Health Systems Strengthening

Health Systems Strengthening (HSS)

Visit MSH at AIDS 2012. {Photo credit: MSH.}Photo credit: MSH.

Over 40 Management Sciences for Health (MSH) staff from around the world will join the twenty thousand health workers, activists, researchers, donors, and policy makers at the XIX International AIDS Conference, "Turning the Tide Together". Visit us at the following events, poster and oral presentations, Booth , or online.

Togolese health hut. {Photo credit: S.Holtz/Peace Corps.}Photo credit: S.Holtz/Peace Corps.

The World Health Statistics 2012 report released this year reveals a mixed bag of amazing progress and underachievement.

The report --- the World Health Organization's (WHO) annual compilation of health-related data for its 194 Member States --- includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets.

Countries have achieved amazing success in some areas and little or no progress in others. Here are some highlights:

Jessica, David, and Matuet are members of the community, HIV-positive clients, and a key to HIV care and treatment at Masafu Hospital. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

I visited Masafu Hospital in eastern Uganda on a busy Tuesday morning. Tuesdays are antiretroviral therapy (ART) clinic days at this Ugandan facility. Patients come on their designated date for a checkup and to pick up their prescription refill. (Clients get a one month supply of medicines; ideally health workers see the HIV-positive clients once a month to check their health status.)

Three volunteer expert clients --- Jessica, David, and Matuet --- assist the trained health workers on clinic and non-clinic days.

On ART-clinic days, Jessica, David and Matuet organize files, greet patients, inform patients about side effects, educate on prevention methods, support CD4 collection, and communicate with relatives. On non-clinic days, the expert clients reach out to the communities to reduce stigma, inform people about the services available at health centers, and encourage others to know their status.

David explains that he chose to become an expert client because, “I have the challenge too; I want to help others understand HIV better.”

Matuet said, “Other community members don’t want to know their status. I had to stand up.”

{Photo credit: MSH/Democratic Republic of the Congo.}Photo credit: MSH/Democratic Republic of the Congo.

On this historic World Population Day --- the first with the world’s population at seven billion and growing --- we call your attention to a crucial summit in London happening today, and to the ongoing importance of supporting access to family planning and sexual and reproductive health.

The London Summit

Over one hundred high-level decision-makers are convening at The London Summit on Family Planning in hopes of securing a better future for women and girls globally. Hosted by the UK government and The Bill & Melinda Gates Foundation, with UNFPA and others, the summit seeks to provide an additional 120 million women in resource-poor countries with lifesaving contraceptives, information and family planning services by 2020.

Anna outside Kaginima Hospital, eastern Uganda. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

“I knew I wanted to be a nurse since I was 10. A woman used to come home to my village in her nurse uniform on the weekends and she was so smart and nice. It was my goal,” said Anna.

Anna finished nursing school and her formal training in 1998 and started working in 1999. In 2000, she began working at Kaginima Hospital in eastern Uganda, where she still works today.

Kaginima Hospital is an expanding facility and uniquely has a lot of space for patients and services. The facility has a surgical theater with two beds and is well stocked with medical supplies. As a private, nonprofit hospital, Kaginima does not receive any support from the Ugandan government. The hospital relies on support from USAID, international organizations, faith-based organizations, and local nongovernmental organizations. They also charge nominal fees for the services directly to patients.

Rabi giving a public awareness lecture on HIV in her locality. {Photo credit: MSH, Nigeria.}Photo credit: MSH, Nigeria.

Rabi gives a public awareness lecture on HIV. (Photo credit: MSH, Nigeria)

Forty-year old Rabi Suleiman lives in Koko Besse area in Kebbi state, Nigeria. She is married without children. Rabi, who now lives with her third husband, recalls that her ordeal with illness and social ostracism began in 2009. Rabi’s three marriages were the result of her inability to conceive, and a continuous search for a partner with whom she could successfully bear children. In the course of her marriages she contracted HIV.

