Across Jordan, young authors are being ‘discovered’ in elementary schools every day. Most will not become nationally or internationally recognized but their skills are on display in their local schools. They, along with their teachers and parents, couldn’t be prouder. All thanks to an initiative called Our Collective Story.

Our Collective Story is an effort to promote creative writing in order to strengthen growing literacy skills while building creativity and social-emotional skills.

It is part of the Early Grade Reading and Mathematics Initiative (RAMP), co-funded by the United States Agency for International Development and the United Kingdom’s Foreign, Commonwealth and Development Office and launched by Her Majesty Queen Rania Al Abdullah in 2015, with the goal of improving education learning outcomes of over half a million early grade students (Kindergarten through Grade 3) in 2,550 schools.

School Principal Dr. Khawla Obaid has seen first hand how her students have improved not only in their writing but also gained valuable social benefits:

[Our Collective Story] is an integrated learning activity where students communicate to collect information, develop their vocabulary, and develop their artistic senses… As they work collectively, they develop their relations and ties with their peers which is important as their socio-emotional skills have suffered from the long COVID-19 school interruption.

Our Collective Story, initially piloted in 5 schools in Southern Aghwar Field Directorate in 2019, has been extended to 140 classes in 35 Field Directorates across Jordan. The Ministry of Education (MOE) plans to expand the Our Collective Story activity to all schools in Jordan. School and District leaders are currently working to integrate creative writing into District and School Improvement Plans with the necessary funds allocated for stationery and other necessary supplies.

Students’ stories come to life

After receiving training and coaching from supervisors and Senior Teachers, classroom teachers lead their students through the creative writing process.

This begins with the class selecting an age-appropriate subject which they are interested in or which the class is exploring. The teacher then posts pictures related to the chosen topic. Students ask questions about the pictures to generate ideas and brainstorm as a group.

Guided by their teachers, students work together to collectively imagine, plan, write and illustrate stories.

For each writing period, the teacher organizes the class into small groups. Each group includes children with different proficiency levels so lower-performing students can learn from their higher-performing peers or bring a different set of skills to the group (their creativity, imagination, drawing skills, etc.).

[E]ven the weakest ones got enthusiastically involved in the learning process, said Teacher Amal Farid.

Next, on the board or in their notebooks, students record vocabulary words inspired by the pictures and work together to create meaningful sentences which are then crafted into paragraphs.

Each group collaborates to illustrate their sentences and paragraphs with various media. Students’ drawings and paintings really bring the stories to life!

Some of the stories even have a chance for wider distribution than the local school. From all the stories created, each school submits the best to a national committee and if selected, they will be published, printed and distributed to all primary schools in Jordan. Books which are not selected will remain at the schools for students and parents to enjoy.

Field trips inspire students to write collective stories

One class used a field trip to a mosque as the core of a collective story. Together they wrote about the history of the mosque and its importance in the local community.

They later explained, with pride in their voices, to school visitors that when they visited the mosque, they learned that it is one of the oldest in Jordan and served as a cultural center for the local community.

One student shared:

“What I liked the most about writing the books, was that we were working together with my friends.”

Another collective story — “The Treasures of Fifa Nature Reserve — was created by third grade students at the Fifa Secondary Mixed School following a visit to the Fifa Nature Reserve.

Students wrote and illustrated the story and received help from The Royal Society for the Conservation of Nature (RSCN) who shared scientific information about the Fifa Reserve and facilitated the brainstorming process with the students and their teacher.

“The Treasures of Fifa Nature Reserve” was selected to be printed with the financial support of the Arab Potash Company and the book was distributed to all early grade classrooms in Jordan.

Focusing on writing improves student’s literacy

In the past seven years, RAMP interventions have helped increase reading comprehension levels. Part of this success in undoubtedly due to initiatives like Our Collective Story. The increased focus on writing skills has greatly enhanced both the teaching and learning of reading and writing in Jordan and has given children an exciting opportunity to author and illustrate their own stories.

Third grade teacher Ms. Renad Al-Ndanat, sums up the initiative well:

We plant seeds for future writers.

Volunteers in bright yellow vests travel door to door in rural Haiti with medicine in hand. Others sit under tents in village centers, calling out to passersby. Their target: A devastating and disfiguring disease spread by mosquitoes.

To eliminate lymphatic filariasis — or LF as the public health community calls it — people who live in at-risk areas must take medicine annually for at least 5 years. The medicine reduces the amount of LF parasites in a person, which makes it more difficult for mosquitoes to then spread the illness to other people.

Despite facing political unrest and natural disasters that have driven poverty up across this Caribbean country, Haiti has made great strides in eliminating LF since 2001. In fact, sixty-three percent of the population is no longer at-risk of getting this neglected tropical disease (NTD).

The challenge now is to reach the final 18 communes and people in Haiti that are still at-risk for the disease. This requires an annual mass distribution of LF medicines to more than 4.4 million people.

In December 2021, USAID’s Act to End Neglected Tropical Diseases | East Program supported Haiti’s Ministry of Public Health and Population, to gather stakeholders to review progress, challenges, and implementation of the annual LF campaign in Haiti. The government used the findings to adapt its approach to medicine distribution in an effort to advance elimination of LF in the remaining communes.

Meeting Haitians where they are at

During this year’s LF campaign, Act to End NTDs | East supported the Haitian government in implementing new and adapted methods to ensure everyone in these communes got the opportunity to take medicine. In addition to distribution posts at local points of interest like football stadiums and markets, and distribution in schools, volunteers also traveled door-to-door in the afternoons so people who worked from home, including farmers, could get medicine.

This reached people like Elinise Joseph, a farmer, seamstress, and shopkeeper who works from her home in the mountains. Last year, she happened upon a booth that was distributing LF medicine while she was shopping in a larger town. This year, she benefited from door-to-door distribution.

“For me it is a good thing, a sign of love, that the agents came here to see me and give me the medicine,” Elinise said. “I am often busy here in my sewing room.”

“The door-to-door service shows your willingness to help us protect ourselves from this disease,” she continued. “This change is beneficial because there are areas here that are hard to reach.”

