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 {Photo credit: Gladys Lavien}Amelia G. Mulbah, a newly trained midwife, works in a remote area of Liberia’s Lofa County.Photo credit: Gladys Lavien

Amelia G. Mulbah, 33, is a newly trained midwife working in a remote region of Liberia. She received a scholarship through the USAID Collaborative Support for Health (CSH) Program and graduated from nursing school in December 2016. After passing the state board test, she became a registered midwife and was deployed for two years to work at the Lutheran Referral Hospital in northwestern Lofa County.

 {Photo credit: MSH-Perú staff}Women leaders at a fair in Bolivia share healthy eating tips to pregnant and breastfeeding women.Photo credit: MSH-Perú staff

A partnership with MSH-Perú and White Ribbon Alliance is promoting self-care in Bolivia

On a bright July day in San Ignacio de Moxos, Bolivia, 13 indigenous women leaders gathered in the central plaza around a long table decorated with bowls of beans, rice, plantains, corn, tomatoes, greens, and other foods. As part of an all-day fair to promote the health and nutrition of pregnant women and breastfeeding mothers, these indigenous women leaders presented their dishes to over 150 community members and local officials, gathered in the plaza to celebrate the town’s anniversary, and offered ideas on how to cook with locally- grown ingredients provided by the national government’s food subsidy program.

Through the White Ribbon Alliance’s Self-Care Initiative, MSH-Perú is organizing workshops and other outreach activities, to motivate women in 11 indigenous Bolivian communities to actively care for themselves, especially during pregnancy and while breastfeeding, by practicing healthy behaviors, and preparing nutritious meals.

 {Photo credit: Kate Ramsey/MSH}Women learn about their pregnancies during a pregnancy club session in eastern Uganda.Photo credit: Kate Ramsey/MSH

Earlier this year we wrote about our ongoing experience reaching pregnant women in Uganda with a model that we called “pregnancy clubs” – an effort to improve the quality of health services women receive during pregnancy and after delivery by organizing them into groups to discuss their personal experiences and learn important self-care skills, guided by a healthcare provider. The region where we are working is particularly vulnerable because there are very high rates of adolescent pregnancy (30.6%), and younger women often find that services are unable to meet their specific needs – especially for the first pregnancy. It can be a lonely time for younger women, especially if they are in a new household and a new marriage, or if experiencing stigma from pregnancy outside of marriage.

 {Photo credit: Samy Rakotoniaina, MSH}Community health volunteers use a mobile phone app to guide their patient interaction in rural Madagascar.Photo credit: Samy Rakotoniaina, MSH

How community health volunteers are using mobile technology to provide better care in remote areas of Madagascar

In remote villages of Madagascar, people who live miles away from a health center largely depend on community health volunteers for basic health care, such as family planning services, or the diagnosis and treatment of simple childhood infections. These volunteers are identified and elected by the community, and are then trained and supervised by the head of the nearest health center. The country's national Community Health Policy places them at the foundation of the health pyramid, as they are serving the most isolated communities. However, ensuring the quality care provided by these volunteers can be challenging: one study reported that only 49% of health volunteers offer family planning in accordance with national standards, and only 53% of children under the age of five are correctly treated for diarrhea, malaria, and pneumonia by health volunteers.

Being a community health volunteer is a tricky job. Among the many difficulties they already face, they are expected to report their activities by completing paper registers on a daily basis. But these paper tools, which are long and time-consuming, often result in delays and errors in the reporting process.

We’re excited to launch MSH Leading Voices, a monthly profile that features the incredible talent that makes up MSH.

We’re chatting with Seneca, our technical advisor for quality of care. Seneca is a Utah native with a passion for improving the health services that every person receives, no matter who they are or where they live. She’s responsible for integrating quality of care initiatives into all MSH health programs. 

What do you think makes MSH different?

Our legacy of working in health systems strengthening and capacity building. Excellence in quality can't be achieved by only one intervention; it's a multi-dimensional mosaic resulting from holistic thinking about an entire system that is enveloped in compassion, equity, and leadership. To that end, I am so excited about the work MSH has done around local leadership development.This is a powerful asset for cultivating a local culture of excellence toward quality of care across the healthcare spectrum. 

What are you most proud of in your work?

