USAID

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.

 {Photo credit: Mahjan CLTS Facilitator.}Washing hands. Itarchi Hakimabad, Badakhshan, Afghanistan.Photo credit: Mahjan CLTS Facilitator.

The USAID-funded Sustainable Water Supply and Sanitation Project, Afghanistan (SWSS) project increases access to potable water and sanitation services in Afghan communities and decreases the prevalence of water borne diseases through household hygiene interventions. Led by the Association for Rural Development, in partnership with Management Sciences for Health, SWSS has led nearly 400 communities in Afghanistan to become Open Defecation Free. The MSH components of the project have succeeded under the astute leadership of Dr. Abdul Hatifie, the team leader for Sustainable Health Outcomes, and Dr. Logarwal, the BCC Material and Media Specialist. Together they have led the successful implementation of innovative approaches in all aspects of the SWSS project. To learn more about SWSS’s accomplishments, please see the cover article in this month’s USAID Global Waters magazine.

{Photo credit: MSH.}Photo credit: MSH.

Policy makers and health sector leaders in low- and middle-income countries are recognizing the value of smart governance for significant and sustained gains in health status outcomes. The new USAID Leadership, Management and Governance (LMG) project, led by MSH with a consortium of partners, is actively engaged in building the capacity and competencies of those expected to accomplish smart governance.

To explore smart governance, LMG convened a Roundtable on Governance for Health in low- and middle-income countries May 18, 2012, at The Brookings Institution in Washington DC.

Sophia is now the go-to person for family planning and reproductive health services at Rwesande health center IV in western Uganda. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

Sophia is a humble woman. She has been working as a nurse for 10 years, and is currently one of five nurses posted at Rwesande health center IV in the hills of western Uganda.

When I arrived I was impressed by the number of services the health center offers, and the general appreciation felt around the compound. Rwesande health center IV has a maternity ward to safely deliver babies; counseling areas for family planning, reproductive health, and HIV; a general ward, a surgery theater, and health education space.

Family planning counseling and services now available

As Sophia shows me her meticulously-kept record books I can see the pride she takes in her work. She explained how women are now coming and asking for family planning services.

Not too long ago clients were not coming, and the nurses didn’t have proper training on methods to offer clients.

Scott Kellerman, around age 5. {Photo courtesy of S. Kellerman.}Photo courtesy of S. Kellerman.

The prevention of mother-to-child transmission (PMTCT) of HIV is taking center stage this week during USAID’s 5th Birthday campaign -- and rightly so.  Preventing mother to child transmission of HIV is one of the most critical, effective tools to helping kids reach their fifth birthdays.

Arifa leads a computer class at FACT in Guyana. {Photo credit: MSH.}Photo credit: MSH.

When Arifa arrived in August 2010 at Family Awareness Consciousness Togetherness (FACT), a USAID-funded non-governmental organization (NGO) that receives technical support from the MSH-led GHARP II Project, it was immediately evident that she had major communication challenges. At age 17, Arifa found it difficult to have even brief conversations with anyone.

The Berbice Technical Institute had sent Arifa to FACT as a work-study student for a two-month term. At the time, she was studying for a Certificate in Information Technology (IT).

FACT assigned Arifa to be an assistant teacher in their computer program with 40 orphans and vulnerable children (OVC), ages twelve to fifteen. Most of the time, Arifa could be found sitting in a corner all alone. When she did speak, the children made fun of her.

Ms. Apegnon Akpene, a family planning client and role model, in Diguegue. {Photo credit: Niagia Santuah/MSH.}Photo credit: Niagia Santuah/MSH.

Apegnon Akpene is a 20-year-old mother of three children: four-year-old Joseph, two-year-old Romance, and one-month-old Akou Jacqeline. Since attending USAID's Action for West Africa Region, Phase II (AWARE II)  community health worker training, she has become a client of family planning -- and a role model for family planning in her community.

Akpene is one of three community health workers in Diguegue, a small village of about 800 people in the hills of the southwestern forest separating Togo and Ghana. Distance and difficult terrain are major hindrances to accessing health care for the inhabitants of the village. Diguegue is 47 kilometers from the nearest health facility, a small clinic, in the Prefecture of Tchifama. The village is served by a 12-kilometer dirt road that winds through the thick forest.

Akpene attended school for eight years. When she became pregnant at age 16, she was forced to drop out. She gave birth to three children within four years.

Honor your mother, support healthy moms, and help kids reach their 5th birthdays: click the image to donate {Photo credit: MSH.}Photo credit: MSH.

Improving Child Health in Communities and at Home, the April/May 2012 edition of MSH's Global Health Impact newsletter (subscribe), features personal stories about child survival and child health in developing countries.

"Prevention, treatment and care close to the home are keys to saving children's lives," says Dr. Jonathan D. Quick, MSH president & chief executive officer, who blogs about saving children's lives through interventions closer to home, shares his 5th birthday picture, and encourages us to support USAID's 5th Birthday Campaign.

Stories about child survival and child health

The newsletter highlights a number of compelling stories from the Democratic Republic of the Congo, Uganda, Nigeria, and Lesotho.

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.

Chinaecherem Nwodo {Photo credit: MSH.}Photo credit: MSH.

Stigmatized, isolated, and conditioned to undertake hard labor, 14 year-old Chinaecherem Nwodo shows that one can overcome the most dire circumstances. Chinaecherem was despised and accused of witchcraft in her community, the Onu-Orie-Obuno-Akpugo village in Nkano West Local Government, Enugu State, Nigeria. Her abusive treatment by community members reflected the challenges facing some children in rural areas of Nigeria.

The community blamed her for her mother’s death and father’s insanity. She was barely two years old when her mother died, and she was abandoned to the care of her sixty-three year-old maternal grandmother. As a teenager, she was traumatized and suffered intense malnourishment. To this day she looks like a 6 year-old girl, though her health has improved.

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