Health Systems Strengthening

Health Systems Strengthening (HSS)

{Photo Credit: Mark Tuschman}Photo Credit: Mark Tuschman

There was an awkward silence and then soft giggling as the girls looked at each other. I had just finished talking about strategies for persuading sexual partners to use a condom. Laughter during these skills-building and girls empowerment sessions with 30+ secondary school students in Morogoro, Tanzania was not uncommon, particularly given the sometimes sensitive topics of discussion, but this time, the joke was lost on me.

I asked the student nearest to me, a confident teenager that I knew wouldn’t be too shy to respond, why everyone was laughing. She told me, “You speak about this as if we have a choice.” She wasn’t being sarcastic or combative, nor was she complaining - she was simply matter-of-fact about it, stating her truth.

{Photo credit: Ben Greenberg/MSH}Peter SandsPhoto credit: Ben Greenberg/MSH

On November 13, approximately 100 global health security and development experts, public health practitioners, private sector representatives, academics, researchers, NGO staff members, scientists and students gathered at Harvard Medical School for the Ready Together Conference on Epidemic Preparedness. The day-long event was co-hosted by No More Epidemics, Management Sciences for Health (MSH), Harvard Global Health Institute, and Georgetown University Center for Global Health Science and Security with support from the James M. and Cathleen D. Stone Foundation. We attempted to find answers to the following questions: 1. What are the financial, economic and other risks to the private sector associated with major disease outbreaks and what is being done to minimize risk and ensure resilience?; 2. What innovations have been developed for pandemic preparedness?; 3. How can a whole of society collaboration be enhanced to ensure global health security?; and 4. How can we overcome barriers, ensure country engagement and public private partnerships?

Here are 5 key takeaways from the discussion:

1. “We must stop ignoring the economic risks. We need Finance Ministers to recognize health threats.”- Peter Sands 

Watch Peter's keynote

{Photo Credit: WHO Uganda.}The GHSA High-Level Ministerial Meeting was hosted by the Government of Uganda.Photo Credit: WHO Uganda.

At the 4th Global Health Security High-Level Ministerial Meeting held in Uganda on October 25-27, “Health Security for All: Engaging Communities, Non-governmental Organizations, and the Private Sector,” more than 600 participants including ministers from 41 countries recommitted to and eagerly embraced the agreements made under the Global Health Security Agenda (GHSA) to accelerate progress toward a world safe and secure from infectious disease threats.

The GHSA initiative was launched in 2014 to increase the capacity of countries to prevent disease outbreaks from becoming epidemics. The meeting brought together senior leaders across many sectors of government, international organizations, and nongovernmental stakeholders to evaluate the progress made so far and prioritize actions needed to close the gaps that remain. To succeed, nations recognized the urgent need to refine and improve their health systems – so that they are capable of delivering everything it takes to keep people healthy and safe from infectious disease threats.

Management Sciences for Health (MSH) was proud to be among the participants, drawing on more than 45 years of experience supporting countries to build the prevention, rapid detection, and effective response needed to mitigate global health threats.

 {Photo credit: Jones Dizon/SIAPS.}Training participants try out the Pharmacovigilance Monitoring System (PViMS), a web-based application to help clinicians, regulatory bodies, and implementing partners monitor medicine safety specifically in resource-limited countries.Photo credit: Jones Dizon/SIAPS.

The Philippines has one of the highest TB burdens in the world—and 2.6% of its more than 286,000 new cases in 2015 were of multi-drug-resistant TB (MDR-TB). This threatens the progress the country has made in addressing the deadly disease over the past few decades and its goal to make the country TB-free by 2030. Further, MDR-TB cases will likely rise steadily in the Philippines and the world over the next two decades.

There’s a new medicine that can help. Through a partnership with Janssen Therapeutics of Johnson & Johnson that began in 2015, USAID introduced a program to distribute a new medicine called bedaquiline that helps patients with MDR-TB in low-income countries including the Philippines. The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, which Management Sciences for Health (MSH) leads, has been helping to roll out bedaquiline in low- and middle-income countries.

But with any new treatment, active pharmacovigilance (PV) is needed to help ensure both patient safety and drug effectiveness. This means being able to monitor patients to identify and evaluate adverse events, such as unexpected or serious side effects, to better understand possible risks and improve treatment protocols.

