December 2010

On this World AIDS Day, we reflect yet again on progress made toward global commitments to fight the HIV epidemic. According to UNAIDS, new infections have decreased this past year from 2.7 million to 2.6 million, but, 30 years into the epidemic, only 5.2 million people out of the estimated 15 million who need drugs have access to treatment. Stigma, discrimination and human rights violations against persons living with HIV still exist, even in countries with generalized epidemics.

Integrated HIV programming across the entire health system can minimize many of these barriers to HIV prevention, care and, treatment.

"It's not over yet." World AIDS Day 2010 at MSH in Cambridge, MA.

Today, MSH teams around the world  observed World AIDS Day by participating in national commemorations and offering HIV testing, counseling, and prevention messages.

There have been a collection of high-profile and well attended mobile health (mHealth) “summits” held around the world in the past few years, including last month’s second annual mHealth Summit in Washington, D.C. (headlined by Bill Gates and Ted Turner), but the really interesting conversations are happening on the African continent. While large providers in the “developed world” are talking about the need for business plans and analysis, the debate in Kenya and Nigeria and Ghana is on how country-based leadership can scale up proven programs, develop sustainability, and provide practical and integrated models for cooperation between the government, mobile service providers, the medical community and the private sector.

Annie Likhutu, shown right, receiving volunteer HIV counseling and testing services from Word Alive’s HTC volunteer, Charles Sapala.

Three months ago, Annie Likhutu, a mother of six, came to Migowi Health Center in Phalombe, Malawi to receive voluntary HIV counseling and testing (VCT); now, she is back at the health center and ready to be tested for a second time.“It is very important to know your status, it is no good waiting until you get sick,” she said.

Annie initially learned of the importance of testing through a radio advertisement from Word Alive Ministries International (WAMI), which is aired regularly and encourages listeners to go to health centers for VCT.

Although Annie takes pride in knowing her status and encourages others in her village to do so, her husband refuses to go for testing. This motivates Annie to continue returning to confirm her negative status.

Halida Akhter receiving the United Nations Population Award in 2006.

Bangladesh, which is situated in a resource poor setting with a population of over 150 million, faces the major health challenge of a high maternal mortality rate. In the 1970s, the maternal mortality rate was 700 deaths per 100,000, and now it is still at 320 per 100,000. Although Bangladesh has made progress in reducing its infant mortality, much progress needs to be made to reach the Millennium Development Goals for maternal mortality. Bangladesh will need more than five years to achieve the goals. The Global Health Initiative (GHI) will help address the major health challenges women face in Bangladesh. Bangladesh has successful models of collaboration and public-private partnerships to share with other countries.

This blog post was co-written with Morsi Mansour. Joan and Morsi are leadership development specialists in MSH’s Center for Leadership and Management.

Students in Uganda participate in a leadership development program during their pre-service medical training.

How can we empower the front-line of health care managers and service providers in the developing world?

As the Leadership, Management and Sustainability Program completes five years, it is an important moment to sum up what we have learned about sustainability and to reflect on how local ownership of health improvement programs supports sustainability of health results.

At the First Global Symposium on Health Systems Research in Montreux, Switzerland in November, Dr. Yogesh Rajkotia, of USAID Rwanda, moderated a panel discussion noting that Performance-Based Financing (PBF) is an effective health systems strengthening strategy. The presentations were made on behalf of the Rwandan Ministry of Health with the guidance of Dr. Agnes Binagwaho, Permanent Secretary.

In 2000, Rwanda’s health system was perceived as weak: there were human resources shortages, especially in rural areas; poor quality of services; and a high morbidity/mortality rate of women and children. Since 2001, Rwanda has committed itself to better health and to pushing for achievement of the Millennium Development Goals (MDG) by 2015.

PBF is a powerful means for increasing the quantity and quality of health services by providing incentives to health providers to improve performance. A PBF program typically includes performance-based grants or contracts. Health clinics and their staff are rewarded for reaching or exceeding health indicators.