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 {Photo credit: Samy Rakotoniaina/MSH}Community Health Volunteer in a remote village of Tulear, Madagascar, giving instructions to a client on the use of pregnancy tests.Photo credit: Samy Rakotoniaina/MSH

How Countries Can Move toward Building Sustainable Community Health Programs

Universal health coverage (UHC) is increasingly recognized as the best way to achieve the Sustainable Development Goal targets on health. But with 400 million people lacking access to essential health services and a projected shortage of 18 million health workers, it will take unprecedented effort and funding. Community health workers (CHWs) could be an important part of the solution—but without effective investments and sound planning, we will fall short of achieving UHC.

 {Photo credit: MSH staff.}Journalists raise their hands in solidarity to support AMR advocacy and containment at the close of a SIAPS-supported workshop organized by the Food, Medicine and Health Care Administration and Control Authority of Ethiopia in June 2012.Photo credit: MSH staff.

Achieving universal health coverage (UHC) won’t be possible without paying close attention to one of our most pressing global health threats: drug-resistant infections.

Antimicrobial resistance (AMR) occurs when microorganisms develop resistance to a medicine that was originally intended to disable or kill them. While microbes naturally develop resistance to antimicrobials over time, excessive or inappropriate use of antibiotics speeds up AMR. The issue is a big challenge to UHC, jeopardizing the effectiveness of surgical procedures and threatening the treatment of many infectious diseases, including malaria, tuberculosis, and HIV/AIDS.

According to estimates from The Review on Antimicrobial Resistance, a report commissioned by the U.K. government and the Wellcome Trust, the financial burden from AMR could be as much as USD 100 trillion and the global gross domestic product could decrease 3.5% by 2050. AMR also causes immense loss of life—700,000 people die from drug-resistant infections each year, and this number is expected to grow to 10 million by 2050 if AMR is not contained.

 {Photo Credit: Geoffrey Ddamba.}A peer educator mobilizes clients for outreach services in the Kawempe area of Kampala, Uganda.Photo Credit: Geoffrey Ddamba.

Many civil society organizations (CSOs) play an essential role as service providers and advocates in health systems around the world. They can connect policymakers and providers to the communities they serve, promote smarter decision-making, and foster local ownership. If countries are going to make Universal Health Coverage (UHC) a reality, it will be side-by-side and in partnership with civil society.

Delivering essential health services

Although many low- and middle-income countries lack public sector healthcare infrastructure and human resources for health, civil society can help fill in the gaps. Governments can partner with CSOs through mechanisms such as grants and contracts to leverage these organizations’ capacities to avoid duplication, reduce inefficiencies, and increase access.

For example, the USAID-funded Leadership, Management, and Governance (LMG) Project, led by Management Sciences for Health, worked with the Honduran Ministry of Health from 2012 to 2016 to contract with NGOs to provide HIV/AIDS services to key populations. In total, the LMG Project helped the ministry sign 25 contracts with NGOs to provide education, prevention, and rapid testing services for nearly 40,000 people over three years.

{Photo Credit: Melissa Garcia}Photo Credit: Melissa Garcia

(Cross-posted on the International Consortium for Emergency Contraception website).

With the current largest generation of young people, there is much to celebrate on August 12, International Youth Day. In particular, there is the growing recognition that as agents of change, adolescents and young people and their organisations are essential stakeholders who contribute to inclusive, just, sustainable and peaceful societies. Crucially, advocates working on sexual and reproductive health (SRH) and reproductive rights (RR) advance access for young people in meaningful ways.

 {Photo Credit: Aubrey Clark}A technician tests a child for malaria at a health center in Kinshasa, DRC.Photo Credit: Aubrey Clark

(Cross-posted on the Global Health Council website).

Between 2000 and 2015, great strides have been made in fighting malaria. Globally, malaria case incidences declined by 41% and mortality rates by 62%. However, approximately 212 million people were infected and 429,000 people died in 2015, with the majority being children under the age of 5 in sub-Saharan Africa. Malaria also places a great financial burden on individuals and health systems. In sub-Saharan Africa alone, the annual cost of case management related to malaria is estimated at USD 300 million.

