Start with Women, Girls to Build Better Health for All

Clinic in Kenya
A health clinic in Kenya is providing an expanding array of services in one place. Kenya has been a leader in improving health care infrastructure with U.S. assistance.

By Charlene Porter
IIP Staff Writer
Washington,
March 14, 2012

Officials implementing the Global Health Initiative say the program has made solid progress in improving services for women and girls in the developing world. GHI programs, they say, have corrected an age-old social injustice, empowered women and girls in their own communities and improved general health in the communities where the women live.

Lois Quam, executive director of the GHI for the U.S. State Department, described those successes during a panel discussion at the Center for Strategic and International Studies in Washington March 13. The discussion was attended by more than 100 people representing a variety of agencies and nongovernmental organizations involved in global and women’s health programs.

Quam said a key factor in achieving GHI’s goal was the realization that a variety of health services must be provided in the same place. Developing-world women, already carrying substantial responsibility for the daily care and well-being of their households, can’t manage multiple trips around their region to receive their own care, their children’s care and reproductive health services at different facilities.

“Anyone who has ever taken more than one child to a doctor’s appointment can see the sense in this approach,” said Quam, who drew on her own experience with three boys under age 2 in a medical care waiting room. “Consolidation of services in one facility is a way to improve health and quality of life for women.”

That health care approach may seem self-evident now, but it wasn’t decades ago when donor nations, institutions and nongovernmental organizations began responding to health needs in developing nations, usually to one crisis at a time, Quam said. The funding and structure of international health assistance programs evolved from a history of emergency responses to famine, plague, refugee crises and other disasters. A motivating principle of the GHI is to help nations build their own capabilities in health care, to transcend crisis management and to construct health care systems that are prepared to cope with crises of the future and lessen dependence on outside donors.

“Our job,” said Quam to the health development specialists, “is to work ourselves out of a job.” A central goal of the program, she said, is to work with partner nations to build reliable health care systems so that each of their future citizens might be born into a society where health care and nutritional assistance “allow them to reach their full potential” as human beings.

The United States is supporting development of health care services in 80 partner nations, building on strategies of collaboration, expansion of existing health care delivery systems and long-standing public health approaches known to be successful. Women are key factors in this strategy for their proven performance as implementers of good health practices learned in clinics and passed on to children, neighbors and communities.

Relating her observations from visits to partner nations, including Uganda, Malawi, Nigeria, Nepal, Zambia and Lesotho, Quam said she’s seen solid evidence that GHI is on the way to achieving these goals.

In Malawi, trained health assistants are helping women and their children gain access to a greater range of services, from mothers’ prenatal care to children’s immunizations. As a result, the number of women who have access to a range of services has risen from 28 percent to 42 percent over the last few years. The number of women who give birth with the supervision of skilled caregivers has gone from 57 percent to 72 percent.

In Zambia, Quam met with health care teams working to establish a blood supply safety system in the country. She learned that this new system offers a “profound opportunity” to virtually eliminate severe loss of blood in childbirth, Zambia’s leading cause of death in childbirth.

With its own history as a strategy born from crisis, the U.S.-backed global HIV/AIDS assistance program is also re-evaluating how to integrate the health of women and girls into its existing programs, according to the representative from the State Department’s Office of the Global AIDS Coordinator, Daniela Ligiero. Under the President’s Emergency Plan for AIDS Relief (PEPFAR), launched in 2003, participating countries submit annual plans for how they will attack the HIV/AIDS epidemic in their country. Now, said Ligiero, those plans must specify how the nations will address the particular needs of women and girls affected by the disease. “This is an integration of GHI and PEPFAR,” said Ligiero.

Ligiero also said the AIDS program is working to better integrate family planning and other reproductive health services at sites where HIV/AIDS patients are monitored and treated. Helping HIV-positive women prevent unwanted pregnancies will also be an important goal. Care facilities initially established for AIDS patients are expanding to serve as core programs around which communities are adding a wide range of health care services, meeting broader community needs, Ligiero said.

The United States faces budget pressures that raise questions domestically about the nation’s ability to continue high funding levels for international programs. Quam said it is a time to make programs smarter, more effective and more efficient to yield a greater impact from the resources invested.