May 2013

Makasi after two months of tuberculosis treatment. {Photo credit: A. Massimba/MSH.}Photo credit: A. Massimba/MSH.

With less than 1000 days until the Millennium Development Goals expire, the process for setting post-2015 goals continues to ramp up.  We take this opportunity to reflect on the current state of community health systems in low- and middle-income countries and consider how the post-2015 agenda could reshape them—perhaps dramatically.

Community health systems today

Integration moves ahead

Poor and rural communities in low- and middle-income countries are leaving behind the “one clinic, one service” approach. So-called vertical programs, which organized resources according to single health conditions, created a patchwork of health services at the community level. You could get HIV care from one provider, but would have to go down the hall, down the street, or often much farther to get maternal health care or malaria care.

{Photo credit: KNCV/TB CARE I}Photo credit: KNCV/TB CARE I

TB CARE I Indonesia, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and Indonesia’s National TB Program (NTP) organized a mass-mobilization World TB Day event on March 24, 2013, called "Run 4 TB".

This 5K race drew thousands of runners, bikers, walkers, and observers.

(Photo credits: KNCV/TB CARE I)

DRC. {Photo credit: Warren Zelman}Photo credit: Warren Zelman

Millions of girls in developing nations will avoid getting a deadly form of cancer---cervical cancer---due to a major drop in costs for two vaccines against cervical cancer. Merck and GlaxoSmithKline announced May 9 that costs for the vaccines against human papillomavirus (HPV) would be cut to below $5 per dose.

Over 275,000 women die from cervical cancer per year in poor countries.

Merck’s Gardasil vaccine will cost $4.50 per dose and GlaxoSmithKline’s Cervarix will cost $4.60 per dose. The costs were negotiated through the GAVI Alliance (see infographic).

This is welcome news, with cancers and other chronic diseases becoming one of global health’s biggest challenges, moving towards the post-Millennium Development Goals era.

Teams of national and regional HIV program managers work together to discuss the issue: “Where will the next new infections come from?” {Photo credit: BLC/MSH.}Photo credit: BLC/MSH.

This post originally appeared on the Southern Africa HIV and AIDS Regional Exchange (SHARE) blog.

"All the people we need to make a difference in HIV globally are sitting in this room," said Paul Waibale, deputy director of the Building Local Capacity Project (BLC) for the Delivery of HIV Services in Southern Africa, during the opening of the Southern African Development Community (SADC) HIV prevention workshop, "New evidence, new thinking."

With funding from USAID, the week-long workshop on enhancing national and regional approaches to HIV prevention kicked off April 8, 2013, with 32 of Swaziland's key stakeholders in HIV prevention.

The Supply Chain Management Subgroup of the Community Case Management (CCM) Taskforce is organizing a webinar series, beginning May 15, 2013.

Hosted by the CORE Group, the May 15 webinar will "provide an overview of the common pitfalls and bottlenecks of the CCM supply chain and potential solutions to these challenges."

Jane Briggs, principal technical advisor for USAID's Systems for Improved Access to Pharmaceuticals and Services (SIAPS) at MSH, and Sarah Andersson, a country technical advisor for the Bill & Melinda Gates Foundation's Supply Chain for Community Case Management (SC4CCM) at John Snow, Inc. (JSI), will present.

Visit the CORE Group website for the webinar link, or (if you miss it) to watch the recording.

In a couple of days, thousands of decision-makers, leaders, advocates, health professionals, media, and more will gather to focus on our most valuable investment: women and girls.

We are honored to be a Gold Sponsor and Advisory Group member of Women Deliver 2013. Over 30 staff members representing 10 countries will participate in the conference by speaking, moderating, leading, and learning together with the 5,000 attendees in Kuala Lumpur.

For over 40 years, MSH has worked shoulder-to-shoulder in partnership with over 150 countries---currently in over 65---saving lives and improving the health of women, girls, men, and boys. Our programs empower women; sensitize men; and integrate maternal, newborn, and child health, family planning and reproductive health, and HIV & AIDS services to improve access to quality care and, ultimately, save lives.

{Photo credit: Dominic Chavez}Photo credit: Dominic Chavez

(This post has also appeared on the Bill & Melinda Gates Foundation blog, Impatient Optimists and on the blog of the Frontline Health Workers Coalition.)

Our MSH colleague Lucy Sakala was an HIV counselor in Malawi. She worked with clients who were receiving HIV tests. When clients were diagnosed HIV positive, many were eligible for treatment and could begin antiretroviral therapy. HIV care had become available in Malawi because of transformative efforts to reduce ARV prices and increase their availability, such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, TB and Malaria.

A girl in the Democratic Republic of Congo {Photo credit: Warren Zelman}Photo credit: Warren Zelman

All involved with women’s health and gender wish that access to quality health care for women and girls was easy to achieve at scale. But the attitudes and expectations of many societies limit women’s and girls’ access to resources and skills associated with better health. And health-related vulnerabilities and poor outcomes for women and girls have social and financial costs that hamper the consistency and quality of available health services. 

To advocate for universal health coverage (UHC), and help countries achieve this worthy goal, health leaders, managers, and those who govern must work to end social biases and gender-based discrimination--whether deliberate or unintended. 

Among other things, health leaders must support the hiring and promotion of women; advocate for gender-sensitive employment and working conditions; help to reduce women’s out-of-pocket healthcare payments (that are generally higher than men’s due in part to the high costs of newborn deliveries and reproductive health services); adjust clinic hours to accommodate women and girls’ mobility constraints; and consider how even unexpected health provider bias can make female clients hesitate to seek the services they need in a timely fashion.