Read the blog on the MTaPS websiteAs we mark Universal Health Coverage (UHC) Day this month, countries continue to battle the spread of COVID-19. The lack of effective treatments and testing capabilities at the onset of the pandemic was a stark reminder that access to safe and affordable medical products is key to achieving healthy outcomes. With more therapeutics and diagnostics becoming available, the preparedness of pharmaceutical systems to get medical products and services to people is particularly worrisome in low- and middle-income countries (LMICs).
COVID-19 has highlighted the need for long-term investments in regulatory systems to secure faster access to medical products. During a recent Livestream hosted by MSH and Deloitte, Professor Mojisola Christianah Adeyeye, Director General of Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC), emphasized the role regulatory agencies play in ensuring pharmaceutical system impact now and beyond the pandemic. One such breakthrough─local manufacturing─requires agencies shore up regulatory capacities and address challenges now. Prof. Adeyeye discusses how her agency supports the local manufacturing of medicines and prepares for the roll-out of vaccines against COVID-19.
COVID-19 will impact the prevention and treatment of many diseases, and there are particularly grim possibilities for tuberculosis (TB), which could set back our progress toward its elimination. Fortunately, our emphasis on strengthening local health systems is helping to build resilience against this kind of shock. We reached out to MSH technical experts leading three new global and national TB programs to learn what’s on their minds as their teams begin implementation under a COVID-19 reality. They all agree: COVID-19 reminds us why we cannot become complacent, and when it comes to the global fight to eliminate TB, it is no longer business as usual. Read what Ersin Topcuoglu, Daniel Gemechu, and Ehsanullah Darwish had to say about how we can fundamentally improve the way countries fight TB.
Low- and middle-income countries (LMICs) struggle to reach and sustain universal health coverage (UHC) due to limited and inefficient allocation of resources. Their health systems are strained by a dual burden—continuing to manage infectious diseases, such as HIV, TB, and malaria, while responding to the prevalence growth of noncommunicable diseases, such as diabetes and cardiovascular conditions. COVID-19 is placing even more demands on already stretched resources.
Originally published in Think Global HealthAs COVID-19 spreads across the world, falsified medicines for the novel coronavirus are leaking into Africa, where almost 19 percent of medicines are already substandard and where a number of countries are promoting untested treatments for the virus.
Until recently, “PPE” was an obscure acronym for many people, but now it has become a vital global commodity. Today, with the realities of COVID-19, health workers around the world are experiencing a troubling shortage of Personal Protective Equipment (PPE)—a mix of items including gloves, mask, aprons, and goggles that can help prevent disease transmission in health care settings. This shortage puts health workers in harm's way while trying to respond to the unrelenting COVID-19 pandemic.
Raian Amzad, a technical advisor with the DFID-funded Better Health in Bangladesh (BHB) project, and her colleagues took time away from their regular work to help Bangladesh’s central response to COVID-19. Here’s how the project and the country are handling the pandemic threat. Can you tell me about your recent work assignment related to COVID-19? What did your typical day look like?On March 17, the Directorate General of Health Services opened a temporary Integrated Control Room for COVID-19 response. Fifteen different groups are working there.
Originally published by Global Health NOWCOVID-19’s lethal invasion in late 2019 has turned the world inside out. Yet, another disease, tuberculosis, has been plaguing humans since the Upper Paleolithic era, some 20,000 years ago. In fact, many infection-prevention precautions promoted for the coronavirus—coughing etiquette, distancing, and hand washing—originated as TB-control measures in Victorian times.
Originally published by Scientific American“Rise of the superbugs.” “Global crisis.” “Nightmare bacteria.” “Deadly fungus.”The media has caught on to the dire threat that antimicrobial resistance (AMR) presents, and it has certainly captured the urgency of the situation.Global health professionals know this crisis has been years in the making and have been acting accordingly.
By Matthew Ziba
Many health facilities across Malawi don’t have enough trained pharmacy staff to adequately manage stock and dispense medicines. These tasks often fall on health care providers, who already have many other responsibilities, namely caring for patients. In some cases, even a ground laborer or a security guard—who may have no training in pharmacy management—must step in to help.
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.
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.
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.
In recent years, global health stakeholders have begun to recognize the profound potential that drug shops have to advance public health goals, such as those related to malaria diagnosis and treatment, child health, and family planning. These outlets, for reasons of convenience and cost, are the first choice of care for millions of people - and until recently, they have largely been ignored. “Drug shops and pharmacies are important sources of health care, particularly in rural areas or urban slums with few public clinics.
This story was originally published by SIAPS.Over its six years working in dozens of countries, SIAPS has carried out a vision for health system strengthening that USAID developed and has supported for more than two decades. In partnership with countries and organizations, the agency has led pharmaceutical systems strengthening interventions that have helped countries deliver affordable, quality-assured medicines and related products and services.SIAPS has had the privilege of carrying out significant tasks under the USAID mandate.
This story was originally published on the SIAPS Program homepage.
To be fully effective, health system strengthening projects should have sustainable impact and lay the groundwork for future progress. Here’s how SIAPS’ work supported health system reform in Ukraine.
Irrational medicine use and poor pharmaceutical management are widespread problems throughout all levels of Sierra Leone’s health system. Misuse, underuse, and overuse of medicines are particularly worrying because they contribute to the rise of antimicrobial resistance (AMR) and threaten the effective prevention and treatment of infections caused by bacteria, parasites, and viruses.
The Philippines has one of the highest TB burdens in the world—and 2.6% of its more than 286,000 new cases in 2015 were of multi-drug-resistant TB (MDR-TB). This threatens the progress the country has made in addressing the deadly disease over the past few decades and its goal to make the country TB-free by 2030. Further, MDR-TB cases will likely rise steadily in the Philippines and the world over the next two decades.
(Cross-posted on the Global Health Council website).
