Strengthening Pharmaceutical Systems (SPS) Program

2007–2012

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Strengthening Pharmaceutical Systems is a follow-on to the Rational Pharmaceutical Management (RPM) Plus Program. MSH is pleased to announce that the US Agency for International Development has awarded us the Strengthening Pharmaceutical Systems (SPS) Leader with Associates Cooperative Agreement. SPS will focus on four key results:

• Improve governance in the pharmaceutical sector
• Strengthen pharmaceutical management systems to support public health services
• Contain the emergence and spread of antimicrobial resistance
• Expand access to and improved use of essential medicines

The five-year, $147.5 million cooperative agreement is led by Dr. Douglas Keene as Program Director, Dr. Sameh Saleeb and Dr. Francis Aboagye-Nyame as Deputy Directors. To help meet goals relating to the key result areas, the SPS Program is building on the successes of RPM Plus while expanding the range of technical areas to include financing, pharmacovigilance, pharmaceutical care, integration of new health technologies, and increased use of the private sector, among others. MSH will accomplish this enhanced program of activities by collaborating with a number of new partner organizations. The SPS core partner team includes:

• BroadReach Healthcare
• Ecumenical Pharmaceutical Network
• The Lewin Group
• LMI Government Consulting
• University of Washington Department of Global Health
• WHO Collaborating Center in Pharmaceutical Policy: Harvard University/Boston University

In addition to the core team, MSH is joined by a select group of organizations that will serve as specialized resources for SPS. These organizations include:

• African Medical and Research Foundation
• American Society of Health-System Pharmacists
• Euro Health Group
• Infectious Disease Institute at Makerere University
• Joint Commission International
• London School of Hygiene and Tropical Medicine

As we work toward the overall goal of SPS, the SPS team is striving to advance the science and "art" of strengthening pharmaceutical management systems. The SPS Program provides a great opportunity for MSH and USAID to continue supporting developing countries in their quest to increase access to essential medicines and facilitate the scale up of vital treatment programs.

In 2008, USAID/Afghanistan asked the SPS Program to build on the work initiated under its previous projects, while increasing the scope of the country's ability to manage pharmaceuticals. As a result, the SPS Program works with Afghanistan partners to establish and maintain a transparent procurement system; increase the availability to safe, effective, and affordable pharmaceuticals; and ensure the quality of pharmaceuticals, particularly in the private sector.

Technical Support to the Central and Provincial Ministry of Public Health (Tech-Serve) Project

2006–2010

Tech-Serve works with the Ministry of Public Health (MOPH) at the central and provincial level to build its capacity to perform its primary function of guiding the health system by establishing national health objectives that address national health priorities while ensuring equity and fostering sustainability. Tech-Serve provides ongoing technical assistance in key public health technical areas and engages both central and provincial managers in developing their management and leadership skills to focus on health results and accountability. The Tech-Serve Management support for Provinces (MSP) initiative works directly with provincial health directors and their teams to effectively articulate their health priorities, strategies to address health needs, to plan, implement the strategies an to monitor their activities. This project was launched in July 2006 by Management Sciences for Health under an Associate Cooperative Agreement.

Basic Support for Institutionalizing Child Survival (BASICS) : Afghanistan

1999–2011

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As a technical assistance partner for newborn and child health to the USAID Bureau for Global Health, the Basic Support for Institutionalizing Child Survival (BASICS) Project develops and implements strategies to reduce preventable infant and childhood deaths in the developing world. MSH works as a partner in BASICS, which began its third phase in October 2004. Under this indefinite quantity contract (IQC), BASICS assists USAID/Washington Bureaus, USAID field missions, host-country governments, donor agencies, NGOs, PVOs, research institutions, and the private sector to scale up and increase the use of newborn and child health and nutrition interventions by families, communities, and health systems. Since 1993, BASICS has worked to achieve substantial improvements in coverage and to expand effective newborn and child health interventions. BASICS focus areas include newborn health, essential nutrition actions like vitamin A supplementation, immunization, integrated management of childhood illness, treatment of diarrhea and pneumonia, and malaria control. In addition to strengthening the delivery of basic newborn and child health services, BASICS has expanded its technical scope to include pediatric HIV & AIDS, birth spacing, and child survival and nutrition in complex humanitarian crises. BASICS areas of expertise include assistance to countries on comprehensive strategies or selected interventions for newborn and child health, building partnerships, delivery of quality newborn and child health services, community-based treatment and private sector approaches to expand access to services, and capacity building and training.

