What it takes for health systems to provide lifelong antiretrovirals
Soon after her husband’s death in 1991, Bahati Shellinah tested positive for HIV, but antiretroviral drugs (ARVs) were not yet available. In 2004 she fell ill, but, luckily, this time ARVs were available. Bahati visited the Joint Clinical Research Centre (JCRC) outside of Kampala, Uganda, and she began taking ARVs for the first time
Before the civil war in the late 1990s, the Democratic Republic of Congo (DRC) had a large network of clinics and health facilities. But decades of conflict weakened a fragile health system and robbed this resource-rich country of its potential to become one of sub-Saharan Africa’s wealthiest nations. By 2010, 70 to 80 percent of Congolese people had little or no access to healthcare, and the country suffered from a lack of basic security, communication systems, power, clean water, and transportation.
Niranjan KonduriMotivated frontline health workers play a key role achieving global strategies to fight tuberculosis (TB), writes MSH Principal Technical Advisor Niranjan Konduri, of USAID's Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, for The Lancet Global Health Blog. Using the story of Irina Chaban, a Ukrainian TB doctor, as an example, Konduri highlights the challenges health workers in low- and middle-income countries must overcome while working to eradicate TB.
In many developing countries, true life-and-death decisions hinge on information that’s old, unreliable or both.
Without strong national capacity for data collection, health officials are left in the dark when monitoring outbreaks of diseases like Ebola or trying to improve care for cancer patients. Many countries are unable to produce an accurate picture of their progress toward universal health coverage (UHC) or even assess their starting point.
Health workers throughout the developing world provide vital services and improve the lives of the people they serve, and yet they are often invisible. These men and women conduct community outreach, provide key prevention messages in the community, and deliver clinical care, treatment, and follow-up. In Uganda, the US Agency for International Development (USAID) TRACK TB project, led by Management Sciences for Health (MSH), supports 52 community linkage facilitators to help increase tuberculosis (TB) case detection and treatment success rates.
Nearly three years ago, I blogged about a systems approach to improving access for a Maternal Health Task Force (MHTF) series on maternal health commodities: Increasing access to essential medicines and supplies for maternal health requires a systems approach that includes: improving governance of pharmaceutical systems, strengthening supply chain management, increasing the availability of information for decision-making, developing appropriate financing strategies and promoting rational use of medicines and supplies. It was an exciting year for maternal health.
The strengthening of health systems in low and middle income countries is central to the global effort to promote economic and social development through universal health coverage, reduce mortality, and improve health and sustainability of health care over the next 15 to 25 years.
For more than a decade, health teams in over 40 countries have improved their performance using MSH’s Leadership Development Program (LDP) and the latest version, Leadership Development Program Plus (LDP+), which improves public health impact and scale-up. During the same period, there has been a tremendous expansion of information and communication technologies (ICTs) in health and mHealth interventions, particularly using mobile devices.
My name is Tiglu. I was born and raised in Bahir Dar. When I first learned that I am living with the [HIV] virus, my mind went blank. I was depressed. After that, I started taking antiretroviral treatment. Then they found TB in me... Meet Tiglu, a living example of how partnering for stronger health systems saves lives. In Ethiopia, about 790,000 people are living with HIV. Tiglu, a patient at the Bahir Dar Health Center in the Amhara Region of north-western Ethiopia, discovered he is HIV positive three years ago, and started on antiretroviral treatment (ART).
Today, September 26, is World Contraception Day. The Family Planning 2020 (FP 2020) Initiative says the vision for the day "is a world where every pregnancy is wanted. Its mission is to improve the awareness of contraception to enable young people to make informed decisions on their sexual and reproductive health." We share part two of our interview with Dr. Fabio Castaño, MSH’s global technical lead of family planning (FP) and reproductive health, in celebration of World Contraception Day. Join the conversation on social media with hashtag #WCD2014.
Read Choice: Part One
Azmara Ashenafi, a 35-year-old woman from the Amhara region of Ethiopia, was diagnosed with tuberculosis (TB) and placed on treatment. She was fortunate. Many people with TB are missed by health systems altogether. But Azmara’a treatment wasn’t helping. Despite taking medicine for months, her symptoms persisted and became more severe.
In many places, her story would have a sad ending—TB is one of the top three leading causes of death for women 15 to 44 in low- and middle-income countries.
