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 Topcuoglu, Daniel Gemechu, and Ehsanullah Darwish had to say about how we can fundamentally improve the way countries fight TB.
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 recent Management Sciences for Health (MSH) study conducted with mental health patients in Afghanistan revealed that people being treated for mental illness were almost 20 times more likely to have tuberculosis (TB) than the general population. Years of conflict, poverty, stress, and illicit drug use have led to Afghanistan’s high rates of mental disorders, including depression, anxiety, and post-traumatic stress disorder. Studies have shown depression and anxiety rates as high as 72% and 85%, respectively, among Afghan adults.
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.
Tuberculosis remains the world’s leading infectious disease killer. Ending TB will require a comprehensive approach and targeted action, rapid innovation and proven interventions, bold leadership, and intensive community engagement.
On this World TB Day, the global health community is calling for “Leaders for a TB-Free World” to work together, make history, and end TB once and for all.
MSH will host and support events in five countries this week to honor World TB Day.
Observed March 24, World TB Day raises awareness and mobilizes support for efforts around the world working to end tuberculosis (TB). The World Health Organization (WHO) has designated this year’s theme as “Unite to End TB: Leave No One Behind,” and many of the day’s activities will focus on addressing stigma, discrimination, and marginalization.
Update, July 30, 2015:
Prior to 2002, the vast majority of health service delivery systems in Afghanistan were non-existent or informal. The Leadership, Management, and Governance (LMG)-Afghanistan project improved family planning, reproductive health, and maternal and child health using strategies to strengthen health leadership developed by Afghans, for Afghans.
See the Journey to Restoration on Exposure
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MSH's May 2015 newsletter highlights the global health impact of pharmaceutical management: Ensuring access to affordable, quality medicines saves lives (subscribe).
by Jonathan D. Quick, MD, MPH
Health care is largely dependent upon essential medicines for preventing infection, reducing pain, and treating illness. The development of effective medicines, however, is only the beginning.
Quality care means getting the right medicine, in the right dose, at an affordable price, for all the people who need it.
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.
“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?
Members of the global health community commemorated International Women’s Day (IWD) on March 8 by celebrating recent advances in women and girls’ health and indeed there was much to celebrate: maternal deaths have declined 45% worldwide, The Global Fund to Fight AIDS, Tuberculosis and Malaria has distributed over 450 million bed nets, and over 1 million babies have been born HIV-free thanks to the President’s Emergency Plan for AIDS Relief (PEPFAR); but there is still work to do. What happens once the day is over? How do we turn that attention into action?
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.
Today, February 3, 2015, is 10 years since the tragic loss of three Management Sciences for Health (MSH) colleagues, Carmen Urdaneta, Amy Lynn Niebling, and Cristi Gadue, in a plane crash outside Kabul, Afghanistan. MSH held a remembrance of Amy, Cristi, and Carmen today for all staff, friends, and family. The slideshow below includes photos of and by our beloved colleagues.
In 2013 diarrhea killed 578,000 children under the age of five, 9 percent of all deaths in this age group globally. The tragedy of these deaths is that they are avoidable at many levels. The risk of contracting diarrhea can be drastically decreased through basic hygiene measures, such as consistent and exclusive use of a latrine and washing one’s hands with soap. Once a child becomes ill with diarrhea, most cases can be managed with oral rehydration salts and zinc.
This post, cross-posted with permission from The Leadership, Managment, and Governance (LMG) project blog on LMGforHealth.org, is part of our Global Health Impact series on the 67th World Health Assembly in Geneva, May 18-24, 2014. MSH is co-hosting three side events focusing on the role of universal health coverage (May 20), chronic diseases (May 20), and governance for health (May 21) in the post-2015 framework. This year, six MSH representatives are attending WHA as part of the 60-plus-person Global Health Council (GHC) delegation.
Pablos-Méndez Applauds and Encourages MSH Representatives and Partners at DC Country Health Impact Fair
Representatives from 13 MSH countries—Afghanistan, Angola, Cote d’Ivoire, DRC, Ethiopia, Ghana, Haiti, Kenya, Nigeria, Rwanda, South Africa, Tanzania, and Uganda—shared stories and materials about the lives saved and health impact of MSH’s work, in partnership with US Agency for International Development (USAID) and others, at the MSH Country Health Impact Fair at the Ronald Reagan Building in Washington, DC, last week. Country ownership and health impact were common themes at the fair. Ariel Pablos-Méndez (MD, MPH), assistant administrator for global health at the US Agency for International Development (USAID), addressed participants and attendees.
