2013 Annual Report

LIVES SAVED

ethiopia

uganda

drc

2013 ANNUAL REPORT · MANAGEMENT SCIENCES FOR HE ALTH

A MESSAGE FROM THE CEO

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— L

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tao of leadership

Since our founding in 1971, MSH’s operational philosophy

has been the 3,500-year-old Tao (Way) of Leadership, working shoulder to shoulder with our

local colleagues and partners and empowering them for success.

Dear Friends,

A world where everyone has the opportunity for a healthy life—this is MSH’s vision, guiding our efforts to achieve lifesaving results by strengthening health systems. In the coming years, universal health coverage (UHC) will play a pivotal role in attaining this vision. UHC is the only approach that helps countries mobilize all viable funding for health, transforms health systems, responds to changing health needs, and protects households from health-related financial hardship. For this reason, in 2013, we vigorously supported UHC in the post–Millennium Development Goals framework.

UHC is more than merely aspirational or a privilege for wealthy countries. It has been proven achievable for countries at every income level. We are especially proud to have worked with Nigeria, Kenya, and Ethiopia as they set out on the path toward UHC in the past year.

More than 280,000 lives saved—this is the evidence-based estimate of impact we share with you in this report. The stories here show that strengthening health systems toward UHC is not merely working , it’s multiplying health impact. In the fragile state of Democratic Republic of the Congo and the emerging economy of Uganda, children’s lives saved also means parents teaching other parents to better care for their families. In the relatively stable economy of Ethiopia, support for women with HIV also means fewer babies born with HIV and more husbands engaged in caring for the health of their families. By 2018, MSH aims to have saved one million lives.

We still have much work to do. As we continue to improve the measurement of our progress, we will continue to improve our knowledge of what works in global health so that no one is left behind.

We are deeply grateful to our diverse funding and implementing partners and the local health leaders with whom we work shoulder to shoulder. Together we will strengthen health systems and save more lives. We will forge a path toward a healthier world.

With warm regards,

Jonathan D. Quick, MD, MPHpresident & chief executive officer

ANNUAL REPORT

ESTIMATING LIVES SAVED

MSH is dedicated to achieving lifesaving results. We generated the lives-saved figures in this report using two tools from the SPECTRUM suite.

The Lives Saved Tool (LiST) allows health leaders to model the estimated impact of maternal, newborn, and child health interventions by combining the best scientific information about the effectiveness of those interventions with local demographic, mortality, and program coverage information.

The AIDS Impact Model (AIM) estimates infection and death rates, as well as the number of AIDS orphans.

For more information on SPECTRUM, visit www.futuresinstitute.org/spectrum.

MSH is committed to the continuous improvement of our data reliability. For more information on our results management initiative, contact Juan-Carlos Alegre at [email protected].

“We are the talk of the town. Now pregnant mothers

come to the health facility for delivery because it’s like

their homes,” says Jember Alemayehu, an MSH-trained

mother mentor in Korem town. In 2013, Alemayehu

and three other HIV-positive mothers—Teberih Tsegay,

Almaz Haile, and Yeshi Derebew—began an innovative

project to perform a highly valued traditional Ethiopian

birth ceremony at the local health center, encouraging

at-risk women to deliver there. The US Agency for

International Development (USAID) Ethiopia Network

for HIV/AIDS Treatment, Care and Support (ENHAT-CS)

program, funded by the US President’s Emergency Plan

for AIDS Relief (PEPFAR) and implemented by MSH,

has helped train 340 mother mentors at 85 health centers

in three years. The mother mentors facilitate mother

support groups and provide individual counseling to

HIV-positive mothers to teach them how to prevent

HIV in their babies and how to live healthy, positive lives

themselves. Nearly 10,000 mothers have participated.

The mother mentors also reach out to women in their

homes and educate husbands. Supporting women and

their babies, as well as husbands, makes families stronger,

multiplying health impact. Since 2011, the ENHAT-CS

project has helped increase the number of patients

receiving antiretroviral therapy in supported HIV clinics

by 57.5 percent.

