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 {Photo: Gabriel Daniel/MSH}Data clerks, hospital pharmacists, and representatives from the DDMS and SIAPS enter data and discuss eTR operations at Ola During and PCMH hospitals in August 2017.Photo: Gabriel Daniel/MSH

Irrational medicine use and poor pharmaceutical management are widespread problems throughout all levels of Sierra Leone’s health system. Misuse, underuse, and overuse of medicines are particularly worrying because they contribute to the rise of antimicrobial resistance (AMR) and threaten the effective prevention and treatment of infections caused by bacteria, parasites, and viruses.

Recognizing that coordinated action is needed to minimize the emergence and spread of AMR, Management Sciences for Health (MSH) has catalyzed multidisciplinary and cross-sectoral coalitions to build awareness of the threat of AMR and advocate for its containment.

As part of its post-Ebola recovery work to strengthen its pharmaceutical system, Sierra Leone’s Directorate of Drugs and Medical Supplies (DDMS) partnered with the US Agency for International Development-funded Systems for Improved Access to Pharmaceutical and Services (SIAPS) Program, implemented by MSH, to develop efficient procurement, distribution, and inventory systems and establish stakeholder coordination and oversight mechanisms known as hospital Drug and Therapeutics Committees (DTCs).

{Photo credit: Brooke Barker/MSH}Participants in an LDP+ in Bangolo, Cote d'Ivoire.Photo credit: Brooke Barker/MSH

In 2014, an Ebola outbreak that started in Guinea and quickly spread to Liberia and Sierra Leone threatened health systems across West Africa. During the crisis, the Côte d’Ivoire National Institute of Public Health (INSP) mobilized a One Health cross-sectoral collaboration in the country’s western regions bordering the Ebola-affected countries and established committees to address the epidemic.

Thanks to emergency funds made available by USAID, the Leadership, Management and Governance (LMG) project, led by MSH, quickly focused on supporting the committees to form and run more efficiently.  A six-year, global project that strengthened health systems to deliver more responsive services to more people—LMG also placed technical advisors at the regional health offices to support integrated supportive supervision visits, data validation workshops, planning, coordination, and communication.

{Photo Credit: WHO Uganda.}The GHSA High-Level Ministerial Meeting was hosted by the Government of Uganda.Photo Credit: WHO Uganda.

At the 4th Global Health Security High-Level Ministerial Meeting held in Uganda on October 25-27, “Health Security for All: Engaging Communities, Non-governmental Organizations, and the Private Sector,” more than 600 participants including ministers from 41 countries recommitted to and eagerly embraced the agreements made under the Global Health Security Agenda (GHSA) to accelerate progress toward a world safe and secure from infectious disease threats.

The GHSA initiative was launched in 2014 to increase the capacity of countries to prevent disease outbreaks from becoming epidemics. The meeting brought together senior leaders across many sectors of government, international organizations, and nongovernmental stakeholders to evaluate the progress made so far and prioritize actions needed to close the gaps that remain. To succeed, nations recognized the urgent need to refine and improve their health systems – so that they are capable of delivering everything it takes to keep people healthy and safe from infectious disease threats.

Management Sciences for Health (MSH) was proud to be among the participants, drawing on more than 45 years of experience supporting countries to build the prevention, rapid detection, and effective response needed to mitigate global health threats.

We’re excited to bring you this month’s edition of Leading Voices, a series that features the incredible talent that makes up MSH.

We’re chatting with Ashley Arabasadi, Campaign Manager of the No More Epidemics campaign and MSH's Global Health Security policy advisor. Ashley is a Pennsylvania native with a passion for global health security. She’s responsible for the strategy, planning, and execution of global health security activities here at MSH. See Ashley speak at the upcoming symposium "Pandemic Risk: A Threat to Global Health Security," November 6, University of Pennsylvania's Perry World House.

 {Photo Credit: Matt Iwanowicz/MSH}The MSH tuberculosis team delegation at a conference retreat.Photo Credit: Matt Iwanowicz/MSH

Management Sciences for Health’s (MSH’s) significant TB work was recognized as some of the best during this year’s 48th Annual World Conference on Lung Health that took place in Guadalajara, Mexico from October 11-14, 2017.

MSH staff from seven countries participated in a variety of symposia, workshops and presentations. MSH also produced three symposia, three workshops, 36 posters, 24 oral presentations, and six technical briefs and technical highlights to share our experience and expertise on a range of topics, including GeneXpert implementation scale-up; TB/HIV/diabetes integration model; QuanTB; Urban DOTS implementation, and more.