This post originally appeared on the Maternal Health Task Force (MHTF) Blog as part of a series celebrating the one-year anniversary of The Lancet publishing “A Manifesto for Maternal Health post-2015,” co-authored by Ana Langer, Richard Horton, and Guerino Chalamilla.
Azmara Ashenafi, a 35-year-old woman from the Amhara region of Ethiopia, was diagnosed with tuberculosis (TB) and placed on treatment. She was fortunate. Many people with TB are missed by health systems altogether. But Azmara’a treatment wasn’t helping. Despite taking medicine for months, her symptoms persisted and became more severe.
In many places, her story would have a sad ending—TB is one of the top three leading causes of death for women 15 to 44 in low- and middle-income countries.
MSH staff are commemorating World TB Day through awareness-raising activities around the globe, including in Afghanistan, Cambodia, Ethiopia, Ghana, Indonesia, and Nigeria. Here are photos (some from 2013) with activities this year.
Afghanistan - TB CARE I
MSH staff and projects participated in International Women's Day celebrations in dozens of countries around the world. We share some of our stories with photos and excerpts from South Africa, Uganda, and Afghanistan.
International Women’s Day, March 8, signifies more than a single day can encompass. At MSH, International Women’s Day is a day for celebrating women health leaders who inspire change and an opportunity to recommit ourselves to another year of action toward gender equity.
We celebrate International Women’s Day with Drs. Suraya Dalil and Florence Guillaume, Ministers of Health from Afghanistan and Haiti.
Hepatitis is a personal disease for me. Some years ago, I spent two weeks leading training workshops for faculty at the University of Costa Rica in San Jose, Costa Rica. The work and the participants were delightful, as we worked together to improve medicine prescribing practices. Every day I ate lunch at a local seafood restaurant, often joined by a colleague. One Friday, two weeks after returning home, I felt exhausted—so tired that I could not continue working. By Sunday I was orange as a pumpkin, unable to walk or keep food down.
This edition of MSH's Global Health Impact e-newsletter (subscribe) explores our worldwide work supporting healthy communities, families and kids, including:Mobilizing communities to care for orphans and vulnerable children in Lesotho;Empowering Ugandan couples with information and access to modern family planning;Training community health workers to provide TB services in rural Afghanistan;Supporting Kenya's efforts to utilize mobile technology for pharmacovigilance reporting; andCommunicating strategically to influence health-seeking behaviors (i.e. proper use of bed nets).
World Health Worker Week (#WHWW) is April 8-12, 2013. Let's show the world just how much #HealthWorkersCount. Watch and share the video, thank a health worker, and donate $10 in honor of a health worker. "We realized that educating the community was something we had to focus on," says Madina, a trained Afghan midwife, as she describes involving elders and religious leaders in helping to improve access to family planning and perinatal care for women in Khost province, including one woman who came to the health facility suffering complications from a home birth.Health workers save lives.
In a postoperative ward of Kibagabaga Hospital, the district hospital serving Rwanda’s capital city of Kigali, Eric Bizimana sits up in bed. Bizimana, 25, had sought care after severe pain in his right leg forced him to stop work as a barber. He was diagnosed with a bone infection called osteomyelitis. Antibiotics alone couldn’t clear the infection. Without an operation to remove the diseased bone, Eric faced the possibility of losing his leg.
Stop TB in my lifetime.
This global call to action---the Stop TB Partnership's theme for March 24, World TB Day 2013---is as relevant now as it was over a hundred years ago.
Progress toward reducing the global burden of tuberculosis (TB) has been impressive in recent years: TB mortality has fallen by 41 percent since 1990.
Yet, TB remains one of the world’s leading causes of death, killing more than 1.4 million people per year, including 70,000 children. In 2011, 600,000 people died of TB in Africa alone---including many people with HIV.
Sunday, March 24, 2013, is World TB Day, and MSH staff and partners are promoting global efforts to stop TB throughout the week.Here are highlights from some of our activities around the world:The Afghanistan TB CARE I team is working with the national TB program (NTP) to conduct celebration events at 290 health facilities and communities in 13 USAID-supported provinces. TB messages will be aired through local telephone companies to approximately one million people throughout the nation.
