I grew up in West Africa. I lived in Togo and la Côte D’Ivoire until I was 14 years old. Ever since then, I always wanted to come back. Africa gets in your blood, and stays forever like malaria. That is cliché, but true. I heard about CURE and the great work they do through a friend, so when the opportunity to come to Niger came up, I jumped at it. We jumped at it, I should say. My wife, who works here with me, is actually much more jumpy than I am.

The CURE hospital is primarily a children’s hospital, and we specialize in treating burn victims and children with cleft lip or cleft palate and clubfoot. As spiritual director, I provide spiritual and emotional support to the patients and staff at the hospital. In practice, this can mean many different things. My job description is pretty vague, and purposely so, I think, because it is hard to define what I do. I work very closely with the hospital’s social worker in trying to determine what the needs of our patients are and what we can do to help. Giving a child a life-changing, life-saving surgery is a big deal, but I am realizing more and more that often, it is just scratching the surface.

For example, consider this (hypothetical but very typical) case: A mother of a child with cleft lip lives in a village a couple hundred kilometers from Niamey. She hears about our hospital, decides to come. She gathers together all the money she can for the trip; maybe she sells a few chickens, or some roasted peanuts. Usually, it does not amount to very much. She is not used to handling money anyway. She comes to the hospital and her child is treated, but she learns that they have to stay in the hospital for three weeks. She also learns that the child will be fed, but she will have to feed herself. Her money runs out after the first week, and she has nothing to feed her other baby (the one that is always on her back) or herself. Also, it is cold at night and her child does not have anything warm to wear.

So we try and figure out how we can help, aside from the medical care that we provide. There are so many things that I would have never thought of, and I am learning new things all the time. There are also a lot of emotional issues to deal with, for the patients and for their family members. People with disabilities are viewed with suspicion, discriminated against and generally mistreated. Usually people say that their condition is because of some sin they committed, or the result of a curse someone put on them. Life is very difficult even for people that are totally healthy in Niger, for the sick and disabled it is nearly unbearable.

They are suffering physically, but often they are also traumatized by the way they have been treated. Having a disabled child is a burden for the whole family, and community, in many different ways. Not least among them is the financial burden it represents. It is another mouth to feed, and usually one that cannot work. The surgeries we provide are very literally helping people get back on their feet, back to a normal, productive life, and back to work. They alleviate a real burden, which frees up resources for other things, and the impact of these operations is felt well beyond the patient and immediate family.

The culture in Niger is very communal. When you talk to someone, you are not just talking to them, you are talking to their whole family, their whole village, their whole tribe. The same goes for healing. When a child is brought to the hospital and receives treatment, it is not just the child that is healed. The child’s family is healed as well, and their whole community is blessed by it. Almost every time we talk to parents after their child has been healed, their first reaction is, “Wait until we get back home and everyone sees this!”
Everything and everyone is connected.

But more importantly, at CURE, we try to encourage and empower people, even as we offer them help. We do this by asking the patients and their families to contribute towards their own healing. We ask them to pay for their surgery if they can. If they cannot pay for all of it, we ask them to pay for a part of it. Even if it is a tiny fraction of the real cost, it makes a difference, for us and for them. Even if they cannot pay anything at all, they are still expected to contribute in other ways. They have to follow the post-op instructions from the doctor (which can be quite extensive and can take months, especially with the clubfoot cases). They have to come to their follow up appointments. They have to take their medicine. Sometimes they even have to change the dressing, etc.

The point is, they are involved in the process. They come to our hospital for help, but not for a handout. They don’t want a handout. They come to us for help, but we try to give them a chance to help themselves.

To sum it up, I love my job. Basically, I am here to welcome those who are usually unwelcome, to care for the uncared for, and to love the unloved. I am always blown away by how generous the Nigerien people are.

Even if they have nothing, they will share with you the little they do have. And they are really full of joy. Niger may be one of the world’s poorest countries, but they have a wealth of natural resources: smiles, handshakes, laughter and general friendliness abound. Also, it seems to me like they really embrace the fullness of life, both the good and the bad. They don’t ignore the aspects of life that are difficult. You can’t when you live in a place like this, where signs of poverty and hardship are everywhere, and drought and famine are common. But they also don’t dwell on the hardship. They don’t sit around feeling sorry for themselves, letting hopelessness set in. They take the good with the bad because they recognize that life is filled with both good and bad.

