Health Systems Strengthening

This article was first published on the Brookings Institute Future Development Blog, found here.

When epidemics or pandemics hit, they usually hit the poor first and worst. We have known this for a while. The German pathologist Rudolf Virchow described this link between poverty and vulnerability to outbreaks in his 1848 study of a typhus epidemic in Upper Silesia: "For there can now no longer be any doubt that such an epidemic dissemination of typhus had only been possible under the wretched conditions of life that poverty and lack of culture had created in Upper Silesia."

What we have not known, until recently, is how best to help the poor protect themselves from pandemics.

To understand why the poor are more vulnerable to epidemics and pandemics and what protections are required, we need to consider how outbreaks first start, how they spread, and how they affect individuals and societies.

How health workers use technology to combat illness

Treatments for diseases like tuberculosis (TB) and HIV are lengthy and complex. Medications need to be taken regularly and for extended periods. Interruptions come at a high cost for patients, their families, and the health systems that treat them. 

Over the past several years, professionals across a range of disciplines have focused on creating solutions at all levels of the health system. From a tool that helps governments calculate the economic cost of medicine stock-outs to a piece of software that allows doctors across Ukraine to follow a patient’s complex TB treatment, technology can play a critical role in bringing solutions to scale and making significant progress in the age-old fight against deadly diseases. 

Here are two examples of how MSH is helping health workers use computers to fight back.

For many people living in poor and underserved regions – whether rural communities or growing cities – midwives are the health system.

Midwives play a vital role for women during pregnancy and childbirth, but their care expands much more than that. Midwives provide solutions that ensure girls and women have access to a comprehensive range of services promoting their right to physical and mental health. They provide family planning and reproductive health services and care for newborns and young children not only at health facilities but also in communities. They deliver the respectful and excellent quality of care that can prevent more than 80 percent of all maternal deaths, stillbirths, and newborn deaths worldwide.

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Some 13.5 million people desperately require humanitarian assistance in Syria, which includes access to essential medicines and other pharmaceutical products. Managing a sound supply chain is challenging in the best of circumstances—and in a crisis like this, there are many potential pitfalls and little room for error.

That becomes clear when health workers from relief organizations talk about their work in the country. The large number of displaced persons fleeing the conflict and the unstable, dangerous conditions in Syria require a tight strategy and concerted international effort to deliver vaccines, medical products and devices, and medicines. 

First, there are the painstaking tasks of procuring supplies, including negotiating prices, estimating consumption rates, and quantifying stock—all against the backdrop of a situation in flux. Items shipped across the border require a specific type of sealing and more than a year of shelf life. Stock needs to be transported and stored in temperature-controlled trucks.

As the Trump Administration released its truncated global health budget last week, ministers of health, members of civil society and the private sector, and government delegations met in Geneva for the annual World Health Assembly to discuss programs that exemplify the value of foreign assistance and its tangible effect on families in some of the poorest countries. In advance of the meeting, MSH released position statements on WHA agenda items. Dozens of governments led by Germany and South Africa, signed the Global Compact for Universal Health Coverage 2030 committing to make affordable and quality healthcare accessible for all. This year’s WHA was particularly historic with the nomination of the WHO’s first African Director-General, Dr.

It is early afternoon in the village of Kanjuwale at the foot of Nguluyanawambe Mountain in central Malawi. Charlene Chisema, a community mobilization officer, asks a group of local women about best antenatal care (ANC) practices.

“It should start early – in the first months,” said one woman.

“You need four visits,” said another.

“Great!” said Chisema, who works with the Organized Network of Services for Everyone’s (ONSE) Health Activity. “How many ANC visits did you all have during your last pregnancy?”

Silence.

Suddenly, a frail woman with a baby on her lap stood up, wiped a tear from her face, and said, “I will not return to ANC.”  

The women looked shocked – they were not used to such candid talk.

“Thank you for being honest,” said Chisema, leaning forward with an encouraging smile.  “Please tell us why.”

One Project in Ethiopia Shows Us That Investing in Health Systems Pays Dividends 

Over the past five years, the Ethiopian government and MSH have been working shoulder to shoulder to improve and expand the country’s tuberculosis services with the goal of alleviating the burden of the disease.

If you wonder whether foreign assistance is money well spent, just look at the remarkable progress we’ve made in Ethiopia, where only a few years ago the stock out rate for TB drugs was as high as 20 percent. That number today is about two percent.

Our tuberculosis work in Ethiopia supported 55 million people between 2010 and 2016. During that period, we improved case detection, diagnosis, and treatment mechanisms; strengthened the laboratory capacity of more than 2,000 facilities to diagnose TB; improved the supply management of TB drugs; and trained tens of thousands of health workers at all levels of the health system.

The upside is not just the thousands of lives saved or improved, but the strengthening of a health system that is now better equipped not only to respond to TB, but also to other diseases, therefore helping the people of Ethiopia live healthier lives, contribute to their economy, and make their country a more stable and peaceful place to live.