also contributed to the overall success. In Eritrea, there are around 2.2 million people who live in the malaria-prone areas. Reported deaths dropped from 176 in 1999 to 16 in 2004.

  USAID/Eritrea, with technical support from USAID’s Bureau for Global Health, worked with the NMCP to develop a detailed risk map of Eritrea with an evidence-based decision process. It’s also working to increase private sector participation and social marketing of ITNs, combined with continued highly-targeted subsidized distribution for the most vulnerable – pregnant women – through antenatal clinics at health facilities.

• USAID Micronutrient Supplementation Programs Dramatically Increase Reach and Effectiveness
  USAID-supported vitamin A supplementation programs increased from nine to 20 countries from 1999 to 2004, achieving greater than 75 percent coverage in more than half of these countries. In 14 USAID-assisted countries, the availability of salt fortified with iodine increased by 35 percent. Highly successful micronutrient supplementation programs were also launched in India, Ethiopia and Haiti.

  Fortifying staple foods and condiments with vitamins and minerals can reduce birth defects, maternal death, childhood mortality, blindness, anemia and increased vulnerability to infections.

  More than two billion people suffer from vitamin A, iron and iodine deficiencies. The United Nations System’s Standing Committee on Nutrition March 2004 Report on the World Nutrition Situation estimates that 30 percent of all children in developing countries are malnourished. This means that 147.5 million children in the world do not have sufficient amounts of nutritious foods to meet their needs. There is strong evidence that poor nutrition is an underlying factor in almost 60 percent of all childhood deaths. Among children who survive, inadequate nutrition results in diminished physical growth, impaired ability to learn, and increased injury from childhood diseases.

• New Website for HIV/AIDS, TB and Malaria Information
  Updated daily with the latest information on HIV/AIDS, TB and malaria, www.GlobalHealthReporting.org offers an easy and efficient way to stay on top of breaking news, current reports and data, and events from around the world. The site is operated by the Kaiser Family Foundation with major support from the Bill & Melinda Gates Foundation to help journalists efficiently search the latest and most accurate information on global health. Researchers, policymakers, and nongovernmental organizations (NGOs) will also benefit from information on the free site, which includes daily news summaries; a calendar of upcoming events related to HIV/AIDS, TB, malaria and health journalism; current regional and global health statistics; in-depth country spotlights; and reporting tools for journalists.

January/February 2005 Highlights

• USAID-Supported Research Finds Three-Fourths of Newborn Deaths Are Preventable
  New USAID-supported research recently published in the medical journal The Lancet indicates that more than half of the 4 million deaths of babies each year who die in the first month of life could be avoided with simple measures such as cutting umbilical cords with sterile blades, prescribing antibiotics for pneumonia and keeping newborns warm.

  USAID supported the research by an independent group of academics and health practitioners to provide recommendations on how the global community could further reduce death and illness in children, particularly newborns, through simple, low-cost approaches.

  The papers, which were published in a series on newborn survival, also emphasized the need for skilled birth attendants at delivery, the importance of recognizing pregnancy and delivery complications, and the need for families and communities to be prepared for birth emergencies.

  USAID participated with The Lancet, the World Health Organization (WHO), UNICEF, the Gates Foundation, Save the Children and other organizations to announce the findings at an event on March 3. More than 200 publications, including the Washington Post and New York Times, covered the story.

  USAID remains strongly committed to child survival and newborn health programs and will launch a new global initiative on newborn health this year. In Asia, recommendations from USAID research studies will inform postpartum care programs in countries with high rates of newborn deaths. In Africa, links between maternal and newborn care and prevention of mother-to-child transmission of HIV/AIDS (PMTCT) programs will be strengthened. In the Latin America and Caribbean region, USAID will collaborate with the Pan American Health Organization (PAHO) to develop a regional neonatal strategy. In the Europe and Eurasia region, the results of a recent child health study will influence the contents of a regional health neonatal strategy. Globally, USAID has been actively involved in the Healthy Newborn Partnership, the Child Survival Partnership and the Partnership for Safe Motherhood and Neonatal Health.

• Planned Agreement with GlaxoSmithKline on Malaria Vaccine
  On February 23, technical staff from the USAID Bureau for Global Health met with counterparts from GlaxoSmithKline (GSK) and the Walter Reed Army Institute of Research (WRAIR) to discuss collaboration on malaria vaccine research. The three parties agreed to develop a formal memorandum of understanding (MOU) for future collaborations, particularly concerning several of USAID's highest priority vaccine candidates. One of these candidates is now undergoing an efficacy trial in Kenya, the results of which will be available later this year. GSK is the only major pharmaceutical company working on malaria vaccines. They supported a recent field trial in Mozambique that demonstrated efficacy for one malaria vaccine candidate. USAID has a formal agreement with WRAIR, and WRAIR has a formal agreement with GSK. This MOU will facilitate a direct relationship among all three parties and allow USAID to have a greater voice in future discussions.

• Photo Documentary on Polio Eradication
  USAID has launched a photo documentary illustrating the efforts of the Global Polio Eradication Initiative (PEI). USAID, a longstanding partner in the PEI, has been waging a major campaign against the crippling disease since 1988. Polio now occurs in the wild in six nations, down from 125 when the campaign began.

