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{Photo credit: MSH.}Photo credit: MSH.

Policy makers and health sector leaders in low- and middle-income countries are recognizing the value of smart governance for significant and sustained gains in health status outcomes. The new USAID Leadership, Management and Governance (LMG) project, led by MSH with a consortium of partners, is actively engaged in building the capacity and competencies of those expected to accomplish smart governance.

To explore smart governance, LMG convened a Roundtable on Governance for Health in low- and middle-income countries May 18, 2012, at The Brookings Institution in Washington DC.

Three Afghan children. {Photo credit: MSH.}Photo credit: MSH.

About 7.6 million children under age five die each year of preventable causers; 3 million — 40 percent — are newborns (under 28 days old). Ninety-nine percent of these occur in developing countries; three-quarters are mainly due to preventable causes such as neonatal conditions, pneumonia, diarrhea, malaria, and measles. Many of these under-five deaths could be averted by known, affordable, low-technology interventions.

Any preventable child death is one too many.

Here are 10 important interventions for child survival --- a list that is by no means exhaustive:

  1. Exclusive breastfeeding

    Could keep 1.3 million infants from dying (including by preventing pneumonia)

  2. Long-lasting, insecticide-treated bednets

    Would save more than 500,000 children by preventing malaria

  3. Vaccines, such as PCV, Hib, and rotavirus

    Would help prevent common childhood illnesses, such as measles, and save children’s lives

  4. Micronutrient supplements, such as vitamin A and zinc

    Would fight malnutrition. (While not a direct cause of death, malnutrition contributes indirectly to more than one-third of these deaths.)

Sophia is now the go-to person for family planning and reproductive health services at Rwesande health center IV in western Uganda. {Photo credit: M. Hartley/MSH.}Photo credit: M. Hartley/MSH.

Sophia is a humble woman. She has been working as a nurse for 10 years, and is currently one of five nurses posted at Rwesande health center IV in the hills of western Uganda.

When I arrived I was impressed by the number of services the health center offers, and the general appreciation felt around the compound. Rwesande health center IV has a maternity ward to safely deliver babies; counseling areas for family planning, reproductive health, and HIV; a general ward, a surgery theater, and health education space.

Family planning counseling and services now available

As Sophia shows me her meticulously-kept record books I can see the pride she takes in her work. She explained how women are now coming and asking for family planning services.

Not too long ago clients were not coming, and the nurses didn’t have proper training on methods to offer clients.

While global health and policy efforts to protect young girls from early or forced marriage are increasing, millions of girls are forced into early marriage every year. Pictured: four Senegalese girls. {Photo credit: S. Galdos/MSH.}Photo credit: S. Galdos/MSH.

If you think that child marriage is not an issue in the twenty-first century, think again.  In developing countries, 82 million girls who are now ages 10 to 17 will be married before their 18th birthday. Over the past decade, 58 million girls in developing countries -- one in three -- have been married under the age of 18; 15 million -- one in nine -- were married by age 15.

These girls are often married against their will, despite national laws that prohibit marriage until the age of 18, and numerous international declarations, conventions, and global conferences that “guarantee” the rights of girls, like the Universal Declaration of Human Rights.

Senate Passes Preventing Child Marriage Act

Child marriage is increasingly becoming a hot topic within the realm of global health -- and influencing U.S. domestic and global policy.

The International Protecting Girls by Preventing Child Marriage Act (S. 414) -- reintroduced in the U.S. Congress in February 2011 --- passed on the Senate floor by way of voice vote on May 24, 2012. (The bill also passed the Senate unanimously in December 2010.)

Scott Kellerman, around age 5. {Photo courtesy of S. Kellerman.}Photo courtesy of S. Kellerman.

The prevention of mother-to-child transmission (PMTCT) of HIV is taking center stage this week during USAID’s 5th Birthday campaign -- and rightly so.  Preventing mother to child transmission of HIV is one of the most critical, effective tools to helping kids reach their fifth birthdays.

Arifa leads a computer class at FACT in Guyana. {Photo credit: MSH.}Photo credit: MSH.

When Arifa arrived in August 2010 at Family Awareness Consciousness Togetherness (FACT), a USAID-funded non-governmental organization (NGO) that receives technical support from the MSH-led GHARP II Project, it was immediately evident that she had major communication challenges. At age 17, Arifa found it difficult to have even brief conversations with anyone.

The Berbice Technical Institute had sent Arifa to FACT as a work-study student for a two-month term. At the time, she was studying for a Certificate in Information Technology (IT).

FACT assigned Arifa to be an assistant teacher in their computer program with 40 orphans and vulnerable children (OVC), ages twelve to fifteen. Most of the time, Arifa could be found sitting in a corner all alone. When she did speak, the children made fun of her.

The NCD Alliance announced today that delegates at the 65th World Health Assembly are likely to pass a historic target on chronic non-communicable diseases (NCDs) tomorrow, May 26.

The NCD Alliance, a network of over 2,000 civil society organizations, including Management Sciences for Health, urged delegates to "support comprehensive Global Monitoring Framework and Targets; support the establishment of a Global Coordinating Platform on NCDs; and put NCDs at the heart of the post-2015 development agenda."

Civil society call to action on universal health coverage.Civil society call to action on universal health coverage.

At the 65th World Health Assembly this week, Management Sciences for Health (MSH) and civil society organizations from three continents launched a joint call to action on universal health coverage (UHC). The statement -- initiated by Action for Global Health, Centre for Health & Social Services (CHeSS), Doctors of the WorldMedicus Mundi InternationalOxfamSave the Children, and MSH -- calls on political and world leaders, governments and ministries of health, and civil society to take a stand for UHC.

Three women gather outside a Tanzanian health center. {Photo credit: M. Paydos/MSH.}Photo credit: M. Paydos/MSH.

The 65th World Health Assembly is convening this week in Geneva, beginning May 21. For six days, the Assembly will focus the world’s attention on chronic non-communicable diseases (NCDs), universal health coverage, mental disorders, nutrition and adolescent pregnancy, among other health issues.

This is the second time in less than a year that chronic NCDs --- such as cancer, cardiovascular disease, diabetes and lung diseases --- are in the international spotlight. Last fall, the High Level Summit on Non-Communicable Diseases convened in New York, when, for only the second time in the history of the United Nations, a high level summit focused on a global health concern.

Ms. Apegnon Akpene, a family planning client and role model, in Diguegue. {Photo credit: Niagia Santuah/MSH.}Photo credit: Niagia Santuah/MSH.

Apegnon Akpene is a 20-year-old mother of three children: four-year-old Joseph, two-year-old Romance, and one-month-old Akou Jacqeline. Since attending USAID's Action for West Africa Region, Phase II (AWARE II)  community health worker training, she has become a client of family planning -- and a role model for family planning in her community.

Akpene is one of three community health workers in Diguegue, a small village of about 800 people in the hills of the southwestern forest separating Togo and Ghana. Distance and difficult terrain are major hindrances to accessing health care for the inhabitants of the village. Diguegue is 47 kilometers from the nearest health facility, a small clinic, in the Prefecture of Tchifama. The village is served by a 12-kilometer dirt road that winds through the thick forest.

Akpene attended school for eight years. When she became pregnant at age 16, she was forced to drop out. She gave birth to three children within four years.

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