Summer 2011 Internship Program

Global Health Fellows Program
Internships
Summer 2011
The Public Health Institute implements USAIDs Global Health Fellows Program in
partnership with: Harvard School of Public Health Management Systems International
Tulane University School of Public Health and Tropical Medicine
529 14th St., NW
Suite 650
Washington, DC 20045
202-661-8020
www.ghfp.net

USAIDs Global Health Fellows Program is implemented by the Public Health Institute and its
partners: Harvard School of Public Health Management Systems International Tulane
University School of Public Health and Tropical Medicine

The Global Health Fellows Program

The Global Health Fellows Program (GHFP) is a five-year cooperative agreement with the US
Agency for International Development. The vision of the Global Health Fellows Program
(GHFP) is a sustainable pool of talented global health professionals and strong individual and
organizational performance that improves the effectiveness of USAID Population, Health and
Nutrition programs. GHFP achieves this with a two-to-four year fellowship program; an
internship program that placed over 60 highly qualified candidates throughout USAID
worldwide; a diversity initiative that brings underrepresented individuals into the field of global
health and supports Foreign Service Nationals; and a tailored professional and organizational
development program worldwide.

GHFPs 2011 Internship Cohorts

Domestic Cohort: Washington, DC
This year, GHFP had 21 interns working at USAID in Washington, DC for the Bureau of Global
Health in the Office of HIV/AIDS, Office of Population and Reproductive Health, and the Office
of Health, Infectious Diseases and Nutrition. These outstanding interns worked on projects
focused on PEPFAR, prevention strategies, child protection, orphans and other vulnerable
children, and more.

International Cohort: Kampala, Uganda
We had 6 successful interns this summer working at the USAID-sponsored NGOs of Mengo
Hospital, Meeting Point, and The AIDS Support Organization (TASO). At these organizations,
our interns worked on projects such as HIV counseling, gender-based violence workshops, and
orphans and vulnerable children infected with and/or affected by HIV.

Sponsored Cohort: India, Ghana, South Africa
This year, we had 10 sponsored interns who with two different organizations in international
settings. Six worked with Child Family Health International (CFHI) in India where the interns
gained experience in areas such as tropical diseases, traditional medicine, maternal and child
health care, and Ophthalmology. The remaining four worked with Cross-Cultural Solutions in
Ghana and South Africa on projects such as working with local people affected by HIV/AIDS,
teaching sex education, and assisting local health professionals.

Domestic Interns
Summer 2011
529 14th St., NW
Suite 650
202-661-8020
www.ghfp.net

Gl obal Heal t h Fel l ows Program
Summer 2011 GHFP Domest i c Int erns
Shreya Agrawal
Highly Vulnerable Children Intern
Office of the Assistant Administrator

Hometown: Miami, Florida

Originally from India, Shreya has been residing in the US over the last decade, com-
pleting her undergraduate degree in International Studies from the University of Mi-
ami. Her passion for education led her to join Teach for America, teaching Mathe-
matics to seventh graders, all of whom were minority students coming from low-
income backgrounds and having very low knowledge of the subject. Many of her
students were considered delinquents or at risk because of, amongst other things,
their backgrounds, their status as gang members and drug users, and their arrest and
juvenile records. Shreya really enjoyed working with her students, making it one of
the best experiences of her life. Recently, she has been living in Baltimore, studying
International Health at Johns Hopkins University. Shreya loves travelling and hopes
to eventually venture to all the continents, seeing the magnificent wonders of the
world.
Fun Fact: Throughout the course of my Teach for America experience, I have pre-
vented/broken up/stopped more than 50 fights in my school (including both boys and
girls).
Lauren Arrington
Fistula and Post Abortion Care
Office of Population and Reproductive Health

Hometown: Washington, DC
Lauren Arrington is a certified nurse midwife practicing in Towson, MD and an instruc-
tor at Sojourner Douglass College School of Nursing. She has a MSN from the Frontier
School of Midwifery and Family Nursing, a BSN from Georgetown University and a
BA from Brown University. She has traveled extensively throughout Sub Saharan Af-
rica and conducted research on topics such as labor management in Gambia, traditional
education in Ghana and land reform in Zimbabwe.

Fun Fact: I performed "the vagina workshop" in The Vagina Monologues.

Emily Delmotte
HIV/AIDS Testing and Counseling Intern
Office of HIV/AIDS

Hometown: Detroit, Michigan
Emily majored in International Health and Human Rights at the University of Michigan,
and after a semester in South Africa, she became particularly interested in the intersec-
tion of HIV and human rights. Following graduation, she interned with the University
of CaliforniaSan Francisco AIDS Health Project in San Francisco where she had the
opportunity to assist with harm reduction programs focused on HIV and mental health,
and became an HIV test counselor. Emily is currently a graduate student at the Johns
Hopkins School of Public Health in the International Health Department, Health Sys-
tems track. Through the GHFP internship, she is particularly looking forward to gain-
ing a better understanding of innovative policy and programmatic responses to the chal-
lenges associated with scaling up HIV counseling and testing.

Fun Fact: I won an air guitar contest in 4th grade (it's the only music award I've ever
won).
Elizabeth Edouard
HIV/AIDS Research Intern
Office of HIV/AIDS

Hometown: Port Louis, Mauritius
Elizabeth is a graduate student at the Monterey Institute of International Studies in Cali-
fornia where she is pursuing an MPA with a specialization in monitoring and evalua-
tion. She has a BA from Middlebury College in International Studies with a focus on
Africa and economics. Her extensive international experience includes living in Canada,
Mauritius, Senegal and Chile. Elizabeths language skills include fluency in French and
Spanish, as well as proficiency in Italian and Wolof. She recently assisted in research
for the annual State of the Worlds Mothers Report by Save the Children. Additionally,
she is currently working on a capacity development evaluation for the International Fed-
eration of Red Cross and Red Crescent Societies using network analysis. After her in-
ternship with GHFP, Elizabeth will be serving as an National Security Education pro-
gram Boren Fellow in Zanzibar and in the Mara region in Tanzania from September to
May 2012. During this time, she will both learn Swahili and carry out monitoring and
evaluation of HIV/AIDS programs.

Fun Fact: I have been a synchronized figure skater for over 12 years. My synchronized
skating team qualified for the United States Synchronized Skating National Champion-
ships three years in a row.
Kenneth Matthew Fornoff
HIV/AIDS Nutrition Intern
Office of HIV/AIDS

Hometown: Tucson, Arizona
Matt is originally from central Illinois. Right now he is a graduate student at the Univer-
sity of Arizona. In between he lived in Malawi and Maine. From a Midwestern grain/
vegetable farm to a 10-acre Southwestern organic farm, Matt has been around agricul-
ture most all of his life in some fashion, and loves it. There was a time Matt thought
he'd likely never leave his home state. Now, he can't imagine his life having not left.

Fun Fact: I have never broken a bone. I have never spent a night in a Kenyan jail
(though that was threatened). But I have been to the highest point in Nebraska, which is
actually higher than the highest point in Maine but not nearly as difficult (or fun) to
reach.

Fatumo Guled
HIV/AIDS Community Care and Prevention Intern
Office of HIV/AIDS

Hometown: Worcester, Massachusetts
Fatumo received her undergraduate degree from Brandeis University and later worked
as a research assistant at Johns Hopkins School of Medicine. The last two years, she has
been enrolled at Emory's Rollins School of Public Health with a focus on reproductive
health and population studies. Fatumo enjoys spoken word (poetry) and hiking up
mountains; however, public health is her passion.

Fun Fact: I am originally from East Africa.
Pamala Horugavye
HIV Prevention Intern
Office of HIV/AIDS

Pamala began her career in corporate America, and she has over thirteen years of ex-
perience in marketing and communications. After working as a project manager and
consultant for many top brands, her passion for international development inspired her
to transition her career to the nonprofit sector in 2007. During Pamalas first field-
based consulting role with TechnoServe Mozambique, she managed the marketing and
communications component of a grant from the US Department of Agriculture. Work-
ing alongside local stakeholders, she developed a mass media campaign to stimulate
demand for local poultry rather than Brazilian imports, thereby fighting poverty and
providing sustainable livelihoods to smallholder farmers. Since that life-changing ex-
perience, Pamala has used her skills to address critical issues in global health, economic
development, environmental protection, and human rights, both in the US and abroad.
After working on projects in Namibia, Rwanda, Kenya, and Ethiopia, she chose to pur-
sue a Masters degree from American Universitys School of International Service to
prepare for a career in public service. Earlier this year, she continued to hone her skills
in global health by working as an HIV Communications Consultant with Population
Services International; and is extremely excited about the opportunity to apply her
knowledge of HIV prevention in her role as a GHFP Intern.

Fun Fact: As an engaged global citizen, I have visited 26 foreign nations. My regional
passion is Africa, and I have traveled to 15 countries in sub-Saharan Africa.

Andrea Kautza
HIV/AIDS Orphans & Other Vulnerable Children Intern
Office of HIV/AIDS

Hometown: Ankeny, Iowa
Annie earned her Bachelor of Science in Nursing at the University of St. Catherine, St.
Paul, Minnesota and began her nursing career on a pediatrics unit. In 2005 she started
thirteen months of volunteer work as a nurse with Nuestros Pequeos Hermanos
(NPH) - "Our Little Brothers and Sisters", Honduras, a home for over 500 orphaned
and abandoned children. That year she became the in-country logistics coordinator for
annual medical brigades to rural villages, an activity she continues to participate
in. Upon returning to the US, Annie worked for a short time as a Medical-Oncology
nurse. In 2007 she returned to NPH Honduras as Co-Clinic Coordinator and HIV Pro-
gram Developer. Following that assignment, Annie worked as a Regional Medical
Coordinator with NPH International, managing health care quality in collaboration
with local and international staff for nearly three years in the NPH homes of Bolivia,
El Salvador, Honduras and Peru. After the earthquake in January 2010, Annie was
invited to Haiti, where she coordinated medical relief personnel in a hospital in Port-
au-Prince for one month. Annie is currently pursuing a Masters Degree in Interna-
tional Health at Charit Universittsmedizin, Berlin, Germany.

