Universal Health Coverage

"Medicines are a key component of treatments to save lives"

~ Kwesi Eghan, trained Ghanian pharmacist and MSH portfolio manager for the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program in South Sudan and Afghanistan

A child in Tanzania has a fever for three days. A pregnant woman in Namibia is taking antiretroviral therapy (ART) to treat HIV and prevent transmission of HIV to her baby. A man in Swaziland suffers from drug-resistant TB and struggles to adhere to treatment.

Who helps ensure they take the right drug, at the right time, and for the right reason?

A pharmacist.

In many developing countries, pharmacists are primarily responsible for medicines selection, procurement, distribution, and explaining rational use of these medicines to their patients. But, many low- and middle-income countries suffer shortages of trained pharmacists. MSH and partners are helping countries and communities ensure that pharmacists and related health workers are equipped with the skills, systems, and support to provide quality services every day.

A woman. A newborn. A child. In many countries, their basic health and rights are tenuous. These women, newborns, and children are the health system.

A woman is ostracized: abandoned by her husband, her family, and her community. She suffered a fistula after giving birth to her son. After 20-plus years, an operation repairs her fistula; now, she is teaching again, and a part of the community.

Impact. Scale. Sustainability. As public health professionals, we are dedicated to high-impact and high-coverage interventions that significantly improve the health of large human populations. We also hope that the benefits become part of the timeless fabric of their families, communities, and the health system.

This triple expectation—impact, scale, and sustainability—has accompanied global health for decades and especially during the last  generation. In 1990, Dr. Thomas Bossert reported that, among five US government-funded health programs in Africa and Central America, a project’s capacity to show results was the most important factor to ensure the sustainability of its benefits.

Tuberculosis (TB) claims a life every 15 seconds; it is the single largest infectious killer and is universally recognized as a global epidemic. Nearly 200 children die every day of TB.

The challenges of tackling TB are well known, particularly in settings with limited resources, crowded urban environments, and among high risk groups including people living with HIV, prisoners, and children. The emergence of multidrug resistant strains of the disease (MDR-TB), the result of incomplete or poor managed TB treatment, present further obstacles and add exponential costs to already burdened health systems. Furthermore, challenges with access to, affordability, and proper use of pharmaceuticals and laboratory materials can have devastating consequences on diagnosis and treatment.

The key to ending TB is to work together to strengthen health systems in high TB-burden countries to be able to effectively implement both proven and innovative strategies. Four approaches will help save lives by uniting stakeholders to collaborate, innovate, and end TB:

When my daughter got sick, I took her to a clinic in my neighborhood. They gave her cough syrup for seven days.

I thought she was getting better, but it was apparent that she was still ill. After another examination, they referred her to St. Paul Hospital in Addis Ababa where they put her on oxygen and started taking blood sample after sample and injection after injection for a month. Her condition did not get better so they gave her another medicine. The doctors then decided to take blood from her back… only then did they know it was tuberculosis.

~ Atsede Tefera

Tuberculosis (TB) kills more people each year than any other infectious disease, causing over 1.5 million deaths globally. More than a quarter of cases are in Africa, the region with the highest burden of TB disease relative to population. Children are amongst the most vulnerable, and all too often children with TB remain in the shadows, undiagnosed, uncounted, and untreated. Today, more than 53 million children worldwide are infected with TB and over 400 die each day from this preventable and curable disease. 

It isn’t easy being a woman–or a girl–in Nigeria.

I grew up in a little village in the North where the tradition was very patriarchal. But my family was quite revolutionary. My father, right from the beginning, supported all of his children to go to school. When he got ill, he told my mother:  ‘You must promise me this: If I’m not around, and you are forced to choose between who to send to school, always choose the girl. The boy will inherit the land; he will always have a livelihood. The girl, she is not allowed to inherit anything; the girl child needs an education to find a livelihood for herself. '

It’s the opposite of what everyone thought! This is how I learned to lead.

A version of this post originally appeared on the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program blog. SIAPS is funded by the US Agency for International Development (USAID) and implemented by Management Sciences for Health (MSH).

More than 900,000 children die of pneumonia each year. Many of these cases go undiagnosed and untreated. The countdown to 2015 report notes that only 54 percent of children with pneumonia symptoms are taken to a health care provider, while the Global Action Plan for Pneumonia and Diarrhea reports that only 31 percent of children with suspected pneumonia receive antibiotics.

Medicines are a critical component of quality health care. In fact, most of the leading causes of death and disability in low- and middle-income countries could be prevented or treated with the appropriate use of affordable, effective medicines.

Yet, about two billion people—one third of the world’s population—lack consistent access to essential medicines. Fake and substandard medicines exacerbate the problem. When these people fall ill and seek treatment, too often they end up with small quantities, high prices, poor quality, and the wrong drug. This leads to prolonged suffering, and even death.

Management Sciences for Health (MSH) is a global leader on pharmaceutical management and universal health coverage (UHC). 

In 2012, the United Nations unanimously passed a resolution endorsing the concept of universal health coverage (UHC), urging governments everywhere to “provide all people with access to affordable, quality health care services”. Management Sciences for Health (MSH) and the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program are among global champions for UHC and joined global leaders celebrating UHC’s notable inclusion in the Sustainable Development Goals (SDGs) last Fall. Now, we continue to help countries face the obstacles of making UHC a reality.

Access to medicines has not always been at the forefront of the global discourse on UHC, which instead has tended to focus on financing. UHC programs must include adequate health financing and coverage of essential medicines if they are to deliver meaningful health outcomes. Policymakers attempting to establish and maintain UHC programs therefore need to have a sound understanding of the pharmaceutical sector and those pharmaceutical system components that must be considered to ensure ready access to the pharmaceuticals needed to support any UHC program.

“When we started our project in 2011, there was no system in place to identify multidrug-resistant tuberculosis (MDR-TB),” explained Muluken Melese, project director for the Help Ethiopia Address the Low Tuberculosis Performance (HEAL TB) project. However, since then, the five-year USAID-funded project, implemented by Management Sciences for Health (MSH), has expanded access to TB services to over half the population of Ethiopia and led a 15-fold increase in the number of MDR-TB patients on treatment.