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Low- and middle-income countries (LMICs) struggle to reach and sustain universal health coverage (UHC) due to limited and inefficient allocation of resources. Their health systems are strained by a dual burden—continuing to manage infectious diseases, such as HIV, TB, and malaria, while responding to the prevalence growth of noncommunicable diseases, such as diabetes and cardiovascular conditions. COVID-19 is placing even more demands on already stretched resources. Systematic priority setting through the use of health technology assessment (HTA) is part of the policy ammunition at the disposal of those making such difficult distributional calls in these settings. 

A health worker administers a COVID-19 test in Antananarivo, Madagascar. Photo credit: Misa Rahantason/MSH

Originally published in Think Global Health

As COVID-19 spreads across the world, falsified medicines for the novel coronavirus are leaking into Africa, where almost 19 percent of medicines are already substandard and where a number of countries are promoting untested treatments for the virus. The global health community is funneling tens of billions of dollars of aid into procuring medical products for countries without full evidence of their safety, efficacy, or quality—let alone their cost effectiveness.

VillageReach van delivers PPE to hard-to-reach areas in Malawi.

Until recently, “PPE” was an obscure acronym for many people, but now it has become a vital global commodity. Today, with the realities of COVID-19, health workers around the world are experiencing a troubling shortage of Personal Protective Equipment (PPE)—a mix of items including gloves, mask, aprons, and goggles that can help prevent disease transmission in health care settings. This shortage puts health workers in harm's way while trying to respond to the unrelenting COVID-19 pandemic.

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

Swift and effective action to address the COVID-19 pandemic has required countries to engage in an all hands on deck approach. We recently asked our colleagues on the frontlines in Malawi and Kenya, Dr. Ann Phoya and Dr. Ndinda Kusu, to share how their teams are working with all sectors of society to scale up preparedness and response measures, strengthen capacities and systems to meet the challenge of COVID-19, and help maintain uninterrupted essential health services.

{A medicines management supervisor visits pharmacy staff in Uganda. Photo credit: MSH staff}A medicines management supervisor visits pharmacy staff in Uganda. Photo credit: MSH staff

Pandemics challenge the efficacy and resiliency of many systems, including the pharmaceutical system—how medicines and other medical products are managed in health systems. That’s particularly true in low- and middle-income countries, which already face significant challenges in securing sustainable access to and appropriate use of quality-assured affordable medical products.

As governments, researchers, and health care workers work to develop and deliver medical products to adequately prevent, test for, and treat COVID-19, countries will benefit from a response that strengthens the pharmaceutical system to ensure that any medical product deployed in the pandemic protects and promotes public health as opposed to causing harm. 

Key areas country governments and development partners should focus on include:

{A lab scientist at a general hospital in northern Nigeria. Photo Credit: MSH Staff}A lab scientist at a general hospital in northern Nigeria. Photo Credit: MSH Staff

Nwando Mba is the Director of Public Health Laboratory Services at the Nigeria Centre for Disease Control (NCDC), a sub-recipient to the Resilient and Sustainable Systems for Health (RSSH) project, funded by the Global Fund and managed by MSH. A medical laboratory scientist by profession, Mba started her career over 30 years ago in Nigeria’s Vaccine Production Laboratory at Yaba, Lagos. Mba discusses Nigeria’s efforts to increase the country’s testing capacity for coronavirus.

{Asther Zabibu, an MDR-TB survivor sits outside the TB treatment centre at Mulago National Referral Hospital in Uganda. where she now provides psycho-social support to other patients and counsels them on adherence. Photo Credit: Sarah Lagot}Asther Zabibu, an MDR-TB survivor sits outside the TB treatment centre at Mulago National Referral Hospital in Uganda. where she now provides psycho-social support to other patients and counsels them on adherence. Photo Credit: Sarah Lagot

For some groups of particularly vulnerable people - the elderly, disabled, those suffering from physical and mental ill-health or those at risk of violence and abuse - the restrictive measures have a significant and negative effect. These people’s health and wellbeing, in all senses, are being corroded. In some cases, people are in extremely threatening and deadly situations.

So who is making these decisions on isolation and lockdowns? How do their judgments take into consideration the wider impact on the population and the secondary effects of these restrictions, especially on vulnerable people? We, a group of colleagues working on universal health coverage, decided to do a rapid analysis of 24 national COVID-19 Taskforces to identify their composition and investigate their decision-making processes. What we found out was shocking.

{The USAID MTaPS Program is supporting the Philippines in responding to the COVID-19 pandemic and ensuring the availability of quality health commodities in communities. Photo credit: MTaPS staff}The USAID MTaPS Program is supporting the Philippines in responding to the COVID-19 pandemic and ensuring the availability of quality health commodities in communities. Photo credit: MTaPS staff

Andre Zagorski of the MSH-led, USAID-funded MTaPS Program talks about the program's urgent work to help contain the virus in more than a dozen countries.

{Andre Zagorski} Andre ZagorskiHow did you and MTaPS rally to support USAID’s call for a rapid response to COVID-19 in a dozen countries? What were the challenges? 

MTaPS is the USAID Global Health Security Agenda (GHSA) go-to program for infection prevention and control (IPC), and we have been implementing activities to strengthen health systems for stronger IPC programs in 10 countries since the MTaPS award in 2018. We have offices and small but strong professional teams in these countries and have established productive working relations with national stakeholders and partners.

Story by Samy Rakotoniaina and Misa Rahantason

Malaria is one of the leading causes of mortality among children under five in Madagascar. Atsimo Andrefana is one of Madagascar’s regions most severely impacted by endemic malaria. More than half of the population in this region lives more than five kilometers from the nearest health facility, putting Community Health Volunteers (CHVs) on the front lines in the fight against malaria.

Retsilake is one of the 6,000 high-performing CHVs supported by the USAID-funded Accessible Continuum of Care and Essential Services Sustained (ACCESS) project. ACCESS is implemented by Management Sciences for Health (MSH), in partnership with a consortium of international and local organizations, and alongside Madagascar’s Ministry of Public Health. The project is partly funded by the U.S. President’s Malaria Initiative (PMI).

Retsilake diagnosed and treated nearly 2,000 children from his village and the surrounding area during a particularly severe malaria outbreak in 2015. He understands the impacts of malaria on children's health and this keeps him motivated to serve his community.

{Retsilake, a community health volunteer in Madagascar, uses a mobile app to carry out epidemiological surveillance of malaria and other diseases at the community level. Photo Credit: Samy Rakotoniaina/MSH}Retsilake, a community health volunteer in Madagascar, uses a mobile app to carry out epidemiological surveillance of malaria and other diseases at the community level. Photo Credit: Samy Rakotoniaina/MSH

A conversation with Dr. Bernard Nahlen, Director of the Eck Institute for Global Health at the University of Notre Dame and member of the MSH Board of Directors  

{Dr. Bernard Nahlen}Dr. Bernard NahlenSome countries are entering peak malaria transmission season over the next few months, overlapping with the COVID-19 pandemic. How might the crisis affect ongoing malaria eradication efforts? 

One issue is case management. As a reminder, there were more deaths due to malaria than to Ebola in West Africa in 2014, because people were reluctant to go to clinics for treatment for fevers and aches. And in many areas communities began to protest that, while their children continued to become ill and die of malaria, suddenly there was a single focus on Ebola. We may see something similar with COVID-19. 

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