Health Systems Strengthening

Health Systems Strengthening (HSS)
Antibiotics are commonly used in animals to boost their growth and keep them from picking up infections.

Their consensus was inevitable. As the 74th World Health Assembly (WHA) discussed a solution in May to contain the grave and growing threat of antimicrobial resistance (AMR), one mandate emerged: any action must take a multisectoral One Health approach to human, animal, and environmental health. 

Antibiotics are commonly used in animals – often without the input of veterinarians – to boost their growth and keep them from picking up infections. Estimates indicate that more than 70% of the antimicrobials sold globally are used in animals, and in some countries up to 80%, mostly for growth promotion. This indiscriminate antimicrobial use fuels resistance. 

A health worker in Madagascar prepares to deliver the COVID-19 vaccine. Photo credit: Samy Rakotoniaina/MSH

by Wade Warren and Marian W. Wentworth

This post originally appeared on the Next Billion website. 

As the world takes action to overcome the COVID-19 pandemic in low- and middle-income countries (LMICs), we are reminded of the effectiveness of vaccination for many routine childhood diseases. According to the World Health Organization, routine vaccination prevents 4 to 5 million deaths each year, a testament to the success of vaccine programs and the commitment of stakeholders, including GAVIUSAID and country governments.

Ugandan dairy farmer Tonny Kidega takes a keen interest in preventing antimicrobial resistance (AMR) in his country. Photo credit: Tony Kidega.

This article was originally published by Health Policy Watch 

Dairy farmer Tonny Kidega is passionate about his cattle and his country’s health systems – and has been championing the importance of limiting the use of antibiotics to curb the development of drug-resistant “superbugs” and antimicrobial resistance (AMR).

Based in the Gulu district in northern Uganda, Kidega is a veterinarian and the Managing Director of the Gulu Uganda Country Dairy Limited.

He is also a firm supporter of Uganda’s new national action plan to eliminate the use of unnecessary antibiotics in livestock farming, which is the main driver of drug resistance – which could mean that common antibiotic medicines will no longer work on humans or animals.

“If I am reckless and I do not follow the procedures within my milk production value chain, and it gets antimicrobial residues, AMR will continue in the system,” said Kidega.

As COVID-19 began to spread around the globe in March 2020, drug supplies — ironically — shrank, because of the pandemic’s impact on global supply chains. 

Chinese factories, which produce about 70% of the active pharmaceutical ingredients (APIs) that Indian drug manufacturers use, were shuttered during China’s severe lockdown early last year. Much of the world relies on India’s exports of 26 key generic drugs and drug ingredients, but without raw ingredients, India was forced to restrict its pharmaceutical exports, which account for one fifth (in volume) of the world’s exports of generics

{Photo Credit: Fabrice Duhal}Photo Credit: Fabrice Duhal

La résistance aux antimicrobiens (RAM) est une menace importante pour la Côte d’Ivoire et qui nécessite des mesures rapides pour la contenir. Pour ne citer qu’un exemple, la résistance moyenne à l’amoxicilline est passée de 73,7% en 2012 à 87,3% en 2017 , ce qui montre que la résistance à cet antibiotique fréquemment utilisé est importante et en augmentation dans le pays. Cependant, depuis plusieurs années et à la suite de l’évaluation externe conjointe de l’Organisation mondiale de la Santé (OMS) en 2016, la Côte d’Ivoire a pris des mesures fortes afin de lutter contre la RAM. Dans cet entretien, Professeur Mireille Dosso, Présidente du Groupe de Coordination Multisectorielle pour la Résistance aux Antimicrobiens et Directrice de l’Institut Pasteur de Côte d’Ivoire parle des efforts effectués par la Côte d’Ivoire ainsi que les défis et les priorités pour contenir la RAM.

{Photo credit: Samy Rakotoniaina/MSH}Photo credit: Samy Rakotoniaina/MSH

Read this story on USAID's Exposure page. 


Tsiraiky Abotono has never taken a vacation. 

Day after day, for 15 years, he has kept watch over his village, Andravindahy, in southwest Madagascar. Abotono, 56, is one of the thousands of community health volunteers who provide basic health care services to the country’s rural areas.

His absence would be missed. To reach a health center, people would have to walk for two hours across cactus fields under a burning sun. 

“It can be a challenge when I’m busy with personal duties and have to leave the village. The population relies on me entirely for health matters,” Abotono says. 

{A woman visits the pharmacy at Hopital Methodiste in Dabou, Cote D'Ivoire. Photo Credit: Fabrice Duhal}A woman visits the pharmacy at Hopital Methodiste in Dabou, Cote D'Ivoire. Photo Credit: Fabrice Duhal

To read this article in French, please click here.

Antimicrobial resistance (AMR) is a major threat in Côte d’Ivoire and requires rapid measures to contain it.

For example, the average resistance to amoxicillin rose from 73.7% in 2012 to 87.3% in 2017 (Report of the Observatoire des résistances des microorganismes aux antiinfectieux en Côte d’Ivoire (Observatory on the resistance of microorganisms to anti-infectives in Côte d’Ivoire) for 2017). This shows that resistance to this commonly used antibiotic is very high and rising in the country.

However, in recent years and following the World Health Organization (WHO) Joint External Evaluation in the country in 2016, Côte d’Ivoire has forged ahead with strategic measures to advance its fight against AMR.

{Photo credit: Samy Rakotoniaina/MSH}Photo credit: Samy Rakotoniaina/MSH

As the COVID-19 pandemic continues to impact communities worldwide, several vaccines have been authorized for emergency use in various countries, with many more in the final stage of clinical trials. The successful deployment of a COVID-19 vaccine has the potential to eradicate the global coronavirus pandemic, but the task is challenging. COVAX, co-led by Gavi, the Coalition for Epidemic Preparedness Innovations, and the World Health Organization (WHO), was established to accelerate the development and manufacture of COVID-19 vaccines and to guarantee fair and equitable access for every country. However, for governments, making decisions on COVID-19 vaccine options and deployment poses complex challenges. Success will depend on how key essential components of the vaccine introduction process are planned, implemented, monitored, and evaluated.

A health care worker trains a colleague in Agbowo Primary Health Care Center in Oyo State, Nigeria. Photo credit: Taiwo Olarinde/MSH

Even as we battle COVID-19, there are new challenges in our ongoing struggle to eradicate malaria.

The pandemic is causing major disruptions in health services due to lockdowns, budget crunches, and anxious health workers. Imperial College London estimates that malaria deaths over the next five years may increase by up to 36%. We’re also fighting complacency. In many countries, cases have levelled off rather than declining; in some, the disease is on the rise. 

Health facility staff set up an outdoor waiting area at Divine Grace Medical Center, Philippines. Photo credit: MSH staff

Originally published in Think Global Health

The colossal undertaking that is the global rollout of COVID-19 vaccines is facing another gargantuan challenge: monitoring their safety over time.

The vaccines have proven to be safe and effective in clinical trials. Yet as with the rollout of any new medicine or treatment, it takes time to see the bigger picture. Clinical trials, including those for the COVID-19 vaccines, follow thousands of volunteers from a limited population for several months. Now billions of people all over the world will be inoculated with them, with a lifetime of consequences. Even as policymakers and experts communicate the benefits of the vaccines to win over the hesitant, we must monitor for unwelcome side effects. If these adverse events are not documented and publicly addressed, they can further undermine public confidence in the vaccines, and scientific medicine more generally. And right now, there are big blind spots in our global ability to do this.


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