Fun Fact: I have lived abroad for 5 1/2 of the past six years, and am looking forward
to being stateside again for a few months!
Laura Khan
Demographics Health Surveys Intern

Hometown: Brookline, Massachusetts
Lauras interest in global health began in the Fiji Islands where she was a Peace Corps
Volunteer working with an Indian women's group on social infrastructure creation,
health promotion and income-generating projects. Indians are a marginalized population
in the South Pacific and Laura saw how socioeconomic status, educational attainment
and land rights affected health outcomes. After finishing her service, she worked at the
Franois-Xavier Bagnoud Center for Health and Human Rights at the Harvard School
of Public Health (HSPH) for the Research Program on Children and Global Adversity to
investigate risk and resilience processes among children affected by HIV/AIDS in
Rwanda and former child soldiers in Sierra Leone. She began a Master of Science de-
gree at HSPH in the fall of 2009 and did demographic, fertility and policy research with
various faculty members at the Harvard Center for Population and Development Stud-
ies. Laura did her own research for her Masters thesis in India investigating barriers to
access and utilization of quality maternal health services among slum-dwelling women
in Mumbai. She will begin a PhD program in Demography and Social Policy at Prince-
ton University this fall.

Fun fact: I've run the Boston and Chicago marathons; and a half in Fiji.

Yabsera Marcos
PMTCT/Pediatric Intern
Office of HIV/AIDS

Hometown: Addis Ababa, Ethiopia
Yabsera grew up in a family that greatly values doing ones part for our fellow man/
woman so it was inevitable that she would end up pursuing a career in public health.
Yabsera started the journey in a completely different place with a BA in English from
Amherst College. In the three years between her undergraduate education and graduate
school, she taught primary school for two years and worked with Save the Children
USA in Addis Ababa on Early Childhood Care and Development. Yabsera wanted to
find a way to balance her love of writing and research with her passion for improving
the health and welfare of women and children, especially in sub-Saharan Africa. She
worked with International Center for AIDS Care and Treatment Programs (ICAP) New
York on HIV Care and Treatment programs for their country teams for ten months and
spent six months in South Africa supporting ICAP South Africas PMTCT programs.
She recently completed an MPH in Population and Family Health with a concentration
in Global Health from Columbia University.

Fun Fact: I sing jazz and blues
Kate Roders
HIV/AIDS Monitoring and Evaluation Intern
Office of HIV/AIDS

Hometown: Cleveland, Ohio
Kate is a passionate advocate for reproductive health rights focusing on a career in
global HIV/AIDS prevention and project development. Currently, she is a Masters of
Public Health candidate with a graduate certificate in Maternal and Child Health at the
University of South Florida and also the official Peace Corps Representative at the Uni-
versity of South Florida. Kate graduated cum laude from the University of South Flor-
ida in 2007 with a Bachelors Degree in Women's Studies and a rich background in pub-
lic health campus-based activities. Immediately after graduating, she left for Peace
Corps Kazakhstan to serve as a Non-Profit Development Volunteer at an HIV/AIDS
prevention non governmental organization. She was involved in monitoring and evalua-
tion activities for multiple HIV/AIDS prevention and outreach projects in resource poor
settings, and organized quite a few conferences focusing on HIV/AIDS prevention that
were funded by PEPFAR. Right after Peace Corps, she had an incredible experience
working at a grassroots women's clinic as a medical assistant on abortion provider days.
Kate is very excited about this internship, and cannot wait to meet everyone!

Fun Fact: Kates favorite summer was spent on a chainsaw crew as an Americorps
Volunteer in Lake Tahoe. Her environmental conservation project created forest breaks
to prevent forest fires. The tallest tree she helped bring down was a deadwood over 100
feet tall!

Christianna Malia Savino
HIV/AIDS Orphans & )ther Vulnerable Children
Office of HIV/AIDS

Hometown: Boulder, Colorado and Santa Rosa, California
Christianna is currently a graduate student focusing on International Development and
Non-Profit Management at UC San Diego's School of International Relations and Pa-
cific Studies. She has extensive international experience from teaching health, working
within orphanages, managing projects, developing curriculum and initiating environ-
mental programs in Nepal, Vietnam, El Salvador, Mexico and Panama. Her interest in
equal rights to education and health for vulnerable children stem from her teaching ca-
reer in Thailand and San Diego. Her passion for working in orphanages is rooted from
her unique background as an orphan from South Korea. Christiannas work in environ-
mental initiatives grew from her experience as a 2004 tsunami survivor, in which she
gained a deep understanding of international disasters and their social and environ-
mental impacts. Currently, she directs the Net Impact Nonprofit Board Leadership Pro-
gram, is a visiting board member for Voices of Women, a San Diego organization dedi-
cated to expanding knowledge of global human rights issues and equal participation of
women, and she leads the Clinton Global Initiative Hats4Hope, which knits hats for
orphans around the world.

Fun Fact: I have lived, worked, and traveled to 26 countries and got engaged in Machu
Picchu, Peru.
Bryan Shaw
HIV/AIDS Community Care and Prevention Intern
Office of HIV/AIDS

Hometown: Council Bluffs, Iowa
Bryan is currently a PhD student at Johns Hopkins in International Health and resides in
Baltimore, Maryland. He is an anthropologist by training so he has an interest in the
influences of culture as well as social and behavioral determinants of health. Most of
his field experience has been conducting ethnographies in rural populations in several
sites in India where he has learned of the complex challenges to maintaining health and
wellness in these settings. Bryan has also conducted several consultancies for research
projects involving nutrition in mothers and children with HIV/AIDS in Zambia and HIV
awareness in Northeast India. He is currently planning a dissertation project focusing
on mental health in Cambodia, but is looking forward to expanding his interests and
skills in community-based prevention projects throughout the world.

Fun Fact: I am an avid fiction reader and am actually looking forward to commuting
from Baltimore to DC so I can finally have time to read novels.

Shegufta Sikder
Health Research Analyst Intern
Office of HIV/AIDS

Hometown: Staffordsville, Kentucky
Born in Bangladesh, Shegufta had the opportunity to work with a Bangladeshi NGO to
evaluate their maternal health interventions. This experience encouraged her to improve
her analytical skills by completing a Master of Health Sciences at the Johns Hopkins
Bloomberg School of Public Health. As a masters student, she worked in northwest
rural Bangladesh with one of the largest community-based field trials in South Asia. For
her Masters research, Shegufta interviewed women who had life-threatening obstetric
complications about their health care experiences. Currently, she is researching mater-
nal morbidity in rural Bangladesh as a PhD student at the Johns Hopkins School of Pub-
lic Health. Previously, she worked with the Johns Hopkins Center for Communication
Programs to assess national preparedness plans for pandemic avian influenza and the
use of mobile phones to increase adherence to antiretroviral therapy in sub-Saharan Af-
rica. She has also worked as a program assistant with Ashoka: Innovators for the Public,
a campus organizer with the Millennium Village Project, and an economic research
assistant with the Bangladesh Embassy in Washington, DC Sheguftas language skills
include Bengali, Arabic, and Spanish.

Fun Fact: To conduct field interviews in rural Bangladesh, I drove a motorcycle
through rural roads often occupied by cows, goats, flat-bed bicycle vans, rickshaws,
trucks, and, of course, crowds of people.
Tara Vecchione
Commodities Security and Logistics Intern

Hometown: Southfield, Michigan
Tara is currently pursuing her MPH and MBA at Johns Hopkins University. She has
over 6 years of experience working in both domestic and international health contexts.
Her previous experience includes policy advocacy with the Advance Family Planning
program at the Gates Institute, program development and fundraising for a local HIV/
AIDS organization, working as a health education specialist for youth, and serving as a
Program Coordinator for Pathfinder International. Tara has competencies in business
and health-related quantitative analysis such as cost effectiveness, biostatistical analysis,
monitoring and evaluation, and financial analysis. She has a strong background in re-
productive health and is interested in improving the efficiency of global health systems
and exploring innovative approaches to health financing.

Fun Fact: Tara has been bungee jumping off of the worlds highest commercial bungee
jump bridge in the world at Bloukrans River in South Africa (216 meters).

Kristen Wenz
HIV/AIDS Orphans and Other Vulnerable Children
Office of HIV/AIDS

Hometown: Thetford, Vermont
Kristen is graduating from Columbia University with her MSW in International Social
Welfare Policy. During her time at Columbia, she conduced research on orphans in the
Millennium Villages through the Center for Global Health and Economic Development.
She also interned at UNICEF in the Child Protections Division working on policy
around alternative care for vulnerable children. Before attending Columbia University
she worked for Human Capital Foundation, an international non-profit that provided
alternative care for children orphaned by AIDS in Ethiopia.

Fun Fact: I have seven brothers.
Anahita Molayi
HIV/AIDS Care and Treatment Intern
Office of HIV/AIDS

Hometown: Lawrenceville, NJ
Anita graduated from the University of Massachusetts, Amherst with a BS in microbiol-
ogy. She is currently enrolled in the MS for public health program, with a concentra-
tion on tropical medicine, at Tulane. She has become increasingly passionate about the
issue of antiretroviral treatment dissemination, treatment of co-infections and opportun-
istic infections, and management with emphasis on nutritional demands. Her overall
focus is on improving health information dissemination and health equality in develop-
ing countries.

Fun Fact: I am a synchronized figure skater and instructor.

Angelina Caruso
HIV/AIDS Health Systems Strengthening Intern
Office of HIV/AIDS

Hometown: Merrick, NY
Angelina is a rising senior at Princeton University majoring in Anthropology with a
focus in medical anthropology and global health. Prior to her internship at USAID,
Angelina worked as a Research Intern at Human Rights Watch in the Health and
Human Rights Division and as a Research Assistant for the Princeton Social Science
Library, a Princeton Sociology professor, and a Princeton English professor. She is very
active on campus as a Deputy Chief-of-Staff for the International Relations Council, a
member of Professor Joao Biehls research group The Future of Global AIDS
Treatment and Social Determinants of Health, a Peer Educator in the Residential
Education Program for freshman, and former Council Chair of the Forbes College
Council.

Fun Fact: I just recently returned from studying abroad at Oxford University.
Kate Wilson
Office of HIV/AIDS

Hometown: Raleigh, NC
Kate received at Master of Global Public Health with a concentration in management
from The George Washington University. Prior to beginning her internship at USAID,
Kate worked as a Research Assistant at The Center for Global Health at The George
Washington University. She received a Bachelor of Arts in Political Science and Biol-
ogy in 2006 from the University of North Carolina - Chapel Hill. Kate has extensive
research experience at organizations such as Women for Women International, The GW
Cancer Institute, and the Association of State and Territorial Health Officials (ASTHO).
Kate gained international work experience when she served as a: Community Health
Mobilization Officer at Serving in Mission (SIM) HIV/AIDS Care and Treatment
Project; a Service Aide at the Cherokee Gives Back Foundation; and an Independent
Consultant for CURE International; all in Addis Ababa, Ethiopia.

