medicines

 {Photo credit: John Marmion.}A malaria diagnosis and treatment kit is delivered to a gold mining camp in Suriname.Photo credit: John Marmion.

This post originally appeared on the SIAPS blog.

Many countries in Central and South America have made significant progress toward eliminating malaria. Between 2000 and 2012, 13 countries in the Americas saw malaria incidence rates drop by more than 75 percent. Argentina, Belize, Costa Rica, Ecuador, El Salvador, Mexico, and Paraguay have all reached the pre-elimination phase, a designation given by the World Health Organization (WHO) when countries meet certain critical steps in eliminating the disease and preventing its reintroduction.

While this progress is encouraging, efforts to eliminate and control other global threats like polio illustrate that the last cases are often the most difficult to address. In the case of malaria, fewer cases bring new challenges in ensuring the supply and proper management of antimalarial medicines.

Unpublished
 {Photo credit: Anteneh Tesfaye/MSH.}MSH staff Grace Gatebi and Patrick Borruet at the MSH Kenya UHC Symposium photo exhibition.Photo credit: Anteneh Tesfaye/MSH.

The goal of universal health coverage (UHC) is to improve equitable access to health services while protecting households from impoverishing out-of-pocket health spending. In principle, UHC means that lifesaving services and medicines will be accessible and affordable for those who need them. To create deeper awareness of UHC in Kenya, Management Sciences for Health Kenya (MSH Kenya) country office organized a symposium on setting the national health agenda post 2015, called, “Achieving Universal Health Coverage through Stronger Health Systems”.

During the symposium, MSH Kenya organized a photography contest. MSH staff submitted photographs on the theme of “Achieving Universal Health Coverage in Kenya – Financing, Quality, Access and Essential Medicines” (with a focus on the most vulnerable populations). An independent jury selected 19 of the photos for an exhibition at the symposium.

 {Photo credit: © 2011 Arturo Sanabria, Courtesy of Photoshare}A health care provider dispenses TB drugs for Directly Observed Treatment (DOTS) at Tete's Urban Health Center, Mozambique.Photo credit: © 2011 Arturo Sanabria, Courtesy of Photoshare

Successfully combating the tuberculosis (TB) epidemic requires that national TB programs (NTPs) prevent new infections and ensure that current patients are cured. Although the treatment for drug-sensitive TB is very effective, curing the disease requires that patients adhere to a strict daily regimen of multiple pills for six to nine months. Adding to the challenge is the fact that treatment for drug-resistant TB is longer, more toxic, and less effective.

All medicines carry some risk of adverse events, and anti-TB medicines are no exception. In addition to threatening the health of patients, adverse events, if not well managed, may also result in individuals stopping their treatment early. Patients who prematurely discontinue treatment may remain sick, develop resistance to the medicines, and spread TB to others in their community.

To support NTPs and health professionals efforts to meet treatment goals and improve the safety of anti-TB medicines, the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program developed the first guide of its kind on minimizing risks associated with anti-TB medicines.

 {Photo credit: MSH/Paula Champagne}Participants of "Medicines as Part of UHC: Starting a Dialogue".Photo credit: MSH/Paula Champagne

What do medicines, financing, governance, and management have in common?

They are all essential pieces of the puzzle that must come together in order to make universal health coverage (UHC) a realizable goal.

From June 2-4, 2013, Management Sciences for Health (MSH), in collaboration with the Rockefeller Foundation and Harvard Medical School’s Department of Population Medicine, and additional support from the Pan American Health Organization (PAHO) and the US Agency for International Development (USAID), brought representatives of countries working towards UHC, private insurance schemes, and medicines and financing experts from across the globe to start a dialogue around medicines coverage under UHC.

Dr. Jonathan Quick, MSH’s President and CEO opened the event: “UHC is about filling the tragic gaps that exist in health systems around the world: gaps in access, in affordability, and health needs that go unanswered.”

Patients wait in a well-ventilated area outside the TB clinic in Homa Bay, Kenya. {Photo credit: A. Kwiecien and A. Salakaia / MSH.}Photo credit: A. Kwiecien and A. Salakaia / MSH.

The state of tuberculosis (TB) is in a tug-of-war as current challenges threaten to undo past successes. One of the primary hurdles currently facing TB prevention and cure is the emergence of strains that are resistant to at least two of the most effective medicines (rifampicin and isoniazid).

So-called drug-resistant (DR)-TB arises when patients are unable to complete a full-course of appropriate, high quality anti-TB medicines. As compared with the 6 month treatment regimen for drug-sensitive (DS)-TB, DR-TB requires 18-24 months of treatment with medicines that are less effective, can cause sometimes severe side effects, and can cost up to 300 times more.

Dr. Quick discusses Myanmar’s health system with Dr. Pe Thet Khin, the minister of health. {Photo credit: Myanmar Ministry of Health.}Photo credit: Myanmar Ministry of Health.

In Myanmar, 50 years of military dictatorship left behind a seriously underdeveloped health system, serving barely one in twenty of the country’s 60 million people. You might expect that the first minister of health under civilian rule would be despondent. But on my recent trip I found the opposite: Dr. Pe Thet Khin and his team are aligned around an ambitious vision for building a strong health system for the country.

Jane Briggs of the USAID-funded SIAPS program at MSH gives examples from Rwanda and Kenya during the Improving Access to Essential Maternal Health Medicines session on the first day of the conference. {Photo credit: C. Lander / MSH.}Photo credit: C. Lander / MSH.

Cross-posted from the SIAPS website.

“Respectful maternal care was said to be more than just a means to an end, and can be framed as several issues: human rights, quality of care, equity and public health,” Jocalyn Clark, senior editor of PLoS Medicine, noted about the final day of the 2013 Global Maternal Health Conference (GMHC).

The conference brought together scientists, researchers, practitioners, and policymakers to share knowledge, ideas, innovations, research, programs and policies on maternal health quality and access, among several other topics. Participants also worked on building progress towards reducing and eliminating preventable maternal mortality and morbidity.

Quality of maternal care was a consistent theme throughout the conference.

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

Richard Horton moderates a panel on post-2015 development goals. {Photo credit: HSR-Symposium.org}Photo credit: HSR-Symposium.org

Last month, I joined over 1,800 participants from more than 100 countries in Beijing at the Second Global Symposium on Health Systems Research. We've made some concrete steps forward since we last met in Montreux, Switzerland, two years ago, among them the launch of a new research society Health Systems Global. Central topics of this year's discussions included: “Inclusion and Innovation towards Universal Health Coverage” (UHC), the symposium theme, and monitoring and evaluation.

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