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Food for thought: How nutritional programming can ease the burden of HIV/AIDS in Uganda

This guest post was provided by Tahiya Alam, Cardno Emerging Markets

The United States remains at the forefront of increasing global trends targeting nutrition as a vital component for global health programming. In its far-reaching 2014-2025 Multi-Sectoral Nutrition Strategy, the United States Agency for International Development (USAID) reaffirms its commitment to global nutrition and aims to reduce chronic malnutrition by 20% across its own health, food security and other development programs. These efforts address the significant health risks associated with malnutrition in developing nations that not only contribute to stunting, but also further compromise the health status of people living with HIV/AIDS. Having HIV/AIDS can lead to reduced nutrient absorption, often contributing to significant weight loss, known as wasting. Simultaneously, poor nutrition can exacerbate infections in HIV positive individuals, creating a compounding negative effect on overall health.  Of those affected by food and nutritional insecurities, orphans and other vulnerable children (OVC) are often the biggest victims due to their reliance on caregivers, who may also be directly impacted by HIV/AIDS in their communities.

With roughly 20% of the population living in poverty, Uganda is particularly susceptible to the burden of poor nutrition on health.  According to the 2011 Uganda Demographic and Health Survey, 33% of Ugandan children under five years of age are stunted.  Furthermore, children residing in rural areas of the country, where the majority of the population resides, have a significantly higher risk of being underweight than children from urban areas.  Considering the significant effects of HIV/AIDS in the Ugandan population, the USAID/Uganda Private Health Support Program works to both prevent and treat malnutrition, contributing to the reduction of the burden of malnutrition.

This five-year, flagship USAID private sector program in Uganda works to contribute to a more viable and cost-effective private sector option for health services in the country.  Implemented by Cardno Emerging Markets USA Ltd., the program has expanded to include private not for profit (PNFP) sites in an effort to mobilize and strengthen a larger portion of basic health services in Uganda.  While program activities span a wide breadth of health areas, key strategic activities have focused on nutrition in an effort to highlight the inherent link between nutrition and HIV/AIDS.

Capacity Building Efforts:

Through the program’s collaboration with the Ugandan Ministry of Health, more than 25 private sites have been given technical training and support for their Nutrition Assessment, Counselling and Support (NACS) services.  These trainings serve to further reinforce to health workers how to best identify symptoms of malnutrition and provide messaging on the importance of nutrition.  Effective monitoring and referral systems ensure that the proper treatment is being given to patients to prevent further deterioration of health.  This capacity building strategy is especially important in Uganda since a significant portion of HIV positive patients visit private facilities for their treatment.

Collaboration with Community Stakeholders:

In conjunction with the trainings provided to private health service providers, the program’s PNFP activity liaises with faith-based and community organizations to educate community members on essential communication, nutrition, food safety, and hygiene issues.  Through grassroots techniques, this activity targets OVC caregivers in an effort to disseminate critical health information to the most vulnerable families. Local languages and foods are customized for different regions to provide culturally appropriate trainings in community settings.  The classroom learning is paired with practical demonstrations to facilitate absorption and retention of the information provided. Additionally, follow up support is given to the community organizations to ensure sustainability of trainings.  Over the past year, the program has successfully conducted trainings for over 3,200 caregivers/households across 25 districts in Uganda.

Vegetable Gardening Projects:

The program also works to establish school vegetable gardening projects in an effort to supplement the nutritional training given to caregivers through the PNFP activity.  The Masanafu Children Support Project represents one of the many organizations that receives funding under the Program.  Children in the Masanafu area of Kampala District were previously unable to practice agricultural skills due to the lack of space resulting from crowded housing.  The gardening project has given children the chance to participate in growing vegetables by providing them with a communal gardening space.  This project not only highlights the importance of dietary diversity to the students but also directly contributes to their improved nutritional status through the addition of harvested vegetables into school lunches.  The Masanafu Children Support Project currently supports six schools, benefiting an estimated 1,200 children.


