Health

  • September 19, 2012

    Building Program Capacity in the Prevention of Neglected Tropical Diseases

    Written by
    Bolivar Pou, Project Director, END in Africa Program, FHI 360

    Neglected tropical diseases (NTDs) strike hundreds of millions of people in Africa, causing blindness, permanent disfigurement, and possibly ostracism from the community and life-long poverty. These diseases are a huge problem that requires an integrated, cost-efficient and sustainable solution.

    The first line of defense against NTDs is disease prevention via mass drug administration (MDA). The Program to End Neglected Tropical Diseases in Africa (END in Africa) has distributed more than 72 million drug treatments to almost 34 million people in Burkina Faso, Ghana, Niger, Sierra Leone and Togo in just the past 18 months. The program is funded by the U.S. Agency for International Development (USAID) and administered by a team of partners led by FHI 360, which provides overall program and financial management as the prime partner.

    A drug treatment program on such a scale wouldn’t have been possible a few years ago, when national prevention efforts were fragmented and lacked central coordination. It is possible now — thanks to integration efforts and public–private partnerships between national NTD programs, USAID and other funders, pharmaceutical companies and international NTD control program administrators, such as END in Africa. Together, these integration mechanisms have cut per-person MDA costs by more than 50 percent, from 27 cents to just 12 cents!

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  • September 18, 2012

    Toolkit Uses Community Conversations to Counter HIV in Malawi

    Written by
    Maclean Sosono, Executive Director, Friends of AIDS Support Trust (FAST)

    Awareness of HIV is high in Malawi, studies show. But HIV continues to persist. Clearly, knowledge and messages about HIV and AIDS are not enough to change behaviors, especially where there are high rates of illiteracy. My organization, FAST, which works with FHI 360 on HIV/AIDS awareness and prevention in some of the most culturally traditional parts of Malawi, began thinking of creative ways to deepen the dialogue around HIV/AIDS-related issues.

    FHI 360’s Communication for Change (C-Change) project developed a Community Conversation Toolkit to help communities take action against the HIV epidemic. We partnered with C-Change to tailor the toolkit for Malawi. The tools, such as role-play cards and finger puppets for storytelling, were customized in collaboration with community mobilizers with whom we have built trusting relationships over many years.

    What is powerful about the toolkit is that instead of prescribing behavioral changes, it is inspiring an organic dialogue among community leaders on specific drivers that spread HIV and AIDS, including cross-generational sex, gender-based violence and alcohol abuse.

    Local leaders are custodians of culture. Because their personal attitudes toward issues such as gender-based violence are linked to overall community acceptance and understanding, they can help change cultural norms that contribute to the epidemic. The toolkit encourages leaders to create culturally relevant solutions, gives them a sense of ownership and inspires them to become peer educators who promote change beyond the boundaries of their community.

    Communities follow up their conversations with their own action plans. Later, our trained facilitators check in with the communities to learn what worked, what didn’t work, and why. Thus, the toolkit allows us to understand a community’s underlying dynamics from the perspective of its people. In addition, if the facilitator takes the community’s concerns to higher-level officials, and those officials choose not to take these concerns seriously, we can act as mediators and initiate conversations because we already have built-in relationships with district officials.

    Local bicycle taxi operators, called “Shapa Boys,” have become integral to bringing the issue of gender-based violence to the forefront. Using the toolkit helped the Shapa Boys feel empowered to bring together key stakeholders, including police officers, to discuss possible actions on issues that affect their community. In these discussions, no one is arrested or punished, but the sensitive issue of gender-based violence is openly discussed by members of the community.

    In addition, issues that came to light through community conversations were included in our strategic plan. In this way, the plan is responding better to community needs that are voiced by the people, so they own the process.

    To learn more about the design and impact of the Community Conversation Toolkit, watch these videos of Maclean Sosono and C-Change Director Neill McKee (below).

