Fragile States

Fragile States (including Afghanistan, Democratic Republic of Congo, Haiti, Liberia and South Sudan)
 {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 credit: MSH staff}Irene Koek of USAID’s Global Health Bureau gives closing remarks at the health security side event in Geneva.Photo credit: MSH staff

This is the second in a new series on improving the health of the poorest and most vulnerable women, girls, families, and communities by prioritizing prevention and preparing health systems for epidemics (read Part 1). Join the conversation online with hashtag .

World Health Assembly and Beyond: Advancing the Global Health Security Agenda

Outbreaks are inevitable. Epidemics are preventable.

Last month, the No More Epidemics campaign convened a high-level, multi-sectoral panel on the Global Health Security Agenda during the 69th World Health Assembly (WHA69) in Geneva, Switzerland.

{Photos: Warren Zelman (left); Associated Press/Aurelie Marrier d’Unienvil (right)}Photos: Warren Zelman (left); Associated Press/Aurelie Marrier d’Unienvil (right)

This is the first in a new series on improving the health of the poorest and most vulnerable women, girls, families, and communities by prioritizing prevention and preparing health systems for epidemics. Join the conversation online with hashtag .

Prioritizing prevention of regional epidemics and global pandemics

{Photo: Warren Zelman}Photo: Warren Zelman

Last month, MSH President & CEO, Jonathan D. Quick, MD, MPH, urged G7 leaders (Huffington Post Impact) meeting in Ise-Shima, Japan, to prioritize pandemic prevention:

 {Photo credit: Rebecca Weaver/MSH} bit.ly/msh_May2016Photo credit: Rebecca Weaver/MSH

MSH is a worldwide leader in strengthening health care financing systems toward universal health coverage (UHC). Stronger systems. Stronger women and children.

MSH has made tremendous impact on health care financing and UHC in the last two decades.

Performance-based financing

In 1999, MSH pioneered performance-based financing in Haiti, and has continued to adapt and improve upon it since. We contributed to and supported Rwanda to design, implement, and achieve UHC through community-based health insurance and performance-based financing; drastically reduce maternal and child mortality; and meet all of its health Millennium Development Goals.

In Democratic Republic of the Congo, we contributed to drastic reductions in child mortality and some of the greatest results-based financing outcomes in two decades.

Altogether, we've designed and/or implemented performance-based financing interventions in 14 countries across 3 continents (sub-Saharan Africa, Latin America, and South-East Asia).

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

This post appears in its entirety on HuffPost Impact.

Pandemics are back on the agenda for the 2016 G7 Summit, which convenes this week in Ise-Shima, Japan. The Group of Seven is expected to further its commitments to global health security.

Look what has happened in less than one year since the G7 last met (June 2015), just after the Ebola crisis peaked at over 26,300 cases, 10,900 deaths.

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

There are no magic bullets in life. For fixing a healthcare system, though, there is one approach that comes close: results-based financing. Management Sciences for Health (MSH) pioneered results-based financing in Haiti in 1999, and has been adapting and improving it ever since in sub-Saharan Africa, Latin America, and South-East Asia, including in fragile states.

In my 20-plus years in global health, I’ve seen what happens without results-based financing: A major donor sends millions of dollars’ worth of equipment and supplies to a developing country—and the quality of health services delivered doesn’t improve—or worse, it declines. Why?

Health providers are human, like all of us—sensitive to incentives, motivation, and demotivation. Say a hospital improves and now is well stocked: the community realizes this and the utilization rate doubles. Suddenly, a nurse may be facing 40 patients a day instead of 20, but without any added pay or assistance. It’s only natural he or she might work less under the crushing workload.

{Photo credit: Rui Pires}Photo credit: Rui Pires

Are you interested in health systems strengthening for the Sustainable Development Goals (SDGs), epidemics prevention, and global health security? Join MSH at these events during the 69th World Health Assembly in Geneva. Can't join us in person? Join the conversation online with hashtag . On Twitter, follow , , , and .

 {Photo credit: Associated Press/Aurelie Marrier d’Unienvil}Women celebrate as their country is declared Ebola free in the city of Freetown, Sierra Leone, Saturday, Nov. 7, 2015.Photo credit: Associated Press/Aurelie Marrier d’Unienvil

When 18-year-old Ianka Barbosa was 7 months pregnant, an ultrasound showed the baby had an abnormally small head, a dreaded sign of microcephaly due to Zika infection.  Upon hearing the news, Ianka’s husband fled. In her poor neighborhood of Campina Grande, Brazil, Ianka soon became a young mother alone.

As Ianka’s baby Sophia grows, she may never walk, or talk. She could develop seizures before she reaches six months.  By the end of the year there may be a staggering 3,000 Sophias in Brazil – mostly in the poorest places.

Epidemics erase the gains women have achieved.

The world has suffered a series of “Zikas”—virtually unknown diseases that seemed to come from nowhere and explode with devastating consequences for families and entire countries – before Zika, Ebola, SARS, AIDS, and others.

Epidemics don’t just leave behind a death toll.  They can demolish the gains women have made in maternal, newborn, child, adolescent, and reproductive health—gains that have been propelled by women’s rights and empowerment. 

SCMS supported local partners in 25 countries to build country ownership of supply chain management. Read more about SCMS’s impact in its report: 10 Years of Supporting PEPFAR through Stronger Public Health Supply Chains

By Sherif Mowafy

[Chantal, an HIV-positive woman, waits for her monthly supply of antiretroviral medication at the Hôpital Immaculée Conception in Haiti.] {Photo credit: Jean Jacques Augustin, SCMS}Chantal, an HIV-positive woman, waits for her monthly supply of antiretroviral medication at the Hôpital Immaculée Conception in Haiti.Photo credit: Jean Jacques Augustin, SCMSAs the warm Haitian sun comes up, Chantal leaves her four children behind to get her HIV treatment, traveling for three hours in the back of a crowded jeep.

She bumps over unpaved roads to her monthly visit for antiretrovirals, one that she has been doing routinely for several years to keep her disease at bay.

Her children don’t know that she is HIV positive, and she doesn’t want to tell them. She makes this long trip over rough and ragged terrain to preserve her privacy and escape the possibility of stigma, still prevalent in Haitian society.

 {Photo credit: Rebecca Weaver/MSH}A community health worker in Democratic Republic of the Congo.Photo credit: Rebecca Weaver/MSH

This Global Health Impact issue highlights community health and community health workers, and presents a glimpse of MSH's work at the community level, in partnership with national ministries of health, civil society organizations, the private sector, and more.

The community is the center of the health system in developing countries.

Throughout sub-Saharan Africa, community health workers, often volunteers, represent the foundation of the health system, addressing priority health areas ranging from maternal and newborn health to family planning and infection prevention. The community health worker (known by different names in different countries) is the fundamental frontline promoter, provider of services and medicines (through integrated community case management), and the one who refers and links beneficiaries with more complex health needs to facilities. Not only do community health workers extend access to health services for the underserved and those living in hard-to-reach or conflict-ridden areas, they help countries accelerate certain health outcomes and achieve the Sustainable Development Goals and related targets for universal health coverage.

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