 Children at Bugolo primary school in Rubaga Division Kampala in a school garden supported under the USAID/Uganda Private Health Support Program through MASANAFU Children Support Project.  The leafy green vegetables grown by students here are used to enrich their lunch meals.

Children at Bugolo primary school in Rubaga Division Kampala in a school garden supported under the USAID/Uganda Private Health Support Program through MASANAFU Children Support Project. The leafy green vegetables grown by students here are used to enrich their lunch meals.

Five things to know about the first-ever global progress report on universal health coverage

This blog was cross-posted from The World Bank and written by GHC Board Member Robert Marten 

Last Friday, I had the privilege of attending the launch of a new global report that provides the clearest picture to date of countries’ progress moving toward universal health coverage (UHC). UHC is critical for building resilient health systems, which protect communities and strengthen societies in times of crisis and calm alike.

The report, released by the World Health Organization and the World Bank Group, builds on long-standing engagement and support by my organization, The Rockefeller Foundation, to develop indicators to measure and monitor progress for UHC. It is the first of its kind and represents a significant step forward in the global push to achieve health for all. Here’s why:

  1. This report reflects the continued global movement for UHC. More than 100 low- and middle-income countries, home to three-quarters of the world’s population, have taken steps to move toward UHC. Today, more people have access to health services with financial protection than ever before in history.
  2. Still far too many people are not able to access needed health services. Progress has not been swift or sweeping enough. According to the report, 400 million people lack access to one or more of seven lifesaving health services, including childhood immunization, malaria control, HIV/AIDS treatment, and family planning. The report also found that 17% of people in low- and middle-income countries are tipped into or pushed further into poverty because of health spending.
  3. UHC is measurable. One of the biggest obstacles to UHC has been lack of tools to monitor and measure progress. Better measurement is urgently needed to drive progress—for example, for progress on non-communicable diseases such as cardiovascular diseases and cancer, which are a growing health challenge in many countries.
  4. UHC is an opportunity to consolidate Millennium Development Goal progress in the Sustainable Development Goals (SDGs). The SDGs will further elevate UHC as a global priority. Better measurement will equip governments and empower civil society with tools to track progress and ensure that commitments turn to action.
  5. Six-month countdown. The report kicked off the six-month countdown to Universal Health Coverage Day 2015. On December 12, 2014, The Rockefeller Foundation convened a global coalition of more than 500 health and development organizations to launch the first-ever Universal Health Coverage Day. This year, Universal Health Coverage Day will provide a platform to call for even greater commitments to build stronger, more equitable health systems.

The Rockefeller Foundation looks forward to accelerating the global movement toward UHC in the post-2015 era.  This report gives us a critical boost in making the movement more targeted and data-driven, which should help us galvanize policymakers and, ultimately, reach the 400 million people in need of health coverage.

Follow Robert Marten on Twitter: @MartenRobert

From West Africa to South Korea, No Pause between Outbreaks

This blog was cross-posted from IntraHealth International and written by Allison Annette Foster and Aanjalie Collure

As nurses prepare to gather in Seoul, South Korea, later this week for the annual International Council of Nursing’s 2015 Conference, the country is experiencing an alarming outbreak of the Middle East Respiratory Syndrome or MERS Coronavirus.

Just last Thursday, South Korea announced the closure of a second hospital following the confirmation of four new cases of MERS. The country’s most recent case count stands at 153, with 19 deaths, as of June 16. This deadly virus has a survival rate of only 64%, and more than 5,500 people have already been quarantined. As of last Friday, 2,900 South Korean schools and kindergartens were closed around the country. Decisions to temporarily close the Mediheal Hospital in western Seoul and Changwon SK Hospital in Changwon resulted from new information that MERS patients were found to have had contact with hundreds of people at the two hospitals prior to diagnosis.

Certainly, there is no time to lose. The global community learned this the hard way recently in West Africa. It was only just over a month ago, on May 9, 2015, that the world took a sigh of relief as the World Health Organization officially declared Liberia Ebola-free. Guinea and Sierra Leone, while making progress, are still struggling to bring Ebola to an end.