  • September 13, 2012

    Sex, Money and Girls: Reflections from Day 2 of the Global Youth Economic Opportunities Conference

    Written by
    Joy Cunningham, Senior Technical Officer, FHI 360

    Many of us who spend our time in the youth sexual and reproductive health (YSRH) world don’t often cross paths with those in the business of economic empowerment and livelihoods programs for young people. Although both worlds are aware of the converging paths, funding streams generally keep us operating on parallel roads. Therefore, I was pleased to facilitate a panel session this morning at the conference: “Exploring the Intersection of Adolescent Girls’ Reproductive Health and Economic Empowerment.” During a lively session, panelists shared their experiences with both issues for girls. Some of the themes were:

    • Even though we are aware of the problem, the data on SRH and economic empowerment for girls, taken together for developing countries, is shocking. The rates of HIV, maternal mortality and morbidity, poverty and isolation paint a dismal picture for girls.
    • Programs that target girls and adults in the community, with messages on both SRH and economic empowerment, are showing some successes. There’s more to learn, but results are encouraging.
    • Models that incorporate peer education and work with girls on SRH and economic empowerment show positive results: the Tesfa program led by the International Center for Research on Women, the Siyakha Nentsha program in South Africa led by Population Council, and a program by Restless Development in Northern Uganda all included a peer education component.
    • Reducing social isolation seems key for increasing both SRH and economic outcomes for girls. Girls need access to other girls for many reasons, but importantly, to give them an outlet to talk about themselves: their ideas, dreams and goals.
    • It’s important to work with the adults, not just the girls. Teachers, parents and faith leaders all play roles in girls’ lives, and we need to get them on board with difficult topics. Sex and money are not easy to discuss with young people, and the adults need to build their skills to do it.

    Today’s session initiated some vital discussion about next steps. It’s my hope that the two worlds of SRH and economic empowerment for young people will start to cross more often and begin to operate more closely together. This year’s conference is an encouraging step toward that. Look for more information on this topic, including a research brief and e-forum, by visiting the Interagency Youth Working Group website.

  • July 20, 2012

    A Smart Approach to Human Development

    On July 14, 2012, U.S. Ambassador at Large for Global Women’s Issues, Melanne Verveer, made a special visit to the SMARTgirl project in Cambodia, a USAID PRASIT project initiative, led by FHI 360. SMARTgirl aims to prevent and mitigate the impact of HIV and improve the sexual and reproductive health of entertainment workers, many of whom are sex workers. There are an estimated 35,000 entertainment workers in Cambodia, working at night clubs, bars, massage parlors, karaoke clubs (KTV), restaurants, beer gardens, as well as on the street. Prevalence of HIV is as high as 14 percent, among some groups of entertainment workers.

    SMARTgirl stands apart from other programming among entertainment workers in Cambodia because of its positive, non-stigmatizing approach. It combines evidence-based interventions with the strong SMARTgirl brand, which empowers women to protect their health and well-being. SMARTgirl reaches nearly half of all EWs in Cambodia in their workplace, because it treats them respectfully, recognizes what is important to them and improves health-seeking behavior by raising self-esteem.

    SMARTgirl is one of a number of projects that validates what the international community and national leaders have been emphasizing for more than a decade— that empowering women and girls are vital components of human development. Since coming into office, U.S. Secretary of State, Hillary Clinton, as well as Ambassador Verveer, have continually underscored the importance of integrating these issues into Department of State foreign policy objectives.

    During Secretary Clinton’s recent ASEAN development meeting in Phnom Penh, she was influential in integrating gender equality and women’s empowerment into the Lower Mekong Initiative agenda. In a statement, she emphasized the importance of reproductive rights for achieving gender equality; an area that the innovative FHI 360 SMARTgirl program has been integrating into its HIV mitigation program:

    “Reproductive rights are among the most basic of human rights. … Millions of women and young people in developing countries don’t have access to information to plan their family. They don’t have health services and modern methods of contraception. This is not only a violation of their right…it’s also a question of equity as women everywhere should have the same ability to determine this fundamental part of their lives.”

    As this short video on SMARTgirl reveals, the women in the program feel inspired, often for the first time. They see themselves as “smart girls”– women who are empowered to change their lives, and educate others about health issues and rights.

    Says Kheng, “Before I became a SMARTgirl leader, I used to face issues on my own, … but we have the right to help each other and we have to participate in the community where we live.”

    Read more stories from participants in FHI 360’s SMARTgirl program.