The government also extended distribution from 5 to ten days and Act to End NTDs | East provided badges and vests for volunteers so community members could easily pick them out of a crowd and trust that the medicine they were distributing was safe, effective, and part of a national campaign.

As a result, distribution reached the majority of the population in the targeted communes, helping to advance Haiti’s progress to eliminate LF.

Overcoming skepticism and reluctance

In reviewing past LF campaigns, Act to End NTDs | East found that young men and other youth were less likely to have taken medicine for LF. They often considered themselves to be too cool or invincible to need it — a common attitude among youth in many countries.

To address this, the 2022 distribution campaign engaged local youth associations, leaders, and influencers in microplanning (early and targeted planning, usually at a very local level) as well as in communications and outreach campaigns before and during distribution.

Communications focused on educating young men on the devastating impacts of LF, which include visible disfigurement (known as elephantiasis), as well as the less visible complications, such as impacts to a person’s immune system and kidneys. Special ads and messaging were developed to speak directly to young men’s concerns and motivations; and the Ministry of Public Health and Population trained distributors on how to address the questions — and skepticism — they expected youth to have.

These efforts convinced young men like Duclervil Davidson, a father and musician, to take LF medicine for the first time. Curiosity drew him to the booth this year. “I was always reluctant [in the past] because I don’t like to take medicine,” he said. “What convinced me this year were the [distributors]. They spoke to me in a way that made it clear why it was important to take the medicine.”

Davidson realized that the distributors had his interests in mind, and that it was for his own good to take the medicine and protect himself. This conversation and new understanding helped him overcome his reluctance and become a supporter of LF elimination.

“Good health is what safeguards the life of a community,” he said. “You can’t have a good life without good health. So, it is up to us to…take these medicines to ensure that we are protected against filariasis.”

Building local systems

Elimination of LF in Haiti ultimately depends on the leadership of governments and communities throughout the country. Local leaders like Carole Molière are a critical part of elimination efforts.

Carole is well loved in her community and has worked for the Haitian Ministry of Public Health and Population for over 30 years. She has supported national efforts to eliminate LF since they began in 2001, raising awareness about LF and supervising annual medicine distribution in her community.

“I do not like to see a person in the community, either a girl or a boy, with big feet,” she said of the effects of LF. “It is true that the disease does not kill you immediately, but it does exclude you from society. Not to mention the psychological effects.”

She was enthusiastic about the changes in the LF campaign this year, including the provision of snacks with the medicine. “With the sweets we have noticed that there is more motivation to take the tablets,” she said.

Act to End NTDs | East supports and works through the government of Haiti — from the central Ministry of Public Health and Population to district and commune-level entities — to plan, conduct, and evaluate distribution campaigns like the one in 2022. In doing so, it helps to build the long-term capacity of the government to effectively eliminate NTDs like LF. The distribution campaigns source volunteers from local communities as well, with volunteers often participating year-after-year under supervision from the Ministry of Public Health and Population.

As a result, Haiti has continued to make strides in eliminating LF even as it faces worsening political upheaval, gang violence, and environmental disasters. The long-term commitment born of local volunteers and supporters has made this possible. “There is still hope that one day filariasis will be eliminated here,” Carole said.

Toward elimination

Haiti’s goal is to eliminate LF by 2030. By learning from what’s working and what isn’t, and by trying new approaches based in evidence and learning, the USAID Act to End NTDs | East Program is helping the country achieve this goal. Since 2008, USAID has distributed LF medicine to 9 million Haitians — nearly 76% of the population.

The Haitian Ministry of Public Health and Population continues to monitor and track progress across all communes, to ensure the disease is eliminated for good. While 2030 fast approaches, Haiti — with the help of partners like USAID — is moving closer to the day when all Haitians are free from this disabling disease.

About Act to End NTDs | East

USAID’s Act to End NTDs | East is a global flagship program working to eliminate neglected tropical diseases in 12 countries in Africa, Asia, and Latin America. With USAID support, Act to End NTDs | East works with health ministries to treat communities, measure progress, and strengthen health systems to deliver NTD services. Learn more about USAID’s Act to End NTDs | East Program.

Since I arrived in Guinea, it has been raining — sometimes lighter, sometimes harder — non-stop. I am here to visit colleagues who through the U.S. Agency for International Development (USAID) Guinea StopPalu and StopPalu+ programs have been supporting the Ministry of Health to control malaria in the country for the past 10 years.

In these 10 years, with USAID support, Guinea has scaled-up testing for malaria and treatment of confirmed cases across health facilities and communities, expanded access to intermittent preventive therapy for pregnant women, and distributed insecticide-treated bed nets. Collectively, these efforts have paid dividends; the prevalence of malaria in children under five years of age has decreased from 44% to less than 17% since 2012. Incredibly, Guinea achieved this progress despite the Ebola epidemic that ravaged the country and brought its health infrastructure to the brink of collapse in 2015–2017, the COVID-19 pandemic since 2020, and continued political instability.

The latest effort to drive malaria down even further is a national insecticide-treated bed net distribution campaign — the fourth of its kind in Guinea after others in 2013, 2016, and 2019. Widely considered one of the most effective tools for reducing malaria transmission, bed nets serve as an essential first line of defense. They serve both as a physical barrier from mosquitoes and are also covered with insecticide that kills mosquitoes, and it’s estimated that the use of bed nets has majorly contributed to the reduction of malaria cases observed in Africa since 2001.

This new campaign represents an immense country-led, nine-month-long, all-hands-on-deck collaborative effort between the Ministry of Health and National Malaria Control Program, various partners such as the President’s Malaria Initiative, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Against Malaria Foundation, as well as district administrations and — of course — communities.

With a population of 14.1 million people, Guinea is currently in the last stages of distributing 9.4 million insecticide-treated nets so that every household has one net for every two people. This required holding hundreds of planning meetings at the national level and across 38 districts throughout the country, enumerating 2.4 million households, including by piloting a new digital platform, training almost 16,000 household enumerators, bed net distributors and supervisors, renting more than 500 trucks to distribute the nets from national to regional warehouses and then to district and community distribution sites, and conducting a community mobilization and sensitization campaign using radio, plays, and town criers.