BASICS provides technical assistance to the Ministry of Public Health of Afghanistan to address newborn health, community case management of childhood illnesses, nutrition, pediatric hospital care improvement, behavior change communications, and systems strengthening.

Beginning its country program in 2007 and establishing a local office in Kabul in 2008, BASICS specifically works to improve child health in the country by revising and developing child survival and health policies and strategies; improving the delivery of child health care in communities, and in peripheral facilities and hospitals, including by reinforcing IMCI protocols; and strengthening cross-cutting health system components, such as the use of health information system data for decision making.

Grant Management Solutions (GMS)

2007–2012

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The Grant Management Solutions (GMS) project was established by the US Government to provide urgent, short-term technical support to countries receiving grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria. GMS is a USAID-funded project managed by the Office of the Global AIDS Coordinator (OGAC). It is led by MSH with four partners. GMS assists in governance and leadership challenges; financial and grants management; procurement and supply management; monitoring, evaluation, and reporting; and improving the skills and participation of civil society organizations and local consultants. Through a small core staff that draws upon a large, evolving network of local, regional, and international consultants, GMS primarily works with Country Coordinating Mechanisms and Principal Recipients at country level. GMS is located within the Center for Leadership and Management.

In Afghanistan, the GMS team is working with the Country Coordinating Mechanism (CCM) to ensure that it is in conformity with Global Fund minimum criteria, and to undertake any reforms that might be needed. With the CCM, GMS will clarify the respective roles of the CCm and the Principal Recipient, create a secretariat, and build capacity of CCM members to carry out the core CCM functions and, in particular, grand oversight.

Afghanistan COMPRI-A

2006–2010

The Communication for Behavior Change: Expanding Access to Private Sector Health Products and Services in Afghanistan (COMPRI-A) Project is working to increase Afghans’ access to health information and products by strengthening private-sector capacity through a comprehensive and integrated social marketing program. MSH, as subcontractor to The Futures Group LLC, leads the training and policy components of the project. Specifically, MSH provides the senior team member in Training and Communications for Community Mobilization. This team member will reach many cadres in Afghanistan (mullahs, community shuras, and the general public) with relevant health messages; provide refresher training to community health workers and pharmacists; and equip retailers with interpersonal communication skills about the correct use of socially marketed products. MSH also provides the senior team member in Policy Development and Implementation/Research who will focus on pharmaceutical regulation and policy; Ministry of Public Health policies, standards, and guidelines related to quality of care; building public/private partnerships; and coordinating policy activities among the implementing partners.

Leadership, Management and Sustainability (LMS) Program

2005–2010

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The Leadership, Management and Sustainability (LMS) Program develops managers and leaders who achieve results in the areas of reproductive health, HIV & AIDS, infectious disease, and maternal and child health. LMS works with health organizations in the public and private sectors to create sustainable programs and systems through improved leadership and management. By strengthening management systems and increasing system-wide leadership, LMS improves the performance of health care organizations at all levels, develops human resources, and builds the capacity to anticipate and respond effectively to changing external environments.

Building on USAID's successful REACH Project, completed in 2006, LMS is strengthening the leadership and management capacities of the Ministry of Public Health (MOPH) at the central and provincial levels, as well as ensuring reliable access to high-quality pharmaceuticals throughout 13 USAID-supported provinces through the Tech-Serve project, a five-year Associate Award initiated in July 2006. 

Major accomplishments to date include:

More than 1,800 health professionals, including senior Ministry of Public Health and NGO managers, were trained in leadership and management development, and other priority public health subjects to equip them with the necessary skills to achieve better health outcomes.

As a result of training community health supervisors and community health workers (CHWs), two-thirds of all family planning services are conducted by CHWs at the community level.  The Contraceptive Prevalence Rate increased to 40.6% (up 10% from the start of the project), as reported in a household survey conducted by the health service delivery organizations.

The Tech-Serve Project supplied a total to $11.9 million of essential drugs and contraceptives since its inception.

The MOPH is now certified to administer USAID funds, and manages 17 health service provision contracts with local and international NGOs, thereby increasing access and equity to health care across the 13 provinces.