  • July 10, 2012

    London Summit on Family Planning

    On Wednesday, July 11, 2012, the U.K. Government and the Bill & Melinda Gates Foundation are hosting the groundbreaking London Summit on Family Planning. According to the Summit’s website, the meeting plans to, “mobilize global policy, financing, commodity, and service delivery commitments to support the rights of an additional 120 million women and girls in the world’s poorest countries to use contraceptive information, services and supplies, without coercion or discrimination, by 2020.”

    FHI 360 believes that family planning is a key aspect of human development. The following posts are perspectives from FHI 360 staff on family planning’s importance around the world.

  • June 28, 2012

    Improving Health System Performance Starts from the Ground Up

    Written by
    FHI 360 Health Systems Strengthening Unit

    Imagine: a district health official sits at her desk with the results of a country-wide assessment that details 20 pages of vague recommendations to improve the health system. Suggestions range from “increasing use of financing mechanisms” to “providing adequate benefit packages for health workers” to “utilizing budget-neutral retention schemes to improve rural retention of health workforce.”

    She realizes that these issues are potentially important to her work, but she faces more immediate challenges on a day-to-day basis. Just this morning, a local hospital director was in her office discussing the low number of women who attend their antenatal care appointments. Everyday issues such as this seem disconnected from the greater health system — but are they?

    It is widely recognized that failure to reach health care goals can be attributed to constraints on the system, but the relationship between these constraints and specific health issues is not well understood. FHI 360’s Health Systems Strengthening unit has developed a tool to examine the links between the concrete problems in performance experienced at a subnational level and overarching health system issues.

    FHI 360’s Health System Rapid Diagnostic Tool guides identification of bottlenecks and sets the scene for addressing those hurdles. The Rapid Diagnostic Tool provides a step-by-step framework, operational guide and metrics for an in-country team to process to identify and measure the strength of priority health system functions.

    Other health system assessment tools exist, but their results are aggregated into lengthy reports — such as the report on our imaginary district health officer’s desk — full of recommendations that are difficult to act on and not linked to daily work. These other tools focus on assessing what health system problems exist at a high level. In Kenya, for instance, a dozen assessments have been performed in the past decade, and Kenyan health officials are very aware of the issues they face. What is not clear, however, is how to address those issues and how to achieve better outcomes.

    The Rapid Diagnostic Tool dives deep with focused data collection and analysis to identify root issues that lead to poor health-system performance. Its level of detail makes it ideal for assessment at the regional, district or subdistrict level, as opposed to the health sector as a whole. The final diagnostic report serves as a basis for designing health systems strengthening interventions.

    Delving into the root causes of many health system problems is like pulling a thread on a sweater. It quickly becomes clear that one problem is interrelated with many other issues and can be overwhelming for a project or individual to deal with alone. With the Rapid Diagnostic Tool, stakeholders work together to prioritize systems issues and find the root cause of more proximate problems. With this understanding in hand, they are equipped to design initiatives that will improve health system efficiency and effectiveness by addressing the underlying causes of poor performance. For more information on the Rapid Diagnostic Tool, contact the FHI 360 Health Systems Strengthening Unit at HSSD[at]fhi360.org.

  • June 27, 2012

    The Co-founder of National HIV Testing Day asks, “Why do we need a special day for HIV testing?"

    Written by
    A. Cornelius Baker, Technical Advisor and Co-project Director, Be the Generation Bridge, FHI 360

    Today, June 27, is National HIV Testing Day in the United States. It is an observance that is now recognized in many countries around the globe. Why set aside a special day for something that should be a routine part of medical care for people at risk of getting HIV? Because ending the stigma of HIV and creating multiple opportunities for testing is an urgent need in our effort to create an AIDS-free generation.

    In the late 1980s, many of my friends had died of AIDS or were very sick. The decision to get an HIV test was not an easy one. But in 1986, I went for an HIV test at Whitman-Walker Clinic in Washington, DC, because it was important for me to know my HIV status. This was at a time when there were few treatment options, and the testing process involved a long and scary wait for your results. In 1995, I worked with my colleagues at the National Association of People with AIDS (NAPWA) and we created National HIV Testing Day. This effort was designed to help reduce the stigma of HIV testing and to normalize it as a component of regular health screening. At that time, there was a lot of fear about testing. Because there were few treatments, many thought it unnecessary. People who were known to be HIV positive were subjected to being fired from their jobs or becoming victims of violence. At NAPWA, we believed it was important to confront this situation by encouraging people to “Take the Test, Take Control.” We also believed that the more of us who stood up, the less the world would be able to ignore the epidemic.

