Impact No. 11 by Impact Magazine

No. 11

THE MAGAZINE OF PSI

TOP

10 G L O B A L H E A LT H MILESTONES OF 2012

Reach thought leaders in more than 65 countries. Impact Magazine sets the tone for the global health communityâ&#x20AC;&#x2122;s conversation, engaging 128,000 readers through the practiced approach of conveying stories â&#x20AC;&#x201C; about global health challenges, voices from the field, policy perspectives, innovation in development, the sciences and more. It invites discussion, while bringing informative depth to the issues it covers.

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BENIN

BURKINA FASO

CAMEROON

CENTRAL AFRICAN REPUBLIC

CENTRAL AMERICA

AFFILIATES

NO. 11

PSI is a global non-profit organization dedicated to improving the health of people in the developing world by focusing on serious challenges like a lack of family planning, HIV and AIDS, barriers to maternal health and the greatest threats to children under five, including malaria, diarrhea, pneumonia and malnutrition. psi.org

COSTA RICA

6 NAMIBIA

NIGERIA

2. . 4.

WORLD MAP

• Top 10 in 2012 A LOOK BACK AT 2012

By Marshall Stowell, Editor-in-Chief

. 5. TOP 10 MILESTONES IN GLOBAL HEALTH

PAKISTAN

PARAGUAY

SOUTH AFRICA

UGANDA

ZAMBIA

• 6 London Summit on Family Planning Ignites $2.6B in Commitments • 8 India Celebrates One Year Polio Free • 9 Global Leaders Convene Child Survival Call to Action • 10 Child Mortality Declines Globally • 12 AIDS 2012 Touts “AIDS-Free Generation” • 14 Public-Private Partnerships Thrive • 15 Gates Foundation Calls for Reinventing the Toilet • 16 Nutrition Gets its Turn • 17 Girls Movement Mobilizes Action, Funding • 18 GAVI Adds HPV Vaccine to Portfolio

20. T ECHNICALLY SPEAKING

By Steven Chapman, Ph.D., Chief Technical Officer, PSI

. 21. WORLD POLICY

EDITOR-IN-CHIEF

Marshall Stowell

MATTERS

mstowell@psi.org

• 21 Europe Policy News By Michael Chommie, Director, PSI/Europe • 22 U.S. Policy News By Sally Cowal, Senior Vice President & Chief Liaison Officer, PSI

MANAGING EDITOR

Mandy McAnally

amcanally@psi.org

EDITOR

Jyoti Kulangara jkulangara@psi.org

EDITORIAL CONTRIBUTORS

Ryan Cherlin

. 28. FINAL WORD

Communications

Diana Denton Graphic Design

• By Karl Hofmann, President and CEO, PSI

Andrea Edwards Corporate Marketing

Abel Irena Malaria Control and Child Survival

Regina Moore Advocacy

Cate O’kane Corporate Marketing

Elizabeth Petoskey Advocacy © MANPRIT SHERGILL

DEMOCRATIC REPUBLIC OF CONGO

Scott Thompson Communications

CONNECT WITH PSI COVER PHOTO: © BILL & MELINDA GATES FOUNDATION/RUNE HELLESTAD

blog.psiimpact.com

Population Services International

follow @PSIimpact

youtube.com/ HealthyBehaviors

world map

AROUND THE

➌

WORLD

➍

THE NUMBERS BEHIND THE MILESTONES

Below, you will read callouts about the top 10 global health milestones of 2012. To understand the significance of each milestone, please read the accompanying article.

➎ UGANDA

310

➊ PAKISTAN

27% 2.3 ➋ INDIA

➌ WASHINGTON D.C.

➍ LIBERIA

56+ 9

women in Uganda die due to complications from pregnancy or childbirth, per every 100,000 live births. A new public-private partnership – Saving Mothers, Giving Life – is working with the Government of Uganda to reduce their maternal mortality ratio.

of married women in Pakistan between the ages of 15-49 use contraception. The Government of Pakistan has committed to raising the contraceptive prevalence rate to 55% by 2020.

million+

volunteers in India vaccinated 172 million+ children under 5 against polio.

governments and 100 civil society partners signed a pledge to reduce child mortality to 20 or fewer deaths per 1,000 live births in every country by 2035.

SOURCE: LONDON SUMMIT

SOURCE: GLOBAL POLIO

SOURCE: USAID 5TH

CHILD SURVIVAL: A PROMISE

SOURCE: MERCK FOR

ON FAMILY PLANNING

ERADICATION INITIATIVE

BIRTHDAY CAMPAIGN

RENEWED. UNICEF

MOTHERS

Accompanying article: pg. 6

Accompanying article: pg. 8

Accompanying article: pg. 9

Accompanying article: pg. 10

Accompanying article: pg. 11

low-income countries, including Liberia, reduced the mortality rate of children under 5 by 60%+ between 1990 and 2011. SOURCE: COMMITTING TO

impact | No. 11

Source: UNAIDS World AIDS Day Report 2011

➓

•

➊ ➋ ➒

➎

➐

➏

➏ SOUTH AFRICA, BOTSWANA, SWAZILAND

Among 22 priority countries, three countries – South Africa, Botswana and Swaziland – have achieved 90% coverage for preventing mother-to-child transmission of HIV with dual- and triple-therapy regimens.

➑

➐ MOZAMBIQUE

15%

of the world’s population – 9.5 million people in Mozambique alone – practices open defecation. The global community has called for increased attention to address this challenge. In 2012 the Bill & Melinda Gates Foundation brought together a diverse group of experts to innovate on how to best meet the needs of households who do not have access to improved sanitation.

➑ MADAGASCAR

50%+ of the children in Madagascar are stunted. The Copenhagen Consensus’ 2012 Expert Panel says that fighting malnourishment should be the top priority for policy-makers and philanthropists. SOURCE: COPENHAGEN CONSENSUS CENTER

➓ GENEVA, SWITZERLAND

➒ NIGER

75%

of girls in Niger will be married before they turn 18. The first International Day of the Girl Child, celebrated this year, called for an end to child marriage.

AND A LIFE FREE FROM

88%

of the 275,000 deaths caused annually by cervical cancer occur in developing countries. GAVI Alliance set a goal to vaccinate 2 million women and girls against the human papillomavirus (HPV) by 2015. A vaccine against HPV can avoid up to 70% of cervical cancer cases.

SOURCE: WHO/UNICEF JOINT

HUNGER: TACKLING CHILD

SOURCE: MARRYING

SOURCE: TOGETHER WE WILL

MONITORING PROGRAMME

MALNUTRITION, SAVE THE

TOO YOUNG: END CHILD

END AIDS. UNAIDS.

2012

CHILDREN.

MARRIAGE. UNFPA

SOURCE: GAVI ALLIANCE

Accompanying article: pg. 12

Accompanying article: pg. 18

Accompanying article: pg. 21

Accompanying article: pg. 22

Accompanying article: pg. 10

psi.org | impact

A Look Back THE 10 MOST IMPORTANT MILESTONES IN GLOBAL HEALTH IN 2012

Marshall Stowell visits with kids in Cameroon during an insecticide treated net distribution organized by the Cameroonian Government and PSI, and funded by the United Nations Foundation.

