Health Systems Strengthening

Health Systems Strengthening (HSS)
Pfizer Global Health Fellow, Megan Montgomery, and Peter Mmbago, Human Resources for Health Advisor for TSSP, interview a health care provider in Bagamoyo, Tanzania.

Meet Megan Montgomery, one of two impressive Pfizer Global Health Fellows currently working with MSH in Tanzania. This international corporate volunteer program places Pfizer colleagues in short-term fellowships with international development organizations. Megan is lending her skills and expertise in marketing and business strategy to MSH’s Technical Support Services Project (TSSP) in Tanzania, which provides assistance to the Ministry of Health in key technical areas to help control the HIV epidemic and sustain HIV-related health systems and services. 

How are you supporting the TSSP project in Tanzania?

My main focus while here is partnering with the team to strengthen the health system in Tanzania through human resources for health (HRH) activities, such as the implementation of task-sharing initiatives, recruitment, retention and productivity management, as well as developing communication pieces to share the work being accomplished.  

Can you explain what task sharing for HIV services looks like in this context? 

{A secretary records the weekly collection amounts for a savings and internal lending group in Madagascar. Photo credit: Samy Rakotoniaina/MSH}A secretary records the weekly collection amounts for a savings and internal lending group in Madagascar. Photo credit: Samy Rakotoniaina/MSH

By Amy LiebermanJenny Lei Ravelo

This story was originally published by Devex

The onus to help everyone — including the most marginalized — secure universal health care coverage will likely depend more on individual government spending than on new foreign assistance, experts say.

Funding will be a critical, but not guaranteed, element in the forthcoming universal health coverage agreement governments will sign in September during the opening of the U.N. General Assembly session.

“Aid is not going to help achieve the global health goals. It has to come from domestic spending. But aid is very important for purposes of equity and that the poor do not get left behind.”— Jacob Hughes, senior director of health systems, Management Sciences for Health

Peter Mbago, TSSP Principal Technical Advisor, Human Resources for Health and Megan Montgomery, Pfizer Global Health Fellow interview health care workers at Kaole Dispensary in Bagamoyo District to better understand training needs and provider motivations.

By Megan Montgomery

Tanzania needs more health care workers. Its workforce is only 44%1 of the required staff, per its national human resources for health plan. This shortage is more dire in rural areas, where 80%2 of the country’s population lives, as well as among mid-level health care workers. Hospitals are often filled beyond capacity, as they must also take referrals from less well-equipped facilities. Patients sometimes share beds or sleep on the floor, and health care workers struggle to provide patients with the care they need.

The Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC) has begun a number of initiatives to help ease gaps and improve health services, particularly for the 1.5 million3 people estimated to be living with HIV in Tanzania. One initiative, called task sharing, aims to enable lower level health care providers to perform tasks that would typically be outside their scope of responsibilities. This frees up staff with higher-level skills to focus on more complicated cases and help a greater number of patients receive timely, quality care.

“The shortage of staff makes task sharing a necessity,” said Restituta Kushaba, assistant nursing officer at Bagamoyo District Hospital. “It plays a major role in helping the patients.”

{Photo credit: Julius Kasujja}Photo credit: Julius Kasujja

This op-ed was originally published in The Hill.

Along with the Ebola outbreak that’s already infected more than 1,600 people, the Democratic Republic of the Congo (DRC) is fighting another battle: An epidemic of fear and mistrust. Community members are afraid to seek treatment, including a promising experimental vaccine.

Meet Hortense Kossou, Principal Technical Advisor for the USAID-funded Integrated Health Services Activity (IHSA) in Benin. Hortense previously served as the national malaria coordinator for the Ministry of Health in Benin and today leads IHSA’s malaria-related activities on the ground. In this issue of Leading Voices, she presents the challenges that the country faces in its fight against malaria and the actions being taken to combat it.

Malaria is the leading cause of mortality among children under five and morbidity among adults in Benin. How has the landscape changed since you first began working at the MOH in 1997?

There have been many changes between the 1990s and today. The Ministry of Health has implemented the newest technological innovations: for example, it has gone from providing untreated mosquito nets to providing long-lasting, insecticide-treated nets. Changes were also made to increase access to these products. Nets were first provided only to the most vulnerable groups, such as children under five; nowadays, there is broader coverage that includes all members of the population.

