Newsletter

Strengthening Sierra Leone Health Systems: Applying Lessons from the 2014 Ebola Outbreak to Future Emergencies

This guest post was written by Laurentiu Stan (laurentiu_stan@jsi.com), MD,MPH, MBA, Chief of Party, Advancing Partners and Communities (APC) Project, Sierra Leone, JSI Research & Training Institute, Inc. John Snow, Inc., a member of Global Health Council (GHC), and the nonprofit JSI Research & Training Institute, Inc., are public health management consulting and research organizations dedicated to improving the health of individuals and communities in the US and around the globe.

Zainab Jalloh, holding her one-year-old daughter Khadijatu, at the Gbanti Community Health Post (CHP) on April 3, 2017 in Bombali District, Sierra Leone.

I’ve lived in Sierra Leone for almost two years, working to help this country’s long-battered health system recover from the Ebola outbreak that took the lives of more than 200 health professionals. Now the country has been affected by an epic landslide. Despite these tremendous setbacks, health systems and health indicators are improving.

Even before the Ebola Virus Disease (EVD) outbreak, Sierra Leone had the world’s highest maternal mortality ratio: 1630 of 100,000 live births (UNICEF, 2010). By 2015, the ratio had dropped to 1360, but Sierra Leone still held the top spot in this dismal measurement. Ebola compounded the problem because about 1 in every 4 women stopped coming to clinics for prenatal care and delivery. In fact, although almost 4,000 Sierra Leoneans died due to the EVD outbreak (between May 2014 and January 2016), during that same period more than 4,500 women died in childbirth.

The Ministry of Health and Sanitation (MOHS) focused its post-Ebola health recovery priorities on strengthening the health system’s capacity to safely detect and prevent diseases and respond to future epidemics in cooperation with its neighbors. It also recognized the need to contribute to global health security to improve health and economic opportunities.

A health facility water pump before APC revitalization. Photo courtesy/ JSI Research & Training Institute, Inc.

Between September 2015 and August 2017, under the umbrella of the USAID-funded and JSI-managed Advancing Partners & Communities (APC) project, I have helped implement a number of programs that are contributing to MOHS recovery objectives by improving primary care service delivery in the communities hardest hit by Ebola. APC has revitalized 305 primary care facilities, ensuring access to basic health services—with a focus on improving quality of maternal health services—for almost 2 million Sierra Leoneans, including the 3,400 registered Ebola-survivors.

A health facility water pump after APC revitalization. Photo courtesy/ JSI Research & Training Institute, Inc.

APC’s community health facility upgrades dramatically improved water and sanitation standards, installed solar power systems, provided basic equipment, and trained more than 900 health professionals and 1,500 community health workers (CHWs) on reproductive, maternal, newborn, and child health and as—importantly, given how Ebola was spread—infection prevention and control practices. Today, more than 2 million Sierra Leoneans in five districts have access to revitalized primary care and community health services in these primary care units and their catchment villages.
We know that another epidemic or emergency could come at any time, and while the Sierra Leone health system is going through significant transformations as part of the five-year recovery plan, it is better equipped now to address it.

The tragic August 14 landslide was just such an emergency—and the new systems that the U.S. government has invested in are working. The emergency coordination and resource mobilization mechanisms put in place with CDC support reacted well and fast. Mental health nurses who were trained to support Ebola survivors are providing psychosocial support to the several-thousand people who lost homes and relatives: more than 1,000 people died in the landslide. The CHWs recently trained by APC have undergone a 15-day social mobilization exercise to identify and convey messages on the prevention of cholera and other waterborne diseases to at-risk populations. With USAID and DfID support, JSI is assisting the MOHS relief efforts with emergency delivery of essential pharmaceutical and medical consumables to one area hospital and six primary care units.

This most recent tragedy has demonstrated that the country’s service delivery system has improved. One year after the outbreak ended, the MOHS data showed about a 10% positive change in uptake of facility deliveries and outpatient services in the four districts where 70% of Ebola survivors live. Now that health facilities have been revitalized, and health care workers are providing higher-quality services, we are seeing more and more Sierra Leoneans returning to their local health facilities.