Read more about Josh and Julie’s life in Niger on their blog, http://joshjulieblog.wordpress.com/.

When was the last time your cell phone saved your life?

In the world’s poorest countries, this happens every day. Cell phones help mothers get the medicine they need, babies receive life-saving vaccines and families stay healthy and strong.

As a ONE member and founder of Every Mother Counts, the advocacy and mobilization campaign I started to increase education and support for maternal mortality reduction globally, I’ve seen these programs in action and they work.

That’s why I’m working ONE Campus Challenge to launch their second challenge of the semester –- a cell phone drive in partnership with Hope Phones. Every phone collected from ONE and Every Mother Counts will benefit antenatal care (ANC) programs and ensure safe deliveries of babies in Coastal Kenya. But you don’t have to be a student to help — which is why we’re extending the opportunity to help to ONE members across the nation.

Have a phone (or two) to donate? Click here to download a shipping label, and just drop it in the mail! We’ll keep track of how many phones ONE members donate from around the country and report back to you at the end of the month. We set a goal of 35,000 phones -– so we need every ONE member to chip in. Think we can do it?

Like Every Mother Counts, the challenge provides a solution to preventable deaths. I’m excited to get started!

P.S. Have questions about any of the above? Email us!

In Ghana, 8 out of 10 children under the age of five and 3 out of 10 adult women suffer from some form of malnutrition, including stunting, wasting, and/or deficiencies in iron, iodine, and vitamin A. I recently visited Nyankpala Community Management of Acute Malnutrition in Tamale, Ghana, a Health Service (GHS) project that integrates and promotes community-based management of acute malnutrition (CMAM) services and supplies.

With funds from USAID and UNICEF, GHS has established support units for acute malnutrition at the national, regional and district levels. Between 2008 and 2011, Ghana has increased CMAM from two learning sites in two districts to 403 sites in 31 districts. In total, 2,040 health care providers have been trained on CMAM services and 5,973 children with severe acute malnutrition have been admitted to the program. Of these children 71 percent were cured, 2 percent died, and 1 percent did not recover; 26 percent failed to follow up.

Funded by the Global Fund through financial support from Product (RED), Tema Hospital cares for 2,200 people living with HIV. We recently visited their facility again –- their work never ceases to amaze me. The Global Fund make it possible for the hospital to provide ARV treatment and PMTCT (prevention of mother-to-child-transmission). Thanks to these interventions, only 4 percent of babies at Tema with HIV-positive mothers are born with the virus.

Berthé Aissata Touré is a health worker in Mali, where women have an average of six children. In this country’s vast rural areas, childbirth complications are life-threatening. Touré is a frontline health worker, someone who’s often the only link to health care for people who live beyond the reach of hospitals and clinics. Referring her patients to a hospital in cases of hemorrhage isn’t much use — the trip is simply too long. “There is too much time to lose blood on the way,” Touré explains, and in the past “many women were lost.” She received training in a WHO-recommended technique to prevent excessive blood loss and was authorized to administer uterotonic drugs, a critical component of this lifesaving practice.

Childbirth should be miraculous, not deadly, a colleague once said. Skilled health workers like Touré save lives, yet access to them remains difficult or impossible for millions of people. According to the WHO, there is a global shortage of at least one million frontline health workers.

Their absence means that many people may suffer and die needlessly. A woman perishes in labor. A child succumbs to pneumonia. A farmer is felled by malaria. The cost in disrupted families and lost productivity mounts. All of this can be prevented or treated by introducing a skilled health worker.

That’s why we’re proud to be part of a new coalition urging US leadership and investment in frontline health workers. The Frontline Health Workers Coalition includes 15 major global health organizations — including IntraHealth International, the Bill & Melinda Gates Foundation, and Save the Children — who are calling on the US government to train and support an additional 250,000 new frontline health workers.

