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{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:

{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.

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