For most of my life, women in Uganda---as in most countries---were treated as inferior to men. Girls were less likely to be educated than their brothers, and had little control over the direction of their lives. Many girls grew up being told how to act, eat, and talk; many women were regarded as little more than domestic caregivers. However, in 1986 the ruling government radically changed the dynamics of Ugandan women in global development and their participation in decision-making at all levels of government.
In my 35 years working in international health, I've attended hundreds of conferences. Conferences are opportunities to exchange ideas and form connections. They’re often fascinating. But once in a while a conference itself can be a pivotal moment.
Private sector companies, like McDonald's and General Electric, have successfully been using internal universities or academies for decades. So how can programming for health service managers be better, more cost effective and more sustainable? Embed programming within special “Leadership Academies” based in ministries of health.
A new report from the USAID-funded Afghan Sustainable Water Supply and Sanitation (SWSS) Project, led by Tetra Tech ARD, describes the methodology and results from the Sustainable Health Outcomes component, led by Management Sciences for Health (MSH). The SWSS project worked to improve the health and infrastructure of rural Afghans, with an emphasis on providing water supply and sanitation facilities and improving community hygiene behaviors (read stories).
Management Sciences for Health (MSH) invites you to attend the following sessions and poster presentations at the Global Maternal Health Conference in Arusha, Tanzania --- whether in person at the Arusha International Conference Center, or watching via archived videos online. (All times are listed in Eastern Africa Time: UTC/GMT +3 hours.
Cross-posted from the MSH at the Union World Conference on Lung Health 2012 blog. Management Sciences for Health (MSH) presented at several symposia and workshops throughout the 43rd Union World Conference on Lung Health (read more).Friday’s symposium on November 16 dealt with: Saving lives in areas of conflict or disaster: partnering for results (PDF). Dr. Eliud Wandwalo of MSH Tanzania coordinated the session along with Morgan Richardson.First up was Dr.
Eugénie, a widow in Rwanda, farms to provide for her children. In January 2012, she had surgery to remove a tumor, a procedure that would have devastated her family economically if she did not have insurance.
Moen Kas, a hilly remote Afghan village absent of latrines or even a functioning water well, became an Open Defecation-Free (ODF) community within 24 days of arduous commitment from its leaders and people.
Moen Kas’ remarkable milestone makes it the first village in Afghanistan to reach ODF status in less than one month--inspired entirely from personal stories that are spreading across the country regarding the benefits of living in ODF communities.
Seven-year-old Makasi, an HIV-positive orphan in Tanzania, was diagnosed with advanced tuberculosis (TB) and started on curative treatment. Clinicians at a local health center used standardized TB guidelines to overcome the difficulty of identifying TB in children co-infected with other diseases. In Afghanistan, sixteen-year-old Hamida provides for her family while trying to complete school. Hamida was visited by a community health worker, who identified her TB symptoms, and helped her access appropriate diagnosis and treatment.
Steady Progress Against Daunting Challenges
Each year over 10 million men, women, and children in developing countries die as a result of our collective failure to deliver available safe, affordable, and proven prevention and treatment. A recent analysis of innovations in products and practices for global health, from the Hepatitis B vaccine to use of skilled birth attendants, revealed virtually none of these life-saving interventions reaches much more than half their target population—even after as many as 28 years of availability.
Afghanistan has yet another village which has successfully become an Open Defecation Free (ODF) zone. Baghalak is a village in Nahrin district with 630 inhabitants dispersed among 90 households --- each with unused latrines in poor condition. For this reason, Baghalak was selected by the USAID-funded project, Sustainable Water Supply and Sanitation (SWSS) and the Organization for Health Promotion & Management to partake in community-led total sanitation (CLTS) training.
In the small Afghan village of Toghak, where open defecation affected the sanitation and health of the community, two women took the initiative to mobilize themselves and others into transforming Toghak.
Ms. Fatima and Ms. Rukhsar attended a community-led total sanitation (CLTS) workshop in the neighboring village of Gheyas Said Abd and learned life-saving lessons they wanted to take back to their village. They learned that flies tend to breed in bacteria infested places, particularly human feces, and then transport the fecal matter to food meant for human consumption.
The USAID-funded Sustainable Water Supply and Sanitation Project, Afghanistan (SWSS) project increases access to potable water and sanitation services in Afghan communities and decreases the prevalence of water borne diseases through household hygiene interventions. Led by the Association for Rural Development, in partnership with Management Sciences for Health, SWSS has led nearly 400 communities in Afghanistan to become Open Defecation Free. The MSH components of the project have succeeded under the astute leadership of Dr.
