Health Systems Strengthening

Health Systems Strengthening (HSS)

 {Photo credit: Gashaw Shiferaw/SIAPS}SIAPS technical advisor Alan George (standing left) conducts an inventory management exercise.Photo credit: Gashaw Shiferaw/SIAPS

Some 13.5 million people desperately require humanitarian assistance in Syria, which includes access to essential medicines and other pharmaceutical products. Managing a sound supply chain is challenging in the best of circumstances—and in a crisis like this, there are many potential pitfalls and little room for error.

That becomes clear when health workers from relief organizations talk about their work in the country. The large number of displaced persons fleeing the conflict and the unstable, dangerous conditions in Syria require a tight strategy and concerted international effort to deliver vaccines, medical products and devices, and medicines. 

First, there are the painstaking tasks of procuring supplies, including negotiating prices, estimating consumption rates, and quantifying stock—all against the backdrop of a situation in flux. Items shipped across the border require a specific type of sealing and more than a year of shelf life. Stock needs to be transported and stored in temperature-controlled trucks.

MSH Delegation: Matthew Martin, Crystal Lander, Catharine Taylor, Marian Wentworth, Stuart Knight, Barbara Ayotte, and Alison Corbacio

As the Trump Administration released its truncated global health budget last week, ministers of health, members of civil society and the private sector, and government delegations met in Geneva for the annual World Health Assembly to discuss programs that exemplify the value of foreign assistance and its tangible effect on families in some of the poorest countries. In advance of the meeting, MSH released position statements on WHA agenda items. Dozens of governments led by Germany and South Africa, signed the Global Compact for Universal Health Coverage 2030 committing to make affordable and quality healthcare accessible for all. This year’s WHA was particularly historic with the nomination of the WHO’s first African Director-General, Dr.

{Photo credit: Amelie Sow-Dia}Charlene Chisema, a community mobilization officer, conducts an Education Through Listening session on antenatal care.Photo credit: Amelie Sow-Dia

It is early afternoon in the village of Kanjuwale at the foot of Nguluyanawambe Mountain in central Malawi. Charlene Chisema, a community mobilization officer, asks a group of local women about best antenatal care (ANC) practices.

“It should start early – in the first months,” said one woman.

“You need four visits,” said another.

“Great!” said Chisema, who works with the USAID Organized Network of Services for Everyone’s (ONSE) Health Activity. “How many ANC visits did you all have during your last pregnancy?”

Silence.

Suddenly, a frail woman with a baby on her lap stood up, wiped a tear from her face, and said, “I will not return to ANC.” 

The women looked shocked – they were not used to such candid talk.

“Thank you for being honest,” said Chisema, leaning forward with an encouraging smile.  “Please tell us why.” 

Grace sat back down, wiped her face with her cloth wrap, and explained how the nurse at the local health post has been teasing her for “being pregnant again, while my baby, barely six months old, is still exclusively breastfeeding!”[1]

 {Photo credit: Warren Zelman for MSH}Health worker in TB ward in Ethiopia.Photo credit: Warren Zelman for MSH

One Project in Ethiopia Shows Us That Investing in Health Systems Pays Dividends 

Over the past five years, the Ethiopian government and MSH have been working shoulder to shoulder to improve and expand the country’s tuberculosis services with the goal of alleviating the burden of the disease.

If you wonder whether foreign assistance is money well spent, just look at the remarkable progress we’ve made in Ethiopia, where only a few years ago the stock out rate for TB drugs was as high as 20 percent. That number today is about two percent.

Our tuberculosis work in Ethiopia supported 55 million people between 2010 and 2016. During that period, we improved case detection, diagnosis, and treatment mechanisms; strengthened the laboratory capacity of more than 2,000 facilities to diagnose TB; improved the supply management of TB drugs; and trained tens of thousands of health workers at all levels of the health system.

The upside is not just the thousands of lives saved or improved, but the strengthening of a health system that is now better equipped not only to respond to TB, but also to other diseases, therefore helping the people of Ethiopia live healthier lives, contribute to their economy, and make their country a more stable and peaceful place to live.

