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8 Facts About Life Expectancy in Malawi

Facts About Life Expectancy in Malawi

The landlocked country of Malawi has a life expectancy rate of 60.2 years for males and 64.3 years for females. While this is much lower than the global average of 69.8 years for males and 74.2 years for females, it represents an improvement from previous years. These eight facts about life expectancy in Malawi will help shed light on the reasons for the low rate as well as what the country has done, and can still do, to improve it:

8 Facts About Life Expectancy in Malawi

  1. HIV/AIDS: As of 2017, an estimated 1 million people in Malawi were living with HIV/AIDS which places the country at 10th in the world in terms of the number of people living with HIV/AIDS. In addition, there were also 13,000 deaths from the virus in the same year. Still, the government has made major strides to curb the epidemic in the last 10 years. Part of its strategy includes providing free condoms as well as educating young people. As of 2018, 78 percent of all people living with HIV in Malawi are on medication. There was also a decline in the number of new infections from 55,000 in 2010 to 38,000 in 2018.
  2. Maternal Health: In 2015, maternal mortality stood at 634 deaths for every 100,000 live births. This is considerably higher than the global average of 216 deaths per 100,000 live births. However, it represents a significant improvement as the government along with support from USAID has been able to reduce maternal mortality by 53 percent between 1990 and 2013. Today, more expectant mothers in both rural and urban areas are now receiving prenatal care as well as skilled birth assistance.
  3. Child Health: Great improvements have also been made in terms of child health, as most children under 5 in both rural and urban areas are vaccinated. This has helped reduce deaths from communicable childhood diseases such as measles, tetanus and pneumonia. The Ministry of Health has also implemented strategies like deworming and has also distributed vitamin A supplements to deal with other major causes of childhood death.
  4. Fertility Rate: In the 1980s Malawian women had about seven children per woman. Today, that number is at 5.5 children per woman. The high fertility rate affects life expectancy in Malawi as it puts pressure on the government to provide adequate social amenities in order to improve people’s lives.
  5. Population Growth: According to a 2018 census, Malawi’s population is 17.6 million people. By 2020 this is projected to hit 20.2 million, before doubling by 2050. This rapid population growth puts a lot of pressure on the country’s land, water and forest resources and threatens life expectancy as most Malawians derive their income from agriculture. The Third Malawi Growth and Development Strategy (MGDS III) sets out a number of policies including promoting family planning and sexual and reproductive health rights as a means to slow population growth, and better managing migration and urbanization.
  6. Infectious Diseases: Malawians are at very high risk of contracting infectious diseases. Food and waterborne diseases include diarrheal diseases and typhoid fever. In order to deal with diarrheal deaths, Malawians are in need of nutritious food as well as an unpolluted environment. Other diseases include malaria, dengue fever and rabies from animal contact. The country has been dealing with malaria by subsidizing mosquito nets. Additionally, Malawi is one of the three African countries taking part in a malaria vaccine pilot. The pilot aims to reach 360,000 children each year across Kenya, Ghana and Malawi.
  7. Water and Sanitation: One in three Malawians do not have access to clean water while 9.6 million people do not have a decent toilet. This affects the life expectancy in Malawi as it leads to an increase in diarrheal diseases. With the support of UNICEF and organizations such as Water Aid, the government of Malawi has made significant progress in reducing the number of people who lack access to safe water. Additionally, the rate of open defecation has declined from 29 percent in 1990 to four percent in 2015.
  8. Education: Malawi introduced free primary education in 1994 which put a strain on the education system. This is because the infrastructure, number of teachers and number of teaching and learning materials were inadequate when compared to the number of students who enrolled. It resulted in poor performance by the students, especially in terms of literacy.  The government of Malawi has been making an effort to improve the education sector by allocating more than 20 percent of the national budget to education.  It has also partnered with bodies such as USAID and UNICEF to improve literacy levels as well as student enrollment and completion rates. An educated and skilled population will help increase Malawi’s economic growth. Educational reforms will help reduce the unemployment rate which is currently more than 20 percent.

Malawi is considered one of the poorest countries in the world, and a lot still needs to be done to improve the lives of its people. It is however clear that the government is working with the support of nonprofit organizations around the world to make life better for its people.

