MLI Newsletter - April 19th, 2011

April 21, 2011

Sierra Leone's Dr. Kargbo speaks at Harvard

For years, many around the world looked at Sierra Leone as a broken down place. That's changing, and innovations in health care are helping to change that perspective. Earlier this month at Harvard University's John F. Kennedy School of Government, the Director of the Reproductive and Child Health Unit in Sierra Leone's Ministry of Health and Sanitation, and close MLI collaborator, Dr. Samuel A.S. Kargbo, joined Dr. Paul Farmer, the founding director of Partners in Health and the Kolokotrones University Professor at Harvard, for a panel discussion on free health care. The program, entitled "Health Financing for Universal Coverage," focused on current global debate on the fiscal viability of high quality health services in poor countries as well as the obstacles for the successful implementation of free care. Dr. Kargbo spoke about the design and roll out of Sierra Leone's free care initiative for pregnant women, lactating mothers, and children under the age of five. The initiative has been widely credited for more than doubling malaria treatment for children under the age of five and increasing the number of women giving birth in health facilities – even if the country faces obstacles in extending services.

The program also included panelists Rob Yates, a Senior Health Economist at DFID; Dr. Cristian Baeza, Director of Health Nutrition and Population Cluster at the World Bank; and Dr. Agnes Bingawaho, Permanent Secretary of Rwanda's Ministry of Health. It was sponsored by Partners in Health, Department of Global Health and Social Medicine at Harvard Medical School, Center for Global Health at Massachusetts General Hospital and the Francois-Xavier Bagnoud Center for Health and Human Rights at Harvard University.

MLI blogs live from Ethiopia

Last week Senior Consultant John Donnelly was in Ethiopia on a reporting trip sponsored by MLI. While there, he documented his trip in a blog series for Global Health Magazine. Donnelly was able to gain insight into Minister Tedros' TB outreach programs, observe a 'model family' and sit in on the Federal Ministry of Health's weekly meeting.

Researchers present findings on free care policies in Mali

The Ministry of Health (MoH) in Mali has been extending its free care policies in the last 10 years to include coverage of anti-retrovirals in 2004, Cesarean sections in 2005, and new treatments against malaria (ACT) in 2007. Free care is defined as the elimination of user fees at the point of service. Given the number of initiatives being implemented in Mali, the Ministry of Health requested researchers to gather useful evidence for decision-making particularly around the effects, implementation challenges, and costs associated with these various free care initiatives. Their findings were presented to over 100 researchers, policymakers, and technical experts in Bamako at the National Conference on Free Care Policies, which was organized by the MoH and co-sponsored by MLI. In addition to providing a venue to feature research results and recommendations from research projects and institutions, the conference was a catalyst for debate and lively discussion among both policy makers and implementers. Recommendations that emerged from the conference included the need to better plan, manage costs, and anticipate the effects of free care; reinforce community mechanisms to support indirect costs such as transportation; and devise a sustainability strategy for free care through health insurance systems.

More information about the studies presented, along with the presentations and the policy brief developed at the meeting are available online.

MLI Case-Study: Implementing a Balanced Scorecard at St. Paul's Hospital

Dr. Lina Mohammed is an emergency department specialist at St. Paul's Hospital in Addis Ababa, Ethiopia. Over the past year, Dr. Mohammed has seen much change inside the country's second largest medical facility. "Before the training course, you just came to work every day and then you left. You didn't get to see the bigger picture," she said. "We weren't working for a larger goal. We were just putting in the hours." The training course that Dr. Mohammed is referring to is the Balanced Scorecard (BSC), a strategic planning and performance management tool. In 2008, Hon. Minister of Health Dr. Tedros Adhanom Ghebreyesus requested support from MLI to implement the BSC, and to apply it throughout the health sector in Ethiopia. One of the first targets was St. Paul. While the BSC is still being implemented in all 13 departments of the hospital, changes are already being observed as Dr. Lia Tadesse Gebremedhin, CEO of the hospital, and Rahel Gizaw, MLI country lead in Ethiopia authored a case study documenting the process. Some of the observations include improvements in emergency room triaging, a decreased surgical waiting list and outpatient waiting time, and improved management of all referrals, admissions, and discharges. While some were skeptical about the impact of BSC, it has proved to be transformative for the hospital's daily operations. Just ask Dr. Mohammed.

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