Health Systems Strengthening

Health Systems Strengthening (HSS)

Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.

In the 1990s many Brazilian patients infected with tuberculosis (TB) were not being cured, despite starting treatment. Some patients stopped taking their medication, which led to the reemergence of TB. In 1993, the World Health Organization declared that TB was a global emergency. Eventually, a multi-resistant strain of TB surfaced, making it even more difficult to fight the disease.

These occurrences --- referred to as “chronic cases” --- became apparent in some Brazilian states, but health units lacked standardized management systems to treat these cases of TB.

Centro de Referência Professor Hélio Fraga (CRPHF), which is Brazil's National Tuberculosis Reference Laboratory, took control of TB surveillance in 1994. CRPHF defined a more effective treatment scheme and a national network to register and monitor the chronic cases in 1999. CRPHF builds human capacity through training and carries out operational and epidemiological studies. They also evaluate TB and other lung disease control activities and function as a Macro Regional Reference Lab.

Uganda's Koboko health center IV store: Left, boxes of medicine and supplies piled in a store room before the SURE program's capacity building training. Right, Lebu Akim, stores assistant, in the newly organized medicine and supplies room. {Photo credits: Jimmy Ondoma/MSH.}Photo credits: Jimmy Ondoma/MSH.

Over the years, the Koboko health centre IV located in the West Nile region of Uganda has experienced challenges in the management of essential medicines and health supplies. Stock-outs of vital medicines were widespread, while huge quantities of slow-moving medicines were at risk of expiring. These problems were attributed to health workers’ poor skills in logistics management. In addition, there a was lack of reliable information to guide staff on when and what to order since stock cards were not regularly updated.

In July 2011, USAID's Securing Ugandans’ Right to Essential Medicines (SURE) program, led by Management Sciences for Health (MSH), began capacity-building activities aimed at strengthening essential medicines and health supplies systems at health facilities in the region. SURE has used the supervision, performance assessment, and recognition approach in 45 districts in Uganda. This approach involves mentoring and coaching pharmacy and stores’ staff at private not-for-profit and public health facilities in medicines management.

Lelo PHCU staff treat the young patient. {Photo credit: MSH.}Photo credit: MSH.

"Diktor! Diktor!" The urgent call for a doctor came from several school boys who had run to the facility. I glanced over and saw a boy about 12 years old tensely sit down in the waiting patio at Lelo Primary Health Care Unit in South Sudan.

Women learning about family planning at Bikone Health Center II, Western Uganda. {Photo credit: MSH.}Photo credit: MSH.

This was my first trip to Africa working with a development agency. While I had visited the African continent for personal trips previously, arriving in this context felt different. I was immediately aware of the challenges Uganda is facing. From the crumbling road infrastructure and high incidence of traffic accidents in Kampala, to the mobile phone networks that are pretty reliable while internet access is often spotty, to the prevalence of street children --- I can for the first time see what my local colleagues are up against.

I felt a bit overwhelmed in the first few days. Is there any way we can address all these challenges? Can we make a difference?

Visiting communities and health centers in Kampala, Eastern and Western Uganda -- and seeing first-hand the impact MSH is having across the country -- quickly re-inspired me.

I had the pleasure of meeting a particularly passionate and committed Clinical Officer, Rodger Rwehandika, at Bikone Health Center II in Western Uganda. As a health center II, Bikone is an outpatient facility, but the staff of the facility can also conduct outreach programs to educate and serve the community.

Rodger and his two staff facilitate health education programs at the local schools and also host youth-friendly programs on using condoms.

Yambayoh Magaji (right), a student laboratory technician, works with Garkida General Hospital's HIV Laboratory Focal Person Dahiru Sabo. {Photo credit: MSH.}Photo credit: MSH.

The USAID-supported Prevention Organizational Systems AIDS Care and Treatment (ProACT) project provides HIV & AIDS services to five sites in Adamawa State, Nigeria.

The greatest challenge for ProACT Adamawa has been the fragile health system, particularly in terms of human resources for health (HRH), one of the six building blocks of the health system. The inadequate health workforce in the laboratory affects other components of the health systems, such as: 1) medicines, vaccines and technology, 2) information, 3) governance and leadership, 4) health financing, and 5) service delivery.

