Health Systems Strengthening

Health Systems Strengthening (HSS)

Health for All.Health for All.

The October edition of MSH's Global Health Impact newsletter (subscribe), features stories of people, communities, and countries on the road toward universal health coverage (UHC).

The vital role of the essential package for health impact

On the Road to Universal Health Coverage: The Vital Role of the Essential Package for Health Impact

A Rwandese woman shows her child's community-based health insurance card. {Photo credit: C. T. Ngoc/MSH.}Photo credit: C. T. Ngoc/MSH.

Eugénie, a widow in Rwanda, farms to provide for her children. In January 2012, she had surgery to remove a tumor, a procedure that would have devastated her family economically if she did not have insurance. Rwanda’s health insurance program is the most successful of its kind in sub-Saharan Africa: it supports the health of more than 90 percent of the population, including the most vulnerable, like Eugénie.

Children in Yogyakarta, Indonesia, a community supported by TB CARE I volunteers. {Photo credit: D. Collins/MSH.}Photo credit: D. Collins/MSH.

Each year, as many as 64,000 people die from tuberculosis (TB) in Indonesia. Although the Ministry of Health’s (MOH) National TB Program (NTP) has made great progress over the last few years, the country is still one of twenty-two high TB-burden countries in the world. Indonesia is also one of the twenty-seven countries considered to have a high burden of multi-drug resistant TB (MDR-TB). In 2011, the nation reported 6,100 cases of MDR-TB.

Donor funding has been a major factor in the success of Indonesia’s TB program over the last few years, especially The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) grants.  Indonesia has, however, progressed economically and is now a relatively low priority for Global Fund grants, which are expected to end or reduce significantly by 2015.

Despite Indonesia’s economic growth, the sustainability of the TB program will be a major challenge without support from this critical donor, especially during the funding transition period.

The convoy faced many challenges, including the rainy climate en route to Mulungu. The vehicles often got stuck in the mud, requiring the help of many people to get them moving again. {Photo credit: MSH.}Photo credit: MSH.

The Democratic Republic of the Congo’s Sud Kivu province has been an area of armed conflict for many years, with various rebel factions fighting for control over the resource-rich region.

The continued fighting has disrupted health services --- which were weak to begin with --- due to geographic isolation and poorly supported health workers.

In the health zone of Mulungu, there had been no delivery of medicines or supplies for more than six months. More than 105,000 people live in the remote area, where health issues include malaria, malnutrition and anemia. In April 2012, the USAID-funded Democratic Republic of Congo-Integrated Health Project (DRC-IHP) deployed a team of health workers from Bukavu to Mulungu, to transport more than 2,640 pounds of medicines and supplies; 2,700 insecticide-treated mosquito nets; and 50 containers of petrol to supply cold chain storage units for vaccines.

Dr. Jonathan D. Quick of MSH at Washington Post Live's forum on noncommunicable diseases. {Photo credit: Jeff Martin / for the Washington Post.}Photo credit: Jeff Martin / for the Washington Post.

The Washington Post Live panel on October 17 featured high-level noncommunicable diseases (NCDs) experts from around the world discussing how to tackle the global epidemic of NCDs.

We've compiled key moments from the panelists in a "Storify" story, told through tweets.

The panel featured some twenty high-level chronic diseases experts from around the world discussing how to tackle the global epidemic of noncommunicable diseases (NCDs).

http://storify.com/MSHHealthImpact/washington-post-live-high-level-panel...

A woman receiving antenatal care in South Sudan. {Photo credit: J. Warren/Save the Children.}Photo credit: J. Warren/Save the Children.

On a dark August night in rural South Sudan, Linda Kenneth felt the swift kick of labor pains begin. Having previously delivered five children, Linda recognized the pains and immediately called for the nearby skilled birth attendant, as it was too late in the evening for her to travel safely to the health facility. In her previous two pregnancies, she had experienced heavy bleeding after delivering, and worried similar complications might arise this time.

