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Learning from failure in global development

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A Deeper LookHealth

The specter of segregation haunts global health

By Patrick Fine, Chief Executive Officer, FHI 360 and Leith Greenslade, Vice Chair, Office of the U.N. Special Envoy for Financing the Health Millennium Development Goals and Co-chair of Child Health at the MDG Health Alliance

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

Photo by: Getachew / UNICEF Ethiopia / CC BY-NC-ND

There is no question that the greatest health achievements under the Millennium Development Goals have focused on single diseases. Arresting the spread of HIV and AIDS and malaria is perhaps the most significant development success of the new century. And vaccination, especially of measles, is one of the reasons that deaths among older children have fallen faster than deaths among infants or women during pregnancy and childbirth.

In contrast, the lowest-performing areas across all eight MDGs — reducing infant and maternal deaths — are targets that don’t lend themselves to a single disease strategy. Just six countries have met the MDG target for reducing infant deaths, and only 15 countries have achieved the target for reducing maternal deaths.

Could these targets have actually been achieved if we had pursued an integrated approach to advancing the health of women and children? Did our fascination with and confidence in the segregation of single-disease initiatives cost us achievement in other areas requiring more complex solutions?

Read the remainder of the blog here.

Health

The thin blue line: Increasing access to pregnancy tests in family planning programs

By Kate Rademacher, Technical Advisor and John Stanback, Senior Scientist, FHI 360

A version of this post originally appeared here on The Lancet Global Health Blog. Reposted with permission.

Increasing access to pregnancy tests

Photo: Jessica Scranton/FHI 360

What is the true value of a 10-cent (US$) pregnancy test? In many countries, women are routinely denied same-day provision of family planning methods if they arrive at the clinic on a day when they are not menstruating. When it comes to ensuring reliable access to contraception, it turns out that simple, low-cost pregnancy tests can be extremely valuable.

Sonia, a 49-year-old woman in Rwanda, is a long-time user of Depo-Provera, the popular three-month injectable contraceptive. She explains that women who are not menstruating are often turned away for family planning services because health care providers are concerned that these women might be pregnant. Many are told to return during their next menses, leaving them at risk of unintended pregnancy in the meantime. Sonia says, “When you get there, they ask if you are having your period. When it is ‘no,’ they give you another appointment. When it is ‘yes,’ they give you cotton wool and you go somewhere discreet to put some blood [on it] and come back to show it to the provider. It is only then that the provider shows you the methods.” (more…)

HealthResearch

A unique partnership develops emerging global health researchers

By Dr. Timothy Mastro, Director, Global Health, Population and Nutrition, FHI 360

At FHI 360, cultivating partnerships and building capacity are high priorities that lead to lasting impact globally. Capacity development in global health has many facets. In the more than 70 countries where we work, many of our global health, population and nutrition programs and research studies include the training of public health workers and scientists. We also value partnerships in the United States that foster the development of the next generation of public health leaders.

This year marks the 10th anniversary of the FHI 360 and University of North Carolina Gillings School of Global Public Health (UNC-GSGPH) Research Fellowship Program. This relationship provides UNC-GSGPH graduate students with the opportunity to work side by side with leading global health researchers. For the last decade, FHI 360 and UNC have built and sustained a local partnership through which yearly at least two students from UNC-GSGPH work at FHI 360 and are mentored by our global health research experts.

Through this program, FHI 360 has had the privilege of working with some of the brightest young minds in the growing field of global health research. Over the years, 23 fellows have worked on a wide range of topics, generated research protocols, analyzed data, written manuscripts for scientific journals and developed technical skills that are essential to global health research. (more…)

A Deeper Look

Let’s get real in Addis: The high cost of people-centered development

By Patrick Fine, Chief Executive Officer, FHI 360

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

When heads of state, ministers of finance and leaders of the international development community gather in Addis Ababa this July for the Third Conference on Financing for Development, I hope that the discussion will be grounded in the hard realities facing the least-developed countries struggling to provide basic services to their growing populations.

I also hope that conference participants rise above the popular but misleading narrative that the private sector is the panacea.

Looking to the private sector as the primary source of financing for development is particularly seductive for two reasons: Statistical evidence seems to support the argument, and it provides a rationale for reducing official development assistance at a time when donor nations are struggling with debt and budget crises.

However, placing unrealistic expectations on the private sector to meet basic needs in health, education and public administration clouds a critical debate.

