Jonathan Quick

Women meeting in Senegal. {Photo credit: Galdos/MSH.}Photo credit: Galdos/MSH.

Good governance in health care matters at all levels of the health system—from communities to health facilities to governments. When a community HIV & AIDS association in Zanzibar grew from 40 members to more than 1,000, it needed better governance. When women in Senegal raised concerns about lack of privacy and poor security at a district hospital, it needed better governance. And when the national health insurance program in Kenya was underperforming even after efforts to address its management and leadership, it too needed better governance.

Until recently, governance was arguably the most tenacious but unspoken barrier to achieving widespread, large-scale, sustainable health impact. In the 1990s, global health programs focused on training health managers. In the 2000s, as management improved and the need for stronger leaders became evident, the focus expanded to leadership development. By now, we’ve developed robust practices for building the capacity of health managers and leaders at all levels of country health systems.

MSH President Jonathan D. Quick, age 5. {Photo courtesy of Dr. Quick.}Photo courtesy of Dr. Quick.

Cross-posted on USAID's IMPACT blog

My most vivid early childhood memory is waking up to excruciating pain in my throat, and seeing the goldfish swimming in the aquarium of the pediatric surgical ward. Although penicillin had been discovered 30 years earlier, doctors had not learned yet that treating "strep throats” with penicillin was better than operating. I didn't need the tonsillectomy. But, I was lucky to receive quality care in a health facility, close to my home.

Millions of children today are not so lucky. Over 7 million children under the age of 5 die each year; 70 percent of child deaths occur in sub-Saharan Africa and South-East Asia. The vast majority -- over two-thirds -- are entirely avoidable with existing safe, effective, low-cost prevention and treatment.

A woman and baby rest at St. Josephs' Health Center -- the only health institution in Abricots, Haiti. {Photo credit: MSH.}Photo credit: MSH.

Suzanna Ile, a 26-year-old woman from South Sudan, lost her first two babies in childbirth. Suzanna did not have a nurse or midwife to tell her that her pelvis was dangerously small for childbirth; nor was there a safe place for a caesarian section even if she had known the risk.

Suzanna’s experience is typical of what women have faced in South Sudan, the newest country in the world. South Sudan is home to 10 million people, spread across an area about the size of France. The people have experienced civil war off and on for five decades --- hardly anyone remembers a time without conflict. In places like the capital city of Juba, the infrastructure has been seriously damaged. The conflicts have devastated the economy and disrupted the education system.

South Sudan has some of the worst health indicators in the world. Health facilities are grossly understaffed as health workers fled the country: only ten percent of staff positions are appropriately filled. There are less than two doctors for every 100,000 people. A woman in South Sudan is five-hundred-times more likely to lose her life giving birth than a woman in Europe. Forty-five percent of children suffer from physical stunting due to malnutrition.

Video that highlights the work of thousands of Tanzanians---mostly women---working as accredited community drug sellers operating in rural areas.Video that highlights the work of thousands of Tanzanians---mostly women---working as accredited community drug sellers operating in rural areas.

Today is International Women’s Day, celebrated around the world as an opportunity to look back on women’s accomplishments and look forward to the realization of their full economic, political, and social rights. The United Nations theme for this year, “Empowering Rural Women,” is one that resonates powerfully with MSH’s work.

A midwife in Wau, South Sudan. {Photo credit: MSH.}Photo credit: MSH.

Josephine, a wife and mother of six living in rural Uganda, tried to soothe her 3-year-old daughter. The girl was suffering from diarrhea and a high fever and her crying filled the home. Recognizing that the girl's health was in danger, Josephine summoned the courage to ask her husband for permission to take their second-youngest child to the local health facility unit -- and pleaded for money to cover the travel and treatment expenses.

Requesting permission from her husband to travel to the facility was not her only choice, however: choosing to take her daughter for treatment also meant leaving her other children -- including her youngest -- unattended at home. Once at the health center, she continued to navigate the challenging road to treatment for her daughter, communicating her situation to the health providers and negotiating the financial and provider aspects of the health center system, without assistance. Relieved and exhausted, Josephine returned home safely with her daughter, oral rehydration salts, and knowledge.

Recognizing women leaders

What makes a person in the health system a good leader? Who determines that he or she is a leader? How do we empower leaders to improve the health of those around them?

Inside Story: The Science of HIV/AIDSInside Story: The Science of HIV/AIDS

Kalu, a young man from Kenya, dreamed of becoming a star footballer (soccer player). Little did he know when he traveled to South Africa to pursue his dream that he carried in him a hidden passenger: the HIV virus. And little did he know that his forbidden romance with Ify, the coach’s daughter, would spread the virus, infecting her with HIV.

Presented by Discovery Channel Global Education Partnerships (DCGEP) and produced by Curious Pictures, Inside Story: The Science of HIV/AIDS is a modern tale of young love with false accusations, heartbreak and ultimately reconciliation. Inside Story is an African sports drama, with team rivalries, individual jealousies and xenophobia. In its most creative dimension, Inside Story is a masterful and pioneering AIDS education vehicle with sophisticated animated clips that show the science of HIV including the virus infecting cells.

MSH's 40th anniversary year has been a catalyst to revisit our origins, recommit to our mission and renew our values. As we approach the holidays and look toward 2012, I’d like to share reflections on one of the most poignant events of the year for me: my recent visit with Mrs. Fumiko Iwamura in Japan. Fumiko-san is the widow of Dr. Noboru Iwamura, who inspired our founder Ron O’Connor to create MSH.

MSH President Jonathan Quick and Fumiko Iwamura. (Japan, 2011) Photo credit: Miho Sato.

 

This year is not only MSH’s 40th anniversary; it is also 30 years since the first reported cases of HIV. Thirty years ago HIV was considered a new, always-fatal disease. ...Today 6.6 million people—nearly half of those in need—will take life-saving antiretrovirals.

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.

Over the past 25 years, the number of people worldwide with access to essential medicines has more than doubled. Yet more than 30 percent of the world’s population still does not have reliable access to essential medicines.

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