However, even a carefully and collaboratively planned effort like this can encounter countless obstacles. The team conducting the campaign had to face almost daily challenges: delays in bed net shipments that result in delays of all other downstream activities; traversing expansive marshes by foot and steering small boats in the open sea to deliver bed nets to remote communities and households; competing health campaigns such as child immunizations; a week-long strike by local banks holding up remuneration payments to campaign staff; and digging the trucks and four-wheel vehicles out of the mud on roads that have been battered by incessant rains for weeks.

Navigating such curveballs requires incredible dedication and commitment, creativity and solutions-oriented thinking, diplomacy, and — perhaps most importantly — dogged determination.

But as Dr. Keita Sitan, StopPalu+ Senior Technical Manager says,

“It’s absolutely worth it. We will not stop the campaign until every household is covered. With malaria peak transmission season around the corner, the population at risk of infection — particularly pregnant women and children under five years of age — needs to be protected from the bites of the malaria mosquito vectors. Not protecting them leaves them extremely vulnerable, because not only is their health impacted if they do get malaria, but also their household’s livelihood.”

It is this unwavering determination that will propel the StopPalu+ team to achieve its goal to deliver the last bed nets over the last four weeks of the campaign, and help Guinea continue its remarkable progress in its fight against malaria.

Learn more about Guinea’s 2022 national malaria bed net campaign.

Funded by USAID Guinea under the U.S. President’s Malaria Initiative, StopPalu+ is implemented by RTI International, in collaboration with Medical Care Development, Jhpiego, Project C.U.R.E., Centre Africain de Formation pour le Développement, Club des Amis du Monde, Comité des Jeunes Mon Avenir D’abord, Initiatives et Actions pour l’Amélioration de la Santé des Populations, and Solidarité Guinéenne pour le Dévelopement.

A small boat slips through narrow channels off Mozambique’s Zambezi River, carrying a special team of investigators.

They don’t have badges or uniforms — but they are certainly on a mission.

The team is part of a global effort to investigate why some geographic areas are falling behind in the fight against neglected tropical diseases (NTDs) and to design solutions to ensure every affected community can eliminate these diseases.

USAID’s Act to End Neglected Tropical Diseases | East (Act | East) program, led by RTI International, supports Mozambique’s Ministry of Health to eliminate trachoma, an NTD that can cause permanent blindness. Despite continued rounds of treatment, rates of trachoma remain high in Chinde district, a result that contradicts progress demonstrated in many communities within Mozambique and around the world.

“We launched an investigation in collaboration with the Ministry of Health, not just from our desks in Maputo, but in Chinde itself,” said Dr. Mawo Fall, Act | East lead in Mozambique. “As trachoma elimination edges closer in Mozambique, we need to understand how we can better reach the most remote and vulnerable communities, like Chinde, so no one is left behind.”

Crocodiles, Hippos, and NTDs

The Ministry of Health investigation teams supported by Act | East, started by examining community, district, and provincial data to zero in on potential problems and gaps.

Next, it was time to make the journey to Chinde.

A port city on the Indian Ocean in central Mozambique, just reaching Chinde itself is a trek. Travelling there from Mozambique’s capital city of Maputo requires a three-hour plane ride, five-hour drive, two-hour boat ride, and another 45-minute drive.

And that is just the beginning.

Many parts of the wider district are extremely hard to access, requiring four-wheel vehicles to navigate tough terrain and small boats to navigate narrow water channels. In the boats, teams contend with crocodiles, hippos, and other hazards — often taking the really long way around to avoid danger and safely reach remote communities.

Once there, the investigation team worked to identify challenges and to determine how treatment campaigns could be improved. No matter how difficult locales are to get to, the teams visited communities where trachoma prevalence remains high, interviewing key people at all levels of the NTD response — from provincial medical chiefs to local leaders to the trained volunteers who distribute the antibiotics during treatment campaigns.

They discovered that some communities were even more isolated and remote than anticipated. Supervisors, who play a key role in ensuring the quality and effectiveness of treatment campaigns, were struggling to reach these communities due to intense logistical obstacles. They also found that access to safe and clean water, sanitation and hygiene services were limited in many of these communities.

Once the investigation was complete, the team worked to rapidly respond to findings in time for the next round of treatment, which was scheduled a couple of months later.

“We had to make sure that what we have found in the investigation was quickly reflected in reality,” said Dr. Marilia Massangaie, Director of NTDs at Mozambique’s Ministry of Health. “For the next treatment campaign, we allocated additional resources for more pre-planning, more volunteers and supervisors, more boats and motorcycles, and more intensive social mobilization, and more extensive training for community drug distributors.”

Beyond Chinde, the Ministry of Health is debriefing with each level of Mozambique’s NTD response, including all NTD focal points across the country.

“Findings from the investigation must ensure not only that Chinde’s next treatment campaign is as successful as possible, but that other districts facing similar challenges can be more effective at reaching hard-to-reach and vulnerable communities,” said Dr. Massangaie.

A rapid and systematic approach to investigation

The investigation in Chinde is part of a wider effort to achieve global targets for trachoma elimination, often in extremely challenging environments.

Sometimes, the reasons for slow progress are abundantly clear or even anticipated due to known variables like tough logistics. Other times, it takes an intense amount of sleuthing to decipher why a specific community has not seen the reduction in disease that was expected.

Act | East has taken a rapid and systematic approach to these investigations, working closely with ministries of health to investigate issues in districts that — based on various surveys — seemingly are unable to meet programmatic target thresholds, and therefore may require a different approach.

Like in Chinde, this investigative work is rapid, often beginning within 48 hours of receiving results, with the clock ticking to make changes before the next round of treatment; it’s collaborative, with Act | East working closely with ministries of health, the World Health Organization, and other partners; and it’s data-driven, often using a gender equity and social inclusion lens to ensure we understand who is being missed and why.

Even without cool badges and uniforms, and despite the crocodiles and hippos, Mozambique’s trachoma investigators who doggedly reach remote villages and communities in districts such as Chinde are a critical part of the global mission to eliminate NTDs like trachoma once and for all.