impact | No. 11

convened more than 100 civil society partners and 56 governments to commit to reduce child mortality to 20 or fewer deaths per 1,000 live births in every country by 2035. Dr. Ariel Pablos Mendez, Assistant Administrator for Global Health at USAID, writes about why the Call to Action stands out. The year wouldn’t be complete without a few shakeups. Andrew Mitchell stepped down as International Development Secretary after championing value for money and transparency at UKAID. We are grateful for his leadership and look forward to working with his successor, Secretary Justine Greening. We said a sad goodbye to the Global Health Council, an esteemed convener of nongovernmental partners of which PSI was a very proud member. We saw transitions at the Global Fund to Fight AIDS, Tuberculosis and Malaria as Michel Kazatchkine stepped down as Executive Director. Dr. Mark Dybul, former U.S. Global Ambassador for HIV/ AIDS and the head of PEPFAR during the George W. Bush Administration, took over the position in November. PSI’s Chief Technical Officer shares his thought on trends for 2013 and beyond. We’re confident the global health community will maintain the momentum, partnerships and ingenuity necessary to continue making landmark moments for years to come. – Marshall Stowell, Editor-in-Chief, PSI’s Impact Magazine

t’s fitting that the last issue of the year is one of reflection. We asked Impact readers to tell us the top 10 milestones in global health in 2012. You responded overwhelmingly via Twitter, Facebook, PSI’s Impact blog and through direct outreach with insightful suggestions that made the task of identifying only 10 items difficult. Some of the suggestions came as no surprise. The London Summit on Family Planning received the most nominations from readers. This landmark partnership between the U.K. Department for International Development (UKAID) and the Bill & Melinda Gates Foundation mobilized billions in commitments to help the more than 200 million women and couples in the developing world access family planning products and services. Melinda Gates has made it a personal goal to take the controversy out of contraception. Inside this issue, Mark Lowcock, UKAID Permanent Secretary, Dr. Chris Elias, President of Global Development for the Foundation, and Dr. Gary Darmstardt, Director of Reproductive Health for the Foundation, share their thoughts on why this was a landmark moment. A polio-free year in India was an incredible achievement. Leading advocates in this achievement – Dr. Robert Scott, Chair of Rotary International's PolioPlus Committee, Mr. Deepak Kapur, Rotary National’s PolioPlus Chair for India – write about the success. The U.S. Agency for International Development (USAID) Child Survival Call to Action also made the list. The effort

1 TOP 6 2 7 3 10 8 4 9 5 10 L ondon Summit on Family Planning Ignites $2.6 Billion in Commitments

AIDS 2012 Promotes “AIDS-Free Generation”

Gates Foundation Calls for Reinventing the Toilet

India Celebrates One Year Polio Free

Global Leaders Convene Child Survival Call to Action Global Child Mortality Declines

Public-Private Partnerships Thrive

G L O B A L H E A LT H MILESTONES OF 2012

Nutrition Gets its Turn

Girls Movement Mobilizes Action, Funding GAVI Alliance Adds HPV in Vaccine Portfolio psi.org | impact

M I L E S T O N E

On July 11, 2012, UKAID, the Bill & Melinda Gates FoundaÂtion, the United Nations Population Fund and other partners, hosted the groundbreaking London Summit on Family Planning. The event mobilized policy, financing, commodity and service delivery commitments to provide an additional 120 million women and girls in the developing world with family planning by 2020.

impact | No. 11

London Summit Ignite

he London Summit on Family Planning help make this hope a reality. By enabling 120 was a momentous day that surpassed million more women and girls in the poorest 69 expectations, with global leaders comcountries to use contraceptives by 2020, more ing together to make commitments than 110 million unintended pregnancies will be that will provide 120 million more girls avoided and more than 200,000 fewer women and women in the poorest countries who want and girls will die in pregnancy and childbirth to be able to decide whether and when to have â&#x20AC;&#x201C; which is equivalent to preventing one death a child with contraceptive information, services every 20 minutes. and supplies. Family planning is often seen as a controThe London Summit, which the British Govversial issue that all too often gets bundled ernment co-hosted with the Bill & Melinda Gates together with population control. Control and Foundation, together with the U.S. Government coercion are not, and have never been, part of and the United Nations Population Fund, will reignite progress on voluntary family planning, If we are going to be successful in which has largely stagnated in recent years. Prime Minister David tackling poverty, women have to Cameron summed up its purpose in his keynote speech, when he be able to decide, freely and said that, if we are going to be sucfor themselves, whether, when cessful in tackling poverty, women have be able to decide, freely and and how many children to have. for themselves, whether, when and how many children to have. This is a choice that approximately 220 million women in the developing world who this agenda. Empowerment and giving women want to delay, space or limit their pregnancies access to family planning information, supplies do not have. The consequences are staggering: and services most definitely are. As the Prime 80 million unintended pregnancies a year, 30 Minister set out in his speech, family planning million unplanned births and 40 million aborenables women to fulfill their own potential and tions. is an essential first step toward growth, equality Behind each statistic is a personal story. and development. The message I hear when I meet women in While the support of donors is vital, it is the developing countries is unequivocal: they want commitments made by developing country govthe power to plan their lives and to invest in the ernments for the women and girls in their counchildren they already have before having more. tries that will drive the transformational changes The commitments made at the Summit will needed. For the London Summit to be a success,

UK Prime Minister David Cameron and Melinda Gates speak with attendees at the London Summit.

es $2.6 Billion in Commitments it was imperative that these nations committed to tackling the many barriers which prevent girls and women from using contraception. More than 20 countries made substantial promises to deliver on financial, policy and programming, to address both supply and demand-side barriers, such as working to change laws, and to increase social acceptance at the community level. For example, India will ensure free services and commodities through public health facilities for 200 million couples; Nigeria will train frontline health workers to deliver a range of contraceptives; the Ethiopian government will work with NGO and private providers to meet the family planning needs of married and unmarried adolescent girls; and Senegal has committed to making family planning a national priority, including taking action to improve the supply chain and eliminate stockouts of contraceptives. The commitments made in London mark the start of a movement that will improve the lives of millions of girls and women around the globe. But we are clear that this is only the beginning and that a collective effort will be required to maintain the momentum generated by the London Summit. n

MARK LOWCOCK

Permanent Secretary, U.K. Department for International Development

he London Summit on Family Planning demonstrated the impact that the world community can achieve when it comes together to address an urgent global health issue. In recent years, family planning has been less prominent on the global health agenda, despite the fact that an estimated 220 million women and girls in developing countries lack access to contraceptives and other family planning services. What the Summit did was put the spotlight back on family planning. More than 150 leaders from donor and developing countries, international agencies, civil society, foundations and the private sector pledged US$2.6 billion toward a plan that will enable an additional 120 million women and girls in the worldâ&#x20AC;&#x2122;s poorest countries to have access to contraceptive information, services and supplies. Leaders from 24 developing countries committed to tackle the policy, financing and delivery barriers that have prevented women from accessing these services in their countries in order to reach national-level goals. The private sector is engaged and committed, testing new pricing models with volume guarantees never before used for contraceptives. Efforts to coordinate procurement and donor support to country programs are forcing a different conversation and approach to family planning. By 2020, this initiative will result in 200,000 fewer women and girls dying in pregnancy and childbirth, more than 100 million fewer unintended pregnancies, more than 50 million fewer abortions, and nearly 3 million fewer infants dying in their first year of life. The economic impact will also be seen, as studies show that

every US$1 invested in family planning services yields up to $6 in savings on health, housing, water and other public services. The Summit was a game-changer for family planning and the rights of women and girls around the world. One of the things that impressed us was the willingness of partners to transcend ideological differences. Everyone understood that we were coming together to support something fundamental: the right of all women to determine freely and for themselves whether, when and how many children they will have. The Summit put women at the heart of the global health agenda. Achieving the intended outcomes will require the continued collaboration and commitment of all partners involved in womenâ&#x20AC;&#x2122;s health. Seeing how the global community came together at the London Summit, weâ&#x20AC;&#x2122;re optimistic that we can do that so millions of women and girls around the world have an equal opportunity to plan their families and achieve their full potential. n

DR. CHRIS ELIAS

President of Global Development, Bill & Melinda Gates Foundation

DR. GARY DARMSTADT Director of Family Health, Bill & Melinda Gates Foundation

psi.org | impact

India celebrated one year without a new case of polio on January 13, 2012. The country launched a massive vaccination campaign with more than 2 million volunteers. The campaign drastically reduced polio cases from 741 in 2009 to 42 in 2010 and 1 in 2011. More than 172 million children under 5 throughout India were vaccinated during this campaign.

