United States Agency for International Development (USAID)

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UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID)

The United States Agency for International Development (USAID) is an independent government agency that provides economic development and humanitarian assistance to advance U.S. economic and political interests overseas. This type of activity started in the United States in 1947 with the Marshall Plan, the forerunner of current development programs. President John F. Kennedy established the USAID in 1961 to promote development around the globe. The agency is currently based in Washington, with field missions abroad. USAID programs have provided aid in Africa, Asia and the Near East, Latin America and the Caribbean, Central and Eastern Europe, and the independent states of the former Soviet Union. The structure of the agency is shown in Figure 1.

To promote development, USAID partners with other U.S. government agencies, U.S. businesses, private voluntary organizations, indigenous groups, and universities. USAID contracts with more than 3,500 U.S. firms and over 300 U.S. based private voluntary organization (PVOs).

The agency works in five principal areas crucial to achieving U.S. foreign policy objectives: promoting economic growth; advancing democracy; delivering humanitarian assistance to victims of famine and other population-wide emergencies; protecting the public's health and supporting family planning; and protecting the environment.

Figure 1

When considering a nation for development assistance, USAID looks at a number of important factors, including strategic interests, a country's commitment to social and economic reform, and a willingness to foster democracy.

FOREIGN AID

What happens in the developing world has a dramatic impact on America's economic prosperity, environment, and public health. The fortunes of the United States are closely linked to those of other nations. Air pollution, the AIDS (acquired immunodeficiency syndrome) epidemic, rapid population growth, and deforestation are only a few examples of the many problems in the developing world that touch American lives. U.S. development programs reflect the nation's compassion for the poorest of the poor and America's interest in a more prosperous and peaceful world.

Foreign assistance is seen as an investment in creating the markets of the future, preventing crises, and helping advance democracy and prosperity. Foreign aid creates U.S. jobs and advances American economic well-being.

Economic and humanitarian assistance is also an investment in the future of America's economy. Foreign assistance fosters an enabling environment for U.S. trade and investment in developing nations by establishing fair business codes, viable commercial banks, and reasonable tax and tariff standards. Foreign assistance helps create the stable and transparent business standards by which U.S. companies need to operate. Between 1990 and 1995, exports to developing and transition countries increased by nearly $99 billion. This growth supported nearly 2 million U.S. jobs. Foreign assistance has often resulted in a huge payoff in terms of creating export markets for U.S. goods and services. For example, the United States now exports more to South Korea in just one year than was given to that country in total foreign assistance during the 1960s and 1970s.

HUMANITARIAN RELIEF

The United States has a long and generous tradition of providing assistance to the victims of man-made and natural disasters. Humanitarian assistance has been viewed as both an act of national conscience and an investment in the future. USAID is the world leader in providing assistance to the victims of floods, famine, conflict, and other crises around the globe.

Each year the U.S. government provides food, shelter material, and relief assistance to millions of people around the world who are affected by disasters and conflict. For example, following the mass exodus from Rwanda to Zaire in 1994, tens of thousands of refugees lost their lives due to a cholera epidemic that swept through refugee camps. USAID Disaster Assistance Response Teams and U.S. military forces were sent to the region to assist in establishing a clean-water distribution system to combat the epidemic. These efforts, along with other donors, helped stem one of the largest humanitarian crises of the decade.

CHILD HEALTH PROGRAMS

Among the most important of USAID's public health programs have been its child health programs. USAID has supported child health programs since 1975, intensifying its efforts in 1985 with the Child Survival Initiative. The initiative, carried out in collaboration with host governments and international organizations, has resulted in a 10 percent decline in infant mortality in USAID-assisted countries. Today more than 4 million infant and child deaths are prevented annually due to health services provided by USAID and its partners. These programs include oral rehydration therapy (ORT); acute respiratory infections (ARI); immunizations; breastfeeding; vitamin A; health technologies; malaria; guinea worm; river blindness (onchocerciasis); displaced children and orphans; and war victims.

Oral Rehydration Therapy (ORT). A simple, inexpensive, and easily administered sugar-salt solution for treatment of dehydration from diarrhea was developed through USAID-assisted programs in Bangladesh. It is estimated to save the lives of 1 million children annually, and is one of the most important medical advances of the century. USAID financed the basic research on ORT, and has led the global effort to ensure that ORT is widely available and correctly used. ORT has been successfully used in recent cholera epidemics in Latin America, Asia, and Africa as well as in treating epidemics in refugee camps in Rwanda and Zaire.