  The Global Polio Eradication Initiative is spearheaded by the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), and the United Nations Children's Fund (UNICEF). USAID, a major partner, supports polio eradication in more than 40 countries with a special focus on the six remaining endemic countries. To date, the PEI has reduced the number of polio cases worldwide from an estimated 350,000 cases in 1988 to 784 cases at the end of 2003. Approximately 5 million cases of paralysis have been averted since the launch of the global polio eradication effort. The documentary features photographs taken by USAID Polio Eradication Coordinator Ellyn Ogden, and was produced by the Population Health & Nutrition Information (PHNI) Project. View the documentary

• Fighting Antimicrobial Resistance in Zambia
  USAID's global response to the growing problem of antimicrobial resistance (AMR) has achieved success through a program in Zambia, which operationalizes the World Health Organization (WHO) global strategy for AMR containment. Increasing rates of AMR " often caused by ineffective regulation and oversight of the supply and use of medications " threaten gains achieved through USAID's health interventions around the world, by reducing the effectiveness of treatment. The WHO strategy provides a framework of interventions proven to reduce AMR.

  USAID efforts in Zambia enabled the formation of a local AMR Advocacy Working Group that is successfully focusing national attention on AMR prevention. Uniting partners from government, academia, the media, the medical community and the private sector, the group is working to address issues such as ensuring proper drug usage, strengthening surveillance systems and advocating for improved regulation. In November 2004, the group hosted a meeting opened by the Zambian Minister of Health to launch historic new treatment guidelines designed to improve the use of medicines.

• USAID Battles Neonatal Deaths in India
  India faces the world’s biggest challenge in reducing the number of neonatal deaths. Each year, over one million newborns die before they complete their first month of life - accounting for 30 percent of the world’s neonatal deaths.

  In partnership with the Government of India’s Integrated Child Development Scheme (ICDS), local non-governmental organizations (NGOs) and CARE, USAID is battling to reduce infant mortality and child malnutrition in 70 districts of 10 states, covering a population of 100 million through an Integrated Nutrition and Health Project. The program focuses on strengthening health systems and communities and facilitates the convergence of three institutions: health, ICDS, and the Panchayati Raj (local self-government). With the involvement of community workers, community leaders, and the staff of the health department and ICDS, the program interventions include a package of health services and behavior change communication that aim to reduce neonatal mortality. CARE has developed a low-cost model of scaling up the program; innovations are tested in demonstration sites and then rolled out to the rest of the program areas.

  Within one year, the program increased tetanus toxoid immunization coverage and the number of contacts with community workers on the day of delivery and in the first week after birth - overcoming a major challenge in rural areas where most births take place at home. Home-based practices improved - more families began to practice clean delivery, thermal care of the newborn, and early breastfeeding. The program also reached those from a low socioeconomic status more successfully compared to the non-program areas.

• Newborn Health Interventions in Senegal
  While there has been a significant reduction in the number of children dying under the age of 5 in Senegal in the last 15 years (with a 30 percent decrease in under 5 mortality), the number of infant deaths has decreased significantly less during the same period. In fact, 27 percent of childhood deaths in Senegal take place during the first month of life.

  In response to this critical statistic, USAID, with support from the cooperating agency BASICS, worked on a pilot program in the Senegalese district of Kebemer, covering a population of about 68,000. The program applied key components of essential newborn care and maternal health, targeting and creating links between the community and peripheral facilities. A number of partners were involved in this effort, forming a National Committee on Newborn Health.

  Within a year and a half, this approach improved the quality of basic care provided by community and facility level health workers. There was improved knowledge and behavior on the part of mothers and families, and increased involvement of community groups. At the national level, close and continuous involvement resulted in increased participation by the partners, and a very early consensus to proceed to scale, which will be carried out in the next phase.

• No Cases of Guinea Worm in Uganda for Past 18 Months, Indicating Elimination of Disease
  Uganda has seen a dramatic reduction in Guinea worm disease from 126,369 cases in 1992 to zero over the past 18 months. This is considerably longer than the 12-month incubation period of Guinea worm and indicates that Uganda has eliminated transmission of the disease, although concern still exists about possible importation of cases from southern Sudan.

  In 1980, when the global Guinea worm eradication effort began, more than 3 million people were infected with Guinea worm worldwide. Since that time, the disease has been eliminated from Asia and from four of 17 African countries.

  People become infected when they drink water contaminated with microscopic Guinea worm larvae that migrate through the body and grow into thin, thread-like worms up to one yard long. The worms emerge from the body one year later through painful blisters and can cause permanent scarring and crippling. In highly endemic areas, 50 percent or more of the population may become disabled for weeks or months.

  Guinea worm disease can be prevented through health education and water purification. In addition, installing borehole wells to improve drinking water systems prevents Guinea worm infections and other water-borne diseases.

December 2004 Highlights

• A Mini-Revolution in Albania’s Health System
  USAID and its partner Primary Health Reform Plus (PHRplus) held a national workshop near Tirana with the Albanian Ministry of Health and the Public Health and Primary Health Care Directorates in Berat District to examine the new Health Information System. It’s the first step in creating an innovative information system that’s completely computerized to include electronic patient charts. The system will allow data to “flow out” of every primary health care unit, not only in the cities but also in the most distant villages helping translate health knowledge into health care.

  According to Deputy Minister of Health Eduard Hashorva, “the new, Albanian version of the information system is simple, rapid and complete with accurate data. Certainly, it has proven to be a ‘mini-revolution.’ In concrete terms, when a general practioner and other medical staff access the primary health care system, within one to two minutes a form with basic data is filled out. Thereafter, this form is computerized, processed and analyzed. The processed information provides instant familiarity with the patients’ current condition and health history. This information ultimately affects the quality of the continuum of care for the patient, and improves management and planning of the health care system.”