Fun Fact: I love to bake and have been told that I make some pretty awesome
chocolate chip cookies.
Uganda Interns
Summer 2011
529 14th St., NW
Suite 650
202-661-8020
www.ghfp.net

Summer 2011 Uganda Cohort
Elizabeth Daube
HIV/AIDS Gender-Based Violence Intern
TASO

Hometown: Bronson, Florida
Liz is a former journalist and current MSW/MPH student at Boston University (BU). Af-
ter getting her BA in communication, she served in writing and editing roles for a newspa-
per and for a college magazine and public relations office. More recently, she interned
with a dating violence prevention program and volunteered as a community awareness/
prevention educator for an award-winning rape crisis center. Currently, she manages a
Mental Health First Aid training program for a partnership between the Somerville Health
Department and Cambridge Health Alliance. In addition, she works as a research assistant
for the BU Understanding the Mentoring Process Study. Much of her work has focused on
gender-based violence and on the challenges facing immigrant populations; these experi-
ences have inspired her to work toward reducing GBV and other inequities in low-income
countries. At TASO, she hopes to make progress on that goal and learn as much as she can
from staff, interns, and the populations that TASO serves.

Fun Fact: Her 16 years as a vegetarian belie a passion for unpasteurized cheese, pastry,
baguette and most things delicious and/or French.
Anita Harshman
HIV/AIDS Counseling and Testing Intern
TASO

Hometown: Albuquerque, New Mexico
While traveling in India in 1973 Anita became interested in Global Health and returned
to the States to pursue this. In 1978 she received a BS in Nursing and in 1983 she re-
ceived a MSN in Nurse-Midwifery. As a Nurse-Midwife she has been an OB/GYN
instructor at various levels of nursing, a Nurse-midwife in private and public care, and a
Sub-investigator in HPV vaccine trials. She has also home-schooled two children, co-
taught meditation classes, trained in colposcopy, mediation and childbirth education and
has been involved in the New Mexico Health Equity Working Group and the NGO
AMURT. As a midwife, education was the most rewarding part of work. Providing
informed decision making information about health has become a core principle. She
began to look closely at options for pursuing her interests in health education and global
health. She is presently in an MPH program. Her focus is on community health,
CBPR, and global health.

Fun Fact: Presently our only pet is a feral rooster that sleeps in our trees at night and
eats from our compost and the bird feeders in the yard. I like to hear him crow in the
morning unlike most of the neighbors!

Karrin Parker
HIV/AIDS Orphans and Vulnerable Children Intern
Mengo Hospital

Hometown: Fort Collins, Colorado
Karrin has years of experience as a registered nurse, with a specialty in emergency
medicine. She recently returned from serving in the Peace Corps 2008-2010 in Lesotho,
Africa, working on community health and economic development. Some of her projects
included developing a first aid program and teaching it and other health care issues,
especially focusing on HIV and TB, to village health care workers. She has also worked
with women to develop an income generating project and teaching first year nursing
students the Fundamentals of Nursing and English at the National Health Training Cen-
ter of Lesotho. She is currently working on her MPH at Colorado State University with
a focus on global health and health disparities.

Fun fact: I used to fight forest fires in Alaska in my 20s.
Lindsey Junk
Meeting Point

Hometown: Angola, Indiana
Lindsey is currently an MPH student at Tulane University studying Epidemiology of
Infectious Diseases.

Fun Fact: I just biked over 500 miles across Mississippi and Tennessee this summer!

Veronica Saccoh
Meeting Point

Hometown: Raleigh, North Carolina
Veronica Saccoh will graduate with a Masters of Social Work degree in May 2011,
with a focus on International Social Welfare, from Columbia University. She is
currently completing an internship at Sauti Yetu Center for African Women and
Families, where she has had the opportunity to work with West African immigrant
women on domestic violence and immigration related issues. Previously, Veronica has
worked with adults affected by HIV/AIDS, as well as abused and neglected children in
the child welfare system. Veronicas professional goals are to continue to work with
the refugee and immigrant populations, populations subjected to gender-based
violence, and populations affected by HIV/AIDS.

Fun Fact: I am always cold; always! Knowing that, my co-workers never searched far
for ideas during secret Santa. For three consecutive years, they would always give me
some winter accessories (socks, hat, glove, scarf, and legwarmers).
Anand Sandesara
HIV/AIDS Care and Treatment Intern
Mengo Hospital

Hometown: Glenview, Illinois

Anand is a rising second year medical student in Chicago at the University of Illi-
nois. His passion lies in working for health equality in underserved communities. He
spent a year as a Rotary Ambassadorial Scholar to Tanzania, where he obtained his
MPH degree with a focus on public health management in resource-poor settings.
While there, he also volunteered with the Tanzanian Red Cross Society on a project
relating to men's health in refugee camps. He has previously worked for the AIDS
Foundation of Chicago in policy analysis, and he has also worked for three years
with his university in implementing HIV/STI interventions and Post Traumatic
Stress Disorder assessments for juvenile offenders in Cook County. He is thrilled to
be going back to East Africa, and he looks forward to combining his love of public
health, service, medicine, and teaching.

Fun Fact: I climbed Mt. Kilimanjaro last year
Sponsored Interns
Summer 2011
529 14th St., NW
Suite 650
202-661-8020
www.ghfp.net

Summer 2011 USAID Sponsored Int erns
Ramotalai Coker
Child Family Health InternationalIndia

Hometown: Baltimore, Maryland

Ramotalai is currently studying for her MPH with a concentration in Epidemiology, and
a research focus on Infant Mortality. She received her BS in Health Science at Towson
University, where she also worked as a Research Program Assistant. Ramotalai has
extensive experience in community health including interning at the Maryland State
Department of Health and Mental Hygiene where she developed, implemented and
evaluated health education programs, serving as a community aide for Healthy Teens
and Young Adults, and volunteering as a group leader for Play Centers, Inc. where
she developed and coordinated weekly thematic programs for young children.

Fun Fact: I am a member of a sorority
Mona Muse

Hometown: Vallejo, California

Mona is currently a candidate for a Masters of Public Health at Touro University. In
addition to her strong academic background, Mona also has an extensive experiential
history. She has served on the Hepatitis Education Project, a Breast Cancer Needs As-
sessment Study for Touro University, the Toxic Triangle Coalition and an H1N1 clinic,
where she also received a Certificate of Appreciation for her efforts. Out of this intern-
ship, Mona hopes to learn first hand what an organization does to help communities in a
global setting, and gain the knowledge she needs to pursue a career solving global water
and sanitation issues.
Shauna Raboteau

Hometown: Vallejo, California

Shauna currently holds a Bachelors degree in Psychology/Pre-Medicine from the Uni-
versity of Hawaii at Manoa. Through this internship opportunity, she hopes to learn
about different cultures, the different challenges they face, and possible solutions that
are being implemented in the community. She strongly believes that the insights and
realities to which she will be exposed this summer will make her a stronger physician,
public health professional, and future advocate in global health. She is also very excited
to meet other students that share her passion for global health and to have the opportu-
nity to learn from them.

Fun Fact: I was born and raised in Hawaii, and the furthest I have travelled is to Bos-
ton. This will be my first time traveling out of the US!
Emily LittleJohn
Cross-Cultural SolutionsSouth Africa

Hometown: Wake Forrest, North Carolina

Emily A. Littlejohn was born in Charlotte, NC, and raised in Wake Forest. She attends
North Carolina Central University, where she is a double major in Public Health Edu-
cation and Business Administration with a Concentration in Management. Her antici-
pated graduation date is December, 2011. Upon graduation, Emily plans to earn dual
Masters degrees in Business Administration and Health Administration. She has re-
ceived numerous awards and recognition for academics, community service, and or-
ganizational involvement. Her most recent achievement includes becoming a member
of the Alpha Chi Chapter of Alpha Kappa Alpha Sorority, Inc. Her future career
goal is to serve as a Health Administrator within the health care system.

Fun Fact: I'm the only girl of 2 older brothers and I like sports.

Tyneshia Powell

Hometown: Durham, North Carolina

Tyneshia currently holds a BS in Biology/Pre-Med from North Carolina Central Uni-
versity. From this experience she hopes to gain better knowledge of the global health
field and all that it has to offer in reference to medicine, health care, and disease pre-
vention in foreign countries to help broaden her spectrum of options regarding where
to practice medicine. She also hopes to get more acquainted with other people and
cultures that she can bring back home to share with her family and friends.

Fun Fact: I have been dancing nonstop for 11 years: 8 years with the Brooklyn Step-
pers Marching Band back home and 3 years with a dance group at NCCU!
Rashida Muhammad
Cross-Cultural SolutionsGhana


Rashida Muhammad is a native of Washington, DC and is a currently Dr. PH Candi-
date from Morgan State University. Rashida has over 15 years of experience with pub-
lic health and community development. She has worked with such organizations as
AANSRR Business Solutions, the National Association of State Boards of Education,
Health Education Resources and Solutions, and Jerusalem House. She is very excited
to finally get to go overseas and experience healthcare systems overseas.

Fun Fact: I once presented at the Smithsonians National Folk Life Festival!
Darryl Fields

Hometown: Hampton, Virginia

Darryl Fields is a first year Masters of Public Health Student attending Drexel Univer-
sity. He is a military child who has lived in many places, but claims Hampton, Virginia
as his hometown. He is a recent graduate from Morehouse College in Atlanta, GA
where he obtained a Bachelors of Science in psychology with a minor in public health.
Initially, he wanted to become either a psychiatrist or a neuroscientist. However, after
being introduced to a few public health classes as an undergraduate student, he changed
his career path. He is very excited about his trip to India and cannot wait to see every-
one there!

Fun Fact: One fun fact about me is I recently joined a Muay Thai boxing gym.

Turner Coggins

Hometown: La Plata, Maryland

Turner Coggins is a recent graduate of Morehouse College in Atlanta, Georgia.
While attending Morehouse he was a member of the Varsity Football Team and
Track Team. Upon graduation he earned a degree in Business Finance with a minor
in Economics. For two summer and winter breaks he interned in Northern, VA at the
ODAR headquarters of the Social Security Administration. This past summer he
worked for the US Agency for International Development in the Office of Small
Business located in Washington, DC. He is very active in the community and often
tutors children or coaches childrens sports teams. He has always had an interest in
helping others, particularly in the areas of public health and social services. From
this experience abroad he hopes to gain a greater understanding of how he can help
others not only domestically but around the world.
Fun Fact: I hold the Morehouse school record for both the Shot Put throw and Dis-
cus throw.
Amber Taylor

Hometown: Philadelphia, Pennsylvania

Amber L. Taylor is a Georgia native who hails from Clark Atlanta University with a
B.S. in Biological Sciences. She is currently pursuing a Master's of Public Health de-
gree concentrating in Epidemiology through the School of Public Health at Drexel Uni-
versity. She plans to study infectious and communicable diseases with emphasis on
global health. Upon graduating her goal is to obtain a Ph.D. in Epidemiology with a
background in laboratory analysis.
Fun Fact: I received a fellowship from Drexel University.