The Act | East Door to Door, Community by Community series (#DoortoDoorForNTDs) features the stories of health workers, volunteers, and others on the frontlines who are forging ahead — during a pandemic, no less — to safely eliminate neglected tropical diseases. Thanks to the commitment and tenacity of NTD fighters like the trachoma investigators of Mozambique, communities and countries are edging closer to NTD control and elimination goals. Contributions from Mawo Fall, Sabrina Eyob, Laura Cane.

When COVID-19 hit the Philippines, health worker Maricel Cruz monitored the condition of suspected cases in her Manila neighborhood, Barangay 374.

It was summer and COVID-19 cases were surging in the Southeast Asian country. Low-income neighborhoods of large cities, like Cruz’s, were becoming hotspots.

“I experienced a lot of challenges because I was dealing with so many people…at first I was scared,” says Cruz.

The fear and misinformation that came along with COVID-19 only made her job harder. Cruz’s neighbor filed a complaint after seeing her remove personal protective equipment just outside her home. “Many people testified for me and helped me win the case,” says Cruz.

After an initial summer surge that made the Philippines the most heavily impacted country in Southeast Asia, the rate of new COVID-19 infections has generally been declining at the national level — but some communities still experience more widespread transmission than others. Slowing and stopping the spread of COVID-19 therefore starts with the hard work of people like Cruz in the country’s neighborhoods, called barangays.

To support their efforts, the USAID ReachHealth project acted quickly to help local governments fight the virus in 15 priority areas and hotspots throughout the country. USAID ReachHealth, implemented by RTI International, is a five-year project that strengthens and improves Filipino families’ access to family planning and maternal and child health services.

“We saw the drastic effect of COVID-19 when the government placed the country on lockdown in March. We tried to understand how the pandemic might hinder the continued provision of family planning services and eventually the country’s local response to COVID-19,” says Dr. Laurentiu Stan, USAID ReachHealth Chief of Party. “Leveraging our already-established relationships and local knowledge, we helped local governments identify and enact solutions to hinder the spread of COVID-19 in some of the hardest hit areas.”

Fortifying the frontline

As a key part of its response, USAID ReachHealth helped local governments strengthen Barangay Health Emergency Response Teams (BHERTs) in priority areas.

BHERTs form the frontline of efforts to delay COVID-19’s spread and locally contain the pandemic. They communicate risk, facilitate contact tracing and quarantine processes, tackle stigma associated with being COVID-positive, and connect communities with broader health systems.

When a rapid assessment showed that the presence and functioning of BHERTs were highly uneven in communities, the project worked to ensure BHERTs in hotspot communities were active and effective. USAID ReachHealth provided training on elements of the COVID-19 community response, including risk communication, infection prevention and control, adolescent and reproductive health, gender-based violence, contact tracing, and quarantine protocols. Local leaders received similar training since their support was critical to success.

Cruz was the first BHERT member in Barangay 374. Now, she’s part of a team — and the last recorded case of COVID-19 in her area was on October 21st.

“If people have symptoms, they now know how to follow the quarantine procedures,” says Cruz. “They listen to our Barangay Chair and other colleagues have learned so much during this pandemic.”

So far, USAID ReachHealth has supported the training of more than 4,000 BHERT members from selected areas across the Philippines.

Assessing and aiding contact tracing efforts

Contact tracing is one of the most essential activities for fighting COVID-19 at the barangay level.

Ahannah Joy Marquez is a 30-year-old nurse and contact tracer in Davao City, Mindanao, a group of islands in the southern Philippines. Marquez interviews and advises close contacts to COVID-19 patients — in addition to her day job providing family planning and maternal and child health services.

When the District Health Office informs Marquez of a positive case, she coordinates with health workers and local leaders to enact local quarantine measures. She also interviews the patient, going through questions to help them remember the details of where they have been in the last 14 days.

“It takes me 10 to 12 hours to fully complete the tracing in a day,” says Marquez. “I am too tired at the end of the day and cannot even play with my children.”

USAID ReachHealth assessed contact tracing efforts in six COVID-19 hotspots, showing the need for improved trainings, including how to deal with fear and misinformation; enhanced tools, such as those for data management; and more resources, for essential needs like transportation and phone calls. The project is helping fill some of these gaps, including by supporting data management systems and facilitating connections with BHERTs so these teams can support contact tracing efforts with their local knowledge.

Partnering for sustainability

To further assist community-led COVID-19 response efforts, USAID ReachHealth recently supported microplanning exercises in 46 barangays in seven cities and provinces. In each barangay, the exercise brought together all levels of the COVID-19 response — from community workers like Cruz to local government officials — to understand how national COVID-19 plans and policies could be applied locally and how each stakeholder could best fill gaps in the local COVID-19 response.

In some cases, USAID ReachHealth stepped in to respond to identified needs. In Barangay 374, for example, the project supplied contact tracing materials, personal protective equipment, and a communication allowance to Cruz and her colleagues.

And to facilitate the sustainability of its support to barangays, the project partners with a range of local government partners and local civil society organizations.

In Visayas, a group of islands in the central Philippines, USAID ReachHealth works with Bidlisiw Foundation, a civil society organization founded 31 years ago to protect vulnerable people, particularly children.

“At the beginning of the pandemic there was a difference between what was on paper and what could happen on the ground,” says Lolita Ganapin, Bidlisiw’s Executive Director. “We acted as a bridge, helping officials understand what would be practical in the barangays.”

Bidlisiw and USAID ReachHealth worked together to train BHERT members in 10 barangays in Visayas. The project provided Bidlisiw with reference materials and tools to standardize their trainings. And when project support for COVID-19 ends in January 2021, Bidlisiw will still be present in the barangays. “Working in the community, our door is always open,” says Ganapin.

The work continues

BHERT members, contact tracers, frontline health workers, and local organizations are important pieces of the puzzle when it comes to fighting COVID-19 at the community level. But local government and health officials, local leaders, and law enforcement officials are all working incredibly hard to fight COVID-19.