Since the mother mentors in Korem began supporting

pregnant women in 2011, not a single baby from the town

has been born with HIV. The mother mentors are now

the talk of the global health world as well: they have

been honored with 2014 REAL Awards, a global award

created by Save the Children and the Frontline Health

Workers Coalition to develop greater appreciation for

health workers everywhere.

In 2014, MSH will celebrate ten years of partnership with

Ethiopia. The mother mentor groups are one piece of

our integrated, comprehensive approach to saving lives

and expanding health care in all regions of the country.

Since 2008, MSH’s four programs supporting distribution

and use of antiretrovirals in Ethiopia have contributed

to an estimated 177,000 lives saved. In 2013 alone,

MSH projects in Ethiopia have helped train more than

5,400 health workers.

In March 2013, MSH helped launch the Health for All

advocacy campaign for universal health coverage.

With support from The Rockefeller Foundation, MSH

is working with the Ethiopian Health Insurance Agency

as it rolls out nationwide insurance schemes covering

both the formally and informally employed populations.

MANAGEMENT SCIENCES FOR HE ALTH · 2013 ANNUAL REPORT

Ethiopia MSH FIRST ARRIVES 2003

STAFF IN COUNTRY 432

ACTIVE PROJECTS 13

HEALTH WORKERS TRAINED IN 2013 5,449

Ethiopia: Lives SavedFOUR MSH PROJECTS CONTRIBUTE TO SAVING AN ESTIMATED 177,000 LIVES IN FIVE YEARS

LIVES SAVED

Antiretroviral provisions continue to grow through the Ethiopia Network for HIV/AIDS Treatment, Care and Support (ENHAT-CS) program.

EXPANDED ANTIRETROVIRAL REACH

baselineF Y11 F Y12 F Y13

11,311

45,071

11,668

56,694

16,678

71,007

Newly Enrolled ART Patients Current ART Patients

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Justine Mbombo is a seamstress in a village of roughly

520 people. More than 100 are children under five,

and her village has no doctor. In 2010, the village lost

17 children to measles. Two years later, an MSH project

trained local residents, including Mbombo, to promote

good family health behaviors and practice community-

based management of childhood illness. Mbombo now

educates families on the warning signs of illness; cares for

nearly 20 children each month with uncomplicated cases

of pneumonia, diarrhea, or malaria; and refers children

with critical symptoms to a health facility. “I realize that

my small gestures and my commitment save lives,” she

says with pride. “Epidemics used to be frequent; today

we no longer have outbreaks.” The engaged community

will sustain these results, multiplying health impact.

In fragile states such as Democratic Republic of the Congo

(DRC), evidence reveals that low-cost, high-impact

interventions reaching many people are highly effective.

MSH’s Integrated Health Project (IHP) in DRC, funded

by USAID, is active in more than 1,500 health facilities in

80 health zones, reaching more than 12 million people

with high-impact interventions in child survival; maternal

health; reproductive health and family planning; water,

sanitation, and hygiene; and HIV and AIDS, tuberculosis,

and malaria. In the past year alone in DRC health facilities,

the project treated more than 650,000 children under

five for malaria. Between 2011 and 2013, IHP increased

preventive malaria treatment in pregnant women from

26 to 74 percent. In the same period, the project

increased treatment of pneumonia (62 to 86 percent)

and diarrhea (29 to 57 percent) in children under five,

exceeding IHP’s goals.

IHP is one of five MSH projects working together in

DRC. In 2013, MSH projects in DRC helped train more

than 5,300 health workers.

Democratic Republic of the Congo: Lives Saved

THE INTEGRATED HEALTH PROJECT CONTRIBUTED TO SAVING AN ESTIMATED 68,000 LIVES OF YOUNG CHILDREN IN TWO YEARS

LIVES SAVED


MSH FIRST ARRIVES 2008


ACTIVE PROJECTS 5

HEALTH WORKERS TRAINED IN 2013

5,311

SAVING CHILDREN’S LIVES

Proportion of children’s lives saved by interventions in Democratic Republic of the Congo

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ANTIMALARIALS

38 %

VITAMIN A SUPPLEMENTATION

3 %IMPROVED WATER SOURCE

1 %

ORAL REHYDRATION SOLUTIONS

18 %

DPT VACCINES

3 %

IMPROVED SANITATION

9 %

HiB VACCINES

8 %

ORAL ANTIBIOTICS

case management of pneumonia in children

17 %

ZINC

for treatment of diarrhea

3 %

Democratic Republic of the Congo

Advocating for Universal Health Coverage

20 Years of Health Impact in NigeriaDuring a 20-year partnership with Nigeria,

MSH has helped improve the country’s

services for child survival, reproductive

health, tuberculosis, and HIV and AIDS.