As of mid-November, only 187 cases had been reported worldwide, all but five confined to the endemic countries.

impact | No. 11

he year 2012 has seen unprecedented progress in the war against polio – as well as the emergence of a major challenge. The year began as we counted down to January 13, the date India marked a full 12 months with no new polio cases – an incredible accomplishment given that many experts predicted this vast nation of 1.2 billion people would be the disease’s final stronghold. But the historic milestone ultimately was reached through the unwavering commitment of the Indian government at every level and the dedication of many thousands of health workers and volunteers – including India’s Rotary club members – who were determined to reach every child with the oral polio vaccine. This set the stage for India’s removal from the list of polio endemic countries in February, leaving only Afghanistan, Nigeria, and Pakistan as nations where transmission of the wild poliovirus has never been stopped. As we enter 2013, it is imperative that we focus our efforts on stopping polio in the endemic countries to prevent the 'importation' of cases into polio-free countries – the key to achieving total eradication. Globally, new polio cases are at an all-time low. As of mid-November, only 187 cases had been reported worldwide, all but five confined to the endemic countries. In contrast, we had 520 cases at the same point in 2011, and more than half of those were imported cases in nonendemic countries. When Rotary International began the fight to end polio more than 25 years ago, the disease crippled about 350,000 children a year in more than 120 countries. The case numbers confirm that the time has never been better to press the fight and

end polio once and for all – to achieve history by making polio the first human disease to be eradicated since smallpox was vanquished in 1979. But another set of numbers – numbers with dollar signs attached – presents perhaps our most formidable challenge ever in the form of a $700 million funding gap that could derail the entire program unless it is addressed quickly. If this gap is not bridged, polio could easily stage a resurgence that could paralyze millions of children in a matter of years, wasting the world’s $8 billion investment in polio eradication to date (nearly $1.2 billion of it from Rotary) and squandering the estimated $40-$50 billion in economic savings and benefits that eradication would generate. The funding gap must be bridged, and Rotary and its partners are working tirelessly to convince world leaders to commit the resources needed to immunize every child against polio. India has proven it can be done, and now we must build off the momentum gained in 2012 if we are to finally achieve our goal of a polio-free world. Failure is not an option. n

DR. ROBERT S. SCOTT International PolioPlus Committee Chair Rotary Foundation of Rotary International

DEEPAK KAPUR

National PolioPlus Committee Chair, India Rotary Foundation of Rotary International

M I L E S T O N E

India Celebrates One Year Polio Free

Global Leaders Convene Child Survival Call to Action countries. Certain behaviors are essential to ending preventable child deaths and ensuring healthy development. These include healthy timing and spacing of pregnancies, giving quality antenatal care and nutrition, making sure newborns are sheltered, breastfed, kept warm, shielded from diseases like HIV, and given proper nourishment, and protecting children with vaccines, bed nets, and antibiotics as well as supportive caregiving and healthy attachment. Since the Call to Action, more than 150 government leaders have signed the pledge to end preventable child deaths. In addition, 185 civil society organizations have pledged their support and 220 faith-based organizations have committed to take action promoting the 10 best practice behavior changes to prevent maternal and child deaths. Our goals are ambitious, but our sense of purpose is resolute. We are closer now than ever before to closing the gap between our aspirations for improving the health of the world’s children, and the reality of its time. Let’s keep the momentum going. n

DR. ARIEL PABLOS-MENDEZ

Global leaders convened Child Survival Call to

Action on June 14-15, 2012, in Washington, D.C. As a result of this effort, more than 100 civil society partners and 56 governments signed on to reduce child mortality to 20 or fewer deaths per 1,000 live births in every country by 2035.

Assistant Administrator for Global Health, USAID

3 M I L E S T O N E

n June 14, the Governments of the U.S., India and Ethiopia, in collaboration with the United Nations Children’s Fund (UNICEF), convened more than 700 global leaders and public health experts to achieve an ambitious, yet achievable goal – ending preventable child deaths. The Call to Action was a momentous occasion for the child survival community. For many, the aura surrounding the event and the 5th Birthday campaign was reminiscent of the child survival revolution launched by James Grant in his 1982 annual State of the World’s Children report. It provided a new sense of purpose and urgency to the cause of child survival. In the past last 40 years, thanks to advances in science, technology, service delivery and programs that create informed demand for health services, child deaths have been reduced by more than 50 percent. The Call to Action challenged the global community to do even more – to reduce child mortality to below 20 child deaths or fewer per 1,000 live births in every country by 2035. Reaching this goal will save an estimated 50 million children by 2035, pushing us ever closer to ending preventable child deaths in our lifetime. Evidence has shown that we have, in our hands, the combined tools and knowledge to reduce under-five mortality rates in developing countries to levels similar to those in wealthier

psi.org | impact

M I L E S T O N E

In September 2012, the United Nations Children's Fund (UNICEF)

released its latest report on child survival – Committing to Child Survival: A Promise Renewed. The report acclaims a 40 percent decline in child mortality for children under five over the past

Global Child Mortality

20 years. Global child

from around 12 million in 1990 to 6.9 million in 2011. Impact interviews UNICEF Director of Programs Dr. Nick Alipui about this turning point. Source: UNICEF

impact | No. 11

Impact interviews Dr. Nick Alipui, Director of UNICEF Programs, on global achievements in child health.

IMPACT: Why would you consider the decline in child mortality a global health milestone in 2012? ➤ NA: Reductions in child mortality over recent years have been tremendous, as 14,000 fewer children die each day compared to two decades ago. Even sub-Saharan Africa, despite lagging behind other regions, has registered a significant decline. Today in 2012, we know more than ever before about which interventions and which equity-based implementation strategies

can make a difference for these children. As a result, more and more countries are using innovative approaches to scale up coverage, and more children are being reached than ever before.

IMPACT: What are the key interventions that influenced the decline in child survival? ➤ NA: Expansion of effective preventive and treatment interventions such as immunization, improved water and sanitation services, prevention of maternal to child transmission of HIV, and integrated community case management of childhood illnesses including pneumonia, malaria and diarrhea have played an important

mortality rates have fallen

A child death occurs with every blink. IMPACT: In light of these developments where do you think we should prioritize resources to continue the decline in child mortality? What message do you have for the global community? ➤ NA: In order to continue the decline in child mortality, resources should focus on reaching families within the most deprived settings of countries with the highest maternal and child mortality rates. Efforts should not only focus on expanding coverage of inexpensive and evidence based interventions, but also on monitoring why these interventions are or are not effectively implemented. Within each setting, we need to better understand – and act on – the critical bottlenecks that prevent coverage. These include factors such as insufficient health workers, essential medicines, poor geographic access, and on the demand side, both financial and non-financial barriers. Further, it is important to invest in strategies that respond to the social determinants that influence a child’s health and nutritional status, including for example education, women’s empowerment and fulfillment of child rights and protection.

IMPACT: Following the recent World Health

Declines role. In addition, several new tools such as rapid diagnostic tests and mobile technologies are being used to facilitate the roll out of these interventions in disadvantaged areas. Female education, especially of young girls has also played an invaluable role in many areas, including child survival efforts worldwide. Aside from specific interventions, the collective effort of governments, donors, nongovernmental organizations, UN agencies, scientists, practitioners, communities and families to reduce preventable child deaths must be acknowledged as having played a key role in reducing child mortality.

Organization recommendation on chlorhexadine, how do you see this intervention complementing existing efforts to reduce neonatal mortality, and how can PSI play a role to expand its use? ➤ NA: In spite of overall achievements in child mortality, progress in reducing neonatal deaths has lagged behind and so these now account for approximately 40 percent of all under-5 deaths. Along with prematurity and asphyxia/ birth trauma, infection is one of the leading causes of deaths among newborns. Globally, more than 1 million newborns die as a result of neonatal infections. Through simple and cost-effective interventions most of these deaths can be prevented. For example, immediate and exclusive breastfeeding, kangaroo mother care, hand washing, access to antibiotics and skilled attendance at birth are critical. In addition, it is critical to prevent infections from contaminating the umbilical cord stump. In many settings, this has remained a stubborn challenge, as mothers and those who provide them with care and support during the postnatal period may have harmful socio-cultural beliefs regarding what should be applied to the umbilical cord stump of their newborns.