• USAID Improves Access to Health Care for the Poor in Senegal
  With USAID assistance, community-based health insurance systems known as Mutual Health Organizations (MHOs) in Senegal increased seven-fold between 1997 and 2003. At least 136 are in operation throughout the country today. MHOs are not-for-profit groups, often operated through community organizations such as women’s groups or local credit unions, allowing members to pool limited resources to provide health insurance for basic services. A recent USAID-funded study showed that MHOs are increasing access to health care for the poor in Senegal and improving community participation. An examination of just three groups receiving USAID assistance included more than 1,700 members and 8,200 beneficiaries.

• Eritrea First Country in Africa to Achieve Abuja Mortality Target
  Eritrea announced in March 2004 that it achieved the Abuja Goal of halving its mortality from malaria, making it the first country in Africa to achieve the goal set by African Heads of State in Abuja, Nigeria, in April 1999. In addition, Eritrea increased its coverage of households in malaria-endemic areas with insecticide-treated nets to above 60 percent, and reduced the number of malaria outpatient cases by 60 percent. This success is particularly notable, as it comes at a time when the Roll Back Malaria campaign faces increasing criticism for lack of success in reaching these targets.
  
  Eritrea’s success in distributing ITNs is equaled by an unparalleled success in re-treating bednets. (The insecticide on the netting declines over time, and nets must be re-treated with insecticide each year to maintain their preventive effect.) Through close collaboration with local government administrators at the kebabi level, the National Malaria Control Program (NMCP) has been able to attain re-treatment rates of between 28 and 40 percent (proportion of households owning nets in which all nets were re-treated within the past six months). The highest reported rates for other projects (not national programs) in Africa have been around 23 percent.

November 2004 Highlights

• Nigerian Guinea Worm Eradication Program Success
  For the first time since the Nigerian Guinea Worm Eradication Program began in 1988, zero new cases were detected for a full month -- September. When the program began, Nigeria reported more cases than any other country in the world - approximately 400,000 per year, or more than 33,000 per month. Only 395 cases have been reported for the entire country in nine months for 2004. Guinea worm disease is an ancient parasitic disease that is painful and debilitating that cripples agricultural production and reduces school attendance.

  As recently as 10 years ago, more than three million people were infected with the disease. Today, Guinea worm disease has been eradicated from Asia and now affects fewer than 40,000 people in eight African countries. People become infected when they drink water contaminated with microscopic Guinea worm larvae that migrate through the body and grow into thin, thread-like worms up to one yard in length. The worms emerge from the body one year later through painful blisters and can cause permanent scarring and crippling similar to polio. In highly endemic areas, 50 percent or more of the population may become disabled for weeks or months.

  Guinea worm disease can be prevented through health education and by filtering drinking water. Also, installing borehole wells to improve drinking water systems also can stop transmission of Guinea worm and other water-borne diseases.

  USAID has been an important supporter of the Guinea Worm Eradication Program over the years. In 2004, USAID signed a new agreement with the Carter Center to support the final stages of the eradication campaign. This grant was initiated with resources from USAID’s Africa Bureau, and is being managed by the Bureau for Global Health.

• Strengthening Community-Based Health Financing Schemes in Uganda
  "The health plan is like a parent to us," says a member of a community-based health financing (CBHF) scheme in western Uganda. This commentary was received during a recent assessment carried out by USAID through the Partners for Health Reformplus project with the Uganda Community-Based Health Financing Association. CBHF schemes allow members to pay a modest premium on a regular basis to access a defined package of health care with select providers. The assessment aimed to identify strengths and weaknesses of CBHF schemes in Uganda and to collect information pertinent to implementing CBHF strengthening activities. Scheme managers and members reported significant benefits to membership including increased access to preventive and curative health services.

  The assessment revealed that scheme membership size is a better predictor of cost recovery than premium rates. Strengthening activities, such as improvements in scheme accounting mechanisms and financial management, will lead to stronger financial and decision-making practices. Likewise, sensitization of scheme members will raise understanding of insurance concepts and increase effective community participation in scheme management. The assessment presents stakeholders with a portrait of CBHF activities throughout Uganda and provides a framework for facilitating CBHF sustainability.

• Saving Children's Lives in Haiti through Clean Water
  USAID and its partners in the Safe Drinking Water Alliance this week launched a new point-of-use water purification product developed by Procter & Gamble (P&G) to provide safe water in Haiti, where diarrhea is endemic and a major killer of children under five.

  Diarrhea, the leading cause of death among children ages one-to-11 months and the second leading cause of death among children ages 12-59 months, is responsible for 41 percent of all deaths in Haitian rural areas, compared to 32 percent in urban areas.

  The Safe Drinking Water Alliance is a public-private partnership consisting of USAID, P&G and three nonprofit organizations -- Population Services International (PSI), the Johns Hopkins University Bloomberg School of Public Health's Center for Communication Programs (CCP) and CARE -- created to increase access to safe water. In addition to work in Haiti, the Alliance is also implementing safe drinking water projects in Pakistan and Ethiopia.

  PUR Purifier of Water is a dry P&G product in a sachet that treats 10 liters of water and contains a flocculent to remove suspended sediment from the source water as well as a chlorine-based disinfectant to insure ongoing protection of treated water. View the related USAID press release on providing safe water in Haiti.

