Health Systems Strengthening

Health Systems Strengthening (HSS)

Nehema Bubake, seen recovering here at the Kaziba General Reference Hospital, is full of optimism now that her fistula has been repaired. {Photo credit: MSH.}Photo credit: MSH.

In the Democratic Republic of Congo, many women suffer complications during pregnancy and delivery, including obstetric fistula. Prolonged labor may result in a hole (“fistula”) between a woman’s birth canal and bladder or lower intestine, resulting in chronic leaking of urine or feces. This, in turn, leads to social isolation as the women can’t keep themselves clean, are ashamed of their condition, and withdraw from society. Many women and their families believe that this condition is due to a curse, leading to further separation from the community.

World Contraception Day 2012World Contraception Day 2012

Cross-posted on the K4Health blog. K4Health is a USAID project, led by Johns Hopkins Bloomberg School of Public Health's Center for Communication Programs (JHU-CCP), with partners FHI-360 and Management Sciences for Health (MSH).

Worldwide 222 million women have an unmet need for modern contraceptives. That means of those women wanting to delay or prevent pregnancy, 222 million are not using contraceptives.

This number is burned into my brain: 222 million. Let’s put this in perspective.

Currently in the US, there are roughly 156 million women, so the number of women worldwide without access to contraceptives is greater than the entire population of women in the US.

Bolivian nurses. {Photo credit: MSH.}Photo credit: MSH.

Building local capacity is a pillar of the United States Agency for International Development's USAID Forward reforms. This post is one example of how USAID worked through Management Sciences for Health (MSH) to build, nurture, and support a local development stakeholder that is still thriving today. The story was written by global health writer John Donnelly, and first appeared in MSH’s book Go to the People in 2011. Cross-posted on Modernize Aid in the Modernizing Foreign Assistance Network (MFAN) blog field feedback series.

A temporary bin shelter improves medical waste management. {Photo credit: MSH.}Photo credit: MSH.

After the meeting, I meet Francinah, a 24-year-old district environmental health technician. In a soft voice, she tells me that as part of the QIL program, she worked with her own hospital and with the nearby Xhosa clinic to address the issue of waste management. With help from the support team, they convinced the government department in charge of construction to build a shelter to protect household and medical waste bins from the elements, curious people, and animals before it could be safely disposed of.

Earlier that morning, she received confirmation that the department was procuring materials to build the shelter.

Meanwhile, the clinic has sourced fencing and roofing materials to construct a temporary shelter. Later that afternoon, I visit the clinic to see the temporary shelter; it serves the purpose for now, but needs to be upgraded.

I observe in sympathy as a staff member hesitates over the electronic planning and monitoring tool that the support team suggests to him. He admits that it would make work easier for him but he is clearly more comfortable with his hand written notes on a notepad. I speculate that perhaps his reluctance is due to uncertainty about using the technology, and perhaps a slow typing speed. I am hopeful that by the end of the accreditation process, he will be confidently using all the tools and technology.

Health workers listen during the Mahalapye Hospital staff meeting, Botswana. {Photo credit: MSH/}Photo credit: MSH/

“J’mappelle Mompati. Comment t’appelles tu?”

Overcoming my confusion at being greeted by a French-speaking man in Botswana, I smile, take his proffered hand and reply in my rusty, stilted French, “J’mappelle Naume...”

Mompati is Mahalapye Hospital’s dynamic public relations officer. Now that he has my full attention, Mompati wastes no time in telling me about his work linking the hospital and the surrounding community through events and the media. We exchange contacts and he hands me a few copies of his newsletter before dashing off to his duties.

Mahalapye is a small town in the Central District of Botswana on the edge of the Kalahari Desert. Situated along the main road between the capital, Gaborone, and the second largest city, Francistown, Mahalapye is a convenient stopover place.

The hospital has been recently renovated and serves 300 outpatients a day and up to 200 inpatients.

Sheba (right), her siblings and their aged blind grandmother. {Photo credit: MSH.}Photo credit: MSH.

Sheba Joshua became the head of her household at just 18 years of age, when she lost her parents to AIDS. She is responsible for seven siblings and her blind grandmother and earns money by running a catering business out of her home in Gombe State, Nigeria. Becoming the main caregiver for an entire family at that age would have been a daunting experience for most teenagers, but Sheba was not fazed. Now 23, the young woman is fast becoming a respected business owner.