Between 2000 and 2015, great strides have been made in fighting malaria. Globally, malaria case incidences declined by 41% and mortality rates by 62%. However, approximately 212 million people were infected and 429,000 people died in 2015, with the majority being children under the age of 5 in sub-Saharan Africa. Malaria also places a great financial burden on individuals and health systems. In sub-Saharan Africa alone, the annual cost of case management related to malaria is estimated at USD 300 million.
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.
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.
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.
This post originally appeared on the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program blog as, "UHC Day 2016: Strong pharmaceutical management boosts access to essential medicines".
by Devex's Noa Gutterman and Management Sciences for Health
This summer, Devex partnered with Management Sciences for Health (MSH) to host Access to Medicines (#Access2Meds), a conversation that has analyzed and amplified the discussion on global access to medicines.
Over the last three weeks, #Access2Meds has examined major questions including: bringing medicines to the world
from communities to global policy -- innovations to access medicines underway
engaging the private sector for better health care delivery
This week, Devex and Management Sciences for Health (MSH) are discussing innovations for access to medicines in low- and middle-income countries. Public-private partnerships are key to ensuring innovations help medicines affordably reach the people who need them most.
From communities to global policy: Innovations to access to medicines underway
Saving lives and improving health continues long after diagnosing disease or delivering medicines.
(Watch Faith tell her story)
Faith had been ill for months. She was 31 and had two daughters. She didn’t know what was wrong. A friend urged her to get an HIV test; it came back positive.
Faith started on antiretroviral treatment.
But, in 2013, one of her antiretroviral medicines started to work against her, causing misshapen fat deposits to develop on her body.
Strong health systems are necessary to help prevent and mitigate epidemics, including the oft-overlooked epidemic of antimicrobial resistance. This is the third post 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 (see also: Part 1 and Part 2). Join the conversation online with hashtag #HealthSystems.
The Epidemic We Can See Coming: A Call to Act on Antimicrobial Resistance
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, 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.
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.
Many child deaths in developing countries are preventable: Children die from treatable conditions, such as pneumonia, diarrhea, and malaria, because families in rural, hard-to-reach, or conflict-ridden areas can’t access or afford the treatments. The Sustainable Development Goals (SDGs), launched in September 2015, set ambitious targets of ending preventable child deaths by 2030 and reducing mortality among children under age five to at least 25 per 1,000 live births.
Four-year-old Amina is why I work on malaria. I met her in Basse District, The Gambia, last year when I was visiting the team distributing lifesaving malaria treatment to children under five. Words can’t describe the feeling of seeing this young Gambian girl, who had been severely ill with malaria, now beaming with joy, literally running to me for her fourth treatment.
Cross-posted with permission from Devex.com.
The World Health Organization’s first global report on diabetes released this month highlights the disease’s “alarming surge” with rates that have quadrupled in fewer than three decades. The report reminds us that essential diabetes medicines and health technologies, including lifesaving insulin, are available in only one in three of the world’s poorest countries.
"Medicines are a key component of treatments to save lives"
~ Kwesi Eghan, trained Ghanian pharmacist and MSH portfolio manager for the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program in South Sudan and Afghanistan A child in Tanzania has a fever for three days. A pregnant woman in Namibia is taking antiretroviral therapy (ART) to treat HIV and prevent transmission of HIV to her baby. A man in Swaziland suffers from drug-resistant TB and struggles to adhere to treatment.
Medicines are a critical component of quality health care. In fact, most of the leading causes of death and disability in low- and middle-income countries could be prevented or treated with the appropriate use of affordable, effective medicines.Yet, about two billion people—one third of the world’s population—lack consistent access to essential medicines. Fake and substandard medicines exacerbate the problem. When these people fall ill and seek treatment, too often they end up with small quantities, high prices, poor quality, and the wrong drug.
In 2012, the United Nations unanimously passed a resolution endorsing the concept of universal health coverage (UHC), urging governments everywhere to “provide all people with access to affordable, quality health care services”. Management Sciences for Health (MSH) and the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program are among global champions for UHC and joined global leaders celebrating UHC’s notable inclusion in the Sustainable Development Goals (SDGs) last Fall.
Niranjan KonduriMotivated frontline health workers play a key role achieving global strategies to fight tuberculosis (TB), writes MSH Principal Technical Advisor Niranjan Konduri, of USAID's Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, for The Lancet Global Health Blog. Using the story of Irina Chaban, a Ukrainian TB doctor, as an example, Konduri highlights the challenges health workers in low- and middle-income countries must overcome while working to eradicate TB.
MSH's Douglas Keene, PharmD, MHS, Vice President, Pharmaceuticals & Health Technologies Group, was among the speakers at a recent event in Basel, Switzerland, hosted by Novartis, with representatives from NGOs, academia, and government discussing how to expand access to health in developing countries, including through the newly-launched program, Novartis Access. MSH is partnering on Novartis Access to help empower governments of low- and lower-middle-income countries to provide access to health for chronic diseases patients who need it most.
This blog post is a web-formatted version of the Global Health Impact newsletter: Stronger Health Systems Stop TB and Save Lives (December 2015). (View or share the email version here.) We welcome your feedback and questions in the comments or email us. On social media, use hashtag #GlobalHealthImpact and tag @MSHHealthImpact. Subscribe
An estimated two billion people worldwide are infected with mycobacterium tuberculosis, more commonly known as tuberculosis, or TB. Despite major successes reducing global TB prevalence and mortality rates, TB is the single greatest infectious disease killer globally, surpassing HIV & AIDS. In 2014, 1.5 million people died from TB, including about 400,000 who also had HIV.
This week, at the 46th Union World Conference on Lung Health (hashtag #WCLH2015), the US Agency for International Development (USAID)-funded and Management Sciences for Health (MSH)-led, Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program is launching a new tool to improve how the safety and effectiveness of medicines is monitored in low- and middle-income countries.
Picture a scenario where infections become totally untreatable because none of the available antimicrobial agents work. This is not imaginary, but is likely to happen very soon if we don’t act urgently, intensely, and consistently to tackle the rising tide of antimicrobial resistance (AMR).