• Food Fortification Institutionalized in the Philippines
  USAID's efforts to improve nutrition through food fortification in the Philippines were highlighted this month as the Food Fortification Law of 2000 officially went into effect, and by executive order of President Gloria Macapagal the country celebrated its first National Food Fortification Day. The USAID Bureau for Global Health has supported the fortification of wheat flour, cooking oil, sugar, and rice with key micronutrients - most notably vitamin A and iron - to help ensure nutritionally rich foods reach all Filipinos, and the new law makes these fortifications mandatory. Since the Philippines Food Fortification Program began in 2000, USAID has provided technical assistance in fortification to all of the 12 flour mills and 29 major cooking oil manufacturers, as well as one producer of premix rice and two producers of premix and fortified sugar.

October 2004 Highlights

• USAID Extends Successful Partnership to Fight Childhood Illness in Rural Uganda
  USAID’s Bureau for Global Health extended its highly successful partnership with the nongovernmental organization Africare for another five years with a $1.3 million grant. Africare’s Community Based Integrated Management of Childhood Illness (C-IMCI) program, supported by USAID/Uganda and the Africa Well Fund, backed by the singer Bono, works on safe water supply, nutrition improvement through vegetable gardening, and HIV/AIDS prevention.

  Phase I of the community health program resulted in a 97 percent increase in the use of health facility utilization. The new funds will support the expansion of the program from eight sub-counties to 15 in the Ntungamo District of southwestern Uganda.

  Phase II of the program will focus on malaria, diarrhea, malnutrition, and pneumonia prevention, targeting more than 82,000 people with visits by healthcare workers to more than 4,000 households.

• Georgia Expands Disease Surveillance Reform
  Following a successful pilot, the Government of Georgia endorsed the countrywide roll-out of a disease surveillance reform program. The pilot program, conducted in the Imereti region, resulted in doubling the detection of infectious diseases in the region, and gave early warning of a measles outbreak that affected nearly 3,000 people.

  The surveillance reform package, developed by local experts and USAID, improved data quality and availability as well as the technical capacity of health workers to analyze available information. This new Georgian surveillance system can serve as a regional model for other Newly Independent States countries and, due to an increasing pool of technical human resources in the region, can be replicated with relatively few additional resources.

• Mozambique Malaria Trial Described as Breakthrough in Search for Vaccine
  A malaria vaccine tested in Southern Mozambique was described as a breakthrough in the search for a vaccine against the mosquito-borne disease. The vaccine tested reduced the risk of malaria infection by 45 percent, clinical malaria by 29.9 percent, and severe malaria by 57.7 percent in 2,022 children ages one to four in two rural districts, and protected the children for up to six months.

  The vaccine, known as RTS,S/AS02A, was developed by GlaxoSmithKline (GSK) Biologicals and has been in development and testing for 17 years. The vaccine is directed against Plasmodium falciparum, which produces the most deadly form of malaria. It fuses a portion of the hepatitis B virus with a portion of the malaria parasite. Portions of the hepatitis virus were added because they result in a vaccine which provokes strong immune responses. The trial was conducted by the Mozambique Ministry of Health with financing from the Malaria Vaccine Initiative (MVI), created in 1999 with $50 million from the Gates Foundation. USAID provided support to the project and is working with the Walter Reed Army Institute of Research, GSK, and MVI on a vaccine which, used in combination with RTS,S/ASO2A, may provide even greater benefit.

• USAID has Major Role in Five of 17 Global Health Successes
  For Millions Saved: Proven Successes in Global Health, a book that will be released in early December, the Center for Global Development convened a working group of experts to document 17 cases in which large-scale efforts to improve health in developing countries have succeeded, saving millions of lives and preserving the livelihoods and social fabric of entire communities. USAID has played a major role in five of the cases, including the prevention of diarrhea through oral rehydration therapy in Egypt, polio eradication in Latin America, river blindness and guinea worm control in Africa and family planning in Bangladesh.
  
  Fifteen experts in international health, development economics and public policy examined large-scale public health programs in the developing world lasting five years or more, employing a cost-effective intervention and leading to millions of lives saved and millions more improved. The lessons in the book are powerful: far-reaching success is possible even in the poorest of countries, in the face of grinding poverty and weak health systems. The economic and social returns from successful health programs far outweigh the outlays required.

September 2004 Highlights

• Infant and Child Deaths Decline More than 60 Percent in Southern Mozambique
  World Relief Mozambique, working through USAID's Child Survival and Health Grants Program in the Gaza province of Southern Mozambique, reduced child mortality by 62.2 percent (from 119 to 45 deaths per 1,000 live births) and infant mortality by 65.8 percent (from 69.8 to 23.9 deaths per 1,000 live births) in the period from 2001 to 2002.

The project trained mothers and church leaders as volunteer community health workers in the areas of nutrition, malaria, pneumonia and diarrhea prevention, maternal and newborn care, child spacing and STI/HIV/AIDS prevention. The workers covered a population of 130,000 in the rural area of the Chokwe district. The project also helped the Ministry of Health expand its network of health centers and health posts.

• USAID Targets Iron-Folate Supplementation for 100,000 Women in India
  On August 17, USAID, with the micronutrient project MOST, began a program to provide iron folic acid supplementation for 100,000 women of reproductive age in the northern Indian state of Jharkland. The nutrient supplementation helps prevent anemia. Women who are anemic and pregnant have a higher rate of poor maternal health during pregnancy plus low birthweight and other health problems in their newborns.

USAID is partnering in this effort with Vikas Bharti, a local NGO that has won the confidence of "hard-to-reach" populations, largely tribal, in the southwest part of the state. The program was officially launched at the Vikas Bharti Office in Ranchi, the state capital, with the goal of expanding to five of the 11 districts before the end of the year.  

In an effort to motivate staff and volunteers, community health workers will have their own anemia status determined with portable Hemocue machines.

