Health Systems Strengthening

Health Systems Strengthening (HSS)

{Free antenatal and postnatal services encourage women to seek care at health facilities. Antenatal visits are of particular importance for awareness and early screening for chronic illnesses, which can avert costly treatment and save lives. (Photo credit: Adam Kone)}Free antenatal and postnatal services encourage women to seek care at health facilities. Antenatal visits are of particular importance for awareness and early screening for chronic illnesses, which can avert costly treatment and save lives. (Photo credit: Adam Kone)

This article was originally posted on the NCD Alliance's website. 

A few weeks ago I visited a health center in Freetown, the main port city and commercial center in Sierra Leone, West Africa. The health center is one of few health facilities serving the city, located in an urban area that is home to an estimated 1 million people. The clinic offers free antenatal care during pregnancy as part of the government's commitment to ensuring health care reaches all citizens.

The risk of a woman dying during pregnancy has long been unacceptably high in Sierra Leone, a problem that only worsened when Ebola hit in 2014. According to the latest figures from 2015, Sierra Leone has the worst maternal mortality ratio in the world. It is estimated that the lifetime risk of death during pregnancy and childbirth is 1 in 17. The burden of newborn deaths is also among the world’s highest, with a newborn mortality rate of 35 deaths per 1,000 live births in 2015.

{Dr. Carissa F. Etienne, Director of the Pan American Health Organization, addressing the Fourth Symposium on Health Systems Research in Vancouver, Canada. (Photo credit: Health Systems Global)}Dr. Carissa F. Etienne, Director of the Pan American Health Organization, addressing the Fourth Symposium on Health Systems Research in Vancouver, Canada. (Photo credit: Health Systems Global)

Strong health systems can protect the poor and promote equity. That was the resounding main message at the Fourth Global Symposium on Health Systems Research, held in Vancouver, Canada, just a few weeks ago.

Policymakers, practitioners, and researchers at the symposium agreed: marginalized communities in low, middle, and high-income countries confront daily challenges that impede their health and lives. So experts called for global leaders to learn lessons both from poor and rich nations to address the inequities that exist in all communities. But a few other important themes echoed throughout the four-day event. And they are worth noting.

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{A woman at provincial health services department in Sri Lanka. (Photo Credit: Simone D. McCourtie/World Bank)}A woman at provincial health services department in Sri Lanka. (Photo Credit: Simone D. McCourtie/World Bank)

This article was originally published on Devex on November 18, 2016

As finance advisers in global health, we are regularly in conversations with health ministers in low- and middle-income countries who have been charged with the commendable but daunting task of achieving universal health coverage for their citizens.

In other words, they must ensure that all people obtain the health services they need without suffering financial hardship when paying for them, with special emphasis on serving the poor and disadvantaged. Our conversations often boil down to some key questions: How much will it cost, who will pay, and how do we ensure that funds are used effectively and responsibly?

Dr. Frank Mugabe, Manager of the National Tuberculosis and Leprosy Programme in Uganda, describes the urban DOTS model.

Thirty MSH staff coordinated 2 workshops and 7 symposia and contributed 13 oral and 53 poster presentations to the 47th Union World Conference on Lung Health in Liverpool from October 26 through 29—a historic presence at this event. USAID and WHO experts called the MSH-led symposia on multidrug-resistant TB (MDR-TB) and urban DOTS “outstanding.” In the area of urban DOTS, presenters described the successful approaches that MSH has used in Kabul and Kampala under Challenge TB/Afghanistan and Uganda Track TB.

Four main themes emerged from the conference:

{A clinic doctor befriends a child waiting for vaccination at Delma 75 clinic near Port-au-Prince, Haiti. (Photo Credit: Carole Douglis/MSH)}A clinic doctor befriends a child waiting for vaccination at Delma 75 clinic near Port-au-Prince, Haiti. (Photo Credit: Carole Douglis/MSH)

This is the last in a series of four blog posts about the impact of leadership, management, and governance in strengthening health systems. See the full series on our blog.

Hurricane Matthew weakened Haiti’s already vulnerable health system when it struck last month, adding to the many challenges that the country’s government already faces in providing quality health services to its population.

