Afghanistan

Private sector companies, like McDonald's and General Electric, have successfully been using internal universities or academies for decades. So how can programming for health service managers be better, more cost effective and more sustainable? Embed programming within special “Leadership Academies” based in ministries of health.

In Moen Kas, one of the villages where the project introduced community-led total sanitation, officials and villagers celebrate Open Defecation Free (ODF) certification. {Photo credit: Noorgha CLTS Supervisor/Afghanistan.}Photo credit: Noorgha CLTS Supervisor/Afghanistan.

A new report from the USAID-funded Afghan Sustainable Water Supply and Sanitation (SWSS) Project, led by Tetra Tech ARD, describes the methodology and results from the Sustainable Health Outcomes component, led by Management Sciences for Health (MSH). The SWSS project worked to improve the health and infrastructure of rural Afghans, with an emphasis on providing water supply and sanitation facilities and improving community hygiene behaviors (read stories).

SWSS was the first project in Afghanistan to implement community-led total sanitation (CLTS) on a broad scale. While challenges for ongoing hygiene and sanitation remain, the project’s success led the Afghan Ministry of Rural Rehabilitation and Development to include CLTS as part of its national water and sanitation policy and strategy.

Tanzanian woman (Photo credit: MSH)Tanzanian woman (Photo credit: MSH)

Management Sciences for Health (MSH) invites you to attend the following sessions and poster presentations at the Global Maternal Health Conference in Arusha, Tanzania --- whether in person at the Arusha International Conference Center, or watching via archived videos online. (All times are listed in Eastern Africa Time: UTC/GMT +3 hours. Sessions will be recorded and available within 24 hours.)

Sessions: Tuesday, January 15

Improving access to essential maternal health medicines (Track 3): 13:30–15:00 · Simba

Moderator: Deborah Armbruster, USAID

Investing in Asia (PDF).Investing in Asia (PDF).

"Investing in Asia" (PDF), a new supplement published by MediaPlanet as part of its "Investing in Development" series, hit newsstands in select markets of USA Today on Friday, December 21, transporting readers to the Asian continent.

MSH President and CEO Dr. Jonathan D. Quick was interviewed in the "Panel of Experts" section. Asked by MediaPlanet "Why is now the time to invest our time, energy, and abilities into the Asian continent?," Dr. Quick said:

MSH is driven by the ancient Chinese Tao of Leadership, working shoulder-to-shoulder with our local colleagues for their success. China and India, two of Asia’s most populated countries, are moving toward universal health coverage. Malaysia reduced maternal deaths. Afghanistan’s thousands of community health workers have increased access to family planning. Asia’s populations are hit hard by chronic diseases, including cancer, lung and heart disease, and diabetes. Now is the time to make even greater impact.

Read the full interview in the publication, "Investing in Asia" (PDF).

Dr. Stephen Macharia of MSH TB CARE I South Sudan speaking at Union World Conference symposium. {Photo credit: MSH.}Photo credit: MSH.

Cross-posted from the MSH at the Union World Conference on Lung Health 2012 blogManagement Sciences for Health (MSH) presented at several symposia and workshops throughout the 43rd Union World Conference on Lung Health (read more).

Friday’s symposium on November 16 dealt with: Saving lives in areas of conflict or disaster: partnering for results (PDF). Dr. Eliud Wandwalo of MSH Tanzania coordinated the session along with Morgan Richardson.

A Rwandese woman shows her child's community-based health insurance card. {Photo credit: C. T. Ngoc/MSH.}Photo credit: C. T. Ngoc/MSH.

Eugénie, a widow in Rwanda, farms to provide for her children. In January 2012, she had surgery to remove a tumor, a procedure that would have devastated her family economically if she did not have insurance. Rwanda’s health insurance program is the most successful of its kind in sub-Saharan Africa: it supports the health of more than 90 percent of the population, including the most vulnerable, like Eugénie.

Moen Kas, Afghanistan {Photo credit: Noorgha CLTS Supervisor.}Photo credit: Noorgha CLTS Supervisor.