• USAID has Major Role in Five of 17 Global Health Successes
  According to a recent study, USAID played a major role in five of 17 large-scale successes in global health. USAID's contributions included prevention of diarrhea through oral rehydration therapy in Egypt, polio eradication in Latin America, river blindness and guinea worm control in Africa and family planning in Bangladesh.

Fifteen experts in international health, development economics and public policy examined large-scale public health programs in the developing world lasting five years or more, employing a cost-effective intervention and leading to millions of lives saved and millions more improved. The findings will be released November in a book titled "Millions Saved: Proven Successes in Global Health," from the Center for Global Development's Global Health Policy Research Network.

• Frontline Providers: Midwives Battle Maternal and Child Mortality
  Over half a million women die each year from complications related to pregnancy and childbirth " 99 percent of them in developing countries " and another 15 to 20 million women suffer long-term effects from such complications. But some childbirth complications, particularly postpartum hemorrhage - the biggest maternal killer, are preventable with the help of skilled birth attendants.

  Midwives are increasingly stepping up to the challenges of both preventing and managing obstetric complications. USAID is supporting them as a key maternal and child health intervention. Often the "frontline providers" of obstetric care during childbirth, midwives are formally trained health workers that significantly reduce risks to mothers and children during childbirth throughout the developing world.

  "Midwives achieved substantial declines in neonatal and maternal mortality even before modern obstetric care was available," says Mary Ellen Stanton, USAID's maternal health policy advisor. Indeed some of the first successful results of midwifery care were reported in 18th century northern Europe, where midwives helped cut maternal mortality rates in half among a mostly rural and poor population.

  Supporting midwives in the broader health system entails not only increasing the supply of skilled midwives, but also increasing the demand for their services. USAID's strategy has focused on approaches that support midwifery from both sides. However, cost is a major obstacle to increase demand for midwifery services. Reducing the cost to mothers and families through risk pooling and insurance schemes has also been a key aspect of many USAID programs.

  One of the key components of early European successes in midwifery was a concerted effort to raise professional standards of care. USAID recognizes the importance of improving the quality of care and standards of professionalism among midwives through improvements in midwife education.

  Today in Afghanistan, where maternal health statistics are among the worst in the world, USAID programs are working to increase the number of trained midwives and set professional standards for training and care.

  Another important strategy for achieving higher professional standards is through support for local, national and international midwife associations, as USAID is providing in countries like Yemen and Sri Lanka. A well-functioning midwifery association can be an important benefit to practitioners by providing opportunities for continuing education, keeping members informed of best practices and giving midwives a seat at the policy-making table to advocate for the health of women and children.

  Midwifery is a time-tested profession and it's likely we've only seen the beginning of what midwives can do to improve childbirth outcomes in developing countries. By supporting the education of professional midwives, reducing barriers to demand for services, increasing quality of care and increasing the number of trained midwives, USAID will continue to work to empower these frontline providers to reduce the risk of serious injury, long term disability or death resulting from childbirth.

Addressing Multidrug Resistant Malaria in Asia
While improved access to prompt diagnosis and efficacious treatment contributed to a decrease in the number of malaria deaths in Southeast Asia over past decades, the recent emergence of multi-drug-resistant (MDR) malaria threatens to reverse these gains. USAID is providing support at the country and regional level to strengthen capacity and monitor and respond to drug-resistant malaria in Southeast Asia. View more information here.

August 2004 Highlights

• USAID Extends Effort to Create Malaria Vaccine
  USAID is providing a $1.2 million grant to Maxygen, Inc., to support the continued research and development of a new broadly protective malaria vaccine. Maxygen began work to develop a malaria vaccine in September 2001 under an initial three-year, $3.7 million grant from USAID. The Bill and Melinda Gates Foundation also provides funding for this program. The creation of an effective vaccine is critical in the worldwide fight against the spread and devastation of malaria.

  Malaria has reached epidemic proportions in many parts of the world. It is a public health problem in more than 90 countries inhabited by approximately 40 percent of the world's population. Worldwide, it is estimated that malaria kills more than one million people each year, making it the world's third deadliest infectious disease, after AIDS and tuberculosis (TB). Malaria is the most common of the three diseases, with more than 500 million persons experiencing acute malaria illness annually, compared with 5.3 million for AIDS and 8.8 million for TB. Research on new and better drugs is an important part of USAID's malaria strategy.




• USAID Grant to MSH to Improve Health Services in South Africa
  USAID is providing Management Sciences for Health (MSH) a $20 million grant for a four-year project to improve use and access to child health, reproductive health, and HIV/AIDS services. With this award, MSH will work closely with the South African Department of Health (DOH) and local partners in five of the country's nine provinces to strengthen management systems such as planning, financial management, human capacity development, and quality assurance. The new project builds on the success of the EQUITY Project (1997-2003), a USAID-funded initiative implemented by MSH and the national DOH. More information can be found at www.msh.org.



• All-Women Teams Vaccinate 27,000 Children in Kabul
  In August 2004, for the first time, all-women teams of vaccinators participated in a Polio National Immunization Day (NID) that reached more than 27,000 children in Kabul, Afghanistan. Teams of women vaccinators went from village to village and house to house to ensure that all children up to five years of age received two drops of the oral polio vaccine. The Afghanistan Ministry of Health led the effort, with support from USAID, United Nations Children's Fund (UNICEF) and the World Health Organization (WHO). The trained teams included parents, teachers, health officials, and volunteers.

