Building strategic partnerships to reach people living with HIV in Belize

“Miriam stopped taking her medication. Can you go see her?”, says Ms. Georgia White, a thirty year old woman from Belize City who is participating in a home visit program for people living with HIV (PLHA).

On this occasion, Georgia was receiving a visit from Laverne Gentle, a peer outreach worker from the Collaborative Network of Persons Living with HIV (C-Net+), a local NGO in Belize working with the Pan American Social Marketing Organization (PASMO) under the USAID Combination Prevention Program for HIV.

Under this Program, reaching people living with HIV in Belize in community-based settings had been traditionally a challenge. However, in late 2012, PASMO and CNet+, partnered to develop a new strategy to increase the coverage of combination prevention interventions for people living with HIV through a peer home visit initiative.

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The Daily Impact: Doctor in Pakistan Wins Grant to Reduce Child Mortality

December 11, 2013

Dr. Anita Zaidi won a $1 million grant to fight early child mortality in a small fishing village in southern Pakistan, on Tuesday. From the AP:

Pakistan Floods Devastated Children

The prize was founded and funded by entrepreneur Ted Caplow to find impactful and cost-effective ways to save children’s lives, according to a press release announcing the results.

Zaidi said in a telephone interview that her project will focus on reducing child mortality rates in Rehri Goth, on the outskirts of Karachi. According to Zaidi, 106 out of 1,000 children born in the town die before the age of five. That is almost double the worldwide under-five child mortality rate of 51 deaths per 1,000 live births in 2011, according to UNICEF.

Few of the women in the area of roughly 40,000 people have access to medical care during pregnancy or money to pay for things like multivitamins, said Zaidi. There is no nearby hospital, and women usually give birth accompanied by a birthing attendant with little or no formal training.

When women do run into complications giving birth, the babies often die while the women seek medical care, the doctor said.

The money will be used in Rehri Goth to eliminate malnutrition among expectant and new mothers and their babies, ensure that children have access to primary health care and immunizations and train a group of local women at Aga Khan University to become midwives.

Women taking part in the program would get two medical checkups to monitor their pregnancy, multivitamins to promote a healthy fetus and food if they are malnourished, she said.

Zaidi has been working in the area for the last ten years on various health-related research projects carried out by the university so she was familiar with its needs.

“I know this community. I know what its problems are,” Zaidi said. “It’s a really good match between what the community needed and what this prize was offering.”


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Back to Measurement Basics

by Farron Levy, President, True Impact

For years, companies seeking to justify and guide their investments in corporate social responsibility have looked to each new research study seeking linkage between corporate social responsibility (CSR) and profitability, stock price, growth and the like.

This focus is misguided. Enterprise-level metrics are too blunt an instrument to help, for example, measure the value of individual community programs or cross-sector partnerships. And in any case, sophisticated regressions and longitudinal studies are too costly in terms of time, resources and technical expertise to be practical tools for already overburdened managers. While the quest continues for that elegant, singular equation that captures CSR’s total return on investment, we suggest an interim solution: refocus on bottom-line outcomes. Though pedestrian, this back-to-the-basics perspective can help you leverage everyday metrics on sales, recruiting, productivity and so on to piece together an ROI picture – both financial and social – that you can use to continuously improve your programs, build support among stakeholders and guide investment decision-making.

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The Daily Impact: Progress Against Measles, More to Go

December 10, 2013

Improved immunization rates across the world for measles has contributed to a decline in deaths by 71% since 2000, but there is still more to be done.

As the measles vaccine reaches its 50th anniversary, the U.S. Centers for Disease Control and Prevention (CDC) is recognizing these achievements and renewing its dedication to make further progress against the disease.

“As long as there is measles anywhere in the world, there is a threat of measles anywhere else in the world,” said Dr. Tom Frieden, CDC director, at a December 5 event. “We have seen an increasing number of cases in recent years coming [to the United States] from a wide variety of countries.”

Frieden called the development of the measles vaccine a great accomplishment of science, medicine and human ingenuity. Thorough and effective vaccination programs by nations of the Western Hemisphere have effectively eradicated the disease in the region for about a decade. But measles is a highly infectious pathogen, and until vaccination is thoroughly and regularly conducted everywhere, global health security is still at risk, he said.

“Pathogens cross borders effectively, and that’s why we need to improve further on our support and partnership with the World Health Organization and with countries around the world to better find, stop and prevent threats to health,” said Frieden.

Before the introduction of the measles vaccination, as many as 2 million people died from the viral disease each year. After successful testing and trials, the vaccine won a license in the United States in 1963, and large-scale vaccination began.

Dr. Samuel Katz was a co-creator of the vaccine with Dr. John Enders, now deceased. Katz, who attended the CDC event, expressed appreciation for the recognition, but said equal appreciation should be given to people making sure the vaccine reaches children.

“The people who are taking the measles vaccine into Mozambique, Pakistan, Afghanistan, Bangladesh” deserve adulation, Katz said. Noting that low-income countries with undeveloped health care systems carry the greatest disease burden, Katz still expressed hope. “It is possible to eliminate measles even in these countries,” he said.