John Valcourt

Hometown: Brooklyn, NY

John currently holds a BS in Health and Nutrition Sciences from Brooklyn College.
He has served as an intern in a physical therapy clinic as well as the Kingsborough
Community College HELM Center, where he counseled peers, made classroom
presentations and assisted students with day-to-day operations. He is excited to
travel to India and view healthcare procedures in a developing nation.
Fun Fact: I use myspace much more than facebook.
Internship Presentations
Office of HIV/AIDS
USG Secretariat for
Orphans and Vulnerable Children
Public Law 109-95: The Assistance to Orphans and Other
Vulnerable Children in Developing Countries Act of 2005
Shreya Agrawal
The history of PL 109-95
Public Law 109-95 (PL 109-95), The Assistance for Orphans and Other
Vulnerable Children in Developing Countries Act of 2005 (the Act). The Act
was signed into law six years ago to promote a comprehensive, coordinated,
and effective response on the part of the U.S. Government (USG) to the
worlds most vulnerable children. Public Law 109-95 focuses on highly
vulnerable children children who are in dire situations and circumstances.
Tremendous work is being done by USG departments and agencies and
incremental progress being made on behalf of the worlds most vulnerable
children. In 2009, approximately 1,900 projects in 107 countries a total
investment of $2.62 billion are tracked in a publicly accessible online
database.
The history of PL 109-95
Public Law 109-95 (PL 109-95), The Assistance for Orphans and Other
Vulnerable Children in Developing Countries Act of 2005 (the Act). The Act
was signed into law six years ago to promote a comprehensive, coordinated,
and effective response on the part of the U.S. Government (USG) to the
worlds most vulnerable children. Public Law 109-95 focuses on highly
vulnerable children children who are in dire situations and circumstances.
Tremendous work is being done by USG departments and agencies and
incremental progress being made on behalf of the worlds most vulnerable
children. In 2009, approximately 1,900 projects in 107 countries a total
investment of $2.62 billion are tracked in a publicly accessible online
database.
PL 109-95 Call for Projects
Projects assisting highly vulnerable children are included in
the PL 109-95 assistance data base that meet the
following objectives:
1.Provide humanitarian and emergency services to
children in need of immediate help due to natural disaster
or conflict.
2.Help children who are outside family/parental care
including children who are orphaned or living on the street
or in institutions
3.Help children who are being subjected to or are highly
vulnerable to trafficking; the worst forms of child labor;
child marriage; violence, including sexual violence; abuse
or exploitation
4.Provide care, support and treatment to children affected
by HIV/AIDS
5.Strengthen the capacity of the most vulnerable families
and communities to care for and protect their children
6.Identify effective, sustainable interventions to achieve the
preceding objectives through research and evaluation
Evidence Summit on Children
Outside of Family Care
The Evidence Summit on Children Outside of Family
Care is a USAID-led initiative whose overarching goal is
to determine which systems and strategies are required
to support a systematic shift in lower- and middle-
income countries towards evidence-based interventions
that safely and effectively assist children living outside
of family care.
Expected outcomes from the Summit include:
1.Clarity on evidence to inform USG programming
relevant to children outside of family care; and
2.Identification of evidence gaps to shape the USG
research agenda.
The Summit will lead to the establishment of
programming principles for USG assistance to children
outside of family care. An evidence-to-action strategy
will be developed following the Summit to ensure
application of the principles, implement evidence-based
best practices and address critical evidence gaps in
USG-funded initiatives.
This topic will be addressed through a review of the
evidence pertaining to four focal questions:
1.What systems/strategies are most effective in
identifying and enumerating children outside of family
care?
2.What are the most effective systems/strategies/
interventions to assess and address the immediate
needs of children outside of family care?
3.What systems/strategies/interventions are effective for
sustainable long-term care and protection of children
with a history of living outside of family care?
4.What systems/strategies are effective for monitoring
both the children formerly outside of family care and the
impact of the programs and systems intended to serve
them?
Map 1: Number of projects Assisting Highly Vulnerable Children per country Map 2: Number of USC Offices Assisting Highly Vulnerable Children per Country
What would improve coordination
among USG Agencies and
between USG and Partners look like?
Increased knowledge of who is doing what where
Lessons learned regarding the effectiveness of technical
interventions shared and applied
Lessons learned regarding program implementation
shared and applied
Service coverage maximized through collaborative
planning
Common constraints identified and addressed
Countries where USG coordination is successful identified
and reasons for success understood and emulated
In countries receiving assistance from multiple USG
agencies, the package of USG assistance is
complementary and synergistic
Different target groups that are considered
highly vulnerable children
Different types of interventions to assist
highly vulnerable children
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Supply Chain Management for HIV Rapid
Test Kits
Preliminary Assessment of Challenges
Emily Delmotte
Global Health Fellows Program Summer Internship Program
HIV Testing and Counseling Intern
Introduction: HIV Rapid Test
Kit Supply Chain Management
What is supply chain management?
Supply chain management encompasses the planning and management
of all activities involved in sourcing and procurementIn essence, supply
chain management integrates supply and demand management within
and across companies. The Council of Supply Chain Management Professionals (1)
Why is supply chain management important for HIV Testing and
Counseling?
The uninterrupted availability of HIV Rapid Test Kits (RTKs) at the service
delivery point is critical to enable individuals to learn their sero-status and
to ensure access to a continuum of care and prevention services.
What do we know?
Continued anecdotal reports from countries acknowledge a wide range of
supply chain management challenges and regular occurrences of stock-
outs of HIV RTKs at service delivery points.
Research Question:
Describe challenges facing countries in the supply chain management for
HIV RTKs in order to identify gaps and potential ways forward.
Methodology
Data Collection
Surveys were sent to HIV Testing and Counseling (HTC)
and the Supply Chain Management System (SCMS)
representatives from the field.
Survey of Key Informants
All countries with HTC and/or supply chain advisors were
sent the survey by email. These countries represent a
range of population sizes and diverse epidemiological
scenarios. In total, surveys were sent to 34 countries and
responses have been received from 15.
Professional Development
Completed USAID DELIVER PROJECTs Introduction to
Supply Chain Management and Commodity Security
course in preparation for project.
References
1 The Logistics Handbook: A Practical Guide for the Supply Chain
Management of Health Commodities. (2011). USAID DELIVER PROJECT.
Results: Preliminary Analysis
Many sitesreported test kits
stock-out relative to demands for
testing in the field. The average
number of days of stock out vary
considerably from site to site,
but in the range of two weeks to
a few months in some cases.
Conclusions & Future
Directions
Conclusions
Continuing to receive survey results
Preliminary findings suggest that a significant number of
countries experience challenges in ensuring continuous
HIV RTK availability at the service delivery point; the
range of issues, including challenges with forecasting,
distribution, and warehousing, vary across contexts.
Recommendations
Further country-level research is needed to quantify the
types and extent of these challenges, as well as potential
opportunities in order to tailor interventions to most
effectively address gaps and minimize the occurrence of
RTK stock-outs.
Vincent Wong, MSc; Charlene Brown, MD MPH
On-site Managers, Office of HIV/AIDS, USAID
Countries with survey responses
Quotes from survey respondents
Often sites will run out and
may lose between a half to two
days service while stock is
located and delivered. Sites
see a large number of clients
so potentially this could equate
to a substantial number of lost
opportunities or delays in
outreach campaigns, but it is
difficult to quantify.
Mat t hew Fornoff, MPH( c)
HI V/ AI DS Food and Nut rit ion I nt ern
Global Healt h Fellows Program
Manager: Amie Heap, MPH, RD
Tim Quick, PhD, MS
Office of HI V/ AI DS, USAI D
LessonsLearnedandFutureDirection
NACS piogiams aie still heavilyclinicbased Piogiam staff must assist clinic staff to shifttoacomprehensiveNACSprogramthat effectively
engagesthecommunitycomponent in oiuei to achieve goals of impioving livelihoous anu pieventing client ielapse By utilizing community
basedsolutions 0SAIB piogiams can hainess the benefits of sustainable livelihoous effoits anu move away fiom acute malnutiition clinical caie
piogiams Clinic anu piogiam staff aie encouiageu to utilize best piactices anu effective mouels of community extension agentsincluuing com
munity health woikeis agiicultuial extension agents anueconomicstrengtheningopportunities 0iganizational anu goveinment policy shoulu
incieasingly focus behaviorchangeanu determinantsofmalnutritionin an effoit to maximize pievention effoits Strategiccollaborations with
othei uevelopment agencies additionaltrainingsfoi clinic anu community woikeis anu socialmarketingeffoits shoulu be consiueieu as possi
ble methous foi stiengthening anu impioving nutiition feeuing anu livelihoous piogiams
HI V, Nut r i t i on and Food Secur i t y
Li nk i ng Cl i ni cal Nut r i t i on Ser vi ces w i t h Communi t y Economi c
St r engt heni ng, Li vel i hoods and Food Secur i t y Pr ogr ammi ng
Overview
BIv anu nutiition uiiectly anu significantly impact each othei People Living with BIv PLBIv iequiie moie nutiients expeiience al
teieu nutiient metabolism anu pooiei nutiient absoiption than uninfecteu inuiviuuals Nalnouiisheu inuiviuualsespecially piegnant
anu lactating motheis anu chiluien unuei two yeais of agehave a weakeneu immune system anu aie moie susceptible to oppoitunis
tic infections 0SAIB suppoits a compiehensive appioach to impioving nutiition in clinics anu communities The Nutiition Assess
ment Counseling anu Suppoit NACS piogiam evolveu fiom the clinicbaseu Foou By Piesciiption piogiam anu is uesigneu to allevi
ate moueiate anu seveie acute malnutiition anu to link clients with necessaiy clinical as well as community seivices such as agiicul
tuial extension agents community health woikeis anu economic stiengthening mechanisms 0ne of 0SAIBs piominent aieas of focus
is stiengthening the linkage between clinical activities anu these uiveise community piogiams
I NTERNSHI P ACTI VI TI ES
ClinicCommunityLinkage
Issue:In oiuei to piomote sustainable healthy livelihoous anu pievent ie
lapses malnouiisheu inuiviuuals must be effectivelyreferredtoandutil
ize economic strengthening, food security, livelihood and homebased
careseivices in theii communities
Activities:Because the quality anu quantity of seivices available in a given
community vaiies 0SAIB piogiamming focuses on strengtheningthe
healthsystem via the implementation of NACS anu impioving the linkage
between clinics anu communities Identifyinganddocumentingchal
lenges,opportunitiesandbestpracticesandestablishingevidence
baseis the fiist step to scalingup this initiative
Results
Challenges
x Inauequate availability of
theiapeutic anu supple
mentaiy foou anu equip
ment at clinics
x Lack of tiaineu staff pio
fessional anu volunteei
x Accuiacy of iepoiting
fiom clinics CBWs to
piogiam staff
x Basic costs in community
communication tians
poitation etc
Best Piactices
x Woik with anu uevelop
welltiaineu commu
nitybaseu oiganiza
tions
x Becentialize piogiams
to uispeise buiuen of
iefeiials to clinics
x Incoipoiate tiaineu
community membeis
into NACS Quality Im
piovement teams
0ppoitunities
x Focus on community
suppoit poition of
NACS piogiam mouel
x Nonitoi anu scaleup
Quality Impiovement
piactices in clinics
x Collaboiate with othei
aiu oiganizations to
maximize effectiveness
of foou anu nutiition
piogiamming
N
A
C
S
NutritionProfiles
Issue: A snapshotstyle uocument was iequesteu at the countiy
level to pioviue a summaryofundernutrition,HIVprevalenceand
impact,degreeoffoodinsecurity anu piogiess in piogiam scaleup
in countiies implementing NACS activities
Activities: uatheieu statistics on BIv pievalence anthiopometiics
anu chionic foou insecuiity Reseaicheu cuiient piogiamming pio
giess in NACS countiies Relevant activities incluue those ielateu to
NACS, PEPFAR and Feed the Future Aftei final appioval fiom
0SAIBWashington profiles will be disseminated internally to
0SAIB Nissions anu appiopiiate staff
Results
Continuum of Response
Fatumo Guled, MPH Ugochukwu Amanyeiwe, BDS,FWACS,MS
Summer 2011 Intern On Site Manager
HIV/AIDS Community Care & Prevention
Continuum of Care (CoC)
Continuum of care (CoC) is a network that links and
coordinates treatment and support services for PLHIV from
tertiary heath care facility to the household level.
Continuum of Response (CoR)
The concept of continuum of response comprehensively covers
HIV/AIDS prevention to care and treatment. The CoR approach
addresses the lifetime needs of the target population.
Ethiopia site visit
Intern spent two weeks in Ethiopia
as part of an interagency
continuum of care assessment
National
Level
stake
holder
Regional
Health
Bureau
Regional
Hospital
Zonal Zonal
Health Health
Bureau Bureau
Health
Center
Health
Post
Director, Program
manager
X X X
Physician/
Medical
Director/Head
X X
HIV and PMTC
clinical focal
point
X X
Case
Manager/mothers
support Group
X X
Health Extension
worker
X
Lab Personnel X X
Table 1. Ethiopian Health system structure
1
References
Figure 1. Regions
1 JP, PEPFAR core principles for CoR
2 Continuum of care toolkit, FHI
3 Site visit protocol
4 WHO disability report
1
Site Visit Protocol
Sites visited
2 Regional and 1 Zonal
Health Bureau
4 Hospitals and 6 health
centers
Interviewed
Case managers and mother
support groups
Conducted a general facility
observation assessment
Inclusive Disability Programming
Introduction
People with disabilities are at risk of being exposed to
HIV/AIDS, and yet the least likely to receive adequate HIV
prevention information, post-test counseling, care and support.
Therefore it is important to include these marginalized
populations in HIV/AIDS prevention, care /support and treatment
programs.
According to WHO approximately 15% of the population in the
world are disabled and the majority live in developing countries.
During a site visit in Ethiopia I noticed that 2 renovated HIV
health facilities had wheel chair ramps.
Making Inclusive Disability Programming for HIV Real
Accessibility to clinical and reproductive health services to
persons with disability.
Cultural or gender norms and practices that may
increase/decrease risk of infection.
Perceptions of persons with disability in the community.
Availability of HIV prevention information for the deaf, blind and
mentally disabled.
Post-test counseling to accommodate the deaf, blind and
mentally disabled.
Internship activities
Literature reviews
Current services for persons with disability in Sub Saharan Africa
Systematic Literature Search
Evidence on the elements of HIV care and support of PLHIV that has an impact on morbidity and
mortality in the absence of ART
USAID OHA,TLR, CT2 meetings
Participated in PEPFAR-Ethiopia continuum of care assessment
The Continuum of Response Approach
1
Assure and Improve upon the sustainability of
available service systems
Reduced HIV Transmission
Improved access and distribution of services
Improved retention and adherence of HIV + clients in
care/treatment programs
Improved client, family and community health
outcomes
Ensuring Comprehensive Behavior Change
Communication for VMMC in South Africa
Step I: Initial
VMCC
Education &
Counseling
(Group or
Individual)
Key Messages For All Clients:
HIV test results are confidential.
Modes of HIV transmission are...
Methods of HIV prevention are
Risk reduction strategies such as
correct and consistent condom
usage, reduction of multiple and
concurrent partnerships, etc.,
are very important in order to
stay HIV-.
The process of HIV testing is...
Partner testing is very
important.
VMMC is different than traditional MC (use photos/poster to illustrate).
VMMC reduces the risk of HIV infection but provides only partial (60%)
protection.
VMMC does not protect clients partner(s) from HIV.
Circumcised men still need to practice risk reduction strategies.
Correct and consistent condom use is critical (demo male/female condoms).
HIV and STI testing are part of the VMMC evaluation.
Post-op care during the VMMC recovery period requires hygienic wound care
as well as 6-weeks of abstinence from sexual intercourse and masturbation.
Female partners deserve respect/intimate partner violence is unacceptable.
Objective: Ensure that BCC promoting increased risk reduction is reinforced throughout all steps of VMMC service delivery
Step II:
Individual
Pre-test
HIV
Counseling
& Testing
For consenting clients:
We are here to offer mental support
regardless of the outcome of your test.
For clients who dont consent:
You should not hesitate to test for HIV.
There are benefits to knowing your
status.
VMMC is only partially protective
(60%) and must be combined with
other HIV prevention strategies.
You are encouraged to seek testing in
the future; here is information about
other HCT locations.