  Health authorities in Afghanistan have been making significant strides in recent years towards stopping the virus. Since 1997, Polio NIDs have been conducted in Afghanistan, and of the five rounds conducted last year, the immunization effort successfully reached 6 million children. In 1999, there were 150 polio cases in Afghanistan but only 10 cases were confirmed last year. The southern region is the last remaining indigenous focus of poliovirus transmission in Afghanistan.

  Polio is endemic in Niger, Nigeria, Egypt, Pakistan, India and Afghanistan. April to September is considered the peak season for polio transmission.




• First Integrated Effort in Yemen Vaccinates Nearly 3,000
  USAID, with the Adventist Development and Relief Agency (ADRA)'s Basic Health and Education Program and a local Yemeni health office, organized a vaccination campaign in two districts in the Al Jawf Governorate.

  Forty-eight specially trained teams battled rough terrain, long distances, wild dogs, heavy rains, and sometimes suspicious people, going door to door in every village in the districts to reach all children under one year of age.

  The teams, which included 14 midwives and female health workers consisting of a vaccinator and a volunteer from the community, vaccinated at total of 2,882 children against polio, diphtheria, and measles. This was the first time such a campaign was successfully implemented in Al Jawf.

  The teams knowledge, understanding, and involvement of the local people - especially the members of the locally elected Health Facility Committees - made it possible for them to successfully negotiate and work within the strong tribal customs of the areas. Villagers were surprised, but happy, to see the vaccination teams visit their houses.

July 2004 Highlights

• USAID Aggressively Pursues Plant Extract to Treat Malaria
  Facing an upsurge in drug-resistant strains of malaria that no longer respond to treatment by chloroquine (79 percent in Ethiopia, 64 percent in Kenya), USAID has aggressively supported the development of artemisinin-combination therapy as a safe and effective alternative treatment for malaria. Derived from a wormwood plant in China, artemisinin-based drugs are now commonly used in Southeast Asia to treat drug-resistant malaria.

  USAID and its partners in Roll Back Malaria are currently negotiating with agricultural producers in Africa to encourage farmers to cultivate more artemisinin-based drugs, with an eye towards generating enough of the active pharmaceutical drug ingredient to triple the drug availability in 2005 to a total 150 million doses.




• Yemeni Midwives Meet to Form National Association to Reduce Deaths During Childbirth
  The United Nations and USAID, through PHRplus/Yemen, supported the participation of midwives from Lebanon, Bahrain, and Indonesia at a workshop in Yemen to establish a national midwives association. Yemen has a high death rate for mothers during childbirth. The International Confederation of Midwives, an international non-governmental organization (NGO) that unites 85 national midwives' associations from over 75 countries, also participated. The shared experiences from the visiting countries enriched the discussion, helped to identify pitfalls and lessons, and encouraged the way forward for Yemen in working towards the goal of reducing deaths each year of women during childbirth. A core group of Yemeni midwives are finalizing the draft by-laws, clarifying their future role, and developing an action plan. The Yemeni association's first general meeting will take place in October. The formation of the association will be a major step in the history of Yemen in assuring participation and recognition of the role that midwives play in maternal, child, and family health.



• USAID Finds Success in Fighting Vector-borne Diseases in South Asia
  Across South Asia, diseases transmitted by mosquitoes and sand flies (vector-borne) are the main causes of illness and death. Over the past five years, a USAID supported regional health program implemented by the Environmental Health Project (EHP) in Bangladesh, Bhutan, India, and Nepal has led to more effective diagnosis, treatment, prevention, and control of the three most significant vector-borne diseases: malaria, Japanese encephalitis, and kala-azar. These diseases are recurrent and an annual drain on a country's resources. Out-of-date medical practices, poverty, and inaccessibility to health care have allowed these diseases to gain a strong grip on the region and move across national borders. Malaria and Japanese encephalitis, carried by infected mosquitoes, cause approximately 50,000 deaths annually in South Asia. Kala-azar, carried by sand flies, affects 500,000 people annually, and approximately 90 percent of these cases occur in Bangladesh, India, Nepal, and Sudan.

  USAID is supporting EHP in training these communities to administer preventive measures. By using locally made materials for treatment such as lime, costs have dropped and prevention has become more accessible to people in rural areas. Another of the project's initiatives involves comprehensive cross-border plans for tackling these diseases by sharing methodologies and information from more developed neighbors. Vector-borne diseases have a high prevalence at cross border areas. With case detection virtually non-existent in Nepal, a viable vaccination program could not be introduced. EHP helped the country develop a database to determine the number of people who have the disease.




• Model National Food Fortification Begins in Uganda

  A man works in a food storage area.

  
  USAID and MOST, the Agency's Micronutrient Program, through a unique public-private partnership with the Government of Uganda and private food industries, have supported a model National Food Fortification partnership to reduce micronutrient deficiencies. It received high praise from U.S. Ambassador Jimmy Kolker who said, "There is no question that the National Food Fortification Program of Uganda can and will be held up as an example to other countries in Africa and throughout the world of what happens when the public and private sector work together to address a public health issue."

USAID provided extensive support including funding industry assessments, conducting a food consumption survey to determine what foods to fortify, and the procuring, supplying, and installing of food fortification equipment for the participating industries. With the Uganda National Bureau of Standard and Ministry of Health, USAID also provided technical assistance to producers to meet Good Manufacturing Practices, a pre-requisite for food fortification; develop food fortification standards and regulations; train technical personnel on fortification procedures; and analyze and conduct trials to ensure the fortified foods are safe and contain the required amounts of micronutrients.



• A woman receives treatment at a health facility.

