More From the Blog

    Why we shouldn’t be working ourselves out of a job

    Patrick FineRecently, I heard the head of a nonprofit organization that works in Africa declare that the goal of his organization is to work itself out of a job.

    “With your support now,” he assured the audience, “in just a few years, our help won’t be needed.”

    This is an old adage among development workers and one that is especially popular with some funders, such as the U.S. Congress, who think of foreign assistance as global philanthropy to provide a short-term hand up — not a hand out.

    With this view goes the belief that if we just do a good job, then prosperous, well-governed communities will quickly take root and eliminate the need for further assistance. After all, that’s what happened in South Korea. Unfortunately, success in one country does not predict success in another, and all the evidence on social and economic development tells us we still have a long row to hoe.

    If you date the modern era of international development to the emergence of the post-World War II world order and the end of European colonialism in the late 1950s, then we’ve been trying to work ourselves out of a job for more than 60 years.

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  • The issues we must address to #EndHIV4Her

    Adolescent girls and young women continue to be at unacceptably high risk for HIV infection. UNAIDS estimates that 7,500 girls and young women, 10 to 24 years of age, become infected with HIV every week, with the highest rates in southern and eastern Africa. Girls and young women account for 71 percent of new HIV infections among adolescents in sub-Saharan Africa, highlighting the gender disparity in this age group. Despite active prevention efforts, recent clinical trials in southern Africa have measured new HIV infection rates of 4 to 6 percent per year among young women. It is imperative that we implement aggressive measures to decrease new HIV infections among girls and young women.

    Our current HIV prevention package of HIV testing, behavioral risk reduction, management of sexually transmitted infections and condom use is inadequate because young women often lack the ability to control their risk. The evidence is clear that the source of HIV infection for most girls and young women in southern Africa is older men. For young women, a complex mix of economic dependency, limited educational opportunity, gender inequality, unequal power dynamics and social norms leads to a lack of choice of how and with whom to have sex.

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  • Does evidence tell us that integrated development approaches work? It depends!

    ID Summit logoWhen we tackle complex, global challenges and their many root causes, intuition tells us that development initiatives need to be more holistic — the approaches may need to be as interconnected as the problems. Even the Sustainable Development Goals (SDGs) agenda states its aims are integrated and indivisible. Yet, the critically important question, “What evidence supports integrated development in practice?” can best be answered through the saying “context is king.”

    Integration is an umbrella phrase that can describe thousands of different cross-sector approaches — from health and microfinance, to nutrition and education, to conservation and livelihoods. Consider how evidence showing huge impacts in the integration of savings groups with girls’ education would be relevant for people trying to decide whether to integrate agriculture and environmental conservation. Context matters. A lot. What is being integrated with what? How? For what purpose?

    Global development decisionmakers must resist the temptation for a simple, universal answer to whether integration works. The notion that any one gold-standard study on its own will answer the integrated development hypothesis is false. Evidence for cross-sector approaches will always depend on the specific sectors, geography and people in question.

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  • What do AIDS 2016 in Durban and integrated development have in common?

    A version of this post originally appeared on Huffington Post. Reposted with permission.

    As FHI 360 and the global health community prepare to travel the “Road to Durban” to the 21st International AIDS Conference (AIDS 2016), it is poignant to reflect on how far we have come since the AIDS 2000 meeting held in Durban, South Africa. I recommend taking the time to read a recent message from the conference organizers titled, The Return to Durban: A Critical Moment in History.

    After reading the piece, I was reminded of what a critical role the entire development community, including organizations like FHI 360, has played in the global response to HIV. I am inspired every day to witness how the broad global response has rallied around the concept of building on the available evidence and advancing integrated development solutions — which is why we continue to make real and sustainable progress in battling HIV.