“It is exhausting, but I look forward to the day…when I could have more time with my family and be able to play with my children without the worry,” says Marquez. “For now, we continue to do the work.”

Cruz says she finds inspiration in daily successes that make a difference in her neighbors’ lives.

“Sometimes, 80% of my life is devoted to serving the Barangay…But I am happy because every time I finish my job — assisting those who finished the quarantine get their clearance papers — I get surprised when they thank me for the help I extended to them.”

Learn more about other aspects of USAID ReachHealth’s response to COVID-19 in the Philippines including communications initiatives to address adolescent health and gender-based violence; the provision of personal protective equipment; and efforts to improve water, sanitation and hygiene.

By Kaitlin Lesnick, RTI International

In Haiti, you can find maize nearly everywhere. This staple crop makes up a key portion of the Haitian diet through products such as maïs moulin, maïs moulu, and farine, which are cooked with greens and protein. In fact, the average Haitian consumes approximately 20 kilograms (about 44 pounds) of maize per year, a number that increases for individuals living in rural, maize-producing areas. Of the 320,000 MT of maize produced in Haiti annually, about 70 percent is consumed as porridge, and approximately 10 percent is consumed fresh, either boiled or grilled.

Haiti’s southwest region is agronomically ideal for maize production, providing some of the most fertile soil and flat terrain in the country. But several constraints have limited the ability of the area’s small-scale maize producers to scale up their production and sell to urban markets or export abroad.

In 2018, RTI partnered with Papyrus S.A., a Haitian management firm implementing the Maize Adaptive and Innovative Solutions (MAIS) project, a five-year effort funded by Global Affairs Canada to improve the livelihoods of Haitian smallholder farmers and their families. While the project aims to reduce some of the common market constraints that inhibit the expansion of the maize value chain in Haiti’s south, it is also focused on building the resilience of smallholder maize and bean farmers to shocks and stresses.

“When any type of disaster hits a country, it’s likely that agricultural markets and food systems will be affected,” says Tracy Mitchell, Senior Resilience and Food Security Advisor at RTI.

“Therefore, building resilience to be able to withstand and ‘bounce back better’ from market system shocks is critical for maintaining food security, nutrition security, and economic wellbeing in a community.”

A Complex Context

There has been no shortage of shocks in Haiti, which ranks fourth among countries most affected by extreme weather events. In 2010, the historic 7.0 earthquake disrupted food production and access throughout the country. In 2016, Hurricane Matthew, a Category 5 storm, devastated crops and infrastructure. More recently, from 2019 to date, civil unrest has impeded progress in food security efforts, compounded by the spread of COVID-19.

Each time these shocks occur, there’s a threat that previous development gains can be eroded, and that the goalposts for economic success will be moved back through no fault of the citizens. “By consistently thinking about and integrating resilience throughout our development programs, we can help vulnerable populations to better manage risk and buttress their progress,” explains Mitchell.

That’s just what MAIS has done. In addition to linking farmers to markets and improving producers’ yields through better tools and technologies, MAIS incorporates a climate event mitigation component to support communities in the south with tools and approaches that can improve their ability to adjust, mitigate, and respond to negative consequences that accompany external shocks and natural disasters. Part of this effort includes community disaster risk reduction (DRR) training, instruments, and awareness-raising, as well as tree planting in targeted areas by women and youth.

Local Organizations Take the Lead

Camp Perrin-based non-profit ORE (Organization for the Rehabilitation of the Environment) works to improve environmental, agricultural, and economic conditions in rural Haiti. Their work promotes high-value tree crops, improved seeds, cash crops, and marketing programs to increase yields and farmer income, produce nutritionally rich foods, and protect the environment. As part of MAIS’ effort to strengthen the market system to improve resilience, the project has partnered with ORE to help maize and bean farmers in the south build their long-term resilience to any number of shocks and stresses.

Through the partnership, MAIS works with farmers that have worked with ORE for decades to help them scale up their efforts and is pairing them with a farmer field school approach to reach more farmers in the area. MAIS is also working with ORE to formalize their status as a regional buyer and processor, opening up new access to buyers in the area.

“This part of the island has a lot of hurricanes, and climate change brings with it a lot of drought,” says ORE CEO Eliassaint Magloire. “MAIS provides training and other support, so when a natural disaster comes, we can be better prepared.”

Magloire says that MAIS’ focus on training, climate-smart practices, and inclusion are helping southern Haiti’s farmers prepare for the next shock — whatever that may be.

“We have enough land,” he says of Haiti’s potential for agricultural growth. “We have 12 months a year [during which] we can produce. Some countries only have six months, [whereas] we have sun all year.”

But to build resilience, he adds that, “We have to take steps. We mustn’t be shy. We can’t think that the U.S. will feed us all the time. We have to take responsibility.”

Women’s Empowerment = Increased Resilience

Beyond training on climate-smart production practices and introducing new tools and technologies, MAIS is working specifically with women in male-headed households, knowing that women play a critical role in maize farming. Plots are farmed jointly by men and women, and women take on an even larger role during processing, sorting, taking the household’s harvest to market, and negotiating sales with wholesalers, or “Madam Saras.” MAIS’ baseline data show that women are contributing to their households through more than just maize production and sale, with 50 percent of women also working in petty trade and self-owned business to augment their household’s income.

Initial results from deeper analysis of the baseline data on women’s empowerment show that women who are involved in market sales and trade activities are more likely to have greater influence on household decisions. As MAIS strengthens the market for maize, more women may join in these activities, resulting in increased gender equity which is recognized more and more as a resilience capacity that can transform nations.

To learn more about the MAIS program, visit the Papyrus website

To learn more about RTI’s work in food security and resilience, visit rti.org/food-security

When Dr. Leda Hernandez began managing the Philippines’ lymphatic filariasis (LF) program more than 25 years ago, she was given just one piece of paper to work with: a prevalence survey from 1960 and reports of a “mysterious disease” coming from some districts.

Dr. Hernandez believed the reported symptoms to be those of LF, a parasitic disease spread by mosquitoes that causes thread-like worms to develop in a person’s lymph system. If left untreated, LF can lead to disability, stigma, and economic hardship.

