Health Systems Strengthening

Health Systems Strengthening (HSS)

 {Photo credit: Jones Dizon/SIAPS.}Training participants try out the Pharmacovigilance Monitoring System (PViMS), a web-based application to help clinicians, regulatory bodies, and implementing partners monitor medicine safety specifically in resource-limited countries.Photo credit: Jones Dizon/SIAPS.

The Philippines has one of the highest TB burdens in the world—and 2.6% of its more than 286,000 new cases in 2015 were of multi-drug-resistant TB (MDR-TB). This threatens the progress the country has made in addressing the deadly disease over the past few decades and its goal to make the country TB-free by 2030. Further, MDR-TB cases will likely rise steadily in the Philippines and the world over the next two decades.

There’s a new medicine that can help. Through a partnership with Janssen Therapeutics of Johnson & Johnson that began in 2015, USAID introduced a program to distribute a new medicine called bedaquiline that helps patients with MDR-TB in low-income countries including the Philippines. The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, which Management Sciences for Health (MSH) leads, has been helping to roll out bedaquiline in low- and middle-income countries.

But with any new treatment, active pharmacovigilance (PV) is needed to help ensure both patient safety and drug effectiveness. This means being able to monitor patients to identify and evaluate adverse events, such as unexpected or serious side effects, to better understand possible risks and improve treatment protocols.

 {Photo credit: Alison Corbacio/MSH}From left: Ugochi Daniels, UNFPA; Chunmei Li, Johnson & Johnson; Antoine Ndiaye, MSH; Lara Zakaria, Syrian American Medical Society; Irene Koek, USAID; Loyce Pace, Global Health Council.Photo credit: Alison Corbacio/MSH

Health systems strengthening was front and center in discussions held in New York on the sidelines of the 72nd United Nations General Assembly. MSH hosted three events spotlighting how strong health systems are critical to resiliency and stability in fragile environments, at the core for global health security and essential for achieving universal health coverage. Here are some highlights from the week. See more on Twitter , and .

 {Photo Credit: Denise Museminali}A doctor at Bushenge Hospital attends to a mother and her newborn in the maternity ward.Photo Credit: Denise Museminali

The National Accreditation Program at Bushenge Provincial Hospital

Tucked in the outermost region of the Western Province of Rwanda, Bushenge Provincial Hospital serves a population of over 171,000 people, including expectant mothers referred by neighboring health centers for pregnancy complications that require Cesarean section. Cesarean section (C-section) delivery is one of the most frequent surgeries performed at health facilities worldwide. At Bushenge Provincial Hospital, it accounts for approximately 48% of annual births. As with any surgical procedure, there are a number of complications that could occur during or post-operation. Surgical site infections (SSI) are a common complication following Cesarean section procedures that do not adhere to infection prevention and control principles. Such infections place a great deal of physical and emotional burden on the mother and family and present substantial costs for health facilities.

Because of the Accreditation Program, I work with an objective and not just out of routine as I did before. I always ask myself what can I do to contribute to the quality of care at Bushenge? If there is an infection risk, I ask myself, what can I do to help?

—Noëlla Benemariya, Environmental Health Officer at Bushenge Hospital

 {Photo Credit: Rui Pires}A pregnant woman is given an ultrasound.Photo Credit: Rui Pires

(This post originally appeared on the Next Billion website.)

Why Greater Ultrasound Availability Doesn’t Always Benefit Patients

Advances in health technologies have reshaped the lives of communities, families and individuals, undoubtedly contributing to better health outcomes around the world. For the most vulnerable populations, technology may significantly improve access to preventive, diagnostic, and treatment services and help increase demand for greater quality care. Yet, despite their potential, new technologies can also add new challenges, risking potential gains in quality, safety or cost. Particularly in settings where health systems are weak, the introduction of technological interventions requires thoughtful execution.