This week, conference organizers announced that the anticipated 2015 International Conference on Family Planning (ICFP) in Nusa Dua, Indonesia would be postponed due to a volcanic ash cloud limiting air travel and presenting health concerns. We stand in solidarity with all those in the region. Although the conference is postponed, the family planning conversation must go on.
The Global Maternal and Newborn Health Conference held last week in Mexico City was an action-packed three days of presentations and conversations about state-of-the-art strategies to improve maternal and newborn health. Throughout it all, the following key themes stood out as critical for the post-2015 development agenda, particularly in the context of pursuing universal health coverage (UHC). Optimize health systems.
Novartis launched Novartis Access, a novel social business program, in collaboration with the Kenyan government, Management Sciences for Health (MSH), and other partners, on Thursday, October 15, at the Kenyatta National Hospital (KNH).
Novartis Access is an industry first: “a novel social business model that aims to deliver affordable medicines for non-communicable diseases (NCDs) also known as chronic disease in lower income countries”.
As the 70th United Nations General Assembly convenes later this week in New York, NY to endorse the 17 new Sustainable Development Goals (SDGs), Management Sciences for Health (MSH) is leading conversations on universal health coverage, resilient health systems, noncommunicable diseases (NCDs), partnerships, and women's and children's health.Stay tuned here and on Facebook for updates. For the latest on Twitter, follow @MSHHealthImpact and @MSHActs with hashtags: #UNGA2015, #CGI2015, and #GlobalGoals.
Management Sciences for Health (MSH) is pleased to announce the availability of the 2014 edition of the International Drug Price Indicator Guide. The Guide provides a spectrum of prices from 25 sources, including pharmaceutical suppliers, international development organizations, and government agencies.
Use the Guide to determine the probable cost of pharmaceutical products for programs, compare current prices paid to prices available on the international market, assess the potential financial impact of changes to a medicines list, and to support rational medicine use education.
In May 2015, the World Health Assembly discussed and endorsed a global action plan on antimicrobial resistance. The action plan sets five strategic objectives to promote better understanding of the threat of antimicrobial resistance, and to ensure the proper use and conservation of existing antimicrobials.
Just a few months ago, the province of KwaZulu Natal, South Africa, captured the world’s attention for unfortunate reasons: xenophobic attacks on foreign African nationals. This week, from June 9 to 12 in Durban, the same province is hosting the 7th South African AIDS conference, a gathering expected to bring together thousands of activists from within the country, the Southern African region and, indeed, the rest of the continent and the world, to “reflect, refocus, and renew” efforts in response to HIV and AIDS.
MSH's May 2015 newsletter highlights the global health impact of pharmaceutical management: Ensuring access to affordable, quality medicines saves lives (subscribe).
by Jonathan D. Quick, MD, MPH
Health care is largely dependent upon essential medicines for preventing infection, reducing pain, and treating illness. The development of effective medicines, however, is only the beginning.
Quality care means getting the right medicine, in the right dose, at an affordable price, for all the people who need it.
We spoke with MSH’s Chryste D. Best, BS, product quality assurance manager, The Partnership for Supply Chain Management (PFSCM), about her selection as one of the top 300 women leaders in global health by the Global Health Programme of the Graduate Institute of International and Development Studies in Geneva. Best provides innovative quality assurance oversight for the global procurement of medicines and commodities by MSH and partners.
The Partnership for Supply Chain Management (PFSCM), an organization formed through a partnership between Management Sciences for Health (MSH) and John Snow Research & Training Institute, Inc., (JSI R&T), uses an innovative consortium model that draws on the capabilities and experience of 13 internationally-renowned organizations. PFSCM harnesses this expertise to strengthen, develop and manage secure, reliable, cost-effective and sustainable supply chains to meet the needs of health care and other public services.
Antimicrobial resistance is a major threat to the long-term security of public health and has the potential to negatively impact our society. It is a serious and growing global health security risk, which needs to be prioritised at local and international levels.
Management Sciences for Health (MSH) sponsored a Congressional Staff Study Tour to South Africa and Zambia in February 2015 to examine the local impact of US funded health capacity strengthening in Southern Africa. During the trip, site visits and meetings highlighted the impact of local health capacity building efforts in pharmaceutical management of essential medicines and HIV & AIDS drugs and technical and managerial development opportunities for community workers.
Nearly three years ago, I blogged about a systems approach to improving access for a Maternal Health Task Force (MHTF) series on maternal health commodities: Increasing access to essential medicines and supplies for maternal health requires a systems approach that includes: improving governance of pharmaceutical systems, strengthening supply chain management, increasing the availability of information for decision-making, developing appropriate financing strategies and promoting rational use of medicines and supplies. It was an exciting year for maternal health.
The strengthening of health systems in low and middle income countries is central to the global effort to promote economic and social development through universal health coverage, reduce mortality, and improve health and sustainability of health care over the next 15 to 25 years.
In December 2013, Africa’s newest country, South Sudan, imploded with violence between government forces and a rebel opposition led by a former vice president. The violence continues today despite regional efforts at reconciliation by the Intergovernmental Authority on Development (IGAD) and other state actors. The war, however, has not stopped South Sudan’s frontline health workers in their efforts to build a public health system, including access to medicines, from the ground up.
The US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, led by Management Sciences for Health (MSH), in collaboration with the Stop TB Partnership Global Drug Facility, will host a technical conference titled, “Building the Post-2015 Agenda: Novel Approaches to Improving Access to TB Medicines and Pharmaceutical Services” from March 2-6, 2015 at the Conrad Bangkok Hotel in Bangkok, Thailand.
The Supply Chain Management System (SCMS), established in 2005 under the US President’s Emergency Plan for AIDS Relief (PEPFAR) administered by the US Agency for International Development (USAID), supplies lifesaving medicines to HIV & AIDS programs around the world and is led by the Partnership for Supply Chain Management (PFSCM), a nonprofit organization established by Management Sciences for Health (MSH) and John Snow, Inc. SCMS first established a presence in Haiti in 2007. MSH manages SCMS operations in Haiti.