    As part of FHI 360’s deliberate approach to advancing integrated development solutions, we will be hosting a summit June 13, 2016, in Washington, DC, titled, Greater than the Sum of its Parts: The Power of Integration. The event will be a space for innovative thinking, learning and dialogue that will focus on the “how” to achieve the Sustainable Development Goals. The discussions will include global development leaders and practitioners, policymakers, donor organizations and other change-makers.

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  • Integrated development approaches are challenging but resonate with clients

    Tamimah grew up in Nakuru, a community in Kenya’s Rift Valley where the rate of HIV infection is high and where many young people don’t graduate high school. Tamimah’s early home life was precarious: Her mother left her and her three younger siblings, and her father provided limited support. The children were raised primarily by their grandmother.

    Before Tamimah turned 13, her grandmother died, leaving the children without primary support. Tamimah and her two sisters and brother struggled to take care of themselves, stay in school and be healthy. It was “very hard to grow up in this place,” Tamimah said.

    Things began to shift, however, when they were recruited to take part in APHIAplus, an FHI 360 project focused on improving health care delivery and multisector services to vulnerable populations in the Rift Valley. Through APHIAplus, which is funded by the U.S. Agency for International Development, Tamimah gained access to health education and services. She also received support to cover the costs of her school fees and supplies.

    From these multipronged activities, there was a ripple effect: She was able to stay in school. Upon graduation, Tamimah studied tailoring through a vocational program also offered through APHIAplus and was able to provide for her siblings. After a year, she saved enough to open Al Hamis Café, named after her brother.

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  • Women and girls deserve better

    How can an adolescent girl succeed in school if she is not protected from sexual violence inside the classroom? How does a child thrive when his mother must choose between buying medication or nutritious food? We know that poverty, lack of access to education, poor health and violence are intimately linked, and how we tackle these problems is a global issue with important implications for the way the United States funds international development programs for women and girls. At the moment, we tend to compartmentalize our efforts in top-down, single-issue solutions, not because that is the most effective way to meet the needs of women and girls, but because it meets the needs of funders and their implementing partners. As we enter the new era of the Sustainable Development Goals (SDGs), we need to do better.

    There is an obvious starting point.

    We need to be a lot more deliberate and get a lot better at integrating efforts to improve the well-being of women and girls. Given the siloed nature of how we organize development work, especially in terms of funding and specialized expertise, we tend to think and act with narrowly predetermined notions of cause and effect. As a result, we miss vital connections and opportunities for action and impact. For example, I recently asked an African Minister of Health what was the biggest obstacle to women’s and girls’ health, and he immediately responded, “access to transport” to get to health facilities and obtain medicines. And yet, how often does transport come up as a priority when funders and development agencies plan health programs?

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  • Zika infection during pregnancy: Why we need gender and social norms changes for girls and young women

    A version of this post originally appeared on Devex. Reposted with permission.

    The link between Zika virus infection during pregnancy and birth defects poses yet another threat for girls and women of reproductive age in the Americas as they struggle to chart a positive course through life transitions.

    Unfortunately for girls and young women, the choice of whether or when to become pregnant is often not their own. Age and power dynamics heighten the impact of traditional gender and social norms for girls and young women and can inhibit informed decision making and positive sexual and reproductive health behaviors. Lack of empowerment leaves them more vulnerable to gender-based violence, increasing the risk of unintended pregnancy, while fear of discrimination from health providers or condemnation from family and community means girls and young women delay seeking and receiving contraception or antenatal care.

    The Zika virus is another threat for girls and women as they chart a positive course through life. Click To Tweet

    A public health response to the Zika virus must include addressing some of these root causes that preclude girls and young women from realizing their sexual and reproductive health choices — and social norms that inhibit contraceptive use for girls and young women need to be addressed in programming.

    Note: The authors would like to thank their colleagues from the Passages project team. FHI 360 is part of a team of global health organizations implementing this new reproductive health initiative in Asia and Africa, which aims to improve the healthy timing and spacing of pregnancies by youth and first-time parents in developing countries.

    Read the entire blog here.