– Sophia Wanyonyi
Photo: Flickr

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New HIV Drug Implemented In Kenya

HIV Drug Implemented in Kenya
In 2017, there were approximately 36.9 million people living with HIV/AIDS worldwide. Additionally, 6.1 million of those with HIV were located in western and central Africa. Kenya, a country in eastern Africa, had approximately 1.5 million people living with HIV/AIDs in 2017. That same year, an HIV drug implemented in Kenya started to successfully combat this deadly immune system virus. Unitaid and the Kenyan government simultaneously introduced it to the country.

Dolutegravir and Antiretroviral Therapy

The new HIV/AIDS drug, Dolutegravir or DTG, received approval in 2014 and is the most recent and effective antiretroviral drug used in the treatment against HIV/AIDs. DTG has been the drug of choice in high-income countries for its antiresistance properties, few side effects and easy one pill a day treatment. In 2015, the World Health Organization recommended this drug replace other first-line regimens for adults and adolescents. Recently this drug was not available in low-income countries, like Kenya, because of its high cost.

In 2018, only 62 percent of people with HIV/AIDs had access to antiretroviral therapy, which was an increase from the previous year. This corresponds to the 23.3 million people who were able to receive treatment, however, approximately 14.6 million people could not access treatment. In Kenya, 75 percent of adults with HIV/AIDs received treatment in 2018, which increased from 2016, when only 64 percent of people received treatment. One reason for the increase in HIV/AIDs testing is the partnerships between the government of Kenya and Unitaid that began in 2017 which introduced the generic brand of DTG.

Now, the generic brand of this life-saving drug has been available to people in Kenya since early 2018. This new HIV drug implemented in Kenya has the potential to make life-saving drugs more accessible to those who would normally not be able to afford it. In 2017, a number of nonprofits including the Bill & Melinda Gates Foundation, Unitaid, USAID, PEPFAR and others agreed to a pricing agreement to help make the drug more affordable in developing countries. This pricing agreement would allow public sector purchases at $75 per person, per year.

Side Effects of Other Drugs

Before the introduction of DTG, the first-line drug in Kenya was Efavirenz, an antiretroviral medication with side effects for some users including nausea, dizziness, rash and headaches. When the pricing agreement first emerged, the Kenyan Ministry of Health decided that the first round of DTG it distributed would go to 27,000 people who suffered the negative side effects from efavirenz. Then, the Ministry of Health assigned various other health clinics to receive the drug until it could become available to the entire country.

The number of new HIV/AIDs diagnoses in Kenya has halved over the last decade to approximately 80,000 people a year. The new HIV drug implemented in Kenya will only help decrease the number of people suffering from HIV/AIDs. Comprehensive sex education, HIV/AIDs testing centers and the continuation of drug pricing agreements will help alleviate the prevalence of HIV in developing countries, like Kenya.

– Hayley Jellison
Photo: Flickr

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The Fight Against HIV/AIDS in Zambia

HIV/AIDS in Zambia
Zambia is a tropical country in southern Africa with a population of approximately 16,445,079 people. It has a rich history of copper production and is one of the world’s fastest-growing economies. However, HIV/AIDS has become prevalent throughout Zambia and is a large contributing factor to the country’s low life expectancy, which currently ranks second to last in a global comparison.

HIV, or the human immunodeficiency virus, attacks a person’s immune system by destroying white blood cells that fight disease and infection. Though there is no cure for HIV, people can control it successfully. Without proper medical care, the infection can lead to AIDS, which is the most severe phase of HIV infection.

The Current State of the HIV/AIDS Epidemic in Zambia

Heterosexual intercourse is what mainly drives Zambia’s HIV/AIDS epidemic. HIV/AIDS particularly affects adolescent women compared to other age groups in Zambia. In fact, according to data collected by UNAIDS, one million women between the ages of 10 and 19 were living with HIV in 2017, while only 770,000 of their male counterparts had the same prognosis.

This discrepancy is due in part to the many societal issues that permeate throughout the lives of Zambian women. Younger Zambian women are more likely to have an older partner already infected with HIV. Additionally, many Zambian women are not in charge of their own reproductive health or education.

In fact, only 56 percent of Zambian women are literate. Meanwhile, the country only has a contraceptive prevalence rate of 49 percent. Both issues decrease a Zambian woman’s ability for education on the matter, as well as the ability to prevent pregnancy and the eventual exposure of HIV to a fetus in the womb.