Post updated December 19, 2014.
This post originally appeared on the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program Blog. Funded by the US Agency for International Development (USAID) and implemented by Management Sciences for Health (MSH), SIAPS works to assure the availability of quality pharmaceutical products and effective pharmaceutical services to achieve desired health outcomes.
Cross-posted with permission from the Bill & Melinda Gates Foundation Blog, Impatient Optimists.
Primary health care has many different definitions, but can be defined simply as the first place where people seek care. Within this definition, private sector providers constitute an important source of primary health care in many parts of the world.
Private providers of primary health
My name is Tiglu. I was born and raised in Bahir Dar. When I first learned that I am living with the [HIV] virus, my mind went blank. I was depressed. After that, I started taking antiretroviral treatment. Then they found TB in me... Meet Tiglu, a living example of how partnering for stronger health systems saves lives. In Ethiopia, about 790,000 people are living with HIV. Tiglu, a patient at the Bahir Dar Health Center in the Amhara Region of north-western Ethiopia, discovered he is HIV positive three years ago, and started on antiretroviral treatment (ART).
This post originally appeared on the Frontline Health Workers Coalition blog.
Ayelew Adinew was working as a pharmacist in a large public hospital in Addis Ababa, Ethiopia. He looked around and saw that the 100-year old pharmaceutical system was broken.
November is Prematurity Awareness Month in the US, and the 17th is World Prematurity Day. But I never need any reminders about the importance of access to medicines and services for premature babies. Every November, I celebrate the birthday of my own little preemie. On November 30, 1997, I went into labor just after reaching 32 weeks. I was terrified. I had had a healthy second pregnancy up to that point and my doctor did not believe me at first when I told her I was in labor.
This post originally appeared on SIAPSProgram.org. Accounting for more than one million under-five deaths each year, pneumonia is the leading killer of children under the age of five worldwide, claiming more lives than AIDS, malaria, and tuberculosis combined. This year’s World Pneumonia Day (WPD) theme is “universal access to pneumonia prevention and care”. In commemoration of WPD, child health advocates are calling for pneumonia control through proven interventions that protect against, prevent, and treat pneumonia.
Guaranteeing that patients have uninterrupted access to anti-tuberculosis (TB) treatment begins with national TB programs (NTP) making complex calculations about how many cases to expect in the future. Vigilant stock management, accurate number of cases started on each type of treatment along with forecasting the expected number of patients that will be enrolled on treatment, are vital to ensure that medicines are available to all patients who need them.
Experience the 69th UN General Assembly (UNGA) and Clinton Global Initiative (CGI) Annual Meeting as we take you through some of the key events in photos, videos, and tweets. More than a dozen Management Sciences for Health (MSH) representatives led or participated in UNGA and CGI activities in New York City, New York, last week.
Today, September 26, is World Contraception Day. The Family Planning 2020 (FP 2020) Initiative says the vision for the day "is a world where every pregnancy is wanted. Its mission is to improve the awareness of contraception to enable young people to make informed decisions on their sexual and reproductive health." We share part two of our interview with Dr. Fabio Castaño, MSH’s global technical lead of family planning (FP) and reproductive health, in celebration of World Contraception Day. Join the conversation on social media with hashtag #WCD2014.
Read Choice: Part One
Expanding access to essential maternal health medicines saves mothers’ lives. Access to life-saving maternal medicines requires an effective supply chain that delivers the right medicines to the right people at the right times. In many countries, weak pharmaceutical management systems are unable to meet the challenges of providing access to these essential medicines.
Dr. Trevor Mundel and other senior staff of The Bill & Melinda Gates Foundation traveled to Tanzania this summer to see first-hand the successes of Accredited Drug Dispensing Outlets (ADDO). The ADDO program, which began in 2001, grew out of the need to transform the duka la dawa biridis—unlicensed retail drug shops—into profitable, government-accredited drug dispensing outlets that supply quality medicines and services to underserved populations in Tanzania.
This post originally appeared on the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program blog.
Does antimicrobial resistance mean the end of modern medicine as we know it? Not quite yet. However, in a report recently released on global surveillance of antimicrobial resistance (AMR), the World Health Organization (WHO) warned that "a post-antibiotic era–in which common infections and minor injuries can kill–is a very real possibility for the 21st century."
We are pleased to announce the availability of the 2013 edition of the International Drug Price Indicator Guide. The Guide provides a spectrum of prices from 30 sources, including pharmaceutical suppliers, international development organizations, and government agencies.
Although the global community has had significant success in reducing maternal and child deaths in the past two decades, they continue to die of preventable causes at an alarming rate. This is especially pronounced for the most vulnerable and hard-to-reach populations. Universal access to maternal, newborn, and child health (MNCH) commodities and services remains a major challenge, even among countries that are on track to achieve the Millennium Development Goals for reducing maternal and child mortality.
This post originally appeared on the SIAPS blog. Many countries in Central and South America have made significant progress toward eliminating malaria. Between 2000 and 2012, 13 countries in the Americas saw malaria incidence rates drop by more than 75 percent. Argentina, Belize, Costa Rica, Ecuador, El Salvador, Mexico, and Paraguay have all reached the pre-elimination phase, a designation given by the World Health Organization (WHO) when countries meet certain critical steps in eliminating the disease and preventing its reintroduction.
The availability of new and essential medicines and other health technologies to treat life-threatening illnesses have helped millions of people lead long and productive lives. However, global availability does not necessarily mean access by the end-consumer to these lifesaving health products in low-and middle-income countries. Effective supply chains are needed to deliver these health products in hard-to-reach, resource-constrained settings that often times are inhospitable to collaborative, high-performing supply chain systems.
So how do we get safe, quality, essential medicines and commodities to the people who need them, at the right time and in the right quantities?