The situation in Adamawa was such that one or two laboratory staff members did all the work in the laboratory, including phlebotomy, chemistry, hematology, immunology, malaria and tuberculosis (TB) microscopy. On average, there was a patient/staff ratio of 40:1 on clinic days. This situation applied to all the sites with regard to health workforce in the laboratories.

Norah Nakato (right) receiving care from Fausta Nalukwago, midwife at Mpigi Health Center IV in Uganda. {Photo credit: MSH}Photo credit: MSH

Norah, a 21-year-old teacher at a private school in Nansana, Uganda, did not know she was pregnant. Pain in her lower abdomen prompted her to go for a consultation at a private clinic in Nansana, where a urine test revealed the pregnancy. “I was shocked because I had last had my period on the 15th of that month,” Norah said.

At the clinic, Norah was given an antibiotic and a pain killer to relieve abdominal pain. Norah left the clinic excited about her pregnancy. But, two weeks later, the pain persisted and Norah began bleeding. Her mother advised her to go to Mpigi Health Center IV for an ultrasound.

At the health center, Norah saw a problem on the ultrasound screen. “The doctor showed me what was in my uterus and there was no baby," Norah said. "It was swollen with liquid and unclear substances. He said the substance had to be removed. I was very scared."

After counseling from the doctor, Norah was admitted and given medication to induce labor. When the contractions began, she was taken into surgery.

The doctor advised her to wait at least one and a half years before conceiving another child to allow time for her uterus to heal and the abnormal hormone levels to normalize.

Yvonise is a good-natured 40-year-old woman with an easy smile. She is mother to four children: two boys and two girls. Her youngest, a little girl, is six years old.

Today, Yvonise sits patiently at the pharmacy of Hôpital Immaculée Conception de Port-de-Paix (HIC Port-de-Paix) in Haiti, waiting for Miss Sevrine, her caregiver, to provide her with a month’s supply of life-saving medicine.

Yvonise is one of 2,200 patients enrolled in the HIV/AIDS program at HIC Port-de-Paix. She was infected years ago with the AIDS virus, but her family does not know. Keeping her secret is a constant burden.

“I tell my kids that I have an infection for which I am being treated,” she said. This is how she justifies her monthly trips to the hospital.

Yvonise knows first hand how important it is for her to keep her appointments. “Since I’ve been coming to the clinic and taking my medication, I’ve been feeling more energetic,” she said, grinning from ear to ear.

MSH's 40th anniversary year has been a catalyst to revisit our origins, recommit to our mission and renew our values. As we approach the holidays and look toward 2012, I’d like to share reflections on one of the most poignant events of the year for me: my recent visit with Mrs. Fumiko Iwamura in Japan. Fumiko-san is the widow of Dr. Noboru Iwamura, who inspired our founder Ron O’Connor to create MSH.

MSH President Jonathan Quick and Fumiko Iwamura. (Japan, 2011) Photo credit: Miho Sato.

 

All key indicators for SHTP II improve from FY10 to FY11: Diphtheria, Pertussis, Tetanus, third dose (DPT3); Intermittent Preventive Therapy, second dose (IPT2); first and fourth antenatal care visits (ANC1, ANC4); skilled birth attendant (SBA) deliveries; and family planning (FP) visits.

 

All project health indicators for the second phase of the USAID-funded Sudan Health Transformation Project (SHTP II), led by Management Sciences for Health (MSH) in partnership with the International Rescue Committee, have shown improved performance over the past two years.

On the ground, this means that more people are being immunized against diseases, communities are receiving education on HIV, and lives are being improved.

Cross-posted from the Global Health Magazine blog.

How did Malawi control its brain drain?

The British Medical Journal issued a report last month estimating that nine African countries have lost $2 billion worth of investment in training and educating doctors who have subsequently migrated abroad. It needn't be this way. Doctors, nurses and other health professionals do not have to give up home, family and country to earn enough money to give themselves and their children a future, even a modest one. And it needn't cost low income countries billions of dollars to train the doctors and nurses who then leave for greener pastures.

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