“At first I did not know what to do,” she remembers. “But I collected my presence of mind and gathered all available data, including survey results and write ups.”

Dr. Hernandez then lobbied for a small amount of money from the Department of Health to convene health workers from the regions found to be endemic back in 1960, asking them to gather any additional regional data on LF that they could find.

“Sure enough, with these results and the data gathered, we had evidence that LF was not yet controlled and contained in the Philippines.” Armed with this data, Dr. Hernandez and her team made a case for national and local efforts to eliminate the disease.

Since then, Dr. Hernandez and her team have not only led successful efforts against LF — the country is on track to eliminate the disease — but she has also risen through the ranks of the Philippines Department of Health (DOH). In 2004, she began overseeing national efforts to fight neglected tropical diseases (NTDs) and malaria.

Fighting for the Health of Filipino Children

A trained medical doctor with a master’s degree in public health, Dr. Hernandez also set her sights on deworming efforts in children, channeling the determination and advocacy skills that were so successful in advancing progress on LF.

Known as intestinal worms or soil-transmitted helminthiases, these infections most heavily impact school-aged children and can hinder their cognitive and physical development.

“Soil- transmitted helminth infections are one of the diseases I consider most important for my country to control because doing so will have a tremendous impact on future generations. This should be backed by a strengthened WASH initiative and environmental sanitation” says Dr. Hernandez

The DOH leads the nationwide programs needed to support these deworming efforts. Partners like the U.S Agency for International Development (USAID) and donations from pharmaceutical companies GlaxoSmithKline and Johnson & Johnson have also supported the Philippines to reach their NTD goals and prepare for a sustainable response into the future.

Early research estimates revealed up to 67% of the population could be at-risk for these intestinal worms — with the greatest concern for the more than 40 million preschool and school-age children. To ensure the healthy development of Filipino children, the DOH has been procuring drugs and treating annually for more than a decade, carried out in schools and communities. In 2015, a survey showed the prevalence among children at only 28%, a sign of incredible progress to date and the importance of continuing these efforts.

Dr. Hernandez played a key role in this success. She encouraged DOH leadership to be strong advocates for NTDs, supporting them to champion the program with national and local leaders. She also personally testified in front of Parliament and advocated for creative ways to help fund the fight against NTDs, including the allocation of revenues from an excise tax levied by the Philippines government.

“I used advocacy to emphasize the benefits that mass deworming treatment has on vulnerable children across the country,” says Dr. Hernandez. “We used data to make this argument, disseminating the results of disease surveys and showing the health implications of this data on the populations impacted.”

Ultimately, under Dr. Hernandez’s leadership, the Philippines increased its domestic funding for deworming and today the program is fully funded through annual congressional budget appropriations.

Dr. Hernandez not only helped ensure the financial sustainability of the program, but also improved how the program was conducted. For instance, she played a key role in bringing the DOH together with the Department of Education, which started the program, to collaborate formally and effectively on deworming efforts. Now, the two departments work closely to coordinate treatment activities for school-age children both in and out of school, synchronizing the timing of treatment campaigns, providing joint training, and improving reporting forms and systems.

And in 2015, the DOH launched an annual National School Deworming campaign, a month-long effort for treatment that is widely promoted on radio and television. To ensure all children are reached with deworming treatment, many activities were initiated to increase buy-in at local levels, with an emphasis on educating parents on the importance of deworming.

Leadership for the Future

Dr. Hernandez and her team looked beyond a challenging start with a meager budget and outdated data towards a healthier future for Filipinos. It’s this forward-looking approach that has made their efforts so successful.

“True leadership involves looking beyond today, to tomorrow and beyond,’’ says Dr. Hernandez. “A leader must not be afraid to try something new if the current approach isn’t working.”

Dr. Hernandez is doing just that in her leadership of the LF program. As the program advances, it faces challenges in reaching some of the hardest to reach populations and geographies in the Philippines. Dr. Leda and her team continue to innovate and adapt their strategies to meet these at-risk populations, drawing on the support of research and collaborating partners.

The program continues to have an ambitious vision for the future: Over the next 5 years, the program aims to eliminate lymphatic filariasis as a public health problem and significantly reduce the burden of intestinal worms, specifically those that cause symptoms like diarrhea, abdominal pain, weakness and are more likely to lead to impaired development. That means a future in which Filipino children are able to grow, attend school, and eventually work free from these diseases. Dr. Hernandez and her team are also looking to the future to ensure that these health gains are sustained through strong monitoring and surveillance systems

USAID’s Act to End NTDs | East program is supporting the Philippines on this journey, with a focus on capacity-building and sustainability, including support for the strengthening of an NTD regional laboratory network and the development of NTD curriculum modules for health professional training.

The road to this goal will not be easy, but Dr. Hernandez has cultivated a philosophy of leadership that will continue to guide her efforts and encourage and influence the next generation of NTD leaders.

“Leaders must be able to inspire and motivate others, naturally setting a powerful example for their team. They are aware of their abilities and are unafraid of responsibility and pressure. This imparts strength and assurance to others,” says Dr. Hernandez. “To people starting out in NTDs, I’d encourage you to be responsible, committed, passionate and to work with integrity.”

Learn more about how the Philippines is Creating Sustainable Soil-Transmitted Helminthiases Control Among School-Age Children.

Special thanks to Dr. Leda Hernandez for agreeing to be interviewed and share her story. Contributions from Laura Cane, Daryll Gutierrez, Angela Pereira, Nandini Pillai, Oknoy Poblete, and Alexis Serna.

By Kaitlin Lesnick, RTI International

Adan Hasan Salad, 25, was one of many youth seeking employment in Somalia, where more than 60 percent of the population is under the age of 25. More than half of the country’s youth face the risk of continued unemployment.

“Finding a job in Somalia is really a challenging task in itself,” Adan says. “Here there are no big factories or industries to employ the large number of youth.”

Youth in Somalia are consistently confronted with roadblocks to economic success, influenced by limited educational opportunities, low literacy rates, and weak vocational training systems. Because of this, few young people have the education and skills required to enter the labor market when the time comes.

