{Photo credit: Rejoice Phiri/MSH}Midwife Chirford Semu stands in the labor and delivery room at Bowe Health Center, in Dowa district, Malawi.Photo credit: Rejoice Phiri/MSH

Chirford Semu knows that time is of the essence when complications arise during labor and delivery. He is a midwife at Bowe Health Center in Dowa district, one of the most remote areas in Malawi. This single health center serves an estimated 42,445 people. Of these, 9,762 are women of childbearing age, and there are approximately 2,100 expected births per year in the district. Women who develop birth complications at this facility have to travel 96 kilometers on unpaved roads to reach Dowa District Hospital, the district’s referral facility.

 {Photo credit: MSH Rwanda}Left to right: Lisa Godwin, USAID Rwanda Health Office Director, Dr. Diane Gashumba, Rwanda's Minister of Health, Alain Joyal, RHSS Project Director, Management Sciences for Health.Photo credit: MSH Rwanda

Over the past five years, the United States Agency for International Development (USAID) has invested in measures to strengthen and sustain Rwanda’s health sector through its Rwanda Health Systems Strengthening (RHSS) Project (2014-2019). In a ceremony at the Kigali Serena Hotel, USAID, the Ministry of Health (MoH), as well as the implementing partner, Management Sciences for Health (MSH), marked the culmination and remarkable achievements of the five-year effort to strengthen the country’s health sector.

Pharmacy Assistant Aaron Sendeza wants to rid Malawi of malaria. Thanks to the mentorship program, Aaron works to ensure that all medicines and medical supplies in his health center are available, reliable, and of high quality. Photo credit: Paul Joseph Brown for VillageReachPharmacy Assistant Aaron Sendeza wants to rid Malawi of malaria. Thanks to the mentorship program, Aaron works to ensure that all medicines and medical supplies in his health center are available, reliable, and of high quality. Photo credit: Paul Joseph Brown for VillageReach

By Matthew Ziba

Many health facilities across Malawi don’t have enough trained pharmacy staff to adequately manage stock and dispense medicines. These tasks often fall on health care providers, who already have many other responsibilities, namely caring for patients. In some cases, even a ground laborer or a security guardwho may have no training in pharmacy managementmust step in to help.

 {Photo credit: Kenza Abu-Arja/MSH}From left to right: W. Gyude Moore, Reid Wilson, Ambassador Bonnie Jenkins, Dr. Rebecca Martin, and Marian W. Wentworth.Photo credit: Kenza Abu-Arja/MSH

On April 10, Congressman Gerry Connolly (D-VA) and Steve Chabot (R-OH) reintroduced the bipartisan Global Health Security Act, which reaffirms US commitment to promoting global health security. This proposed legislation aims to help the US prepare for and respond to infectious disease threats and prevent cross-border epidemics.

 {Photo credit: Samy Rakotoniaina/MSH}A health worker checks malaria commodities at a private clinic in Balaka, Malawi.Photo credit: Samy Rakotoniaina/MSH

“Malaria is a very big problem that we are still fighting,” says Dr. Samantha Musasa, Medical Officer for Balaka district, located in Southern Malawi. Indeed, Malaria kills some 435,000 people around the world each year, the majority of them children. In Malawi, the prevalence of malaria among children under five remains dangerously high, at around 23.6%.

In the spirit of the 3,500-year-old Tao (Way) of Leadership, MSH works closely with local institutions and communities to create lasting and sustainable changes; changes that improve the health of people among the world’s poorest and most vulnerable groups.

And as the Tao indicates, sustainability starts with ownership, “The people will say, we have done it ourselves.”

Women in Kakamega County, Kenya are taking charge of their pregnancies, supporting their peers, and learning about healthy practices and self-care from skilled health providers. MSH’s Lea Mimba (“Take care of your pregnancy”) project, funded by UK Aid through the County Innovation Challenge Fund (CICF), tested an innovative group model for antenatal care (ANC) that responds to the needs and perspectives of women and front-line health providers. At six Kenyan health facilities, Lea Mimba provides a forum where pregnant women share experiences, learn birth planning and self-care practices, provide each other with emotional and social support, and receive essential health information from a skilled health provider, who is usually a nurse.

Meet Hortense Kossou, Principal Technical Advisor for the USAID-funded Integrated Health Services Activity (IHSA) in Benin. Hortense previously served as the national malaria coordinator for the Ministry of Health in Benin and today leads IHSA’s malaria-related activities on the ground. In this issue of Leading Voices, she presents the challenges that the country faces in its fight against malaria and the actions being taken to combat it.

Malaria is the leading cause of mortality among children under five and morbidity among adults in Benin. How has the landscape changed since you first began working at the MOH in 1997?

There have been many changes between the 1990s and today. The Ministry of Health has implemented the newest technological innovations: for example, it has gone from providing untreated mosquito nets to providing long-lasting, insecticide-treated nets. Changes were also made to increase access to these products. Nets were first provided only to the most vulnerable groups, such as children under five; nowadays, there is broader coverage that includes all members of the population.

{Health Surveillance Assistant (Community Health Worker) recording data in health card at outreach clinic, Mulanje, Malawi, ONSE Health Activity} Health Surveillance Assistant (Community Health Worker) recording data in health card at outreach clinic, Mulanje, Malawi, ONSE Health Activity

This article was originally published by Global Health Now.

Paid or volunteer?

Community health workers are on the frontlines in many countries—and vital to achieving universal health coverage. Yet the public health community has not reached a consensus on which model is the best.

Consensus is urgently needed, both at the global and country levels, to inform future policies and strategies for strengthening health systems and delivering on UHC.

Based on our experiences in rural Peru and Ethiopia, it’s not either-or. It’s both.

Full-time, paid CHWs form the backbone of family- and community-based services, but there aren’t enough to reach all families. We envision teams of government-paid, full-time CHWs providing comprehensive services to a given population, with a primary health center hub as the base of operations. Each CHW, in turn, would lead a team of part-time community health volunteers providing limited health education and referral services—such as maternal and newborn health, nutrition, hygiene, tuberculosis, malaria, and HIV/AIDS—to a small number of neighboring families.

The chart above shows the good-news-bad-news scenario that is the decades-long fight against TB in Afghanistan. TB is still a crushing problem there; the country has among the world’s highest rates of the disease, which killed some 10,000 people in 2017. But if you glance at this chart and think that we haven’t made much progress, look again. We’re finding and treating more people with TB in Afghanistan than ever before. In 2001, we were missing three quarters of presumptive TB patients — that is a whopping 75% gap in case detection.

Pages

Subscribe to Management Sciences for Health RSS