{Photo credit: Simon Chambers/PWRDF}Indigenous midwives' centre, Chiapas, MexicoPhoto credit: Simon Chambers/PWRDF

Over the past year, Tijuana, Mexico, has seen an influx of U.S.-bound Haitian migrants fleeing communities left in disrepair from the 2010 earthquake and further devastated by Hurricane Matthew in October 2016. These migrants often begin their journey in Latin America and trek through multiple countries and hostile terrain only to find they cannot enter the U.S. once at the border. Among the stalled Haitian migrants living in makeshift shelters as they contemplate their next steps, pregnant women face another uncertainty: whether they or their baby will languish during pregnancy and childbirth without access to skilled maternal and newborn health care.  Recognizing this health crisis, a group of midwives, Parteras Fronterizas (Borderland Midwives in English), arrived on the scene to provide antenatal and safe childbirth care, with help from women who translated from Spanish or English to Haitian Creole. 

 {Photo credit: Todd Shapera}Emanuel Bizimungu a community health worker in Rwanda, examines a girl, Sandrine Uwase, two and a half, who he treated for malaria. She recovered after several days. They are in Nyagakande village, near the Ruhunda health center in eastern Rwanda.Photo credit: Todd Shapera

Malaria is a complex disease – how it’s transmitted and where, who becomes sick, the numerous efforts to control and combat it and, yet, after centuries we still haven’t managed to eradicate it.

During the past five years, the global partnership to fight malaria has witnessed some success including a 29% reduction in malaria mortality and a 75% increase in use of insecticide-treated nets (ITNs). Despite these successes, the global burden of disease still sits heavily at 212 million new cases and 429,000 deaths in 2015 – the majority of which are in sub-Saharan Africa. Nearly half the world’s population is at risk of contracting malaria with 70% of malaria deaths occurring in children less than five years of age, who are particularly susceptible to the disease (WHO, 2016).

{Photo Credit: Warren Zelman}Photo Credit: Warren Zelman

Malaria in pregnant women contributes to several negative outcomes including miscarriage, premature birth, labor complications, low birth-weight babies, anemia, and maternal and newborn death. In Sierra Leone, malaria in pregnancy and child mortality rates are especially high: the disease contributes to nearly 40 percent of deaths of children under the age of five. While there is a clear understanding of the interventions needed throughout the country, at training institutions and health facilities, there is a gap in the skillset and knowledge of how to implement effective malaria diagnosis and treatment.

{Photo Credit: Todd Shapera}Photo Credit: Todd Shapera

We have made great strides in ridding the world of malaria, but there’s still work to be done—and the time is right to finish the job. New technology is helping communities around the world prevent, diagnose, and treat malaria in new and innovative ways. In Mozambique, the Malaria Consortium has developed a phone app that helps community health workers diagnose and treat malaria. In Zanzibar, Tanzania, local health facilities can use text messages to report malaria cases. And Mali uses a system called OSPSANTE, developed by the MSH-led, USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) project, to track the availability and use of pharmaceuticals in the fight against malaria.

A health worker fills in a child’s immunization booklet during an immunization clinic at Phebe Hospital in central Bong County, Liberia. (Cindy Shiner/MSH)

After losing both her parents to Ebola, Liberian nurse Salome Karwah recovered from the virus herself. Protected by her new immunity, she returned to work to care for countless other victims. Time Magazine recognized her as a 2014 Person of the Year for her compassion and tirelessness. In February of this year, Nurse Karwah was rushed to the hospital with seizures following a cesarean delivery of her son. Her garish symptoms frightened the hospital staff that knew she had survived Ebola. They would not touch her. They let her die without treatment.

That is what stigma looks like.

Even after being declared free of Ebola, many survivors found themselves alone, as the International Federation of Red Cross and Red Crescent Societies reported. A chilling new normal replaced the terror and death in the isolation wards: rejection by family, friends, and neighbors, even by their places of worship. Employers fired them. Customers abandoned them. There was no carrying on with the lives they knew before Ebola. There was only more loss.

A community health volunteer explains the use of pregnancy tests to a client.

This World Health Worker Week (April 2-8), we honor the health workers around the world who work every day to improve health in their communities. This photo essay illustrates the important role that community health volunteers play in strengthening Madagascar's health system.

Community health volunteers (CHVs) play a critical role in providing primary health care services in Madagascar, especially for rural populations who live far from health facilities. In many areas of the country, CHVs often collectively offer services to more people than health centers do. CHVs are important extensions of the Malagasy health system, particularly for women and children.

As of 2016, the USAID Mikolo Project, led by MSH and funded by USAID, supported nearly 7,000 CHVs across 506 communes. They fill a critical gap in human resources for health in support of the Ministry of Public Health’s efforts to improve health care in the country.

[A CHV provides reproductive health education.]A CHV provides reproductive health education.

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