South Sudan has the world’s worst maternal mortality ratio (2,054 deaths per 100,000 live births), and roughly one third of these deaths can be attributed to postpartum hemorrhage (PPH). Administration of misoprostol or another uterotonic (a drug that reduces bleeding after childbirth) could prevent the majority of these deaths. Misoprostol does not require a cold supply chain, and is cheap and effective, making it a perfect candidate for community-based interventions.

Upon the birth attendant’s arrival, Linda presented the three misoprostol pills she had recently been given by a home health promoter. Several days prior, a home health promoter had visited Linda and discussed with her a birth preparedness plan, informing her of the benefits of taking misoprostol immediately after delivery to prevent excessive bleeding.

Seven-year-old Ladi Muhammed. Nigeria. {Photo credit: S. J. Garlora / MSH.}Photo credit: S. J. Garlora / MSH.

Seven-year-old Ladi Muhammed wants to become a teacher. The third of five children ranging 3 to 20 years old, Ladi and her family live in a poor Nigerian village.

The likelihood of Ladi attending primary school is low.

Public primary education is free in Nigeria, but Ladi’s parents can barely afford to feed their children. The children supplement their parents’ income with menial jobs, such as street trading, which leaves little time or energy for schooling.

Her father, Ahmadu Mohammed, wants to send all of his children to school, but does not have the financial means to do so. “It is my heartfelt desire to send my children to school, but I can’t support them due to the meager salary I earn from my work as a gateman. Our situation is tough; we can barely feed ourselves,” says Mohammed.

Without an education, Ladi’s desire to one day become a teacher appeared a distant dream.

Moen Kas, Afghanistan {Photo credit: Noorgha CLTS Supervisor.}Photo credit: Noorgha CLTS Supervisor.

Moen Kas, a hilly remote Afghan village absent of latrines or even a functioning water well, became an Open Defecation-Free (ODF) community within 24 days of arduous commitment from its leaders and people.

Moen Kas’ remarkable milestone makes it the first village in Afghanistan to reach ODF status in less than one month--inspired entirely from personal stories that are spreading across the country regarding the benefits of living in ODF communities.

The quick transformation was the direct result of a man from Moen Kas who had attended an ODF certification ceremony in the nearby, yet secluded, village of Ghalani.

As he watched the ceremony and learned of ODF’s benefits, he asked to speak on behalf of his village. During his speech, he praised Ghalani’s achievements within the past two months and publicly vowed that his own village would achieve ODF status in under a month.

Recognizing that this ambitious goal could not be achieved through him alone, he urged the other Moen Kas’ villagers who were also present at the ceremony to stand with him and work together.

So determined was the man in his vision to transform his village, that he invited the audience to visit Moen Kas in one week to verify it as an ODF community.

Global Handwashing Day. {Image credit: MSH.}Image credit: MSH.

Today, October 15, children, schools, and communities around the world mark Global Handwashing Day.

Washing hands with soap is the "most effective and inexpensive way to prevent diarrheal and acute respiratory infections, which take the lives of millions of children in developing countries every year." In addition to handwashing with soap, proper sanitation and safe drinking water are key to preventing disease.

"Most of what we need to do to bring down the rate of child deaths is inexpensive & straightforward," USAID Administrator Raj Shah said today on Twitter. In addition to handwashing with soap, "add a bednet, vaccines, nutrition, rehydration, newborn care; we know how to drastically reduce child deaths."

Luke and volunteers construct a new house. {Photo credit: L. Ross/MSH.}Photo credit: L. Ross/MSH.

In January 2011, Amelia and her partner, Luke --- both HIV positive --- began accessing HIV care and support services at the Agape Network through its community home and palliative care program.

Agape Network is one of the NGOs that receives technical support from the PEPFAR-funded, USAID-implemented, Guyana HIV/AIDS Reduction and Prevention Project (GHARP II), led by MSH.

When the Agape staff first met Luke and Amelia, they were living with their two daughters at Luke’s family’s home. The situation was tense because Luke’s relatives did not approve of his relationship with Amelia.

Finally, in December 2011, the tension escalated and Luke, Amelia, and their family were thrown out of the house.

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