    Last week, members of parliament in Zimbabwe provided the type of leadership needed in the United States and worldwide to end the stigma of HIV testing. Over 47 legislators, and 60 of their staff, underwent voluntary counseling and public testing for HIV in an effort to encourage other citizens to follow suit. As a result, Blessing Chebundo, chairman of the Zimbabwe Parliamentarians Against AIDS, told SW Radio Africa that, “181 people went through the doors for testing, and 23 men underwent circumcision (proven to reduce the risk of HIV infection).”

    Today, there are dozens of treatments available to keep people with HIV healthy. There is excitement also about the progress we are making in biomedical prevention interventions such as circumcision, PrEP (pre-exposure prophylaxis) and treatment as prevention. HIV testing itself is easier and quicker with results available in 20 minutes. The promise of these new opportunities begins with everyone knowing their HIV status without fear of discrimination, stigma or violence.

    To learn more about National HIV Testing Day, visit the website here.

  • June 20, 2012

    The Domino Effect of Family Planning

    Written by
    Megan Averill
    Tricia Petruney
    Ward Cates

    Imagine a line of dominos stretched out as far as the eye can see, with additional lines branching off into the distance. This web of dominos represents the multiple connections between family planning and every dimension of sustainable development. What many still don’t comprehend is how large and far reaching this web truly is.

    We’ll begin with a simple and intuitive causal relationship: voluntary use of contraception prevents unintended pregnancies. Unintended pregnancies result in thousands of deaths globally and many more disabilities each year. Many unplanned pregnancies end in abortion. Almost half of the 40 million abortions performed each year are unsafe, placing nearly 20 million women at risk for infection, hemorrhage, disability, and death. Thus, contraception prevents unintended pregnancies and saves women’s lives.

    Dr. Ward Cates, President Emeritus at FHI 360, visits health workers that are involved with the Bill & Melinda Gates Foundation-funded Urban Health Initiative (UHI) in India.

    And the benefits of family planning don’t end with women. Families using contraception have fewer, healthier children and reduced economic burden. Children born to mothers who have used modern contraception in planning their families are not only more likely to have a mother, and one who is healthy, they also are more likely to have been breast fed for longer and received more parental attention, support and resources than children born in to families that were not planned. All of these factors increase the chances that they will survive infancy into childhood. Therefore, family planning also saves children’s lives. Moreover, if after childhood girls and women are given control over their fertility, they are more likely to stay in school and to get jobs. Educated, employed women are in turn more likely to use contraception, thus re-initiating the virtuous cycle of benefits that family planning brings to women and their families.

    The benefits still don’t end there. Ensuring that we can feed our growing population while protecting the planet has quickly become one of the most pressing challenges in sustainable development. Regions of the world with the highest unmet need for family planning are already forced to bear the burden of climate change effects to which they have contributed the least. These effects include drought and famine. Turning an extra acre of forest into tilled land is not a choice for a woman without access to reproductive health resources. It is a matter of survival. And it is a preventable scenario. Right now more than 200 million women worldwide want to plan and time their pregnancies but are unable to do so for lack of information and access to contraceptive resources. If the percentage of women with unmet family planning needs remains constant, developing country populations are expected hit 9.7 billion by 2050, and 25.8 billion by 2100. By filling this need, we could greatly relieve some of the combined pressures being placed on resources and communities, including a growing demand for food.

    The right and ability of women and couples to plan their families is not peripheral to the aims and objectives of Rio+20. Indeed, the call for greater attention to women’s rights and issues at Rio+20 is growing into a crescendo. Women’s Major Group is mobilizing women across the world to share their stories and ensure that women’s rights are front and center on the agenda. Over 100 of the world’s leading scientific academies have called upon world leaders to enact rational, evidence-based responses to sustainable development challenges, including global access to comprehensive reproductive health resources.

    Until now, too few people have been aware and too few leaders willing to acknowledge the essential role that family planning plays in achieving sustainable development. Rio+20 is our chance to tip this pivotal domino piece forward, and witness the measurable cascade of progress it evokes.

