access to medicines

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

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.

 {Photo credit: Dominic Chavez}South Sudan.Photo credit: Dominic Chavez

In December 2013, Africa’s newest country, South Sudan, imploded with violence between government forces and a rebel opposition led by a former vice president. The violence continues today despite regional efforts at reconciliation by the Intergovernmental Authority on Development (IGAD) and other state actors. The war, however, has not stopped South Sudan’s frontline health workers in their efforts to build a public health system, including access to medicines, from the ground up.

The US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program is working with our South Sudanese partners to build the institutional, technical, and organizational capacity of the country’s health system—despite the ongoing conflict.

Our approach to strengthening the health system is based around the concept of embedment—where full-time technical advisors work with their South Sudanese counterparts on a day-to-day basis. This approach strengthens the technical and managerial capacity of local leaders, ensuring sustainability, while, at the same time, getting the job done: building a strong health system.

 {Photo credit: SCMS/Haiti.}SCMS staff provides technical assistance to head of pharmacy at Hôpital Bernard Mevs in Haiti.Photo credit: SCMS/Haiti.

The Supply Chain Management System (SCMS), established in 2005 under the US President’s Emergency Plan for AIDS Relief (PEPFAR) administered by the US Agency for International Development (USAID), supplies lifesaving medicines to HIV & AIDS programs around the world and is led by the Partnership for Supply Chain Management (PFSCM), a nonprofit organization established by Management Sciences for Health (MSH) and John Snow, Inc. SCMS first established a presence in Haiti in 2007. MSH manages SCMS operations in Haiti. 

This post is part of MSH's Global Health Impact Blog series, Improving Health in Haiti: Remember, Rebuild

 {Photo credit: MSH}A woman and her child consult with an ADDO dispenser in Tanzania.Photo credit: MSH

Cross-posted with permission from the Bill & Melinda Gates Foundation Blog, Impatient Optimists.

Primary health care has many different definitions, but can be defined simply as the first place where people seek care. Within this definition, private sector providers constitute an important source of primary health care in many parts of the world.

Private providers of primary health

Private providers can run the spectrum–from private hospitals, pharmacies, and non-profit clinics, to informal providers such as faith-based healers and drug shops. A 2013 review suggests that informal providers account for as much as two-thirds of health care visits in Bangladesh and Thailand, and a substantial percentage of visits in Nigeria and Kenya as well.[1]

 {Photo credit: Nicole Quinlan/MSH.}Dr. Jonathan Quick pitching for partnerships to reach more people with quality healthcare and medicines through the Accredited Drug Shops at the Clinton Global Initiative.Photo credit: Nicole Quinlan/MSH.

MSH President & CEO Dr. Jonathan D. Quick shared MSH's vision to bring quality healthcare and medicines closer to home through our proven Accredited Drug Shops program at the Clinton Global Initiative () "Scalable Ideas: Pitching for Partnerships" session September 24, 2014. Watch a video of Dr. Quick's pitch and learn more about how you can partner with us.

 {Photo credit: Durmuş Şahin}(left to right) Dr. Raed Arafat, Chair of the Conference, Secretary of State, Ministry of Health of Romania; Dr. Martin van den Boom, TB Program Focal Officer, WHO Regional Office for Europe; Francis (Kofi) Aboagye-Nyame, Director, SIAPS Program; and Dr. Joel Keravec, Head of Operations, Global Drug Facility, Stop TB Partnership, at the First Conference on Pharmaceutical Management for TB and M/XDR-TB for the WHO European Region.Photo credit: Durmuş Şahin

The highest rate of multi-drug resistant (M) and extensively drug-resistant (XDR) cases of tuberculosis (TB) is found in the World Health Organization (WHO) European Region. The Consolidated Action Plan to Prevent and Combat M/XDR-TB in the WHO European Region specifies that, by the end of 2013, all member states assure provision of an interrupted supply of quality first- and second-line medicines for treatment of all TB and M/XDR-TB patients.

Safe and rational use of these medicines is also a challenge. To deal with these demanding challenges means an increased need to strengthen pharmaceutical management, especially in the areas of second-line TB medicines management, new TB medicines, and novel treatment regimens.

{Photo credit: Rui Pires, Ghana}Photo credit: Rui Pires, Ghana

MSH reconfirmed its commitment to ending childhood deaths due to diarrhea and pneumonia by renewing its endorsement of the Declaration on Scaling Up Treatment of Diarrhea and Pneumonia (PDF).

MSH has a long history of acting on two of the areas specifically outlined in the declaration, namely promoting "access to affordable, high-quality, over-the-counter ORS and zinc products and/or access to and rational use of amoxicillin in both public and private sectors" and supporting "sustained demand creation to increase awareness of use for diarrhea and/or pneumonia treatments, including teaching caregivers when and where to seek treatment and improving knowledge and skills of health providers to promote and deliver appropriate treatment and care."

Makasi after two months of tuberculosis treatment. {Photo credit: A. Massimba/MSH.}Photo credit: A. Massimba/MSH.

With less than 1000 days until the Millennium Development Goals expire, the process for setting post-2015 goals continues to ramp up.  We take this opportunity to reflect on the current state of community health systems in low- and middle-income countries and consider how the post-2015 agenda could reshape them—perhaps dramatically.

Community health systems today

Integration moves ahead

Poor and rural communities in low- and middle-income countries are leaving behind the “one clinic, one service” approach. So-called vertical programs, which organized resources according to single health conditions, created a patchwork of health services at the community level. You could get HIV care from one provider, but would have to go down the hall, down the street, or often much farther to get maternal health care or malaria care.

Celia Tusiime Kakande. {Photo: Tadeo Atuhura/MSH.}Photo: Tadeo Atuhura/MSH.

For most of my life, women in Uganda---as in most countries---were treated as inferior to men. Girls were less likely to be educated than their brothers, and had little control over the direction of their lives. Many girls grew up being told how to act, eat, and talk; many women were regarded as little more than domestic caregivers. However, in 1986 the ruling government radically changed the dynamics of Ugandan women in global development and their participation in decision-making at all levels of government. This International Women’s Day we, in Uganda, are celebrating this transformation with a theme of “connecting girls, inspiring futures,” and wishing women around the world similar progress and success.

Women Lead: Government

Women in Uganda now hold more leadership positions than ever before—35 percent of the seats in Parliament are now occupied by women, and our Speaker of Parliament and Minister of Health are women. The introduction of universal primary education has allowed more girls to begin their schooling, and affirmative action at the university level has provided more women the opportunity to realize their dreams for fulfilling professional careers.

Celia Tusiime Kakande. {Photo: Tadeo Atuhura/MSH.}Photo: Tadeo Atuhura/MSH.

For most of my life, women in Uganda---as in most countries---were treated as inferior to men. Girls were less likely to be educated than their brothers, and had little control over the direction of their lives. Many girls grew up being told how to act, eat, and talk; many women were regarded as little more than domestic caregivers. However, in 1986 the ruling government radically changed the dynamics of Ugandan women in global development and their participation in decision-making at all levels of government. This International Women’s Day we, in Uganda, are celebrating this transformation with a theme of “connecting girls, inspiring futures,” and wishing women around the world similar progress and success.

Women Lead: Government

Women in Uganda now hold more leadership positions than ever before—35 percent of the seats in Parliament are now occupied by women, and our Speaker of Parliament and Minister of Health are women. The introduction of universal primary education has allowed more girls to begin their schooling, and affirmative action at the university level has provided more women the opportunity to realize their dreams for fulfilling professional careers.

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