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Haiti, One Year On: Realizing Country Ownership in a Fragile State

Tuesday, January 11, 2011, 3:00-5:00 p.m., B-340, Rayburn House Office Building, Capitol Hill
This Washington DC event will be webcast live. You can tune in and join the discussion, below, starting at 3:00 p.m.

Dr. Florence Duperval Guillaume, MSH’s Deputy Chief of Party and Technical Director, Santé pour le Développement et la Stabilité d’Haíïti, will be discussant at this Oxfam America-hosted policy discussion to examine aid effectiveness in Haiti within the context of country ownership. Other speakers will include:

January 12, 2011 marks the one year anniversary of the earthquake that devastated Port-au-Prince, Haiti. I have the good fortune of visiting MSH’s USAID-funded SDSH (Santé pour le Développement et la Stabilité d’Haíïti) project team in Port-au-Prince this week, and I traveled out into the city to see the devastation the earthquake caused.

Rubble and dust in Haiti a year after the earthquake.

It has been a catastrophic year for Haitians. The Haitians themselves say this, a people who are used to dealing with poverty, combined with yearly hurricanes, and near constant political instability. However, one thing has been made clear to me in the past few days that I have been on this island: Life Goes On.

Women Nurses at Results Presentation in Aswan, Egypt

In Aswan, Egypt’s sunniest southern city located about one and a half hours by plane from Cairo, the Nile is at its most striking. Tropical plants grow along the edges of the flowing river, and the amber desert and granite rocks surround orchards of palm trees.

I was honored to be present in Aswan during one of Management Sciences for Health’s most important events; the results presentation of the Leadership Development Program (LDP), funded by the US Agency for International Development (USAID) as part of the Improving the Performance of Nurses in Upper Egypt (IPN) project in the Aswan governorate.

This blog post originally appeared on K4Health's blog.

The most important item in Amon Chimphepo’s medical kit is a small cell phone. This single piece of technology has proved to be a lifeline for people living in one of the most remote regions of Malawi. Its power to reach and initiate help immediately from the closest hospital is saving lives and improving health outcomes. In fact, I met a woman, alive today, because Mr. Chimphepo and his cell phone were there to make an emergency call to the district hospital and get an ambulance.

Health Workers in Southern Sudan

A few weeks ago, I had the opportunity to visit Southern Sudan. For over five decades, Southern Sudan endured civil war, unrest, and several waves of forced displacement and refugees. The infrastructure of nearly every sector was mostly destroyed throughout the region. It is a classic fragile state situation.

Since the Comprehensive Peace Agreement was signed five years ago, the Government of Southern Sudan, donors, international organizations, nongovernmental organizations, private organizations, and, most importantly, health workers are coming together to rebuild a shattered health system.

Now the global community focuses attention on Southern Sudan as they prepare for a Referendum vote to decide if they will officially break away from Northern Sudan to become an independent state. The vote is scheduled to begin January 9, 2011.

Kitchen Garden Produce & Afghan Boy

The carefully irrigated and shaded kitchen garden provided welcome splashes of different shades of green against the surrounding dry brown soil and rocks. We congratulated Shukria, a community health worker (CHW), on the lush vegetables and ripening fruits as we entered her home.

Shukria explained that the gardens that she and other women were growing started with the community-based growth monitoring program through the Family Health Action Groups. The growth monitoring is successfully identifying children under two who were not gaining enough weight or were undernourished. She and other mothers spent time counseling the mothers of the identified underweight children.

At the First Global Symposium on Health Systems Research in Montreux, Switzerland in November, Dr. Yogesh Rajkotia, of USAID Rwanda, moderated a panel discussion noting that Performance-Based Financing (PBF) is an effective health systems strengthening strategy. The presentations were made on behalf of the Rwandan Ministry of Health with the guidance of Dr. Agnes Binagwaho, Permanent Secretary.

In 2000, Rwanda’s health system was perceived as weak: there were human resources shortages, especially in rural areas; poor quality of services; and a high morbidity/mortality rate of women and children. Since 2001, Rwanda has committed itself to better health and to pushing for achievement of the Millennium Development Goals (MDG) by 2015.

PBF is a powerful means for increasing the quantity and quality of health services by providing incentives to health providers to improve performance. A PBF program typically includes performance-based grants or contracts. Health clinics and their staff are rewarded for reaching or exceeding health indicators.

This blog post was co-written with Morsi Mansour. Joan and Morsi are leadership development specialists in MSH’s Center for Leadership and Management.

Students in Uganda participate in a leadership development program during their pre-service medical training.

How can we empower the front-line of health care managers and service providers in the developing world?

As the Leadership, Management and Sustainability Program completes five years, it is an important moment to sum up what we have learned about sustainability and to reflect on how local ownership of health improvement programs supports sustainability of health results.

Halida Akhter receiving the United Nations Population Award in 2006.

Bangladesh, which is situated in a resource poor setting with a population of over 150 million, faces the major health challenge of a high maternal mortality rate. In the 1970s, the maternal mortality rate was 700 deaths per 100,000, and now it is still at 320 per 100,000. Although Bangladesh has made progress in reducing its infant mortality, much progress needs to be made to reach the Millennium Development Goals for maternal mortality. Bangladesh will need more than five years to achieve the goals. The Global Health Initiative (GHI) will help address the major health challenges women face in Bangladesh. Bangladesh has successful models of collaboration and public-private partnerships to share with other countries.

Female community health worker teaching mothers to improve hygiene and preventing diarrhea in their homes through regular hand washing.

Many children in Afghanistan die each year of easily preventable diseases; nearly 25% of those deaths are due to diarrhea. However, it is not only the fatal cases of severe diarrhea that are imperative to address. Between a quarter and a half of mothers of children less than five years old report their child had diarrhea in the two weeks prior to questioning. These frequent cases of diarrhea are among the main causes of under nutrition, which delays development and is implicated in over half of all childhood deaths.

One of the most effective ways of preventing diarrhea is to improve hygiene in the home, especially through regular hand washing with soap before preparing and eating food, after using the toilet or handling a child’s feces.

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