  • June 7, 2012

    Making Disease Prevention Fun and Educational

    Written by
    Olivia Aglah-Dotse, CVD Project Coordinator, Ghana, FHI 360

    A section of attendees, including some members of the Police Wives’ Association (POLWA) and Policemen during the aerobics exercise.

    Can cardiovascular disease (CVD) prevention be entertaining, fun and educational? If you ask attendees of FHI 360’s community CVD prevention events, you’ll hear a resounding “Yes!” An inaugural event, held on May 26th, took place in the barracks of the Police Hospital in Accra, Ghana. The program offered women, men and children an afternoon of upbeat music, dancing, cooking demonstrations and energizing aerobics exercises.

    Several community events are offered within FHI 360’s pilot cardiovascular disease prevention, screening and referral program. The facility-based screening program was launched in August 2011 in partnership with the Ghana Health Service and the Ghana Police Service, and focuses on the communities surrounding the Police Hospital in Accra, the capital, and Atua Hospital, a semi-rural district in Ghana. Through the facilities, we have screened approximately 14,000 clients so far. Our preliminary results indicate that in Atua Hospital, 55 percent of those screened were either pre-hypertensive or hypertensive. In the Police Hospital, 75 percent of clients were either pre-hypertensive or hypertensive. We have also found that the proportion of overweight or obese clients was 48 percent in Atua Hospital and 59 percent in the Police Hospital.

    In order to strengthen prevention activities – and address the high prevalence of CVD risk factors in the pilot communities – we recently complemented the facility intervention with a community-based behavior change campaign to promote healthy lifestyles. The campaign targets female heads of households. The slogan, “from your heart to theirs,” reinforces the position of women as the primary decision makers on what the family eats as well as their health-seeking behaviors.

    Actress and Caterer Akorfa Edzeani-Asiedu at her stand during the cooking demonstration at the Launch.

    The central component of the community campaign lies in monthly community events, which provide a range of entertainment and educational activities. During the first event in May, physical activity was promoted through music, dancing and group aerobics instruction from a professional trainer. Cooking demonstrations and taste testing were led by a local celebrity, Akorfa Edzeani-Asiedu, to promote a reduction in salt, unhealthy fats and oils, sugar and alcohol. Additionally, health care workers were on hand to screen 125 attendees for behavioral and biomedical CVD risk factors. Prevention counseling was provided and referrals were made as necessary. Additionally, health care workers were on hand to screen 125 attendees for behavioral and biomedical CVD risk factors. Prevention counseling was provided and referrals were made as necessary. The positive response to this initial event is an encouraging sign that these educational social gatherings can engage communities in making healthy lifestyle changes.

    “We are learning a lot. This program is very good for us. We will try to eat healthy and stay active so that as Policemen, we will be healthy enough to maintain security and protect life and property in this country” Police Constable Ofei, Cantonments Police Barracks, Accra.

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  • May 29, 2012

    ‘DisAbility Connect’ app launches for smartphones

    Last year 2,614 people contacted FHI 360’s National Dissemination Center for Children with Disabilities with urgent questions. What’s an IEP? What does it mean when a teacher says my child has AD/HD? Where can I find other parents of deaf children?

    And those were only the calls and emails. Thousands of others came to the center’s website and scoured its online database.

    The center, which goes by the acronym NICHCY (pronounced NEE-chee), now has a new way to get information to parents, teachers, and others whose lives are touched by children with disabilities: a smartphone app. With the touch of a finger on an iPhone or a Droid, users can now literally tap into NICHCY’s extensive database of hundreds state organizations and local parent centers.

    “Some of the information requests are our job to answer. But a lot are really for other organizations,” explains Elaine Mulligan, NICHCY’s project director. “We’re referring parents out to local centers all the time. DisAbility Connect means they can now refer themselves.”

    Amar Trivedi developed DisAbility Connect. He says NICHCY’s database translates perfectly into a mobile app because users need site-specific information and can be immediately connected to the organization’s email address, phone number, and website. And the best part, Trivedi says, is that when NICHCY updates its information online, the app will also automatically update — meaning that no parent rushing to an IEP meeting will be left with too little information too late.

    For more information about NICHCY, visit their website here.