We have assisted 23 state governments in

improving access to quality health care and

social welfare services. We have also built

the capacity of civil society and communities.

At the civil society level, we have empowered

nearly 100 organizations to improve their

operating systems, resource mobilization,

and service delivery. At the community level,

we have strengthened community systems

to bring services to nearly 50,000 orphans

and vulnerable children, and we have enrolled

more than 65,000 people living with HIV in

care, with over 40,000 of them on lifesaving

antiretroviral therapy.

In the last six years alone, MSH has helped

build a countrywide cadre of 225 health

professionals, including doctors, nurses,

laboratory scientists, program managers,

and policymakers.

MSH is also honored to partner with the

Government of Nigeria on its universal health

coverage initiatives that work toward health

for all people.

NIGERIA

Building a Healthier Nation with Afghanistan

Maternal mortality in Afghanistan has fallen

by more than 70 percent since 2002. Child

mortality under five has fallen by more than

60 percent—the equivalent of saving 150,000

infants and children per year. MSH is honored

to have partnered with the Ministry of Public

Health in Afghanistan over a 10-year period

to bring a basic package of health services

for maternal and child health to Afghans in

all 34 provinces. Our additional efforts to

strengthen Afghan leadership, management,

and governance have made these lifesaving

results possible. The government now leads

the management of the basic health care and

hospital services and manages funding from

the US and other donors for delivery of

these services. In the last year, MSH’s ongoing

health systems strengthening programs in

Afghanistan have contributed to the delivery

of essential medicines to 8 million people

in rural areas and the establishment of a

community-based health care system with

23,000 volunteers.

Envisioning a World Where Everyone Has the Opportunity for a Healthy Life: Photography Exhibit and DiscussionIn November 2013, MSH hosted Envisioning a World Where Everyone Has

the Opportunity for a Healthy Life, a global health photography exhibit featuring

photos from MSH’s 2013 Africa Photography Fellowship at the Institute of

Contemporary Art (ICA) in Boston. Moderated by National Public Radio’s

Tom Ashbrook, host of WBUR’s “On Point,” the panel discussion on achieving

universal health coverage around the world featured distinguished speakers

US Representative Jim McGovern (D-MA); former Kenyan Minister of Health

Peter Anyang’ Nyong’O; Priya Bery, Vice President for Strategic Initiatives at

TOMS; and Jonathan D. Quick, President and Chief Executive Officer at MSH.

Investing in women as leaders is not only the right thing to do, it’s the smart thing to do. An Open Mind and a Hard Back: Conversations with African Women Leaders, a new publication by MSH and the International Planned Parenthood Federation, amplifies the voices of women leaders from 12 nations, illuminating how they lead, the challenges they encounter, and the impact of their work across sectors. An Open Mind and a Hard Back aims to accelerate progress toward gender equality and good governance in the health sector while promoting and inspiring new leaders along the way. For more information on this publication, please contact Belkis Giorgis at [email protected].

Videos of both the ICA and UN events are available at WWW.MSH.ORG.

NPR’s Tom Ashbrook and US Representative Jim McGovern (D-MA)

ICA event featured photo banners from MSH’s work in Ethiopia, Democratic Republic of the Congo, Ghana, Rwanda, and Uganda.

An action plan developed during

a leadership training in Nigeria.

In Ethiopia, SCMS has supported our key partner, the Pharmaceutical Fund and Supply Agency (PFSA), to transform warehousing and distribution as the country rapidly scaled up HIV and AIDS testing and treatment programs. Pictured here is the Bahir Dar Regional Hub.