 {Photo credit: Jones Dizon/SIAPS.}Training participants try out the Pharmacovigilance Monitoring System (PViMS), a web-based application to help clinicians, regulatory bodies, and implementing partners monitor medicine safety specifically in resource-limited countries.Photo credit: Jones Dizon/SIAPS.

The Philippines has one of the highest TB burdens in the world—and 2.6% of its more than 286,000 new cases in 2015 were of multi-drug-resistant TB (MDR-TB). This threatens the progress the country has made in addressing the deadly disease over the past few decades and its goal to make the country TB-free by 2030. Further, MDR-TB cases will likely rise steadily in the Philippines and the world over the next two decades.

There’s a new medicine that can help. Through a partnership with Janssen Therapeutics of Johnson & Johnson that began in 2015, USAID introduced a program to distribute a new medicine called bedaquiline that helps patients with MDR-TB in low-income countries including the Philippines. The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, which Management Sciences for Health (MSH) leads, has been helping to roll out bedaquiline in low- and middle-income countries.

But with any new treatment, active pharmacovigilance (PV) is needed to help ensure both patient safety and drug effectiveness. This means being able to monitor patients to identify and evaluate adverse events, such as unexpected or serious side effects, to better understand possible risks and improve treatment protocols.

We’re excited to bring you this month’s edition of Leading Voices, a series that features the incredible talent that makes up MSH.

We’re chatting with Degu Jerene, our project director in Ethiopia. Degu hails from Addis Ababa and has a passion for stopping the spread of infectious diseases like tuberculosis, malaria, and HIV. He’s responsible for leading the USAID-funded Challenge TB project in Ethiopia. Degu will be representing MSH this week at the Union World Conference on Lung Health in Guadalajara, Mexico.

What do you think makes MSH different?

Our expertise in health systems makes us unique. Others might be experts in childhood TB, for example, or research, or MDR-TB. But we have a comprehensive approach that looks at the health system as a whole and finds integrated solutions to very complex problems. At the same time, we are equally good or even better in disease specific areas.

What are you most proud of in your work?

Proving that our approach works. Gathering evidence and publishing it in peer-reviewed journals, which I’ve done dozens of times, is a contribution to the field I’m very proud of having made.

Finish this sentence: Health is _______.

A right, not a privilege.

 {Photo credit: Alison Corbacio/MSH}From left: Ugochi Daniels, UNFPA; Chunmei Li, Johnson & Johnson; Antoine Ndiaye, MSH; Lara Zakaria, Syrian American Medical Society; Irene Koek, USAID; Loyce Pace, Global Health Council.Photo credit: Alison Corbacio/MSH

Health systems strengthening was front and center in discussions held in New York on the sidelines of the 72nd United Nations General Assembly. MSH hosted three events spotlighting how strong health systems are critical to resiliency and stability in fragile environments, at the core for global health security and essential for achieving universal health coverage. Here are some highlights from the week. See more on Twitter , and .

 {Photo Credit: Denise Museminali}A doctor at Bushenge Hospital attends to a mother and her newborn in the maternity ward.Photo Credit: Denise Museminali

The National Accreditation Program at Bushenge Provincial Hospital

Tucked in the outermost region of the Western Province of Rwanda, Bushenge Provincial Hospital serves a population of over 171,000 people, including expectant mothers referred by neighboring health centers for pregnancy complications that require Cesarean section. Cesarean section (C-section) delivery is one of the most frequent surgeries performed at health facilities worldwide. At Bushenge Provincial Hospital, it accounts for approximately 48% of annual births. As with any surgical procedure, there are a number of complications that could occur during or post-operation. Surgical site infections (SSI) are a common complication following Cesarean section procedures that do not adhere to infection prevention and control principles. Such infections place a great deal of physical and emotional burden on the mother and family and present substantial costs for health facilities.

Because of the Accreditation Program, I work with an objective and not just out of routine as I did before. I always ask myself what can I do to contribute to the quality of care at Bushenge? If there is an infection risk, I ask myself, what can I do to help?

—Noëlla Benemariya, Environmental Health Officer at Bushenge Hospital

 {Photo Credit: Rui Pires}A pregnant woman is given an ultrasound.Photo Credit: Rui Pires

(This post originally appeared on the Next Billion website.)

Why Greater Ultrasound Availability Doesn’t Always Benefit Patients

Advances in health technologies have reshaped the lives of communities, families and individuals, undoubtedly contributing to better health outcomes around the world. For the most vulnerable populations, technology may significantly improve access to preventive, diagnostic, and treatment services and help increase demand for greater quality care. Yet, despite their potential, new technologies can also add new challenges, risking potential gains in quality, safety or cost. Particularly in settings where health systems are weak, the introduction of technological interventions requires thoughtful execution.

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