Acute Respiratory Infections (ARI). To combat ARI, now the leading cause of death among children under five years of age, USAID has supported the development of new means of diagnosis and treatment involving the training of health workers, counseling of mothers, and the development of effective communication messages. In 2000 USAID supported ARI programs in thirty-seven countries and funded research on vaccines to prevent ARI. USAID-supported research on behavioral change, drug resistance, and potential preventive technology for controlling ARI is also underway.

Immunization. In 1980 fewer than 5 percent of children in developing countries were immunized against measles, diphtheria, pertussis, polio, and tuberculosis. In 2000 more than 80 percent were protected against these diseases. Immunization programs prevent close to 3 million child deaths annually from measles, neonatal tetanus, and tuberculosis.

Poliomyelitis (a viral infection of the spinal cord) has historically caused lameness in young children. It can also cause paralysis of the respiratory control mechanism, require assisted breathing, or result in death. Polio has been successfully eradicated from the western hemisphere and the western Pacific, and efforts are underway to achieve global eradication by the year 2005. There was more than a 90 percent decline in the reported polio cases worldwide from 1988 to 2000. By mid-2000, 150 countries had reported zero cases of poliomyelitis.

Following the breakup of the Soviet Union, USAID carried out emergency immunization support programs in the Central Asian Republics. Millions of doses of vaccine and huge quantities of cold-chain equipment were provided while immunization systems were rebuilt.

Breastfeeding. USAID has established a model program to promote breastfeeding that is being used to train health professionals from developing countries. The program, in conjunction with UNICEF, is currently providing assistance to more than forty countries in establishing "baby-friendly" hospitals to encourage breastfeeding.

Vitamin A. USAID-supported research has shown that vitamin A supplementation can substantially reduce child mortality in vitamin A-deficient populations. Vitamin A programs are now underway in fifty countries. Indonesia, which reported in 1978 that thirteen of every thousand children under the age of five suffered from night blindness, is now free of nutritional blindness due to vitamin A deficiency. In Central America, because of a vitamin A sugar fortification program, childhood blindness has been prevented in more than half a million children.

Health Technologies. USAID has also invested in research on health technologies. A single use, automatic self-destruct syringe, which prevents the reuse of soiled syringes and needles, has the potential to interrupt the transmission of hepatitis B and C, HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), Chaga's disease, and malaria. Vaccine vial monitors (indicators placed on vaccine vials that show if vaccines should be discarded due to heat exposure) are now being used by UNICEF for poliomyelitis vaccine. New technologies now also make it possible for traditional birth attendants and midwives to provide safe care and home delivery by using kits that include strips to detect protein in urine, low cost delivery kits, and color-coded scales that identify low birth weight infants.

Malaria. USAID has had success in malaria-related research and in programs to fight the increasing incidence of the disease in various countries, including El Salvador, Pakistan, Nepal, Thailand, India, and Sri Lanka. New antimalarials are now used as alternative treatments in the face of drug-resistant malaria. Insecticide-impregnated mosquito nets also provide protection against malaria infection. The development of an effective vaccine is underway through a joint domestic and international effort. Since 85 percent of the malaria occurs in Africa, USAID is focusing its efforts to reduce the burden in the region.

Guinea Worm. As a result of its partnerships, more than a 97 percent reduction in the incidence of guinea worm has been achieved. Eradication of the disease is expected.

River Blindness (Onchocerciasis). The Onchocerciasis Control Program (OCP), launched in 1974 by the World Bank, the World Health Organization, the United Nations Development Programme, the Food and Agriculture Organization of the United Nations (FAO), and other organizations to eliminate river blindness as a public health problem, has eliminated onchocerciasis transmission in seven African countries. This program has prevented an estimated 350,000 cases of river blindness and the infection of 10 million individuals, and it has made possible the reopening of 250,000 square kilometers of fertile agricultural land for settlement and economic development.

