This story was originally published by Global Health NOWAfter decades of effort by the global health community and governments, more women are giving birth in health facilities than ever, and maternal and newborn mortality have declined since 1990.But global and country-level averages hide a tragic, more complex story: Even in countries where 80% of births take place in health facilities or are attended by skilled health workers, maternal mortality often remains high.Many of these deaths could be prevented.
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.”
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.
Photos by: Samy Rakotoniaina/MSH
In Malawi, over 80% of people live in rural areas. For many (10%), the nearest health center is more than 8 kilometers (5 miles) away, making it difficult to access health care regularly. The USAID-funded Organized Network of Services for Everyone’s (ONSE) Health Activity, led by Management Sciences for Health, works to improve quality and access to care in rural communities.
Meet Andrew Etsetowaghan, Associate Director for Technical Services with the CaTSS project in Nigeria. Fueled by a passion to help others since childhood, Andrew was determined to find a way to fulfill his dreams. He decided to pursue medicine—otherwise becoming a priest or superhero—and dedicate his career to improving health systems in his community. This interview has been edited for length and clarity.
Describe your daily work briefly.
By providing compassionate and culturally appropriate care to women throughout their reproductive life, trained and supported midwives are critical to closing the gaps in human resources for health and helping to reduce maternal and newborn deaths. Gloria Flores, a licensed nurse and perinatal specialist from Morelos state, Mexico, is working to improve the quality of care moms and babies receive and to help mainstream professional midwifery practice at the primary health care level.
Elimase Kamanga is a mother, a midwife for more than 15 years, and the Senior Technical Advisor for Maternal and Newborn Health for the USAID-funded Organized Network of Services for Everyone’s (ONSE) Health Activity, led by MSH. Chisomo Mdalla, ONSE’s Chief Communications and Knowledge Exchange Officer, talked with Kamanga about her work to improve the quality of care for mothers and newborns in Malawi. This interview was edited for length and clarity.
Elimase, can you tell us about how you got to where you are today?
Photos by Chisomo Mdalla, ONSE Health communications officer.
As the globe marks World Water Day on March 22, the Organized Network of Services for Everyone’s Health (ONSE) Activity has been supporting the Government of Malawi in responding to a months-long cholera epidemic.
The Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program helped make sure that some of the world’s most vulnerable people have timely access to safe, affordable medicines and to quality services to improve their health. Funded by USAID, the program worked for six years in 46 countries to comprehensively strengthen pharmaceutical systems by addressing five interrelated functions, with a focus on medical products—governance, human resources, information, financing, and service delivery.
After more than 15 years working on women’s health and development issues, I feel hopeful as the growing movement for women’s rights brings us closer to a breakthrough. Everyday, more women around the world -- from Madagascar to Mexico -- are emerging as leaders. They are organizing and demanding justice, equality, and the full realization of their fundamental human rights.
In the late 19th and early 20th centuries, Poliomyelitis, or polio, was a greatly feared scourge of the industrial world. It would paralyze hundreds of thousands of children every year. Once effective vaccines were introduced in the 1950s the number of cases of polio dropped dramatically and the virus was eliminated in many countries, but in some places, it still remains a real threat.
In recent years, global health stakeholders have begun to recognize the profound potential that drug shops have to advance public health goals, such as those related to malaria diagnosis and treatment, child health, and family planning. These outlets, for reasons of convenience and cost, are the first choice of care for millions of people - and until recently, they have largely been ignored. “Drug shops and pharmacies are important sources of health care, particularly in rural areas or urban slums with few public clinics.
The Philippines has one of the highest TB burdens in the world—and 2.6% of its more than 286,000 new cases in 2015 were of multi-drug-resistant TB (MDR-TB). This threatens the progress the country has made in addressing the deadly disease over the past few decades and its goal to make the country TB-free by 2030. Further, MDR-TB cases will likely rise steadily in the Philippines and the world over the next two decades.
