How Health Technologies Can Improve Maternal, Newborn, and Child Health:

USAID’s Role

September 15, 2009

Richard Greene, USAID

Global Health Approach

The ladder of child survival and maternal health programming: A sequenced, evidence-based approach to achieving impact

500,000 maternal deathsFocus on the highest

disease burden

4 million neonatal deaths

9.7 million child deaths

Focus on solutions to address the greatest burden of disease

Improve health for the most vulnerable—women, children, the poor

Are low-cost and scale-able

Strengthen partnerships with the private and public sectors

Involve end users from the beginning in design of technologies

Research to Use

USAID invests in health technologies that:

Sustainable, widespread use

Private sector involvement

Market assessments

Global recommendations

Procurement

Manufacturing capacity

Key Elements

Key Events in the Diffusion of Vitamin A

0

100

200

300

400

500

600

700

800

900

1972: Secretary of State Kissinger pledges support for VA at first World Conference

on Food in Rome

1975: Sugar fortification in Central America

1975: IVACG established

1983: Sommer article in Lancet

1984: Congressional Hunger Committee

1985: U.S. Congress creates VA funding

mandate

1985-1987: USAID funds research confirming VA saves children’s lives

1987: WHO and UNICEF recommend VA for

treatment of measles

1993: World Bank Development report

highlights higher cost-benefits of VA

1993: Beaton/Fawzi meta-analysis

1996: CIDA commits to VA capsule procurement

1998: WHO/ UNICEF endorse

integrating VA and EPI/NIDS

1965: U.S. begins fortifying nonfat dry milk for Food for Peace Program

1972: U.S. devotes $3 million to VA

1972: 5 countries begin VA supplementation

1985: UNICEF focuses on VA

Meetings setting VA goals

1990: World Summit for Children

1990: UNICEF/WHO Montreal Conference

1992: International Conference on

Nutrition

1992: Bellagio2002: Vitamin A supplementation

in over 80 countries

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1984: Jim Grant (UNICEF) epiphany

1999: USAID’s Global VITA

Alliance

1986-1992: Confirmational studies

Vaccine Vial Monitors: Over one billion used. Required for all GAVI and UNICEF procured vaccines.

Auto-disable syringe: 2.5 billion supplied to public health programs in 40 countries.

Uniject: Health workers in Mali, Afghanistan, and Ghana have safely and easily delivered 6.6 million doses of tetanus toxoid in Uniject to women. 5 million newborns a year in Indonesia vaccinated by midwives against Hep B using Uniject.

Jadelle two-rod conceptive implant

Zinc as treatment of diarrhea

Clean Delivery Kits: Over 850,000 sold in Nepal

Past USAID Investments

USAID’s partners include PATH, Johns Hopkins, ICDDRB, WHO,

Pop Council, MI, UNICEF, BU, private sector, and others

Newborn Vitamin A

The technology solution:

A 50,000 IU dose of vitamin A given in the first days of life

Reduces infant mortality by 20% in South Asia

STATUS

Capsules manufactured and field tested for ease-of-use and acceptability

Pilots underway in South Asia

Studies in Africa designed (Gates/WHO)

The problem: 4 million infants die each year

Oxytocin-Uniject

The technology solution:

Safe

Pre-filled

Cannot be reused

Can be used in home births by community workers

STATUS

Regulatory approval in Latin America.

Manufactured in Argentina.

Private sector in other countries exploring manufacturing possibilities.

Introduction activities in Angola, Indonesia, Vietnam, Mali, Guatemala

The problem: Post-partum hemorrhage is the leading cause of maternal deaths in developing countries.

Chlorhexidine

STATUS

Introduction in Nepal and replication/introduction in Bangladesh

Partnerships with private sector manufacturers

Bundling with clean delivery kits

The problem: Infections cause 30% of neonatal deaths

The technology solution:

Applied to the cord after birth, prevents infections and reduces neonatal mortality by 24% in Nepal

Low cost liquid solution that can be used by mothers and sold or distributed through existing mechanisms

Nevirapine Pouch

The problem: Nearly 700,000 children infected with HIV each year

The technology solution: A simple foil pouch design to hold the nevirapine dispenser with easy-to-read instructions

STATUS

Partnership between USAID, PATH, and Boehringer Ingelheim formed

Field tested in Kenya

BI now makes the dispenser, drug, and pouch available for free through the PMTCT Donations Program

The problem: Three million children a year die from vaccine preventable diseases.

The technology solutions:

Solar refrigerators

Cold Chain Equipment Management

Sharps disposal systems

Jet injectors

STATUS

Various stages of development, piloting, and commercialization

Immunization

Safe Water

The problem: Diarrheal disease spread through contaminated water and poor sanitation kills 1.8 million people per year.

The technology solutions:

Chlorination

Solar disinfection

Ceramic filtration

Combined flocculant/disinfectant (e.g. PuR)

STATUS:

USAID collaborates with private sector partners such as Proctor & Gamble as well as local partners to prove effectiveness of products field settings, then facilitating introduction and helping expand use

The technology solutions:

Low-cost high-quality devices are readily available

Create field guide, including bench test rankings, market price, and procurement options

Assess current markets in Asia and Africa

Expand distribution systems and procurement options

The problem: Birth asphyxia causes 23% of neonatal deaths

Neonatal Resuscitators

The technology solutions:

Therapeutic foods like PlumpyNut

Multiple micronutrient powders like Sprinkles

Lipid Nutrient Supplements like Nutributter

STATUS

Therapeutic foods being introduced through community management of acute malnutrition programs in Africa

Sprinkles scale-up in Asia

LNS effectiveness trials and operations research in Africa and Asia

The problem: 30-50% of children under five die from malnutrition

Nutrition products

Woman’s condom

TB MODS and other approaches

Anemia etiology tool

Eclampsia treatment kits

Simplified antibiotic regimens for neonates

Microneedles

Cell phone surveillance and monitoring

First ever field use of Gentamicin-Uniject, by a Female Community Health Volunteer in Nepal (May 2009)

Other Technologies on the Horizon