Foreign Aid Cuts Affect Us All

By: Lisa Meadowcroft, AMREF

Photo Credit: AMREF

The final segment of the presidential debates is over.  Unfortunately, not much was said about the importance and impact of US aid to developing countries.  We all know that the global economic climate is tough and it’s unreasonable to expect any increases in foreign aid.  But what we can expect and hope will come to pass no matter who is in elected President next month, is that foreign assistance for global health and humanitarian aid will not be cut disproportionately.

Such drastic cuts would be ruinous.  In fact, they would cost lives.

In their July 2012 issue brief on the human impact of potential, substantial budget cuts on global health, The Foundation for AIDS Research (amfAR) found that, “applying sequestration cuts to US government global health programming would have minimal impact on deficit reduction, but would be devastating to the lives of many thousands of people globally.”

In the key areas of HIV/AIDS, TB and malaria alone, which are not only high priority for AMREF but sectors where frontline health workers have critical impact on the millions of people who depend on them the world over, the amfAR brief notes that cutting by US government support of 8.2 percent :

  • HIV/AIDS treatment for 276,500 people will not be available, potentially leading to 63,000 more AIDS-related deaths and 124,000 more children becoming orphans
  • An additional 100,000 people will not be treated for HIV/AIDS
  • 2.2 million fewer insecticide-treated nets will be procured, leading to nearly 6,000 deaths due to malaria; 3.6 million fewer people will receive treatment
  • 88,000 fewer TB patients will receive treatment, leading to 11,000 more TB deaths.

And the list goes on.

Compare this though to the great strides AMREF, along with other NGOs operating in the global health arena in the developing world, have made over the last 10 years.   Strides in both improving health outcomes and creating sustainable change by partnering with frontline health workers and their communities to give them the skills, knowledge and means to improve their own health.

As a result of the U.S. commitment to health in Africa alone, according to USAID’s Africa Bureau, “more children are living to see their first birthday, fewer people are dying from curable diseases like malaria and tuberculosis, and more communities have access to safe drinking water.  Two million Africans now benefit from life-saving HIV treatment and another 10 million people living with AIDS are receiving care through PEPFAR.”

Health improvement in developing countries is not only critical to the populations of African countries, it’s also key to US interests abroad.  Improved health results in larger labor forces and greater educational opportunities, leading to more stable economies and the potential for growth.   Stronger economies usually promote more stable political systems.  Stable political systems and strong economies in Africa are in the strategic interests of the US to promote peace overall and increase our trade opportunities around the globe.

What’s more, Americans are genuinely moved to help ameliorate human suffering – and according to a recent poll by the Better World Campaign, three out of four say that international issues influence their vote.  We Americans want and expect the US to do its fare share around the world.  In the next Presidential administration, we can’t cut foreign aid.  We will all feel the consequences.

AMREF, along with our colleagues in the Frontline Health Workers Coalition, see the impact of US aid in our work in Africa on a daily basis.

Because of the support of the US government, frontline health workers like Esther Madudu, a Ugandan midwife, receives advanced training to upgrade her skills, enabling her provide the emergency obstetric care needed to reduce preventable maternal deaths.

We see education programs in Tanzania that teach adolescent girls about their sexual and reproductive rights – helping create more gender parity and reduce unwanted teenage pregnancies.

Young Maasai women in northern Kenya learn that there are alternative rites of passage to female genital cutting, which in the past has led to so much trauma and even death for those women when they reach child bearing age.

And we see senior health care professionals from all over sub-Saharan Africa participate in advanced management training provided by AMREF and partners so they can master the skills needed to run hospitals and busy health care facilities.

And the list goes on.  In fact, this is the list that we should all want to go on and on and on.

Sustaining the Impact of Community Health Workers: Evidence from Health System Assessments

By: By Avril Ogrodnick, Abt Associates

Photo Credit: John Palen

Countries seeking to expand health services to the community-level to ensure equity of access to care frequently turn to community health workers (CHW) as an essential expansion of the health team.  A variety of approaches to training, hiring and supporting community health workers have been implemented by countries, and there are many important lessons learned to be shared across countries.

Through the Health Systems 20/20 project, Abt Associates examined the approaches that countries are taking to expand services through training and deploying CHWs. Health Systems 20/20 completed 25 Health System Assessments, a rapid indicator-based methodology that determines the key strengths and weaknesses of a health system using a set of internationally recognized qualitative and quantitative indicators.  The assessments found that a variety of approaches to utilizing CHWs are implemented by countries, from fully public and salaried employees to volunteers, and to autonomous, private providers who sell health and other products to generate income.

For example, in Angola, the government has recently reintroduced the CHW cadre, which existed until the civil war disrupted the health system. An estimated 6,000 CHWs have been trained in several separate initiatives by different organizations. CHW are responsible for home visits and community education and have strengthened the link between communities and health facilities.

In Uganda, the Living Goods model, launched in 2007, combines microfinance with the CHW concept. Village women are selected and trained to educate their communities on health promotion, sell health protection products door-to-door for a profit, and refer people to health facilities. Their first basket of products is obtained on credit, and the NGO provides close monitoring and supervision.

CHWs have been providing health services at the household/community level in Lesotho since 1975. The CHW program was adopted as a national strategy for PHC in 1979 following Lesotho’s participation at the 1978 Alma Ata Conference. Until 2008, CHWs received no remuneration, and their only benefit was free medical care for themselves and their immediate family. In 2008, the government took a step towards institutionalizing the community-based health service by paying CHWs a small monthly salary.