Health systems strengthening was front and center in discussions held in New York on the sidelines of the 72nd United Nations General Assembly. MSH hosted three events spotlighting how strong health systems are critical to resiliency and stability in fragile environments, at the core for global health security and essential for achieving universal health coverage. Here are some highlights from the week. See more on Twitter @MSHHealthImpact, @MSHACTS and @FCIatMSH.
Resilient and Stable: Building Strong Health Systems to Protect Women, Adolescents, and Children | September 18, 2017
Earlier this year we wrote about our ongoing experience reaching pregnant women in Uganda with a model that we called “pregnancy clubs” – an effort to improve the quality of health services women receive during pregnancy and after delivery by organizing them into groups to discuss their personal experiences and learn important self-care skills, guided by a healthcare provider.
(Cross-posted on the International Consortium for Emergency Contraception website).
With the current largest generation of young people, there is much to celebrate on August 12, International Youth Day. In particular, there is the growing recognition that as agents of change, adolescents and young people and their organisations are essential stakeholders who contribute to inclusive, just, sustainable and peaceful societies. Crucially, advocates working on sexual and reproductive health (SRH) and reproductive rights (RR) advance access for young people in meaningful ways.
This year’s World Population Day coincides with the Family Planning Summit—a global moment where intentions and commitments to the right to health for all are revitalized. An essential component of HIV prevention and treatment, family planning must be prioritized in global and national agendas. Here are four reasons why: Family planning is essential to maintaining progress on HIV goals: Meeting the needs of young people, particularly in developing countries, is critical to maintaining progress and momentum in controlling the HIV and AIDS epidemic.
Improving the quality of care that women experience during pregnancy, childbirth, and the postpartum period has become a major global priority. Achieving good quality care requires not only clinical improvements, but also a person-centered approach that takes into account women’s and health workers’ needs and perspectives.
It is early afternoon in the village of Kanjuwale at the foot of Nguluyanawambe Mountain in central Malawi. Charlene Chisema, a community mobilization officer, asks a group of local women about best antenatal care (ANC) practices.
“It should start early – in the first months,” said one woman.
“You need four visits,” said another.
“Great!” said Chisema, who works with the Organized Network of Services for Everyone’s (ONSE) Health Activity. “How many ANC visits did you all have during your last pregnancy?”
Over the past year, Tijuana, Mexico, has seen an influx of U.S.-bound Haitian migrants fleeing communities left in disrepair from the 2010 earthquake and further devastated by Hurricane Matthew in October 2016. These migrants often begin their journey in Latin America and trek through multiple countries and hostile terrain only to find they cannot enter the U.S. once at the border.
Malaria in pregnant women contributes to several negative outcomes including miscarriage, premature birth, labor complications, low birth-weight babies, anemia, and maternal and newborn death. In Sierra Leone, malaria in pregnancy and child mortality rates are especially high: the disease contributes to nearly 40 percent of deaths of children under the age of five.
Pregnancy and childbirth are times of unparalleled change and hope for the future. But for many women, the arrival of a new baby is also a challenging time — one that can be overshadowed by depression.
This World Health Worker Week (April 2-8), we honor the health workers around the world who work every day to improve health in their communities. This photo essay illustrates the important role that community health volunteers play in strengthening Madagascar's health system.
Follow the conversation at the Commission on the Status of Women: #CSW61
As we prepare to join the Commission on the Status of Women (CSW) next week, where the focus will be on women’s economic empowerment in the changing world of work, I am reminded of my visit to Malawi last month.
Mettre un enfant au monde est tout un travail différent. Tout le monde peut aider quelqu'un qui est malade, mais tout le monde ne peut pas faire le travail d'une sage-femme--guider une femme et son bébé en toute sécurité pendant la grossesse et l'accouchement. Je sais ce que signifie garder les femmes et les bébés vivants et en bonne santé parce que je suis une sage-femme.
This is the last in a series of four stories about how strong health systems improve the health of women and children. It was originally published on Global Health Now's website.
The Democratic Republic of the Congo has a chance to save millions of children with an inexpensive grassroots community effort.
This is the second in a series of four stories about how strong health systems improve the health of women and children.