Moen Kas, a hilly remote Afghan village absent of latrines or even a functioning water well, became an Open Defecation-Free (ODF) community within 24 days of arduous commitment from its leaders and people.

Moen Kas’ remarkable milestone makes it the first village in Afghanistan to reach ODF status in less than one month--inspired entirely from personal stories that are spreading across the country regarding the benefits of living in ODF communities.

The quick transformation was the direct result of a man from Moen Kas who had attended an ODF certification ceremony in the nearby, yet secluded, village of Ghalani.

As he watched the ceremony and learned of ODF’s benefits, he asked to speak on behalf of his village. During his speech, he praised Ghalani’s achievements within the past two months and publicly vowed that his own village would achieve ODF status in under a month.

Recognizing that this ambitious goal could not be achieved through him alone, he urged the other Moen Kas’ villagers who were also present at the ceremony to stand with him and work together.

So determined was the man in his vision to transform his village, that he invited the audience to visit Moen Kas in one week to verify it as an ODF community.

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

Seven-year-old Makasi, an HIV-positive orphan in Tanzania, was diagnosed with advanced tuberculosis (TB) and started on curative treatment. Clinicians at a local health center used standardized TB guidelines to overcome the difficulty of identifying TB in children co-infected with other diseases. In Afghanistan, sixteen-year-old Hamida provides for her family while trying to complete school. Hamida was visited by a community health worker, who identified her TB symptoms, and helped her access appropriate diagnosis and treatment.

Steady Progress Against Daunting Challenges

Tuberculosis mortality has fallen by a third since 1990. Yet TB is still the second leading cause of death from infectious disease worldwide. The vast majority of new cases (8.8 million in 2010) and deaths (1.1 million in 2010) occur in poorer countries. TB’s effects are often most devastating among people in fragile circumstances. Poverty and conflict push people into crowded, unsanitary conditions without appropriate nutrition and health care.

Even more, TB is fast spreading, easy to misdiagnose, often co-morbid with other diseases, and, increasingly, highly drug-resistant.

Frieda Komba, a licensed drug dispenser in Tanzania. {Photo credit: MSH.}Photo credit: MSH.

Each year over 10 million men, women, and children in developing countries die as a result of our collective failure to deliver available safe, affordable, and proven prevention and treatment. A recent analysis of innovations in products and practices for global health, from the Hepatitis B vaccine to use of skilled birth attendants, revealed virtually none of these life-saving interventions reaches much more than half their target population—even after as many as 28 years of availability. This reflects a vast gap between knowledge and action in global health.

Successful Health Systems Innovations

Low- and middle-income countries (LMIC) benefit from continued innovations in health products and health practices, such as use of misoprostol to prevent post-partum hemorrhage, and technologies such as internet-based mHealth applications to protect the poor from catastrophic health expenditures.  To ensure such innovations achieve large-scale, widespread coverage, they must be accompanied by much more effective health systems innovations.

SWSS team and NGO members visited a local shop for information, education, and communication materials in Baghalak village of Nahrin district, Baghlan province. {Photo credit: Bashir Ahmad, CLTS Supervisor/SWSS.}Photo credit: Bashir Ahmad, CLTS Supervisor/SWSS.

Afghanistan has yet another village which has successfully become an Open Defecation Free (ODF) zone. Baghalak is a village in Nahrin district with 630 inhabitants dispersed among 90 households --- each with unused latrines in poor condition. For this reason, Baghalak was selected by the USAID-funded project, Sustainable Water Supply and Sanitation (SWSS) and the Organization for Health Promotion & Management to partake in community-led total sanitation (CLTS) training.

Prior to CLTS’ involvement in the village of Baghalak, the traditional latrines also lacked hand washing facilities, which is crucial to proper sanitation. In addition, significant amounts of human waste could be seen on farms, gardens, and sidewalks. As is a common problem in communities without CLTS instruction, latrines tend to go unused due to the lack of communal education regarding their importance. While the hygienic and sanitation status of the community were in severe need of improvement, there also existed a strong desire within the community to reduce their high incidences of infectious illnesses, particularly diarrheal diseases.

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