Much has been done since 2000 to eliminate this disease, and ensuring improved access to and appropriate use of quality-assured malaria medicines is necessary to sustain these gains.

The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program recently published the results of its activities in eight countries (Angola, Burundi, the Democratic Republic of the Congo, Ethiopia, Kenya, Guinea, Mali, and South Sudan) to control malaria.

{Photo credit: MSH}Members of government and civil society from Myanmar, Cambodia, Laos, Vietnam, and Philippines work together on priority challenges related to ensuring persons with disabilities in their countries can access the rehabilitation services they need.Photo credit: MSH

A recent increase in political commitment and global cooperation has led many countries to adopt Universal Health Coverage (UHC) strategies—such as establishing packages of essential health services and implementing health financing reforms—in an effort to ensure their citizens have access to basic health care services. Health is increasingly being embraced as the driver of human welfare and sustained economic and social development, but I wonder: If persons with disabilities are not deliberately included in the design of UHC strategies and reforms, will they be left behind? What do we, as a development community, stand to gain if we prioritize disability inclusion?

UHC is for everyone

Persons with disabilities are the world’s largest minority group. One in seven people around the world—15 percent of the world’s population, accounting for more than one billion individuals—live with some form of disability. Yet, they are rarely at the table when health policies and programs are being designed, governed, or evaluated. The majority of these persons live in the developing world. Disability disproportionately affects the key populations who already face development inequities, such as women, the elderly, people living in poverty, indigenous populations, ethnic minorities, and LGBT persons.

 {Photo credit: Julius Kasujja}Team of doctors and nurses at the Joint Clinical Research Centre in Uganda Photo credit: Julius Kasujja

What it takes for health systems to provide lifelong antiretrovirals

Soon after her husband’s death in 1991, Bahati Shellinah tested positive for HIV, but antiretroviral drugs (ARVs) were not yet available. In 2004 she fell ill, but, luckily, this time ARVs were available. Bahati visited the Joint Clinical Research Centre (JCRC) outside of Kampala, Uganda, and she began taking ARVs for the first time

Thankfully for Bahati, a local service provider was able to start her on treatment, but that is not the case for many people living with HIV, who often find themselves facing long waiting times, overwhelmed staff, medicine stock outs, stigma, and discrimination. No organization is immune to these challenges, and although JCRC was prepared when Bahati returned, they, too, grappled with organizational challenges as they scaled up services between 2003 and 2010. The gaps in management systems put JCRC's eligibility for donor funding at risk, which would mean patients like Bahati would lose access to their essential medicines. 

 {Photo Credit: Gwenn Dubourthournieu}HIV education is a crucial aspect of family planning services.Photo Credit: Gwenn Dubourthournieu

This year’s World Population Day coincides with the Family Planning Summit—a global moment where intentions and commitments to the right to health for all are revitalized. An essential component of HIV prevention and treatment, family planning must be prioritized in global and national agendas. Here are four reasons why: 

  1. Family planning is essential to maintaining progress on HIV goals: Meeting the needs of young people, particularly in developing countries, is critical to maintaining progress and momentum in controlling the HIV and AIDS epidemic. In Sub-Saharan Africa, where the youth population has nearly doubled since the beginning of the epidemic, millions more young people are entering a stage in life where they may be at increased risk of exposure to HIV. With the world’s highest fertility rates and the lowest use of modern contraception, family planning services are urgently needed to help young people protect themselves and prevent new infections.

{Photo Credit: Fabrice Duhal}Photo Credit: Fabrice Duhal

How health workers use technology to combat illness

Treatments for diseases like tuberculosis (TB) and HIV are lengthy and complex. Medications need to be taken regularly and for extended periods. Interruptions come at a high cost for patients, their families, and the health systems that treat them. 

Over the past several years, professionals across a range of disciplines have focused on creating solutions at all levels of the health system. From a tool that helps governments calculate the economic cost of medicine stock-outs to a piece of software that allows doctors across Ukraine to follow a patient’s complex TB treatment, technology can play a critical role in bringing solutions to scale and making significant progress in the age-old fight against deadly diseases. 

Here are two examples of how MSH is helping health workers use computers to fight back.

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