Part of the problem is definition. “Private sector financing” is one of those catch-all terms. It encompasses business spending (foreign and domestic direct investment), remittances from migration in a globalized world, user fees to private providers of public services, and large-scale private philanthropy that has exploded out of the technology revolution.

Read the remainder of the blog here.

Health

Sayana® Press could mean a breakthrough in family planning

By John Stanback, Scientist, and Holly Burke, Scientist, FHI 360

Photo: Leonard Bufumbo/FHI 360

As elsewhere in Africa, a woman in rural Malawi often must walk for miles to reach the nearest health clinic. When she finally arrives, long queues await and a preferred contraceptive, Depo-Provera®, is often unavailable. Even if the barriers of distance, long waits and stock-outs did not exist, a busy clinic would not be an ideal venue for those who seek contraception in a private setting away from the prying eyes of neighbors and acquaintances. Many women use Depo-Provera because it is effective, requires only a single injection every three months and can be used without the knowledge of a sexual partner.

In many villages in Malawi, and other countries, an auxiliary nurse sells a wide variety of over-the-counter medicines, as well as condoms and oral contraceptives, in a small drug shop. Women in these villages wish that injectable contraceptives were as easily and discreetly available as the pills and condoms in the drug shop.

This situation may soon change with the arrival of a new, lower-dose formula of Depo-Provera called Sayana® Press. Sayana Press provides the same three months of safe, effective pregnancy prevention as Depo-Provera but comes in an easy-to-use, pre-filled injection device designed to allow low-level health workers, and even users themselves, to inject the product. To further simplify the injection, the long needle formerly required for deep muscle injections has been replaced by a much shorter needle for a simple injection just beneath the skin.

Several countries in Africa, such as Senegal and Uganda, are beginning to use Sayana Press in their family planning programs, especially those in which community health workers provide contraceptives. More importantly, a few countries will soon begin stocking Sayana Press in pharmacies and perhaps rural drug shops. (more…)

Health

Exploring the potential link between hormonal contraceptive use and HIV acquisition

By Charles Morrison, Director of Clinical and Epidemiological Sciences, FHI 360

Are women who take hormonal contraceptives at an increased risk of acquiring HIV? If so, do some contraceptives put women at higher risk than others?

This week, the influential health journal, PLOS Medicine, published the results of a large individual-participant data meta-analysis, authored by FHI 360 and collaborators, that seeks to answer these questions.

While this issue matters to the field of reproductive health, it is especially critical to women in East and Southern Africa. In these regions, women potentially have a double risk factor: high rates of HIV and high use of hormonal contraception, particularly depot-medroxyprogesterone acetate (DMPA), a type of contraceptive that is injected every three months. So far, the evidence on DMPA shows that it is the hormonal contraceptive that has the most potential to increase HIV acquisition; however, the evidence is inconclusive.

FHI 360’s meta-analysis combines the results of 18 prospective studies, including more than 37,000 women, of whom more than 1,800 became infected with HIV. We found that women who used DMPA had a 50 percent increased risk of HIV acquisition compared with women who did not use hormonal contraceptives. We found no significant increase in HIV risk among women using combined oral contraceptives (COCs) or norethisterone enanthate (Net-En), a contraceptive injected every two months. Women using DMPA also had an increased HIV risk when compared directly with COC or Net-En users. (more…)

A Deeper Look

Words count!

By Patrick Fine, Chief Executive Officer, FHI 360

Photo by Ben Barber

Let’s start the New Year by looking at how we talk about development. It is striking how certain concepts and buzzwords rally people around ideas and mobilize us into action. The buzzwords themselves become powerful change agents. Yet, when they mature into unquestioned orthodoxy, they can restrict our vision and dull our understanding. Here are two buzzwords we love to use in development that are ripe for a deeper look.

Sustainability. Development and sustainability go together like bricks and mortar. But this term now has two distinct meanings in development parlance. One meaning refers to policies and actions that safeguard the environment and do not deplete our natural resources. This meaning has gained currency over the last 15 years. The second, and at least in my experience more common use, refers to a recipient partner’s interest and ability to continue projects or reforms financed by donors once donor funding ends. This use is closely associated with the concept of country ownership. When USAID adopted sustainable development as its credo in the mid-1990s, it was a response to the criticism that donor-funded projects collapsed when the funding ran out, often up-ending years of effort. This was partly a result of donors not wanting to take on recurrent costs that were seen as the partner’s responsibility. The lack of serious planning for recurrent costs remains a major challenge in international development.