Nine countries, with support from the World Health Organization (WHO), the United Nations International Children’s Fund (UNICEF), and other partners, launched the Network for Improving Quality of Care for Maternal, Newborn and Child Health last week.
Before the civil war in the late 1990s, the Democratic Republic of Congo (DRC) had a large network of clinics and health facilities. But decades of conflict weakened a fragile health system and robbed this resource-rich country of its potential to become one of sub-Saharan Africa’s wealthiest nations. By 2010, 70 to 80 percent of Congolese people had little or no access to healthcare, and the country suffered from a lack of basic security, communication systems, power, clean water, and transportation.
This post originally appeared on the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program blog as, "UHC Day 2016: Strong pharmaceutical management boosts access to essential medicines".
When it comes to contraceptives, having choices is key.
More than 220 million women around the world want to avoid pregnancy but are not using modern methods of contraception.
Reasons for this vary, from family disapproval, to fear of side effects, to infrequent sex. Increasing access to multiple contraceptive options can allay some of these barriers.
Without multiple options, a woman who is dissatisfied with her current method may stop using contraception completely. With more choices, she can switch to another method and have the support she needs to avoid an unwanted pregnancy.
When 18-year-old Ianka Barbosa was 7 months pregnant, an ultrasound showed the baby had an abnormally small head, a dreaded sign of microcephaly due to Zika infection. Upon hearing the news, Ianka’s husband fled. In her poor neighborhood of Campina Grande, Brazil, Ianka soon became a young mother alone.
As Ianka’s baby Sophia grows, she may never walk, or talk. She could develop seizures before she reaches six months. By the end of the year there may be a staggering 3,000 Sophias in Brazil – mostly in the poorest places.
This Global Health Impact issue highlights community health and community health workers, and presents a glimpse of MSH's work at the community level, in partnership with national ministries of health, civil society organizations, the private sector, and more.The community is the center of the health system in developing countries.Throughout sub-Saharan Africa, community health workers, often volunteers, represent the foundation of the health system, addressing priority health areas ranging from maternal and newborn health to family planning and infection prevention.
Many years ago I began my public health career in Ciudad Nezahualcoyotl, then a squatter settlement of 1.8 million people, bordering Mexico City in the State of Mexico. Lack of land and unaffordable rents forced poor migrants, streaming in from the country side in search of employment and a better life in the city, to settle in the surrounding peri-urban areas. This large municipality, with few paved streets, was difficult to navigate in the rainy season. During the dry season, the wind would kick up dust storms that made it hard to see a block ahead.
Many child deaths in developing countries are preventable: Children die from treatable conditions, such as pneumonia, diarrhea, and malaria, because families in rural, hard-to-reach, or conflict-ridden areas can’t access or afford the treatments. The Sustainable Development Goals (SDGs), launched in September 2015, set ambitious targets of ending preventable child deaths by 2030 and reducing mortality among children under age five to at least 25 per 1,000 live births.
“In 509 days, my country will go to the ballot box, and I will be running for office in Kenya,” announced Stephanie Musho, a law student and staffer at a global health non-profit. Musho made this bold statement while speaking on a panel of young African women leaders during the 60th session of the Commission on the Status of Women (CSW) in March.
Management Sciences for Health (MSH) celebrated 10 Years of Improving the Health of Women and Children in Nigeria with 250 stakeholders and supporters at a special event in Abuja on March 31, 2016. Distinguished guests included the chairman of the Nigerian House of Representatives, director of the Federal Ministry of Health in Nigeria, high-level representatives from state governments and partner organizations, and more.
Today, April 7, we celebrate World Health Day, started by the World Health Organization (WHO) to mark its founding in 1948.Amid Ebola, Zika, maternal and child mortality, and other global health challenges, WHO chose diabetes, for the first time, as its World Health Day theme (“Stay super. Beat diabetes”).