Touré’s ability to meet the critical needs of the mothers who rely on her for safely delivering their children can be the difference between a death and a miracle. Increasing the number of frontline health workers like her is a “best buy” — the most cost-effective way to save lives, improve the health of communities, and advance U.S. economic and strategic interests. It can cost as little as $300 to train a frontline health worker in crucial lifesaving skills.

And U.S. leadership makes good sense. Investing in frontline health workers in developing countries can advance US strategic interests by building more stable, prosperous communities in developing countries.

Join us. Visit frontlinehealthworkers.org to learn more, and connect on Facebook.

-Maurice Middleberg, Vice President for Global Policy, and Sarah Dwyer, Communications Manager, IntraHealth International

Photo credit: J-PAL South Asia

It is easy to get overwhelmed by the enormity of the challenge of global poverty, but there are many quick and easy things that have been proven to work. Preventative health care, including childhood vaccinations, is particularly effective and has saved millions of lives. But millions of children are still not vaccinated, even where vaccines are free and available. Time to despair about deep-rooted cultural hostility to modern medicine? Actually, procrastination is probably just as big a culprit.

In rich countries, we are constantly nudged to do the right thing. My son was fully immunized only after I got a threatening letter saying he would be expelled from preschool unless I submitted proof of immunization by the end of the week. Did I fail to do it earlier because I was uncertain of the benefits of immunization? No, I have written a book on the subject. But I was busy, and I kept putting it off. It turns out, I have much in common with mothers in Rajasthan, India.

Photo credit: J-PAL South Asia

My colleagues at J-PAL and I collaborated with the NGO Seva Mandir to test whether small non-monetary incentives at convenient and reliable mobile clinics could improve immunization coverage in rural Rajasthan. Decades after a policy of free immunization at government clinics was implemented, only 6 percent of children were fully immunized.

Giving parents a bag of lentils for each shot and plate set when the course was complete, brought the full immunization rate to 39 percent, a six-fold increase. Excited as we were by our results, we were surprised by reactions from some policymakers when we suggested using incentives as a way to increase immunization.

Across the political spectrum, there is a mistrust of giveaways, and even more of incentives: “You mustn’t bribe people to do the right thing.” The right calls it wasteful, the left calls it degrading. They would rather just convince the poor of the benefits of immunization.

But to me, that is putting ideology above saving children’s lives. If I needed a nudge to get my son immunized, why is it wrong to provide a small incentive to those parents who carry their children, sometimes for miles, to immunization camps? Incentives for immunization in areas where immunization rates are low is just one of the simple, effective, rigorously evaluated solutions to poverty that are within our grasp.

Rachel Glennerster is Executive Director of the Abdul Latif Jameel Poverty Action Lab (J-PAL). Find out more about this research in the J-PAL Policy Briefcase “Incentives for Immunization.”

J-PAL is a network of affiliated professors around the world who are united by their use of randomized evaluations to answer questions critical to poverty alleviation. J-PAL’s mission is to reduce poverty by ensuring that policy is based on scientific evidence.

Intestinal worms rarely make headlines, but for millions of children in developing countries they remain a pernicious obstacle to good health, growth and learning. For that reason, we should be cheering the State of Bihar in India, which recently announced that 17 million children benefited from safe, low-cost deworming drugs administered at schools — the largest such campaign to date.

Worms are often a “silent problem,” rarely discussed even in places like Bihar where more than 50 percent of children suffer from the parasites. If untreated, however, severe worm infections can cause symptoms ranging from abdominal pain and listlessness to iron-deficiency anemia, malnutrition and stunting. Giving children treatment at their local schools is an incredibly efficient and cost-effective strategy for improving not just health, but education and longer-term outcomes. Safe, effective medication costs only pennies per dose, and needs to be given only once or twice a year.

The deworming program in Bihar is an exciting success for the global fight against poverty for a number of reasons:

First, millions of children will be healthier and better able to attend school. A randomized evaluation I conducted with Ted Miguel of UC Berkeley more than ten years ago found that a school-based deworming program in rural Kenya reduced children’s school absences by 25 percent. Even children who didn’t directly receive the treatment still benefited because their friends and neighbors were less likely to pass on the infection.