Yet, should sustainable development even be an objective in a world where technology is changing everything around us at an exponential rate? Do we really want to sustain yesterday’s solutions? I think not. (more…)

Economic DevelopmentEducationHealthYouth

A warm welcome in Mumbai

By Lisa Johnson, Associate Director of Workforce Programs, National Institute for Work and Learning, FHI 360

A version of this blog originally appeared here on The Huffington Post/Global Motherhood. Reposted with permission.

It was 100 degrees outside when we pulled up in front a school in Mumbai last month. We were greeted by the sounds of booming drums, singing voices and ringing tambourines. The children were assembled outside of the school to welcome us. Before arriving, I was curious about how these children would receive us, but all doubts slipped away as they met us with open arms. The memory of that welcome continues to humble and inspire me in my travels to similar schools around the globe. Fifty students from two Mumbai schools were selected to participate in the three-year Johnson & Johnson Bridge to Employment (BTE) program designed to provide academic support, encourage lifelong learning and build awareness of careers in health care. BTE also works with parents, teachers and employees to support and guide students to new opportunities.

According to 2012 data, only 58 percent of students from municipal areas graduate, leaving 42 out of every 100 young people without a high school diploma. For more than 20 years, BTE has been focusing on impacting communities all around the world with similar statistics.

We’ve trained over 20 Johnson & Johnson employees, who serve as volunteers to mentor these 50 children, ages 13–16. BTE volunteers here in India and in all programs around the globe talk to their mentees about life and what it took to reach their own career goals and why civic engagement matters. Mentors teach students time management as well as resume writing, interviewing, teamwork and communication skills. (more…)

Health

Can women living with HIV and taking antiretroviral therapy use hormonal contraceptive methods?

By Chelsea Polis, Senior Research Associate, Guttmacher Institute and Kavita Nanda, Senior Medical Scientist, Contraceptive Technology Innovation Department, FHI 360

A version of this post originally appeared here on K4Health. Reposted with permission.

Extraordinary gains have been made in the last decade toward increasing access to antiretroviral therapy (ART) for HIV. With an eye toward ending the AIDS epidemic by 2030, UNAIDS recently released bold targets related to HIV diagnosis and treatment. By the year 2020, their aim is to have 90 percent of all people living with HIV aware of their status, 90 percent of people diagnosed with HIV receiving sustained ART and 90 percent of people on ART achieving viral suppression. As we move closer to these laudable public health goals, we must also consider how expansion of ART may affect and be affected by other health issues, such as prevention of unintended pregnancy among women living with HIV.

… An increasingly important issue is whether certain ART regimens are expected to have drug interactions when used with certain hormonal contraceptive methods. In theory, an interaction could affect the efficacy of either medication or cause side effects or toxicity. If contraceptive efficacy decreases, the chances of contraceptive failure, unintended pregnancy and the accompanying consequences increase. A decrease in ART efficacy could lead to treatment failure, viral resistance and greater likelihood of subsequent HIV transmission. Increases in side effects or toxicity can affect quality of life and medication adherence. Yet, despite the importance of this issue, relatively few studies (particularly those with clinical outcomes such as ovulation, pregnancy or treatment failure) have been conducted. (more…)

Education

Making strides in college and career readiness in North Dakota

By Louise Dardis, North Dakota Program Manager, Succeed 2020 project, FHI 360

The goal of Succeed 2020, an education and workforce development project in North Dakota, is to help the state’s students become better prepared for college and 21st century careers.

Achieving this goal is no small task. North Dakota’s eight Regional Education Associations (REAs), our primary partners, are leading implementation of Succeed 2020. With management and technical assistance from FHI 360, the REAs work with school districts to improve their educational programs and services through professional development, direct services and data analyses. The REAs are bringing together institutions of higher education, community-based organizations, business associations and employers, state and local government agencies, and Native American groups to ensure that all students have access to rigorous curricula, ongoing college and career planning, and the supports they need to succeed in school.

Our numbers show that Succeed 2020 is making significant progress. In the 2013–2014 school year, 2,000 teachers, 300 administrators, and 150 counselors and careers advisors participated in professional learning opportunities that ranged from workshops on how to improve students’ literacy and numeracy skills to one-on-one guidance to understand classroom data. Professional learning communities bring together teachers from similar grades and content areas to solve common challenges.


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