In commemoration of World Malaria Day, SIAPS joins the global health community in recognizing the remarkable strides that have been made in the fight against malaria. More than ever, people in malaria-endemic countries, especially those who are particularly vulnerable like mothers and children, are receiving effective prevention, diagnosis, and treatment services and have better access to life-saving antimalarial medicines and health supplies. In 2012, over 200 million rapid diagnostic tests and over 330 million courses of antimalarial treatment were provided globally.
Pablos-Méndez Applauds and Encourages MSH Representatives and Partners at DC Country Health Impact Fair
Representatives from 13 MSH countries—Afghanistan, Angola, Cote d’Ivoire, DRC, Ethiopia, Ghana, Haiti, Kenya, Nigeria, Rwanda, South Africa, Tanzania, and Uganda—shared stories and materials about the lives saved and health impact of MSH’s work, in partnership with US Agency for International Development (USAID) and others, at the MSH Country Health Impact Fair at the Ronald Reagan Building in Washington, DC, last week. Country ownership and health impact were common themes at the fair. Ariel Pablos-Méndez (MD, MPH), assistant administrator for global health at the US Agency for International Development (USAID), addressed participants and attendees.
It can be easy to take healthcare workers for granted. For the majority of us living in the United States, you know that a trained doctor and nurse will see you when you need assistance; a lab technician will do your blood work; and a certified pharmacist will dispense your prescriptions. But imagine going into labor and not knowing if a midwife or doctor will be present? Or, if you need a medication and there is no pharmacy to provide it?
In the absence of effective treatment and access to quality health services, diarrhea, malaria, and pneumonia remain the leading causes of child mortality in sub-Saharan Africa and cause nearly 44 percent of deaths worldwide in children under five years old. To improve access to life-saving treatment among children, many African countries have begun implementing and scaling-up integrated community case management (iCCM), a strategy that focuses on the delivery of timely and low-cost interventions at the community level by community health workers.
Successfully combating the tuberculosis (TB) epidemic requires that national TB programs (NTPs) prevent new infections and ensure that current patients are cured. Although the treatment for drug-sensitive TB is very effective, curing the disease requires that patients adhere to a strict daily regimen of multiple pills for six to nine months. Adding to the challenge is the fact that treatment for drug-resistant TB is longer, more toxic, and less effective.
The highest rate of multi-drug resistant (M) and extensively drug-resistant (XDR) cases of tuberculosis (TB) is found in the World Health Organization (WHO) European Region. The Consolidated Action Plan to Prevent and Combat M/XDR-TB in the WHO European Region specifies that, by the end of 2013, all member states assure provision of an interrupted supply of quality first- and second-line medicines for treatment of all TB and M/XDR-TB patients.
This post originally appeared on the Maternal Health Task Force (MHTF) Blog as part of a series celebrating the one-year anniversary of The Lancet publishing “A Manifesto for Maternal Health post-2015,” co-authored by Ana Langer, Richard Horton, and Guerino Chalamilla.
Azmara Ashenafi, a 35-year-old woman from the Amhara region of Ethiopia, was diagnosed with tuberculosis (TB) and placed on treatment. She was fortunate. Many people with TB are missed by health systems altogether. But Azmara’a treatment wasn’t helping. Despite taking medicine for months, her symptoms persisted and became more severe.
In many places, her story would have a sad ending—TB is one of the top three leading causes of death for women 15 to 44 in low- and middle-income countries.
"At the Duka" tells the story of a Systems for Improved Access to Pharmaceuticals and Services Program (SIAPS) project to increase early detection of tuberculosis in Tanzania.
SIAPS partnered with the Tanzanian National Tuberculosis and Leprosy Program to train drug dispensers on the symptoms of TB, so that they could refer clients with these symptoms to TB diagnostic and treatment centers for follow up.
MSH's Principal Technical Advisor for Reproductive, Maternal, Newborn and Child Health (RMNCH) Beth Yeager has been named Chair of the Maternal Health Caucus of the Reproductive Health Supplies Coalition.
Management Sciences for Health (MSH) invites you to attend the following presentations by MSH staff at the Integrated Community Case Management (iCCM) Evidence Review Symposium in Accra, Ghana, hosted by UNICEF and partners March 3-5, 2014. All times are listed in GMT. For those who are unable to attend in person, presentations will be made available online during or after the Symposium.
Costs, Cost Effectiveness and Financing
Every year, billions of US dollars’ worth of medicines are purchased by or through international procurement agencies, NGOS–such as UNICEF, UNITAID, The Global Fund, Médecins Sans Frontières (MSF)–and governments for use in developing countries. The World Health Organization’s (WHO's) PreQualification of Medicines Programme (PQP) helps ensure that these medicines meet acceptable standards of quality, safety and efficacy.
SCMS and MSH at the forefront of efforts to remove supply chain barriers to the scale up of HIV/AIDS treatment programs For many of us in the developed world, it is easy to overlook the critical role that well-functioning supply chains play in effective healthcare. When supply chains are operating as they should, we take for granted that the medicines we need will be in stock and available.
Last month, I had the honor of welcoming United States Agency for International Development (USAID) Administrator Rajiv Shah to Democratic Republic of the Congo (DRC) during a visit that took place December 15-18, 2013.
November 14 is World Diabetes Day. This year’s theme, “Protect our future,” emphasizes the importance of engaging and inspiring local communities to promote awareness and education on the effects of diabetes and its preventable risk factors.
Today, November 12, is World Pneumonia Day. Pneumonia is the leading cause of death among children under five, killing more children annually than AIDS, malaria, and tuberculosis combined. About 1.1 million children under five died of pneumonia last year, 99 percent in developing countries.
Earlier this month, NASA confirmed that Voyager 1 reached the border of the solar system. This momentous occasion is a major milestone in space exploration. As we close World Contraception Day (WCD2013), September 26, there are many lessons we can learn from Voyager on our journey beyond WCD2013 toward access for voluntary family planning for all.
In developing countries, a community medicines shop often serves as the first point of contact for health care. Empowering the drug shop owner and dispenser to provide safe, quality medicines, and referrals to a health facility for more complex care, is key to improving maternal and children’s health in rural areas.