The use of chlorhexadine will be a tremendous complement to other neonatal interventions by preventing umbilical cord stump infections. For this reason, UNICEF and its implementing partners such as PSI can play a key role in expanding its use, particularly in the most underserved areas of countries with a high burden of neonatal death due to infections. The focus of these efforts should be on making the right concentration of chlorhexadine available at local levels, training local health workers on its appropriate application and use, and on ensuring that chlorhexadine use is incorporated into an integrated package of effective newborn interventions through postnatal care home visits that occur within the newborn’s first day of life. Because of its expertise in social marketing and integrated community-based care, PSI will be a key partner in ensuring that the world’s most vulnerable newborns can benefit from this important new recommendation. n

DR. NICK ALIPUI Director of Programs, UNICEF

SNAPSHOT: LEVELS & TRENDS . IN CHILD MORTALITY

➤ The number of under-five deaths worldwide has decreased from nearly 12 million in 1990 to less than 7 million in 2011. ➤ The rate of decline in under-five mortality has drastically accelerated in the last decade — from 1.8% per year during the 1990s to 3.2% per year between 2000 and 2011. ➤ Under-5 deaths are increasingly concentrated in sub-Saharan Africa and South Asia. In 2011, 82% of under-five deaths occurred in these two regions, up from 68% in 1990. Source: UNICEF

To learn more, go to www.apromiserenewed.org.

psi.org | impact

M I L E S T O N E

Nearly 24,000 partici pants from 183 countries attended the 19th Inter national AIDS Conference from July 22-27th. The Conference gathered policymakers, people living with HIV and those work ing in the field of HIV, and was especially significant because it was the first gathering around the goal of ending the pandemic. Impact interviews U.S. Global AIDS Coordinator Eric Goosby about the significance of AIDS 2012 and the U.S. government's role in elevating the dialogue around an AIDS-Free Generation.

impact | No. 11

AIDS 2012 Touts Possible AIDS-Free Generation

ow health products and services are delivered and global health programs are funded is changing. Enter the private sector and the public sector, working together. Public-private partnerships target shared values and develop joint business plans that better serve beneficiaries or ‘consumers’ and help strengthen health delivery systems. Bilateral agencies, foundations and governments are increasingly seeing the value of these partnerships. In March, the Global Fund to Fight AIDS, Tuberculosis and Malaria highlighted Chevron, the President’s Emergency Plan for AIDS Relief and other partners for their assistance with drug delivery and mobilizing consumer markets. Unilever launched the Unilever Foundation, in conjunction with its sustainable living plan, to support the company’s goal of helping more than 1 billion people improve their health. The U.S. and Europe are accelerating their private sector engagement. The U.S. has developed some 1,000 public-private partnerships in the last decade. This year, public-private partnerships came into their own, and the trend is set to continue as the funding landscape for development evolves.

Q&A with US Global AIDS Coordinator Ambassador Eric Goosby IMPACT: Why was it significant to host International AIDS Conference (AIDS 2012) in the U.S., specifically in Washington, D.C.? ➤ ERIC GOOSBY: Thanks to the Obama Administration, this meeting took place in the U.S. for the first time in more than 20 years, because of the elimination of HIV-related visa entry restrictions. As Americans, this should make us proud. What should also inspire pride is that the conference came to our nation’s capital at a pivotal moment in our fight against AIDS, as we showed the world how we are addressing the issue here in America. In July 2010, President Obama launched the first comprehensive National HIV and AIDS Strategy, which addresses the domestic response to the epidemic – especially important here in Washington D.C., which is deeply impacted by HIV and AIDS. For PEPFAR, it was a chance to communicate our impact to key domestic and international audiences. As of the midpoint of 2012, PEPFAR supported life-saving antiretroviral treatment for more than 4.5 million men, women and children worldwide, putting the U.S. on target to reach 6 million people with treatment by the end of 2013.

IMPACT: Why do you feel AIDS 2012 was one

PHOTO CREDIT

Ambassador Goosby speaks at a session at the International AIDS Conference.

of the top 10 global health moments of 2012? ➤ EG: AIDS 2012 clearly highlighted how far we have come in responding to this virus. In presentation after presentation, we heard the incredible impact of scientific research and an evidence-based response to AIDS, both in the U.S. and around the globe. It was inspiring to hear how program implementers are translating recent scientific advances into practice to save lives.

At the conference, U.S. President's Emergency Plan for AIDS Relief (PEPFAR) participated in many technical sessions in which our staff and partner organizations like PSI had dialogue on best practices toward the goal of achieving an AIDS-free generation. Ultimately, the combination of this professional exchange, the sharing of lessons learned and the greater reliance on evidence-based interventions will contribute to a more effective global response. Lastly, AIDS 2012 demonstrated real momentum toward a sustainable response. Everyone has a role to play, including host country governments, multilateral organizations, the private sector and civil society – including faith-based organizations. I think people now get that in a way they didn’t before and that’s great news.

IMPACT: You have been involved in the HIV and AIDS movement since the 1980s in San Francisco. What does the prospect of achieving an AIDS-free generation mean to you? ➤ EG: It’s true that the response to this disease has really defined my career, for over 30 years now. None of it has been easy, but we’ve come so far. The goal of achieving an AIDS-free generation would have been unimaginable just a few years ago. But because of major scientific advances that have been led by the U.S., we know we can get there, and our government is committed to doing its part to make it a reality, as Secretary Clinton and President Obama have made clear. So it’s an exciting moment, and it is truly an honor to be leading a unified U.S. government effort to reach millions across the globe. We’re already seeing the beginning of the end, and I am full of hope that we can finally turn the tide against this devastating disease. n psi.org | impact

M I L E S T O N E

Momentum around public-

Public-Private Partnerships Thrive

private partnerships (PPPs) in global health shifted into high gear in 2012. An increasing number of bilateral agencies, foundations and governments have become vocal supporters of these partnerships. For example,

Impact interviews Geralyn Ritter, Senior Vice President of Global Public Policy and Corporate Responsibility, and President of the Merck Company Foundation, about the Merck Company's new partnership Merck for Mothers, a 10-year, $500 million initiative to reduce maternal mortality globally, which Geralyn oversees.

in March, the Global Fund to

➤ GERALYN RITTER: We are excited to be

Fight AIDS, Tuberculosis and

partnering with PSI and its local affiliate in Uganda, PACE, to reduce the high number of maternal deaths in target regions of the country. As you know, most of these deaths can be prevented if women have better access to good-quality, affordable health care. In Uganda, many women seek care from public health facilities, but what people often don’t realize is that the private sector, such as independent midwives and drug shops, also plays a vital role in delivering maternal health care throughout the country. Merck for Mothers is exploring how to strengthen these local private health providers as well as health businesses (like pharmacies), which is why we decided to collaborate with PSI, an expert in social franchising. Our new joint project, called the MUM Partnership, seeks to improve maternal health by working with private health-care providers, pharmacies, drug wholesalers, transportation operators and others to improve the quality, accessibility, awareness and affordability of care women receive during pregnancy and childbirth. Our work complements the efforts of Saving Mothers, Giving Life, a public-private partnership among the U.S. government, the Norwegian Ministry of Foreign Affairs, the American College of Obstetricians and Gynecologists, Every Mother Counts, and Merck.

Malaria recognized Chevron, PEPFAR and other partners for their help with drug delivery, supplying essential resources and mobilizing consumer markets. Unilever launched the Unilever Foundation to support the company’s goal of helping more than 1 billion people improve their health. The U.S. and Europe accelerated their support for private sector engagement; the U.S. has developed some 1,000 publicprivate partnerships in the last decade.

