{Photo credit: Warren Zelman}Photo credit: Warren Zelman

COVID-19’s lethal invasion in late 2019 has turned the world inside out. Yet, another disease, tuberculosis, has been plaguing humans since the Upper Paleolithic era, some 20,000 years ago. In fact, many infection-prevention precautions promoted for the coronavirus—coughing etiquette, distancing, and hand washing—originated as TB-control measures in Victorian times. The COVID-19 response can draw on more challenges and lessons from TB programs that emphasize investments in research and rapid uptake of new diagnostic, prevention, and treatment tools for universal health coverage.

{Photo credit: MSH}Photo credit: MSH

by Barbara K. Timmons, PhD

Tuberculosis (TB) is the pandemic that won’t go away. This ancient disease, the leading infectious cause of death in the world, kills more than a million people every year. One-third of the world’s population lives with latent TB infection. Despite being a preventable and curable disease, TB has been difficult to eradicate in part because of the stigma around the infection, preventing people from getting tested and continuing treatment. 

Ethiopia is among the 30 countries with the highest burden of TB in the world. One TB patient in Eastern Ethiopia, a woman from the small city of Dire Dawa, told researchers from Management Sciences for Health (MSH), “My husband’s family stigmatized me a lot. Since they knew that I am a TB patient, they didn’t sleep in our house. They sleep outdoors. They are not also willing to eat with me. . . . Before I was infected with TB, our social life with other people was great. The social life of Dire Dawa community is well known. But after they knew that I am a TB patient, only one of my neighbors sometimes comes to visit me.”

A community volunteers provides free HIV tests at a local market in Eyokponung, Nigeria. Photo Credit: Gwenn Dubourthournieu/MSH

Following the economic recession of 2016, the Nigerian government developed an Economic Recovery and Growth Plan for 2017-2020 with three broad strategic objectives: restoring growth; investing in human capital; and building a globally competitive economy that achieves agriculture and food security, industrialization, improved transport infrastructures and energy sufficiency. Of these three objectives, one stands out: recognizing the importance of investing in human capital.

This represents a major shift by the government, as it previously focused mostly on developing infrastructure—a move that came at the expense of other sectors, including healthcare. Nigeria’s healthcare spending as a percentage of GDP remains one of the lowest in the world: about 0.6% of GDP in 2016, according to the World Bank. Per capita health spending by the Nigerian government is US$11, well below the recommended US$86 for low- and middle-income countries to deliver basic health services.

Photo Credit: Samy Rakotoniaina/MSH

This article was originally published in NextBillion.

What does scalable innovation in global health look like?

It could be a piece of software that provides faster access to blood supplies in Cameroon, an m-health platform that links virtual health coaches to people facing chronic illness in Nigeria, or an app that lets people use points to buy and exchange health products in Senegal, helping them save for out-of-pocket expenses. Or it might be a primary care service that reaches underserved people in India via telemedicine, or a microscope app that can diagnose breast and cervical cancers in remote areas in sub-Saharan Africa, where some 400,000 women die each year because they cannot access screening services.

{Participants during one of the trainings on the integrated support model for GBV survivors. Photo credit: Raphael Gnonlonfoun/IHSA}Participants during one of the trainings on the integrated support model for GBV survivors. Photo credit: Raphael Gnonlonfoun/IHSA

Meet Dr. Omer Adjibode, Gender-Based Violence (GBV) Advisor for the USAID-funded Integrated Health Services Activity (IHSA) in Benin. The purpose of IHSA is to strengthen local capacity for the delivery of high-impact malaria, family planning, maternal and child health (MCH), and GBV services with strong citizen engagement to reduce maternal, newborn, child, and adolescent girls’ mortality and morbidity.

In his role, Omer is responsible for defining strategies to improve care for GBV survivors. In this issue of Leading Voices, he talks about the virtual One Stop GBV center, an innovative resource for GBV survivors in Benin. According to national legislation in Benin, “GBV includes physical, moral, sexual or psychological violence, female genital mutilation, forced or arranged marriages, "honour" crimes and other practices harmful to women.”

