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July 03, 2019
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Without 'Concrete' Directives, New UHC Agreement Could Fall Flat

Health Systems Strengthening
Universal Health Coverage
{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 Lieberman, Jenny 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

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June 24, 2019
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Health Workers Learn Task Sharing to Improve HIV Services in Tanzania

Health Systems Strengthening
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.

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May 28, 2019
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Opinion: We can curb potential pandemics by investing in prevention tactics

Health Systems Strengthening
{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.

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May 08, 2019
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Changes at the Drugstore: This Mentorship Program is Improving Malawi’s Rural Pharmacies

Pharmacy Assistant Aaron Sendeza wants to rid Malawi of malaria. Thanks to the mentorship program, Aaron works to ensure that all medicines and medical supplies in his health center are available, reliable, and of high quality. Photo credit: Paul Joseph Brown for VillageReachPharmacy Assistant Aaron Sendeza wants to rid Malawi of malaria. Thanks to the mentorship program, Aaron works to ensure that all medicines and medical supplies in his health center are available, reliable, and of high quality. Photo credit: Paul Joseph Brown for VillageReach

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.

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April 26, 2019
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Kenya's Group Antenatal Care Model: Sustainability from the Word "Go"

Women & Gender

In the spirit of the 3,500-year-old Tao (Way) of Leadership, MSH works closely with local institutions and communities to create lasting and sustainable changes; changes that improve the health of people among the world’s poorest and most vulnerable groups.

And as the Tao indicates, sustainability starts with ownership, “The people will say, we have done it ourselves.”

Women in Kakamega County, Kenya are taking charge of their pregnancies, supporting their peers, and learning about healthy practices and self-care from skilled health providers. MSH’s Lea Mimba (“Take care of your pregnancy”) project, funded by UK Aid through the County Innovation Challenge Fund (CICF), tested an innovative group model for antenatal care (ANC) that responds to the needs and perspectives of women and front-line health providers. At six Kenyan health facilities, Lea Mimba provides a forum where pregnant women share experiences, learn birth planning and self-care practices, provide each other with emotional and social support, and receive essential health information from a skilled health provider, who is usually a nurse.

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April 24, 2019
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Leading Voices: Defeating Malaria is Everyone’s Responsibility

Health Systems Strengthening

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.

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April 08, 2019
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Community Health Workers and Volunteers: The Most Effective Path to UHC

Health Systems Strengthening
Universal Health Coverage
{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.

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April 08, 2019
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How can we each accelerate the pace of positive change for women in the workplace?

Women & Gender
{Marian W. Wentworth visits with health workers during a trip to Uganda in 2017. Photo credit: Warren Zelman}Marian W. Wentworth visits with health workers during a trip to Uganda in 2017. Photo credit: Warren Zelman

I began my career in the private sector almost always as the only woman in the room. Like many women of my generation, I experienced the kind of casual sexism that for too long was considered acceptable. But I also experienced firsthand more abusive forms of discrimination.  As I moved up in the organization, I began to see how sexism affected other women around me. I remember reviewing male and female candidates who were being assessed for readiness for promotion and noticing a distinct trend: The female candidates were assessed on their achievements; the male candidates on their potential. This situation worsened as candidates were actually selected for roles. Average achieving, “high potential” male candidates were being promoted over women who had tangible track records of accomplishments. While the trend was obvious, the solutions were not. We tried a series of different ways to shift this trend in our organization, but none produced quick results.  How we assess potential — and in whom — is but one example of the kind of systemic sexism that forces women to work harder to achieve professional success, and why some of us find it too much to fight.

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March 05, 2019
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To end tuberculosis, we must invest in a more streamlined approach

Health Systems Strengthening
{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
This op-ed was originally published in The Hill.
 
When I was a young doctor in Turkey, I quickly learned to take a bird’s eye view of health care. I started working in a village in Mardin Province, visiting households with my first mentor, a midwife. Once in a home, we would do the job we came for, perhaps vaccinating the baby. However, it only made sense to use our time to see other people in the household as well. How was the pregnant sister doing? What about the uncle with tuberculosis (TB) — was he taking his medicines as prescribed? Did the family have clean drinking water and a sanitary latrine?

Later, two colleagues and I oversaw 52 health centers in the province.

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December 12, 2018
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Leading Voices: Meet Hawa Coulibaly Kone

Health Systems Strengthening
{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.

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