Health Systems Strengthening

Health Systems Strengthening (HSS)

A child born in Ghana today will most likely receive a full schedule of immunizations, and her chances of surviving past the age of five are far better than they were a decade ago. Today Ghana boasts a coverage rate for infant vaccination of 90 percent and hasn’t seen an infant die of measles since 2003.

Ghana has been expanding primary health care by bringing services to people’s doorsteps since the 1980s, and since the early 2000s has done so in the context of a commitment to universal health coverage. The secret to its success in child immunization has been both integration and decentralization of health services: Government funding for all health activities is provided through a "common pot." District-level managers are responsible for local budgeting and service delivery. Local staff provide comprehensive rather than specialized care.

Ghana is one of a growing number of low- and middle-income countries demonstrating that strong performance in immunization can go hand-in-hand with the aspiration of universal health coverage, access for all to appropriate health services at an affordable cost.

Blog post updated Dec. 27, 2011.

Nursing Officer in Charge Nancy Thiong'o checks on a mother and her new baby

 

In 2003, after dwindling funds, low staff morale, and accusations of patient neglect had eroded community confidence in Kiriaini Mission Hospital in Kenya, the Catholic Diocese of Murang’a decided to shut it down -- leaving locals to seek treatment at the distant provincial capital of Nyeri.

Six months later five Franciscan nuns arrived from India to reopen the hospital. They hired new staff, renovated the dilapidated structures, and restored much needed services to the rural community. Eight years later the hospital is a clean, efficient, well-run facility with 70 beds, friendly staff, and multiple in-patient and out-patient services.

A nurse communicates with a patient with sign language. 

In the kidney dialysis unit of Kom Ombo District Hospital in Upper Egypt, dedicated nurses prepare for the monthly treatment of a regular patient. They have assured the proper functioning of medical equipment, stocked the dialysis room with necessary supplies, and prepared staff for the dialysis process. However, the patient is missing.

In June 2011, the CSIS Global Health Policy Center asked bloggers around the world, Do you think it's possible to create a unified social movement for NCDs, akin to the movements that already exist for individual chronic diseases?  If so, why?  If not, what initiatives can we implement in the place of an effective social movement to move an NCD agenda forward? Dr. Jonathan D. Quick was one of our four finalists.

For three years, Lucy Sakala has counseled people seeking HIV tests at a District Hospital in Malawi. A year ago, she was diagnosed with uterine cancer. She has had chemotherapy and surgery, which are sometimes painful and tiring, but are extending her life.

During the counseling sessions, she sometimes tells her patients about her illness: “I tell them they should live positively. There are several conditions more serious than HIV. I tell them I have cancer. It’s difficult, but I live positively."

The day before she said this, she had journeyed seven hours to the nearest city to see her doctor. He told her he had no more chemotherapy and she must buy it in a pharmacy. The cost was roughly $180. Insurance would only pay half.  The remaining half is a month’s salary, which she didn’t have.

It was an exciting and insightful week of discussions at this month’s Global Health Council meeting on how to address the drastically growing burden of non-communicable diseases (NCDs), such as cancers, diabetes, and heart and lung disease, in advance of the UN High Level Summit on NCDs in September. Speakers made a strong case for including NCDs as a priority on the global health agenda. The intertwining of these diseases with communicable diseases such as HIV, TB and malaria are striking. Julio Frenk, MD, MPH, Dean of the Harvard School of Public Health described the commonalities:

Discovering MSH blog series graphicOver the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.

The theme of this year’s Global Health Council annual conference was Securing a Healthier Future in a Changing World. As populations are shifting, so are their health priorities. Increasing urbanization has led to more people living in and around cities, creating a series of problems that are new to public health professionals. Nutritional challenges, the need for improved water and sanitation infrastructure, and addressing the issue of unregulated health care providers are all problems facing governments, ministries, NGOs, donors, and populations. In addition, non-communicable diseases (NCDs), including cancer, diabetes, cardiovascular conditions, and mental illness, are adding a new strain to many already resource constrained health systems. Of course, immunization, malaria, pneumonia, diarrhea, and maternal death are all still very serious challenges in many of these systems and remain key priorities.

Discovering MSH blog series graphicOver the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.LILONGWE, Malawi – The problem with writing about improvements in Malawi’s health system is focus. There are multiple directions to explore: extending family planning into rural communities, training HIV counselors, the rapid scale-up of HIV treatment, integrating TB services more into the mainstream of health care. At the US Agency for International Development (USAID) mission here, Dr.

Permanent Secretary of the Ministry of Medical Services, Ms. Mary Ngari, (Right), hands over the new Governance Guidelines to HMC Board Member and Deputy Provincial Commissioner of Central Province, Francis Sila, while USAID/Kenya HRH Specialist Peter Waithaka, LMS/Kenya Project Director Karen Caldwell, and Central Province Provincial Director of Medical Services Gichaiya M’Riara, look on. (Photo courtesy of Hosea Kunithia.)

 

Kenya’s new constitution, promulgated on August 4, 2010, mandates significant transformations in the health sector. Hospital reforms are a key part of these transformations. For MSH’s Leadership, Management and Sustainability Program in Kenya (LMS/Kenya), the opportunity to work closely with health sector partners, including the Ministry of Medical Services, to support the hospital reform agenda is an exciting and rewarding experience.

Pages

Printer Friendly Version
Subscribe to RSS - Health Systems Strengthening