“Ebola may be under control in Liberia and disappearing from headlines, but we are far from meeting the health needs of our populations—and even further from being prepared for the next pandemic.”

One year ago, we would have never imagined an Ebola epidemic of this scale raging through West Africa, threatening the health and well-being of bordering populations and destabilizing health security across the globe. Six months ago, we were having a hard time envisioning an end to this nightmare.

Although the initial response was slow, the global community gained momentum in supporting Liberia with the materials, medicines, and health workers desperately needed by the country’s weak national health system. During the scale up of this organized response, we lost many lives—precious lives—and the global community learned some hard lessons.

First and foremost, we realized that none of us are protected from such a sudden and unexpected outbreak whether in an American urban area such as Dallas, Texas–where one life was lost, two health workers quarantined, and an emergency room closed–or in Monterrado, a remote county in Liberia where 8,881 Ebola cases were confirmed and 3,826 lives lost. The countries suffering the most are those with weak health systems. Weak health systems are not exclusive to the West African countries hardest hit by Ebola. In many countries, over 70% of rural residents lack essential health coverage precisely because they lack the health workers they need to serve their communities.

Ebola may be under control in Liberia and disappearing from headlines, but we are far from meeting the health needs of our populations—and even further from being prepared for the next pandemic.  Even prior to Ebola, Liberia’s population suffered from a high incidence of preventable deaths. In 2010, the country had the eighth highest maternal mortality ratio globally, with 770 maternal deaths for every 100,000 live births. Malaria, diarrhea, and respiratory infections are the leading causes of death. Most of those deaths would be avoidable if skilled health workers were available with basic material and medicines.

We are all vulnerable, even those of us privileged to live in better-staffed and equipped health systems. Between 2002 and 2003, severe acute respiratory infection, or SARS, killed 44 people in Canada, 299 in Hong Kong, and 775 globally. In 2009, the H1N1 virus killed more than 18,000 people around the world. In 2012, the West Nile Virus—spread through mosquitos—killed 16 people in three Texas counties within three months.  Although the CDC does not yet release data on the exact number of influenza related deaths per year in the United States, as many as 49,000 people may have died during the 2006-2007 flu season alone from influenza.

“Nurses know all too well that global threats are felt locally.”

 In a recent interview, Bill Gates warned the world against complacency. Although we may be tempted to breathe a sigh of relief right now as Ebola appears to be on the wane, we must make some drastic changes to ensure our relief is not short-lived. “If anything kills over 10 million people in the next few decades, it is most likely to be a highly infectious virus, rather than a war. Not missiles, but microbes,” says Gates.

At IntraHealth International, we are working to help countries be battle-ready in the face of both current and future threats. We advocate for investing in health systems and the health workers that make them function because we understand the immeasurable return on such investments. Current initiatives including our mHero mobile phone communication platform, our iHRIS suite of health workforce information software, and our health worker crowdsourcing application are empowering  health workers with the information they need to respond rapidly to health emergencies as and when they emerge.

We hope that lessons learned from the tragic Ebola outbreak have become abundantly clear to the global community.

As nurses start to gather together in Seoul to deliberate the conference’s theme of “Global Citizen, Global Nursing” amidst a new global health security threat, nurses and other health workers around the world are risking their lives to do their jobs. Nurses know all too well that global threats are felt locally, as they work every day with frontline teams to support clients in life-or-death battles.

Mr. Gates, we hear your call. Winning the fight to strengthen global health security will require strong commitments of global and local actors. We must be ready and willing to take on tomorrow’s public health emergencies and prevent and treat today’s diseases. To do that, we must build resilient health systems and ensure that all of us have access to a health worker, ready and equipped for the battle.