{Health Surveillance Assistant (Community Health Worker) recording data in health card at outreach clinic, Mulanje, Malawi, ONSE Health Activity} Health Surveillance Assistant (Community Health Worker) recording data in health card at outreach clinic, Mulanje, Malawi, ONSE Health Activity

This article was originally published by Global Health Now.

Paid or volunteer?

Community health workers are on the frontlines in many countries—and vital to achieving universal health coverage. Yet the public health community has not reached a consensus on which model is the best.

Consensus is urgently needed, both at the global and country levels, to inform future policies and strategies for strengthening health systems and delivering on UHC.

Based on our experiences in rural Peru and Ethiopia, it’s not either-or. It’s both.

Full-time, paid CHWs form the backbone of family- and community-based services, but there aren’t enough to reach all families. We envision teams of government-paid, full-time CHWs providing comprehensive services to a given population, with a primary health center hub as the base of operations. Each CHW, in turn, would lead a team of part-time community health volunteers providing limited health education and referral services—such as maternal and newborn health, nutrition, hygiene, tuberculosis, malaria, and HIV/AIDS—to a small number of neighboring families.

{Nurse Gabriella Oroma welcomes patients at Ngetta Health Centre in Uganda, where drug-resistant TB is treated. Photo credit: Sarah Lagot/MSH}Nurse Gabriella Oroma welcomes patients at Ngetta Health Centre in Uganda, where drug-resistant TB is treated. Photo credit: Sarah Lagot/MSH
By Dr. Ersin Topcuoglu
 
This op-ed was originally published in The Hill.
 
{Hawa Coulibaly Kone leads a workshop with partner NGO YA-G-TU to develop its strategic plan. Photo credit: MSH}Hawa Coulibaly Kone leads a workshop with partner NGO YA-G-TU to develop its strategic plan. Photo credit: MSH

Meet Hawa Coulibaly Kone, capacity building advisor and the representative on gender for the USAID-funded Keneya Jemu Kan (KJK) Project in Mali. Most recently, Hawa helped conduct a situational gender analysis of the KJK project and its partner organizations to assess the level of gender integration in the project design, implementation, and monitoring framework. The analysis found that KJK’s work with local partners across the country enabled the project to strengthen its institutional capacity in gender at the policy and programmatic levels and to respond to gender-related challenges.

We caught up with Hawa to learn more about how she and her team are working to break down barriers for women and build mutual trust among the project’s local partner organizations in Mali.

Tell us about your role and daily work on the KJK project in Mali

I joined the KJK project in August 2015. At first, it was a small team of two, myself and Hammouda, the senior technical advisor. I assisted in all activities, from developing plans and budgets to supporting activities for partners.

{Hospital pharmacy in Antananarivo, Madagascar. Photo Credit: Warren Zelman}Hospital pharmacy in Antananarivo, Madagascar. Photo Credit: Warren Zelman

This op-ed was originally published by Devex

Multidrug-resistant germs are spreading. A number of antibiotics and other antimicrobials already don’t work as they should, and as many as 700,000 people die each year because of it.

If we don’t act to contain antimicrobial resistance, it may kill up to 10 million more people yearly by 2050 and cumulatively cost patients and health systems across the globe up to $100 trillion. This crisis may start to seem insurmountable, like a vague scientific problem with no apparent solution. Many of us have contributed to it, and each of us will need to collaborate — as nations, organizations, and individuals — to solve it.

“Without tackling wasteful, inefficient, and irrational use of antimicrobials, we cannot contain AMR.” — Mohan Joshi, a principal technical adviser for Management Sciences for Health 

Photos by: Samy Rakotoniaina/MSH

In Malawi, over 80% of people live in rural areas. For many (10%), the nearest health center is more than 8 kilometers (5 miles) away, making it difficult to access health care regularly. The USAID-funded Organized Network of Services for Everyone’s (ONSE) Health Activity, led by Management Sciences for Health, works to improve quality and access to care in rural communities.

“Before we had a village clinic, we were struggling. For every little sickness, we had to rush to the hospital, especially with our small children.” – Assan Symon, Mitawa village health committee chairperson

Stanley Liyaya, a heath surveillance assistant (HSA), is one of 3,500 community health workers trained to manage childhood illnesses in rural communities. HSAs have improved access to care and treatment of childhood illness to help Malawi reduce the under-five child mortality rate by 73% between 1990 and 2015, achieving Millennium Development Goal 4. Malawi’s vision is that by 2021, all young children will be treated for common illnesses promptly in their own communities.

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