Second, the benefits can be long-lasting. We followed the same children from our evaluation in Kenya for a decade, and we found that those who had benefited from deworming worked more hours as young adults. We estimate that among wage earners, earnings increased by more than 20 percent.

Finally, the campaign in Bihar is a great example of how research can feed into policy change. At the start of 2010, my colleagues at the Abdul Latif Jameel Poverty Action Lab (J-PAL) and Deworm the World spoke with government leaders in Bihar following a conference J-PAL had organized to share lessons on what works in development. Based on these discussions, the Government of Bihar agreed to conduct a massive deworming campaign, and Deworm the World provided technical assistance.

This is smart development policy. A dose of deworming medicine costs only a few cents, and deworming campaigns can use the existing infrastructure of public schools to efficiently reach most children in a community. Intestinal worms may not be the best-known villain in the fight against poverty, but this is one battle that we very easily can, and should, win.

Michael Kremer is the Gates Professor of Developing Societies at Harvard University and Senior Fellow at the Brookings Institution. He was named a Young Global Leader by the World Economic Forum and is an affiliate of the Abdul Latif Jameel Poverty Action Lab. His research examines education and health in developing countries, immigration, and globalization.

This is Sakila. Fourteen years ago she nearly died giving birth to her son.

“I was giving birth at home, there were complications and I fell unconscious. Eventually my family found a way to get me to a doctor. I was lucky I survived.”

Sakila was fortunate. Over the past 14 years, many thousands of mothers in Afghanistan have not been so lucky. But a new survey shows this is changing –- the number of children and mothers dying in Afghanistan has fallen significantly.

It is women like Sakila that are to thank. Sakila is now a community health worker: “My experience motivated me to serve my community. I want to work to support other women and their children.”

Sakila is one of a growing force of community based life-savers in Afghanistan. There are now 22,000 trained community health workers across the country, from just 2,500 in 2004. They are men and women that serve their communities, unpaid, to save lives every day.

Community health workers treat illnesses like pneumonia or diarrhea, which can otherwise be deadly, and play a critical role in promoting healthy lifestyles and encouraging their community to make best use of the health facilities.

By bringing care closer to the community, we are seeing mothers and children’s lives changing, yet the survey shows more attention needs to be given to the plight of newborns. While the rate of children dying under the age of five has halved, it has fallen by only one-third for newborns.

Shakila is part of an innovative pilot project, run by Save the Children, in a district outside Kabul, that trains and supports community health workers to provide specific support to mothers and newborn babies.

“We register pregnant women, and visit them to explain why it is so important to go to a clinic and have a skilled birth attendant with you when giving birth. Then we check up on them and their new baby to make sure they are healthy,” Sakila continued.

Many women that become community health workers aren’t able to read or write, so the project uses pictures and visuals in learning materials. The approach is working. In a country in which only one third of women give birth in a health facility, in the area where the project is taking place, only a quarter of women still give birth at home.

Fourteen years ago, Sakila nearly lost her life. Now Sakila is one of many women that have brought care to the doorsteps of their neighbors. The news today shows that engaging communities to save lives works. It clear that by continuing to invest in the success so far, we can maintain momentum and save many more lives. Women like Sakila are ready to take on the next challenge –- to bring a new focus to saving the lives of newborns.

Research shows more than one-third of children under five in Indonesia are stunted, which can lead to higher infant and child mortality, increased susceptibility to infection and illness, reduced adult physical stature and impaired cognitive abilities — all of which result in long-term economic losses for individuals and the society at large. You may be surprised to learn that after two years of age, the effects of stunting are practically irreversible and have a life-long impact on an individual’s productivity. The community-based health and nutrition project will work to prevent stunting and mitigate its impact by strengthening community engagement, nutrition and sanitation services delivery and national awareness and advocacy.

At the signing ceremony in Bali, Secretary of State Hillary Clinton said, “The scientific research is overwhelmingly clear: If you want a healthier, better educated workforce, it starts in those very early months of life. And ultimately, an early focus on nutrition can reduce poverty, promote broader prosperity, and improve the security and stability of communities and nations.”

