Rwanda

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

This post originally appeared as part of a series produced by The Huffington Post and the NGO alliance InterAction around the United Nations General Assembly's 68th session and its general debate on the Millennium Development Goals (MDGs).  

Thirty years ago, I was a young physician practicing family medicine in rural Talihina, Oklahoma. We saw unusual cases, including snakebites and a man who survived a gunshot through the heart. But what I loved most was delivering babies – bringing new lives into the world and great joy to parents. Sadly, my most vivid memory from those years is of a baby girl who didn’t make it. Her parents, first-time pregnant, didn’t recognize the warning signs. When they reached the hospital, our team was too slow.  Too late.

 {Photo credit: Rui Peres}Children in Uganda, one of many LMICs where good governance at all levels of the health system is key.Photo credit: Rui Peres

This post originally appeared on the LMGforHealth.org Blog. USAID's Leadership, Management and Governance (LMG) Project, led by Management Sciences for Health (MSH), hosted the Governance for Health (G4H) in Low- and Middle-Income Countries Roundtable 2013 (G4H2013) at Georgetown University in August.

The overwhelming consensus of G4H2013? Governance matters.

Health sector leaders gathered in Washington, D.C. in August for the second roundtable on enhanced governance for the health sectors of low- and middle-income countries (LMICs). Governance involves decisionmaking by diverse stakeholders that set the strategic direction for public and private organizations; assembling and allocating resources needed to implement the strategic plan; monitoring the progress of champions; and protecting the mission of the organization.

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

With less than 1000 days until the Millennium Development Goals expire, the process for setting post-2015 goals continues to ramp up.  We take this opportunity to reflect on the current state of community health systems in low- and middle-income countries and consider how the post-2015 agenda could reshape them—perhaps dramatically.

Community health systems today

Integration moves ahead

Poor and rural communities in low- and middle-income countries are leaving behind the “one clinic, one service” approach. So-called vertical programs, which organized resources according to single health conditions, created a patchwork of health services at the community level. You could get HIV care from one provider, but would have to go down the hall, down the street, or often much farther to get maternal health care or malaria care.

Rwandan physicians receive continuing professional development. (Photo credit: C. Tran Ngoc/MSH)Rwandan physicians receive continuing professional development. (Photo credit: C. Tran Ngoc/MSH)

Maintaining state-of-the-art skills and knowledge is crucial for physicians. But in most developing countries, the lack of structured or ongoing educational activities has pushed medical doctors to travel abroad to benefit from the most recent expertise.

To solve that problem---and improve Rwanda's health system---the Rwanda Medical Council (RMC) launched the continuing professional development program in 2011. The continuing professional development sustains practitioners' knowledge through workshops, seminars, practical sessions, and research.

The USAID Integrated Health Systems Strengthening Project (IHSSP), led by Management Sciences for Health, provided technical and financial support to the RMC for the implementation of the continuing professional development program by developing strategic and monitoring and evaluation plans, helping to run an office, accrediting health professional societies as continuing professional development providers, and preparing the national sensitization campaign.

Dr. Jonathan Quick, President and CEO of MSH, tours with Dr. Christian Nzitimira, director of Kibagabaga Hospital in Rwanda. {Photo credit: Jon Jay/MSH.}Photo credit: Jon Jay/MSH.

In a postoperative ward of Kibagabaga Hospital, the district hospital serving Rwanda’s capital city of Kigali, Eric Bizimana sits up in bed. Bizimana, 25, had sought care after severe pain in his right leg forced him to stop work as a barber. He was diagnosed with a bone infection called osteomyelitis. Antibiotics alone couldn’t clear the infection. Without an operation to remove the diseased bone, Eric faced the possibility of losing his leg.

Eric was one of the 40 patients who enter Kibagabaga for surgery every day. In Rwanda’s tiered healthcare delivery system, patients are referred from local health centers up to the district hospital when their conditions require more complex care. Most babies are delivered at health centers, for example, but a woman suffering complications or who was expected to need a C-section would be referred to the district level.

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.

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.

Dr. Agnes Binagwaho is a pediatrician and serves as the Minister of Health of Rwanda. {Photo credit: dr-agnes.blogspot.com/}Photo credit: dr-agnes.blogspot.com/

The second Global Maternal Health Conference began yesterday in Arusha, Tanzania, as an intentional dialogue between scientists, researchers, implementers, advocates, policymakers, and media. More than 700 people (from about 2000 abstracts) were selected to attend and share knowledge on how to improve the quality of care and eliminate maternal deaths.

This is my first global maternal health conference --- but not my first maternal health conference. I keep wondering: how will this one be different?

As I went through the first day of sessions and informal exchanges, I couldn't help feeling like one person "stole the show". At lunch and dinner, the conversations kept coming back to the dynamic Dr. Agnes Binagwaho, the Minister of Health from Rwanda. She served as the keynote speaker in the opening plenary and a panelist for another session.

When you hear Dr. Agnes speak, you know she is smart and accomplished. And, talking with other attendees, it is clear that, regardless if participants agreed with her specific recommendations, Dr. Agnes' commitment, knowledge, logic, and candor are appreciated and needed in the conference conversation.

Malawi mother and children {Photo credit: MSH.}Photo credit: MSH.

I got a call from the resident doctor to come to exam room 6. As soon as I entered the room, I prepared myself. The little girl, 7- or maybe 8-years-old, didn't look well; she was “floppy,” combative, and not entirely aware of where she was or what we were doing to her. She was HIV-positive, and my colleague needed to get an IV line in her arm to test the latest in experimental treatments for kids with HIV– and needed the four of us interns to help hold her still.

It was 1993 during my residency in pediatrics in Cleveland, Ohio. We were at one of the best children’s hospitals in the world; it didn’t matter. The young girl died a few months later.

With the advent of antiretroviral therapy (ART) a few years later, the whole world changed. The world of HIV medicine blossomed; new drugs and drug combinations literally exploded with amazing effect. HIV-positive mothers could give birth to HIV-negative babies, and HIV-positive children and their moms could get treatment.

Health for All.Health for All.

The October edition of MSH's Global Health Impact newsletter (subscribe), features stories of people, communities, and countries on the road toward universal health coverage (UHC).

The vital role of the essential package for health impact

On the Road to Universal Health Coverage: The Vital Role of the Essential Package for Health Impact

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