In developing countries, a community medicines shop often serves as the first point of contact for health care. Empowering the drug shop owner and dispenser to provide safe, quality medicines, and referrals to a health facility for more complex care, is key to improving maternal and children’s health in rural areas.
Over one hundred years ago on this date, (August 20, 1897), British scientist Sir Ronald Ross discovered that infected female mosquitoes transmit malaria between humans. (Like any vector borne disease, the malaria-causing parasite, Plasmodium, needs a specific host: in this case, the mosquito. The female mosquito needs blood to nourish her eggs; the male just eats nectar.) Dr. Ross received the Nobel Prize for his discovery that year. Today, we mark the day, August 20, as “World Mosquito Day.”
What’s all the buzz about?
Strengthening health systems at all levels is the core of MSH’s response to the HIV epidemic. We build organizational capacity to implement innovative HIV, prevention, care, and treatment interventions in over 35 countries---from Côte d'Ivoire to Ethiopia to Vietnam.
Hepatitis is a personal disease for me. Some years ago, I spent two weeks leading training workshops for faculty at the University of Costa Rica in San Jose, Costa Rica. The work and the participants were delightful, as we worked together to improve medicine prescribing practices. Every day I ate lunch at a local seafood restaurant, often joined by a colleague. One Friday, two weeks after returning home, I felt exhausted—so tired that I could not continue working. By Sunday I was orange as a pumpkin, unable to walk or keep food down.
A version of this post originally appeared on the SIAPS program blog.
"Health care is not about what doctors and nurses do in hospitals," said Dr. Sania Nishtar. "There are a range of different stakeholders that need to play their parts."
Management Sciences for Health (MSH) is pleased to announce the availability of the 2012 edition of the International Drug Price Indicator Guide (the Guide). MSH has published the Guide since 1986 and updates it annually.
The Guide provides a spectrum of prices from 23 sources, including pharmaceutical suppliers, international development organizations, and government agencies. The 2012 edition includes prices for about 1,100 products, including nearly 50 new items. The therapeutic classes with the most new entries this year are anti-infective medicines, cytotoxics, and diagnostics.
Reforming a health system in pursuit of universal health coverage (UHC) has the potential to transform health and save lives, but it carries enormous challenges for the leaders committed to this vision. From revenue collection to enforcement of quality standards, every aspect of the system must come together to make UHC successful and sustainable.
By Anita Katharina Wagner & Dennis Ross-Degnan
We were delighted to collaborate with our colleagues at Management Sciences for Health (MSH) and the Rockefeller Foundation, along with the Pan American Health Organization (PAHO) and the US Agency on International Development (USAID), on developing and implementing a first international dialogue dedicated to an important global issue: medicines as part of universal health coverage (UHC).
Universal health coverage (UHC) is the ultimate accomplishment in health systems strengthening: UHC is achieved when a health system is strong enough to deliver high-quality products and services in a reliable, comprehensive and affordable way to its entire population. For the leaders who govern health systems, UHC is an ambitious and worthy goal. And as MSH President and CEO Jonathan Quick explains, success starts with their vision.
Modern medicines, vaccines, and other health technologies have revolutionized health care. Yet these products haven’t improved lives everywhere, often because health systems haven’t made them accessible and affordable. In many developing countries, where health systems still rely heavily on out-of-pocket expenditure, patients face high costs at the point of service. Some people forgo necessary care; others endure financial hardship or even impoverishment. A majority of out-of-pocket spending goes towards medicines.
In a couple of days, thousands of decision-makers, leaders, advocates, health professionals, media, and more will gather to focus on our most valuable investment: women and girls.We are honored to be a Gold Sponsor and Advisory Group member of Women Deliver 2013.
To me, malaria is a very personal disease.I first came face to face with malaria during the war of my time: Vietnam. I was plucked out of residency after my first year, with only an internship under my belt, and sent as a Navy Medical Officer to war.
We know what works to save the lives of children under five years old: We know which antibiotic to give for treating pneumonia, for example. Yet only 31% of children with suspected pneumonia receive antibiotics. And two million children die from pneumonia and diarrhea each year.
Mildred Fernando lives and works in the Philippines for the USAID-funded, MSH-led, Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program. Mildred spoke at several World TB Day events in Washington, DC, including at a senate briefing and an event honoring TB survivors and advocates (watch video). The interview below first appeared on the SIAPS blog.It all began in November 2001 for Mildred Fernando when she was diagnosed with tuberculosis (TB), a preventable and curable disease which caused the death of 1.4 million people in 2011.
For most of my life, women in Uganda---as in most countries---were treated as inferior to men. Girls were less likely to be educated than their brothers, and had little control over the direction of their lives. Many girls grew up being told how to act, eat, and talk; many women were regarded as little more than domestic caregivers. However, in 1986 the ruling government radically changed the dynamics of Ugandan women in global development and their participation in decision-making at all levels of government.
In Myanmar, 50 years of military dictatorship left behind a seriously underdeveloped health system, serving barely one in twenty of the country’s 60 million people. You might expect that the first minister of health under civilian rule would be despondent. But on my recent trip I found the opposite: Dr.
Management Sciences for Health (MSH) invites you to attend the following sessions and poster presentations at the Global Maternal Health Conference in Arusha, Tanzania --- whether in person at the Arusha International Conference Center, or watching via archived videos online. (All times are listed in Eastern Africa Time: UTC/GMT +3 hours.
Formally launched in 2012 in Cameroon, the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, led by Management Sciences for Health, has been working on strengthening the overall pharmaceutical management system, specifically to ensure the people of Cameroon have access to safe and affordable medicines at the central and peripheral levels.
In a new podcast, US Deputy Chief of Mission in Cameroon Lisa Peterson discussed SIAPS’ important work in the country and how it will impact the local population.
Last month, I joined over 1,800 participants from more than 100 countries in Beijing at the Second Global Symposium on Health Systems Research. We've made some concrete steps forward since we last met in Montreux, Switzerland, two years ago, among them the launch of a new research society Health Systems Global. Central topics of this year's discussions included: “Inclusion and Innovation towards Universal Health Coverage” (UHC), the symposium theme, and monitoring and evaluation.Here are my top 10 takeaways from the symposium:1.
