Brief

October 2011

Global Health: Impact through Integration

For more information, please contact: Stephanie Cappa Legislative Coordinator for International Development InterAction scappa@interaction.org

Global health programs are critical to advancing United States interests by securing a healthier, safer, and more prosperous world. To date, U.S. efforts have treated more than 3 million people living with HIV and prevented HIV transmission to millions more; reached 50 million people with malaria treatment programs since 2006; saved more than 3 million lives a year through immunization programs; and supported research to develop and deliver new vaccines, drugs, and other critical health tools. These programs increase economic opportunity, reduce threats from disease, and unlock the potential of women around the world. InterActions Global Health Working Group compiled principles common to successful interventions and case studies to illustrate them in action. Successful and scalable health programs are country-driven and take advantage of the links between food security, the environment, and water and sanitation. In a constrained fiscal environment, integrated approaches to global health are proven to maximize impact.

Principles
The strongest health interventions in relief, recovery, and development settings adhere to these principles:
1. Donors and implementing organizations actively engage local communities, especially marginalized groups and women, in designing, implementing, monitoring, and evaluating strategies, policies, and programs. Programs make progress towards universal health care coverage and equitable access to the underlying determinants of health, including clean water, adequate sanitation, nutritious food, and safe housing. Programs in relief environments lay the groundwork for recovery and development. Program effectiveness is monitored with the appropriate indicators for longterm success and support. 8. 5. Civilian health programs in fragile states or regions of conflict are driven by the health needs of the population rather than security or short-term stabilization objectives. Programs utilize sustainable technologies appropriate for low resource settings and innovation platforms for product development and large-scale production are encouraged. Aid harmonization between bilateral, multilateral, and other donors to fully integrate health programs, leverage funding streams, and avoid program duplication. Programs build local health workforce capacity and retention to effectively implement health programs and the strengthen health systems for the long term.

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The following case studies demonstrate these principles and maximized impact.

Case Studies
Enhancing Food Security in Honduras World Vision In the Western region of Honduras, one of the poorest nations in the Western Hemisphere, one in every four children suffers from chronic malnourishment (World Food Program). Focusing on this region, World Vision partnered with ACDI/VOCA and Counterpart International to target key barriers to food security, including a lack of access to water and sanitation and constraints to small business development. At the conclusion of the five-year project in 2009, regional access to clean water increased to nearly 90%; 15 grain storage banks were installed, increasing community access to food and additional income, as farmers store grain until market prices are high; and nine microenterprises gained legal status, improving access to credit and opportunities to obtain sales contracts. Nearly 70,000 people in Western Honduras benefitted from this integrated approach to food security and health. Combating Diarrheal Disease in Kenya PATH In 2008, PATH launched a program to combat diarrheal illness, a leading cause of death in Kenya (WHO). PATH focused on two objectives: demonstrating an integrated approach to diarrheal prevention and treatment at the community level, and developing national policy guidelines to replicate the success nationwide. At the community level, treatment interventions such as oral rehydration therapy were successfully combined with preventive interventions such as vaccines to reduce the incidence of diarrheal disease. Based on this evidence, in 2010 the Kenyan government adopted an integrated approach to diarrheal prevention and treatment nationwide. Reducing Food Insecurity in Burundi International Medical Corps In post-conflict Burundi, the World Food Program estimates that nearly 60% of the population is severely food insecure or vulnerable to food insecurity. With funding from USAID, International Medical Corps and Catholic Relief Services are implementing a program to reduce food insecurity and improve the nutritional status of vulnerable populations. The program targets 18,000 households in three of the most food insecure regions and focuses on high-impact interventions including improved infant and child feeding practices, nutritional support for HIV-affected households, and promoting hygiene and sanitation practices. Support for HIV/AIDS-Affected People in Zambia World Vision World Vision led the RAPIDS project from 2004-2010 in 52 (of 72 total) districts in Zambia, preventing new cases of HIV/AIDS and providing treatment to those living with the virus. With $57 million from USAID and $160 million in private resources, the project provided critical educational opportunities and psychological support services to nearly 260,000 orphans and vulnerable children and over 65,000 persons living with HIV/AIDS. By the programs conclusion, targeted households were 27% more likely to have been tested for HIV/AIDS and children were 44% more likely to have attended school. Nearly 300 Zambian community organizations received sub-grants to continue this critical work. Improving Water and Sanitation in HIV-Affected Households in Malawi Catholic Relief Services A staggering 12% of the Malawi population is HIV positive, with HIV/AIDS as the countrys primary cause of death (AVERT). Since 2008, Catholic Relief Services, with funding from WHO and USAID, has operated a project to provide clean water, sanitation infrastructure, and improved hygiene (WASH) in HIV-affected households. WASH programs provide wide-ranging benefits, including reducing the incidence of diarrheal and waterborne illnesses that hinder the uptake of HIV/AIDS medication. In first year alone, evaluations revealed a 50% increase in hand washing and use of soap. CRS integrated WASH components into its long-standing home-based HIV care program to ensure that local partners continue this integrated approach. Integrating Maternal and Child Health with Reproductive Health Services in Egypt Pathfinder The five-year USAID-funded Integrated Reproductive Health Services Project was launched in 2006 to pilot the sustainable integration of maternal and child health programs with family planning and reproductive health services at the community level. Led by Pathfinder International, the project combined access to family planning with education about reproductive health and income generation. As women became empowered to seek medical care, family planning and antenatal care caseloads increased over 50% and 20% respectively. By the projects conclusion in 2011, 40% more women under 30 with two or fewer children sought reproductive health services. These results will be used by the Egyptian Ministry of Health to improve family planning use and the overall health status of women and young children, beginning with the training of health officials in additional districts. Supporting HIV/AIDS-Affected Orphans and Vulnerable Children in Haiti, Kenya, and Zambia World Concern Development Organization HIV/AIDS is particularly devastating in sub-Saharan Africa, where four-fifths of the worlds children who have lost a parent to HIV/AIDS are located (UNICEF), and in Haiti, where treatment coverage reaches just over 40% of those in need (AVERT). From 2004-2010 the World Concern Development Organization and ten partner agencies implemented a project in Haiti, Kenya, and Zambia providing care and support of orphans and vulnerable children affected or infected by HIV/AIDS. This PEPFARfunded project benefitted nearly 155,000 orphans and vulnerable children by strengthening caregivers and community-based organizations, increasing access to formal education and vocational training, and raising awareness of HIV/AIDS. To build on this success, local partners received support to connect with other donors, government agencies, and local health facilities.