Health Systems Strengthening

Dr. Mark Dybul, MSH’s newest board member, has been a leader in global health policy as Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria during the Obama administration and as head of the US President's Emergency Plan for AIDS Relief (PEPFAR) during the Bush administration. Dybul is Professor of Medicine and Faculty Co-Director of the Center for Global Health and Quality at Georgetown University Medical Center. He brings tremendous experience and insight into MSH’s work to strengthen systems that improve the health of the world’s most vulnerable populations, including those living with HIV.

As we prepare for the 22nd International AIDS Conference, we sat down with Dybul to discuss the fight against HIV and AIDS, the need for strong systems to support a more effective and sustainable response, and how we must leverage those systems beyond HIV to improve health more broadly. 

Mark Dybul: Building Systems for Health to End HIV and AIDS

This interview was edited for length and clarity.

By providing compassionate and culturally appropriate care to women throughout their reproductive life, trained and supported midwives are critical to closing the gaps in human resources for health and helping to reduce maternal and newborn deaths. Gloria Flores, a licensed nurse and perinatal specialist from Morelos state, Mexico, is working to improve the quality of care moms and babies receive and to help mainstream professional midwifery practice at the primary health care level.

Gloria Flores, licensed nurse and perinatal specialist in Morelos state, MexicoWith the support of the John D. and Catherine T. MacArthur Foundation, the FCI Program of MSH is helping to build the policy and advocacy skills of midwives like Gloria Flores, further equipping them to become advocates and leaders in the health system. The International Confederation of Midwives (ICM) interviewed Flores to about some of the challenges she faces in her work and how she’s working to change the status quo around midwifery practice in Mexico.

Is the world safer today from the threat of infectious diseases than it was a generation ago?

It is true that we have more tools at our disposal: better surveillance and diagnostic systems, stronger frameworks and regulations, such as the Global Health Security Agenda and Joint External Evaluations (JEE), and a deeper understanding of how diseases spread and what is needed to stop them. It is also true that climate change, deforestation, population growth, and our proximity to farm and wild animals are making the threat of epidemics greater than ever before. Although the challenge is great, we have the knowledge to solve it. So what do we need to do?

This story was originally published on Devex

The World Health Organization recently issued a statement calling on all countries to make three specific commitments to universal health coverage and be prepared to announce them at the World Health Assembly, which begins May 21.

UHC — the assertion that every person must have access to the health services they need, when and where they need them, without facing financial hardship — improves health. But that’s not all: It reduces poverty, creates jobs, drives economic growth, promotes gender equality, and prevents epidemics. It’s a momentous occasion and a great opportunity to start making real progress toward UHC.

But unless country commitments include efforts to strengthen pharmaceutical systems, communities will continue to struggle with inadequate health services and rising health costs that put their health and economic well-being in peril.

Elimase Kamanga is a mother, a midwife for more than 15 years, and the Senior Technical Advisor for Maternal and Newborn Health for the USAID-funded Organized Network of Services for Everyone’s (ONSE) Health Activity, led by MSH. Chisomo Mdalla, ONSE’s Chief Communications and Knowledge Exchange Officer, talked with Kamanga about her work to improve the quality of care for mothers and newborns in Malawi. This interview was edited for length and clarity.

Elimase, can you tell us about how you got to where you are today?

It’s quite a long story. I grew up in a very poor family in a village near Kasungu, here in Malawi. But my mom still encouraged me to go to school. Even though I would go to school without shoes, without enough books, maybe even on an empty stomach, I still rose up to go to secondary school. I was also privileged to be selected by the government to go to the University of Malawi’s Kamuzu College of Nursing.

This story was originally published by Women Deliver.

In recent decades, a great deal of resources have been invested in the delivery of essential health services, especially through support to the six building blocks of strong health systems – health financing, health workforce, health information, health governance, medical products, and service delivery. These investments have been hugely important and effective in forming a foundation, supporting frontline health workers to save lives, and in securing unprecedented commitment to the common goal of achieving universal health coverage (UHC).

But the fact remains that over half the world’s population – women, children, and adolescents in particular - is still unable to access the high quality health services they need.

Women, children and adolescents remain underserved by health systems and suffer a disproportionate burden of morbidity and mortality, which endangers the broader well-being of the whole of society.

MSH’s newest Board Member, Dr. Bernard Nahlen, recently spoke with Thomas Hall, MSH’s Senior Principal Technical Advisor for Malaria, about reducing the malaria burden in developing countries most affected by the disease. Dr. Nahlen, Director of the University of Notre Dame’s Eck Institute for Global Health, has decades of experience in research and disease elimination programs worldwide. Prior to his recent appointment at the Eck Institute, Dr. Nahlen served as Deputy Coordinator of the US President’s Malaria Initiative from 2007 to 2017. From 2005 to 2006, he was Senior Advisor, Monitoring and Evaluation, at the Global Fund to Fight AIDS, Tuberculosis and Malaria.  

Antimicrobial resistance (AMR) occurs when a microorganism becomes resistant to a drug that was originally effective for treating the infections it caused. It is one of the world’s most pressing global health threats and could erode progress made thus far in the treatment of HIV/AIDS, TB, malaria, and many other infectious diseases.

Management Sciences for Health’s (MSH) role in combatting AMR was recently featured in the peer-reviewed journal, Global Public Health.

The article describes an approach used by the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program and its predecessors to build and strengthen coalitions to defeat AMR. SIAPS was implemented by MSH.

As the globe marks World Water Day on March 22, the Organized Network of Services for Everyone’s Health (ONSE) Activity has been supporting the Government of Malawi in responding to a months-long cholera epidemic.

ONSE, funded by the United States Agency for International Development and led by Management Sciences for Health (MSH), works in Malawi to reduce maternal, newborn, and child morbidity and mortality by focusing on health system strengthening; family planning and reproductive health; maternal, newborn, and child health; malaria; and water, sanitation, and hygiene (WASH).

The first cases of cholera began appearing in Malawi in November 2017. As of March 20, a total of 827 cases had been reported in 13 of country’s 28 districts. Twenty-six deaths have been reported, according to the Epidemiology Unit of the Directorate of Preventive Health Services at the Ministry of Health. Cholera is an infectious bacterial disease that is often transmitted through poor hygiene and contaminated food and water.

We’re excited to bring you this month’s edition of Leading Voices, a series that features the incredible talent that makes up MSH.

Can you name the biggest achievement that the TRACK-TB project has made in Uganda?

The TRACK-TB project improved TB control indicators in Kampala and rapidly scaled up MDR-TB programs from 3 to 15 facilities by the end of 2017. Patient enrollment and TB treatment outcomes were greatly improved.

What drives you?

I am motivated by good results, availability of efficient work tools, and a conducive work environment.

What do you think makes MSH different?

Its sound capacity and experience in building health systems.

Finish this sentence: Health is a

right and must be.

Anything about yourself that you colleagues may not know about?

I love reading and touring.