 {Photo credit: Gladys Lavien}Amelia G. Mulbah, a newly trained midwife, works in a remote area of Liberia’s Lofa County.Photo credit: Gladys Lavien

Amelia G. Mulbah, 33, is a newly trained midwife working in a remote region of Liberia. She received a scholarship through the USAID Collaborative Support for Health (CSH) Program and graduated from nursing school in December 2016. After passing the state board test, she became a registered midwife and was deployed for two years to work at the Lutheran Referral Hospital in northwestern Lofa County.

 {Photo credit: MSH-Perú staff}Women leaders at a fair in Bolivia share healthy eating tips to pregnant and breastfeeding women.Photo credit: MSH-Perú staff

A partnership with MSH-Perú and White Ribbon Alliance is promoting self-care in Bolivia

On a bright July day in San Ignacio de Moxos, Bolivia, 13 indigenous women leaders gathered in the central plaza around a long table decorated with bowls of beans, rice, plantains, corn, tomatoes, greens, and other foods. As part of an all-day fair to promote the health and nutrition of pregnant women and breastfeeding mothers, these indigenous women leaders presented their dishes to over 150 community members and local officials, gathered in the plaza to celebrate the town’s anniversary, and offered ideas on how to cook with locally- grown ingredients provided by the national government’s food subsidy program.

Through the White Ribbon Alliance’s Self-Care Initiative, MSH-Perú is organizing workshops and other outreach activities, to motivate women in 11 indigenous Bolivian communities to actively care for themselves, especially during pregnancy and while breastfeeding, by practicing healthy behaviors, and preparing nutritious meals.

 {Photo credit: Kate Ramsey/MSH}Women learn about their pregnancies during a pregnancy club session in eastern Uganda.Photo credit: Kate Ramsey/MSH

Earlier this year we wrote about our ongoing experience reaching pregnant women in Uganda with a model that we called “pregnancy clubs” – an effort to improve the quality of health services women receive during pregnancy and after delivery by organizing them into groups to discuss their personal experiences and learn important self-care skills, guided by a healthcare provider. The region where we are working is particularly vulnerable because there are very high rates of adolescent pregnancy (30.6%), and younger women often find that services are unable to meet their specific needs – especially for the first pregnancy. It can be a lonely time for younger women, especially if they are in a new household and a new marriage, or if experiencing stigma from pregnancy outside of marriage.

 {Photo credit: Samy Rakotoniaina, MSH}Community health volunteers use a mobile phone app to guide their patient interaction in rural Madagascar.Photo credit: Samy Rakotoniaina, MSH

How community health volunteers are using mobile technology to provide better care in remote areas of Madagascar

In remote villages of Madagascar, people who live miles away from a health center largely depend on community health volunteers for basic health care, such as family planning services, or the diagnosis and treatment of simple childhood infections. These volunteers are identified and elected by the community, and are then trained and supervised by the head of the nearest health center. The country's national Community Health Policy places them at the foundation of the health pyramid, as they are serving the most isolated communities. However, ensuring the quality care provided by these volunteers can be challenging: one study reported that only 49% of health volunteers offer family planning in accordance with national standards, and only 53% of children under the age of five are correctly treated for diarrhea, malaria, and pneumonia by health volunteers.

Being a community health volunteer is a tricky job. Among the many difficulties they already face, they are expected to report their activities by completing paper registers on a daily basis. But these paper tools, which are long and time-consuming, often result in delays and errors in the reporting process.

We’re excited to launch MSH Leading Voices, a monthly profile that features the incredible talent that makes up MSH.

We’re chatting with Seneca, our technical advisor for quality of care. Seneca is a Utah native with a passion for improving the health services that every person receives, no matter who they are or where they live. She’s responsible for integrating quality of care initiatives into all MSH health programs. 

What do you think makes MSH different?

Our legacy of working in health systems strengthening and capacity building. Excellence in quality can't be achieved by only one intervention; it's a multi-dimensional mosaic resulting from holistic thinking about an entire system that is enveloped in compassion, equity, and leadership. To that end, I am so excited about the work MSH has done around local leadership development.This is a powerful asset for cultivating a local culture of excellence toward quality of care across the healthcare spectrum. 

What are you most proud of in your work?

{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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