Sheba’s family recently began to receive support from the PEPFAR-funded Community Based Support for Orphans and Vulnerable Children (CUBS) project, led by Management Sciences for Health (MSH). CUBS’ support is routed through the Knightingale Women’s Health Organization (KWHO), which registered two of Sheba’s siblings in school and provided the children with school uniforms, books, pens, and care kits that include mosquito nets, buckets, spigots, and a Water Guard. KWHO also periodically provides the family with food, soap, and money.

Frieda Komba, a licensed drug dispenser in Tanzania. {Photo credit: MSH.}Photo credit: MSH.

Each year over 10 million men, women, and children in developing countries die as a result of our collective failure to deliver available safe, affordable, and proven prevention and treatment. A recent analysis of innovations in products and practices for global health, from the Hepatitis B vaccine to use of skilled birth attendants, revealed virtually none of these life-saving interventions reaches much more than half their target population—even after as many as 28 years of availability. This reflects a vast gap between knowledge and action in global health.

Successful Health Systems Innovations

Low- and middle-income countries (LMIC) benefit from continued innovations in health products and health practices, such as use of misoprostol to prevent post-partum hemorrhage, and technologies such as internet-based mHealth applications to protect the poor from catastrophic health expenditures.  To ensure such innovations achieve large-scale, widespread coverage, they must be accompanied by much more effective health systems innovations.

President William Clinton at Closing Session of AIDS 2012. {Photo credit: © IAS/Steve Shapiro - Commercialimage.net.}Photo credit: © IAS/Steve Shapiro - Commercialimage.net.

It's been nearly two weeks since former President William J. Clinton closed the last session of the XIX International AIDS Conference (AIDS 2012) and delegates returned home.

This year's conference featured commitment and calls for an AIDS-free generation, a growing interest in Option B+, and new research towards a cure.  Here are some reflections from what we learned at AIDS 2012, where we truly started "turning the tide together".

Clinton calls for a blueprint toward an AIDS-free generation

Secretary Hilary Rodham Clinton announced significant funding towards preventing mother-to-child transmission (PMTCT) of HIV, South Africa’s plan for voluntary medical male circumcision, and money for “implementation research,” civil society, and country-led plans. Sec. Clinton also called on Ambassador Eric Goosby to provide a blueprint for achieving an AIDS-free generation during her plenary address. Numerous other stakeholders echoed her commitment. But, if we really want to achieve an AIDS-free generation, the $7 billion funding gap that stands between where we are now, and where we should be, will need to be erased

SWSS team and NGO members visited a local shop for information, education, and communication materials in Baghalak village of Nahrin district, Baghlan province. {Photo credit: Bashir Ahmad, CLTS Supervisor/SWSS.}Photo credit: Bashir Ahmad, CLTS Supervisor/SWSS.

Afghanistan has yet another village which has successfully become an Open Defecation Free (ODF) zone. Baghalak is a village in Nahrin district with 630 inhabitants dispersed among 90 households --- each with unused latrines in poor condition. For this reason, Baghalak was selected by the USAID-funded project, Sustainable Water Supply and Sanitation (SWSS) and the Organization for Health Promotion & Management to partake in community-led total sanitation (CLTS) training.

Prior to CLTS’ involvement in the village of Baghalak, the traditional latrines also lacked hand washing facilities, which is crucial to proper sanitation. In addition, significant amounts of human waste could be seen on farms, gardens, and sidewalks. As is a common problem in communities without CLTS instruction, latrines tend to go unused due to the lack of communal education regarding their importance. While the hygienic and sanitation status of the community were in severe need of improvement, there also existed a strong desire within the community to reduce their high incidences of infectious illnesses, particularly diarrheal diseases.

(Cross-posted on MSH at AIDS 2012 conference blog)

On Sunday, July 22, 2012, Management Sciences for Health (MSH) hosted a satellite session, Beyond MDG 6: HIV and Chronic NCDs: Integrating Health Systems Towards Universal Health Coverage at the XIX International AIDS Conference (AIDS 2012). The session panelists were (left to right): Dr Ayoub Magimba, Till Baernighausen, Dr Jemima Kamano, John Donnelly (moderator), Sir George Alleyne, Dr Doyin Oluwole, and Dr Jonathan D. Quick

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