CORPORATE PARTNERS . AT WORK: Partner Focus Alere HIV and AIDS ExxonMobil Malaria H&M HIV and AIDS Johnson&Johnson HIV and AIDS Merck Maternal Health; Social Franchising Nike Girls Empowerment Novo Nordisk Noncommunicable Diseases P&G Child Survival, Clean Water Pfizer Global Health Unilever Child Survival

impact | No. 11

IMPACT: What will the program do? ➤ GR: There are many components of the MUM Partnership – some of which extend beyond traditional public health services – because we know that maternal mortality requires a multi-faceted solution. It is a comprehensive program that addresses the barriers that women face in terms of achieving a safe

and healthy birth experience. For example, we are expanding PACE’s ProFam network of social franchise clinics to give women more options for quality care and connecting them with emergency transportation – using innovative, community-based approaches – to help them get to health facilities quickly and safely. We are also educating local pharmacies and community health workers to help them become advocates for safe motherhood. What I am most excited about is that we are developing a program that at its core is designed to be self-sustaining and that we are hoping will have a measureable impact on saving women’s lives.

IMPACT: What results do you expect this program to yield? ➤ GR: We hope to see the number of ProFam clinics expand from 12 to more than 260 in the five project districts, broadening the reach into remote communities where women are the least likely to have access to high-quality care. Paired with this, we will be mentoring the clinics’ 500+ providers in business management so they are equipped to maintain their business well into the long run. We also hope to connect these providers with loan opportunities to help them expand their services.

IMPACT: That sounds like a unique approach. What’s next beyond Uganda? ➤ GR: The MUM Partnership will be important in informing future Merck for Mothers programs, particularly in other parts of sub-Saharan Africa. We look forward to helping the program evolve and learning about the role that the local private sector can play in improving maternal health care. So, if everything goes as planned, we hope to have valuable lessons to share with the maternal health community as we join with them to help curb avoidable deaths of women during pregnancy and childbirth. n

GERALYN RITTER

Senior Vice President of Global Public Policy & Corporate Responsibility, Merck

7 M I L E S T O N E

Doulaye Kone sits on the toilet at the winning prototype, a system designed by researchers from California Institute of Technology at the Reinvent the Toilet Fair at the Bill & Melinda Gates Foundation in Seattle, Washington on August 14, 2012. Their model is a solar-powered toilet that generates hydrogen and electricity.

Gates Foundation Reinvents the Toilet

©BILL & MELINDA GATES FOUNDATION/MICHAEL HANSON

he need to make sanitation accessible to the poor is clear. Forty percent of the world’s population—2.5 billion people— use unsanitary or unsafe pit latrines or practice open defecation, and the consequences can be devastating. One of the most shocking is this: every year, food and water tainted with fecal matter cause up to 2.5 billion cases of diarrhea among children under 5, resulting in 1.5 million child deaths. The flush toilet as we know it in the developed world hasn’t changed much since the development of the ‘water closet’ more than 200 years ago. While it has saved lives and improved the health of millions, it also uses a significant amount of potable water, requires expensive maintenance and isn’t a sustainable solution for everyone. We kicked off the Reinvent the Toilet Challenge in 2011 looking for new ways to bring sanitation to those who need it. Working with partners around the world, we aim to create a next-generation toilet, one that: removes pathogens from human waste and recovers valuable resources such as energy, clean water and nutrients; operates off the grid without connections to water, sewer, or electrical lines; and costs less

than 5 cents per user per day. The aim is to create a toilet that everyone will want to use—people in wealthy as well as developing nations. We held a landmark event in August 2012, where we brought together people from around the world to showcase their innovations for the next generation of sanitation. At the fair, we announced top prizes of the Reinvent the Toilet Challenge. First prize went to the California Institute of Technology in the United States for a solar-powered toilet that generates electricity; second prize went to Loughborough University in the United Kingdom for a toilet that produces biological charcoal, minerals, and clean water; and third prize went to University of Toronto in Canada for a toilet that sanitizes feces and urine and recovers resources and clean water. Special recognition went to Eawag (Swiss Federal Institute of Aquatic Science and Technology) and EOOS for their outstanding design of a toilet user interface. The fair was exciting because it forged new working relationships between inventors, researchers, academics, governments, and others. We are hopeful that this strong, robust collaboration will help create sustainable sanitation solutions for people around the world. n

Every U.S.$1 invested

in improved sanitation

can yield $9 in benefits,

because it increases productivity and prevents illness and early death. Last year, the Bill & Melinda Gates Foundation issues the Reinvent the Toilet Challenge to develop waterless toilets that can transform human waste into energy and water. Doulaye Kone, Senior Program Officer at the Foundation, writes about the challenge and importantance of sustainable sanitation solutions.

psi.org | impact

M I L E S T O N E

As of October 2012,

countries worldwide have committed to the SUN Movement.

A series of bold commit-

in 2012 have signaled a turning point in the political backing for nutrition programs. In May, President Obama announced the new Alliance for Food Security and Nutrition – a public-private sector effort to remove 50 million people from poverty and reduce undernutrition in the next decade. And 30 countries have signed on to the SUN Movement, a multi-stakeholder, country-led, initiative to reduce undernutrition with a focus on the first 1,000 day of life. Through these and other ambitious efforts, nutrition advocates seek to achieve the Millennium Development Goals of reducing undernutrition by half by 2015.

impact | No. 11

Nutrition Gets its Turn

ndernutrition has a long-term impact on our nations’ health, economies and security, and in the last two years, the political will and leadership to tackle global undernutrition has been unprecedented. While there are many challenges ahead, recent global commitments, country policies and programs, and new partnerships are meaningful indications of nutrition’s elevated role on the development agenda. United Nations Secretary General Ban Ki-moon recently challenged us all to create a world free from stunting. The U.S. is committed to meeting this challenge by maximizing synergies across programs and tapping resources from various sectors such as economic growth, food aid, humanitarian assistance, health and water to maximize investments to improve the nutritional status of women and young children. The U.S. Government, through its Feed the Future and Global Health initiatives, is supporting country-owned programs to address the root causes of undernutrition and improve the future potential of millions of people. Nutrition is the defining link between these two initiatives, which aim to reduce undernutrition through integrated investments in health, agriculture, and social protection. Last year alone, we reached 8.8 million children and trained more than 150,000 people through nutrition programs working to reduce stunting and anemia, increase access to diverse, quality foods, and treat acute malnutrition. However, we realize that to achieve our goals in reducing undernutrition, partnerships are essential. The U.S. views its role in the Scaling-Up Nutrition (SUN) Movement as critical

to achieve results that no individual partner could achieve alone. SUN is a multi-stakeholder, country-led, movement to reduce undernutrition with a focus on the scale-up of proven nutrition interventions, particularly during the 1,000 day window of opportunity from pregnancy to a child’s second birthday. As of October 2012, 30 countries worldwide have committed to the SUN Movement. In September 2012 the U.S., along with other G8 members, announced that Burkina Faso, Cote d'Ivoire and Mozambique would join Ethiopia, Ghana, and Tanzania in the New Alliance for Food Security and Nutrition. First announced by President Obama at the Camp David G-8 Summit in May 2012, the New Alliance is a commitment by G8 nations, African countries, and private sector partners to support agricultural development in sub-Saharan Africa, with the goal of lifting 50 million people out of poverty and reducing undernutrition in the next 10 years. In many ways, nutrition may have indeed arrived in 2012 through these increased efforts, but we must continue to ensure that high level commitments translate into concrete nutrition interventions and forge meaningful partnerships between development agencies, governments, civil society, and the private sector. Only through these collaborative, multi-sectoral approaches will undernutrition become a thing of the past. n

ANNE PENISTON

Nutrition Chief, U.S. Agency for International Development

ments by global leaders

Spotlight on Girls Health Turns Awareness to Action young women, mothers, and couples across the developing world. These private-public partnership models build on successful projects like the Nike Foundation’s 12+ Program in Rwanda, which educates young girls about HIV, delaying sexual debut and other important health issues. In August, U.S. President Barack Obama issued an Executive Order on “Preventing and Responding to Violence Against Women and Girls Globally.” This presidential order will dramatically increase coordination among U.S. government agencies, including the Department of State and the U.S. Agency for International Development, to prevent and respond to gender-based violence globally. In September, the new UN Commission on Life-Saving Commodities for Women and Children (launched in March) defined a priority list of 13 overlooked life-saving commodities and recommended concrete actions that will rapidly increase both their access and use. The commission hopes usage of these 13 commodities alone will save more than 6 million women and children by 2015. One month later, the UN followed this initiative with the October launch of the first-ever International Day of the Girl Child, highlighting the critical topic of child marriage. Collectively, these 2012 milestones will help to fill critical gaps in the new global health policy and donor landscape. Public budgets have constricted, and as a result, governments alone

do not have the capacity to address serious challenges like HIV, family planning, pneumonia, and malnutrition, without strong partnerships. What is needed now are private investments and private-public partnerships to springboard scientifically proven health solutions that have the potential to reach millions of girls and women. The year 2012 was a pivotal step in the right direction. It’s imperative to build on these successes and make sure that access to basic health care will no longer be a barrier for girls and women worldwide to reach their full potential. It starts with a girl.n