Other marginalized Zambian groups disproportionately affected by HIV/AIDS are children, sex workers and prisoners. According to UNAIDS, an estimated 8,900 children were newly infected with HIV in 2016 due to perinatal transmission. Perinatal transmission refers to when a mother passes HIV to her child during pregnancy, labor or breastfeeding. Meanwhile, sex workers and prisoners had HIV prevalence rates of 56.4 percent and 27.4 percent respectively.

The Future of HIV/AIDS in Zambia

Zambia is currently taking steps towards decreasing the prevalence of HIV/AIDS in the country. The first step has to do with prevention and education. According to the 2014 Zambia Country Report, the country’s provision of free condoms nearly doubled from 7.8 million to 19.6 million.

Additionally, according to the National AIDS Strategic Framework (NASF), comprehensive sex education will become a larger focus for adolescent Zambians within forthcoming years. Furthermore, several HIV prevention programs are active in Zambia and focus on empowering the country’s most susceptible population — young and adolescent women. Zambia is one of 10 countries that takes part in the DREAMS initiative, which strives to reduce new infections among women by addressing structural inequalities and gender norms.

Though Zambia has recently scaled up its efforts to fight HIV/AIDS, it needs to do more to effect real change. Zambia’s domestic spending on HIV/AIDS only takes four percent of the overall budget, despite having risen drastically within the past few years. Even if Zambia were to spend this portion of the budget on providing ART, testing facilities and eMTCT services, a real societal change would not occur unless communication in Zambia health care systems increases. Zambia must see to the general population being educated about adhering to treatment, getting tested regularly and exercising effective prevention techniques.

There is much room for improvement when it comes to fighting HIV/AIDS in Zambia. However, by increasing access to education and focusing upon marginalized groups — such as young women — the prevalence of this infection in Zambia will drastically decrease.

– Shreya Gaddipati
Photo: Flickr

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ATM Pharmacies in South Africa Cut Wait Times

ATM pharmacies in South Africa Cut Wait Times for Chronically Ill Patients
The suburb of Alexandra, South Africa, is now home to Africa’s first pharmacy dispensing unit. ATM pharmacies in South Africa are expected to have a profound effect on the wait time for patients and the efficiency of clinics.

Simple Solution to Improve Lives

The machine operates as seamlessly as an ATM that dispenses money and completes the transaction in as little as three minutes as opposed to hours. Also known as an “ATM pharmacy,” the unit comes as a convenience to citizens with chronic illnesses, while freeing up space in local clinics. Most importantly, people dependent on medication have another option in receiving repeat medication that does not compromise safety or effectiveness.

The new development comes from experts from nonprofit Right to Care, Right ePharmacy and the Gauteng Department of Health. Right to Care works to provide prevention, care and treatment for HIV and other sexually transmitted diseases as well as tuberculosis and cervical cancer.

Developers chose Alexandra as the first location because of its large population, burdened facilities, and level of need, Right ePharmacy managing director Fanie Hendriksz said.

The Need for ATM Pharmacies in South Africa

Innovations like ATM pharmacies in South Africa are a step toward higher-quality healthcare, making it easier for patients to be consistent with their medication schedules. One of the main target groups for this project was people with HIV in need of repeat antiretroviral medicine, as South Africa now has the world’s largest AIDS treatment program.

In addition to being overcrowded, some clinics are also understaffed. Nurses may be referred to other clinics to compensate for lack of staff. HIV/AIDS activist Bhekisisa Mazibuko broke into Kgabo clinic pharmacy to make a point about the outlandish wait times for chronic medications in Tshwane, a city not far from Johannesburg. Some patients start waiting in line as early as 3 a.m.

Mazibuko, who lives with HIV, used a brick to break the pharmacy door after it closed for the day at 4 p.m., not attending to patients who had been waiting for hours. He distributed medicine to hypertension, diabetes and HIV patients before being arrested.

A Way Forward

Patients whose conditions are stabilized are encouraged to use the pharmacy dispensing unit (PDU), although a referral from a doctor is necessary. The patient engages in a simple process of scanning their personal ID and entering a pin and speaking with a pharmacist via video correspondence.

Through this video chat, patients can be advised and directed on how to take the medication and its possible side effects. The patient then selects their medication which is robotically dispensed along with a receipt. The PDU has served more than 4,000 people and dispensed 18,000 prescription medications so far.