Sharing Strategies for Integrating Maternal and Newborn Care: Strengthening the Continuum

This guest blog was written by Amy Boldosser-Boesch, Interim President and CEO of Family Care International (FCI)

EPMM ENAP photoThe global health community gathered on Tuesday evening, May 19 to recognize the importance of integrating maternal and newborn care and to celebrate the release of the Every Newborn Action Plan (ENAP) Progress Report May 2015 and Strategies Toward Ending Preventable Maternal Mortality (EPMM).  The side session at the 68th World Health Assembly Integrating maternal and newborn care: Strengthening the continuum was standing room only as a panel of champions for integration of maternal and newborn health took the stage.  FCI was proud to co-host the event with a wide range of EPMM  and ENAP partners.

The evening started with three Ministers of Health sharing perspectives on how implementation of the Every Newborn Action Plan together with maternal health interventions had improved health outcomes for mothers and babies in their countries. Cameroon’s Minister of Health, André Mama Fouda, noted that improving newborn health and preventing stillbirth is integrally linked to improving women’s health throughout the lifecourse. The Minister raised one of the key themes of the evening-the role of midwives in providing these essential, quality and integrated maternal and newborn health services. He noted he was happy and proud that new midwives were being trained in his country. Malawi’s Minister of Health, Jean Kalilani, highlighted efforts to increase access to family planning, reduce the age of marriage, and address cervical cancer as key strategies to reduce maternal mortality. These strategies will be linked to Malawi’s soon to be launched national Every Newborn Action Plan, developed in response to the government’s realization that Malawi was leading the world in pre-term births.  Peru’s Minister of Health, Aníbal Velásquez Valdivia, discussed his country’s Comprehensive Health Insurance Scheme, which includes free access to basic health care for children younger than 5 years and for pregnant women, while giving priority to vulnerable populations living in extreme poverty.

UNFPA, UNICEF and WHO representatives then shared how they are working across the continuum of care to strengthen care for women, newborns and children. Her Royal Highness Princess Sarah Zeid noted that over half of all maternal, newborn and child deaths occur in fragile and humanitarian settings, and the need for urgent action to provide quality care to women and babies in those settings.  Calling for every birth to be counted, she also made a plea for greater attention to stillbirths and the enormous impact on women and communities.

While panelists and audience members shared the specific perspectives from across governments, donors, healthcare professionals, advocates and youth, the core message was strikingly the same:  health outcomes for mothers, their newborns and children are inextricably linked but strategies and programs to improve RMNCH are often planned, managed and delivered separately, and this must change. Kate Gilmore, Deputy Executive Director of UNFPA, called for an end to fragmented programs that separate the mother and child and challenged all in attendance to finally put women and children at the center of all development programs. Nina Schwalbe, Principal Adviser, Health, UNICEF, reminded us that we can’t take care of the child if we don’t take care of the mother.

As we prepare for the launch of the new Global Strategy for Women’s, Children’s and Adolescents Health and the Sustainable Development Goals, there is an increased focus on reaching every woman, newborn, child and adolescent everywhere. The event, and the ENAP and EPMM strategies, demonstrate the importance of an integrated approach to improving quality services, a growing commitment to work and investment across the continuum of care, and propose complimentary targets to get us there. As a global health community success will rely on supporting an integrated approach in research, policies, health services, and advocacy for maternal and newborn survival — one that helps to finally put an end to the preventable deaths of women and their babies.

Family Care International is an international NGO that envisions a world where no woman suffers preventable pregnancy-related injury or death, where childbirth is safe for mothers and their babies, and where all people are able to enjoy their sexual and reproductive health and rights.

How Do We Measure Success in Health in the Post-2015 Agenda?

This blog was cross-posted from Chemonics and written by Dr. Oscar Cordon.

Today, a global summit begins in Washington, D.C. to discuss how to measure health results in the next set of development goals.

Today, a global summit begins in Washington, D.C. to discuss how to measure health results in the next set of development goals.

As we move ever-closer to defining shared health goals for post-2015 development agenda, we must also take the time to stop and think about assessing our progress. What does success look like? And how will we measure it?

