This story was originally published by SIAPS [5].
[5]

Over its six years working in dozens of countries, SIAPS has carried out a vision [6] 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. Through this project and its predecessors–SPS, RPM Plus and RPM–we’ve been following a systems strengthening framework, digging in with activities that address governance, human resource capacity, information management, financial strategies, and effective services.

This story was originally published on the SIAPS Program homepage [9]. 

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.

SIAPS worked in Ukraine for four years, from 2013 through 2017. Ukraine has the most severe HIV epidemic in Eastern Europe and Central Asia and the second highest TB burden in Europe. Ukraine has the highest mortality rate from infectious diseases in the WHO/Euro region, with TB, HIV, and AIDS accounting for 90% of all deaths.

However, the country’s health system was poorly equipped to cope. Following the collapse of the Soviet Union, Ukraine inherited a centrally controlled health system that funded about half of health expenditures as of 2014. Out-of-pocket payments accounted for more than 46% of the rest, and a third of that was for medicines, which are expensive. That meant affordable medicines were out of reach for many people, as well as the medicines essential to treating these diseases.

This post was originally published on the SIAPS website [13]on January 30, 2017. The Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program is funded by USAID and implemented by MSH. This project works to assure the availability of quality pharmaceutical products and effective pharmaceutical services.

Over the past two decades, Ethiopia has improved its delivery of primary health care services and begun to make great progress toward meeting the Millennium Development Goals, particularly with regard to maternal, newborn, and child health and the prevention and control of HIV and tuberculosis. Yet pharmaceutical services—a patient's last point of care and one of the country's single largest health care expenses—remain inadequate. While some medicines in stock expire, other needed medicines are frequently unavailable, and patients are dissatisfied with the poor quality of service they receive.

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 [18] and Part 2 [19]). Join the conversation online with hashtag [20]#HealthSystems [21].

Cross-posted with permission from Devex.com [27].

The World Health Organization’s first global report on diabetes [28] 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.

Availability of medicines is certainly an important piece of the complex challenge of ensuring that health systems seamlessly integrate prevention, screening, referral, treatment, and adherence. However, choosing the best way to spend limited public health budgets amid competing priorities is equally important.

"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 [35] (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.

Who helps ensure they take the right drug, at the right time, and for the right reason?

A pharmacist.

In many developing countries, pharmacists are primarily responsible for medicines selection, procurement, distribution, and explaining rational use of these medicines to their patients. But, many low- and middle-income countries suffer shortages of trained pharmacists. MSH and partners are helping countries and communities ensure that pharmacists and related health workers are equipped with the skills, systems, and support to provide quality services every day.

A version of this post originally appeared on the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program blog [39]. SIAPS is funded by the US Agency for International Development (USAID) and implemented by Management Sciences for Health (MSH).

More than 900,000 children die of pneumonia each year. Many of these cases go undiagnosed and untreated. The countdown to 2015 report [40] notes that only 54 percent of children with pneumonia symptoms are taken to a health care provider, while the Global Action Plan for Pneumonia and Diarrhea [41] reports that only 31 percent of children with suspected pneumonia receive antibiotics.

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. This leads to prolonged suffering, and even death.

Management Sciences for Health (MSH) is a global leader on pharmaceutical management [45] and universal health coverage (UHC). 

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. Now, we continue to help countries face the obstacles of making UHC a reality.

Access to medicines has not always been at the forefront of the global discourse on UHC, which instead has tended to focus on financing. UHC programs must include adequate health financing and coverage of essential medicines if they are to deliver meaningful health outcomes. Policymakers attempting to establish and maintain UHC programs therefore need to have a sound understanding of the pharmaceutical sector and those pharmaceutical system components that must be considered to ensure ready access to the pharmaceuticals needed [48] to support any UHC program.

The universal health coverage (UHC) movement has reached a turning point. With an unprecedented coalition of global partners rallying behind the UHC movement, the inclusion of UHC as a key aim of the newly launched sustainable development goals, and growing recognition of health as a human right, the real work of achieving UHC has begun – many countries are now grappling with the challenge of making UHC a reality.

As a key partner in bringing the UHC agenda to the forefront of the global community MSH is on the leading edge of translating this global momentum into tangible gains for women, children, and families at the country level. This UHC Day, MSH is working to advance #HealthforAll [52] by recognizing that UHC means that people should have access to not only the health services they need, but also to the essential medicines and heath commodities that help to treat many of the most serious global health threats.

Ensuring equitable and affordable access to medicines is a key component of achieving UHC, but one that is often left out of the conversation. As many low- and middle-income countries start implementing a range of UHC policies, programs, and initiatives, MSH is taking steps to ensure that access to medicines remains on the agenda.