Katz serves as a professor and chair emeritus of pediatrics at Duke University Medical School and is co-chair of the National Network for Immunization Information.

Measles caused 158,000 deaths worldwide in 2011, down from 548,000 as recently as 2000, according to WHO. Still, more than 20 million people are affected by measles each year, most in developing countries.

Peter Strebel is a WHO coordinator for immunization and vaccines who also attended the CDC event December 5. He said the success of the vaccine has inspired the goal of measles and rubella elimination in five of WHO’s six regions by 2020.

“Since 2001, the Measles and Rubella Initiative has supported vaccination in 60 countries, reaching more than 1 billion children, and developed a global laboratory network for the diagnosis and identification of both measles and rubella viruses,” Strebel said.

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Focus on Impact Changing Corporate Community Investment

By John Lloyd, London Benchmarking Group

Leading companies are taking their responsibilities to their communities more and more seriously. With this commitment comes an increasing drive to demonstrate what results from the contributions that are made, in terms of benefits both for the communities receiving support and for the business. It’s no longer sufficient to simply report what a company contributes – it’s also necessary to explain what this contribution achieves, what the impact is.

This increased focus on impact is changing the way companies manage their community investment, not just how they measure it. It inevitably makes companies consider their objectives before they embark on a community initiative: why they should support it, what they hope to achieve by doing so, and how it will enable them to achieve their wider sustainability goals. As a result, community investment programs are becoming more strategic and focused. This is evident in companies like Unilever, whose foundation, launched in 2012, is built around five core partnerships all aimed at improving quality of life through the provision of hygiene, sanitation, access to clean drinking water, basic nutrition and enhanced self-esteem. Another good example is KPMG, whose U.K. community program has been reconfigured to focus on improving employability, increasing access to the accountancy profession and strengthening the governance and capacity of the charitable organizations that it supports.

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The Daily Impact: Afghanistan Lags on Law Protecting Women, says UN

December 9, 2013

Afghanistan is failing to implement laws that protect women, says a new UN report. From the AP:

05-02-2013unamafreepressIn a statement, the U.N. High Commissioner for Human Rights Navi Pillay described the law as a “landmark” and said it “was a huge achievement for all Afghans.”

“But implementation has been slow and uneven, with police still reluctant to enforce the legal prohibition against violence and harmful practices, and prosecutors and courts slow to enforce the legal protections in the law,” she said.

Afghanistan enacted its Elimination of Violence Against Women law in August 2009. It criminalizes child marriage, selling and buying women to settle disputes, assault and more than a dozen other acts of violence and abuse against women.

Women have won back many of the rights they lost during Taliban rule from 1996 to 2001, when the Islamic movement was ousted by an American invasion following the Sept. 11 attacks against the United States. Under the Taliban, girls were barred from attending school, women were forced to stay indoors and cover their heads and faces with burqas.

There are fears that many of those freedoms may shrink as foreign forces depart by the end of next year and much of the international aid and assistance they brought to Afghanistan goes with them.

“The law, when applied, has provided protection to Afghan women facing violence,” said Georgette Gagnon, the mission’s director of human rights.

But she added that “most of the women victims remain largely unprotected due to a lack of investigation into most incidents and continued underreporting of pervasive violence against women and girls resulting from discrimination, existing social norms and cultural practices, and fear of reprisals and threat to life.”

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5 Lessons for Successful Results Measurement

By Howard White, Executive Director of 3ie, Co-Chair of the Campbell International Development Coordinating Group, and Adjunct Professor, Alfred Deakin Research Institute, Deakin University.

As both a knowledge broker and funding agency, 3ie funds impact evaluations and systematic reviews that generate evidence on what works in development programs and why. Throughout the past four years, it has made grants for roughly 140 studies in more than 40 countries. Below are the main lessons that 3ie, and others, have learned through the experience of conducting and managing impact evaluations throughout the past decade.

1/  TO UNDERSTAND RESULTS, LOOK TO IMPACT EVALUATION, NOT JUST OUTCOME MONITORING. The rise of the results agenda has, rightly, focused attention on outcomes. This is good. But outcome monitoring is often used to “measure” results. This is wrong. Monitoring tells us what happened. It does not tell us why it happened. The “result” for an agency is that its programs make a difference to the outcomes. And for that we need a comparison of what happened with what would have happened in the absence of the intervention, i.e., estimation of a counter-factual. We have many cases in which outcomes have improved, or worsened, but these changes have nothing to do with development programs. This counter-factual is usually measured by the establishment of a comparison group, that is, a group of people who are, on average, similar to those in the program in all respects except that they don’t receive the program. Where it is an option, randomization is the best way to ensure this equivalence, though other impact evaluation methodologies may also be used.

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The Daily Impact: World Mourns Passing of Nelson Mandela

December 6, 2013

South Africa’s first black president Nelson Mandela passed away early this morning. From his New York Times obituary:

vol_553 Mr. Mandela had long declared he wanted a quiet exit, but the time he spent in a Pretoria hospital in recent months was a clamor of quarreling family, hungry news media, spotlight-seeking politicians and a national outpouring of affection and loss. The vigil even eclipsed a recent visit by President Obama, who paid homage to Mr. Mandela but decided not to intrude on the privacy of a dying man he considered his hero.

