Health Systems Strengthening

Health Systems Strengthening (HSS)

{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.

{Photo Credit: Rui Pires}Photo Credit: Rui Pires

Tuberculosis (TB) kills more people each year than any other infectious disease. It severely strains health systems and local, regional, and national economies. And, like many health crises, the disease disproportionately affects vulnerable populations. Many families incur catastrophic costs, aggravating poverty in communities.

This World TB Day, we reflect on the progress we've made and the challenges we still face in the fight to end TB. The key moving forward is to work together to ensure we don't leave anyone behind.

VIDEO: Working to End TB in Uganda

“We have the medicines that actually cure tuberculosis,” said Raymond Byaruhanga, project director for the USAID-funded, MSH-led TRACK TB project in Uganda. “So the question is why? Why [do we still see] TB today, and why isn’t it being treated?”

In 2015, TB caused 1.8 million deaths around the world, and another 10 million people fell ill from the disease, according to the World Health Organization (WHO). Women and children are particularly vulnerable. TB causes between 6 and 15 percent of all maternal deaths, and childhood TB is too often not detected, diagnosed, or treated.

 {Photo credit: Todd Shapera}Community Health Workers during a morning of training on the lawn at Rukumo Health Center, Rwanda.Photo credit: Todd Shapera

(This post originally appeared on the WomenDeliver blog.)

Throughout global societies, women’s roles place them at the epicenter of risk from disease outbreaks and epidemics. This is true everywhere, but especially so in poor countries with health systems unprepared to meet the ever-surging demands of a public health emergency.

The interaction between gender roles, disease transmission, and socio-economic stability reach a perilous tipping point in epidemics; failing to address that interaction will result in deficient strategies for outbreak prevention and control, and in massive setbacks for women’s health, and development gains. Unless global health security measures help us understand the impact of emerging diseases on women, nations and the world will remain vulnerable to pandemics.

 {Photo credit: Discovery Learning Alliance}"The Lucky Specials" cast members attend the US premiere in Silver Spring, MD.Photo credit: Discovery Learning Alliance

As the global health community prepares to observe World TB Day on March 24, Discovery Learning Alliance, the nonprofit subsidiary of Discovery Communications, opened “The Lucky Specials” in the U.S., a feature-length film about a small-time band in a dusty town in southern Africa with an important message about health.

Mandla (Oros Mampofu) is a miner by day and plays lead guitar for The Lucky Specials by night. He dreams of making it big in the music industry, but when tragedy strikes, the band, Mandla, and their friend Nkanyiso (Sivenathi Mabuya) struggle to hold everything together.

Woven into the narrative are messages to help audiences understand and respond to one of the world’s biggest killers, tuberculosis, which killed almost two million people worldwide in 2015. That is more people than died from AIDS that year. With a unique fusion of live-action drama and state-of-the-art animation, “The Lucky Specials” reveals the unseen world of TB from the inside out.

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

MSH will host and support events in five countries this week to honor World TB Day.

Observed March 24, World TB Day raises awareness and mobilizes support for efforts around the world working to end tuberculosis (TB). The World Health Organization (WHO) has designated this year’s theme as “Unite to End TB: Leave No One Behind,” and many of the day’s activities will focus on addressing stigma, discrimination, and marginalization.

MSH has been a leader in strengthening health systems to fight against TB since 1999 and is working with partners in 22 countries to prevent the spread of the disease and improve the lives of those affected by it.

In Afghanistan, the Challenge TB project — funded by USAID  — will lead 20 awareness events in five cities and will deliver messaging about TB in schools and health facilities. The project will also lead conferences in three provinces, focusing on successful interventions like Urban Directly Observed Treatment and the TB Information System.

The Challenge TB project will also lead World TB Day activities in 11 districts in Bangladesh, ranging from orientations and discussions with workers, to programs at schools, to rallies, to a “sputum collection camp” at an outreach center.

{Women in Malawi are increasingly engaging in sustainable ways to grow household income and end poverty, such as village savings and loans groups. (Photo Credit: Feed the Children / Amos Gumulira)}Women in Malawi are increasingly engaging in sustainable ways to grow household income and end poverty, such as village savings and loans groups. (Photo Credit: Feed the Children / Amos Gumulira)

Follow the conversation at the Commission on the Status of Women:

As we prepare to join the Commission on the Status of Women (CSW) next week, where the focus will be on women’s economic empowerment in the changing world of work, I am reminded of my visit to Malawi last month.

{Photo Credit: Rebecca Weaver/MSH}Photo Credit: Rebecca Weaver/MSH

This is the last in a series of four stories about how strong health systems improve the health of women and children. It was originally published on Global Health Now's website.

The Democratic Republic of the Congo has a chance to save millions of children with an inexpensive grassroots community effort.

In the Democratic Republic of the Congo (DRC), a country beleaguered by years of civil war, official corruption and mismanagement, and civil apathy, the path to building a strong health system is challenging. One initiative, focused on building up community-level care, has shown success—but without more support from the Congolese government, it might not continue.

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