Natalie Campbell and Elizabeth McLean of MSH and colleagues co-authored a new journal article, "Taking knowledge for health the extra mile: participatory evaluation of a mobile phone intervention for community health workers in Malawi," in the latest issue of Global Health: Science and Practice.
This post originally appeared on the K4Health blog.
Strengthening health systems at all levels is the core of MSH’s response to the HIV epidemic. We build organizational capacity to implement innovative HIV, prevention, care, and treatment interventions in over 35 countries---from Côte d'Ivoire to Ethiopia to Vietnam.
Today, as we celebrate International Youth Day and the theme of “Youth Migration: Moving Development Forward,” we are reminded of difficult situations millions of young people experience every day—and of the power young people have to create change in their lives when they connect with their peers.
This week the global health community celebrates World Breastfeeding Week (August 1-7). Breast milk is nutritious, clean, available, natural, and does not require special preparation or handling. Let’s take a moment to consider some of the numerous benefits of breastfeeding to baby and mom:
Breastfeeding is the world's most effective solution to reducing child deaths
Breastfeeding could save the lives of nearly 1 million children per year
Breastfeeding reduces deaths to pneumonia and diarrhea
Breastfeeding and nursing promote closeness for baby and mom
In 2005, "Chima" abandoned "Sinachi" and their four children to marry another woman. Heartbroken and unemployed, Sinachi returned to her home village and became a farmer. Although she worked hard, Sinachi’s children often went hungry and did not attend school for three years because she was unable to pay the fees.
Management Sciences for Health (MSH) has been awarded the contract for “Technical Assistance in Service Delivery and Management Capacity Building for the Salud Mesoamérica 2015 Initiative Countries,” a $9.3 million, 18-month award by the Inter-American Development Bank. The goal of the Salud Mesoamérica 2015 Initiative (“salud” is Spanish for health) is to reduce health equity gaps in eight countries in the Mesoamérica region.
To me, malaria is a very personal disease.I first came face to face with malaria during the war of my time: Vietnam. I was plucked out of residency after my first year, with only an internship under my belt, and sent as a Navy Medical Officer to war.
Silenat Yihune, a 40-year-old woman, mother, and housewife, lives in a remote region of Huletejuenesie District, Ethiopia, which is approximately 20 kilometers from the closest health facility. For nine months Silenat suffered from a cough, chest pain, fever, and weight loss, but was unable to receive treatment. As is common among Ethiopian families, Silenat was economically dependent upon her husband. He refused to pay for her travel to the distant health facility.
Cross-posted with permission from the K4Health blog. With social media being a relatively new channel in the world of global health and development as a tool to share information, to advocate, as a marketing mechanism, or as a public health intervention tool, measurement is always a struggle when the path has not been set ahead of you.
Fact or fiction?About 70% of all cancer deaths occur in low- and middle-income countries.Nearly 30% of cancer deaths could be prevented.Many cancers (such as breast, cervical and colorectal cancer) can be cured, if detected early and treated adequately.Cancers are killing more people in developing countries than HIV & AIDS, malaria, and tuberculosis combined.Answer? Fact.
Shelly has always been very athletic. She competed in both her high school track events and in community races in her hometown of Essequibo, Guyana. In 2010, she was ecstatic after winning a cash prize for placing first in an annual regional championship. However, her life took a turn one year later.Shelly became pregnant and, during an antenatal care appointment, tested positive for HIV. The news devastated her, as she believed that an HIV diagnosis meant her athletic career was over.
Formally launched in 2012 in Cameroon, the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, led by Management Sciences for Health, has been working on strengthening the overall pharmaceutical management system, specifically to ensure the people of Cameroon have access to safe and affordable medicines at the central and peripheral levels.
In a new podcast, US Deputy Chief of Mission in Cameroon Lisa Peterson discussed SIAPS’ important work in the country and how it will impact the local population.
“We’re going to try to drive through that?”After spending nearly two years working in South Sudan, I was on my way with two colleagues to one final meeting. The USAID-funded second phase of the Sudan Health Transformation Project (SHTP II), led by Management Sciences for Health (MSH), ended activities on July 31, 2012, and three of us needed to travel 360 kilometers (220 miles) to a results dissemination meeting.