There is still much to be done, of course. But Sierra Leone is on its way to a health system that meets the needs of its people—and, given the toll that Ebola took, is ready to confront the next infectious disease—be it Ebola or some other virus—with stronger, better prepared health services. And that helps us all.

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The Reach Act: Investing in Maternal and Child Health

This post was written by Melissa Chacko, Policy Associate at Global Health Council.

Over the past few decades great strides have been made in maternal and child health: since 1990, the deaths of mothers and children under age 5 worldwide have been cut by more than half. The decrease in maternal and child mortality rates is a product of simple evidence-based solutions and inexpensive interventions. However, there is still a significant amount of work to do to ensure that no woman or child dies from a preventable death in our generation. Nearly 300,000 women continue to die annually due to complications during pregnancy or childbirth and 99% of these maternal deaths occur in the developing world. Access to quality care is essential for women and children as they are an integral part to building strong and prosperous communities. To reach the overarching goal of ending preventable deaths may seem idealistic, but it is achievable if we maximize the return on U.S. investments in maternal and child health programs.

In 2014, an advisory panel analyzed USAID’s Maternal and Child Health program, and found areas of improvement that would maximize the progress of the program. Since then, the program has undergone the process of implementing reform and exploring innovative financing tools to bring new resources to the field. However, with these measurements and expansion, also comes a need for greater coordination and accountability.

The Reach Every Mother and Child Act (S.1730) would create that accountability and coordination, as well as codify the reforms, all of which will keep USAID on track to reach its goal of reducing preventable child and maternal deaths and maximizing impact. In early August, Senators Susan Collins (R-ME) and Chris Coons (D-DE) led a bipartisan group of 10 Senators in reintroducing the Reach Every Mother and Child Act.

The Reach Act:

1) Requires a coordinated U.S. government strategy for contributing to reducing preventable child and maternal deaths;
2) Establishes rigorous reporting requirements to improve transparency, accountability, efficiency, and oversight of maternal and child health programs;
3) Ensures USAID focuses on the scale-up of highest impact, evidence-based interventions to maximize the return on existing U.S. investments;
4) Establishes the position of Child and Maternal Survival Coordinator at USAID to reduce duplication of efforts and ensure that resources are being used to maximum impact; and
5) Helps USAID explore and implement innovative financing tools, such as pay for success contracting, to leverage additional public and private resources, complementing existing U.S. assistance.

A similar version of the legislation was introduced in Congress last session (S.1911 and H.R. 3706) and received strong bipartisan support in both chambers.

In almost every field of health, women and children are the most vulnerable in areas that lack essential healthcare resources and systems. We can change this narrative by passing the Reach Act. The lasting impact of this legislation will be seen through the thousands of women and children who will live longer and healthier lives, due to access to quality care. With the Senate back in session, outreach for Senate cosponsors on the Reach Every Mother and Child Act is in full swing. It is important to rally support on this issue and vocalize the importance of bipartisan support on the Reach Act.

We encourage you to contact your Senators to voice your support for the Reach Act. You can find contact information for the Senate here.

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Population Reference Bureau (PRB) Releases 2017 World Population Data Sheet

Global Health Council (GHC) member PRB has released the its 2017 World Population Data Sheet package at www.worldpopdata.org featuring key health and population indicators and population projections for the world, regions, and 200-plus countries. This year’s theme is the world’s youth population (ages 15-24) focusing on whether this generation has what it needs to develop into productive adults and build better lives for themselves, their families, and their societies. Several indicators and analytical graphics in the Data Sheet explore specific themes related to youth well-being.

The landing page on www.worldpopdata.org is an interactive feature with sections containing videos and graphics on topics such as the percentage of youth who are not engaged in education or employment, growing noncommunicable disease risk behaviors among youth, trends in modern contraception use among young married women, and HIV/AIDS rates among young people in sub-Saharan Africa.  Please help expand the reach of the Data Sheet! The hashtag is #worldpopdata. For more information or to order print poster copies, email datasheet@prb.org.

View World Population Data Sheet (PDF) here.

