Health Systems Strengthening

Health Systems Strengthening (HSS)
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. 

{As an HIV-positive woman with an HIV-negative husband and three HIV-negative sons, Margaret’s a role model for how women with HIV can thrive with access to essential services and information.  Photo by Patrick Meinhardt for IntraHealth International.}As an HIV-positive woman with an HIV-negative husband and three HIV-negative sons, Margaret’s a role model for how women with HIV can thrive with access to essential services and information. Photo by Patrick Meinhardt for IntraHealth International.

Health workers not only need water, sanitation, and hygiene (WASH) services to prevent the spread of COVID-19 right now but also to provide safe essential health services every day. But 25% of health facilities around the world lack basic water services. One in six facilities doesn’t have hand hygiene services, such as soap and water or alcohol-based hand rub, available at points of care. And health workers in facilities in sub-Saharan Africa face even greater WASH challenges.

Two frontline health workers—Margaret Odera and Dr. Ann Phoya—recently called for improved WASH services during an event alongside the 75th United Nations General Assembly. Read on to find out what it’s like to be a health worker on the frontlines without WASH and the steps they are taking to access and improve WASH in Kenya and Malawi.

Family planning client Meva and her son at their home in Mananjary, Madagascar

In 2018, Madagascar enacted a new family planning law allowing youth to seek family planning services without parental consent. However, young couples still face major obstacles accessing these vital services due to a lack of availability, persistent cultural and religious beliefs, and minimal information about available options.

Training and empowering midwives to provide contraceptive services, particularly to Malagasy youth, is a key to overcoming these challenges. Here’s how the many midwives, supported by the USAID-funded ACCESS program, are playing this critical role.

A USAID MTaPS field consultant talks with a health worker at Marikina Valley Medical Center, Philippines. Photo credit: MSH staff

Originally published in Think Global Health

Half of all medical equipment in Bangladesh’s public health facilities—hospital beds, ventilators, nebulizers, refrigerators, and vehicles—goes unused. Meanwhile, in Uganda, ultrasound machines are overused for a small number of patients, while many in need go without. In Ukraine, about 40 percent of adults have had to borrow money or sell assets to afford medical treatment.

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:

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