  USAID Trains TB Managers from High-burden Countries on Advocacy and Communication
  USAID and Stop TB conducted a five-day 40-hour course for TB managers in 30 high-burden countries at The Research Institute of Tuberculosis (RIT) in Tokyo, Japan. The eight-hour module was designed by USAID and Stop TB and covered advocacy, social mobilization, and communication. It also included working with reporters, crisis communication planning, preparing for an interview to include actual crisis scenarios, and taped press conferences. The Stop TB Partnership organized the 40-hour course with assistance from the Japan Anti-Tuberculosis Association (JATA) and the Japanese International Cooperation Agency (JICA).

June 2004 Highlights

• New Dialogue on Tuberculosis in Prisons
  With support from USAID, the Russian Red Cross has succeeded in introducing more effective tuberculosis (TB) treatment and control programs in four Oblast prison systems. This work with prison officials on TB has now opened the door for broader USAID work in prisons on the HIV/AIDS epidemic and further dialogue between the U.S. mission and prison officials. For example, during her visit to St. Petersburg, USAID Assistant Administrator for Global Health, Dr. E. Anne Peterson discussed incorporating HIV/AIDS prevention, support and care programs with local prison officials. The increased dialogue on these issues is a good example of how public health programs can act as tool to advance the U.S. Government's foreign policy. USAID has observed that in Russia, health programs are leading to expanded dialogue on issues that a decade ago would have been impossible for the U.S. Government to tackle.




• USAID Announces New AIDS Treatment, Care and Support Programs During Visit to Russia
  Dr. E. Anne Peterson, Assistant Administrator for Global Health, accompanied Health and Human Services Secretary Tommy Thompson on a U.S. delegation to Russia aimed at furthering US/ Russia partnerships on HIV/AIDS. The trip is a follow-up to the September 2003 Camp David Summit between President George W. Bush and Russian President Vladimir Putin. Dr. Peterson visited early childhood intervention programs designed to prevent child abandonment and successful TB and maternal health programs in the area. In addition, she announced a recently approved Global Fund grant to Russia. Also, new USAID financed AIDS treatment, care, and support programs (with American partners Yale and American International Health Alliance) will serve as models for Russian government policy as well as scale-up for Global Fund and World Bank financed programs that will be launched in 2005.
  
  
• USAID, ICDDR, B and SMC Launch Joint Effort to Promote Zinc
  The USAID-assisted Social Marketing Company (SMC) has joined the International Centre for Diarrheal Disease Research, Bangladesh (ICDDR/B) in the promotion of zinc for the treatment of children with diarrhea. Diarrhea is still one of the worst disease burdens in developing countries, killing nearly 2 million children every year. In Bangladesh alone, zinc treatment could save between 30,000 and 70,000 lives of young children annually. With assistance from ICDDR,B's "Scaling Up Zinc Treatment for Young Children with Diarrhea Project," SMC will begin a one million dollar nationwide multi-media campaign promoting the use of zinc tablets. SMC will work together with commercial advertising firms to select a brand name and target treatment to all children under five-years-old during a diarrheal episode. Special emphasis will be given to reaching the most poor and malnourished children, and the marketing plan will be based on earlier formative research. SMC will procure the initial shipments of zinc from Nutriset, a French company that holds the patent for the zinc formulation. SMC intends to commence local procurement once the formula is mass produced within Bangladesh. Seed money from ICDDR,B will support initial procurements, after which social marketing will make this a sustainable effort.



• USAID Scaling Up Antiretroviral Treatment in Uganda
  The Ministry of Health estimates that there are approximately 1.1 million people living with HIV/AIDS in Uganda. Currently, the government of Uganda is treating approximately 23,000 people with plans to scale up to 100,000 by the end of 2006. At the request of the Government of Uganda, the USAID-funded Partners for Health Reformplus project estimated that the costs of the Antiretroviral Treatment care package will hover around $100 million per year from 2005 to 2008, rising annually thereafter from $107 to $131 million from 2009 to 2012, with antiretroviral drugs and home-based care (including palliative care) as the major cost elements.

May 2004 Highlights

• Improved Nutrition Could Prevent More Than Half Of the World's Child Deaths Annually
  Undernutrition is the underlying cause of more than 53 percent of all child deaths that occur annually, including those from infectious diseases, pneumonia, diarrhea, measles and malaria, according to a new analysis supported by USAID. Childhood undernutrition, defined as underweight or low-weight-for-age, is the leading risk factor contributing to the global burden of disease. The researchers believe that strategies to prevent undernutrition should be one of the top priorities in the global effort to reduce child mortality. Their study appears in the July 1, 2004, issue of the American Journal of Clinical Nutrition.

  "Malnutrition does not have to be severe to have a significant impact on child health and survival. The analysis showed that even children who were small, but whose weight would not classify them as malnourished, were twice as likely to die as children in our reference group."

  This analysis confirms earlier research that showed that 55 percent of all child deaths were due to undernutrition. The new analysis went further. It examined whether the risk of dying due to being underweight varies by cause of death. Using data from 10 large cohort studies from sub-Saharan Africa and Southeast Asia with information on weight-for-age score and survival or death by cause, researchers calculated the mortality rates by anthropometric status and cause of death (including diarrhea, pneumonia, malaria and measles) in each study.

  The study's authors concluded that undernutrition is responsible for 60 percent of deaths as a result of diarrhea, 52 percent of deaths as a result of pneumonia, 45 percent of deaths as a result of measles and 57 percent of deaths as a result of malaria worldwide. While it is well known that child undernutrition contributes to diarrhea-related morbidity and mortality, this analysis adds new evidence that a large percentage of child deaths related to malaria are attributable to child undernutrition.