Cross-posted from the K4Health blog. No matter which health system building block you are trying to improve, you need specific data, information, and knowledge to inform your decision-making process—this is where good knowledge management comes in handy.“The Intersection of Knowledge Management and Health Systems Strengthening: Implications from the Malawi Knowledge for Health Demonstration Project” provides an interesting case study of the connection between improved knowledge management and health systems strengthening.Even though the K4Health Malawi project was f
Today, October 15, children, schools, and communities around the world mark Global Handwashing Day.Washing hands with soap is the "most effective and inexpensive way to prevent diarrheal and acute respiratory infections, which take the lives of millions of children in developing countries every year." In addition to handwashing with soap, proper sanitation and safe drinking water are key to preventing disease."Most of what we need to do to bring down the rate of child deaths is inexpensive & straightforward," USAID Administrator Raj Shah said today on Twitter.
“J’mappelle Mompati. Comment t’appelles tu?”Overcoming my confusion at being greeted by a French-speaking man in Botswana, I smile, take his proffered hand and reply in my rusty, stilted French, “J’mappelle Naume...”Mompati is Mahalapye Hospital’s dynamic public relations officer. Now that he has my full attention, Mompati wastes no time in telling me about his work linking the hospital and the surrounding community through events and the media.
Crossposted on Maternal Health Taskforce's mhtfblog as part of the Maternal Health Commodities Blog Series.Despite a decade of significant progress reducing maternal mortality rates, very few countries are on target to meet Millennium Development Goal #5a of reducing the maternal mortality ratio by three-quarters by 2015.What is most alarming is that a large proportion of maternal deaths could have been avoided if women had access to adequate health services, where the necessary quality medicines and supplies were available and skilled health providers were present.
The prospect that we may see the end of AIDS in our lifetime has never been greater. Over the last decade, the global HIV & AIDS community has achieved stunning successes, including a steady decrease in new HIV cases, a massive scale-up of antiretroviral therapy (ART), and proof that treatment is prevention. As we begin the XIX International AIDS Conference, we are also excited by new scientific advances in prevention and treatment, such as Option B+ for prevention of maternal-to-child transmission (PMTCT).
Over 40 Management Sciences for Health (MSH) staff from around the world will join the twenty thousand health workers, activists, researchers, donors, and policy makers at the XIX International AIDS Conference, "Turning the Tide Together". Visit us at the following events, poster and oral presentations, Booth #162, or online.Catch live blog updates, July 22-27, and follow us on Twitter with #AIDS2012, #PMTCT, and #OptionBplus.
Ramatu Fullah is a 27-year-old woman in the Pujehun district of Sierra Leone. She comes from a poor family and, for years, had to earn her living as a sex worker to take care of her two children. Recently, Ramatu learned skills that enabled her to change her trade through an awareness-raising campaign supported by the USAID West Africa Regional Health Office's Action for West Africa Region II (AWARE II) project, managed by Management Sciences for Health (MSH).
In the small Afghan village of Toghak, where open defecation affected the sanitation and health of the community, two women took the initiative to mobilize themselves and others into transforming Toghak.
Ms. Fatima and Ms. Rukhsar attended a community-led total sanitation (CLTS) workshop in the neighboring village of Gheyas Said Abd and learned life-saving lessons they wanted to take back to their village. They learned that flies tend to breed in bacteria infested places, particularly human feces, and then transport the fecal matter to food meant for human consumption.
The USAID-funded Sustainable Water Supply and Sanitation Project, Afghanistan (SWSS) project increases access to potable water and sanitation services in Afghan communities and decreases the prevalence of water borne diseases through household hygiene interventions. Led by the Association for Rural Development, in partnership with Management Sciences for Health, SWSS has led nearly 400 communities in Afghanistan to become Open Defecation Free. The MSH components of the project have succeeded under the astute leadership of Dr.
About 7.6 million children under age five die each year of preventable causers; 3 million — 40 percent — are newborns (under 28 days old). Ninety-nine percent of these occur in developing countries; three-quarters are mainly due to preventable causes such as neonatal conditions, pneumonia, diarrhea, malaria, and measles. Many of these under-five deaths could be averted by known, affordable, low-technology interventions.
Any preventable child death is one too many.
Cross-posted on USAID's IMPACT blogMy most vivid early childhood memory is waking up to excruciating pain in my throat, and seeing the goldfish swimming in the aquarium of the pediatric surgical ward. Although penicillin had been discovered 30 years earlier, doctors had not learned yet that treating "strep throats” with penicillin was better than operating. I didn't need the tonsillectomy. But, I was lucky to receive quality care in a health facility, close to my home.Millions of children today are not so lucky.
