GHI Spotlight

Issakha Diallo, MD, MPH, DrPH

Part six of the blog series: Spotlight on Global Health Initiative Plus Countries Amid grave health statistics, the Global Health Initiative (GHI) brings hope of a healthier future in Mali.

Mali is one of the ten poorest countries in the world, ranking 173 out of 175 countries on the 2007 Human Development index of the United Nations Development Program (UNDP). Mali has highest percentage of people living on less than a dollar a day.  And, Mali has some of the worst demographic indicators in the sub-Saharan region: a population growth rate of 2.6%, a 6.6 fertility rate (the highest in the sub-Saharan Africa after Niger, at 6.8), and a birth rate of 49.8 per 1,000. The population is very young, with more than 50% of Malians under 15 years old and 17% under 5 years old.

The Global Health Initiative (GHI) and its approach of integrating health programs with HIV & AIDS, malaria, tuberculosis, maternal, newborn, and child health, nutrition, and family planning and reproductive health is in line with the current approaches and health priorities of the Government of Malawi.

Malawi, with a population of slightly over 13 million people, has 83% of its people living in the rural hard to reach, underserved areas. The biggest health challenge facing the country is access to basic health services by the rural population. The problem of access to health services is multifaceted. For instance, family planning services are mostly facility-based, contributing to a low Contraceptive Prevalence Rate of 28% and high unmet family planning need of 28% (Malawi Demographic and Health Survey, 2004).

However, there is also a critical shortage of trained health service providers and availability of contraceptives is a logistical nightmare in Malawi. Making a routine mix of all contraceptives accessible to women of reproductive age regularly in rural communities can avert unwanted pregnancies and maternal deaths, and reduce high total fertility rate and infant mortality rate. Rural people walk long distances to seek health services, sometimes only to return without a service due to shortage of health personnel and stock-out of supplies.

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.

In mid-June the United States Government continued to show its commitment to global health by announcing the first Global Health Initiative (GHI) Plus countries: Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal, and Rwanda. The GHI is a six-year, $63 billion initiative to help partner countries improve measurable health outcomes by strengthening health systems and building upon proven results. The GHI focuses on women, newborns, and children using an integrated approach including programs that address HIV & AIDS, malaria, tuberculosis, maternal and child health, nutrition, family planning and reproductive health, and neglected tropical diseases. These initial countries will receive additional technical and management resources to quickly implement GHI’s approach.  They will be used as “learning labs” – using best practices and lessons learned when implementing programs in other countries. MSH works in seven of the eight countries, so we asked our country experts: What’s working? Please stay tuned for a continuing series.

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