METTE-MARIT

Her Royal Highness Crown Princess of Norway

M I L E S T O N E

n January, at the World Economic Forum in Davos, Switzerland, United Nations (UN) Secretary-General Ban Ki- moon helped set an important tone for 2012. A father of two daughters himself, the Secretary-General called on leaders to increase their investment in girls’ and women’s health – calling it “the right thing to do and the smart thing to do for national economies and global stability.” His words echoed the groundbreaking research and advocacy efforts of campaigns like the Girl Effect, 10x10, Girl Up and others that have proved that healthy girls and women have the power to lift families, communities and entire countries from the lowest rungs of poverty. Mr. Ki-moon’s call did not go unheeded. On the contrary, 2012 saw an outpouring of new investments, partnerships and enthusiasm for programs that target health challenges facing girls and young women. Awareness, at last, has turned into action. Examples of this shift are evident as one reflects on the year. In July, at the London Summit on Family Planning, private and public stakeholders from around the world pledged US$2.6 billion to scale up family planning programs. During the same month, at the 2012 International AIDS Conference, we saw examples of how private companies like Johnson & Johnson, Alere and P&G are working with non-profit organizations to support HIV interventions for

From United Nations

(UN) Secretary-General Ban Ki-moon’s January call to invest in girls to the creation of the first

International Day of the SNAPSHOT: GIRLS IN . DEVELOPING WORLD

➤ 75% of HIV infections among 15-24 year olds in sub-Saharan Africa are young women. ➤M ore than 1/3 of girls in developing countries marry before age 18. ➤2 5% - 50% of girls in developing countries become mothers before age 18. ➤G irls under 15 are 5 times more likely to die during childbirth than women in their 20s.

Girl Child in October, this year accelerated the call for public and private investment in girls’ health around the world.

psi.org | impact

M I L E S T O N E

10 More than 85 percent of

the 275,000 women who

die annually from cervical

cancer live in the developing world. Responding to

Alliance announced in April that it would include human papillomavirus (HPV) vaccine in its portfolio for the first time. The announcement came after the Alliance’s Board approved a new window of support for the vaccine in November 2011. The GAVI Alliance has set the goal of vaccinating 2 million women and girls against HPV, protecting them against cervical cancer by 2015.

DR. SETH BERKLEY CEO, GAVI Alliance

impact | No. 11

GAVI Alliance Adds HPV Vaccine to Portfolio

woman dies every two minutes from cervical cancer. Of the 275,000 women who die every year from this disease, more than 85 percent of them live in developing countries, where there is little access to cervical cancer screening or treatment. At the GAVI Alliance we are working with our partners to change that. We believe that women and girls should not die because they live too far from health services or cannot afford to pay for treatment. Equal access to vaccines is a top GAVI priority. In 2013, the good news is that young girls (aged 9 to 13) living in poor countries can get access to the same protection from cervical cancer as girls living in wealthier nations. GAVI is supporting countries in introducing vaccines against the human papillomavirus (HPV), the cause of almost all cervical cancer. GAVI is a public-private partnership that exists to save lives and protect people’s health by increasing access to immunization in poor countries. We work with countries’ governments and other partners, particularly the World Health Organization and the United Nations Children's Fund (UNICEF), to help get vaccines to children who need them. In 2013, for the first time, our

support will include HPV vaccines. GAVI’s support for the HPV vaccine will help protect tens of millions of girls from cervical cancer, the leading cause of cancer deaths among women in developing countries. Cervical cancer impacts women in the prime of their lives, when their contribution to families, raising children and the economy is most important. As a doctor and as a father, I know that a child whose mother dies often has lower educational attainment, experiences poorer health outcomes and is more likely to live in poverty. As the CEO of the GAVI Alliance, I know that the HPV vaccine is an important new tool to help us accomplish our goal: a healthier future for all children. That’s why GAVI and its partners are working with manufacturers to ensure that girls living in the world’s poorest countries have access to this life-saving vaccine at a price their economies can afford with GAVI support. We expect to begin introducing the HPV vaccine in pilot projects in the world’s poorest countries (those with a gross national income per capita of US$1,520 or less) in 2013 and nationally in 2014 in countries ready for roll-out. As a result, GAVI will ensure that women, wherever they are born, are protected from cervical cancer. n

GAVI/2012/OLIVIER ASSELIN

country need, the GAVI

M I L E S T O N E

Since 2000, GAVI support has contributed to the immunisation of an additional 370 million children. The GAVI Alliance is a public-private partnership that helps save children’s lives and protect people’s health by increasing access to immunisation in poor countries. In 2013, for the first time, GAVI’s support will include HPV vaccines to protect girls from cervical cancer. Find out more: www.gavialliance.org

GAVI brings together developing country and donor governments, WHO, UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society organisations, the Bill & Melinda Gates Foundation and other private and corporate partners.

PROTECTING BOYS AND GIRLS FROM PREVENTABLE DISEASES

technically speaking

Outlook for 2013: EVIDENCE, INSURANCE AND TECHNOLOGY

NEW GLOBAL HEALTH EVIDENCE

PSI currently offers approximately 50 products and services, from largescale delivery of condoms, contraceptives, insecticide-treated nets and malaria treatment, to a portfolio of pilot initiatives that address infant health and non-communicable diseases (NCDs). Moving a pilot initiative to large-scale delivery requires significant investment by our donors, partners and us. We make our investment decisions in large part based on published evidence of the burden of disease – a global health priority list that ranks from first to last what diseases, injuries and risk factors kill and disable the most people. Thanks to the Bill & Melinda Gates Foundation and hundreds of researchers working around the world, that list of priorities will be completely and systematically revised in 2013; the first time in more than 20 years that the updates, projections and methods used will be made comparable. Surprises are likely. Recently, new evidence of big, and in some cases, unexpected improvements in health among children under 5, mothers and STEVEN those vulnerable to malaria means CHAPMAN that the diseases and risk factors that affect them will become relaSteven Chapman is PSI's Chief tively less important, while nonTechnical Officer. He leads efforts communicable diseases such as to improve the effectiveness, cancers and diabetes – already very cost-effectiveness and equity large contributors to the burden of its interventions. He manof disease – will become relatively ages PSI’s Technical Services team, which consists of about more important. How much, and 50 experts in five departments: whether that leads PSI to change Malaria Control and Child our investment decisions, remains Survival; Sexual, Reproductive to be seen. But undoubtedly, new Health & Tuberculosis; Research opportunities will emerge and we & Metrics; Social Marketing; and will be making adjustments to our Learning and Performance. investment priorities in 2013. 20

impact | No. 11

EXPANDING HEALTH INSURANCE COVERAGE

PSI generates approximately half of its health impact through privatesector interventions that have long relied on an out-of-pocket co-payment by users to give incentives to private sector retailers and clinics to offer the products and services. Without question, this has made condoms, contraceptives, malaria treatments and other essential products and services available in places and at times they would not have been if only public sector or fully commercial approaches had been used. Yet, payments exclude the lowest-income consumers also.1 Since 2006, PSI has hugely expanded its offering of products and services that are free to users, in part through distributing vouchers that, when received by the poorest, are accepted by providers in lieu of payment. Vouchers can be thought of as a simple form of health insurance because they de-couple for the user receipt of the service and payment, and create third-party provider reimbursement mechanisms. Today, in Kenya, a health insurance pilot initiative is underway that will expand in 2013 there and elsewhere, and is of enormous importance to PSI and others operating clinical social franchises in the developing world. The pilot links families covered by the national social insurance program to social franchises through a pre-payment scheme to the provider that eliminates fee for service. Much needs to be accomplished to take this to scale, including perfecting provider reimbursement, and broadening social insurance coverage to those with the lowest incomes and for the bulk of primary care services and other interventions to make it easy for clients to get the service they need. Nevertheless, health insurance offers PSI perhaps the best opportunity for scaling its activities between now and 2016. INFORMATION TECHNOLOGY