Cross-posted on USAID's IMPACT blogMy most vivid early childhood memory is waking up to excruciating pain in my throat, and seeing the goldfish swimming in the aquarium of the pediatric surgical ward. Although penicillin had been discovered 30 years earlier, doctors had not learned yet that treating "strep throats” with penicillin was better than operating. I didn't need the tonsillectomy. But, I was lucky to receive quality care in a health facility, close to my home.Millions of children today are not so lucky.
Suzanna Ile, a 26-year-old woman from South Sudan, lost her first two babies in childbirth. Suzanna did not have a nurse or midwife to tell her that her pelvis was dangerously small for childbirth; nor was there a safe place for a caesarian section even if she had known the risk.Suzanna’s experience is typical of what women have faced in South Sudan, the newest country in the world. South Sudan is home to 10 million people, spread across an area about the size of France.
Nearly 50 countries, including Afghanistan, Democratic Republic of the Congo, Haiti, Liberia and South Sudan, are considered a fragile or conflict-affected state -- a state that is in conflict, recovering from conflict or crisis, or a state that has collapsed or has a strong and repressive government. Over nearly 40 years of working in fragile states, Management Sciences for Health (MSH) has identified best practices, lessons learned, and appropriate interventions for a myriad of situations in fragile states.
On Monday, March 5, 2012, everyone from policymakers to students gathered at the World Bank for a Special Event on the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and Women’s Rights.CEDAW is a treaty that has been ratified worldwide by all but six countries --- the United States, Iran, Sudan, Somalia, and two small Pacific Island nations (Palau and Tonga).The event was hosted by Caroline Anstey, Managing Director of the World Bank, in conjunction with the Nordic Trust Fund, The Leadership Conference Education Fund, and the United Nations Foundation.
Today is International Women’s Day, celebrated around the world as an opportunity to look back on women’s accomplishments and look forward to the realization of their full economic, political, and social rights. The United Nations theme for this year, “Empowering Rural Women,” is one that resonates powerfully with MSH’s work.We’d like to take this occasion to thank all of the women and men who, for over 40 years, have helped MSH enable rural women to have more control over their health and the health of their families.
At a satellite session at the 2011 International Conference on Family Planning on November 30 in Dakar, MSH asked five panelists to discuss successes in family planning, and what still needs to be done. The conversation was moderated by MSH’s Issakha Diallo and held in conjunction with a celebration of MSH’s 40th anniversary.
Zakia, a nurse in Afghanistan, has become a leader in her health center. After participating in an MSH leadership development program, Zakia led a team of nurses in increasing awareness about family planning, resulting in a doubling of the use of contraceptive pills and an eight-fold increase in the number of condoms distributed in two years. “Everyone here no longer thinks of problems as obstacles in our way, but challenges we must face,” Zakia says.
Editor’s Note: Marzila Mashal, an Administrative Coordinator working in Kabul, Afghanistan, was awarded a month long fellowship that is awarded to two MSH staffers each year. The Fellowship was established in honor of Carmen Urdaneta, Amy Lynn Niebling, and Cristi Gadue who on February 3, 2005, died in a plane crash outside Kabul, Afghanistan. The Gadue-Niebling-Urdaneta (GNU) Memorial Fund was established to further the work to which these remarkable women dedicated their lives.
Guest post by Dr. Ahmad Masoud RahmaniDr. Ahmad Masoud Rahmani is the National Director of the Afghanistan National Blood Safety and Transfusion Services Directorate, in Kabul, Afghanistan. Dr. Masoud was a participant in the MSH Leadership Development Program offered by the USAID-funded Technical Support to the Central and Provincial Ministry of Public Health project (Tech-Serve) in Afghanistan last year. The National Blood Transfusion service in Afghanistan has the responsibility for ensuring that a safe and adequate blood supply is available for all people who need it.
Coordination and partnership are often considered critical in global health programs to avoid duplication and waste of resources. Recently, Health Net TPO (HN TPO), an NGO with health programs in eastern and south eastern Afghanistan sought collaboration with MSH’s USAID funded Strengthening Pharmaceutical System (SPS) program to address gaps in knowledge and practice in pharmaceutical management in the provinces of Nangarhar, Laghman, Khost and Paktiya. These are the provinces that have ongoing interventions to promote rational use of medicines through the SPS program.