Maternal Health Programs. Over 600,000 women die annually of causes related to pregnancy and childbirth. The vast majority of women in the developing world prefer to give birth at home. The major immediate causes of maternal mortality—hemorrhage, obstructed labor, eclampsia, (a serious complication, which includes high blood pressure, seizures, and sometimes bleeding), and unsafe abortions—are preventable with known technologies. In addition, millions of women suffer direct complications of pregnancy and delivery, the consequences of which include decreased quality of life, compromised ability to care for children, and diminished productivity.

USAID, along with the World Bank and UNICEF, have made efforts to reduce maternal mortality and promote maternal health by supporting cost-effective approaches to improve pregnancy and reproductive-health services; the increased utilization of essential obstetric services; and improved quality of care through training and quality-assurance programs. Specifically, efforts have been directed toward promoting behavioral change in those instances where traditional practices are harmful (such as restricting nutrient rich foods during pregnancy or speeding labor with potentially harmful local herbs), and training birth attendants, nurses, and midwives in the use of clean and safe birthing techniques. Support has also been provided for tetanus toxoid immunization of mothers to prevent neonatal tetanus.

Family Planning. Further reductions in maternal illness and death requires making family planning services available to all who need them. Twenty-five percent of maternal deaths could be prevented through the provision of family planning services that allow women to prevent unwanted pregnancies and unsafe abortions, and to time their pregnancies for greater safety. More than 100 million couples in developing countries would like to space or limit births, but lack accurate information and access to quality family planning services.

Improving access to family planning is also essential to improving child survival. Babies born less than two years apart are twice as likely to die in the first year of life as those born after an interval of at least two years. If the mother of an infant becomes pregnant again too soon, she may discontinue breast-feeding, putting her infant at greater risk of illness and death. Adequate birth spacing can prevent one in four infant deaths in developing countries.

In addition, children born to women younger than twenty years old are more likely to die before their first birthday than those born to mothers between the ages of twenty and twenty-nine. Children born to mothers over forty, and born to mother who have already had three or more children, are also more likely to die. One hundred thousand women die each year from the consequences of unsafe abortions. Family planning enables couples to prevent unintended pregnancies, thereby protecting themselves from the risks of unsafe abortions.

Since 1965, family planning programs supported by USAID have helped prevent unintended pregnancies in over seventy countries. USAID supports efforts to strengthen the provision of family planning information and services, as well as research to expand the choice of contraceptive methods and improve the quality of care. Contraceptive use has increased dramatically in many countries, from less than 10 percent in 1965 to over 45 percent in 2000. More than 50 million couples worldwide use family planning as a direct result of USAID programs. As a result, the average number of children per family has dropped from more than six to just over four. Family planning programs are improving maternal health by contributing to declining abortion rates in Eastern Europe. Family planning has also helped prevent the spread of HIV/AIDS by encouraging condom use and other reproductive-health measures.

HIV/AIDS. In December 2000, the World Health Organization (WHO) reported that more than 47 million people had been infected with HIV. The vast majority of people infected with HIV remain asymptomatic for years, allowing the disease to spread unknowingly. As the epidemic of AIDS evolves, it creates new pressures for overburdened social, health, and economic infrastructures in countries where resources are already limited and competing demands are increasing.

USAID has initiated HIV/AIDS prevention programs in fifty countries in the developing world, providing prevention-education training, technical and financial support, and the sale or distribution of condoms in developing countries.

USAID has been involved in social-marketing programs, in the development of improved, costeffective approaches for sexually transmitted disease diagnosis and treatment; in behavior change interventions; and in providing assistance with the incorporation of HIV/AIDS in national development planning.

Displaced Children and Orphans and War Victims. The USAID Displaced Children and Orphans Fund has assisted and reunified thousands of children separated from their families as a result of wars in Ethiopia, Liberia, Mozambique, the former Yugoslavia, Angola, and Rwanda. It has provided assistance to others displaced by the AIDS epidemic or for social, economic, or political reasons. More than twenty thousand civilian victims of war have received prostheses and rehabilitation assistance from the USAID Patrick J. Leahy War Victims Fund.

Kenneth J. Bart

(see also: Canadian International Development Agency; Economics of Health; Global Burden of Disease International Development of Public Health; International Health; International Nongovernmental Organizations; International Sanctions, Health Impact of; Nongovernmental Organizations, United States; Policy for Public Health; UNICEF; World Bank )