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There was an awkward silence and then soft giggling as the girls looked at each other. I had just finished talking about strategies for persuading sexual partners to use a condom. Laughter during these skills-building and girls empowerment sessions with 30+ secondary school students in Morogoro, Tanzania was not uncommon, particularly given the sometimes sensitive topics of discussion, but this time, the joke was lost on me.

I asked the student nearest to me, a confident teenager that I knew wouldn’t be too shy to respond, why everyone was laughing. She told me, “You speak about this as if we have a choice.” She wasn’t being sarcastic or combative, nor was she complaining - she was simply matter-of-fact about it, stating her truth.

The Ebola epidemic was raging in West Africa. Management Sciences for Health’s staff in Liberia relayed that “treatment facilities are overrun with cases” and “whole parts of the health system are at a standstill.” Things got much worse before the epidemic was finally defeated. Over 11,000 people died horribly from the disease, leaving more than 16,000 children orphaned.

Once the world woke up to the crisis, there was a generous outpouring of assistance. As the response peaked, I was consumed by nagging questions: Where will we be four or five years from now? Will the world have gone back to sleep? What’s needed to protect the world from future outbreaks? To find the answers, I explored the lessons from epidemics over the last century – smallpox, AIDS, SARS, avian flu, swine flu, Ebola, Zika – and I drew on some of the best minds, experienced professionals and committed citizen activists in global health, infectious disease, and pandemic preparedness.

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.

Recognizing that coordinated action is needed to minimize the emergence and spread of AMR, Management Sciences for Health (MSH) has catalyzed multidisciplinary and cross-sectoral coalitions to build awareness of the threat of AMR and advocate for its containment.

As part of its post-Ebola recovery work to strengthen its pharmaceutical system, Sierra Leone’s Directorate of Drugs and Medical Supplies (DDMS) partnered with the US Agency for International Development-funded Systems for Improved Access to Pharmaceutical and Services (SIAPS) Program, implemented by MSH, to develop efficient procurement, distribution, and inventory systems and establish stakeholder coordination and oversight mechanisms known as hospital Drug and Therapeutics Committees (DTCs).

At the 4th Global Health Security High-Level Ministerial Meeting held in Uganda on October 25-27, “Health Security for All: Engaging Communities, Non-governmental Organizations, and the Private Sector,” more than 600 participants including ministers from 41 countries recommitted to and eagerly embraced the agreements made under the Global Health Security Agenda (GHSA) to accelerate progress toward a world safe and secure from infectious disease threats.

The GHSA initiative was launched in 2014 to increase the capacity of countries to prevent disease outbreaks from becoming epidemics. The meeting brought together senior leaders across many sectors of government, international organizations, and nongovernmental stakeholders to evaluate the progress made so far and prioritize actions needed to close the gaps that remain. To succeed, nations recognized the urgent need to refine and improve their health systems – so that they are capable of delivering everything it takes to keep people healthy and safe from infectious disease threats.

Management Sciences for Health (MSH) was proud to be among the participants, drawing on more than 45 years of experience supporting countries to build the prevention, rapid detection, and effective response needed to mitigate global health threats.