June 2011

When the Taliban were chased from power in Afghanistan in December 2001, the health system was in shambles---devastated by years of war and neglect. Access to primary care was below 10% and immunization rates had fallen below 20% throughout the country. Less than half the hospitals had both electricity and running water.  Medicines and medical supplies were scarce and the quality was often unreliable. There were essentially no female health workers active in most of the Afghanistan---a country in which cultural sensitivities mean female providers are essential for women’s health. Nine out of 10 women were on their own for labor and delivery, with no trained birth attendant. Not surprisingly, maternal, child, and infant mortality were among the highest in the world.

It is 5:30 a.m. on a Thursday morning in the town of Mwene-Ditu, located in the Eastern Kasaï Province of the Democratic Republic of Congo. The skies are still dark as the crieur, the town crier, makes his rounds, calling out to the community that today is the start of the three-day national vaccination campaign against polio.

As the local residents begin their day, health workers are finalizing preparations for the massive door-to-door effort to immunize children under age five years old from this crippling disease. One such worker is Evariste Kalonji, a community mobilization specialist with the Integrated Health Project.

Listen to USAID Deputy Administrator Donald Steinberg and MSH Chief of Party John Rumunu (South Sudan) and MSH Center for Health Services Vice President Diana Silimperi talk about health systems in fragile states.

This teleconference is in conjunction with the health and fragile states conference at US Institute of Peace happening June 9 and 10, co-sponsored by MSH.

Management Sciences for Health (MSH) Press Teleconference on Fragile States and Health, June 8.

Discovering MSH blog series graphicOver the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.

Lucy Sakala at the Salima District Hospital in Salima, Malawi (© Dominic Chavez)

 

South Sudan is recovering from five decades of civil war. A lack of infrastructure, human resources, and ongoing violence has ravished the country’s health services. MSH is helping the new Ministry of Health manage the transition to a national health system in the midst of renewed fighting in Abyei and as masses of people, anticipating the formation of the world’s newest country on July 9, 2011, re-enter South Sudan.

The Ministry of Public Health’s (MOPH) Pharmaceutical Enterprises operates 53 pharmacy stores located near government hospitals nationwide, managed by 118 pharmacists. With 1 million US dollars in capital, pharmaceuticals are purchased, stored, and then distributed to the Afghan people through these government-owned pharmacies.

Dr. Mirza Mohammed Ayoobi, the Deputy Director of Pharmaceutical Enterprises says, “Majority of our government-employed pharmacists have over 15 years of experience, but have not kept pace with the changing landscape of pharmacy practice. They need training on medication counseling, rational use, and good dispensing practices.”

In response, the Strengthening Pharmaceutical Systems Program-Afghanistan team organized and facilitated the first of a series of training programs to upgrade the pharmacist’s knowledge and skills on dispensing and rational use of medicines.

After a training program, MSH interviewed Mr. Mohammad Hasham, a pharmacist in Khairkhana, about the importance and value of this training course.

Permanent Secretary of the Ministry of Medical Services, Ms. Mary Ngari, (Right), hands over the new Governance Guidelines to HMC Board Member and Deputy Provincial Commissioner of Central Province, Francis Sila, while USAID/Kenya HRH Specialist Peter Waithaka, LMS/Kenya Project Director Karen Caldwell, and Central Province Provincial Director of Medical Services Gichaiya M’Riara, look on. (Photo courtesy of Hosea Kunithia.)

 

Kenya’s new constitution, promulgated on August 4, 2010, mandates significant transformations in the health sector. Hospital reforms are a key part of these transformations. For MSH’s Leadership, Management and Sustainability Program in Kenya (LMS/Kenya), the opportunity to work closely with health sector partners, including the Ministry of Medical Services, to support the hospital reform agenda is an exciting and rewarding experience.

Serafina Sabino, a Medical Assistant in Wau, South Sudan (© Dr. Edward Luka)

Thousands of civilians fled from Abyei following the crisis in May, when northern forces took control over the town. The United Nations Office for Humanitarian Affairs (UNOCHA) reports 50,600 people displaced from Abyei town are verified and registered and estimates the full number to be about 84,000 people. Most of the Internally displaced persons (IDPs) fled to nearby Northern Bahr el Ghazal and Warrap States, where many humanitarian agencies are providing assistance in high displacement areas like Agok, Turalei, and Wunrock. However, many IDPs are arriving in Wau town, several hundred kilometers south of Abyei.

That point was made often by the Honorable Dr. Walter T. Gwenigale, Minister of Health and Social Welfare of the Republic of Liberia (also widely known as Dr. G in Liberia) at a conference, co-sponsored by MSH on June 9 and 10 at the US Institute of Peace. The event, Health in Post-Conflict and Fragile States: Challenges for the Next Decade was organized by Leonard Rubenstein, Chair of the USIP Health and Peacebuilding Working Group, and Stephen Commins, of International Medical Corps.

The two-day discussion explored the unique characteristics of health service delivery in fragile and conflict-affected states, making the point that “yes, it can be done,” but there is still a long way to go to get it right and find the balance between short-term interventions and long-term development. Speakers shared lessons learned in reconstructing health systems, especially in Afghanistan and Southern Sudan. They also took a look at human rights, governance, and vulnerable populations, particularly women. Dr. Gwenigale and Deputy Administrator of USAID, Ambassador Donald K. Steinberg provided keynotes.

Discovering MSH blog series graphicOver the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.LILONGWE, Malawi – The problem with writing about improvements in Malawi’s health system is focus. There are multiple directions to explore: extending family planning into rural communities, training HIV counselors, the rapid scale-up of HIV treatment, integrating TB services more into the mainstream of health care. At the US Agency for International Development (USAID) mission here, Dr.

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