Women & Gender

{Photo credit: Mark Tuschman}Photo credit: Mark Tuschman

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.

{Photo credit: Mark Tuschman}Photo credit: Mark Tuschman

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.

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

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:

 {Photo credit: MSH Ethiopia}Atsede Tefera recalls three months of long delays in the diagnosis of tuberculosis for her daughter Nigist, who was eventually able to initiate treatment.Photo credit: MSH Ethiopia

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. 

 {Photo credit: MSH Nigeria}Some members of the Amdo Health Club in Billiri, Gombe StatePhoto credit: MSH Nigeria

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.

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

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). 

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

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.

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

At an event discussing maternal, newborn, and child survival, MSH’s country representative from Nigeria called for more attention on gestational diabetes (GDM) in her country.

The January 19 summit in Washington, DC, titled “Reaching the Last 25 Percent: Saving the Lives of Women and Newborns Through a Life Cycle Approach,” was convened by MSH, Novo Nordisk, and the NCD Roundtable. The meeting’s keynote address and two panel discussions focused on how governments, civil society, and the private sector in low- and middle-income countries are addressing maternal mortality and morbidity from non-communicable diseases (NCDs).

During a panel titled “Examples of NCD Integration in Maternal Health,” MSH Nigeria Country Representative Dr. Zipporah Kpamor discussed a recent pilot program that uses mobile health technology to measure blood glucose levels in pregnant women with GDM. The program aimed to provide women with faster, more convenient, and confidential blood glucose monitoring and a way to limit appointments, and reduce waiting time and transportation costs. The program was funded by MSH’s Internal Innovations Challenge (INCH) fund.

 {Photo credit: Brigid Boettler/MSH}Expert panelists discuss MDR-TB (from left): Joshua Michaud, Kaiser Family Foundation; Alexander Golubkov, USAID; Muluken Melese, MSH, Ethiopia; and Kenneth Mutesasira, MSH, Uganda.Photo credit: Brigid Boettler/MSH

“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.

 {Photo credit: Matt Martin/MSH}About 20 of the nearly 30 MSH staff attending the 4th annual ICFP gather for the opening ceremony.Photo credit: Matt Martin/MSH

Three weeks ago, nearly 3,500 family planning researchers, program managers, and policymakers came together in Nusa Dua, Indonesia to discuss the latest research findings and best practices on family planning at the 4th International Conference on Family Planning (ICFP). It was the largest gathering of family planning enthusiasts to date.

Nearly 30 MSH staff from 8 countries attended ICFP, showcasing our health systems expertise and experiences in family planning.

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