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{Photo credit: Emily Phillips/MSH Afghanistan}Photo credit: Emily Phillips/MSH Afghanistan

Last month I represented Management Sciences for Health (MSH) at Oxfam India’s South Asia Consultation on Maternal Health in Kathmandu, Nepal. The purpose of the meeting was to discuss significant maternal health programming experiences in Afghanistan, Bangladesh, India, Nepal, Pakistan, and Sri Lanka, and to suggest strategic directions for Oxfam India’s future maternal health programming. More than 30 representatives from governments, national and international universities, and nongovernmental organizations attended.

Three elements of improving maternal health outcomes stood out in my mind from discussions at the meeting:

{Photo credit: MSH staff/Afghanistan}Photo credit: MSH staff/Afghanistan

“I started feeling this coughing… so I went to the health center and got tested. It was positive for TB,” says Grace*, a young Ugandan woman. She started on medicines, but after two months, she stopped adhering to treatment.

They told me to continue with the drugs for five more months, but I stopped.

I thought I was ok.

She started coughing again, went to the hospital, and was diagnosed with multidrug-resistant TB (MDR-TB). MDR-TB cannot be treated with two of the most powerful first-line treatment anti-TB drugs. Her treatment regimen? Six months of injections and two years of drugs.

{Photo credit: Katy Doyle}Photo credit: Katy Doyle

Members of the global health community commemorated International Women’s Day (IWD) on March 8 by celebrating recent advances in women and girls’ health and indeed there was much to celebrate: maternal deaths have declined 45% worldwide, The Global Fund to Fight AIDS, Tuberculosis and Malaria has distributed over 450 million bed nets, and over 1 million babies have been born HIV-free thanks to the President’s Emergency Plan for AIDS Relief (PEPFAR); but there is still work to do.  What happens once the day is over? How do we turn that attention into action? How are these issues going to be addressed? After awareness is raised, we still need concerted global action every day of the year if we are to make truly sustainable, impactful improvements in the lives of women and girls’ around the world. Here are a few things I think we can do at the global, US and local level to keep the spirit of IWD alive:

Globally: Elevate women and girls in the Post-2015 Development Agenda

{Photo credit: Rui Pires}Photo credit: Rui Pires

{Photo credit: Mark Tuschman.}Photo credit: Mark Tuschman.

Good governance of a health system enables sound management of medicines, health information, human resources, and finances. Good governance enables health providers to deliver better health service performance which leads to better health outcomes. 

In this series, hosted by The Leadership, Management and Governance (LMG) Project, our speakers will: 

  • Discuss the factors that constrain governance effectiveness in service delivery organizations 
  • Explore solutions to the governance challenges using real life examples
  • Review tools, techniques, and approaches that will help you overcome your own governance challenges

Register now

{Photo credit: Rui Pires.}Photo credit: Rui Pires.

Each year International Women’s Day energizes women and girls all over the world to celebrate and acknowledge the contributions of women globally. Together, we celebrate both the spirit and the essence of women wherever they may be, in whatever role they have taken. Based on our own experiences as women, each of us must align ourselves in solidarity with movements that signify a moment in our lives where we have overcome challenges despite the obstacles faced. 

For me, International Women’s Day represents the everyday successes that occur: when a mother delivers her baby safely in a health facility, the first day that little girl goes to school, and when she graduates from university. These moments of triumph are the result of the struggles of men and women who fought against the injustice of discrimination based on gender.

I want to acknowledge these great achievements of women and girls not only on March 8, but each and every day. 

{Photo credit: Andrew Esiebo/MSH Nigeria}Photo credit: Andrew Esiebo/MSH Nigeria

I am a woman. I am a Nigerian. I am a mother. I am a leader. And, I am a daughter. As the Nigerian country representative, I guide Management Sciences for Health (MSH)’s efforts to ensure the people of my country have access to quality health services. Indeed, I am many things. Before all else:

I am a woman of Nigeria.

The Girl Child in Nigeria

From the beginning, our girl children are at a disadvantage.

Our culture (like many are) is strongly patriarchal. The boy child is given higher status than the girl child. If a family has to choose, the boy child is the first to go to school. The girl child is the first to be dropped from school.

No matter how young she is, the girl child feels that it is her responsibility to care for her siblings. She is expected to take on added responsibilities and earn money to keep the other children. This pressure frequently leads to early sexual activity, transactional sex, and sex with older men-- increasing her risk of getting HIV and other sexually-transmitted infections.

Then Boko Haram came to the North East Zone of Nigeria. They take our girls away. They abuse them. They rape them. They marry them off to older men.

The strengthening of health systems in low and middle income countries is central to the global effort to promote economic and social development through universal health coverage, reduce mortality, and improve health and sustainability of health care over the next 15 to 25 years. ("Health Systems Strengthening: 2015 and Beyond")

MSH has released a new information brief, "Health Systems Strengthening: 2015 and Beyond." The brief looks at lessons learned from working at all levels of the health system for over 40 years, outlines problems that must still be addressed and identifies specific ways to address them.

{Photo: Dominic Chavez}Photo: Dominic Chavez

The key element of any health system is the people who run it. Nowhere is this more true than in countries in the midst of, or recovering from, conflict. Indirect or direct threats faced by health workers exacerbate a population’s challenges in seeking and receiving health care.

In conflict settings, health workers may be forced to flee to safe havens as refugees, internally displaced people, or leave the country as migrants—if they have the means to do so. Some of the most capable are absorbed into international agencies. Those who remain frequently have insufficient resources to perform their jobs and must carry on as best as they can under daunting circumstances.

This situation has worsened in recent years with a growing number of direct attacks on health workers in fragile states, such as those against polio vaccinators in Pakistan and Nigeria. These blatant violations of the Geneva Conventions inhibit an already difficult environment for the delivery of health services and the recovery or development of the health system.

 {Photo credit: Dominic Chavez}South Sudan.Photo credit: Dominic Chavez

In December 2013, Africa’s newest country, South Sudan, imploded with violence between government forces and a rebel opposition led by a former vice president. The violence continues today despite regional efforts at reconciliation by the Intergovernmental Authority on Development (IGAD) and other state actors. The war, however, has not stopped South Sudan’s frontline health workers in their efforts to build a public health system, including access to medicines, from the ground up.

The US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program is working with our South Sudanese partners to build the institutional, technical, and organizational capacity of the country’s health system—despite the ongoing conflict.

Our approach to strengthening the health system is based around the concept of embedment—where full-time technical advisors work with their South Sudanese counterparts on a day-to-day basis. This approach strengthens the technical and managerial capacity of local leaders, ensuring sustainability, while, at the same time, getting the job done: building a strong health system.

When Mearege gets really sick, her husband leaves town. Bedridden and in the care of her parents, Mearege gets tested and learns she--and her daugther--are HIV-positive. Through the support of mother mentors, trained by the Ethiopia Network for HIV/AIDS Treatment, Care and Support Program (ENHAT-CS), Mearege finds solace, guidance, and healing -- and decides to have another child.

Mearege is one of many HIV-positive women in Ethiopia whose lives have been transformed, with the support of ENHAT-CS. Says Mearege:

I was able to have a healthy child because I followed up with the mentor mothers and applied their teaching...

Presented by ENHAT-CS in partnership with the National Network of Positive Women Ethiopians, this video is made possible by the generous support of the US President's Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development (USAID).

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