Suzanna Ile, a 26-year-old woman from South Sudan, lost her first two babies in childbirth. Suzanna did not have a nurse or midwife to tell her that her pelvis was dangerously small for childbirth; nor was there a safe place for a caesarian section even if she had known the risk.Suzanna’s experience is typical of what women have faced in South Sudan, the newest country in the world. South Sudan is home to 10 million people, spread across an area about the size of France.
Nearly 50 countries, including Afghanistan, Democratic Republic of the Congo, Haiti, Liberia and South Sudan, are considered a fragile or conflict-affected state -- a state that is in conflict, recovering from conflict or crisis, or a state that has collapsed or has a strong and repressive government.
The Kasese district in western Uganda is nestled between two national parks. Located hours from the capital city, Kampala, the region attracts tourists to view gorillas and mountain birds.During my recent trip to Uganda, I met with Dr. Yusuf Baseka, the district health officer of Kasese, who described the health challenges his district faces, and his hopes for the future.Although the national parks are beautiful and bring a much needed economic boost to the area, they also offer a challenge, Dr.
This was my first trip to Africa working with a development agency. While I had visited the African continent for personal trips previously, arriving in this context felt different. I was immediately aware of the challenges Uganda is facing. From the crumbling road infrastructure and high incidence of traffic accidents in Kampala, to the mobile phone networks that are pretty reliable while internet access is often spotty, to the prevalence of street children --- I can for the first time see what my local colleagues are up against.I felt a bit overwhelmed in the first few days.
At a satellite session at the 2011 International Conference on Family Planning on November 30 in Dakar, MSH asked five panelists to discuss successes in family planning, and what still needs to be done. The conversation was moderated by MSH’s Issakha Diallo and held in conjunction with a celebration of MSH’s 40th anniversary.
Picture trees, water, mountains, mud, birds and fish. This is Lake Chirwa -- the second largest of the five lakes in Malawi and the main habitat of small fish called Matemba. The lake offers a trading opportunity for fishermen from many walks of life.Lying in the southern region of Malawi, Lake Chirwa is a wetland for people of three districts: Phalombe, Zomba and Machinga. All these people have frequent contact with Mozambique as they lie near the bordering frontiers.
Mary Umoh, colleague and friend -- and one of the winners of an internal MSH abstract contest for staff -- traveled from Nigeria to Rome to present her poster at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011).
Blog post updated Dec. 27, 2011. In 2003, after dwindling funds, low staff morale, and accusations of patient neglect had eroded community confidence in Kiriaini Mission Hospital in Kenya, the Catholic Diocese of Murang’a decided to shut it down -- leaving locals to seek treatment at the distant provincial capital of Nyeri.Six months later five Franciscan nuns arrived from India to reopen the hospital. They hired new staff, renovated the dilapidated structures, and restored much needed services to the rural community.
Deborah Nyantiok is 56 years old and lives with her grandchildren in Kaya, near the border of Uganda. She lost her husband during Sudan’s 20-year civil war and now takes care of her grandchildren. In order to pay for food and school fees, Deborah operates a small business and keeps animals to generate income. Despite her hard work, in the past Deborah found life difficult as she and her grandchildren often fell ill.
Safoura Amadu is the 19 year-old mother of Ibrahim, who was born preterm on March 8, 2011 at 1.46 kg (3.2 pounds). Baby Ibrahim did not grow well in his first days of life. Safoura was very worried---her first child had died at birth---and she did not want to lose Ibrahim, her second child. Safoura sought help and when Ibrahim was ten days old she and the baby were admitted to the new Kangaroo Mother Care (KMC) center at the Maternité Issakha Gazoby in Niger.
Over the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.I’m just back from an incredibly bumpy ride---sitting on a back bench in a 4 x 4 vehicle to West Mundri, South Sudan, eight hours out of and back to Juba. I traveled with Dr.
In March 2011, the CSIS Global Health Policy Center asked bloggers around the world: What should the key priority of the upcoming UN High Level Meeting on Non-Communicable Diseases be and why? We had a number of great submissions. Dr. Jonathan D. Quick was one of our four finalists. Read his entry below and look out in the days and weeks ahead for other finalist's blogs and another blog contest on NCDs. This was originally posted on smartglobalhealth.org.The most common NCDs are diabetes, heart disease, cancers, and chronic lung diseases.
