Health Systems Strengthening

Health Systems Strengthening (HSS)

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.

Abubakar Muhammed Kurfi presenting at ICASA, Dec. 7, 2011. Credit: MSH.

Abubakar Muhammed Kurfi presenting at ICASA, Dec. 7, 2011. Credit: MSH.

The Program to Build Leadership and Accountability in Nigeria's Health System (PLAN-Health) -- led by Management Sciences for Health (MSH) in conjunction with eight local and international partners -- helped the Nigerian National TB and Leprosy Control Program (NTBLCP) in carry out a capacity assessment. PLAN-Health and NTBLCP defined critical gaps in the program and developed a comprehensive plan to ensure effective tuberculosis (TB) control throughout the Nigeria -- which carries the fourth-largest TB burden in the world.

Cross-posted from the K4Health Blog.

The overhead lights dim and in the dark, the high-spirited rhythm and melodic line of a Malawian song rises and overtakes the quiet buzz of conversation. We are seated in a large auditorium at the International Conference on Family Planning in Dakar, Senegal and watching the first film focused on the K4Health Malawi project in a festival hosted by Population Services International (PSI).

The film festival is a rich visual and audio break in an intense day filled with technical presentations and serious conversations about what works in programs that promote reproductive health and family planning.

Nator Namunya, 6-months old, receives a vaccination in Kapoeta North County. Credit: Save the Children.

 

A version of this post originally appeared on the Save the Children website.

The healthcare system in South Sudan is struggling to get on to its feet after the devastation of over 20 years of war. The biggest killers of children in southern Sudan are malaria, diarrhea and respiratory infections. These preventable diseases can be easy to treat. But, on average, only one in four people in South Sudan are within reach of a health center. Only 3 percent of children under two in South Sudan are fully immunized against killer diseases and only 12 percent of families have a mosquito net in their home.

Pages

Printer Friendly Version
Subscribe to RSS - Health Systems Strengthening