Health Systems Strengthening

Health Systems Strengthening (HSS)

A physician assesses a mother and children for malaria at a health center in Bujumbura, Burundi. {Photo credit: Rima Shretta/MSH.}Photo credit: Rima Shretta/MSH.

Today, April 25th, Management Sciences for Health (MSH) joins the global community marking World Malaria Day. "Sustain Gains, Save Lives: Invest in Malaria" -- the theme of this year's World Malaria Day -- recognizes this crucial juncture in the global fight against malaria.

Significant gains have been made in the last ten years; since 2000, malaria mortality rates have decreased 25 percent globally, and 33 percent in Africa. However, progress could be reversed unless malaria continues to be a priority for global, regional, and national decision-makers and donors.

Burundi, Democratic Republic of the Congo (DR Congo), South Sudan, and Uganda are among several MSH countries commemorating World Malaria Day with malaria awareness activities and events, including health talk sessions at football (soccer) games and drama activities with kids.

5thBDay badge in white background.5thBDay badge in white background.

Every child deserves a fifth birthday. It seems simple enough. But for many children in the world — especially in countries with the highest burden of child mortality, such as India, Nigeria, Democratic Republic of the Congo (DRC), Pakistan and Ethiopia — preventable deaths will claim their lives, before they reach the age of five.

Today, USAID launched an ongoing child survival awareness campaign, called, “Every Child Deserves a 5th Birthday.”

The “5th Birthday” campaign kicked off with a briefing event at Kaiser Family Foundation, featuring USAID Administrator Dr. Rajiv Shah and other experts. Dr. Shah and colleagues stressed that reducing the burden of child mortality is critical to our future as a global community.

While the global community has made great strides reducing child mortality, inequality in child mortality remains: several regions and countries continue to shoulder the greatest burden and loss of life.

Meet Okata and his grandmother, watch the video.Meet Okata and his grandmother, watch the video.

On this World Health Day, we invite you to meet Okata, a 3-year-old orphan living with HIV, and his grandmother, his caretaker.

World Health Day, celebrated April 7th, marks the founding of the World Health Organization. This year's theme, "Good health adds life to years," encourages the global community to rethink what it means to be "old".

Watch the video, Building a Stronger Health System in Uganda, and share Okata's story with your network of family and friends.

(Left to right) Aaron Musiimenta, assistant regional behavior change communication officer; Tadeo Atuhura, STRIDES for Family Health communications specialist; Dr. Baseka Yusuf, district health officer; and Kevin Kisembo, principal nursing officer and STRIDES focal person. Kasese, Uganda. {Photo credit: Margaret Hartley/MSH.}Photo credit: Margaret Hartley/MSH.

The Kasese district in western Uganda is nestled between two national parks. Located hours from the capital city, Kampala, the region attracts tourists to view gorillas and mountain birds.

During my recent trip to Uganda, I met with Dr. Yusuf Baseka, the district health officer of Kasese, who described the health challenges his district faces, and his hopes for the future.

Although the national parks are beautiful and bring a much needed economic boost to the area, they also offer a challenge, Dr. Baseka explained.  The population growth and fertility rate of the district are very high. With the two national parks, there is no land for expansion. The town of Kasese is rapidly becoming a slum with unsanitary conditions that are difficult to address.

Another challenge in his district is that children are not going to or staying in school. They are leaving secondary school early and engaging in risky sexual behaviors. He explains, “We’ve seen a dramatic increase in young mothers, under 18 years, some as young as 12.” Their pregnancies offer unique challenges for the health system to address.

Godgift and his caregiver receiving educational supplies from the Executive Director of Synergycare Initiative. {Photo credit: Anayo Chike Charles/MSH.}Photo credit: Anayo Chike Charles/MSH.

Early one morning Mrs. Fred woke up and found a boy outside her house. Alarmed and curious, she asked him why he was there. Godgift, as he identified himself, told her that the continuous appearance of a snake where he lived forced him to abandon the place he called home, after numerous futile attempts to frighten it off with pepper. Highly disturbed, she arranged for him to eat in a nearby restaurant whenever he showed up by her house.

The boy, Godgift Henshaw, is 13 years old. Godgift's mother took him along when she left her husband and eloped with another man. When the burden of care got too heavy, she left Godgift with her mother in Agbia community, Bayelsa State, Nigeria. Godgift’s grandmother beat and neglected him. Most of the time he went without food and often slept outside the house. Finally, she labeled him a wizard and abandoned him, fleeing from their home.

The landlord evicted Godgift when there was no one to pay the rent. He took refuge in an uncompleted building in a nearby bush, completely at the mercy of the elements. Abandoned and stigmatized (following his identification as a wizard), he fed himself by doing odd jobs.

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.

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