HIV+ clients can be circumcised,
but VMMC will not reduce the
risk of transmitting HIV to
partner(s).
The healing process may be
longer for HIV+ clients; therefore
proper wound care is important.
Step III:
Individual
Post-test
HIV
Counseling
& Testing
For HIV Positive Clients:
HIV can be treated with ART.
You need to obtain your CD4 Count.
You may still be circumcised if your
CD4 count is greater than (VMMC
target CD4).
VMMC will not reduce the risk of
transmitting HIV to your partner(s).
Your healing process may be longer, so
proper wound care is important.
Use condoms consistently and
correctly to prevent HIV transmission.
Use this referral for active linkage to
HIV care and treatment.
For HIV Negative Clients:
An HIV- test indicates that there
are no HIV antibodies in the blood.
There is a window period, so
follow-up testing after 3 months is
necessary.
VMMC is only partially protective
against HIV, so it is important to
practice other HIV prevention
strategies in order to stay
negative.
You need to develop a risk
reduction strategy that makes
sense for you.

Keep your penis bandaged and pointing upward for 24 hours; then, remove the
bandage and soak your penis daily following these instructions.
Contact this number immediately if you experience any of these warning signs.
Here is information on where and when your follow-up appointment will occur.
Abstinence from sexual intercourse and masturbation is necessary for 6 weeks.
VMMC should be combined with other strategies to prevent HIV transmission.
Step IV:
Post-
operative
Counseling

VMMC is only partially (60%) protective.
Abstinence from sexual intercourse and masturbation is necessary for 6 weeks.
Please contact this number immediately if you experience any problems or
adverse events.
Here are male/female condoms for use once you reengage in sexual activity.
Step V:
Routine
Follow-up

World Health Organizations Minimum Package of Services
USAID supports VMMC programs that are consistent with the World
Health Organizations Minimum Package of Services guidelines for
medical male circumcision. These guidelines specify that VMMC must
be provided as part of a comprehensive package of services including:
HIV testing and counseling
Screening and treatment for sexually transmitted infections
Provision of male and female condoms and promotion of their
correct and consistent use
Promotion of safer sex practices and risk reduction counseling
Male circumcision or surgical removal of the foreskin
Active linkage of HIV+ clients to care and treatment
Phases of BCC for VMMC Service Delivery

Phase I: Demand Creation

Phase II: Service Delivery
Phase III: Ongoing Risk Reduction
Overview:
VMMC has the potential to dramatically reduce men's risk of acquiring
HIV from their female sexual partners. Three randomized controlled
clinical trials strongly suggest a protective effect of 60 percent for the
insertive partner of heterosexual relationships. Another recent South
African study resulted in a 55% reduction in HIV prevalence and a 76%
reduction in HIV incidence in circumcised men after scaling up VMMC
coverage from 10% to 54% over a period of three years.

VMMC cannot, however, eliminate the risk of acquiring HIV entirely.
Therefore, USAID, in accordance with PEPFAR, promotes a particular
type of MCvoluntary medical male circumcision (VMMC)as part of
a larger, combination HIV prevention portfolio. The VMMC service
delivery package supported through PEPFAR follows the
recommendations of the World Health Organization and includes a
comprehensive communications package which is designed to
reinforce risk reduction messages through comprehensive behavior
change communication (BCC).

PAMALA HORUGAVYE - PEPFAR, USAID, GH/OHA/TLR
The Importance of the Message
Re-explore understanding of HIV and
correct any misconceptions.
Provide psychological support to any
clients in distress.
Encourage and offer assistance with
disclosure to partner(s).
Encourage partner/family testing.
It is important that all malescircumcised or notreduce their risk of HIV infection by
limiting their number of sexual partners, using condoms consistently and correctly, and
seeking prompt treatment for STIs. Therefore, all successful VMMC programs must rely on
comprehensive behavior change communications (BCC) to inform clients, their partners, and
their communities that the procedure only provides partial protection against HIV infection
and encourage them to use combination HIV prevention methods.