Tuberculosis Control Assistance Program (TB CAP)

2005–2011

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The Tuberculosis Control Assistance Program (TBCAP) aims to decrease morbidity and mortality by increasing case detection and treatment success of pulmonary TB patients in USAID priority countries. TBCAP is USAID’s five year centrally funded project focusing on implementing WHO’s Stop TB strategy. MSH is one of eight partners, including KNCV Tuberculosis Foundation, WHO, The International Union Against Tuberculosis, Centers for Disease Control and Prevention, Family Health International, American Thoracic Society, and the Japanese Anti-Tuberculosis Association. TBCAP recently introduced the Management and Organizational Sustainability Tool (MOST) process it has adapted to the TB context. A meeting sponsored by TBCAP for personnel from National Tuberculosis Programs in Mozambique, Namibia, Uganda, Zambia, and Pakistan gave managers hands-on experience using MOST and allowed TBCAP to validate the instrument as adapted for TB. Within TBCAP, MSH makes a unique contribution for addressing constraints such as poor management and lack of sustainable leadership, weak laboratory services and failure of drug supplies, inconsistent drug quality and inadequate drug policies, lacking information systems, weak monitoring and evaluation, and overwhelmed health systems. Through core-funded activities, MSH contributes to TBCAP by aiding in the development and implementation of the International Standards for Tuberculosis Care TB control, guidelines for TB control in prisons, and institutional capacity building. MSH also provides workshops and training for lab consultants, human resource development strengthening, and multidrug resistant tuberculosis (MDR-TB) management. MSH is making important contributions as coordinating partner for Malawi, Ghana, and Souther Sudan for expanding quality DOTS and is currently collaborating in Cambodia, Ethiopia, Indonesia, Kenya, Mexico, Nigeria, Mozambique, Namibia, Pakistan. MSH provides technical assistance in Domincan Republic and Peru.

The overall objective of TB CAP project is to improve the management and technical capacity of the NTP and to strengthen the management and technical systems for the delivery of quality DOTS in Afghanistan.

MSH will be the lead partner for TB CAP Afghanistan project while WHO and KNCV will be the collaborating partners.

Rural Expansion of Afghanistan Community-based Healthcare (REACH)

2003–2006

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In May of 2003, USAID awarded MSH a three-year contract to improve access to basic health services for Afghans and to strengthen the national health system. The goal of the REACH Program is to improve the health of women of reproductive age and children under five. REACH is ensuring that an estimated 7.5 million people in underserved areas of Afghanistan have access to a basic package of health services. REACH is strengthening the existing national health system by assisting with the development of policies and standards, building systems for human resources and health information, training nearly 7,000 health service providers including more than 6,000 community health workers and empowering women and communities to protect their health through training and education.

By working closely with counterparts in Afghanistan and the international community, REACH is addressing immediate needs while ensuring rapid start-up activities are consistent with long-term development objectives. 

Accelerating Contraceptive Use Project

2002–2006

Funding from the William and Flora Hewlett Foundation focused on identifying best practices for improving the quality and impact of family planning services in Afghanistan. The intervention began as a small project focused on providing misoprostal tablets to Afghan women in order to prevent postpartum hemorrhaging and therefore decrease maternal mortality.

The project team quickly discovered that, contrary to earlier research and beliefs, there was also a sizable demand for family planning services. By refocusing the funding on understanding the demand for family planning in Afghanistan, the team realized that there was a larger opportunity to improve women’s health and prevent maternal deaths. The MSH project team refocused the grants funding to provide evidence of family planning demands throughout the country to increase its use in the Ministry of Public Health’s Basic Package of Health Services.

Afghanistan Health Services Enhancement Project (AHSEP)

2002–2003

In 2002, the Ministry of Public Health asked MSH to assist in the reconstruction of the Afghanistan health system by heading the first nationwide assessment of health resources in more than ten years. MSH trained teams of Afghan nationals to inventory health facilities nationwide — reaching more than 1,000 facilities, almost 1,500 pharmacies, and interviewing close to 3,000 workers. The survey revealed districts that had only one health facility for every 5,000 people, and some facilities that tried to serve more than 100,000 people. The survey also showed that only half of more than 750 primary care facilities had safe water and only a quarter had electricity, while one-third functioned without toilets. In addition, 40 percent of facilities had no female workers, and strong social barriers often prevented women from receiving health services from men. MSH concluded that 70 percent of primary care clinics were unable to provide complete maternal and child health services. The outcome of this assessment led to the development of the Basic Package of Health Services (BPHS) through a collaborative process involving a variety of stakeholders. The Ministry of Public Health and the donor community are currently using these estimates to provide services through grants to Afghan and international NGOs. The BPHS is now the official policy of the Islamic Republic of Afghanistan, and those delivering government-supported health services must provide the basic package first before adding other services.