I recently visited Haiti and had the opportunity to meet with some local Haitian non-governmental organizations supported by MSH’s Santé pour le Développement et la Stabilité d’Haíïti (SDSH) project, as well as the central Ministry of Health, and departmental Ministry of Health offices. I was searching for information in an effort to learn more about how Performance-Based Financing (PBF) has affected service delivery in Haiti.
One hundred years ago on March 8, a handful of countries celebrated the first International Women’s Day. Today it is celebrated around the world as an opportunity to look back on women’s accomplishments and look forward to the realization of their full economic, political, and social rights.
Afghanistan’s mountain ranges are beautiful to the eye. Rugged peaks and ridges are separated by valleys, carved out over the centuries by streams and rivers supporting the green web of vegetation along their banks.But many of the small villages that cling to the walls of these valleys are often cut off for months by heavy snow or the floods that follow the spring melt. The cold wet climate, together with smoke from household stoves, increases the risk of pneumonia, particularly among babies and children.
Blog post also appeared on Global Health Magazine. As the country with the second highest maternal mortality rate in the world, outranked only by India, Nigeria loses one in every 18 women during child-birth.
This article originally appeared on The Huffington Post. As world leaders gather next week at the U.N. to review progress on the Millennium Development Goals (MDGs) to eradicate poverty, hunger, and disease by 2015, a new integrated approach to funding and delivering health services in developing countries is critical if the UN's global health targets -- especially for women and children -- are to be met. Currently, the health goals are competing with each other for money, people, and other scarce resources.
A common challenge in advancing family planning is overcoming the misconceptions religious leaders have about the use of contraceptives.Concerns from religious leaders are often based on misconceptions about family planning methods rather than their religious beliefs.
Originally posted on Global Health TV's website. Watch Video Coverage of Dispelling Myths About HaitiThe Global Health Council and its partners held a press conference at the International AIDS Conference in Vienna, to bring the attention of the media back to Haiti six months after it was devastated by earthquake.Experts such as Dr. Paul Farmer, Dr. Jonathan Quick from Management Sciences for Health, Jeff Sturchio from the Global Health Council, and Dr.
At the International AIDS Conference in Vienna, Austria, my colleagues and I gathered to discuss the principles of smart integration and its challenges, successes, and recommendations for implementation. Smart integration means coordinating HIV & AIDS programs with other health programs that have operated independently in the past; providing comprehensive services at all levels of the health system – from households to health facilities and across the continuum of prevention, treatment, and care; and building stronger partnerships between public and private sectors.There are thr
On July 19, here in Vienna at the XVIIIth International AIDS Conference, positive results were announced from the CAPRISA 004 Phase IIb microbicide trial of 1% tenofovir gel, which was tested in 889 South African women.
As we have heard, Haiti is the poorest country in Western Hemisphere and has some of the worst health statistics. Many things did not work well before the earthquake and the recovery effort has not progressed as many had hoped.There is a perception among some, though, that nothing was working before the January 12th earthquake and that nothing has happened since.Certainly in the health sector, and specifically in AIDS, this perception is simply wrong.
Originally appeared in GLOBAL HEALTH magazine.Men who have sex with men (MSM) bear a disproportionate share of the HIV/AIDS burden in Eastern Europe and Central Asia, but data on and services for this population are woefully inadequate. With a better understanding of this marginalized community's needs, donors and implementers can help support effective policies and programs for MSM infected and affected by HIV.In Eastern Europe and Central Asia, as in many parts of the world, the HIV epidemic among MSM is underreported and under”acknowledged.
At the Global Health Council Conference, I attended an interesting event, “Impact of Schistosomiasis and Polyparasitic Infections on Anemia, Growth and Physical Fitness in Children in Coastal Kenya” presented by Dr. Amaya Bustinduy of Case Western Reserve University which focused on neglected tropical diseases (NTD).Schistosomiasis remains one of the most serious and prevalent neglected tropical diseases worldwide. According to Bustinduy, the WHO estimated that there are 235 million cases of schistosomiasis with 732 million to be at risk for contraction.
Global Health TV visits Ethiopia’s capital, Addis Ababa, to see how MSH’s systems approach at the community level results in better lives for people living with HIV & AIDS. Management Sciences for Health, an international nonprofit organization, uses proven approaches developed over four decades to help leaders, health managers, and communities in over 60 countries build stronger health systems for greater health impact.Watch the video.