According to Right to Care chief executive Ian Sanne, the amount of time South Africans spend waiting in line at health facilities is quite extensive and is damaging to economic productivity. ATM pharmacies in South Africa is likely just the beginning of many healthcare innovations in Africa.

– Camille Wilson
Photo: Flickr

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UNAIDS Launches My Health, My Right Campaign

With a new campaign called My Health, My Right, UNAIDS will celebrate World AIDS Day on December 1, 2017. The campaign aims to bring awareness to the universal right to health, and also to shed light on the hardships people face globally in obtaining these rights.

My Health, My Right is meant to remind people that a human’s right to health is not only about accessing the necessary services and medicines, but also about quality living and working conditions that are sanitary and safe with access to basic needs. When these rights are not being met, preventative measures against disease decrease and illnesses increase, including HIV. This campaign allows for open conversation to begin regarding thoughts and concerns about rights to health, the importance of health equality and justice for people worldwide.

The campaign will occur mostly on twitter, with downloadable posters available to hang throughout communities and informational brochures equipped with messages about the rights to proper health care. The right to health for all people is crucial in the U.N.’s Sustainable Development Goals, as one of the goals includes ending the AIDS epidemic by the year 2030.

As of August 2017, 36.7 million people are living with HIV/AIDS throughout the world. 30 percent of these people don’t know the status of their disease. The majority of those infected with AIDS live in low- and middle-income countries; 25.5 million of these people live in sub-Saharan Africa. Although there has been significant progress in ending the AIDS epidemic, experts say it is not being done fast enough to meet the global targets.

World AIDS Day aims to pay respects to those who have died from an AIDS-related illness. The day was originally founded in 1988, as the first-ever global health day. A day to recognize the virus is extremely important for the eradication of the disease, as many of those infected do not know how to protect themselves and the others around them. It also helps demolish the discrimination and stigma associated with people living with the condition. AIDS has not disappeared, and there is a crucial need for funds, resources, increased awareness and improved education regarding the disease.

– Chloe Turner

Photo: Flickr

90-90-90: A Bold New Goal in the Fight Against HIV/AIDS

90-90-90: A Bold New Goal in the Fight Against AIDSWhen the U.N. met its goal to provide 15 million HIV-affected people with treatment by 2015, it did not pause to celebrate its victory. Two years prior, in 2013, the organization had already crafted a new goal in the fight against the HIV/AIDS epidemic. By 2020, UNAIDS hopes to see a world that has accomplished something miraculous: 90-90-90.

90-90-90 is a target comprised of three interconnected objectives:

  1. By 2020, 90 percent of people living with HIV will know their diagnosis.
  2. By 2020, 90 percent of all HIV-positive individuals who have been diagnosed will receive antiretroviral therapy.
  3. By 2020, 90 percent of all HIV-positive individuals undergoing treatment will achieve viral suppression.

While the plan is straightforward and succinct, UNAIDS has self-awarely deemed it a “bold new target,” which may seem impossible to achieve to some. However, many countries around the globe are well on their way to achieving the elusive 90-90-90.

Most of the nations closest to 90-90-90 are part of the developed world, including Australia, Denmark and the UK. Unfortunately, poverty and weak healthcare systems make developing regions particularly vulnerable to the transmission of HIV. In fact, HIV is the second leading cause of death in developing countries.

HIV is more prevalent in Africa than in any other continent. Since the start of the AIDS epidemic, African countries such as Zimbabwe, Uganda and Botswana have exhibited average life expectancies up to 20 years lower than the rest of the world.

Despite HIV’s lethal presence in the developing world, there are methods that can be implemented to decrease HIV transmission and facilitate treatment in all nations.

In order to increase the amount of HIV-positive people who know their status, HIV testing must become more proactive. Some individuals infected with the HIV virus may not present symptoms and, therefore, will not be tested for the disease and never learn their status. Health campaigns in Uganda have increased their coverage of HIV status by 72 percent, simply by incorporating HIV tests in routine healthcare visits.

In many countries, HIV treatment is flawed due to its reliance on CD4 cell count. CD4 T-cells are the immune cells destroyed by the HIV virus. Ordinarily, HIV treatment is only given to people whose CD4 levels are low enough to put them at risk of developing AIDS. However, without treatment, anyone with HIV can pass on the virus, regardless of CD4 levels.

