Health Systems Strengthening

Yambayoh Magaji (right), a student laboratory technician, works with Garkida General Hospital's HIV Laboratory Focal Person Dahiru Sabo. {Photo credit: MSH.}Photo credit: MSH.

The USAID-supported Prevention Organizational Systems AIDS Care and Treatment (ProACT) project provides HIV & AIDS services to five sites in Adamawa State, Nigeria.

The greatest challenge for ProACT Adamawa has been the fragile health system, particularly in terms of human resources for health (HRH), one of the six building blocks of the health system. The inadequate health workforce in the laboratory affects other components of the health systems, such as: 1) medicines, vaccines and technology, 2) information, 3) governance and leadership, 4) health financing, and 5) service delivery.

The situation in Adamawa was such that one or two laboratory staff members did all the work in the laboratory, including phlebotomy, chemistry, hematology, immunology, malaria and tuberculosis (TB) microscopy. On average, there was a patient/staff ratio of 40:1 on clinic days. This situation applied to all the sites with regard to health workforce in the laboratories.

Zakia, a nurse in Afghanistan, has become a leader in her health center. After participating in an MSH leadership development program, Zakia led a team of nurses in increasing awareness about family planning, resulting in a doubling of the use of contraceptive pills and an eight-fold increase in the number of condoms distributed in two years. “Everyone here no longer thinks of problems as obstacles in our way, but challenges we must face,” Zakia says.

An estimated 400 people gathered in Asram, Togo, to watch a ceremony introducing 250 newly-trained community health workers -- part of the Action for West Africa Region II (AWARE II) project, supported by USAID and led by MSH.

Joanie, a woman from Linden, Guyana who is mentally ill, was diagnosed HIV positive in 2005. Her mental illness prevented her from accessing health services and support. Her HIV remained untreated. She rejected the attempts of relatives and friends to assist her, and spent most of the day on the bank of the nearby Demerara River, refusing to wear clothes.

The future is indeed bright for public health in Nigeria, judging from what Dr. Muhammad Ali Pate, the Honorable Minister of State for Health of the Federal Republic of Nigeria, said at the Africare House in Washington, D.C. on September 21. The event, Innovative Approaches to Expanding Health Care Services, was co-sponsored by Management Sciences for Health (MSH), fhi360, the Anadach Group, and hosted by Africare.

Lucia Afiki and Esther Goodson are living positively with HIV. They are counselors for family planning and HIV & AIDS at Salima District Hospital in Malawi, where they openly tell their clients that they are HIV-positive. “When we are open with them about our status,” says Afiki, “people say, ‘Come closer, we want to learn from you.’” Goodson adds: “They say, ‘What should I do to look as good as you?’” The counselors tell them to visit a doctor and join a support group. This is an approach that saves lives. It also transforms social norms about health and gender.

Discovering MSH blog series graphicOver 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.

The theme of this year’s Global Health Council annual conference was Securing a Healthier Future in a Changing World. As populations are shifting, so are their health priorities. Increasing urbanization has led to more people living in and around cities, creating a series of problems that are new to public health professionals. Nutritional challenges, the need for improved water and sanitation infrastructure, and addressing the issue of unregulated health care providers are all problems facing governments, ministries, NGOs, donors, and populations. In addition, non-communicable diseases (NCDs), including cancer, diabetes, cardiovascular conditions, and mental illness, are adding a new strain to many already resource constrained health systems. Of course, immunization, malaria, pneumonia, diarrhea, and maternal death are all still very serious challenges in many of these systems and remain key priorities.

Permanent Secretary of the Ministry of Medical Services, Ms. Mary Ngari, (Right), hands over the new Governance Guidelines to HMC Board Member and Deputy Provincial Commissioner of Central Province, Francis Sila, while USAID/Kenya HRH Specialist Peter Waithaka, LMS/Kenya Project Director Karen Caldwell, and Central Province Provincial Director of Medical Services Gichaiya M’Riara, look on. (Photo courtesy of Hosea Kunithia.)

 

Kenya’s new constitution, promulgated on August 4, 2010, mandates significant transformations in the health sector. Hospital reforms are a key part of these transformations. For MSH’s Leadership, Management and Sustainability Program in Kenya (LMS/Kenya), the opportunity to work closely with health sector partners, including the Ministry of Medical Services, to support the hospital reform agenda is an exciting and rewarding experience.

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