For the past 12 years, PSI has delivered products and services around the world in a highly cost-effective manner – at approximately US$30 per year of healthy life saved. We are increasing our effort to find ways to cut that cost further, and in 2013 we will be rolling out information technology that brings evidence to managers more quickly and cheaply, using phones, tablets and computers, which we believe will result in finding new efficiencies and opportunities for impact. We will broaden the scope of a global, unified information system, and link it to our nearly three dozen mHealth initiatives. Achieving our high ambitions for health impact and contraceptive use by 2016 requires innovation. New health evidence, insurance and information technology will create new opportunities for innovation in 2013. n

1. J-Pal Bulletin (2011). The Price is Wrong: Charging Small Fees Dramatically Reduces Access to Important Products for the Poor. April 2011. www.povertyactionlab.org, accessed 4 November 2012.

ooking forward to 2013, three factors – new health evidence, expansion of health insurance coverage and information technology – are set to influence and create opportunities for PSI’s current five-year strategy. Our aim by 2016 is to achieve large health impact and contraceptiveuse increases, and we believe we can achieve our goal by vigorously executing three initiatives that we launched this year. The first, which we call relevance, will further diversify the product and service range we offer across our programs in the developing world so that it better addresses the diseases and risks our audiences face. Relevance increases are an important contributor also to our second initiative – scale – which aims to make it easier for low-income consumers to use products and services by giving them more choices at a broader range of prices, starting at free. The third initiative – value – involves working to find ways to increase our cost-effectiveness in delivering interventions to our audiences around the world.

policy matters

EUROPE

The Good, the Bad and the… WHILE THE EUROPEAN ECONOMIC CRISIS SHOWED NO SIGN OF ABATING IN 2012, there was still some positive news mixed in with the gloom. The PSI/Europe team takes a look back at the top milestones in global health in Europe: THE NEW AND IMPROVED GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA

The Global Fund’s Executive Director, Michel Kazatchkine, resigned in March and its Board appointed Gabriel Jaramillo to serve as General Manager to oversee a sweeping set of initiatives. Mr. Jaramillo said in a press release: “Significant changes to strengthen grant management and improve efficiency are reshaping the Global Fund as part of a broad transformation to raise overall effectiveness.” Mr. Jaramillo is expected to step down in early 2013 and a new Executive Director will take his place.

CRISIS? THAT CRISIS!

The European crisis first afflicted some of the smaller economies, but is now threatening larger ones like Spain and Italy. And the crisis in those countries also affects support to economic and social development in the non-Western world. Compared with 2010, official development assistance1 dropped in 2011 in Austria, Belgium, Denmark, Finland, France, Greece, Luxembourg, the Netherlands, Norway, Spain and the United Kingdom.2

ANDREW MITCHELL

LONDON SUMMIT ON FAMILY PLANNING

The summit, held in London last July, raised U.S. $2.6 billion in pledges to provide access to family planning for 120 million women in the developing world. See page 6 for more details.

a little over two years, Secretary Mitchell was responsible for instilling transparency and value for money in British aid contributions. Justine Greening, also a member of the Conservative party, was appointed as his successor in September.

next year to tackle barriers to correct and consistent hand washing with soap at key occasions. In these countries, diarrhea and pneumonia are two of the leading killers of children, and the simple act of hand washing with soap can be a lifesaver. A clear ‘win-win’, impacting the health and hygiene behaviors of 1 billion people by 2015.

EUROPEAN UNION WINS NOBEL PEACE PRIZE

The Nobel committee awarded the European Union (EU) the 2012 prize for “promoting reconciliation and peace.” While the critics had a field day over the EU being granted the award at the height of economic turmoil, many others lauded it as a powerful reminder to its value, especially during these crisis-laden times.

STEPS DOWN AS UK’S SECRETARY OF STATE FOR INTERNATIONAL

UNILEVER AND PSI’S WIN-

DEVELOPMENT

WIN PARTNERSHIP IN GLOBAL

Secretary Mitchell, a member of the Conservative party, resigned to take up the post of Chief Whip in the House of Commons on September 4. While he served just

HAND WASHING

NORDIC STATES: A STEADY DEAL FOR OFFICIAL DEVELOPMENT ASSISTANCE

Denmark, Finland, Norway and Sweden have always been at the forefront in making developmentassistance rhetoric a reality. And at a time when other donors are struggling to meet their aid commitments, Sweden is even planning to increase its international assistance budget for 2013.

PSI and Unilever aim to reach more than 250,000 school-aged children and their families in Kenya, Vietnam and Zimbabwe over the

1. As a percentage of GNI. 2. MDG Gap Task Force, 2012 Report, The Global Partnership for Development: Making Rethoric a Reality.

DUTCH GOVERNMENT ISSUES RIGOROUS PRIVATE-PUBLIC PARTNERSHIPS MECHANISM

The Ministry of Foreign Affairs announced a new € 150 million Sustainable Water Fund this past March. This funding mechanism specifies complimentary privatepublic partnerships that will harness the relative strengths of companies, governments, NGOs and other civil society organizations. It fits very well with the Government’s trend of increasing the involvement of the private sector in development cooperation. n

MICHAEL CHOMMIE By Michael Chommie, Director of PSI/Europe and Strategic Partnerships Unit Odette Salden , Program Manager at PSI/Europe, contributed to this article.

psi.org | impact

policy matters UNITED STATES

A Year of Bipartisan Triumphs 2012 appropriations cycle, members from both parties have defended global health programs in times of economic uncertainty. We need this continued support for cost-efficient, health interventions to save the lives of millions around the world. US PRESIDENTIAL ELECTION 2012

impact | No. 11

D.C., in July, the new bipartisan HIV/AIDS Caucus introduced legislation to fight the epidemic. Through the efforts of the Caucus, the U.S. Government showed a unified response to HIV and AIDS before a global audience. WHAT LIES AHEAD?

Looking forward, the global health community braces for another year of budget uncertainty. The Office of Management and Budget estimates the looming sequestration, which takes effect on January 2, 2013, will mean an 8.2 percent across-the-board funding cut to most non-defense discretionary programs, which includes global health. Cutting the global health account will have little effect on deficit reduction but could have devastating implications for the millions benefiting from U.S. foreign assistance. Now is the moment for sustained robust support of global health funding from U.S. Congressional leaders. As witnessed in the

SALLY COWAL Sally Grooms Cowal is the Senior Vice President and Chief Liaison Officer at PSI, overseeing the New Business Development, Advocacy, Corporate Marketing and Communications Departments. Elizabeth Petosky and Regina Moore contributed to this article.

his year was a banner year for U.S. leadership on global health. As we reflect on major milestones, it is the strong bipartisan support for global health funding in the face of drastic U.S. budget cuts that defines 2012. Last December, we watched the House of Representatives and Senate allocate considerably higher global health funding for fiscal year 2012 than we expected. This bold support continued in early 2012 as Congress maintained or increased funding levels for almost all global health programs for FY2013. In June, the Governments of the U.S., India and Ethiopia, in collabora¬tion with the United Nations Children’s Fund (UNICEF), brought together global leaders and public health experts for the Child Survival Call to Action, mobilizing commitments to the Global Roadmap to ending preventable child deaths. At the International AIDS Conference in Washington,