“We’re going to try to drive through that?”After spending nearly two years working in South Sudan, I was on my way with two colleagues to one final meeting. The USAID-funded second phase of the Sudan Health Transformation Project (SHTP II), led by Management Sciences for Health (MSH), ended activities on July 31, 2012, and three of us needed to travel 360 kilometers (220 miles) to a results dissemination meeting.
Cross-posted from the K4Health blog. No matter which health system building block you are trying to improve, you need specific data, information, and knowledge to inform your decision-making process—this is where good knowledge management comes in handy.“The Intersection of Knowledge Management and Health Systems Strengthening: Implications from the Malawi Knowledge for Health Demonstration Project” provides an interesting case study of the connection between improved knowledge management and health systems strengthening.Even though the K4Health Malawi project was f
This is the advice that Esther Wahome, a registered community health nurse in a Kenyan health facility, gives to her clients when they come to the tuberculosis (TB) clinic. Within a short time, Esther dispenses the drugs to the patient, provides health care advice and updates her records.Esther’s TB clinic clients are usually referred to Kayole II sub-district hospital from Toto Bora and other smaller health care centers.
Crossposted on Maternal Health Taskforce's mhtfblog as part of the Maternal Health Commodities Blog Series.Despite a decade of significant progress reducing maternal mortality rates, very few countries are on target to meet Millennium Development Goal #5a of reducing the maternal mortality ratio by three-quarters by 2015.What is most alarming is that a large proportion of maternal deaths could have been avoided if women had access to adequate health services, where the necessary quality medicines and supplies were available and skilled health providers were present.
Rabi gives a public awareness lecture on HIV. (Photo credit: MSH, Nigeria)Forty-year old Rabi Suleiman lives in Koko Besse area in Kebbi state, Nigeria. She is married without children. Rabi, who now lives with her third husband, recalls that her ordeal with illness and social ostracism began in 2009. Rabi’s three marriages were the result of her inability to conceive, and a continuous search for a partner with whom she could successfully bear children.
Sophia is a humble woman. She has been working as a nurse for 10 years, and is currently one of five nurses posted at Rwesande health center IV in the hills of western Uganda.
When I arrived I was impressed by the number of services the health center offers, and the general appreciation felt around the compound. Rwesande health center IV has a maternity ward to safely deliver babies; counseling areas for family planning, reproductive health, and HIV; a general ward, a surgery theater, and health education space.
Family planning counseling and services now available
Improving Child Health in Communities and at Home, the April/May 2012 edition of MSH's Global Health Impact newsletter (subscribe), features personal stories about child survival and child health in developing countries."Prevention, treatment and care close to the home are keys to saving children's lives," says Dr. Jonathan D.
Cross-posted on USAID's IMPACT blogMy most vivid early childhood memory is waking up to excruciating pain in my throat, and seeing the goldfish swimming in the aquarium of the pediatric surgical ward. Although penicillin had been discovered 30 years earlier, doctors had not learned yet that treating "strep throats” with penicillin was better than operating. I didn't need the tonsillectomy. But, I was lucky to receive quality care in a health facility, close to my home.Millions of children today are not so lucky.
Nearly 50 countries, including Afghanistan, Democratic Republic of the Congo, Haiti, Liberia and South Sudan, are considered a fragile or conflict-affected state -- a state that is in conflict, recovering from conflict or crisis, or a state that has collapsed or has a strong and repressive government. Over nearly 40 years of working in fragile states, Management Sciences for Health (MSH) has identified best practices, lessons learned, and appropriate interventions for a myriad of situations in fragile states.
In the 1990s many Brazilian patients infected with tuberculosis (TB) were not being cured, despite starting treatment. Some patients stopped taking their medication, which led to the reemergence of TB. In 1993, the World Health Organization declared that TB was a global emergency.
Over the years, the Koboko health centre IV located in the West Nile region of Uganda has experienced challenges in the management of essential medicines and health supplies. Stock-outs of vital medicines were widespread, while huge quantities of slow-moving medicines were at risk of expiring. These problems were attributed to health workers’ poor skills in logistics management. In addition, there a was lack of reliable information to guide staff on when and what to order since stock cards were not regularly updated.
This was my first trip to Africa working with a development agency. While I had visited the African continent for personal trips previously, arriving in this context felt different. I was immediately aware of the challenges Uganda is facing. From the crumbling road infrastructure and high incidence of traffic accidents in Kampala, to the mobile phone networks that are pretty reliable while internet access is often spotty, to the prevalence of street children --- I can for the first time see what my local colleagues are up against.I felt a bit overwhelmed in the first few days.
Yvonise is a good-natured 40-year-old woman with an easy smile. She is mother to four children: two boys and two girls. Her youngest, a little girl, is six years old.
Today, Yvonise sits patiently at the pharmacy of Hôpital Immaculée Conception de Port-de-Paix (HIC Port-de-Paix) in Haiti, waiting for Miss Sevrine, her caregiver, to provide her with a month’s supply of life-saving medicine.
This year is not only MSH’s 40th anniversary; it is also 30 years since the first reported cases of HIV. Thirty years ago HIV was considered a new, always-fatal disease. ...Today 6.6 million people—nearly half of those in need—will take life-saving antiretrovirals.
Zakia, a nurse in Afghanistan, has become a leader in her health center. After participating in an MSH leadership development program, Zakia led a team of nurses in increasing awareness about family planning, resulting in a doubling of the use of contraceptive pills and an eight-fold increase in the number of condoms distributed in two years. “Everyone here no longer thinks of problems as obstacles in our way, but challenges we must face,” Zakia says.
Over the past 25 years, the number of people worldwide with access to essential medicines has more than doubled. Yet more than 30 percent of the world’s population still does not have reliable access to essential medicines.