  • Creating healthier Nigerian communities through laboratory strengthening

    Laboratory strengthening is a component of Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS), a five-year project to build local capacity for the delivery of sustainable, high-quality and comprehensive HIV/AIDS prevention, treatment, care and support services. FHI 360 implements SIDHAS in 13 states in Nigeria.

    What is laboratory strengthening and how is SIDHAS meeting this need?

    Lab strengthening is a form of support to improve the capacity of a lab for quality service delivery, helping to achieve optimal performance, increase productivity and efficiency, deliver accurate and replicable diagnostics services, achieve customer satisfaction and promote safety. Lab strengthening also provides infrastructural development, equipment maintenance and quality control services to allow timely delivery and accurate results.

    FHI 360 has supported the improvement of labs through training and mentoring to facilitate good quality management systems and record keeping. This work in lab improvement aligns with the World Health Organization Africa Regional Office (WHO-AFRO) initiative known as Strengthening Laboratory Management Towards Accreditation (SLMTA). Working within SLMTA parameters with our Nigerian government counterparts provides regular collaboration and deepens the leadership, stewardship and sustainability of the country’s labs.

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  • A conversation on ending extreme poverty

    What will it take to eradicate extreme poverty?

    I sat down with Carla Koppell, Vice President for the Center for Applied Conflict Transformation at the United States Institute of Peace to discuss the U.S. Agency for International Development’s (USAID) ambitious Vision to End Extreme Poverty. A former Chief Strategy Officer at USAID, Koppell shares her insight on how the international development community can turn vision into reality.

    Why focus on extreme poverty? How do strategies for addressing extreme poverty differ in states with weak institutions? How do we balance getting rapid results with strengthening local capacity? These are just a few of the topics we dive into as we search for ways to turn ideas into action.

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  • Keeping up the momentum to control TB

    Dr. Timothy Mastro

    Dr. Timothy Mastro
    Photo: Leanne Gray/FHI 360

    World TB Day 2016 comes at a watershed time in the history of the tuberculosis (TB) epidemic and the broader global response to health and development. In recent years, we have expanded access to more sensitive TB diagnostic services, increased awareness about the important role of infection control within health care settings and have new treatment options for individuals with multidrug-resistant (MDR) TB. But, there is much work still to be done.

    TB now rivals HIV as the top global infectious disease, yet we have not applied the same vigor to controlling TB as we have to controlling the HIV epidemic. That time is no longer. We have the opportunity to mirror the advances gained toward ending the HIV epidemic, largely based on evidence, driven by ambitious targets and linked to well-designed guidance.

    In many parts of the world, HIV poses a particular challenge to TB control, which we cannot ignore. We have developed HIV prevention and treatment tools that will allow us to end the HIV epidemic, and we must add urgency to align these with TB control efforts. Doing so will assure successful outcomes in the fight against HIV and TB coinfection. The urgency comes from World Health Organization reporting that indicates mortality from TB eclipses mortality from HIV. The tremendous research and program advances from unprecedented investments in the HIV response must be leveraged to take control of TB morbidity and mortality.

    Dr. Carol Dukes Hamilton

    Dr. Carol Dukes Hamilton
    Photo: Leanne Gray/FHI 360

    This moment in time is particularly important as we transition to the Sustainable Development Goals (SDGs) that will guide policy and funding over the next 15 years and are linked to a pledge to end poverty, everywhere, permanently. While health is now only one of 17 goals, the shift in focus may bode well for control of TB, which is a disease of poverty exacerbated by malnutrition, overcrowding and poor hygiene.

    FHI 360’s TB initiatives strategically align with the SDGs. Our projects provide technical assistance to governments to yield evidence-based solutions to their local TB situations. We assist governments with improved disease surveillance so they can invest in ways that will yield the greatest impact by providing curative treatment and limiting new infections. We promote an approach that focuses on those most vulnerable in society because TB concentrates in the most marginalized populations of any given society. A human rights-based approach that engages affected communities is the basis for a sound, effective response.

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