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.

{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.

The chart above shows the good-news-bad-news scenario that is the decades-long fight against TB in Afghanistan. TB is still a crushing problem there; the country has among the world’s highest rates of the disease, which killed some 10,000 people in 2017. But if you glance at this chart and think that we haven’t made much progress, look again. We’re finding and treating more people with TB in Afghanistan than ever before. In 2001, we were missing three quarters of presumptive TB patients — that is a whopping 75% gap in case detection.

{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
By Dr. Ersin Topcuoglu
 
This op-ed was originally published in The Hill.
 
 {Photo credit: Igor Dashevskiy}Deputy Minister of Health, Dr Roman Illyk, presents during the National Health Technology Assessment Forum in Kyiv, Ukraine.Photo credit: Igor Dashevskiy

A health technology assessment (HTA) is an evidence-based instrument to identify which medicines, medical devices, and treatment regimens are optimal for the state to support. It significantly reduces opportunities for corruption and helps countries move toward self-reliance in the health sector. A National Health Technology Assessment Forum took place in Kyiv, Ukraine, on February 28, 2019, to further advance HTA as an important priority-setting tool for Ukraine’s health system. Photo credit: Igor Dashevskiy

Uganda

{Hospital pharmacy in Antananarivo, Madagascar. Photo Credit: Warren Zelman}Hospital pharmacy in Antananarivo, Madagascar. Photo Credit: Warren Zelman

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.

If we don’t act to contain antimicrobial resistance, it may kill up to 10 million more people yearly by 2050 and cumulatively cost patients and health systems across the globe up to $100 trillion. This crisis may start to seem insurmountable, like a vague scientific problem with no apparent solution. Many of us have contributed to it, and each of us will need to collaborate — as nations, organizations, and individuals — to solve it.

“Without tackling wasteful, inefficient, and irrational use of antimicrobials, we cannot contain AMR.” — Mohan Joshi, a principal technical adviser for Management Sciences for Health 

 {Photo credit: Mary Dauda/MSH}After nearly losing her business, Adekeye Dorcas now mentors HIV positive pregnant mothers in her community and trains apprentices in the art of nylon production.Photo credit: Mary Dauda/MSH

A trader skilled in the art of nylon production, Adekeye Dorcas once generated enough income to provide for her family. During a routine visit to the health center in Kwara state, she tested positive for HIV and was immediately offered counseling services and antiretroviral therapy (ART). The growing demands on her time to travel on open clinic days for ART and the cost of transportation began to threaten her family’s financial stability. She knew that adherence to her treatment was key to allowing her to live positively and ensuring that her husband remained HIV negative.

Photos by: Samy Rakotoniaina/MSH

In Malawi, over 80% of people live in rural areas. For many (10%), the nearest health center is more than 8 kilometers (5 miles) away, making it difficult to access health care regularly. The USAID-funded Organized Network of Services for Everyone’s (ONSE) Health Activity, led by Management Sciences for Health, works to improve quality and access to care in rural communities.

“Before we had a village clinic, we were struggling. For every little sickness, we had to rush to the hospital, especially with our small children.” – Assan Symon, Mitawa village health committee chairperson

Stanley Liyaya, a heath surveillance assistant (HSA), is one of 3,500 community health workers trained to manage childhood illnesses in rural communities. HSAs have improved access to care and treatment of childhood illness to help Malawi reduce the under-five child mortality rate by 73% between 1990 and 2015, achieving Millennium Development Goal 4. Malawi’s vision is that by 2021, all young children will be treated for common illnesses promptly in their own communities.

Fom left: Mariame Sene, Hawa Kone Coulibaly, Hammouda Bellamine, Alcha Diarra, and Justine Dembele. Photo Credit: MSH

"Work to lose your job. If you don't have that in mind, you shouldn't be working in development," says Hammouda Bellamine, Senior Technical Advisor for Capacity Building for the USAID-funded KJK (Keneya Jemu Kan) Project in Mali.

Hammouda and his team are modeling important leadership skills and building capacity for social marketing and behavior change communication activities among local NGOs and public and private organizations. This interview has been edited for length and clarity.

Hi Hammouda. Could you start by describing your role and responsibilities on the KJK Project?

Our project has three components. One is social behavior change communication (SBCC), one is social marketing (SM), and one is institutional capacity building. The role of our team is to work with selected partners within the private and public sectors and with NGOs in Mali to improve their capacity to manage SBCC and SM activities.

We approach the work from a performance improvement perspective. We look at both the skills needed and the elements that have an impact on both organizational and individual performance.

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