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Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.Originally known as SITE-TB, Sistema TMBR is the official platform for drug resistant TB monitoring and treatment in Brazil.

In the 1990s many Brazilian patients infected with tuberculosis (TB) were not being cured, despite starting treatment. Some patients stopped taking their medication, which led to the reemergence of TB. In 1993, the World Health Organization declared that TB was a global emergency. Eventually, a multi-resistant strain of TB surfaced, making it even more difficult to fight the disease.

These occurrences --- referred to as “chronic cases” --- became apparent in some Brazilian states, but health units lacked standardized management systems to treat these cases of TB.

Centro de Referência Professor Hélio Fraga (CRPHF), which is Brazil's National Tuberculosis Reference Laboratory, took control of TB surveillance in 1994. CRPHF defined a more effective treatment scheme and a national network to register and monitor the chronic cases in 1999. CRPHF builds human capacity through training and carries out operational and epidemiological studies. They also evaluate TB and other lung disease control activities and function as a Macro Regional Reference Lab.

Uganda's Koboko health center IV store: Left, boxes of medicine and supplies piled in a store room before the SURE program's capacity building training. Right, Lebu Akim, stores assistant, in the newly organized medicine and supplies room. {Photo credits: Jimmy Ondoma/MSH.}Photo credits: Jimmy Ondoma/MSH.

Over the years, the Koboko health centre IV located in the West Nile region of Uganda has experienced challenges in the management of essential medicines and health supplies. Stock-outs of vital medicines were widespread, while huge quantities of slow-moving medicines were at risk of expiring. These problems were attributed to health workers’ poor skills in logistics management. In addition, there a was lack of reliable information to guide staff on when and what to order since stock cards were not regularly updated.

In July 2011, USAID's Securing Ugandans’ Right to Essential Medicines (SURE) program, led by Management Sciences for Health (MSH), began capacity-building activities aimed at strengthening essential medicines and health supplies systems at health facilities in the region. SURE has used the supervision, performance assessment, and recognition approach in 45 districts in Uganda. This approach involves mentoring and coaching pharmacy and stores’ staff at private not-for-profit and public health facilities in medicines management.

Dr. Sima Samar speaking on 'How to advance women's rights in developing countries.' {Photo from World Bank webcast, March 5, 2012.}Photo from World Bank webcast, March 5, 2012.

On Monday, March 5, 2012, everyone from policymakers to students gathered at the World Bank for a Special Event on the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and Women’s Rights.

CEDAW is a treaty that has been ratified worldwide by all but six countries --- the United States, Iran, Sudan, Somalia, and two small Pacific Island nations (Palau and Tonga).

The event was hosted by Caroline Anstey, Managing Director of the World Bank, in conjunction with the Nordic Trust Fund, The Leadership Conference Education Fund, and the United Nations Foundation.

Video that highlights the work of thousands of Tanzanians---mostly women---working as accredited community drug sellers operating in rural areas.Video that highlights the work of thousands of Tanzanians---mostly women---working as accredited community drug sellers operating in rural areas.

Today is International Women’s Day, celebrated around the world as an opportunity to look back on women’s accomplishments and look forward to the realization of their full economic, political, and social rights. The United Nations theme for this year, “Empowering Rural Women,” is one that resonates powerfully with MSH’s work.

A midwife in Wau, South Sudan. {Photo credit: MSH.}Photo credit: MSH.

Josephine, a wife and mother of six living in rural Uganda, tried to soothe her 3-year-old daughter. The girl was suffering from diarrhea and a high fever and her crying filled the home. Recognizing that the girl's health was in danger, Josephine summoned the courage to ask her husband for permission to take their second-youngest child to the local health facility unit -- and pleaded for money to cover the travel and treatment expenses.

Requesting permission from her husband to travel to the facility was not her only choice, however: choosing to take her daughter for treatment also meant leaving her other children -- including her youngest -- unattended at home. Once at the health center, she continued to navigate the challenging road to treatment for her daughter, communicating her situation to the health providers and negotiating the financial and provider aspects of the health center system, without assistance. Relieved and exhausted, Josephine returned home safely with her daughter, oral rehydration salts, and knowledge.

Recognizing women leaders

What makes a person in the health system a good leader? Who determines that he or she is a leader? How do we empower leaders to improve the health of those around them?