Lucia Afiki and Esther Goodson are living positively with HIV. They are counselors for family planning and HIV & AIDS at Salima District Hospital in Malawi, where they openly tell their clients that they are HIV-positive. “When we are open with them about our status,” says Afiki, “people say, ‘Come closer, we want to learn from you.’” Goodson adds: “They say, ‘What should I do to look as good as you?’” The counselors tell them to visit a doctor and join a support group. This is an approach that saves lives.
Guest post by Dr. Ahmad Masoud RahmaniDr. Ahmad Masoud Rahmani is the National Director of the Afghanistan National Blood Safety and Transfusion Services Directorate, in Kabul, Afghanistan. Dr. Masoud was a participant in the MSH Leadership Development Program offered by the USAID-funded Technical Support to the Central and Provincial Ministry of Public Health project (Tech-Serve) in Afghanistan last year. The National Blood Transfusion service in Afghanistan has the responsibility for ensuring that a safe and adequate blood supply is available for all people who need it.
Coordination and partnership are often considered critical in global health programs to avoid duplication and waste of resources. Recently, Health Net TPO (HN TPO), an NGO with health programs in eastern and south eastern Afghanistan sought collaboration with MSH’s USAID funded Strengthening Pharmaceutical System (SPS) program to address gaps in knowledge and practice in pharmaceutical management in the provinces of Nangarhar, Laghman, Khost and Paktiya. These are the provinces that have ongoing interventions to promote rational use of medicines through the SPS program.
The Ministry of Public Health’s (MOPH) Pharmaceutical Enterprises operates 53 pharmacy stores located near government hospitals nationwide, managed by 118 pharmacists. With 1 million US dollars in capital, pharmaceuticals are purchased, stored, and then distributed to the Afghan people through these government-owned pharmacies.Dr. Mirza Mohammed Ayoobi, the Deputy Director of Pharmaceutical Enterprises says, “Majority of our government-employed pharmacists have over 15 years of experience, but have not kept pace with the changing landscape of pharmacy practice.
This blog post originally appeared on the US Agency for International Development's IMPACT blog. As a procurement specialist with PEPFAR’s SCMS (the Supply Chain Management System) project, I am one of a growing number of women working in supply chain management in Ethiopia. I manage procurements of HIV/AIDS commodities---including the complex procurement of specialized medical equipment used to treat HIV/AIDS---as well as the vehicles that distribute those commodities.Well planned, strategic procurement is a smart investment.
As we celebrate World Health Day on April 7, 2011, the global health community is focusing on an increasingly dangerous health challenge---drug resistance. Antimicrobial resistance (AMR)---defined by the World Health Organization (WHO) as the resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive---is a global public health threat that is rapidly wiping out the effectiveness of many first-line treatments.
Every day people are dying in the developing world because they cannot access affordable, quality medicines. Modern pharmaceuticals have revolutionized health care, but weak health systems prevent many people from accessing basic life-saving medicines. The health of men, women, and children can be dramatically improved throughout the world by enhancing access to and improving the use of essential medicines and other health care technologies.Gaps in the management and availability of essential medicines and health commodities have been a constant weakness for developing countries.
Dr. Karima, General Directorate of Pharmaceutical Affairs, Ministry of Public Health, speaks at the opening ceremony of the Drug and Therapeutics Committee training course for provincial hospitals On the eve of the International Women’s Day, the Strengthening Pharmaceutical Systems (SPS) Program in Afghanistan had the opening ceremony of the Drug and Therapeutics Committee (DTC) training course for provincial hospitals in Paktya, Paktika, Khost, Ghazni, and Badakhshan.
One hundred years ago on March 8, a handful of countries celebrated the first International Women’s Day. Today it is celebrated around the world as an opportunity to look back on women’s accomplishments and look forward to the realization of their full economic, political, and social rights.
The World Health Organization (WHO) recently endorsed a new and novel rapid test for tuberculosis (TB), especially relevant in countries most affected by the disease, and is calling for widespread use of this test and its incorporation into national plans.MSH applauds the research and development experts who developed this new TB test and the WHO for endorsing it so quickly.
The Global Health Initiative (GHI) and its approach of integrating health programs with HIV & AIDS, malaria, tuberculosis, maternal, newborn, and child health, nutrition, and family planning and reproductive health is in line with the current approaches and health priorities of the Government of Malawi.Malawi, with a population of slightly over 13 million people, has 83% of its people living in the rural hard to reach, underserved areas. The biggest health challenge facing the country is access to basic health services by the rural population.
In late October 2010, the USAID Supply Chain Management System project (SCMS) distributed close to 50,000 lbs of essential products including oral rehydration salts, antibiotics, lab supplies, water treatment and ringer lactate to support Haiti's response to the cholera epidemic. The commodities came from existing stock in the SCMS warehouse as well as products available on the local market. SCMS also provided international procurements of 60,000 IV solution units and 20,000 IV sets.Antoine Fadoul is the Supply Chain Management System Country Director in Haiti.
Over 100 delegates from 30 countries participated in the “National Pharmacovigilance Systems: Ensuring the Safe Use of Medicines” conference held in Nairobi, Kenya, August 16–18, 2010. Organized by Management Sciences for Health’s (MSH) Strengthening Pharmaceutical Systems (SPS) program, which is funded by the U.S.
On June 17, 2010, I was honored to attend and speak at a ceremony where Management Sciences for Health officially handed over 35 tons of life saving essential drugs to the Republic of Congo (DRC) in Kinshasa. The ceremony was chaired by Dr. Victor Makwenge Kaput, the DRC’s Minister of Health. These drugs represent the first half of an initial order of pharmaceuticals and medical supplies worth more than $ 1.5 million, and were made available through funding from USAID/DRC.
Just over five months ago, Haiti suffered a devastating earthquake that displaced more than 700,000 people. Addressing the health needs of such a large population in a post-disaster situation is a complex challenge, one Management Sciences for Health (MSH) is supporting through its many programs including our Leadership, Management and Sustainability Program (LMS).