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{A secretary records the weekly collection amounts for a savings and internal lending group in Madagascar. Photo credit: Samy Rakotoniaina/MSH}A secretary records the weekly collection amounts for a savings and internal lending group in Madagascar. Photo credit: Samy Rakotoniaina/MSH

By Amy LiebermanJenny Lei Ravelo

This story was originally published by Devex

The onus to help everyone — including the most marginalized — secure universal health care coverage will likely depend more on individual government spending than on new foreign assistance, experts say.

Funding will be a critical, but not guaranteed, element in the forthcoming universal health coverage agreement governments will sign in September during the opening of the U.N. General Assembly session.

“Aid is not going to help achieve the global health goals. It has to come from domestic spending. But aid is very important for purposes of equity and that the poor do not get left behind.”— Jacob Hughes, senior director of health systems, Management Sciences for Health

Peter Mbago, TSSP Principal Technical Advisor, Human Resources for Health and Megan Montgomery, Pfizer Global Health Fellow interview health care workers at Kaole Dispensary in Bagamoyo District to better understand training needs and provider motivations.

By Megan Montgomery

Tanzania needs more health care workers. Its workforce is only 44%1 of the required staff, per its national human resources for health plan. This shortage is more dire in rural areas, where 80%2 of the country’s population lives, as well as among mid-level health care workers. Hospitals are often filled beyond capacity, as they must also take referrals from less well-equipped facilities. Patients sometimes share beds or sleep on the floor, and health care workers struggle to provide patients with the care they need.

The Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) has begun a number of initiatives to help ease gaps and improve health services, particularly for the 1.5 million3 people estimated to be living with HIV in Tanzania. One initiative, called task sharing, aims to enable lower level health care providers to perform tasks that would typically be outside their scope of responsibilities. This frees up staff with higher-level skills to focus on more complicated cases and help a greater number of patients receive timely, quality care.

{Photo credit: Julius Kasujja}Photo credit: Julius Kasujja

This op-ed was originally published in The Hill.

Along with the Ebola outbreak that’s already infected more than 1,600 people, the Democratic Republic of the Congo (DRC) is fighting another battle: An epidemic of fear and mistrust. Community members are afraid to seek treatment, including a promising experimental vaccine.

Pharmacy Assistant Aaron Sendeza wants to rid Malawi of malaria. Thanks to the mentorship program, Aaron works to ensure that all medicines and medical supplies in his health center are available, reliable, and of high quality. Photo credit: Paul Joseph Brown for VillageReachPharmacy Assistant Aaron Sendeza wants to rid Malawi of malaria. Thanks to the mentorship program, Aaron works to ensure that all medicines and medical supplies in his health center are available, reliable, and of high quality. Photo credit: Paul Joseph Brown for VillageReach

By Matthew Ziba

Many health facilities across Malawi don’t have enough trained pharmacy staff to adequately manage stock and dispense medicines. These tasks often fall on health care providers, who already have many other responsibilities, namely caring for patients. In some cases, even a ground laborer or a security guardwho may have no training in pharmacy managementmust step in to help.

In the spirit of the 3,500-year-old Tao (Way) of Leadership, MSH works closely with local institutions and communities to create lasting and sustainable changes; changes that improve the health of people among the world’s poorest and most vulnerable groups.

And as the Tao indicates, sustainability starts with ownership, “The people will say, we have done it ourselves.”

Women in Kakamega County, Kenya are taking charge of their pregnancies, supporting their peers, and learning about healthy practices and self-care from skilled health providers. MSH’s Lea Mimba (“Take care of your pregnancy”) project, funded by UK Aid through the County Innovation Challenge Fund (CICF), tested an innovative group model for antenatal care (ANC) that responds to the needs and perspectives of women and front-line health providers. At six Kenyan health facilities, Lea Mimba provides a forum where pregnant women share experiences, learn birth planning and self-care practices, provide each other with emotional and social support, and receive essential health information from a skilled health provider, who is usually a nurse.