Mr. Mandela will be buried, according to his wishes, in the village of Qunu, where he grew up. The exhumed remains of three of his children were reinterred there in early July under a court order, resolving a family squabble that had played out in the news media.

Mr. Mandela’s quest for freedom took him from the court of tribal royalty to the liberation underground to a prison rock quarry to the presidential suite of Africa’s richest country. And then, when his first term of office was up, unlike so many of the successful revolutionaries he regarded as kindred spirits, he declined a second term and cheerfully handed over power to an elected successor, the country still gnawed by crime, poverty, corruption and disease but a democracy, respected in the world and remarkably at peace.

The question most often asked about Mr. Mandela was how, after whites had systematically humiliated his people, tortured and murdered many of his friends, and cast him into prison for 27 years, he could be so evidently free of spite.

The government he formed when he finally won the chance was an improbable fusion of races and beliefs, including many of his former oppressors. When he became president, he invited one of his white wardens to the inauguration. Mr. Mandela overcame a personal mistrust bordering on loathing to share both power and a Nobel Peace Prize with the white president who preceded him, F. W. de Klerk.

And as president, from 1994 to 1999, he devoted much energy to moderating the bitterness of his black electorate and to reassuring whites against their fears of vengeance.

The explanation for his absence of rancor, at least in part, is that Mr. Mandela was that rarity among revolutionaries and moral dissidents: a capable statesman, comfortable with compromise and impatient with the doctrinaire.

When the question was put to Mr. Mandela in an interview for this obituary in 2007 — after such barbarous torment, how do you keep hatred in check? — his answer was almost dismissive: Hating clouds the mind. It gets in the way of strategy. Leaders cannot afford to hate.

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Real Voices: How Microbicides can reduce HIV Infections in Women

This is the third video of the Real Voices series from the International Partnership for Microbicides (IPM). The video highlights clinic researchers and outreach workers offering their reflections on the challenges women in their communities face and their hopes for the future.

IPM and its research partners hope to continue to develop promising new health tools for women, including a monthly vaginal microbicide ring to prevent HIV, now in Phase III trials, and a 60-day dual-purpose ring to prevent HIV and unintended pregnancy in pre-clinical development.

“It is our hope that these products, along with other technologies being developed across the field, will one day soon benefit women, families and communities around the world,” says the IPM.

Real Voices is an IPM video series featuring interviews with scientists, clinicians, advocates and community members, who share their views about the need for microbicides women can use to reduce their risk of HIV infection.

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The Daily Impact: Innovation Leads Ambitious Voluntary Male Circumcision Campaign

December 5, 2013

The goal to circumcise 20 million men in 15 high AIDS-risk countries in sub-Saharan Africa will rely on a new medical device. From VOA:

CDD0B4B7-A995-48B5-A1B9-504CE224FA8C_w640_r1_sThe Voluntary Medical Male Circumcision (VMMC) project was launched two years ago by the World Health Organization and UNAIDS to eliminate a major environment for the deadly AIDS virus by surgically removing the foreskin of the male penis.

Now that procedure can be done using the PrePex – a $20 pair of plastic rings and a specially designed rubber band that can be applied in remote villages by a nurse with three days of training. The rings painlessly cut off the flow of blood to the foreskin which dies and falls off within a few days.

Rwanda’s minister of health announced this week the expansion beyond its field trials in order to reach 700,000 Rwandan males with the PrePex device, possibly the first attempt by an African government to apply the non-surgical technique in rural settings where they are most needed.

And Uganda is not far behind.

t is uncertain if the non-surgical devices will enable WHO and UNAIDS to meet their goal of 20 million circumcisions, but Dr. Jason Reed is “optimistic” about the impact of PrePex and other non-surgical devices.

Trials are showing PrePex involves the least invasive procedure because it doesn’t even require a local anesthetic. Reed said products like PrePex are “potentially easier to provide and hopefully more acceptable to the clients.”

Reed, an epidemiologist and the senior technical advisor at the President’s Emergency Plan for AIDS Relief – the U.S. government agency that is the major funder of the initiative – says the device gives men “an opportunity to stand up and play a role in achieving an AIDS-free generation with a five-minute procedure that offers a lifetime of reduced risk.”

But another epidemiologist who has been advising Kenya’s VMMC program in Nyanza Province does not believe PrePex is going to be a game-changer.

“PrePex won’t reach that goal,” said Dr. Robert Bailey, a University of Illinois at Chicago epidemiologist. Bailey supervises a VMMC project in Kisumu for the Kenya Ministry of Health. The project has conducted more than 690,000 circumcisions among Kenyans in the predominantly Luo ethic region, where the custom of male circumcision as a coming-of-age ritual was not practiced. Bailey also supervised a demographic study of 425 men who participated in non-surgical procedures using PrePex and another device called the Shang Ring.

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