Health Systems Strengthening

Health Systems Strengthening (HSS)
{Photo credit: Samy Rakotoniaina/MSH}Photo credit: Samy Rakotoniaina/MSH

Originally published in The Hill 

By Marian W. Wentworth and Wade Warren 

On Dec. 14, the United States crossed a grisly milestone of 300,000 lives lost to the coronavirus pandemic. That same week, we saw the first glimmer of light in this long, dark tunnel of a year as frontline health care workers began to receive an effective vaccine. 

Mothers pick up medicines from a hospital pharmacy in Kenya. Photo Credit: Mark Tuschman

Read the blog on the MTaPS website

As we mark Universal Health Coverage (UHC) Day this month, countries continue to battle the spread of COVID-19. The lack of effective treatments and testing capabilities at the onset of the pandemic was a stark reminder that access to safe and affordable medical products is key to achieving healthy outcomes. With more therapeutics and diagnostics becoming available, the preparedness of pharmaceutical systems to get medical products and services to people is particularly worrisome in low- and middle-income countries (LMICs). Chronic shortages of medicines, low quality, and high cost add to the burden of patients and health systems in LMICs, where up to 60% of health spending is on medicines, mostly from out-of-pocket payments. Poorer households spend up to 9.5% of their income on medicines at the point of care, making them vulnerable to poverty.

Unpublished
A health worker takes a blood sample from an XDR-TB patient at Kitgum Hospital in northern Uganda. Photo credit: Diana Tumuhairwe/MSH

Originally published by Global Health NOW

As the COVID-19 scourge intensifies, it may be weakening our battle against tuberculosis—but pooling resources could boost the fight against both diseases.

While human and financial TB resources have been diverted to fight the pandemic, new TB case notifications have dropped by up to 75% in some countries, according to a Global Fund report published in September. In addition, TB service disruptions could lead to an additional 1.4 million deaths through 2025.

MSH, as a partner to the government of Nigeria and sub-recipient to Catholic Relief Services, supports the Global Fund Malaria grant in building Nigeria’s capacity to implement malaria control activities, strengthen the quality of care for malaria, and improve the use of health data across 13 states.

{Pharmacist Mary Yeesuf dispenses medicine to a patient in Minna, Nigeria. Photo Credit: Gwenn Dubourthournieu}Pharmacist Mary Yeesuf dispenses medicine to a patient in Minna, Nigeria. Photo Credit: Gwenn Dubourthournieu

COVID-19 has highlighted the need for long-term investments in regulatory systems to secure faster access to medical products. During a recent Livestream hosted by MSH and Deloitte, Professor Mojisola Christianah Adeyeye, Director General of Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC), emphasized the role regulatory agencies play in ensuring pharmaceutical system impact now and beyond the pandemic. One such breakthrough─local manufacturing─requires agencies shore up regulatory capacities and address challenges now. Prof. Adeyeye discusses how her agency supports the local manufacturing of medicines and prepares for the roll-out of vaccines against COVID-19.

{Doctors visit patients in Rabia Balkhi hospital, Kabul Afghanistan. Photo Credit: Afghan Eyes/Jawad Jalali}Doctors visit patients in Rabia Balkhi hospital, Kabul Afghanistan. Photo Credit: Afghan Eyes/Jawad Jalali

COVID-19 will impact the prevention and treatment of many diseases, and there are particularly grim possibilities for tuberculosis (TB), which could set back our progress toward its elimination. Fortunately, our emphasis on strengthening local health systems is helping to build resilience against this kind of shock. We reached out to MSH technical experts leading three new global and national TB programs to learn what’s on their minds as their teams begin implementation under a COVID-19 reality. They all agree: COVID-19 reminds us why we cannot become complacent, and when it comes to the global fight to eliminate TB, it is no longer business as usual. Read what Ersin TopcuogluDaniel Gemechu, and Ehsanullah Darwish had to say about how we can fundamentally improve the way countries fight TB.

photo credit: Warren Zelman

Globally, more than 230,000 children died of TB in 2019. According to the World Health Organization (WHO), children under the age of 14 accounted for 12% of the people who developed TB in that year. In any given year, millions of children are infected with TB, which affects especially the most vulnerable, such as those who are malnourished. This tragedy is made worse because TB tends to be difficult to diagnose in children, and they are more likely to develop serious forms of TB. Many cases of childhood TB are missed, and access to services has been further compromised by the COVID-19 pandemic.

A mother and child wait to receive services at Yombo Dispensary in Bagamoyo, Tanzania. Photo credit: Megan Montgomery/MSH

Tanzania is unusually ambitious relative to other countries in sub-Saharan Africa and around the globe in having a national government-led digital health strategy, which it launched in 2013. 

The Centers for Disease Control and Prevention-funded Technical Support Services Project (TSSP), led by Management Sciences for Health (MSH), is supporting Tanzania in overhauling its digital health infrastructure, including introducing electronic medical records, hospital facility management software, and a patient ID system. The end goal is to dramatically improve planning and case management for the country’s health services.

We asked TSSP Project Director Dr. Kenneth Lema and Deputy Director Paul Bwathondi for an update on how the country is progressing toward its ambitious digital health overhaul.

 

How has Tanzania’s ehealth movement been going?

A patient is reviewed by a medical officer at Mukuyuni Sub-County Hospital, Kenya. Photo credit: Urbanus Musyoki

In the midst of the global COVID-19 pandemic, it is hard to think of anything else. And yet, the burden of Non-Communicable Diseases (NCDs) — such as diabetes and hypertension — remains and continues to grow across low- and middle-income countries. Each year, NCDs kill 41 million people, equivalent to 71% of all deaths globally.

In Kenya, over half a million adults were living with diabetes in 2019, and 40% of them were unaware of their condition. Nearly half of hospital admissions and an estimated 55% of deaths in Kenya are associated with an NCD.

Recently, a World Health Organization survey, completed by 155 countries in May 2020, confirmed serious disruptions in prevention and treatment services for NCDs due to the COVID-19 pandemic, noting that low-income countries are most affected. These trends raise great concern, as people living with an NCD are heavily represented among serious cases of the virus. 

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