Mbambu, a midwife at a western Ugandan health center. {Photo credit: MSH.}Photo credit: MSH.

Mbambu is a midwife who works at Isole Health Center III in rural Western Uganda. When I had the opportunity to visit with her, she was the only health care provider at the center. Trained as a midwife nine years ago, her passion for her job pours out of her. Since primary school, becoming a midwife "was always my mission,” she said.

A little over a year ago, Mbambu was trained in family planning and reproductive health skills by STRIDES for Family Health, a USAID-funded program in Uganda led by MSH. Prior to the training, the health center could only offer education and basic family planning services.

Now Mbambu educates women who are waiting to have their children immunized or receive antenatal treatment about family planning, healthy spacing and timing of pregnancies, and the benefits of delivering at a health center. Her new skills also empower her to administer basic and long-term family planning services.

Mbambu shared a compelling story that I promised I would share with others:

Lelo PHCU staff treat the young patient. {Photo credit: MSH.}Photo credit: MSH.

"Diktor! Diktor!" The urgent call for a doctor came from several school boys who had run to the facility. I glanced over and saw a boy about 12 years old tensely sit down in the waiting patio at Lelo Primary Health Care Unit in South Sudan.

Women learning about family planning at Bikone Health Center II, Western Uganda. {Photo credit: MSH.}Photo credit: MSH.

This was my first trip to Africa working with a development agency. While I had visited the African continent for personal trips previously, arriving in this context felt different. I was immediately aware of the challenges Uganda is facing. From the crumbling road infrastructure and high incidence of traffic accidents in Kampala, to the mobile phone networks that are pretty reliable while internet access is often spotty, to the prevalence of street children --- I can for the first time see what my local colleagues are up against.

I felt a bit overwhelmed in the first few days. Is there any way we can address all these challenges? Can we make a difference?

Visiting communities and health centers in Kampala, Eastern and Western Uganda -- and seeing first-hand the impact MSH is having across the country -- quickly re-inspired me.

I had the pleasure of meeting a particularly passionate and committed Clinical Officer, Rodger Rwehandika, at Bikone Health Center II in Western Uganda. As a health center II, Bikone is an outpatient facility, but the staff of the facility can also conduct outreach programs to educate and serve the community.

Rodger and his two staff facilitate health education programs at the local schools and also host youth-friendly programs on using condoms.

"Are family planning methods safe?” wondered Mutombo, a community health worker at the Kawama Village Health Center, in the Democratic Republic of Congo’s Katanga Province. {Photo credit: MSH.}Photo credit: MSH.

Cross-posted on USAID's IMPACT blog.

“Don’t they contain a poison?” he added, directing his question to Isaac Chishesa, a community mobilization specialist with USAID’s Democratic Republic of Congo-Integrated Health Project (DRC-IHP).

Tough question! One Isaac was not expecting, at least not within a discussion among trained community health workers.

An experienced community health professional, Isaac responded with a smile and said, “Thank you, my friend, for sharing your concern,” affirming the participants’ right to ask questions. “Family planning methods are safe,” he reassured the group. “Based on international quality standards, each method is required to go through extensive testing before it is made available to the public.”

The faces of Mutombo and his peers lit up. They sighed, a collective sigh of relief, and burst out laughing to relieve some of the tension. They all recognized that even though they were dedicated to bringing about improvements in health behaviors, they, like most of their fellow community members, harbored misconceptions and rumors about family planning.

"On this World Cancer Day, we celebrate the remarkable progress in prevention, detection, care and treatment of cancer. Overall, treatment success has increased dramatically, with survival rates in high income countries like the U.S. now reaching over 90 percent for certain cancers such as breast, prostate, and testicular for patients with access to treatment. But this life-giving progress has yet to reach most of the world's people, who live in developing countries, where over half of new cases and nearly two thirds of all cancer deaths occur. Unforgivably, there is a huge "cancer divide" between rich and poor.

This year's World Cancer Day theme set by the Union for International Cancer Control (UICC) -- "together it is possible"-- calls on all individuals, organizations and governments to do their part to reduce premature deaths from cancers by 25 percent by 2025.

But there have been four myths that have held back cancer care and control in developing countries. On this World Cancer Day, let's start a global pink revolution to replace the myths with truths and the complacency with action."

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