A Global Pandemic Threatens Progress

Somalia is particularly vulnerable to the new strain of the coronavirus and the socio-economic dynamics associated with it. In an already-strained job market for youth, the global COVID-19 pandemic threatened to shut down businesses, further exacerbating the youth unemployment challenge. In addition, like many locations around the world, Somalia was lacking in several forms of personal protective equipment, or “PPE.”

In May of 2020, as the effects of the pandemic reached Somalia, the United States Agency for International Development (USAID) responded by putting local youth to work in a way that would also help prevent the spread of the disease.

Through the Growth, Enterprise, Employment and Livelihoods (GEEL) Project’s implemented by RTI International, USAID quickly engaged 304 local youth and trained them in basic sewing skills, including how to make non-medical grade protective face coverings that can help slow the spread of COVID-19. As a result of those efforts, on June 9, 2020, USAID completed the handover of 500,000 masks to Somalia’s Ministry of Health for distribution within the local population.

Not only did the USAID-supported youth gain a long-term skill that can help them with future employment prospects, they were also connected with local textile companies who may find use for those skills in the future.

“I am really excited about this training,” says Adan. “It has opened a new door for me. It helped me get an income, and I can now support my family.”

Sustaining the Local Private Sector

Local Somali businesses have also benefited from the effort. “We partnered with USAID in the making of face masks, and we are happy and proud about it,” says Falhado Sheikh Mohamed, manager of the Somali Institute of Social Economy, which offers vocational training in areas such as sewing, cooking, computer repair, electrical installation, and beauty.

“The partnership helped us continue our operations during this difficult time,” Falhado explains. “Without this partnership, we’d not be able to contribute and provide such opportunities for the youth to serve their people and gain an income.”

Businesses can have job openings primed for youth, but the mismatch of youth skills and business needs often results in a pool of under-qualified candidates. Through the mask-making effort, USAID partnered with six Mogadishu-based businesses for training, networking, and job placement.

“It’s important to empower the youth through gainful skills,” Falhado says. “It helps them become independent and build a future for themselves. A jobless youth is vulnerable to engage in unlawful activities. For Somalia to move forward, we need to create jobs and opportunities for the youth through vocational trainings.”

A Promising Future

Through GEEL’s youth skills development activities, USAID plans to create more than 1,000 new job opportunities for Somali youth by helping them develop the skills they need to succeed in today’s global economy. In partnership with leading private sector companies, the program is committed to engaging youth in innovations in the agriculture, fisheries, livestock, and energy sectors.

As for Adan Hasan Salad, the experience making masks to protect his fellow citizens has left him feeling inspired.

“I am grateful to USAID for the training,” he says. “It has surely empowered me and many others. We hope this continues and more jobless youth get an opportunity.”

In the future, Adan says he wants to advance his skills and eventually venture into the textile business, an effort he hopes will provide employment to others and contribute to his vision to “build a better Somalia.”

Yussuf Ali from the USAID GEEL Project contributed to this story.

Read more about USAID’s Somalia GEEL Project

By: Rosana Ombao

“Family planning is a critical part of addressing social determinants of health, like educational level and employment, and actually answering the complex problems that health systems are facing.”

This tenet drives Dr. Jan Villamor Llevado’s work as the Program Manager for Family Planning (FP) under the Department of Health (DOH) in the Philippines. She has devoted her career to improving maternal and child health by ensuring women and girls have access to information and resources to make informed decisions about their reproductive and sexual health. Since joining the DOH in 2019, this 33-year-old mother of two has had the gargantuan task of steering the country in the right direction in terms of FP.

As the second most populous country in Southeast Asia, the Philippines ranks high in terms of unmet need for FP: 17% of married women and 49% of unmarried women who want to delay childbearing are not using any method of contraception. The country also ranks second in Southeast Asia for teenage pregnancy, with over 500 teenage girls getting pregnant every day, a number that has not dropped below 500 since 2010, according to the Philippine Commission on Population and Development (POPCOM) under the National Economic and Development Authority (NEDA).

When adolescent girls get pregnant, this can hinder their ability to continue their education, and have implications for their future wages. In fact, according to the United Nations Population Fund, teen pregnancies can lead to cumulative losses between 24 to 47 billion Philippine pesos — a big loss for young families. This has recently prompted the NEDA, the main economic agency in the Philippines, to declare teenage pregnancy as a “national social crisis” that is affecting the country’s economic growth.

Dr. Llevado is one of the reproductive health advocates working tirelessly to empower Filipino women and their families with access to contraception and FP resources.

Her passion and advocacy started when she was serving as a doctor in the barrios (small towns in the countryside) in 2012. She was deployed to a Geographically Isolated and Disadvantaged Area (GIDA) after getting her medical degree, choosing to serve in one of the poorest island municipalities in the Philippines, with a very high birth rate and where many mothers and infants were in dire need of maternal and neonatal care. Some mothers had 17 children each and Dr. Llevado said it was eye opening to see how lack of access to FP had affected their economic situations, to the point where families would dry fish bones in the sun for food. In other areas, she noted that women resorted to risky abortions for unwanted pregnancies.

“It was shocking for me to hear, in this modern era, coming from the mouths of these women that they had to resort to forced abortions using whatever they had at their disposal, like gas, bamboo sticks, and clothes hangers,” Dr. Llevado recalls.

At first, she was shocked by what she encountered in the barrios, and didn’t understand how these women could resort to such drastic measures. “Masungit ako noon eh (I was short tempered back then),” she laughs at herself. But she started to understand that much of what she was encountering was due to poor health literacy and the health system failing these women.

Armed with a new perspective after her experience in the barrios, she took a job at the Health Policy Development Program with the United States Agency for International Development (USAID), which focused on improving health care policies with FP as the focus. Since then, FP has continued to be the focus of her career.

Today, her top three priorities for the FP program she leads at the DOH are to reinvigorate the national family planning program strategy, get rid of barriers by strengthening health systems, and address the high rate of teen pregnancies.

This work is done in close partnership with other government agencies, non-governmental organizations, and development partners like USAID.