Now, more than ever, Haiti needs strong leadership, management, and governance in the health sector to strengthen the system and ensure that its people have access to the care they need.

Even before the storm, the poorest nation in the western hemisphere was already facing political instability, the lasting effects of the 2010 earthquake, and an ongoing cholera epidemic, all of which seriously impacted the country’s health system.

{Photo Credit: Sara Holtz/MSH}Photo Credit: Sara Holtz/MSH

Strong, well-functioning health systems need strong leadership, management, and governance. Over the next couple of weeks, leading up to conversations that MSH is hosting at the Global Symposium on Health Systems Research next month in Vancouver, we will be sharing stories and insights about the role of leadership, management and governance in health systems strengthening. This is the third in a series of four blog posts on this topic. See the full series

In my nearly 20 years of experience in global health, I have seen that leadership and governance often receives little attention, even though it is an essential building block of any strong health system.

This is why LeaderNet – an online global community of health professionals – recently hosted a seminar entitled Dream Teams: Bringing Boards and Staff Together for Organizational Success.

The seminar aimed to bring leadership and governance to the forefront of the conversation, providing a forum for global health professionals to exchange ideas, experiences, and resources about leading teams that work at all levels of health systems around the world.

{Photo Credit: Rui Pires}Photo Credit: Rui Pires

Strong, well-functioning health systems need strong leadership, management, and governance. Over the next couple of weeks, leading up to conversations that MSH is hosting at the Global Symposium on Health Systems Research next month in Vancouver, we will be sharing stories and insights about the role of leadership, management and governance in health systems strengthening. This is the second in a series of four blog posts on this topic. See part one.

Linvell Nkhoma is a midwife manager at Mitundu Community Hospital in northern Lilongwe, Malawi. She lives on the hospital premises so she can be on call 24 hours a day for emergencies or complicated cases that less experienced midwives don't know how to manage.

"We have limited space, only three delivery beds for 400 deliveries a month," Linvell said.

Linvell and her colleagues were concerned about overcrowding, and more importantly, the high rates at which mothers and babies were dying during deliveries.

{Baby Anika, from northern Bangladesh, was diagnosed with TB at 22 months and was cured after 6 months of directly observed treatment. (Photo Credit: Francies Hajong/MSH)}Baby Anika, from northern Bangladesh, was diagnosed with TB at 22 months and was cured after 6 months of directly observed treatment. (Photo Credit: Francies Hajong/MSH)

This article was originally published on Devex on October 26, 2016

I was exposed to the plight of children with tuberculosis early in my 32 years of experience as a physician. I was a medical intern in a provincial hospital in Peru's jungle region. I noticed Adrian, a severely malnourished 3-year-old child in the corner of the ward, feverish and breathing with great difficulty. His condition didn't respond to pneumonia treatment, and a chest X-ray revealed liquid surrounding the right lung. My attending physician concluded that Adrian had severe malnutrition and pneumonia and decided to continue his antibiotic treatment.

Adrian died on the third day of my watch. An autopsy revealed the little boy had been afflicted with TB. That was likely why he died, not malnutrition or pneumonia. We later found out that Adrian was living with an uncle who had recently died "coughing blood." My attending physician confessed that he had been so focused on managing the presumed pneumonia that he didn't think about TB as an alternative diagnosis.

{Photo Credit: Carmen Urdaneta/MSH}Photo Credit: Carmen Urdaneta/MSH

Strong, well-functioning health systems need strong leadership, management, and governance. Over the next couple of weeks, leading up to conversations that MSH is hosting at the Global Symposium on Health Systems Research next month in Vancouver, we will be sharing stories and insights about the role of leadership, management and governance in health systems strengthening.

Over the last five years at the MSH-led, USAID-funded Leadership Management and Governance Project, our experience has underscored the importance of good governance, management and leadership to achieve service delivery outcomes in all health areas — from family planning to maternal, newborn and child health to HIV and AIDS.

The Leadership, Management and Governance Project's activities range from strengthening leadership and management skills of staff at the centralized level of Haiti's Ministry of Public Health and Population to supporting midwife managers to deliver high-quality family planning and reproductive health services in their communities at the decentralized level in Malawi.

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