Perhaps the strongest example of CHWs is in Ethiopia, with the introduction of Community Health Extension Workers (CHEWs) at the local level in Kebeles under the Health Extension Program. CHEWs operate at the community level and are fully paid by the government. There are now four CHEWs per 10,000 people and their impact is witnessed throughout the health system.  According to Mr. Bizayene, CEO of the referral Mekelle Hospital, maternal mortality is decreasing because of the CHEWs’ efforts; he has personally only seen one maternal mortality case the year the HSA was done.

Findings from the HSAs also informed the steps countries can take to ensure that CHW models are sustainable in the long term.  Countries should first develop clear policies that define the specific roles and responsibilities of CHWs within the health system.  CHWs also require sufficient funding, appropriate training to address the community’s burden of diseases, supervision from health professionals, and appropriate incentives.

The contribution CHWs make to the health system can be substantial.  Further analysis of the lessons learned by countries implementing a CHW model is important to increasing the impact of these vital frontline health workers.

Supporting the World’s Frontline Health Workers

By: Congressman Robert Dold
Representing Illinois’ 10th Congressional District.


In the United States, polio was successfully eradicated in 1977. For years, this disease plagued the world and took the lives of countless children, and left many others disabled. Today, because of increased government support, scientific advances in immunization, and humanitarian groups like Rotary International that deploy dedicated health workers for vaccination campaigns, polio is now endemic in only 3 countries. Soon, many experts believe, polio can be completely eradicated from the world through access to life-saving vaccines.

This is terrific news and it demonstrates the impact of U.S. leadership on the lives of children around the world.

Today, the leading killers of children in the developing world are completely preventable and treatable diseases, pneumonia and diarrhea. Combined, they claim the lives of more than 2 million children under the age of five die every year. Ten countries in the developing world account for 60% of these child deaths. However, with greater access to health education and resources, these countries could save the lives of children.

Earlier this year, I co-sponsored the Frontline Health Workers Resolution (H.Res. 734). This is a bipartisan resolution that is aimed at recognizing the importance of community health workers throughout the world who are providing health care to the poorest of the poor areas. These individuals often have to travel days by foot and rely on a backpack of supplies to deliver life-saving health care to rural communities. In short, without them, millions of families throughout the world would never receive health care because they live too far away to access hospitals, clinics, doctors and nurses.

By providing vaccinations, basic antibiotics to treat pneumonia, oral rehydration therapy and zinc to treat diarrhea, and other health services, frontline health workers are often the difference between life and death. According to RESULTS, the Ethiopian government trained 40,000 community health workers and sent them out into the rural regions across that country. Five years later, there was a 50% reduction in malaria related deaths. This is impressive and speaks volume to the effectiveness of frontline health workers.

This month, UNICEF reported under-five child deaths dropped from 12 million a year in 1990 to 6.9 million a year in 2010 thanks to many of the services provided by frontline health workers. This is an incredible accomplishment, but more must be done.

In order to continue to lower child mortality rates and to prevent further deaths from pneumonia and diarrhea, I will continue to support efforts by our nation and others to support frontline health workers. By aiding those most in need, health workers throughout the world are saving children and teaching them important health skills that they can carry with them for the rest of their lives. I applaud those working on the frontlines and know that you are helping to end preventable childhood deaths.

(Note: This blog first appeared at: )

The Movement For Change

By: Nargis Shirazi, Women Deliver 100 Young Leader

A CHW doing growth monitoring using a MUAC tape
Photo By: Women Deliver

It is a cold rainy day, and a pregnant mother’s water has just broken. A young man stares at the pouring rain hitting the muddy path and sighs. He has no way of getting his wife to the health center that is a two hour walk from his mud-thatched house. He has no money, his bicycle tires are worn out, and they both have no idea what to do! She dies as a result of obstructed labor.

A couple of years later, a 27 year-old lady awakes to the cold morning mist in Isingiro district, Uganda. She eats her breakfast and looks into her backpack to ensure that she has all the supplies she needs. She walks down the hill to start her household visits. She is a community health worker (CHW) for the Ruhiira Millennium Villages. This lady is a link between the community and the health centers.

I spent a year working with the Ruhiira Millennium Villages project, and I learned many things. I used to hear about how difficult it was for pregnant mothers to travel to health centers, but never had I seen just how long the distance would be! For some, this means walking across hills, running down slopes, jumping streams and walking past swamps—thus preventing many pregnant women from accessing health centers on a regular basis.

The CHW is the extension of health services to the household. The pregnant household member appreciates the fact that she can visit the health center even when she is away from it. The CHW promotes the use of birthing plans, intermittent preventive treatment of malaria during pregnancy and infancy, anti-retroviral (ARV) usage to prevent mother to child transmission of HIV, referrals for emergency care, and even the provision of postnatal counseling to promote breastfeeding.

I also learned during my time at the Ruhiira Millenium Villages that this approach is not just a system, but a movement! It is empowering the local communities to take responsibility for their people! It is changing the lives of children under five; it is saving pregnant mothers; and it is inspiring communities to take charge of their very own! In a world where the rural community still follows traditional health practices, there is only one way to encourage community members to seek care in a health center. Culture and belief play significant roles in behavior, and the CHWs have played an even bigger role in linking communities to the health centers by understanding group dynamics and by being empowered to influence the community as a whole!

John Museveni, a senior CHW, smiled as he told me about the visible results of Ruhiira’s approach:

I have seen a change in this community ever since we started working with the health centers. We do growth monitoring, use rapid diagnostic tests for malaria, and promote family planning and healthy behaviors, to name but a few.  We have supervisors and are trained by health worker personnel on danger signs, counseling, how to carry out household visits. We are saving lives!