Meet Hortense Kossou, Principal Technical Advisor for the USAID-funded Integrated Health Services Activity (IHSA) in Benin. Hortense previously served as the national malaria coordinator for the Ministry of Health in Benin and today leads IHSA’s malaria-related activities on the ground. In this issue of Leading Voices, she presents the challenges that the country faces in its fight against malaria and the actions being taken to combat it.

Malaria is the leading cause of mortality among children under five and morbidity among adults in Benin. How has the landscape changed since you first began working at the MOH in 1997?

There have been many changes between the 1990s and today. The Ministry of Health has implemented the newest technological innovations: for example, it has gone from providing untreated mosquito nets to providing long-lasting, insecticide-treated nets. Changes were also made to increase access to these products. Nets were first provided only to the most vulnerable groups, such as children under five; nowadays, there is broader coverage that includes all members of the population.

{Health Surveillance Assistant (Community Health Worker) recording data in health card at outreach clinic, Mulanje, Malawi, ONSE Health Activity} Health Surveillance Assistant (Community Health Worker) recording data in health card at outreach clinic, Mulanje, Malawi, ONSE Health Activity

This article was originally published by Global Health Now.

Paid or volunteer?

Community health workers are on the frontlines in many countries—and vital to achieving universal health coverage. Yet the public health community has not reached a consensus on which model is the best.

Consensus is urgently needed, both at the global and country levels, to inform future policies and strategies for strengthening health systems and delivering on UHC.

Based on our experiences in rural Peru and Ethiopia, it’s not either-or. It’s both.

Full-time, paid CHWs form the backbone of family- and community-based services, but there aren’t enough to reach all families. We envision teams of government-paid, full-time CHWs providing comprehensive services to a given population, with a primary health center hub as the base of operations. Each CHW, in turn, would lead a team of part-time community health volunteers providing limited health education and referral services—such as maternal and newborn health, nutrition, hygiene, tuberculosis, malaria, and HIV/AIDS—to a small number of neighboring families.

{Marian W. Wentworth visits with health workers during a trip to Uganda in 2017. Photo credit: Warren Zelman}Marian W. Wentworth visits with health workers during a trip to Uganda in 2017. Photo credit: Warren Zelman

I began my career in the private sector almost always as the only woman in the room. Like many women of my generation, I experienced the kind of casual sexism that for too long was considered acceptable. But I also experienced firsthand more abusive forms of discrimination.  As I moved up in the organization, I began to see how sexism affected other women around me. I remember reviewing male and female candidates who were being assessed for readiness for promotion and noticing a distinct trend: The female candidates were assessed on their achievements; the male candidates on their potential. This situation worsened as candidates were actually selected for roles. Average achieving, “high potential” male candidates were being promoted over women who had tangible track records of accomplishments. While the trend was obvious, the solutions were not. We tried a series of different ways to shift this trend in our organization, but none produced quick results.  How we assess potential — and in whom — is but one example of the kind of systemic sexism that forces women to work harder to achieve professional success, and why some of us find it too much to fight.

The chart above shows the good-news-bad-news scenario that is the decades-long fight against TB in Afghanistan. TB is still a crushing problem there; the country has among the world’s highest rates of the disease, which killed some 10,000 people in 2017. But if you glance at this chart and think that we haven’t made much progress, look again. We’re finding and treating more people with TB in Afghanistan than ever before. In 2001, we were missing three quarters of presumptive TB patients — that is a whopping 75% gap in case detection.

{Nurse Gabriella Oroma welcomes patients at Ngetta Health Centre in Uganda, where drug-resistant TB is treated. Photo credit: Sarah Lagot/MSH}Nurse Gabriella Oroma welcomes patients at Ngetta Health Centre in Uganda, where drug-resistant TB is treated. Photo credit: Sarah Lagot/MSH
By Dr. Ersin Topcuoglu
 
This op-ed was originally published in The Hill.
 

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