YabseraMarcosMPH
GlobalHealthFellowProgram
Summer2011
PMTCT/PediatricHIVIntern
B.RyanPhelpsMD,MPH
Onsitemanager,Officeof
HIV/AIDS,USAID
Background:
SincetheHIVepidemicwasfirstreportedovertwodecadesago, preventingthetransmissionofthevirusfrommothertochild(PMTCT)remainsone
ofthehardestinterventionstoimplementandmonitor.
While biomedical innovations have made it possible to succeed in preventing the vertical transmission of HIV from mother to child, high loss to
followupofmothersandbabiesalongthePMTCTcascaderesultsinafailuretoachievefullsuccess.
Example:PercentageofinfantsborntopregnantwomenlivingwithHIVwhoreceivedantiretroviralprophylaxisforpreventing
mothertochildtransmission,2005,2008and2009
Project:LiteratureReview
Literature on retention of mothers and babies within PMTCT
programs available on PubMed, PsycInfo and MEDLINE were
searched. Four hundred and thirty peer reviewed articles were
produced and categorized to allow for the selection of those that
addressedlosstofollowupalongthePMTCTcascade(N=48)
Example:ARTInitiationofinfantstestingpositiveforHIV Intheabsenceofanyintervention:3045%ofchildrenborntoHIV
positivemotherswillbecomeinfectedinutero,peripartumor
throughbreastfeeding
In the absence of treatment: 35% of those children will die before
theyturn1
InitialFindings:ChallengestoachievingfullRetentionAlongthePMTCTCascade
Sociocultural
Underuseofexistingservices:healthcareseekingbehavior
Seasonalmigration
Stigmaassociatedwithdisclosuretofamilymembersand/or
communitywhichkeepsmotherfromreturningtositefortreatment
[forherselfandherbaby]
Infrastructure/HealthSystem
Humanresourceconstraints
Highturnover
Poorrecordkeepingatsitehinderslongitudinalfollowupand
monitoringofmotherbabypairs
Poortwowayreferralsystemsfortrackingpatientswhochange
treatmentsitesorarereferredtonewsites
ResearchOngoing:AbstracttobesubmittedtotheJournalofthe InternationalAIDSSocietyonSeptember2nd,2011
OpportunitiesIdentifiedThusFar:CommunityActiontoImproveRetentionAlongthePMTCT
Cascade UsingCommunityActiontoavoidmissedopportunitiesandmitigatelosstofollowup:
IdentifymothersandbabiesinneedofcareandtreatmenttostrengthenpatienttrackingandmonitoringEducateandengage/mobilizemembersof
theircommunityTracedefaultersaftermissedappointments
CommunityActionideallyintegratestheeffortsofCommunityHealthWorkers,TraditionalBirthAttendants,PeerCounselors,AdherenceCounselors,
MentorMothers,CommunityEldersandFamilyMembers
Addressing Loss to Follow Up
Discussing challenges to and strategies for retaining mothers and babies in care
and treatment along the PMTCT cascade
Source: WHO, UNAIDS and UNICEF Towards Universal Access: Scaling up priority HIV/AID interventions in the health sector - Progress Report 2010, WHO, Geneva, September 2010
Source: UNICEF Analysis of Ministry of Health Data Collected between August and December 2008
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Child Safeguarding
Child protection is a term used to describe the actions that individuals,
organizations, countries and communities take to protect children from
violence, abuse, and exploitation. Child safeguarding refers to all activities
intended to prevent and respond to abuse, exploitation, and neglect by
those charged with their care and should be understood as distinct from
child protection programming, which addresses broader range of
protection concern.
Over recent years, there has been an increasing recognition of the global
nature of child abuse, and growing acceptance of the potential risks to
children of adults working in positions of trust. International aid
organizations often work with vulnerable populations in unstable and
impoverished communities across the globe. Vulnerable populations
include highly vulnerable children, women, disaster-affected populations,
internally displaced persons, and persons living in extreme poverty.
Research indicates that persons with a history and proclivity to abusing
children will often seek positions of power and authority in order to gain
access to vulnerable individuals and will often seek employment within
countries social welfare, protection, and judicial systems too weak or
underdeveloped to protect children and other vulnerable populations
against abuse and exploitation. Recognizing that USAID works with very
vulnerable populations and that USAID missions are often located in
countries with weak protection systems, there is a need to develop a
common understanding of child protection issues through trainings,
develop effective policies and standards to prevent and respond to
violence, implement a code of conduct outlining clear roles and
responsibilities of those working with children to improve
professionalism, increase accountability, and minimize reputational risk
and legal liability for the agency.
Child Safeguarding Survey
Preliminary Findings
Annually, between 500 million and 1.5 billion children worldwide are
estimated to experience violence
In 2002, an estimated 150 million girls and 73 million boys under 18
experienced forced sexual intercourse or other forms of sexual violence
Approximately 1.2 million children are trafficked each year into exploitative
work
Approximately 150 million children aged 5-14 are engaged in child labor
Supplemental Findings
A child safeguarding survey will highlight the issues that directly relate to
USAID programs and missions that will create a context that will supplement
the USAID child safeguarding training and asses the extent of staff awareness
of the existing rules and regulations
Child Safeguarding Training
Why its important
Currently there is no child protection training provided for USAID personnel
and there is a very low level of awareness of existing child protection
safeguards. Employees may be unaware of their obligations to report child
abuse and may not know how to recognize and respond to concerns about
child abuse. Policies and procedures put in place by organizations to keep
children safe are only effective if people are aware of them. Similarly,
everyone in contact with children has a role to play in their protection. They
can only carry out this role confidently and effectively if they are sufficiently
aware of child protection issues and have the necessary knowledge and skills
to keep children safe.
What is included
An introduction to the USAID child safeguarding policy and procedures
An outline of the code of conduct and what that means to the employee
A briefing on what child abuse is, how to recognize it, who is vulnerable and
differentiating between appropriate and inappropriate behavior
An explanation for why it happens, where it can occur, and how to identify
potential risks
A guide on how to respond to concerns, where to look for further information
or technical assistance, and the necessary steps to take
Practical case experience and examples
Strengthening Child Protection
Systems in Tanzania
Violence Against Children in Tanzania
Tanzania is one of the first countries in Africa to undertake a National Study on
Violence against Children. The results provide national estimates which
describe the magnitude and nature of violence experienced by both girls and
boys. It highlights the particular vulnerability of girls to sexual violence and the
negative health consequences of these experiences in their childhoods and
beyond. Violence against children is a major threat to national development.
The overall goal of the program is to strengthen the protective environment for
vulnerable children in Tanzania by building a child protection and social welfare
system through the development and implementation of legislation, policy and
service provision.
Key Strategies
Strengthen the understanding of child vulnerability to include a focus on
child protection
Advocacy for policy and legal reform with appropriate and timely
provision of services to most vulnerable children
Institutional capacity building of partners
Social welfare systems strengthening
References
Multi-Sectoral National Prevention
and Response Plan
PEPFAR/USAID and UNICEF Collaborations
Build an effective child protection system
Strengthen legal and regulatory frameworks
Social welfare systems strengthening and build institutional capacity
Strengthen partnerships with the relevant government ministries
Development of a national costed plan of action for vulnerable children
Piloting implementation of the comprehensive plan in selected districts
Strengthening the child protection component of services for vulnerable
children
Future Directions
Keeping Children Safe-Standards for Child Protection. Second ed. 2007..
USAID Policies and Procedures to Prevent And Respond to Abuse of Children by USAID Staff,
Working Paper, Oct 2010.
Violence Against Children in Tanzania. United Republic of Tanzania August 2011.
Working Together to Stop Violence against Children.
Levels
National
Regional
District
Community
Civil organizations
Key Sector Representatives
Ministry of Home Affairs (police force)
Ministry of Constitutional and Legal Affairs
Ministry of Education and Vocational Training (safety in schools)
Ministry of Health and Social Welfare (health, trauma, psychosocial services)
Ministry of Community Development, Gender and Children
Commission for HIV and AIDS (prevention, care, and treatment programs)
Prime Ministers Office (Regional administration and local government)
Child Right Forum (civil society organizations)
Prevention with Positives (PwP) and
Positive Health, Dignity and Prevention
(PHDP) in Community Settings
Prevention with Positives (PwP) and
(PHDP) in Community Settings
PwP and PHDP in Mozambique
In Mozambique, most prevention strategies
currently target persons who are either HIV
negative or unaware of their HIV status.
However, there has been an increased
awareness in recent years that prevention
efforts need to address not only risk
reduction among these individuals but also
the adoption of preventive measures by
persons living with HIV/AIDS (PLHIV). There
is increased recognition that a change in the
risk behavior of a PLHIV will have a much
bigger effect on the spread of HIV than an
equivalent change in the behavior of a HIV-
negative person. This shift in thinking about
prevention poses both opportunities and
challenges by expanding understandings of
participation and human rights for PLHIV in
determining prevention strategies and
expanding beyond clinical settings into
communities and national policy.
Internship Activities
(1)Support interagency technical assistance (TA) PwP visit to Mozambique
(2)Provide literature on evidence-base for community PwP activities
(3) Assist in USAID Prevention Guidance document
(4) Future backstop for C-Change PHDP study in Mozambique
Research Question: How to integrate
PwP and PHDP in community settings?
Methodology
Figure 2. PHDP Model
References
Conclusions & Future Directions
There currently exists a sound, evidence-base for several community-based PwP and
PHDP intervention strategies. However, there are several gaps and challenges, most
notably surrounding monitoring and evaluation of community activities in relation to
current PwP and PHDP indicators.
These challenges are even more pronounced in practice. Local partners recognize the
necessity of situating PwP and PHDP activities within communities, but lack a coherent
and integrated framework that can be evaluated and scaled up.
The forthcoming C-Change study will spur understanding of the challenges related to