 

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2017 Triangle Global Health Annual Conference

This guest post was written by Emily Kiser (emilykiser@triangleglobalhealth.org), Program Coordinator at Triangle Global Health ConsortiumThe Triangle Global Health Consortium is a non-profit member organization representing institutions and individuals from the pharmaceutical and biotechnology industry, the international health development NGO community, the faith community, and academia. The Consortium’s mission is to establish North Carolina as an international center for research, training, education, advocacy and business dedicated to improving the health of the world’s communities. To learn more, visit www.triangleglobalhealth.org.

The Triangle Global Health Consortium warmly invites you to attend the 2017 Triangle Global Health Annual Conference to share, learn, and build relationships within North Carolina’s rich global health community! The conference will be held September 28 on the North Carolina State University campus in Raleigh, NC. Conference registration is now open, and early bird rates are available through September 7. The day will feature global health leaders, compelling speakers, exciting breakout sessions, and plenty of time to network!

North Carolina is a leader in global health, housing more than 220 organizations, companies, and academic institutions that work in more than 185 countries to improve the health of people around the world. Global health work supports over 26,000 jobs in North Carolina, and in 2015, the global health sector in North Carolina contributed about $3.7 billion in gross state product. Our conference sessions will highlight many areas of global health work taking place in our state and their far-reaching impacts.

We are thrilled to present keynote addresses from three incredible speakers who will discuss the impacts of global health work, both here at home and around the world. Keynotes include:

Health, Peace, & Prosperity, All Within Reach

Pape Gaye, MBA
President & CEO of IntraHealth International

 

Global Health, the US Government, and our Future

Michael H. Merson, MD
Wolfgang Joklik Professor of Global Health, Vice President and Vice Provost for Global Affairs at Duke University, founding director of the Duke Global Health Institute

 

Women Leaders in Global Health: Say it with Stats and Stories

Nandini Oomman, PhD
Independent consultant in global health & development and founding curator for the Women’s Storytelling Salon

 

The day will also feature two plenary panel discussions which will illustrate the economic and security impacts of global health work. Panelists will discuss the many ways in which global health work contributes to development, diplomacy, and defense and the improvements that are generated in arenas far beyond health alone.

We will also offer the opportunity to select from a variety of breakout sessions which reflect the vast diversity of global health work taking place in North Carolina. We are excited to present:

1) Building Multi-Sectoral Coalitions
2) Can we translate the multilateral strategies for cervical cancer prevention to address other global health disparities?
3) Creating and Managing Specialized and Remote Health Worker Training using Referenceable Replays
4) Food and Nutrition Security in a Climate-Changed World: Health, Socioeconomic, and Environmental Inputs and Impacts
5) Impacts of Global Environmental Health Efforts: Perspectives from Federal Agencies
6) Innovation Challenges and Co-creation for Digital Health: Hands on Training
7) Story-Gathering for Social Impact
8) The global pandemic of substandard and falsified medicines

We hope you will join us to learn, share, create, and connect in Raleigh, NC on September 28!

​For more information on conference programming, speakers, sponsors, and more, visit www.triangleglobalhealth.org/annual-conference.

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Community Health Workers: A Priority for Universal Health Coverage?

This guest post was written by Colin Gilmartin, Senior Technical Officer at Management Sciences for Health (MSH), a nonprofit global health organization and GHC member organization. Gilmartin specializes in health care financing and the planning and costing of community-based services. He can be followed on Twitter, @colingilmartin. MSH’s mission is saving lives and improving the health of the world’s poorest and most vulnerable people by closing the gap between knowledge and action in public health.

Community Health Volunteer in a remote village of Tulear, Madagascar, giving instructions to a client on the use of pregnancy tests. Image by Samy Rakotoniaina/MSH

How countries can move toward building sustainable community health programs.

Universal health coverage (UHC) is increasingly recognized as the best way to achieve the Sustainable Development Goal targets on health. But with 400 million people lacking access to essential health services and a projected shortage of 18 million health workers, it will take unprecedented effort and funding. Community health workers (CHWs) could be an important part of the solution—but without effective investments and sound planning, we will fall short of achieving UHC.

Many low- and middle-income countries rely on a robust community health workforce, but few are self-sustaining and many rely heavily on external donors. CHWs fill critical gaps while delivering quality, affordable services closer to underserved patients. Even during crises, such as West Africa’s Ebola outbreak, CHWs can ensure the continuity of services while helping to stop epidemics.