The community-based health and nutrition project, which is being designed by Indonesia and is a country priority, is projected to benefit up to 2.9 million children and their families in up to 7,000 villages by developing the human capital necessary to increase worker productivity, reduce poverty and stimulate the economy. The preliminary estimate for the economic rate of return for this project is 13 percent.

As Secretary Clinton noted, the evidence base on the benefits of supporting early-life nutritional interventions is clear. The MCC has already been hugely successful in working with countries to support economic growth and improve the lives of millions of people through innovative and results-oriented programs. We are pleased to see through the latest compact, the MCC has demonstrated not only is investing in nutrition for pregnant women, infants and young children the right thing to do, but it is also the economically smart thing to do.

If we’re serious about ending poverty, then we have to get serious about improving nutrition. Nutrition is like the DNA of health and development. At an individual level, nutrition affects virtually every aspect of a human being’s physical and intellectual development. At a global level, how well (or poorly) people are nourished affects the overall health, prosperity and stability of communities and societies.

Yet ironically, poor nutrition, specifically undernutrition, is one of the world’s most insidious, yet least addressed, health and development challenges. It is responsible for more than one-third of all deaths of children under the age of 5 and keeps families, communities and countries locked in a cycle of poverty.

Undernutrition — a condition in which the body does not get the nutrients it needs to sustain healthy growth and development — has largely been an “invisible” problem. Many of those affected by it often do not show the physical or clinical symptoms usually associated with extreme hunger or malnutrition. Addressing undernutrition also requires action in a variety of sectors including agriculture, maternal and child health, water and sanitation and social protection, which can be complex and difficult to coordinate. In countries where gender inequality is great, there are often high rates of undernutrition as female members of a household will “eat least and last.” Undernourished girls grow up to become undernourished mothers who in turn are more likely to give birth to undernourished babies, contributing to a multigenerational cycle of undernutrition. To compound the problem further, funding for nutrition over the past decade has amounted to an estimated $350 to $500 million annually out of $11 billion that the World Bank estimates is required to adequately combat undernutrition.

But undernutrition is not just another global development issue; in many ways, it is the foundational global development issue.

In order to tackle the problem of undernutrition effectively, we have to start at the beginning. Literally. It is early in life — from the time a baby is in his mother’s womb until his 2nd birthday — when undernutrition poses the greatest threat to long-term health and economic development. The damage to babies’ brains and bodies caused by poor nutrition during this critical 1,000 day window from pregnancy to age two is irreversible. This has profound consequences for both individuals and societies. Poor nutrition early in life can make a person more susceptible to infection and chronic disease, significantly increasing the human and economic burden of diseases such as HIV/AIDS, malaria and tuberculosis. It can impair cognitive development in such a way that it leads to lower educational performance and reduces an individual’s earning potential by more than 10 percent over his or her lifetime. Taken together, the health and development impact of early undernutrition is significant — it costs not only lives, but it also costs countries at least 2 to 3 percent of their gross domestic product (GDP).

Though the greatest threat posed by undernutrition is in the 1,000 day window, so is the greatest opportunity to prevent and treat the problem. Data shows that the right nutrition in the 1,000 days between pregnancy and age two can have a lifelong impact on a child’s ability to live a healthy and prosperous life. Building on the evidence outlined in the Lancet’s landmark series on maternal and child nutrition, the World Bank outlined a set of highly cost-effective nutrition interventions targeting the 1,000 day window. Broadly speaking, these interventions focus on three areas: promoting good nutritional and baby-friendly practices, increasing the intake of vitamins and minerals for both mom and baby, and promoting therapeutic feeding for malnourished children with special foods. It is estimated that implementing these solutions at scale could save the lives of 1 million children per year.

The role that nutrition plays in perpetuating disease and poverty cannot be overstated. Leading economists and health experts agree that improving nutrition, particularly in the 1,000 day window, is one of the best investments the world can make to achieve lasting progress in global health and development.

Lucy Sullivan is the Director of 1,000 Days, an initiative launched by the Global Alliance for Improved Nutrition (GAIN) and InterAction, a coalition of U.S.-based international relief and development organizations, with close collaboration from the U.S. Department of State. 1,000 Days promotes action and investment in improving maternal and child nutrition during the critical 1,000 day window from pregnancy to age two.