community-based PwP and PHDP activities. This could potentially lead to innovative
solutions to human resource and monitoring challenges.
The intern will backstop further data collection and analysis in the C-Change study in
Mozambique.
Figure 1. Map of Mozambique
1 UNAIDS (2009) Positive Health, Dignity and Prevention: Technical Consultation Report.
1
UNAIDS, 2010
Figure 3. Community Intervention Points for PHDP
(1)The TA visit was an interagency collaboration designed to provide assistance
for PwP and PHDP technical considerations for the upcoming country
operational plan. Team members conducted clinical and community site visits
in three Mozambican provinces. A one-day workshop was held between the TA
team, Mozambique USG, government, civil society groups, and local partners.
(2) and (3) Literature reviews were conducted focusing on establishing an
evidence base for community PwP and PHDP activities. In particular, these
reviews focused on a) the role of media and civil society organizations; b)
scaling up community services; c) referral to and from communities; and d)
interpersonal communication strategies.
(4) The C-Change study is a three-country study conducted with AED/FHI
focusing on assessing community perceptions of PwP and PHDP. Formative
work has been conducted and a study baseline has recently been completed.
Further data gathering and analysis are planned over the coming months.
Findings
Mozambique TA Visit Literature Reviews C-Change Study
Local partners include community
PwP activities, but have difficulties
implementing all principles and
components in a cohesive and
coordinated strategy
Communication and referral
between community and clinic
settings is often constrained by a
number of local and systematic
challenges
There is little guidance for
monitoring and evaluating
community-level activities
Existing community health
workers and PLHIV networks can
potentially bridge some of these
challenges and gaps
Evidence exists for social and
behavioral-focused
interventions, including:
Local media
Peer networks/interpersonal
communication strategies
Mobile outreach services
These components are often
packaged as community
mobilization secondary to
clinic-based interventions.
There is a literature gap on
their independent effects and
challenges related to
evaluating interventions
according to traditional
PwP/PHDP indicators.
Formative work has been
completed and a study
baseline will soon be
completed, with analysis
focusing on:
(1)Contextual barriers for
PwP/PHDP clinical services
(2)Clarity and integration of
PwP/PHDP in PLHIV network
groups
(3)Linkages between clinic and
community PwP/PHDP services
(4)Community awareness and
consensus on PwP/PHDP
Ugochukwu Amanyeiwe, BDS, FWACS, MS Ugochukwu Amanyeiwe, BDS, FWACS, MS
On On- -site supervisor, Office of HIV/AIDS, USAID site supervisor, Office of HIV/AIDS, USAID
Community Care and Prevention Community Care and Prevention
Bryan Shaw, MA, MPH Bryan Shaw, MA, MPH
GHFP Summer Intern GHFP Summer Intern
Community Care and Prevention Community Care and Prevention
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Opportunities & Lessons:
Mainstream HSS throughout PEPFAR portfolio
Know your epidemic, Know your response
Evidence-based prioritization
Management systems for internal review
Know your systems
Mapping target populations; resources; HRH;
organizational/governance capacity; supply and
demand; coordination and linkages
The continuum of HIV/AIDS needs requires a
multisectoral continuum of response
Provide incentives for quality outcomes
Resource needs estimation
Cost effectiveness studies of different CoR models
Invest in innovation
Integration with a GHI perspective
Kate Wilson, MPH
Strategic Planning, Evaluation, and Reporting,
Office of HIV/AIDS, Bureau of Global Health
On Site Manager: Pamela Rao, MBA, MA, MPH
The Continuum of Response Lens
The primary goal of a Continuum of Response (CoR) approach is to provide clients and their families with essential prevention,
care/support, and treatment services to reduce HIV transmission and disease progression and to maximize health outcomes. In doing so,
strategies are defined locally based on epidemiological, health and social needs data of target populations: such as, young women
through pregnancy and motherhood with infant and young children; MARPs IDUs, CSW, and MSMs; and at risk adolescents and adults
clients and their families.
The CoR approach is expected to:
Assure and improve upon the sustainability of existing service systems
Improve access and distribution of services
Reduce HIV transmission
Improve retention and adherence of HIV+ clients in care/treatment programs
Improve client, family and community health outcomes
The CoR approach should be set within an organized and coordinated network system of community and facility based services and
providers. The CoR builds on existing public and private structures (including government, FBOs, NGOs, CBOs, private) to establish a
functional network with active tracking and referrals procedures, and ideally collocated or closely linked service sites.
National and local laws, policies and regulatory frameworks should be aligned in order to support a CoR approach. In doing so, the
PEPFAR USG team will need to work in close collaboration with host governments and other international organizations/donors to
leverage and build on existing services in order to establish an integrated, comprehensive system of sustainable services based on
population-based health and social service needs.
1
At the individual level, a continuum of response means that
the government orchestrates a health system that identifies
populations at risk and follows them, addressing through all
their needs through their lifespan -- for prevention, and then
for care and treatment if they become infected. And it
means following them through all their non-HIV needs as
well.
2
Primary Health Care
P
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MOH MOLISA Department of
Social Protection
MOLISA Department of
Social Evils Prevention
Continuum of Prevention and Care
Social Support System
Village health workers Social workers Collaborators
Figure 1. Continuum of Needs
3
ETHIOPIAN HEALTH TIER SYSTEM
General Hospital
1-1.5 million
Health
Center
40,000
Primary Hospital
60,000-100,000
Health center 15,000-25,000 -
Health Post
3,000-5,000
-
Tertiary level
Secondarylevel
Primary
Care Unit
URBAN RURAL
Specialized
Hospital
3-5 million
Recommended two-pronged approach:
1.Larger health systems strategy to have a sustainable HIV/AIDS response
(long-term).
2.PEPFAR specific strategy to mainstream a externally funded vertical
response to a government-owned sustainable response (short-term).
SWOT Analysis: HIV/AIDS Continuum of Care
7
Figure 2. HIV Prevention to Care Continuum
4
Figure 4. Organization of GOE health care system
6
May 8-20, 2011
PEPFAR Vietnam HSS Portfolio Review
August 1-12, 2011
PEPFAR Ethiopia Continuum of Clinical Care Assessment
References
1. Appendix 3: Core Principles for the Continuum of Response: from prevention to care and treatment, PEPFAR FY11 COP Guidance Appendices
2. PEPFAR Support for a Country-Owned Continuum of Response to HIV/AIDS, Ambassador Eric Goosby, May 2011
3. Presentation: HIV/AIDS Continuum of Prevention to Care, Minh Ngoc Nguyen, PEPFAR Annual Meeting, May 2011
4. Presentation: Know your Epidemic, Know your response, Build your systems, Pamela Rao, First Global Symposium of Health System Research, Nov. 2010
5. Presentation: Debrief to PEPFAR Vietnam, Pamela Rao, Michael Friedman, and Kate Wilson, PEPFAR Vietnam Interagency HSS TDY, May 2011
6. Presentation: Overview of the Ethiopian Health Sector, Carmela Green Abate, Continuum of Clinical Care Assessment, August 2011
7. Presentation: Dir Biabr Anbessa Yasir, Lara Stabinski, Diana Frymus, Kate Wilson, and Tesfayi Gebreselassie, Continuum of Clinical Care Assessment, August 2011
Figure 3. Support and Linkages for CoPC in Vietnam
5
Office of Health,
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Office of Population and
Reproductive Health
Lessons Learned & Future Goals
FISTULA AND POSTABORTION CARE INTERN (GH/PRH/SDI)
LAUREN ARRINGTON, CNM, MSN
OSM: CAROLYN CURTIS AND ERIN MIELKE
OBJECTIVE
Write article on Postabortion Care (PAC) for
publication in an international peer
reviewed journal
OBJECTIVE
Participate in monitoring and evaluation of
Fistula Care Program
A C T I V I T I E S
O V E R V I E W
O V E R V I E W
A C T I V I T I E S
PAC decreases preventable maternal deaths
by providing a set of comprehensive services
that include emergency obstetrical care for
complications related to unsafe and
spontaneous abortions and access to family
planning information and commodities.
The Three Core Components of PAC
Reviewed evidence from PAC research
compendium: What Works: A Policy and
Program Guide to the Evidence on
Postabortion Care with research from 1994-
2004 and compendium update with research
from 2005-2011
Served on Research Working Group at PAC
Connection Meeting Aug. 19th
Attended PAC Consortium Meeting June 14th
Compiled list of journals for article submission
Submitted article draft to OSM
Obstetric fistulas are most often caused by
obstructed labor and lack of access to
emergency obstetric care. Through a host of
innovative projects USAID works with Fistula Care
and other partners in the field to provide fistula
repair services, counseling and strategies for
prevention.
Reviewed and edited briefs on Fistula Care
Participated in Fistula Care Project
Assessment with GH Tech, USAID and
EngenderHealth
Reviewed program reports
Attended presentation : On-the-job
companion training for fistula surgeons at
Global Health Council
Obtained certificate in Health Systems from
the Global Health eLearning Center.
The Fistula and Postabortion Care Internship has been an excellent opportunity to gain knowledge about USAID and
implementing partners and develop technical skills in global health. The internship will be extended until September 30
th
to
continue revisions of the PAC article and participate in the Fistula Care Evaluation. Within global health there are many
opportunities for the intern to apply her clinical skills and develop new skills related to program evaluation, research and
service delivery in developing nations. The intern hopes to continue pursuing educational and work related opportunities that
strengthen and expand her skills in the above areas.
PerformanceBased
IncentivesforSupplyChains
TaraVecchioneGH/PRH/CSL
CaseStudies
IMPROVINGCONTRACTORPERFORMANCE
IntegratePerformanceBasedIncentivesintoexisting
contractswithpartners
Explorestructuringnewcontractswithincentivesor
awards
Createbalancedscorecardsforprogramsand
incorporatehighorderkeyperformanceindicators
Shareperformanceinformationtransparently
IMPROVINGINCOUNTRYPERFORMANCEAND
CAPACITY
ExplorePerformanceBasedContractswithcentral
leveldistributorsincountry(CentralMedicalStoresor
privatewholesalers)
Createbalancedscorecardswithhighorder
performanceindicatorsthatmeasureendtoend
results
Allowforflexibilityinapproachtoallowfor
innovationandadaptationtocountrycontext
IMPROVINGCAPACITYATTHEFACILITYLEVEL
IntegratesupplychainindicatorsintoexistingPBF/PBI
programsthatmeasureperformanceatthefacility
level
Trackimprovementsinsupply
Studywhatchangesweremadetosupplychainor
inventorymanagementatfacilitylevelwiththe
presenceofperformanceindicators
DOD:PERFORMANCEBASEDLOGISTICS
