HIV & AIDS

MSH Vice President, Pharmaceuticals & Health Technologies Group, Dr. Douglas Keene, tells Devex how strong governance enables access to medicines.MSH Vice President, Pharmaceuticals & Health Technologies Group, Dr. Douglas Keene, tells Devex how strong governance enables access to medicines.

This week, Management Sciences for Health (MSH) and Devex are talking about how to maximize the impact of access to medicines in low- and middle-income countries. Below are excerpts, descriptions, videos, and links to the conversation. See the full conversation on Access to Medicines.

By strengthening governance and promoting transparency, developing countries can be better equipped to regulate the flow of medicines and support their efficient and effective use. Countries could make much progress by assuring the quality of medicines, but what is really being achieved in practice?

Recent global crises such as Ebola and Zika have revealed the dangers of weak health systems. As countries work to strengthen these systems, Dr. Douglas Keene, vice president of the pharmaceuticals & health technologies group at MSH, advises policymakers to first start by addressing existing regulations and governance.

Aster, a grandmother living with diabetes and TB, invited MSH to accompany her on a visit to the pharmacy at the local hospital in Debre Markos, Ethiopia.

written by Daphne Northrop, video by Emily Judem

How do you ensure that patients get the medicine they need -- at the right dose, when they need it, no matter the circumstances?

Answering that question became the foundation of an enduring partnership between Management Sciences for Health (MSH), USAID, and country governments around the world. Over the past 30 years, as a result of that partnership, countries have made monumental progress in building the systems that move medicines to their final destination: the people who need them.

Medicine Movers, a new microsite by MSH, tells the stories of patients who continue to benefit from these pharmaceutical systems, launched during the peak of the AIDS epidemic.

{Photo credit: MSH staff, South Africa}Photo credit: MSH staff, South Africa

This post, first published on The Huffington Post, is part 5 in the MSH series on improving the health of the poorest and most vulnerable women, children, and communities by prioritizing prevention and preparing health systems for epidemics. Join the conversation online with hashtag .

Struck with a prolonged and worsening illness, Faith, a 37-year-old Nairobi woman raising her two children, sought help from local clinics. She came away each time with no diagnosis and occasionally an absurdly useless packet of antihistamines. Finally, a friend urged her to get an HIV test. When it came back positive, Faith wanted to kill herself, and got hold of a poison.

All epidemics arise from weak health systems, like the one that failed to serve Faith. Where people are poor and health systems are under-resourced, diseases like AIDS, Yellow Fever, Ebola, TB, Zika, Malaria, steadily march the afflicted to an early grave, decimating families, communities and economies along the way.

{Photo: MSH staff/Tanzania}Photo: MSH staff/Tanzania

Invest in teenage girls. Change the world.

Sylvia, age 16, knew little about HIV & AIDS or reproductive health when she started primary school. Now, she says: “I am not scared by the pressure from boys and other girls to engage in early sex, I know my rights and am determined to fulfill my vision of completing my education.” Sylvia is one of 485 girls in 6 eastern Ugandan schools who received integrated sexual and reproductive health and HIV information.

Today, July 11, we commemorate World Population Day 2016 and the midpoint toward reaching the Family Planning 2020 (FP2020) goal to ensure the right of 120 million additional women and girls to access contraception. More than half of the 7 billion people on earth are under the age of 30. Most of the FP2020 focus countries are in the very regions of the world where we find (a) the highest population of youth and (b) more marginalized and disenfranchised young people. In many of the world's poorest countries, people aged 15 to 29 will continue to comprise about half of the population for the next four decades.

 {Photo credit: Rebecca Weaver/MSH} bit.ly/msh_May2016Photo credit: Rebecca Weaver/MSH

MSH is a worldwide leader in strengthening health care financing systems toward universal health coverage (UHC). Stronger systems. Stronger women and children.

MSH has made tremendous impact on health care financing and UHC in the last two decades.

Performance-based financing

In 1999, MSH pioneered performance-based financing in Haiti, and has continued to adapt and improve upon it since. We contributed to and supported Rwanda to design, implement, and achieve UHC through community-based health insurance and performance-based financing; drastically reduce maternal and child mortality; and meet all of its health Millennium Development Goals.

In Democratic Republic of the Congo, we contributed to drastic reductions in child mortality and some of the greatest results-based financing outcomes in two decades.

Altogether, we've designed and/or implemented performance-based financing interventions in 14 countries across 3 continents (sub-Saharan Africa, Latin America, and South-East Asia).

