Fragile States

Fragile States (including Afghanistan, Democratic Republic of Congo, Haiti, Liberia and South Sudan)
{Photo credit: LMS Haiti/MSH}Photo credit: LMS Haiti/MSH

Today, as we celebrate International Youth Day and the theme of “Youth Migration: Moving Development Forward,” we are reminded of difficult situations millions of young people experience every day—and of the power young people have to create change in their lives when they connect with their peers.

Adolescents and young men and women need access to quality, affordable reproductive health services. In the developing world, 52 million never-married women, aged 15-24, are sexually active and in need of reproductive health and HIV prevention services and information. Yet, adolescent girls often face greater barriers than adult women in accessing them. In the sub-Saharan Africa region, only 21 percent of married adolescents are using a modern contraceptive method; and the adolescent birth rate in the region is four times the rate in Europe and Central Asia. In the Latin America region, teenagers have doubled their proportion of the fertility rate from 8.5 percent in 1955 to 14.3 percent in 2005, despite a steady decline in overall fertility numbers.

 {Photo credit: MSH/Filmona Hailemichael}Dr. Florence Guillaume, Minister of Health of Haiti.Photo credit: MSH/Filmona Hailemichael

On June 7, Management Sciences for Health (MSH) and partners hosted Dr. Florence Guillaume, the Minister of Health of Haiti, and panelists for a Capitol Hill luncheon on community health workers in fragile states. The day before, MSH hosted Guillaume in Cambridge, MA, for a town-hall style event on improving maternal and child health. Revisit the two events through a "Storify" story of photos, text, and tweets.

Did you notice that our website looks and feels really different?

We've redesigned and rebuilt our site from the ground up: showcasing our unique technical expertise and staff, values, global footprint, and mission to save lives and improve health among the poorest and most vulnerable around the world. 

We also have integrated our Global Health Impact blog into the website to continue cutting-edge discussions on global health.  

And we've made the new MSH.org easier to use.     

Learn more about the new MSH.org

Watch the short video -- and see some of the new features firsthand:

In a couple of days, thousands of decision-makers, leaders, advocates, health professionals, media, and more will gather to focus on our most valuable investment: women and girls.

We are honored to be a Gold Sponsor and Advisory Group member of Women Deliver 2013. Over 30 staff members representing 10 countries will participate in the conference by speaking, moderating, leading, and learning together with the 5,000 attendees in Kuala Lumpur.

For over 40 years, MSH has worked shoulder-to-shoulder in partnership with over 150 countries---currently in over 65---saving lives and improving the health of women, girls, men, and boys. Our programs empower women; sensitize men; and integrate maternal, newborn, and child health, family planning and reproductive health, and HIV & AIDS services to improve access to quality care and, ultimately, save lives.

Makasi after two months of tuberculosis treatment. {Photo credit: A. Massimba/MSH.}Photo credit: A. Massimba/MSH.

With less than 1000 days until the Millennium Development Goals expire, the process for setting post-2015 goals continues to ramp up.  We take this opportunity to reflect on the current state of community health systems in low- and middle-income countries and consider how the post-2015 agenda could reshape them—perhaps dramatically.

Community health systems today

Integration moves ahead

Poor and rural communities in low- and middle-income countries are leaving behind the “one clinic, one service” approach. So-called vertical programs, which organized resources according to single health conditions, created a patchwork of health services at the community level. You could get HIV care from one provider, but would have to go down the hall, down the street, or often much farther to get maternal health care or malaria care.

Voice of America Interviews Dr. Stephen Macharia: On Tuberculosis in South Sudan (Audio).Voice of America Interviews Dr. Stephen Macharia: On Tuberculosis in South Sudan (Audio).

On the eve of World Tuberculosis Day, Voice of America interviewed Dr. Stephen Macharia, the TB CARE I country director for South Sudan.

During the interview (transcript, PDF), Dr. Macharia discussed the TB epidemic in South Sudan, TB CARE I project achievements, and the way forward for improving funding for TB services and multi-drug resistant TB (MDR-TB) control in fragile states, like South Sudan.