The re-election of President Obama and the incoming Congress ensures global health will be an important priority for the U.S. over the next four years. During his first term, the President and Congress proved to the country that global health is a non-partisan issue and smart investment. This January, there will be more than 270 new Congressional members, arriving after the enactment of crucial initiatives such as the President’s Emergency Plan for AIDS Relief and the Millennium Challenge Corporation – bipartisan initiatives championed by President George W. Bush. Many of these newly elected Congressional members have voiced their support for foreign assistance and defended the international affairs account in the election. The next four years hold many opportunities for new partnerships and bipartisan triumphs on global health. PSI looks forward to working with U.S. lawmakers to protect crucial foreign assistance funding and save millions of lives around the world. n

UNITED STATES TAKING ESSENTIAL STEPS TO END MALARIA, NEGLECTED TROPIC DISEASES

he expansion of the Senate Malaria Working Group is an important step in highlighting advancements in global health. The new Senate Caucus on Malaria and Neglected Tropical Diseases, which I co-chair with Sen. Chris Coons (D-DE), reinforces an essential mission: to put an end to malaria and curb the spread of neglected tropical diseases. Like its counterpart in the House of Representatives, the Senate Caucus strives to enhance awareness about proven methods of prevention and treatment that can save millions of lives. I am hopeful that aligning our congressional outreach will lead to even more productive partnerships. Congress lost a true champion of global health with the passing of Rep. Donald Payne (D-NJ) this year. His work is a testament to the kind of bipartisan leadership and policymaking that can make a lasting difference. Other contributions by the President’s Malaria Initiative have led to impressive strides in strengthening America’s efforts to protect the world’s most vulnerable people – particularly pregnant women and young children, who are dispropor-

tionately affected by the disease. There is still plenty of work to do. Malaria remains one of the most deadly infectious diseases and threatens almost half of the world’s population, including Americans who travel to affected regions and our troops overseas. Likewise, the risk of neglected tropical diseases extends far beyond outbreaks in Africa, Asia and Central America. These diseases have been reported in parts of the U.S. and will continue to be a threat in an increasingly mobile world. Global health is an investment that costs less than 1 percent of the U.S. budget and generates far-reaching benefits. In addition to saving lives, disease prevention contributes to international security and economic development. Great progress has been made because of new research and the availability of affordable medicines and insecticide treated nets. Malaria deaths are on the decline, affirming that the fight against this terrible disease is one we can win. I am proud that my home state of Mississippi is playing a meaningful role in putting an end to malaria. Researchers at the University of Mississippi are doing life-saving work on the

development of anti-malarial compounds and a new class of drugs for treatment. The contributions of universities, policymakers, international organizations and advocacy groups are critical to stopping malaria and neglected tropical diseases. The new Senate Caucus is a dedicated part of this collaborative effort, and I am excited about the progress yet to come. n

SEN. ROGER WICKER (R-MS) Roger F. Wicker has represented Mississippi in the Senate since December 2007. During his time, he has championed pro-growth policies to create jobs and has worked to reduce spending, limit federal overreach, and maintain a strong national defense. As Deputy Whip, Wicker works alongside Republican Whip Jon Kyl to promote a conservative agenda and build support for the legislative plan.

BIPARTISAN ACTION ON TUBERCULOSIS CRUCIAL TO CONTINUED PROGRESS, ELIMINATION

here is a frequent misconception that tuberculosis (TB) is a disease of the past, or is only a problem for those living in developing countries. In reality, TB is the second leading cause of death due to infectious disease worldwide, taking approximately 1.4 million lives in 2011 alone.1 It is the third leading cause of death among women of reproductive age and orphaned nearly 10 million children around the world in 2010. TB is a disease that knows no state or international borders. According to the Center for Disease Control and Prevention (CDC), there were more than 11,000 diagnosed cases of TB in the U.S. in 2010, with 954 cases diagnosed in my home state of New York. In 2009, 547 Americans died of TB. The good news is that the Millennium Development Goal (MDG) to halt and reverse the TB epidemic by 2015 has already been achieved in several regions of the world. Yet, the MDG remains elusive in Europe and Africa. Recently, advances have been made in 1. World Health Organization Fact Sheet, October 2012

TB diagnostics with the increased availability of Xpert, a new test that detects the disease – including in HIV-positive people – within 100 minutes. However, we cannot defeat the disease without the introduction of faster drug susceptibility tests and new drugs and vaccines. Continued U.S. leadership is crucial to building on the progress we have made against TB. I was proud to support the bipartisan Lantos-Hyde Global HIV/AIDS, TB and Malaria Act of 2008, which included a historic U.S. commitment to global TB control through its support for the Global Plan to Stop TB. I also co-sponsored the Comprehensive TB Elimination Act of 2008, which renewed efforts to eliminate the disease in the U.S. TB programs supported by the U.S. Agency for International Development, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the CDC have made enormous progress in combating TB, and U.S. investments in research have enabled rapid progress in the development of new drugs, diagnostics and vaccines that will transform the fight against TB.

This is why I am proud to be a co-chair of the TB Elimination Caucus with Representatives Gene Green of Texas and Don Young of Alaska. I look forward to working in a bipartisan manner through the TB Elimination Caucus to build on the progress we have made against TB both in the U.S. and globally. n

REP. ELIOT L. ENGEL (D-NY) Eliot L. Engel has represented New York's 17th District since 1989. He has been a leader in global health, promoting a reauthorization of the President's Emergency Plan for AIDS Relief and championing the Stop Tuberculosis Now Act. Rep. Engel serves on the Foreign Affairs committee, and serves on the Commission on Human Rights. psi.org | impact

final word

Karl Hofmann

PSI President and CEO

A Return on Investment for Women

upporting the health of women and girls offers one of the biggest returns on investment for development and human progress. This is particularly the case for voluntary family planning services. The London Summit on Family Planning, hosted in July by the British Government and the Bill & Melinda Gates Foundation, generated an unprecedented international political and resource commitment to meet the unmet family planning needs of an additional 120 million women by 2020. Permanent Secretary Mark Lowcock at U.K. Department for International Development and the Foundation’s Dr. Chris Elias and Dr. Gary Darmstadt share their thoughts about the Summit on page 6. The London Summit commitments are first and foremost about helping women secure their own rights to plan and manage their fertility. (The fact that this is news reflects how far we

sector in developing countries. We know that the majority of people from resource-poor communities seek healthcare from the private sector, not the weak public sector. In too many cases the private sector too offers uneven or sub-standard care, especially in the most rural and isolated communities, where the need for healthcare is the greatest. PSI is increasing access to quality family planning services for girls and women by strengthening the private sector in countries where we operate. We use branded franchises for health delivery that ensure a consistent quality of service at affordable prices, and that can reach further into underserved communities. As a result, largely through our social franchising work, PSI was able to help avert an estimated 4.7 million unintended pregnancies with the products we distributed and services we provided in 2011 alone. Using strategies such as social franchising, listening to women around the world as good marketers would, leveraging the private sector and improving its quality – we can transform the impressive London Summit commitments into measurable improvements in the rights and health of women, communities, nations and our common planetary home. Seems like a smart investment to me. n

▼ Below, Karl Hofmann visits a shopkeeper who sells PSI’s Prudence Class condoms in Burundi.

still have to go in most parts of the world, in 2012, to respect women.) Helping women secure this right is good for them; good for their families, since children survive and thrive at a higher rate when births are appropriately spaced; good for their communities, since no community can prosper when mothers and children are dying needlessly; good for countries, since strong communities make strong states; and ultimately good for the planet, since meeting women’s unmet need would be the equivalent of halting all deforestation on earth in environmental terms. Right now, the World Health Organization tells us that more than 200 million women globally want to be able to plan whether and when to have children, but because of a variety of barriers, they can’t access modern contraceptive methods. There may be a supply problem; there may be a price and affordability barrier; there may be religious or cultural barriers. We need to identify and break through these and other barriers, and the best way to start doing that is by listening to women, understanding their needs, and finding creative ways to meet them. That’s what good social marketers do. PSI’s experience of more than 40 years working in this field tells us that one important approach is to help strengthen the private

impact | No. 11

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Healthy lives. Measurable results.