Recommenduseoffivehighlevelindicatorsto
measureperformancewhichcanbeadaptedbasedon
context:
PERFORMANCEBASEDINCENTIVESTOPRIVATE
SECTORWHOLESALERSINTANZANIA
CurrentstudyfundedbyGates
providingincentivepaymentsto
drugwholesalersatcentrallevelto
distributeessentialmedicinesto
remoteareapharmaciesandADDOs
Wholesalerperformanceismeasuredbydrug
availabilityatthedispensingoutletwhichismeasured
byanindependentlocalresearchgroup
BALANCEDSCORECARD:AFGHANISTAN
LevelsofImplementation PotentialActions
KeyConsiderations:
MergingPBIPracticesfromGlobalHealthandPrivateSectorSupplyChains
ALIGNMENT
BestPracticeincommercialsectorto
alignsupplychainincentivesofmultiple
actorssoallworkingtowardssame
systemgoals
Whereareasofmisalignedgoalsare
noted,canintroduceincentivestore
align
Importanceofaligninginformation;
makingforecast,demand,supplydata
availabletoallactors
PERFORMANCEMETRICS
Useasetofbalancedmetrics:most
commercialcompaniesuseabalanced
scorecardtomeasureperformance
Usehighordermetrics/indicatorsfor
incentivesinordertoallowforflexibility
andinnovationaswellaseaseof
understandinganddatacollection
Involvestakeholdersinselectionof
metricsandensuremutual
understandingofhowtheyare
measured
TYPEOFINCENTIVES
Ensurethoseresponsiblefor
performancearemotivatedbythe
incentive(doesnothavetobe$$)
Payforincrementalcoverageversuspay
forachievementofathresholdortarget
Bettertoincentivizegroupsthan
individuals
Positiveincentivestendtoworkbetter
butcanhavedisincentivessuchaslossof
currentorfuturecontracts,reductionin
funding,etc.
TYPEOFCONTRACT:
Ensurenottoomuchfinancialrisk
Costpluscontractswithincentivesor
awardsuptoanadditionalpercentageor
sumbasedonperformance
Fixedpricecontractsplusincentivesor
awards
Percentageofincentivesforstructural
improvementsandpercentagetobe
usedasbonuses
Awardingapercentageofshared
savings
VERIFICATIONOFRESULTS
Canuseexistingdatacollectionsystems
butneedtoverifywithindependent
evaluator(preferablylocaltobuild
capacity).
Importanttomonitorandevaluate
whethertherehavebeenunintended
effects
Canhavepenaltiesforinaccurate
reportingtodiscouragegaming
Makingresultstransparentacross
actorscanencouragecompetitionand
learning
AvailabilityofFamily Planning by
Commodity
NGOscontractedto
providehealth
services
Independently
evaluatedon
performanceusing
balancedscorecard
BSCincludedFP
availabilityanddrug
availability
1. OperationalAvailability
2. OperationalReliability
3. Cost per Unit Usage
4. LogisticsFootprint
5. LogisticsResponse Time
Conclusions/Recommendations
RESEARCHGAPS
Determinewhetherinterventionstoclarifygoals,
measureperformance,andprovidetransparentresults
performaswellasthosethatincludeincentives
Needmorelongtermstudiestoseeifperformance
and/ormotivationissustained
Nostudiesorcurrentprogramsexistforperformance
basedincentivesinpublicsectorsupplychains
Needtodocumentfailures(whichtendnottobe
published)aswellassuccesses
IDEASFORPILOTS
ContractingatCentralLevelhaspotentialforhighimpact
becausecaneffectallotherlevelsdownstream.
Goodfitforpilotwouldincludesmallcountrywithpolitical
will,andpotentiallyanexistingPBFmechanisminplacein
othersectorsORcentralmedicalstoresthatisrunprivatelyor
functioningasaparastatal.
Maywanttoinitiallyfocusonacoupleofareaswithpoor
supply/highlevelsofstockouts
Performancemeasuresshouldincludesomemixofquality,
costs,timeliness,availability,reliabilityandinformation
accuracy.Exactmetricsmaybecontextspecificandbasedon
identificationofproblemareas,butshouldbebalanced!
Centrallevelsshouldbeevaluatedonavailabilitydownstream
thiscanbuildincountrycapacitytosolveproblems.
SupplyChaindivisionsshouldadvocateformoreinclusionof
indicatorsinexistingPBIprogramsaswell
POTENTIALFORSUCCESS
Potentialtoachievemeasurableandimmediatecostsavings
tosystemwithimprovementinperformance
PBIapproachcanencourageinnovationandflexibilityin
problemsolvingbasedonlocalcontextsandknowledge
Clarifyingroles,goalsandperformanceexpectationsissystem
strengtheninginitself
Mayachieveintegrationifperformanceismeasuredsystem
wideandNOTforagivengroupofcommodities
Buildsownershipandinstitutionalmemoryofsystems
improvementsandachievements
Insupplychain,improvedperformancemaymean:fewer
stockouts,betterplanning,lesswastage,fasterresponse
timesandimprovedinformationflows
International Interns
GenderBasedViolenceandHIV/AIDS
Intern:ElizabethDaube,MSW
InternshipSite:TheAIDSSupportOrganization,Uganda
OnSiteManager:TinaAchilla
Background
Genderinequalityisincreasinglyviewed
asoneoftheprimaryfactorsfuelingthe
HIV/AIDSepidemic.InUganda,sexual
andgenderbasedviolence(GBV)is
incrediblycommon:Morethan2/3of
womenreportexperiencingviolence
fromintimatepartners(UDHS2006).
Womenlackthepowertoprotect
themselvesfromHIVviacondomuseor
monogamousrelationships,andthey
cannotdiscloseHIVpositivestatusto
partnerswithoutfearof
violence/abandonment.Femalesare
physicallymorevulnerabletoHIV
infectionandoftendiscovertheirHIV
statusfirstviaantenatalclinics.
TheAIDSSupportOrganization(TASO)is
attemptingtoaddresstheseissuesasit
providesHIVpreventionand
managementservicesat11centers
throughoutUganda.Gender
MainstreaminghasbeenpartofTASOs
strategicplansince2008,butthe
initiativehasnospecificfundingor
allocatedstaff.
Objectives Activities
KeyDeliverables
GBV/HIVCurriculaandTrainingMaterials
UpdatedTASOGenderMainstreaming
Overview&FrameworkforImplementation
SupplementaryGenderMainstreaming
Tools/Resources:
o DraftofaSampleGBVCaseManagement
Form
o PaperonHIVPEPforRapeSurvivors
o SummaryofInterviewswithPotential
KampalaareaGBVPartners
Tostrengthenplanningand
implementationofTASOsgender
mainstreaminginHIVprograms
Toidentifystrategiestoaddress/reduce
genderbasedviolenceamongclientsserved
byTASO
y Producedcurriculaandprovided
interactivetrainingonGBV,HIVand
waystohelpto100+clientsandstaff
ClientGroups:Focusongender
norms,humanrights,healthy
relationships,peersupport
techniquesordramaskits
GuluCounselors:Focusoneffectsof
trauma,bestsupportpractices,GBV
referralneeds
y EvaluatedTASOGender
Mainstreaming
MetwithGenderCommitteesat
Entebbe,Gulu,Mulago
Reviewedavailablegender
mainstreamingdocumentation
ConsultedlocalGBVexpertsand
externalresearch
Compiledobservationsand
developedpolicy/programming
suggestions:Strengths/Scopeof
Work,Challenges/Gaps,
Recommendations
ChallengesandLessons
Languageandliteracybarrierswithclients
Communicationandorganizationalculture
differences
Resourcelimitedsetting
UgandangendernormsandGBVservices
provisionpolicies
Usefulgenderequalityframeworks,suchas
humanrights
GendermainstreaminginHIV/AIDS
preventionandcare
Picturedatleft:AGBV/HIV
trainingwiththeTASO
MulagoDramaGroup,
whichiscomprisedofHIV
positiveclientvolunteers.
Duringtraining,members
practicedagenderfocused
skit.
Recommendations
ClarifyrolesandresponsibilitiesofGender
Committees;considerdesignating1personas
acenterlevelGMcoordinator
CreateformalguidelinesandtoolsforGBV
casemanagement:
o HIVPEPandmedicalmanagementofrape
o Casehistoryandreferraldocumentation
AssessM&Eproceduresandindicators:
increasefocusonqualityofgenderfocused
activities,notquantity
Increasestaffunderstandingofsecondary
trauma,burnoutpreventionandselfcare
Acknowledgements:ThispracticumwascoordinatedbyTheAIDSSupportOrganizationand
theGlobalHealthFellowsProgram,whichoperatesviaacooperativeagreementbetweenthe
UnitedStatesAgencyforInternationalDevelopmentandthePublicHealthInstitute.
GenderBeliefs
Womenas
property,not
people
Womenastools
ofmalesexual
satisfaction
Menassexually
aggressive
witharightto
sex
Menasstrong
decisionmakers:
economically,
socially,politically
Effects
Increased
prevalenceofrape,
domesticviolence
andotherGBV
Decreasedfemale
power:tocontrol$,
tousecondoms,to
makehealth
decisionsforfamily
Womenblamedas
vectorofdisease
Concurrentsexual
partnerscommon
formarriedmen
HIVImpact
ABCprevention
messagescannotbe
successfullyused
Womenfear
violence&
abandonment,so
fewertest/disclose
Mendonttestto
avoidlookingweak,
butmayinsist
partnershares
ARVs
Testing/treatment
reduce,HIV
infectionsincrease
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Summer Internship Overview
India Areas of Fieldwork
Acknowledgement
Achievements Public Health Team Assessment
Observed the functions of
not for profit government
organization (NGO) which
provides services to
underserved rural and
urban areas of various
states in India.
Public Health Team in the field
Gained knowledge of public health problems such as
poor sanitation, unclean drinking water, and issues
related to tuberculosis, malnutrition, and HIV/AIDS in
rural and urban areas of India.
Learned how government funds are allocated to
various public health issues and how prejudices
influence who receive funding.
Child Family Health International (CFHI) in collaboration with USAIDs Global Health Fellows Program provided a two
month internship which combined service-learning opportunities in public health and clinical settings throughout urban
and rural areas of India. Interns were allowed to witness collaborative efforts between government, charitable, and
non-profit organizations aimed at improving the delivery of public health services, policy regulations, and
management of infectious diseases. Rotations covered historical cities such as Jaipur, Alwar, and Chandigarh where
interns observed environmental sanitation, social reforms, and immunizations through education, training, and in-
person interviews.
Public Health Team Activities
In India, 25% of the
population live below the
poverty line. Communicable
diseases account for 38% of
the disease burden which is
distributed unevenly
throughout the country.
State of
Rajasthan
Jaipur
Alwar
State of
Punjab
Chandigarh
State of Delhi
Delhi City
Clinical Team Activities
Rotations consisted of
observing healthcare
services provided by public
government facilities and
private medical facilities
Rotations showed the
disparities and
discrepancies between the
health services provided
between government and
private medical facilities
The GHFP Fellows would like to thank the CFHI staff for the wonderful experience we had in India.
Conducted community
outreach with several
public health organizations
throughout India. These
activities consisted of
visiting rural villages with
organizations who
specialized in sanitation
improvements, NGOs
who provided services to
improve infant mortality,
and government
organizations who
providing funding for
HIV/AIDS consultation.
Participated clinical
rotations in the state of
Delhi to observe the
various form of health
services offered in the
state of Delhi and India.
Findings derived from quantitative data that is collected by
mother NGOs is often analyzed but is not facilitated in the
improvement of public health programs
Public health programs have made a considerable impact
within their targeted communities. Unfortunately,
sustainability is an issue where most programs only
survive one or two years.
The sanitation reform has provided citizens in rural areas
and slums with innovative and environmentally
sound solutions to alleviating open defecation.
The disease burden consist of high prevalence of
tuberculosis and leprosy. An estimated 2.4 million
Indians are living with HIV/AIDS throughout the
country. The vast majority of the public funds for health
services have been used mostly for medical services
instead of public health initiatives.
Injection Drug Use Drop-
In Center
Public Health and Community Medicine
in India
Ramotali Coker, Darryl Fields, and Amber Taylor

Summer 2011 Internship Program

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