As a 2015 report shows, CHWs can also yield a sound 10-to-1 return on investment, when accounting for a healthier population’s increased productivity and formal employment and the prevention of costly health crises. Expanding access to community services could prevent up to 3 million deaths annually while substantially reducing patients’ out-of-pocket costs.

Recognizing these benefits, low- and high-income countries alike are developing and expanding CHW programs. In Ethiopia, Community Health Extension Workers (CHEWs) proved instrumental in reducing maternal and child deaths and in meeting nearly all of the country’s 2015 Millennium Development Goals on health. Countries including Ghana and Sierra Leone are training and deploying a combined 35,000 CHWs to bridge gaps. Even in American cities like Philadelphia, CHWs are delivering evidence-based health interventions to high-risk patients while reducing overall health care costs.

While CHWs are not a new concept, the recent momentum for scaling CHWs raises an important question: will they be a long-term investment or simply a palliative solution to achieve short-term results?

Amid competing funding priorities and uncertainty around foreign assistance, countries show reluctance to invest in community health systems. CHWs are often unpaid volunteers, lack a career path, and are rarely considered part of the formal health workforce. These factors, combined with growing demand for their time, contribute to high rates of attrition. Further, in the absence of proper planning, frequently there is no funding for ongoing training, program support, and supervision of CHWs. This can lead to low-quality services or, worse, a complete stoppage of services in the most challenged communities.

To achieve UHC and the health SDG targets, long-term community health planning is essential—and along with helping countries identify solutions to meet health goals, it provides an opportunity to evaluate progress and make improvements. Planning can also help countries identify the costs and resource needs to sustain CHWs, including medicines and supplies; equipment; incentives; training; as well as program management, supervision, and reporting. It also cuts down on duplicative efforts among partners.

To facilitate this process, the NGO where I work, Management Sciences for Health, partnered with UNICEF to create a Community Health Planning and Costing Tool that helps calculate the costs of delivering comprehensive community health services for up to 10 years. To-date, the tool has helped plan the long-term implementation of national community health programs in Madagascar, Malawi, and Sierra Leone.

Understanding the costs and required financing for large-scale community health programs helps governments more effectively advocate for domestic and external funding sources, including the private sector. Plus, identifying funding gaps can help countries pool different sources to ensure that health programs operate fully and consistently.

As countries move toward building and sustaining national community health programs, they should consider a few key takeaways.

First, long-term financing plans should be developed to support continuous services and funding for all elements of a community health program. While domestically-financed programs may prove unrealistic for many countries, there are opportunities to leverage existing initiatives and donor funding. For example, in Rwanda, CHWs are integrated into the country’s national performance-based financing scheme, which provides incentives to fund income-generating activities. Other countries leveraged multi-year Global Fund support to cover antimalarial medicines, rapid diagnostic tests, training, and incentives.

Community health program funding should work to strengthen health systems overall. Embedded in weak health systems, CHWs programs will be ineffective and investments will fall flat. CHWs will only succeed when all building blocks are performing. For example, programs must reinforce strong supply chains, a dynamic supervisory and management workforce, and an effective flow of health information.

As frontline health workers, the CHW role should also be institutionalized in national health systems. Along with clearly defined responsibilities, they should receive ample recognition, incentives, and professional development opportunities. By doing so, countries can improve the quality of service delivery, ensure greater accountability to their communities, and increase CHW retention.

Lastly, we must continue to demonstrate the impact of CHWs and draw lessons. To strengthen the investment case for CHWs, we must go beyond demonstrating achievements of process indicators and coverage metrics and document how effectively CHWs improve patient outcomes, reduce costs to health systems and patients, and contribute to health milestones and targets. By sharing experiences and lessons-learned, other countries might avoid shortcomings and adapt program successes to address their health priorities.

This article was originally published in Global Health NOW. Join the thousands of subscribers who rely on Global Health NOW summaries and exclusive articles for the latest public health news. Sign up for the free weekday e-newsletter, and please share the link with friends and colleagues: http://www.globalhealthnow.org/subscribe.html.

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