July 2016

 {Photo credit: Cindy Shiner/MSH}A mother waits for the nurse to vaccinate her baby during an immunization clinic at Phebe Hospital in central Liberia.Photo credit: Cindy Shiner/MSH

Stronger health systems are critical to preventing outbreaks from becoming epidemics. In fragile states, systems already weakened by conflict, disaster, or instability can crumble under the weight of an outbreak -- devastating access, availability, and quality of basic health for women and their families.

{Photo: MSH staff/Tanzania}Photo: MSH staff/Tanzania

Invest in teenage girls. Change the world.

Sylvia, age 16, knew little about HIV & AIDS or reproductive health when she started primary school. Now, she says: “I am not scared by the pressure from boys and other girls to engage in early sex, I know my rights and am determined to fulfill my vision of completing my education.” Sylvia is one of 485 girls in 6 eastern Ugandan schools who received integrated sexual and reproductive health and HIV information.

Today, July 11, we commemorate World Population Day 2016 and the midpoint toward reaching the Family Planning 2020 (FP2020) goal to ensure the right of 120 million additional women and girls to access contraception. More than half of the 7 billion people on earth are under the age of 30. Most of the FP2020 focus countries are in the very regions of the world where we find (a) the highest population of youth and (b) more marginalized and disenfranchised young people. In many of the world's poorest countries, people aged 15 to 29 will continue to comprise about half of the population for the next four decades.

{Photo credit: MSH staff, South Africa}Photo credit: MSH staff, South Africa

This post, first published on The Huffington Post, is part 5 in the MSH series on improving the health of the poorest and most vulnerable women, children, and communities by prioritizing prevention and preparing health systems for epidemics. Join the conversation online with hashtag .

Struck with a prolonged and worsening illness, Faith, a 37-year-old Nairobi woman raising her two children, sought help from local clinics. She came away each time with no diagnosis and occasionally an absurdly useless packet of antihistamines. Finally, a friend urged her to get an HIV test. When it came back positive, Faith wanted to kill herself, and got hold of a poison.

All epidemics arise from weak health systems, like the one that failed to serve Faith. Where people are poor and health systems are under-resourced, diseases like AIDS, Yellow Fever, Ebola, TB, Zika, Malaria, steadily march the afflicted to an early grave, decimating families, communities and economies along the way.

Aster, a grandmother living with diabetes and TB, invited MSH to accompany her on a visit to the pharmacy at the local hospital in Debre Markos, Ethiopia.

written by Daphne Northrop, video by Emily Judem

DEBRE MARKOS, Ethiopia — A dozen people crowd a small outside window at Debre Markos Hospital, jostling each other, angling to get to the pharmacist who might have the medicine they need. They have already waited in two other lines, one to get their bills, another to pay. An elderly man coughs uncontrollably. One mother with malaria walked two miles to the clinic, three children in tow. The pharmacist shouts to be heard over the racket.

Ultimately, some of these patients receive their medication. Others are too late; the stock bin is empty. Still others may have departed with just one of the several medicines prescribed to them.

written by Daphne Northrop, video by Emily Judem

Nairobi, Kenya — Faith had been ill for months. She didn’t know what was wrong, and her visits to several Nairobi clinics were futile. No diagnosis. No relief. All she got were antihistamines.

“My health continued to deteriorate. I was weak and I did not know what I was suffering from. I could not go to work,” she says.

A friend urged her to get an HIV test. She was 31 and had two daughters. The test came back positive.

“I was traumatized. I wanted to commit suicide.” 

Late one night she came perilously close. She had the poison on hand. But something stopped her.

“I looked at my kids,” she says, her eyes pained with the memory. “I felt sorry for them, because there would be no one to take care of them. They needed me more.”

MSH Vice President, Pharmaceuticals & Health Technologies Group, Dr. Douglas Keene, tells Devex how strong governance enables access to medicines.MSH Vice President, Pharmaceuticals & Health Technologies Group, Dr. Douglas Keene, tells Devex how strong governance enables access to medicines.

This week, Management Sciences for Health (MSH) and Devex are talking about how to maximize the impact of access to medicines in low- and middle-income countries. Below are excerpts, descriptions, videos, and links to the conversation. See the full conversation on Access to Medicines.

By strengthening governance and promoting transparency, developing countries can be better equipped to regulate the flow of medicines and support their efficient and effective use. Countries could make much progress by assuring the quality of medicines, but what is really being achieved in practice?

Recent global crises such as Ebola and Zika have revealed the dangers of weak health systems. As countries work to strengthen these systems, Dr. Douglas Keene, vice president of the pharmaceuticals & health technologies group at MSH, advises policymakers to first start by addressing existing regulations and governance.

Saving lives and improving health continues long after diagnosing disease or delivering medicines.

(Watch Faith tell her story)

Faith had been ill for months. She was 31 and had two daughters. She didn’t know what was wrong. A friend urged her to get an HIV test; it came back positive.

Faith started on antiretroviral treatment.

But, in 2013, one of her antiretroviral medicines started to work against her, causing misshapen fat deposits to develop on her body.

When she finally mustered the courage to speak up one year later, her doctor knew just what to do and shifted her to a different medicine.

(Medicine Movers: Kenya from Management Sciences for Health on Vimeo)

Faith didn’t know it, but her report to the doctor became part of a nationwide database that tracks adverse drug reactions, and poor quality or expired medicines.