  From Johns Hopkins University




• Targeting Community-based Health Workers to Boost Vitamin A in Cambodia
  USAID has recently stepped up efforts in vitamin A supplementation in Cambodia. In USAID focus regions, vitamin A coverage is between 65 to 90 percent. In the remainder of the country, vitamin A reached 39 percent of children and mothers of newborns during the first round of distribution in 2003. It was supplemented by 31 percent during vaccination campaigns. Vitamin A distribution is conducted twice yearly at the village level.

  Currently, the biggest obstacle to increasing vitamin A coverage is the poor utilization of fixed site health facilities. USAID and other partners are working to secure financial support and the requisite training to fully implement an outreach strategy utilizing trained community health workers to deliver vitamin A and possibly assume other preventive health activities. A strategy for finding forms of non-monetary compensation for the community health workers is being developed.

  Almost 85 percent of Cambodia's population lives in rural areas in conditions of severe poverty. Thirty percent of Cambodians face chronic food shortages. As a result, rates of malnutrition in children and anemia in both children and women of reproductive ages are alarmingly high.

April 2004 Highlights

• USAID Presses Forward in Child Health in Haiti
  For many years, Haiti has been the poorest and least developed country in the Western Hemisphere. Recent civil unrest has worsened Haiti's development in areas like food security, water and sanitation, health and nutrition. Notwithstanding, USAID and its micronutrient partner, MOST, are pressing forward with efforts to initiate a program of Child Health Weeks in Haiti, which would include vitamin A supplementation and de-worming tablets. CARE, Catholic Relief Services and the Haitian Health Foundation all have ongoing health activities in Grande Anse, and they have agreed to partner with USAID in this effort. The first Child Health Week is scheduled for the first week of June, just before the National Day of the Child. Despite many challenges, it is expected that Child Health Weeks can raise coverage of vitamin A supplementation from its current low of about 15 percent to 80 percent in the Grande Anse Department, reducing child mortality by more than 20 percent.
  


• USAID Invests $70 Million for Prevention of Diarrheal Diseases
  USAID will invest $70 million over a nine-year period on targeted health programs aimed at the prevention of diarrheal diseases, a leading killer of vulnerable populations, including approximately 2 million children under five every year. The new hygiene and sanitation improvement initiative was announced during a meeting of the 12th session of the United Nations Commission on Sustainable Development in New York. Building on its previous health program experience in water supply, sanitation and hygiene, USAID's new initiative will focus on bolstering key hygiene practices that are proven effective in diarrhea prevention: safe storage, handling, disinfection of household drinking water, effective hand washing, and improved sanitation.
  


• USAID and Southern Sudanese Launch Health Transformation Program
  Dr. E. Anne Peterson, Assistant Administrator for Global Health, Allan Reed, USAID representative to Sudan, and a small team traveled to southern Sudan May 10-15 to review health programs and launch USAID's new five-year $34 million Health Transformation Program. Carried out with the people of Sudan, the program will train health workers, provide quality drugs, expand routine immunization and increase access to safe drinking water in Eastern and Western Equatoria Provinces, Upper Nile, Southern Blue Nile, Bahr el Ghazal and the Nuba Mountains.

  The health status of Southern Sudanese is among the poorest globally. Only about 30 percent of the population use water fit for human consumption and 80 percent has never received any hygiene, sanitation awareness or health education messages. With peace almost at hand, an influx of returnees is expected. The UN estimates that there are 602,000 Sudanese refugees in Kenya, Uganda, Ethiopia, the Central African Republic, the Democratic Republic of the Congo, Egypt, Chad and Eritrea and millions of others displaced within the country. Disease surveillance is a key component of the program fearing an upsurge of infectious diseases, chief among them HIV/AIDS with so many returnees expected.
  



• Efficacy Trial of USAID Supported Malaria Vaccine Recommended
  An independent Data Safety and Management Board (DSMB) meeting in London recommended that a malaria vaccine developed with USAID support be evaluated for efficacy in a field trial. The DSMB was charged with monitoring the accumulating data from the clinical trial and with conducting an independent, objective review of all accumulated data from both blinded and unblinded clinical trials. The vaccine was developed in collaboration with the Walter Reed Army Institute of Research (WRAIR) and GlaxoSmithKline (GSK) with USAID a significant contributor to the project . The vaccine was tested for safety in one-to-four year olds in Western Kenya with support from the Malaria Vaccine Initiative at PATH (MVI).  Plans are underway for the efficacy trial to be initiated in late 2004 or 2005 at the Kenya Medical Research Institute (KEMRI) Walter Reed Project's Kombewa Clinical Research Center near Kisumu.
  


• Zinc Boosts Pneumonia Recovery
  The addition of zinc to standard antimicrobial treatment can help children to recover more quickly from pneumonia, according to a recent study by Johns Hopkins University and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), which was funded and assisted by USAID. Pneumonia kills more children than any other disease, almost all of them in developing countries, affecting children with low birth weight or those whose immune systems are weakened by malnutrition or other diseases. It kills two million children each year. As part of this study, 270 infants between the ages of two and 23 months were given either 20mg of zinc per day or a dummy pill in addition to conventional antibiotics. They found that children given zinc recovered an average of one day earlier than those who had been given dummy pills. They also left hospital one day earlier. A speedy recovery will have a great impact on cost savings. A course of zinc treatment costs just US $0.15. A one day stay in hospital in Bangladesh costs US$25.