Health Systems Strengthening

Health Systems Strengthening (HSS)

On this World AIDS Day, we reflect yet again on progress made toward global commitments to fight the HIV epidemic. According to UNAIDS, new infections have decreased this past year from 2.7 million to 2.6 million, but, 30 years into the epidemic, only 5.2 million people out of the estimated 15 million who need drugs have access to treatment. Stigma, discrimination and human rights violations against persons living with HIV still exist, even in countries with generalized epidemics.

Integrated HIV programming across the entire health system can minimize many of these barriers to HIV prevention, care and, treatment.

At this First Global Symposium on Health Systems Research there have been a number of concurrent sessions on how best to make the link between research and decision-making. How do we make research relevant and timely so that it can inform policy-making?

MSH served as a panelist on the panel “Health systems and national policy-making: Strengthening the Connection,” which provided good examples of studies from Nigeria and the Middle East and North Africa (MENA) Region that provided insight into this gap.

In Nigeria, a study focused on how the gap between policy makers and researchers could be bridged. How can research be made attractive so policy makers desire it? Through a cross-sectional survey, they set out to improve the skills of policy makers in evidence-informed policy making. A platform was created where the two met on neutral ground to develop the research agenda. What came out of this collaboration were five skill building workshops where pre/post data was collected. There was much participation and enthusiasm by both parties which culminated in six policy briefs to improve health systems operation in Nigeria.

Last year, the mHealth Alliance and the National Institute of Health (NIH) sponsored their first mobile health (mHealth) “Summit,” at the Ronald Reagan building in Washington, DC. The location was telling: it is the home of the US Agency for International Development (USAID). This year’s mHealth Summit has nearly doubled in size, moved its location to the Convention Center, and is being keynoted by Bill Gates and Ted Turner. It is safe to say that mHealth is certainly a topic de jour. The problem is that the big names---the global mobile phone network providers, manufacturers, pharma companies, and global consulting firms---are all jumping on the bandwagon, but they are late to the game. And the conversations in the plenary sessions highlight the fact that there’s a huge disconnect between the global companies and the on-the-ground implementers.

Blog post also appeared on Global Health Magazine.

PEPFAR Fellow in the field

As the country with the second highest maternal mortality rate in the world, outranked only by India, Nigeria loses one in every 18 women during child-birth. The country also has one of the highest infant mortality rates in the world, one of the lowest life expectancy rates---estimated at 47 years---and the second largest population of people living with HIV & AIDS, with only 30% of people eligible for anti-retroviral treatment able to access these life-saving drugs.

Fragile states such as Afghanistan, the Democratic Republic of Congo, Haiti, Liberia, and Southern Sudan have among the worst health statistics – especially for women and children.  For political, economic, security and other reasons they can be extremely challenging work environments. Despite this, I have been deeply inspired to see what local health leaders have achieved when they have created strong partnerships among government, donors,  non-governmental organizations and where possible the private sector.  The charismatic former minister of health from Afghanistan, the  medical director of an urban clinic in northern Haiti, and the director of Torit hospital in Southern Sudan stand out as examples of local leadership in action under circumstances that would immobilize many of us.

In fragile states, constraints on governments often prevent them from simultaneously building their stewardship role and immediately expanding service delivery. Supporting the Ministry of Health to establish a basic package of health services, train local organizations to implement those services, and provide incentives (such as through performance-based financing) is critical to success. Additionally, the goal should be to move from many plans and actors across districts to one health plan with committed partners. 

Part three of the blog series: Spotlight on Global Health Initiative Plus Countries

Health Financing is Helping Rebuild Rwanda’s Health Sector

It's been over 15 years since the Rwandan genocide; few would know of the tremendous successes in health that the country has experienced. Rwanda has made good progress towards meeting the Millennium Development Goals since they were identified. These impressive achievements are due to an increase in essential health interventions and the implementation of new health financing mechanisms.

The Health Minister’s Conference for member countries of The East, Central and Southern Africa Health Community (ECSA HC) was opened by the Minister of Health, Zimbabwe in Harare on October 25. The theme, "Moving from Knowledge to Action: Harnessing Evidence to Transform Healthcare" is very relevant to the mission of Management Sciences for Health (MSH).

I’ll highlight two sessions from the first day that support the evolving global health field and the work of MSH.

 

The Global Health Initiative (GHI), with its plans for integrated programs across the spectrum of infectious diseases, maternal and child health, family planning and health systems, seems like it was designed specifically to meet Guatemala’s challenges.

In mid-June the United States Government continued to show its commitment to global health by announcing the first Global Health Initiative (GHI) Plus countries: Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal, and Rwanda. The GHI is a six-year, $63 billion initiative to help partner countries improve measurable health outcomes by strengthening health systems and building upon proven results. The GHI focuses on women, newborns, and children using an integrated approach including programs that address HIV & AIDS, malaria, tuberculosis, maternal and child health, nutrition, family planning and reproductive health, and neglected tropical diseases. These initial countries will receive additional technical and management resources to quickly implement GHI’s approach.  They will be used as “learning labs” – using best practices and lessons learned when implementing programs in other countries. MSH works in seven of the eight countries, so we asked our country experts: What’s working? Please stay tuned for a continuing series.

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