For example, the USAID ReachHealth project, implemented by RTI International, is supporting Philippine counterparts — primarily the DOH, POPCOM, Philippine Health Insurance Corporation (PhilHealth), civil society, and the private sector — to reduce unmet need for FP services and decrease teen pregnancy and newborn morbidity and mortality across 11 regions by identifying and responding to root causes of poor FP outcomes, with a concerted focus on disadvantaged women, adolescents, and the most underserved.

Dr. Llevado believes the Philippines has good laws and policies for family planning but encounters challenges in implementing those policies. FP is increasingly being incorporated into laws, such as the Kalusugan at Nutrisyon ng Mag-Nanay Act, which focuses on improving nutrition during the first 1,000 days of life, and the Universal Health Care Act that was signed into law in February 2019.

When it comes to being able to continuously implement these laws, she cautions, “I still see family planning as politically driven in the country. Without good and sensible politicians, we are going to have barriers along the way.” For this reason, Dr. Llevado continues to push for advocacy activities that educate legislators on the importance of family planning, including supporting the POPCOM’s plan of hosting lectures on FP for the staff of legislators.

Dr. Llevado also acknowledges the role of the civil society organizations that are at the forefront of reproductive health advocacy in the country.

“Without [other agencies, development partners and civil society organizations] pushing for FP as well I don’t think we [the Department of Health] would be strong enough to implement family planning policies.”

With such a huge task of orchestrating goals, plans and activities at the national level, Dr. Llevado reminisces with nostalgia about her time working in the barrios: “I sometimes think I would want to go back to the Regional Health Unit and work as a municipal health officer. Because it’s easy to get a win-win situation there and you’re nearer to the people you’re servicing.”

But she also acknowledges that in her current role as head of the national program, she will be able to help more women have an informed choice for family planning, and thus touch the lives of more Filipino families.

When asked what future she wants to see, she says with hope in her eyes, “I aspire in the future that my kids can use contraceptives without stigma and not have unplanned pregnancies because we are in a society where we are open in discussing family planning or sexual health with them.”

For more information on RTI’s work in global health, please visit http://www.rti.org/globalhealth.

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By Katie G. Nelson for RTI International

“When you handle a child with care or love, it can help them in school,” said Rachel Nabbanja, a teacher at Kiiya Primary School in Luwero, Uganda.

It’s a simple commitment, but a powerful one. Since Kiiya Primary School adopted measures to create a safer and more supportive school environment, absenteeism has dropped. Students feel safer going to school and are developing important social and emotional learning skills.

“Long ago [students] used to think a teacher would cane them, but now they know they will talk to [the] child and then that child can change,” Ms. Nabbanja said.

Ensuring the well-being and safety of students in Uganda so they can learn and grow, in every form, is at the heart of the Journeys program, a newly designed intervention that works with students, teachers, staff, and community members to prevent and respond to school-related gender-based violence (SRGBV). Journeys is part of the USAID-funded Literacy Achievement and Retention Activity (LARA), which is implemented in partnership with Uganda’s Ministry of Education and Sports (MoES).

SRGBV is violence that takes place at school or while students are traveling to and from school. It includes bullying, corporal punishment, and sexual harassment. SRGBV is an all-too-common occurrence in many countries around the world. In Uganda, more than 95 percent of primary school students reported experiencing bullying in the past term, 88 percent reported experiencing harsh forms of punishment such as caning, and 40-50 percent reported experiencing some form of sexual harassment, according to LARA’s baseline findings.

Annet Nakato knows this grim reality firsthand. As a teacher at St. Thereza Kasaala Primary School in Luwero, Nakato said she witnessed widespread use of corporal punishment against students. She learned that use of corporal punishment was even expected of her as a teacher.

“All I knew is that punishing was the only option for the child. Even their parents demanded punishment. They think that if you don’t cane them, you aren’t teaching them,” she said.

Through Journeys, Nakato learned to use appreciation of students’ efforts to encourage improvement (even when their answers were incorrect), as well as techniques of positive discipline to control reactive behavior and help students learn to apply self-discipline to peacefully solve conflicts.

Alan Nasiimnwa, another teacher at St. Thereza Kasaala Primary School, has also seen a change.

“Long ago, a few years back, [teachers] used to issue… corporal punishment without listening to the children,” Nasiimnwa said. “[Now] you listen to each other, you tell [the students] to decide what should be done. Instead of deciding alone, we just sit with the children and we get a resolution,” he said.

“There is peace between the students and the teachers — and that was not there before,” said Sister Mary Narinuuka, the school’s principal.

Journeys is part of LARA’s efforts to improve student retention and reduce school-related violence by shifting social norms and building school environments that are safer, more caring, and more supportive. Through Journeys, school change agents and community leaders are trained to use program materials to guide reflection, dialogues, and hands-on activities with school staff, community members, and students designed to foster positive and caring school communities. The program underscores the importance of collaboration between teachers, students, and community members in order to promote equality of all students, ensure physical and emotional safety of students, build a positive and supportive school atmosphere, and nurture students’ social and emotional learning.

Additionally, Journeys’s emphasis on building social and emotional skills such as responsible decision making, sense of self, sense of agency, social awareness, and relationship skills is taking hold.

“The children have learned how to express their problems,” said Paul Isabirye, Principal at Kiiya Primary School. “They’ve learned how to make good decisions. In case they have a problem, they know how to solve that problem by consulting with others.”

Cissy Abenakyo, Senior Teacher at Kabulasoke Demonstration School in Gomba, Uganda, agreed.

“The difference now is that [students] can express themselves freely, without fear,” she said. They can ask when they don’t understand [a lesson] well. [The program] has even improved their performance in class.”

Back at Kiiya Primary School, Ms. Nabbanja reflected on the program’s impact. “Journeys increased the enrollment at our school and it is helping children stay in school,” she said. “Journeys brought us closer to the children.”

The Literacy Achievement and Retention Activity is being implemented in 38 targeted districts, reaching more than 3,500 schools, 40,000 teachers, and 1.3 million students. RTI International serves as the lead USAID implementing partner for the program.

Learn more about LARA and Journeys.