In the 40 years since the Alma-Ata declaration, much has changed. An essential package of services is the norm in many countries, and health education for prevention is a critical component of primary health care. Merce Gasco, JSI’s Senior Technical Advisor, reflects and shares her thoughts on the changes in public health systems over the past four decades.
While the global community strives to ensure program sustainability, the sad reality is that only a few of these interventions will continue after donor support and technical assistance ends. In addition, many of these projects will end with limited evidence that only includes the impact on health outcomes within a finite number of facilities and districts. As the global community begins to support progress towards universal health coverage (UHC) in low- and middle-income countries, we should ask ourselves: who’s going to pay when the donor support and technical assistance have gone?
Like many Eastern European countries in the early 1990s, Romania had a history of low contraception use and a high rate of abortion. Starting in 1999, progress accelerated dramatically thanks to a number of critical and complementary interventions; a national health insurance scheme, the privatization of health providers, extensive policy change, training to enable more providers to offer family planning services, and a heavy focus on rural access.
We need to look at whether people have the right mix of incentives to avoid unhealthy lifestyle choices, and to access preventive health, such as vaccinating their children, using contraceptives for birth spacing or to avoid pregnancy, using condoms for disease prevention, and sleeping under bed nets in malarial zones. But just as importantly, we need to ensure that health care providers, both individual and institutional, have the right alignment of incentives to deliver high quality, affordable health services and pharmaceuticals.
In 2013, JSI began assessing the quality of the data collected on six key indicators related to HIV by performing data quality assessments at health facilities in Mozambique. These assessments evaluate data collected at the facility level and compare recorded data to data captured at the national level in order to determine discrepancies and improve overall data quality.
For months, the burden of responding to the the unprecedented Ebola outbreak in West Africa fell mostly on fragile national health systems. JSI’s Merce Gasco, Technical Advisor to the Rebuilding Basic Health Systems in Liberia project, explains the toll that has taken on health systems’ ability to provide much-needed basic health services and calls for a stronger international support for outbreak response.
JSI supports the Government of Liberia’s move to extend healthcare to all its citizens.
South Sudan has one the highest maternal mortality rates in the world, with more than 2,000 deaths per 100,000 live births. Most women still give birth at home, and very few of those deliveries include skilled attendants. The lack of basic and emergency obstetric care is a major factor behind the high levels of maternal mortality and morbidity there.
It is time for international attention to children’s health to shift focus to the newborn period – a crucial time of life that requires specific strategies.