Afghanistan

{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

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

This blog post is a web-formatted version of the Global Health Impact newsletter: Stronger Health Systems Stop TB and Save Lives (December 2015). (View or share the email version here.) We welcome your feedback and questions in the comments or email us. On social media, use hashtag and tag .  Subscribe

{Photo credit: Jawad Jalali-Afghan Eyes}Photo credit: Jawad Jalali-Afghan Eyes

Update, July 30, 2015:

Prior to 2002, the vast majority of health service delivery systems in Afghanistan were non-existent or informal. The Leadership, Management, and Governance (LMG)-Afghanistan project improved family planning, reproductive health, and maternal and child health using strategies to strengthen health leadership developed by Afghans, for Afghans.

See the Journey to Restoration on Exposure

The original post follows:

 {Photo credit: Emily Phillips/MSH Afghanistan}A postnatal woman with her newborn and mother-in-law.Photo credit: Emily Phillips/MSH Afghanistan

Last month I represented Management Sciences for Health (MSH) at Oxfam India’s South Asia Consultation on Maternal Health in Kathmandu, Nepal. The purpose of the meeting was to discuss significant maternal health programming experiences in Afghanistan, Bangladesh, India, Nepal, Pakistan, and Sri Lanka, and to suggest strategic directions for Oxfam India’s future maternal health programming. More than 30 representatives from governments, national and international universities, and nongovernmental organizations attended.

Three elements of improving maternal health outcomes stood out in my mind from discussions at the meeting:

{Photo credit: MSH staff/Afghanistan}Photo credit: MSH staff/Afghanistan

“I started feeling this coughing… so I went to the health center and got tested. It was positive for TB,” says Grace*, a young Ugandan woman. She started on medicines, but after two months, she stopped adhering to treatment.

They told me to continue with the drugs for five more months, but I stopped.

I thought I was ok.

She started coughing again, went to the hospital, and was diagnosed with multidrug-resistant TB (MDR-TB). MDR-TB cannot be treated with two of the most powerful first-line treatment anti-TB drugs. Her treatment regimen? Six months of injections and two years of drugs.

{Photo credit: Katy Doyle}Photo credit: Katy Doyle

Members of the global health community commemorated International Women’s Day (IWD) on March 8 by celebrating recent advances in women and girls’ health and indeed there was much to celebrate: maternal deaths have declined 45% worldwide, The Global Fund to Fight AIDS, Tuberculosis and Malaria has distributed over 450 million bed nets, and over 1 million babies have been born HIV-free thanks to the President’s Emergency Plan for AIDS Relief (PEPFAR); but there is still work to do.  What happens once the day is over? How do we turn that attention into action? How are these issues going to be addressed? After awareness is raised, we still need concerted global action every day of the year if we are to make truly sustainable, impactful improvements in the lives of women and girls’ around the world. Here are a few things I think we can do at the global, US and local level to keep the spirit of IWD alive:

Globally: Elevate women and girls in the Post-2015 Development Agenda

{Photo credit: Rui Pires}Photo credit: Rui Pires

{Photo: Dominic Chavez}Photo: Dominic Chavez

The key element of any health system is the people who run it. Nowhere is this more true than in countries in the midst of, or recovering from, conflict. Indirect or direct threats faced by health workers exacerbate a population’s challenges in seeking and receiving health care.

In conflict settings, health workers may be forced to flee to safe havens as refugees, internally displaced people, or leave the country as migrants—if they have the means to do so. Some of the most capable are absorbed into international agencies. Those who remain frequently have insufficient resources to perform their jobs and must carry on as best as they can under daunting circumstances.

This situation has worsened in recent years with a growing number of direct attacks on health workers in fragile states, such as those against polio vaccinators in Pakistan and Nigeria. These blatant violations of the Geneva Conventions inhibit an already difficult environment for the delivery of health services and the recovery or development of the health system.

{Photo: Amy Niebling/MSH, Afghanistan}Photo: Amy Niebling/MSH, Afghanistan

Today, February 3, 2015, is 10 years since the tragic loss of three Management Sciences for Health (MSH) colleagues, Carmen Urdaneta, Amy Lynn Niebling, and Cristi Gadue, in a plane crash outside Kabul, Afghanistan.

MSH held a remembrance of Amy, Cristi, and Carmen today for all staff, friends, and family. The slideshow below includes photos of and by our beloved colleagues.

Remembering Amy, Cristi & Carmen

The Gadue‐Niebling‐Urdaneta (GNU) Memorial Fund -- established to further the work to which these remarkable women dedicated their lives -- awarded 11 fellowships in their honor, and ended in 2012.

Did you know Amy, Cristi, or Carmen?

You are welcome to add a brief remembrance in the comments below.

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