Universal Health Coverage

Universal Health Coverage (UHC)
 {Photo credit: Bright Phiri/MSH}Delegates learn about pharmaceutical management from Systems for Improving Access to Pharmaceuticals and Services (SIAPS) Program staff while visiting Mokopane Hospital in Limpopo Province, South Africa.Photo credit: Bright Phiri/MSH

Management Sciences for Health (MSH) sponsored a Congressional Staff Study Tour to South Africa and Zambia in February 2015 to examine the local impact of US funded health capacity strengthening in Southern Africa. During the trip, site visits and meetings highlighted the impact of local health capacity building efforts in pharmaceutical management of essential medicines and HIV & AIDS drugs and technical and managerial development opportunities for community workers.  

Unpublished
{Photo credit: Warren Zelman.}Photo credit: Warren Zelman.

Nearly three years ago, I blogged about a systems approach to improving access for a Maternal Health Task Force (MHTF) series on maternal health commodities:

Increasing access to essential medicines and supplies for maternal health requires a systems approach that includes: improving governance of pharmaceutical systems, strengthening supply chain management, increasing the availability of information for decision-making, developing appropriate financing strategies and promoting rational use of medicines and supplies.

 {Photo credit: Emily Phillips/MSH Afghanistan}A postnatal woman with her newborn and mother-in-law.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.

 {Maternal Health Task Force}Critical Maternal Health Knowledge GapsMaternal Health Task Force

Cross-posted with permission from the Maternal Health Taskforce (MHTF) blog.

As we reflect on lessons learned from the Millenium Development Goals (MDGs) and set strategies for improving global maternal health, it’s time to identify what has worked and what more is needed to not only avert preventable maternal deaths, but also provide quality health care for every woman.

In a paper published last month, Tamil Kendall, a post-doctoral fellow of the Maternal Health Task Force, summarizes priorities for maternal health research in low- and middle-income countries based on three broad questions she asked 26 maternal health researchers from five continents:

1. Critical maternal health knowledge gaps

“We know what to do. But the interactions between the interventions and the health system have not been studied”

{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: Julie O'Brien/MSH}Haiti.Photo credit: Julie O'Brien/MSH

This post is part of MSH's Global Health Impact Blog series, Improving Health in Haiti: Remember, Rebuild. The post originally appeared on LMGforHealth.org, the blog of the US Agency for International Development (USAID)'s Leadership, Management & Governance (LMG) Project, led by Management Sciences for Health (MSH) and a consortium of partners.

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