Weakened by continuous infections and emaciated beyond recognition, Rabi recalls that she was abandoned, equated to animal status and locked up in a hut meant for cattle in her family home. Her meals were pushed to her through a door opening by relations who refused to look her in the face.

Today, Rabi has a new story to tell. With the assistance of the Prevention Organizational Systems AIDS Care and Treatment (ProACT) project outreach team, Rabi was enrolled with the USAID-supported ProACT antiretroviral therapy (ART) program in the General Hospital, Koko, late in 2009.

GHARF officers and others participate in a CUBS-facilitated proposal writing workshop for community-based organizations in Enugu, Nigeria. {Photo credit: MSH.}Photo credit: MSH.

Securing funds from donors and partners can be challenging for Nigerian non-governmental organizations (NGOs), given the nation’s large pool of competing organizations. In order to earn funds, NGOs must have strong proposal writing skills, the ability to defend their proposals, and efficient operational capacity.

The Global Health Awareness Research Foundation (GHARF) is a community-based organization operating in Enugu state in southeastern Nigeria. GHARF recently participated in a three-day proposal writing workshop, facilitated by the USAID-funded Community Based Support for Orphans and Vulnerable Children (CUBS) project, led by Management Sciences for Health (MSH).

CUBS also conducted a series of training and systems-strengthening exercises with GHARF and MSH provided follow-up technical assistance to build the organization's capacity and improve its status within Nigeria’s large pool of NGOs.

{Photo credit: MSH.}Photo credit: MSH.

Over 100 conference delegates came together at the United Nations Conference on Sustainable Development last week in Rio de Janeiro, Brazil, to strategize smart solutions to global development and poverty reduction while promoting environmental concerns such as clean energy, sustainability, and equitable use of resources.  Popularly known as “Rio+20” --- for occurring twenty years after the 1992 Earth Summit  --- the three days of high-level meetings attended by heads of state and government and high level representatives resulted in “The Future We Want,” a 53-page document that outlines and renews global commitments to sustainable, earth-friendly development.

A new hand-washing station in Toghak, Afghanistan. {Photo credit: Nikmohammad CLTS Facilitator/MSH.}Photo credit: Nikmohammad CLTS Facilitator/MSH.

In the small Afghan village of Toghak, where open defecation affected the sanitation and health of the community, two women took the initiative to mobilize themselves and others into transforming Toghak.

Ms. Fatima and Ms. Rukhsar attended a community-led total sanitation (CLTS) workshop in the neighboring village of Gheyas Said Abd and learned life-saving lessons they wanted to take back to their village. They learned that flies tend to breed in bacteria infested places, particularly human feces, and then transport the fecal matter to food meant for human consumption.

Knowing that this knowledge would motivate their community to improve their sanitation efforts, the women did not waste any time.

When the women returned from the workshop, they recruited twenty women from Toghak willing to help them improve the latrines. They also requested the assistance of CLTS facilitators to come to Toghak and map the high frequency defecation areas in order to identify the best locations for new latrines.

Within a week the women made improvements to 20 latrines. Within three months 50 new latrines were built.

Women meeting in Senegal. {Photo credit: Galdos/MSH.}Photo credit: Galdos/MSH.

Good governance in health care matters at all levels of the health system—from communities to health facilities to governments. When a community HIV & AIDS association in Zanzibar grew from 40 members to more than 1,000, it needed better governance. When women in Senegal raised concerns about lack of privacy and poor security at a district hospital, it needed better governance. And when the national health insurance program in Kenya was underperforming even after efforts to address its management and leadership, it too needed better governance.

Until recently, governance was arguably the most tenacious but unspoken barrier to achieving widespread, large-scale, sustainable health impact. In the 1990s, global health programs focused on training health managers. In the 2000s, as management improved and the need for stronger leaders became evident, the focus expanded to leadership development. By now, we’ve developed robust practices for building the capacity of health managers and leaders at all levels of country health systems.

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