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{Photo Credit: Warren Zelman}Photo Credit: Warren Zelman

On the fifth anniversary of the UHC movement, we reflect on a few key steps to reach UHC.

In the five years since the United Nations adopted the momentous resolution that established the Universal Health Coverage (UHC) movement—achieving equitable, affordable access to high-quality health services for all who need them—countries have made significant progress toward providing basic health services to large segments of the population. This year marks an important moment for advancing UHC, as the new Director General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, has made it abundantly clear that UHC is a priority for his administration.

That is great news. We have seen more countries and institutions working toward practical interventions that will make UHC a reality. We have seen them make financial and managerial commitments that will be critical for the global health community to achieve this noble, oft-lifesaving goal. But more work remains.

 

Achieving UHC through governance and financing

 

{Photo Credit: Mark Tuschman}Photo Credit: Mark Tuschman

There was an awkward silence and then soft giggling as the girls looked at each other. I had just finished talking about strategies for persuading sexual partners to use a condom. Laughter during these skills-building and girls empowerment sessions with 30+ secondary school students in Morogoro, Tanzania was not uncommon, particularly given the sometimes sensitive topics of discussion, but this time, the joke was lost on me.

I asked the student nearest to me, a confident teenager that I knew wouldn’t be too shy to respond, why everyone was laughing. She told me, “You speak about this as if we have a choice.” She wasn’t being sarcastic or combative, nor was she complaining - she was simply matter-of-fact about it, stating her truth.

 {Photo: Adama Sanogo/ Management Sciences for Health}An SGBV survivor arriving for medical and psychosocial care.Photo: Adama Sanogo/ Management Sciences for Health

(Crossposted from the FCI Program of MSH "Rights and Realities" blog).

Communities in the Mopti region of central Mali—which is home to several ethnic groups and to many people displaced by 2012 violence in the country’s northern region—continue to grapple with widespread sexual and gender-based violence (SGBV), including forced and early marriage and other harmful practices. A majority of Malian girls are married by the time they reach 18, and 15% before the age of 15.  About 91% of women between 15 and 49 years old, as well as 69% of girls under 15, have undergone female genital mutilation (FGM). And, as is true in so many conflict-affected areas, widespread sexual violence has been a tragic and infuriating effect of war, dislocation, and migration.

The Ebola epidemic was raging in West Africa. Management Sciences for Health’s staff in Liberia relayed that “treatment facilities are overrun with cases” and “whole parts of the health system are at a standstill.” Things got much worse before the epidemic was finally defeated. Over 11,000 people died horribly from the disease, leaving more than 16,000 children orphaned.

Once the world woke up to the crisis, there was a generous outpouring of assistance. As the response peaked, I was consumed by nagging questions: Where will we be four or five years from now? Will the world have gone back to sleep? What’s needed to protect the world from future outbreaks? To find the answers, I explored the lessons from epidemics over the last century – smallpox, AIDS, SARS, avian flu, swine flu, Ebola, Zika – and I drew on some of the best minds, experienced professionals and committed citizen activists in global health, infectious disease, and pandemic preparedness.

{Photo credit: Ben Greenberg/MSH}Peter SandsPhoto credit: Ben Greenberg/MSH

On November 13, approximately 100 global health security and development experts, public health practitioners, private sector representatives, academics, researchers, NGO staff members, scientists and students gathered at Harvard Medical School for the Ready Together Conference on Epidemic Preparedness. The day-long event was co-hosted by No More Epidemics, Management Sciences for Health (MSH), Harvard Global Health Institute, and Georgetown University Center for Global Health Science and Security with support from the James M. and Cathleen D. Stone Foundation. We attempted to find answers to the following questions: 1. What are the financial, economic and other risks to the private sector associated with major disease outbreaks and what is being done to minimize risk and ensure resilience?; 2. What innovations have been developed for pandemic preparedness?; 3. How can a whole of society collaboration be enhanced to ensure global health security?; and 4. How can we overcome barriers, ensure country engagement and public private partnerships?

Here are 5 key takeaways from the discussion:

1. “We must stop ignoring the economic risks. We need Finance Ministers to recognize health threats.”- Peter Sands 

Watch Peter's keynote

{Photo Credit: Warren Zelman}Photo Credit: Warren Zelman

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.

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