In 2002, Botswana began offering antiretroviral treatment to anyone infected with HIV. Botswana is now closer to 90-90-90 than almost any other country in Africa.

HIV treatment must be sustained in order to reach viral suppression – the final objective. In the Caribbean, 66 percent of individuals receiving treatment attain viral suppression. The ability to ascertain viral suppression status is reliant on viral load testing, which analyzes the amount of the HIV virus in the blood. Unfortunately, the medical technology required for viral load testing is not easily accessible throughout the globe. Recent data shows that the ability to perform these tests will likely inhibit viral suppression in the developing world. However, the work of the Diagnostics Access Initiative, which creates sustainable medical labs, has successfully decreased the global price of viral load tests by 40 percent, which will make them more accessible in impoverished regions.

While 90-90-90 may seem like an ambitious or overly optimistic dream, the methodology of efficiently diagnosing and treating HIV has proven successful in many countries. If strategically implemented on a global scale, these methods could feasibly eradicate HIV/AIDS and eventually heal the world of this epidemic.

– Mary Efird

Photo: Flickr

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Thailand’s New Strategy to Eliminate AIDS

Eliminate AIDS

Thailand has recently launched a new national strategy, with the goal of eliminating AIDS as a public health threat by 2030. The plan, devised by the Ministry of Public Health, aims to use rigorous strategy of detecting, treating and suppressing the AIDS virus within the infected population.

The first step of the plan aims to meet the global 90-90-90 goal by 2020, where the first 90 percent of people who have AIDS are informed of their infection. This 90 percent of infected people should then have access to, and begin, treatment. Then, 90 percent of people who have received treatment are fully virally suppressed. This breakdown provides realistic goals for the plan’s execution.

This plan is targeted to the key demographics among which the HIV rate is the highest. Thailand’s government is committing full efforts to providing the citizens with prevention and outreach programs in highly infectious areas to help inform and protect the uninfected populations.

One of the further goals of this plan is to eventually include hepatitis C, tuberculosis and other infectious diseases as serious public health issues to be resolved within Thailand. The U.N. Programme on HIV/AIDS (UNAIDS) firmly believes in Thailand’s plan, as its pilot tests have resulted in an excellent effective rate. Because of this, UNAIDS would like to implement the plan in more nations dealing with similar situations.

The initial segment of the plan – encompassing 2015 to 2019 – is dedicated to the testing of new measures as well as setting up new two-way coordination frameworks for the execution of the rest of the plan. This segment includes a majority of pilot testing, where the results of the data collected would help to produce the next plan segment.

While Thailand is pioneering new widespread measures to eliminate AIDS, their groundbreaking work will be a stepping stone to the elimination of AIDS in the nation. With massive organizations, such as UNAIDS, working alongside them to study and develop solutions, there is a lot of promise in the eventual elimination of the global AIDS issue.

– Rebekah

Photo: Flickr

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Zambia’s AIDS Response Fast-Track

Zambia's AIDS Response Fast-TrackHIV/AIDS affects millions of people in Africa. Zambia and other countries in Africa are greatly impacted by HIV/AIDS daily. Even though Western countries are working to improve the HIV/AIDS rate in Africa, countries in Africa are working even harder to help their people. Zambia’s AIDS Response Fast-Track Strategy recently launched with important goals for 2017-2021.

Zambia’s AIDS Response Fast-Track Strategy sets out a plan to achieve the global Fast-Track prevention and 90-90-90 targets, where 90 percent of people living with HIV will know their HIV status. The strategy also aims to ensure that 90 percent of people who know they are HIV positive are accessing treatment and 90 percent of people on treatment have decreased their viral loads.

The strategy establishes clear approaches to increase the HIV response for everyone, set yearly targets at the national and state level and estimate costs and resources required. Zambia’s AIDS Response Fast-Track Strategy will provide more facility-based and community-led programs. The strategy will increase HIV testing and help counsel districts that have high HIV rates. The Fast-Track Strategy will also target key populations and partner with other healthcare services regarding HIV testing.

HIV treatment and care services will be guaranteed through the strategy. The most important goal of the strategy is to eliminate all new HIV infections among children. A significant impact has been made in the past few years on new HIV infections. New HIV infections have decreased from 69,000 in 2005 to 59,000 in 2016. The rate of women receiving medicines to prevent mother-to-child transmission has increased to 87 percent.