TB CARE I is a USAID-funded project, led by KNCV TB Foundation with partners, including Management Sciences for Health.

Voice of America, the official external broadcast institution of the United States federal government, produces nearly 1,500 hours of news and programs each week for an estimated global audience of 123 million people.

World Malaria Day 2013 {Photo credit: UNHCR/S. Hoibak.}Photo credit: UNHCR/S. Hoibak.

To me, malaria is a very personal disease.

I first came face to face with malaria during the war of my time: Vietnam. I was plucked out of residency after my first year, with only an internship under my belt, and sent as a Navy Medical Officer to war. Medical school and residency prepared me well for much of the trauma I encountered medically, but I was totally unprepared for the large-scale emotional trauma, and for the tropical diseases I had encountered only in books.

I was overwhelmed by the young children with malaria, some of whom literally died in my arms while treating them.  Yet, I also witnessed bona fide miracles: children at death’s door, comatose and unresponsive, who responded dramatically to treatments, and ultimately went home to their families.

To address malaria, I focused on promoting prevention (long-lasting insecticidal nets [LLINS] for families and intermittent preventive treatment [IPT] for pregnant women), early detection, and early treatment in the community—what is now called community case management.

That was 40 years ago.

Overcoming Barriers to Health Care for Women in Afghanistan.Overcoming Barriers to Health Care for Women in Afghanistan.

World Health Worker Week (" href="https://twitter.com/search?q=%23WHWW&src=hash" target="_blank">) is April 8-12, 2013. Let's show the world just how much . Watch and share the video, thank a health worker, and donate $10 in honor of a health worker. 

"We realized that educating the community was something we had to focus on," says Madina, a trained Afghan midwife, as she describes involving elders and religious leaders in helping to improve access to family planning and perinatal care for women in Khost province, including one woman who came to the health facility suffering complications from a home birth.

Health workers save lives. What will you do to thank a health worker?

 {Photo credit: Stephen Macharia/MSH.}Santo (right) and his father (left) share how Santo was finally diagnosed and treated for TB after being incorrectly treated for malaria for over two months.Photo credit: Stephen Macharia/MSH.

After South Sudan gained independence from Sudan in 2011, disagreements over oil-sharing between the two nations caused fighting and high economic inflation in certain regions. Desperate for security, over 110,000 Sudanese refugees escaped to South Sudan and now reside in camps in Maban County.

Bounj Hospital: Diagnosing and treating residents and refugees

These refugees, and the county’s 40,000 residents, are served by Bounj Hospital, the only TB diagnostic and treatment center in the district. This hospital is currently treating 75 patients for TB, 56 of whom are refugees.

The USAID-funded TB CARE I South Sudan project is helping to build the hospital staff’s capacity in TB treatment and infection control, despite the challenges the health workers face. Led by Management Sciences of Health in partnership with the National TB Program (NTP), the TB CARE I project team has trained over 200 health workers in TB diagnosis and treatment.

TB CARE I also teaches the health workers how to educate their patients about TB infection control and provides the trainees with regular supportive supervision and mentorship.

Mukabaha Ntakwigere (at right) at the General Reference Hospital in Nyangezi, DRC. {Photo credit: MSH staff.}Photo credit: MSH staff.

Tuberculosis (TB) is a leading cause of death in Democratic Republic of the Congo (DRC), partly due to a low case detection rate within the health system, compounded by little knowledge or awareness among patients of the disease’s symptoms. In the province of Sud Kivu, where people have relied on traditional healers for generations, those who were suffering from the persistent, painful coughing that is one symptom of TB were advised by traditional healers that they had been poisoned, and they were not referred to health centers.

In Sud Kivu province, in the health zone of Nyangezi, with a population of roughly 129,000 people, case detection was below 12%, which is the minimum "acceptable" threshold for TB detection.

Medical professionals in Nyangezi realized that they were never going to identify and treat those suffering from TB until they could educate the community about the symptoms and the treatment methods.

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