 {Photo credit: Associated Press/Aurelie Marrier d’Unienvil}Women celebrate as their country is declared Ebola free in the city of Freetown, Sierra Leone, Saturday, Nov. 7, 2015.Photo credit: Associated Press/Aurelie Marrier d’Unienvil

When 18-year-old Ianka Barbosa was 7 months pregnant, an ultrasound showed the baby had an abnormally small head, a dreaded sign of microcephaly due to Zika infection.  Upon hearing the news, Ianka’s husband fled. In her poor neighborhood of Campina Grande, Brazil, Ianka soon became a young mother alone.

As Ianka’s baby Sophia grows, she may never walk, or talk. She could develop seizures before she reaches six months.  By the end of the year there may be a staggering 3,000 Sophias in Brazil – mostly in the poorest places.

Epidemics erase the gains women have achieved.

The world has suffered a series of “Zikas”—virtually unknown diseases that seemed to come from nowhere and explode with devastating consequences for families and entire countries – before Zika, Ebola, SARS, AIDS, and others.

Epidemics don’t just leave behind a death toll.  They can demolish the gains women have made in maternal, newborn, child, adolescent, and reproductive health—gains that have been propelled by women’s rights and empowerment. 

SCMS supported local partners in 25 countries to build country ownership of supply chain management. Read more about SCMS’s impact in its report: 10 Years of Supporting PEPFAR through Stronger Public Health Supply Chains

By Sherif Mowafy

[Chantal, an HIV-positive woman, waits for her monthly supply of antiretroviral medication at the Hôpital Immaculée Conception in Haiti.] {Photo credit: Jean Jacques Augustin, SCMS}Chantal, an HIV-positive woman, waits for her monthly supply of antiretroviral medication at the Hôpital Immaculée Conception in Haiti.Photo credit: Jean Jacques Augustin, SCMSAs the warm Haitian sun comes up, Chantal leaves her four children behind to get her HIV treatment, traveling for three hours in the back of a crowded jeep.

She bumps over unpaved roads to her monthly visit for antiretrovirals, one that she has been doing routinely for several years to keep her disease at bay.

Her children don’t know that she is HIV positive, and she doesn’t want to tell them. She makes this long trip over rough and ragged terrain to preserve her privacy and escape the possibility of stigma, still prevalent in Haitian society.

 {Photo credit: Rebecca Weaver/MSH}A community health worker in Democratic Republic of the Congo.Photo credit: Rebecca Weaver/MSH

This Global Health Impact issue highlights community health and community health workers, and presents a glimpse of MSH's work at the community level, in partnership with national ministries of health, civil society organizations, the private sector, and more.

The community is the center of the health system in developing countries.

Throughout sub-Saharan Africa, community health workers, often volunteers, represent the foundation of the health system, addressing priority health areas ranging from maternal and newborn health to family planning and infection prevention. The community health worker (known by different names in different countries) is the fundamental frontline promoter, provider of services and medicines (through integrated community case management), and the one who refers and links beneficiaries with more complex health needs to facilities. Not only do community health workers extend access to health services for the underserved and those living in hard-to-reach or conflict-ridden areas, they help countries accelerate certain health outcomes and achieve the Sustainable Development Goals and related targets for universal health coverage.

 {Photo credit: Katy Doyle/MSH}A health worker in Togo counsels a woman on reproductive health.Photo credit: Katy Doyle/MSH

Many years ago I began my public health career in Ciudad Nezahualcoyotl, then a squatter settlement of 1.8 million people, bordering Mexico City in the State of Mexico. Lack of land and unaffordable rents forced poor migrants, streaming in from the country side in search of employment and a better life in the city, to settle in the surrounding peri-urban areas. This large municipality, with few paved streets, was difficult to navigate in the rainy season. During the dry season, the wind would kick up dust storms that made it hard to see a block ahead. Nezahualcoyotl means hungry coyote in the Nahuatl language  and too many families in Neza, as people sometimes called it, were poor and hungry.

 {Photo credit: Ghaffar Rabiu}Dr. Zipporah Kpamor, Country Director, MSH Nigeria, is interviewed at the 10th anniversary event.Photo credit: Ghaffar Rabiu

Management Sciences for Health (MSH) celebrated 10 Years of Improving the Health of Women and Children in Nigeria with 250 stakeholders and supporters at a special event in Abuja on March 31, 2016. Distinguished guests included the chairman of the Nigerian House of Representatives, director of the Federal Ministry of Health in Nigeria, high-level representatives from state governments and partner organizations, and more.

After a rousing rendition of “Arise, Oh Compatriots,” the Nigerian national anthem, Country Director, Dr. Zipporah Kpamor, welcomed participants and underscored the intention for the day’s two round-table panel discussions:

In Nigeria, 150 women and 2,300 children die every day from preventable causes. One in five children won’t live to see their fifth birthday. This event can help continue conversations on what we can do to end preventable deaths among women, children, and young people.

Currently, MSH’s partnerships for health system strengthening in Nigeria reach nearly 560,000 people through four projects.

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