That point was made often by the Honorable Dr. Walter T. Gwenigale, Minister of Health and Social Welfare of the Republic of Liberia (also widely known as Dr. G in Liberia) at a conference, co-sponsored by MSH on June 9 and 10 at the US Institute of Peace.
The Ministry of Public Health’s (MOPH) Pharmaceutical Enterprises operates 53 pharmacy stores located near government hospitals nationwide, managed by 118 pharmacists. With 1 million US dollars in capital, pharmaceuticals are purchased, stored, and then distributed to the Afghan people through these government-owned pharmacies.Dr. Mirza Mohammed Ayoobi, the Deputy Director of Pharmaceutical Enterprises says, “Majority of our government-employed pharmacists have over 15 years of experience, but have not kept pace with the changing landscape of pharmacy practice.
When the Taliban were chased from power in Afghanistan in December 2001, the health system was in shambles---devastated by years of war and neglect. Access to primary care was below 10% and immunization rates had fallen below 20% throughout the country. Less than half the hospitals had both electricity and running water. Medicines and medical supplies were scarce and the quality was often unreliable. There were essentially no female health workers active in most of the Afghanistan---a country in which cultural sensitivities mean female providers are essential for women’s health.
Blog post updated Dec. 27, 2011.Taj Bibi sits nursing her 5-month-old baby in the kitchen of her home in the village of Sartal in Takhar province in Afghanistan’s north. The room is dark; the only natural light comes from the doorway to the dusty courtyard outside. The sound of her children playing echoes across the small family compound.Bibi’s first two children died -- one of them from severe diarrhea -- because the family could not afford to take them to the doctor.
Dr. Karima, General Directorate of Pharmaceutical Affairs, Ministry of Public Health, speaks at the opening ceremony of the Drug and Therapeutics Committee training course for provincial hospitals On the eve of the International Women’s Day, the Strengthening Pharmaceutical Systems (SPS) Program in Afghanistan had the opening ceremony of the Drug and Therapeutics Committee (DTC) training course for provincial hospitals in Paktya, Paktika, Khost, Ghazni, and Badakhshan.
Afghanistan’s mountain ranges are beautiful to the eye. Rugged peaks and ridges are separated by valleys, carved out over the centuries by streams and rivers supporting the green web of vegetation along their banks.But many of the small villages that cling to the walls of these valleys are often cut off for months by heavy snow or the floods that follow the spring melt. The cold wet climate, together with smoke from household stoves, increases the risk of pneumonia, particularly among babies and children.
A few weeks ago, I had the opportunity to visit Southern Sudan. For over five decades, Southern Sudan endured civil war, unrest, and several waves of forced displacement and refugees. The infrastructure of nearly every sector was mostly destroyed throughout the region.
The carefully irrigated and shaded kitchen garden provided welcome splashes of different shades of green against the surrounding dry brown soil and rocks. We congratulated Shukria, a community health worker (CHW), on the lush vegetables and ripening fruits as we entered her home.Shukria explained that the gardens that she and other women were growing started with the community-based growth monitoring program through the Family Health Action Groups.
Many children in Afghanistan die each year of easily preventable diseases; nearly 25% of those deaths are due to diarrhea. However, it is not only the fatal cases of severe diarrhea that are imperative to address. Between a quarter and a half of mothers of children less than five years old report their child had diarrhea in the two weeks prior to questioning.
Fragile states such as Afghanistan, the Democratic Republic of Congo, Haiti, Liberia, and Southern Sudan have among the worst health statistics – especially for women and children. For political, economic, security and other reasons they can be extremely challenging work environments.
A common challenge in advancing family planning is overcoming the misconceptions religious leaders have about the use of contraceptives.Concerns from religious leaders are often based on misconceptions about family planning methods rather than their religious beliefs.
Today, the 37th annual Global Health Council Conference “Goals and Metrics” begins in Washington, DC. MSH is pleased to be a Silver Sponsor of the conference.MSH is sponsoring two auxiliary events:“Can Country Ownership Work? Field Perspectives on Health Systems Strengthening” Today, June 14, 2-4pm, Governors Room, Omni Shoreham Hotel, Washington, DC A panel discussion co-hosted by MSH and Oxfam on how “country ownership”—the management of donor funds by a national government—works in practice.