Health Systems Strengthening

Health Systems Strengthening (HSS)

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. 

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.

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.

Originally appeared in Global Health Magazine.

Over the last several decades, millions of dollars have been invested in capacity building interventions, and the chorus of capacity building enthusiasts continues to grow. Yet, both in description and practice, capacity building remains somewhat fuzzy. In many developing countries, one of the greatest obstacles to achieving the health MDGs - in particular those relating to child survival, maternal health, and combating major diseases such as HIV & AIDS - is the deep, persistent lack of organizational capacity among those responsible for attaining these goals.

Some of the essential capacity components that are often lacking include human capacity - adequate numbers of skilled, motivated and well distributed health providers who are supported by strong leadership; financial capacity - money management skills, financial accountability, and costing expertise; systems capacity - information and logistics, monitoring and evaluation, and governance structures and processes.

This article originally appeared on The Huffington Post.

As world leaders gather next week at the U.N. to review progress on the Millennium Development Goals (MDGs) to eradicate poverty, hunger, and disease by 2015, a new integrated approach to funding and delivering health services in developing countries is critical if the UN's global health targets -- especially for women and children -- are to be met. Currently, the health goals are competing with each other for money, people, and other scarce resources. How can we get back on track?

There is much to celebrate next week: over four million people are currently receiving antiretroviral drugs to treat AIDS; eliminating mother to child transmission of HIV is within reach by 2015; malaria deaths have been reduced by over half in some countries; the global burden of TB is falling; and more than 500 million people are now treated for one or more neglected tropical diseases.

Earlier this summer, the Center for Global Development hosted a guest lecture by the Ministry of Health of Ethiopia Dr.Tedros Adhanom Ghebreyesus with a panel of experts from Zambia, Mozambique and Uganda and representatives from United States Government (USG) agencies to discuss one of the most challenging concepts to define right now - Country Ownership.

For the last two years, the USG has tried to find a way to partner with developing country governments while they balance their accountability to Congress.  In recent development reform plans like the Global Health Initiative and Feed the Future, there are numerous references to country ownership, country driven, country-led, and country guided but neither actually come out and define the term “country ownership.”

So, what is country ownership? How will we know when we achieve it? It is an end in itself or the best way to ensure long-term sustainability?

At a time when many are looking for examples of lasting local success in international development and sustainable approaches to healthcare for low income populations, PROSALUD, Bolivia’s largest health nongovernmental organization (NGO), embodies this success.  PROSALUD just celebrated its 25th anniversary last week – and MSH was there to help celebrate. For over two decades, PROSALUD has contributed to the unmet health needs of low-income populations in Bolivia, working with the active participation of the communities it serves.

It is always very special to witness an idea blossom, a theory carried out in practice, a vision becoming a reality. Such occasions are all too rare and when you’re in one, you really feel like you are living a special moment in history.

Ron O’Connor, Founder of Management Sciences for Health (MSH) and I had this very distinct opportunity two weeks ago in Santa Cruz, Bolivia as we were honored to attend the 25th Anniversary Celebration of PROSALUD.  Over the last 25 years, MSH has been privileged to accompany PROSALUD in its successful journey from one small clinic dependent on outside donations to become one of Bolivia’s primer health care providers with 23 health centers and 5 clinics in 9 cities across the country. And, PROSALUD is financially independent and governed by its own Bolivian Board of Directors.

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