"Medicines are a key component of treatments to save lives"
~ Kwesi Eghan, trained Ghanian pharmacist and MSH portfolio manager for the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program in South Sudan and Afghanistan A child in Tanzania has a fever for three days. A pregnant woman in Namibia is taking antiretroviral therapy (ART) to treat HIV and prevent transmission of HIV to her baby. A man in Swaziland suffers from drug-resistant TB and struggles to adhere to treatment.
A woman. A newborn. A child. In many countries, their basic health and rights are tenuous. These women, newborns, and children are the health system.
A woman is ostracized: abandoned by her husband, her family, and her community. She suffered a fistula after giving birth to her son. After 20-plus years, an operation repairs her fistula; now, she is teaching again, and a part of the community.
When my daughter got sick, I took her to a clinic in my neighborhood. They gave her cough syrup for seven days.
I thought she was getting better, but it was apparent that she was still ill. After another examination, they referred her to St. Paul Hospital in Addis Ababa where they put her on oxygen and started taking blood sample after sample and injection after injection for a month. Her condition did not get better so they gave her another medicine. The doctors then decided to take blood from her back… only then did they know it was tuberculosis.
Medicines are a critical component of quality health care. In fact, most of the leading causes of death and disability in low- and middle-income countries could be prevented or treated with the appropriate use of affordable, effective medicines.Yet, about two billion people—one third of the world’s population—lack consistent access to essential medicines. Fake and substandard medicines exacerbate the problem. When these people fall ill and seek treatment, too often they end up with small quantities, high prices, poor quality, and the wrong drug.
Three weeks ago, nearly 3,500 family planning researchers, program managers, and policymakers came together in Nusa Dua, Indonesia to discuss the latest research findings and best practices on family planning at the 4th International Conference on Family Planning (ICFP). It was the largest gathering of family planning enthusiasts to date.
Nearly 30 MSH staff from 8 countries attended ICFP, showcasing our health systems expertise and experiences in family planning.
This blog post is a web-formatted version of the Global Health Impact newsletter: Stronger Health Systems, Healthier Newborns and Children (September/October 2015 issue). We welcome your feedback and questions in the comments. Subscribe
Breastfeeding is a human right, and critical for the health of both newborn and mother. Newborns benefit from early skin-to-skin contact and the antibodies in the mother’s first milk, plus factors that protect against later obesity and chronic diseases such as diabetes and asthma. Mothers benefit because early breastfeeding assists in uterine shrinkage and helps prevent postpartum bleeding. In addition, frequent, exclusive, breastfeeding reduces the likelihood of an immediate new pregnancy.
My home region of Tigray in northern Ethiopia has made great strides in ending preventable maternal mortality. Best estimates suggest that the maternal mortality ratio in our region dropped from approximately 653 maternal deaths per 100,000 live births in 1990, to 267 in 2014. However, while most pregnant women in Tigray attend at least one antenatal care visit, only 41 percent attend the recommended four visits, and less than 63 percent deliver with a skilled birth attendant.
Detecting and treating diabetes in pregnancy offers a simple, low-cost opportunity to improve maternal and child health and reduce maternal deaths. Yet, it has received scant attention as a public health priority, especially in low- and middle-income countries.
I'd like to introduce you to a special mother. Her name is Mama Sophie (meet her in this video). Seven months pregnant and experiencing pain, Sophie went to the Dipeta Health Facility in Democratic Republic of the Congo (DRC): I thought maybe the baby was changing position in the womb, but…[they told me the baby was coming]. Sophie was frightened: she had lost two babies before. She wasn’t the only person concerned. Dipeta Health Facility has an incubator, but doesn't have a reliable source of electricity to use it. When I delivered...
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. It was an exciting year for maternal health.
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.
Currently, there is strong interest in global women and children’s issues on Capitol HIll, with several Members of Congress declaring bipartisan interest in introducing maternal, newborn, and child survival (MNCS) legislation on Mother’s Day 2015. MSH is actively engaged in supporting this effort and using our technical expertise to help ensure any proposed legislation is evidence‐based.To this end, MSH's Policy & Advocacy Unit recently joined the newly‐formed MNCS Working Group, a coalition of like-minded NGOs that are trying to build broader congressional su