Fast-Track Cities was launched on World AIDS Day in 2014 in Paris. Over 70 cities with high HIV rates have signed the Paris Declaration on Fast-Track Cities Ending AIDS, including Zambia’s capital Lusaka. The strategy was created by a team led by the National HIV/AIDS/STI/TB Council and UNAIDS. The International Association of Providers of AIDS Care (IAPAC), the United Nations Human Settlements Program (UN-HABITAT), UNAIDS and the City of Paris are supporting Fast-Track Cities. By participating in this initiative, Zambia can bolster its own Fast-Track Strategy and bring better care and prevention to its people sooner.

– Treasure Shepard

Photo: Flickr

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AIDS in Africa No Longer Leading Cause of Death

Africa has had a long history with AIDS and has struggled to find solutions to keep AIDS-related deaths low. However, in the past few years AIDS rates in Africa have decreased, and it is no longer the leading cause of death.

This achievement is mostly due to better diagnosis and treatment, along with more information and better education on the condition. Additionally, other preventive strategies, such as self-testing, have become more prevalent. In fact, 40 countries have already added HIV/AIDS self-testing to their national policies, with 48 more developing similar policies, almost double the amount in 2015.

With these strategies being implemented, the number of HIV/AIDS-related deaths in Africa have decreased by 24 percent over the last five years. In 2015, there were a reported 5.2 million deaths caused by group 1 conditions, which includes AIDS, with AIDS reportedly causing approximately 760,000 deaths in 2015, a decrease from 1 million in 2010 and 1.5 million in 2005.

With AIDS no longer the leading cause of death, lower respiratory tract infections have taken the lead. Yet AIDS is not the only disease that has decreased; malaria has also seen a decrease in deaths, reporting a drop of 60 percent in the last 15 years, accounting for about 6 million people saved from the disease.

With expanded education regarding AIDS prevention, treatment, and self-testing, Africa is on its way to fulfilling the U.N.’s goal of eradicating AIDS on the continent by 2030. Additionally, with funding from donor countries and supplying clinics with the proper drugs, AIDS in Africa will continue to see a drop in deaths over the next few years, meaning the continent can focus on other leading causes of death.

– Amira Wynn

Photo: Flickr

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US Budget Cuts Could Weaken Global Fight Against AIDS

US Budget Cuts Could Weaken Global Fight Against AIDS
The President’s Emergency Plan for AIDS Relief (PEPFAR) has been the largest national effort by any country to combat a single disease and has resulted in 11.5 million people put on antiretroviral treatment. PEPFAR has received wide bipartisan support since its inception in 2003, but the Trump administration has proposed a 17 percent cut to the program as part of the 2018 budget proposal. Experts are now warning that these cuts to PEPFAR and other global health programs could inflame the AIDS epidemic.

Laurie Garrett, a senior fellow for Global Health at the Council on Foreign Relations fears the worst. “Without a revolutionary breakthrough in either vaccines or the entire model of HIV control, a massive second global wave of AIDS will come, perhaps within the next 10 years.” These predictions come as the U.S. shows a greater reluctance to commit funds to fighting HIV/AIDS.

With the wide distribution of antiretroviral drugs, deaths from AIDS have been halved over the past decade, but new infections haven’t slowed down. Two million people are infected with HIV annually, and these new infections are showing greater resistance to traditional treatments. Despite the need for further research, global funds for research and development have been declining. The Trump administration has proposed a 20 percent budget cut to the National Institutes of Health, America’s leading funder of HIV research.

Though the proposed budget would uproot U.S. efforts in the global fight against AIDS, political analysts have predicted that Congress will fight to reduce these cuts. PEPFAR has bipartisan support and the Republican majority considers it a party accomplishment due to its enactment by President George W. Bush. The National Institutes of Health have also recently gained bipartisan support with both Republicans and Democrats supporting greater funding.

Although the Trump administration’s cuts will likely be reduced by Congress, advocates worry that the proposed cuts will keep these programs from operating at their current levels. “I have no doubt Congress will succeed in restoring some level of funding,” says Scott Morris, director of the U.S. Development Policy Initiative at the Center for Global Development. “But it strikes me as an insurmountable lift to get back to the level of funding these programs currently enjoy.”

– Carson Hughes
Photo: Flickr