 {Photo credit: Alison Corbacio/MSH}From left: Ugochi Daniels, UNFPA; Chunmei Li, Johnson & Johnson; Antoine Ndiaye, MSH; Lara Zakaria, Syrian American Medical Society; Irene Koek, USAID; Loyce Pace, Global Health Council.Photo credit: Alison Corbacio/MSH

Health systems strengthening was front and center in discussions held in New York on the sidelines of the 72nd United Nations General Assembly. MSH hosted three events spotlighting how strong health systems are critical to resiliency and stability in fragile environments, at the core for global health security and essential for achieving universal health coverage. Here are some highlights from the week. See more on Twitter , and .

 {Photo Credit: Denise Museminali}A doctor at Bushenge Hospital attends to a mother and her newborn in the maternity ward.Photo Credit: Denise Museminali

The National Accreditation Program at Bushenge Provincial Hospital

Tucked in the outermost region of the Western Province of Rwanda, Bushenge Provincial Hospital serves a population of over 171,000 people, including expectant mothers referred by neighboring health centers for pregnancy complications that require Cesarean section. Cesarean section (C-section) delivery is one of the most frequent surgeries performed at health facilities worldwide. At Bushenge Provincial Hospital, it accounts for approximately 48% of annual births. As with any surgical procedure, there are a number of complications that could occur during or post-operation. Surgical site infections (SSI) are a common complication following Cesarean section procedures that do not adhere to infection prevention and control principles. Such infections place a great deal of physical and emotional burden on the mother and family and present substantial costs for health facilities.

Because of the Accreditation Program, I work with an objective and not just out of routine as I did before. I always ask myself what can I do to contribute to the quality of care at Bushenge? If there is an infection risk, I ask myself, what can I do to help?

—Noëlla Benemariya, Environmental Health Officer at Bushenge Hospital

 {Photo Credit: Rui Pires}A pregnant woman is given an ultrasound.Photo Credit: Rui Pires

(This post originally appeared on the Next Billion website.)

Why Greater Ultrasound Availability Doesn’t Always Benefit Patients

Advances in health technologies have reshaped the lives of communities, families and individuals, undoubtedly contributing to better health outcomes around the world. For the most vulnerable populations, technology may significantly improve access to preventive, diagnostic, and treatment services and help increase demand for greater quality care. Yet, despite their potential, new technologies can also add new challenges, risking potential gains in quality, safety or cost. Particularly in settings where health systems are weak, the introduction of technological interventions requires thoughtful execution.

 {Photo credit: Gladys Lavien}Amelia G. Mulbah, a newly trained midwife, works in a remote area of Liberia’s Lofa County.Photo credit: Gladys Lavien

Amelia G. Mulbah, 33, is a newly trained midwife working in a remote region of Liberia. She received a scholarship through the USAID Collaborative Support for Health (CSH) Program and graduated from nursing school in December 2016. After passing the state board test, she became a registered midwife and was deployed for two years to work at the Lutheran Referral Hospital in northwestern Lofa County.

 {Photo credit: MSH-Perú staff}Women leaders at a fair in Bolivia share healthy eating tips to pregnant and breastfeeding women.Photo credit: MSH-Perú staff

A partnership with MSH-Perú and White Ribbon Alliance is promoting self-care in Bolivia

On a bright July day in San Ignacio de Moxos, Bolivia, 13 indigenous women leaders gathered in the central plaza around a long table decorated with bowls of beans, rice, plantains, corn, tomatoes, greens, and other foods. As part of an all-day fair to promote the health and nutrition of pregnant women and breastfeeding mothers, these indigenous women leaders presented their dishes to over 150 community members and local officials, gathered in the plaza to celebrate the town’s anniversary, and offered ideas on how to cook with locally- grown ingredients provided by the national government’s food subsidy program.

Through the White Ribbon Alliance’s Self-Care Initiative, MSH-Perú is organizing workshops and other outreach activities, to motivate women in 11 indigenous Bolivian communities to actively care for themselves, especially during pregnancy and while breastfeeding, by practicing healthy behaviors, and preparing nutritious meals.

 {Photo credit: Kate Ramsey/MSH}Women learn about their pregnancies during a pregnancy club session in eastern Uganda.Photo credit: Kate Ramsey/MSH

Earlier this year we wrote about our ongoing experience reaching pregnant women in Uganda with a model that we called “pregnancy clubs” – an effort to improve the quality of health services women receive during pregnancy and after delivery by organizing them into groups to discuss their personal experiences and learn important self-care skills, guided by a healthcare provider. The region where we are working is particularly vulnerable because there are very high rates of adolescent pregnancy (30.6%), and younger women often find that services are unable to meet their specific needs – especially for the first pregnancy. It can be a lonely time for younger women, especially if they are in a new household and a new marriage, or if experiencing stigma from pregnancy outside of marriage.

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