1. How Health Technologies Can Improve Maternal, Newborn, and Child Health: USAID’s Role September 15, 2009 Richard Greene, USAID

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

3. 500,000 maternal deaths Focus on the highest disease burden 4 million neonatal deaths 9.7 million child deaths

4.  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

5.  Private sector involvement  Market assessments  Global recommendations  Procurement  Manufacturing capacity Key Elements

6. 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: Bellagio 2002: Vitamin A supplementation in over 80 countries Number of Medline Citations for MeSH subject “Vitamin A” limited to humans 1984: Jim Grant (UNICEF) epiphany 1999: USAID’s Global VITA Alliance 1986-1992: Confirmational studies

7.  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

8. 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

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16.  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