 {Photo credit: Samy Rakotoniaina/MSH}Community Health Volunteer in a remote village of Tulear, Madagascar, giving instructions to a client on the use of pregnancy tests.Photo credit: Samy Rakotoniaina/MSH

How Countries Can Move toward Building Sustainable Community Health Programs

Universal health coverage (UHC) is increasingly recognized as the best way to achieve the Sustainable Development Goal targets on health. But with 400 million people lacking access to essential health services and a projected shortage of 18 million health workers, it will take unprecedented effort and funding. Community health workers (CHWs) could be an important part of the solution—but without effective investments and sound planning, we will fall short of achieving UHC.

 {Photo credit: MSH staff.}Journalists raise their hands in solidarity to support AMR advocacy and containment at the close of a SIAPS-supported workshop organized by the Food, Medicine and Health Care Administration and Control Authority of Ethiopia in June 2012.Photo credit: MSH staff.

Achieving universal health coverage (UHC) won’t be possible without paying close attention to one of our most pressing global health threats: drug-resistant infections.

Antimicrobial resistance (AMR) occurs when microorganisms develop resistance to a medicine that was originally intended to disable or kill them. While microbes naturally develop resistance to antimicrobials over time, excessive or inappropriate use of antibiotics speeds up AMR. The issue is a big challenge to UHC, jeopardizing the effectiveness of surgical procedures and threatening the treatment of many infectious diseases, including malaria, tuberculosis, and HIV/AIDS.

According to estimates from The Review on Antimicrobial Resistance, a report commissioned by the U.K. government and the Wellcome Trust, the financial burden from AMR could be as much as USD 100 trillion and the global gross domestic product could decrease 3.5% by 2050. AMR also causes immense loss of life—700,000 people die from drug-resistant infections each year, and this number is expected to grow to 10 million by 2050 if AMR is not contained.

 {Photo Credit: Geoffrey Ddamba.}A peer educator mobilizes clients for outreach services in the Kawempe area of Kampala, Uganda.Photo Credit: Geoffrey Ddamba.

Many civil society organizations (CSOs) play an essential role as service providers and advocates in health systems around the world. They can connect policymakers and providers to the communities they serve, promote smarter decision-making, and foster local ownership. If countries are going to make Universal Health Coverage (UHC) a reality, it will be side-by-side and in partnership with civil society.

Delivering essential health services

Although many low- and middle-income countries lack public sector healthcare infrastructure and human resources for health, civil society can help fill in the gaps. Governments can partner with CSOs through mechanisms such as grants and contracts to leverage these organizations’ capacities to avoid duplication, reduce inefficiencies, and increase access.

For example, the USAID-funded Leadership, Management, and Governance (LMG) Project, led by Management Sciences for Health, worked with the Honduran Ministry of Health from 2012 to 2016 to contract with NGOs to provide HIV/AIDS services to key populations. In total, the LMG Project helped the ministry sign 25 contracts with NGOs to provide education, prevention, and rapid testing services for nearly 40,000 people over three years.

{Photo Credit: Melissa Garcia}Photo Credit: Melissa Garcia

(Cross-posted on the International Consortium for Emergency Contraception website).

With the current largest generation of young people, there is much to celebrate on August 12, International Youth Day. In particular, there is the growing recognition that as agents of change, adolescents and young people and their organisations are essential stakeholders who contribute to inclusive, just, sustainable and peaceful societies. Crucially, advocates working on sexual and reproductive health (SRH) and reproductive rights (RR) advance access for young people in meaningful ways.

 {Photo Credit: Aubrey Clark}A technician tests a child for malaria at a health center in Kinshasa, DRC.Photo Credit: Aubrey Clark

(Cross-posted on the Global Health Council website).

Between 2000 and 2015, great strides have been made in fighting malaria. Globally, malaria case incidences declined by 41% and mortality rates by 62%. However, approximately 212 million people were infected and 429,000 people died in 2015, with the majority being children under the age of 5 in sub-Saharan Africa. Malaria also places a great financial burden on individuals and health systems. In sub-Saharan Africa alone, the annual cost of case management related to malaria is estimated at USD 300 million.

Much has been done since 2000 to eliminate this disease, and ensuring improved access to and appropriate use of quality-assured malaria medicines is necessary to sustain these gains.

The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program recently published the results of its activities in eight countries (Angola, Burundi, the Democratic Republic of the Congo, Ethiopia, Kenya, Guinea, Mali, and South Sudan) to control malaria.

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