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

Seven-year-old Makasi, an HIV-positive orphan in Tanzania, was diagnosed with advanced tuberculosis (TB) and started on curative treatment. Clinicians at a local health center used standardized TB guidelines to overcome the difficulty of identifying TB in children co-infected with other diseases. In Afghanistan, sixteen-year-old Hamida provides for her family while trying to complete school. Hamida was visited by a community health worker, who identified her TB symptoms, and helped her access appropriate diagnosis and treatment.

Steady Progress Against Daunting Challenges

Tuberculosis mortality has fallen by a third since 1990. Yet TB is still the second leading cause of death from infectious disease worldwide. The vast majority of new cases (8.8 million in 2010) and deaths (1.1 million in 2010) occur in poorer countries. TB’s effects are often most devastating among people in fragile circumstances. Poverty and conflict push people into crowded, unsanitary conditions without appropriate nutrition and health care.

Even more, TB is fast spreading, easy to misdiagnose, often co-morbid with other diseases, and, increasingly, highly drug-resistant.

Esther manages commodity supplies with meticulous record keeping {Photo credit: Y. Otieno/MSH.}Photo credit: Y. Otieno/MSH.

This is the advice that Esther Wahome, a registered community health nurse in a Kenyan health facility, gives to her clients when they come to the tuberculosis (TB) clinic. Within a short time, Esther dispenses the drugs to the patient, provides health care advice and updates her records.

Esther’s TB clinic clients are usually referred to Kayole II sub-district hospital from Toto Bora and other smaller health care centers. Kayole II, located on the outskirts of Nairobi, provides free health services and receives nearly 300 outpatients each day.

During a routine supervisory visit conducted by the USAID-funded, MSH-led, Health Commodities and Services Management (HCSM) Program, Esther, a mother of two, spoke about her work at the Kayole II TB Clinic, which she has been running for the last three months.

“I like serving in the TB clinic because I get to see patients who are weak regain their strength. Sometimes the patients come in when they are so weak and close to skin and bones that at times I wonder where to inject them. Seeing patients thrive fulfills me and is my joy,” says a smiling Esther.

Nehema Bubake, seen recovering here at the Kaziba General Reference Hospital, is full of optimism now that her fistula has been repaired. {Photo credit: MSH.}Photo credit: MSH.

In the Democratic Republic of Congo, many women suffer complications during pregnancy and delivery, including obstetric fistula. Prolonged labor may result in a hole (“fistula”) between a woman’s birth canal and bladder or lower intestine, resulting in chronic leaking of urine or feces. This, in turn, leads to social isolation as the women can’t keep themselves clean, are ashamed of their condition, and withdraw from society. Many women and their families believe that this condition is due to a curse, leading to further separation from the community.

World Contraception Day 2012World Contraception Day 2012

Cross-posted on the K4Health blog. K4Health is a USAID project, led by Johns Hopkins Bloomberg School of Public Health's Center for Communication Programs (JHU-CCP), with partners FHI-360 and Management Sciences for Health (MSH).

Worldwide 222 million women have an unmet need for modern contraceptives. That means of those women wanting to delay or prevent pregnancy, 222 million are not using contraceptives.

This number is burned into my brain: 222 million. Let’s put this in perspective.

Currently in the US, there are roughly 156 million women, so the number of women worldwide without access to contraceptives is greater than the entire population of women in the US.

An Accredited Drug Dispensing Outlets (ADDOs) dispenser in Tanzania, an example of a successful, scale-able public-private sector collaboration. {Photo credit: MSH.}Photo credit: MSH.

Chronic diseases --- notably cancers, cardiovascular diseases, chronic lung diseases, and diabetes --- now account for nearly 35 million deaths annually. The human and economic burden of chronic diseases are staggering, especially in developing countries. Left unchecked, by 2030 the epidemic will kill twice as many people in low- and middle-income countries as it does today.

One year ago, the world came together to address this emerging global epidemic. Country representatives, policy makers, and civil society convened in New York for the United Nations (UN) High-Level Meeting on Non-Communicable Diseases (NCDs), and the UN General Assembly adopted a declaration, promising to strengthen and accelerate the response.