The World Bank, USAID, and World Health Organization, with support from the Bill & Melinda Gates Foundation, have embarked on an important strategy to construct a common agenda to improve and sustain country accountability systems for health results in the post-2015 era. This strategy aims to: (a) tackle stock of the current state of the systems for measurement and accountability for health results; (b) to identify innovative approaches and strategic investments that can strengthen health data availability, quality, and use; and (c) agree on a common roadmap for health measurement and accountability in the context of the post-2015 agenda.

These organizations have convened a global summit starting today at the World Bank headquarters in Washington, D.C., to discuss with decision-makers and thought leaders representing governments, multilateral agencies, and civil society this measurement and accountability strategy. This strategy will produce a roadmap for Health Measurement and Accountability, and identify smart investments that can be adopted at the country level to strengthen basic measurement systems and align partners and donors around common priorities on a five-point call to action.

Ensuring accountability: Where do we start?

It’s important to define what we understand as “accountability.” Accountability can mean the obligation of an individual or organization to account, as well as to hold others accountable, for activities. It means accepting responsibility for goals and indicators, and disclosing results in a transparent manner.

For all indicators, it will be important to clearly define terms such as use, coverage, and quality; state how data will be measured and in what measurement unit; and provide justification for using the indicator. It’s important to note the need for quality baselines and for each indicator to have a baseline. Additionally, it is important to identify who is responsible for data verification and ensuring data collection. Where possible, low-cost methodologies and tools should be utilized and emphasized.

What will this mean at the country level?

As we discuss these issues during the summit, it is important to keep in mind that while this effort will create opportunities to set national standards, it is likewise critical that appropriate standards will be added to the sub-national level. Stakeholders working at those levels must also be accountable to national poverty reduction efforts as part of the development agenda in each country.

Another important area of this strategy will be to increase the capacity of national institutions to produce quality health data and statistics. The participation of different institutions like the Ministries of Education could play an important role in the data collection, since they have access to children’s vaccination, growth, and development monitoring records, among other things.

What systems do we need to measure success?

In terms of governance, this strategy can describe the basic elements needed for “community information systems” to work—for example, bicycles for volunteers so they can collect and share information, stipends to support their transportation, and trainings for them on data collection using technology such as mobile phones. Funding, specifically for the purpose of longitudinal studies, will be needed. In many countries the community health workers (CHWs) are still not considered official cadres in the health sector, and in most cases are still volunteers. The high turnover rate among volunteer CHWs need to be addressed and options available to address this challenge.

Given the challenges of corruption and fraud in various countries, these measurement and accountability systems should prioritize infrastructure and control mechanisms to deter, detect, and prevent intentional abuse of personal and other sensitive information. It will be important to also supplement these systems with web-based remote assistance or patient consultations in areas where it is difficult to have medical professionals. It would also help to identify platforms for disease surveillance, perhaps tapping the work of existing companies like Google or Amazon. The platform infrastructure could be then used to triangulate that data with other sources of information (e.g., web) and social media (e.g., Facebook or Twitter).

What’s next?

It will be important to include in the monitoring of health goals the final report that the Independent Expert Review Group (iERG) will present before the United Nations General Assembly in September 2015. This report will present the results and resources related to the Global Strategy for Women’s, Children’s, and Adolescents’ Health and on the progress in implementing the Commission on Information and Accountability for Women’s and Children’s Health’s (CoIA) recommendations, which will contain all the findings that the group observed during country visits in 2014 and 2015.

Finally, it’s important that all regions will be represented in the initial group of countries that will implement this strategy, including some countries that have reported significant barriers in reporting data. This will provide a more accurate analysis of current challenges.

This strategy offers a great initiative to educate the media on what the numbers mean, but must emphasize offering raw data for free. This will facilitate analysis of the academic and research community, who may be able to diagnose problems and recommend effective solutions.

Dr. Oscar Cordon is a medical doctor and a director in Chemonics’ health practice. This blog was written with the technical support of Chemonics’ Health; Monitoring, Evaluation and Learning; and Democracy and Governance practices.