Can you tell us more about how GBV is addressed in Benin? What are the key components of successful strategies or, on the contrary, some areas for improvement?

{Girls carry water to their homes in Mopti region, Mali. Photo credit: Debbo Alafia consortium/MSH}Girls carry water to their homes in Mopti region, Mali. Photo credit: Debbo Alafia consortium/MSH

In recent years, and following the coup in 2012, Mali has experienced increased political unrest and violence, especially in the country’s north and central regions. Coupled with droughts and flooding, the situation has resulted in a significant increase in forced internal migration. In the Mopti region, many health centers have closed, and health providers have fled to safer urban areas as a result.  

Such instability has had dire consequences for the health of rural communities there. Women and girls are particularly vulnerable due to power imbalances within the family, limited access to resources, and increased vulnerability to sexual and gender-based violence (SGBV). Sexual violence remains underreported due to insecurity and the stigmatization of survivors, making it more difficult to ensure care and services effectively reach those who experience such violence.

David Kaliisa, a TB community linkage facilitator in Kawempe, Kampala, checks on Celeb and her daughter. While both received treatment for multi-drug resistant TB, Kaliisa made regular house calls to support their adherence to treatment. Photo Credit: Diana Tumuhairwe/MSH.

This op-ed was originally published in The Hill.

{A woman receives depo-provera contraceptive method at Area 18 health center in Lilongwe District, Malawi. Photo credit: Rejoice Phiri/MSH}A woman receives depo-provera contraceptive method at Area 18 health center in Lilongwe District, Malawi. Photo credit: Rejoice Phiri/MSH

Program seeds providers in high-density health center

In July, 23-year old Esther walked a fair distance to Area 18, a health center in Malawi’s Lilongwe District, since no family planning services were available in her area. She has one child and wants to wait before having a second. At the health center, Esther joined a group counseling session where all family planning methods were presented. Afterwards, during individual counseling, she shared her desire to wait at least five years before becoming pregnant. Once informed of her options, including long-term reversible contraceptives, she chose to receive an intrauterine contraceptive device (IUCD), and had it inserted right away.

“I will tell my friends about the IUCD,” says Esther. “I know the truth about how it works. We need to be careful not to pay attention to the stories people tell.”

{A mother and child wait outside a clinic on the outskirts of Mbuji Mayi, Democratic Republic of the Congo. Photo credit: Warren Zelman}A mother and child wait outside a clinic on the outskirts of Mbuji Mayi, Democratic Republic of the Congo. Photo credit: Warren Zelman

In the face of conflict, natural disasters, or other crippling events, women disproportionately suffer from preventable illnesses and death. In such circumstances, women are more likely to experience gender-based violence, and they have more difficulty accessing basic health services, such as obstetric care and family planning. This was evident in the wake of the Ebola outbreak in West Africa, when maternal mortality rose sharply between 2013 and 2015; with the HIV epidemic, when rates of HIV among young women soared in sub-Saharan Africa; and with spikes in sexual and gender-based violence that occur during a humanitarian crisis.

{Photo credit: Rudi Thetard/MSH}Photo credit: Rudi Thetard/MSH

"There is a great joy when the family comes back to hospital wanting to show that their less than 1500g baby has now grown into a healthy newborn with no trace that they were premature. Sometimes we meet parents in the market place who keep appreciating our efforts in saving their premature babies... I appreciate it so much when babies are born in hospital so care can be initiated as soon as possible." - Chelmsford Gondwe, Registered Nurse Midwife

The USAID-funded Organized Network for Everyone’s Health (ONSE) Activity and lead implementer Management Sciences for Health joined the world to commemorate World Prematurity Day on November 17, 2019. This global movement seeks to raise awareness about prematurity, calling for the participation of everyone in the prevention and care of small and sick newborns to avert deaths. This year’s celebrations were under the theme “Born Too Soon: Providing the right care, at the right time, in the right place.”