A tray of supplies, including household vinegar, used for screening patients. Masufu Hospital, Uganda. {Photo credit: M. Miller/MSH.}Photo credit: M. Miller/MSH.

Using a basic household item like vinegar to screen for a deadly disease is one of those "Aha!" solutions that will save lives. I had never imagined that I’d get to see the procedure in action.

Cervical cancer kills some 250,000 women every year -- over 80 percent from low-income countries, according to the World Health Organization (WHO). Early diagnosis can save lives, but many health facilities in developing countries struggle to find a way to screen women in remote, overcrowded settings. Last year, The New York Times talked about the success of using vinegar as a cervical cancer diagnostic method in Thailand, and yesterday SHOTS, NPR's health blog documented its life-saving use in Botswana.

Bolivian nurses. {Photo credit: MSH.}Photo credit: MSH.

Building local capacity is a pillar of the United States Agency for International Development's USAID Forward reforms. This post is one example of how USAID worked through Management Sciences for Health (MSH) to build, nurture, and support a local development stakeholder that is still thriving today. The story was written by global health writer John Donnelly, and first appeared in MSH’s book Go to the People in 2011. Cross-posted on Modernize Aid in the Modernizing Foreign Assistance Network (MFAN) blog field feedback series.

Uganda. {Photo credit: Paydos/MSH.}Photo credit: Paydos/MSH.

The Ugandan government launched a new prevention of mother-to-child HIV transmission (PMTCT) strategy on September 12.

Uganda will transition from an approach based on the World Health Organization's (WHO) Option A --- which is contingent on an HIV-positive pregnant woman’s CD4 count --- to WHO's newest PMTCT strategy, Option B+.

Option B+ — whereby HIV-positive pregnant women receive lifelong treatment, regardless of their CD4 levels — originated in 2010 when the Malawian government decided to combine antiretroviral therapy (ART) with PMTCT in response to the challenges of providing reliable CD4 testing in remote settings.

The WHO updated its PMTCT guidelines with Option B+ in April of this year.

A temporary bin shelter improves medical waste management. {Photo credit: MSH.}Photo credit: MSH.

After the meeting, I meet Francinah, a 24-year-old district environmental health technician. In a soft voice, she tells me that as part of the QIL program, she worked with her own hospital and with the nearby Xhosa clinic to address the issue of waste management. With help from the support team, they convinced the government department in charge of construction to build a shelter to protect household and medical waste bins from the elements, curious people, and animals before it could be safely disposed of.

Earlier that morning, she received confirmation that the department was procuring materials to build the shelter.

Meanwhile, the clinic has sourced fencing and roofing materials to construct a temporary shelter. Later that afternoon, I visit the clinic to see the temporary shelter; it serves the purpose for now, but needs to be upgraded.

I observe in sympathy as a staff member hesitates over the electronic planning and monitoring tool that the support team suggests to him. He admits that it would make work easier for him but he is clearly more comfortable with his hand written notes on a notepad. I speculate that perhaps his reluctance is due to uncertainty about using the technology, and perhaps a slow typing speed. I am hopeful that by the end of the accreditation process, he will be confidently using all the tools and technology.

Health workers listen during the Mahalapye Hospital staff meeting, Botswana. {Photo credit: MSH/}Photo credit: MSH/

“J’mappelle Mompati. Comment t’appelles tu?”

Overcoming my confusion at being greeted by a French-speaking man in Botswana, I smile, take his proffered hand and reply in my rusty, stilted French, “J’mappelle Naume...”

Mompati is Mahalapye Hospital’s dynamic public relations officer. Now that he has my full attention, Mompati wastes no time in telling me about his work linking the hospital and the surrounding community through events and the media. We exchange contacts and he hands me a few copies of his newsletter before dashing off to his duties.

Mahalapye is a small town in the Central District of Botswana on the edge of the Kalahari Desert. Situated along the main road between the capital, Gaborone, and the second largest city, Francistown, Mahalapye is a convenient stopover place.

The hospital has been recently renovated and serves 300 outpatients a day and up to 200 inpatients.

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