The General Hospital, Michika, in Adamawa State, Nigeria, was part of the capacity-building PEPFAR Health Professionals Fellowship Program, which was designed and managed by MSH. The fellowship provided classroom training, community-based activities, practical training, and mentoring/peer support.

Nazima Haqaba, a midwife at the Kalakan Basic Health Center in Afghanistan, received training from MSH. Here, she assists a pregnant woman during her routine visit.

“Women need courage to go into leadership positions and look at themselves differently

than society looks at them.” –Thandi Shongwe

Member of Parliament in Swaziland

“With work, family, and children, we are really busy.

It is a challenge, but a challenge worth all the work.”

–Therese Bishagara Member of Parliament in Rwanda

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PHOTOS: BEN GREENBERG/MSH

A Healthy Future for All: Making Universal Health Coverage a Post-2015 PriorityAs the United Nations General Assembly kicked off general debate on the

post-2015 development agenda in September 2013, MSH, The Rockefeller

Foundation, and the Permanent Mission of Thailand to the United Nations

hosted A Healthy Future for All: Making Universal Health Coverage a Post-2015

Priority. The standing-room-only event featured keynote speaker Jeffrey D.

Sachs, Director of The Earth Institute at Columbia University.

Jeffrey D. Sachs defines UHC.Dr. Ariel Pablos-Mendez, Asst. Administrator, Global Health, USAID led the discussion.

PHOTOS: PAULA CHAMPAGNE/MSH


Delivering Lifesaving MedicinesCost-effective, reliable, secure supply chains

can save millions of lives. The Supply Chain

Management System (SCMS) has virtually

eliminated central-level stock-outs of AIDS

medicines and supplies in PEPFAR-supported

countries and helped reduce the annual cost

of antiretroviral medicines from $1,500 to

$100–$200 per patient. As of mid-2013,

an estimated 2.5 million patients received

antiretroviral medicines through SCMS. In

the past year, SCMS established operations

in Burma; supported the Côte d’Ivoire

central medical store in transitioning to

an independent, nonprofit business; and

supported Guyana in opening a new world-

class warehousing and distribution facility.

SCMS’s innovative approach to pooling

medicine procurement and improving

service delivery makes health supplies

more accessible, affordable, and effective,

even in emergencies. The project was

recognized this year with a World Bank

Science of Delivery Award for procurement

in complex situations.

SCMS is a project of PEPFAR administered

by USAID. It is managed by the Partnership

for Supply Chain Management, a nonprofit

organization established by MSH and JSI

Research & Training Institute.

SUPPLY CHAIN MANAGEMENT

150,000 Mortality of children under five has fallen by more than 60 percent— the equivalent of saving 150,000 infants and children per year.

Services to nearly 50,000 children in 2013.

50,000

An estimated 2.5 million patients received antiretroviral medicines through SCMS by mid-2013.

2,500,000

2013 EVENT HIGHLIGHTS

Giving Voice to Women Leaders

MSH Works Across Priority Health Areas 2013 expenses by priority health area

FUNDRAISING

< 1 %

PROGRAM EXPENSES

89.11 %

ADMINISTRATION EXPENSES

10.88 %

... and Offers Value for Money. fiscal year 2013


REVENUES

contract, grant, & program revenue $321,278,525investment income & contributions $7,511additional support revenue $118,355

total $321,404,391

EXPENSES

total $319,174,173

CHANGES IN FUND BALANCE

balance at beginning of year $25,555,119excess of project support $2,230,218 & revenue over expenses

balance at end of year $27,785,337

COMPOSED OF:

cash & cash equivalents $29,619,298amounts due on contracts $22,898,022other current assets $2,597,345property & equipment net of depreciation $1,043,184other assets $763,458current liabilities ($29,135,970)

total unrestricted net assets $27,785,337

Statement of Revenues, Program Expenses, and Changes in Fund Balanceyear ending june 30, 2013 drawn from audited financial statements

2013 board of directors

James M. Stoneboard chairChairman, The Plymouth Rock Company

Barbara BiererSenior Vice President, Research

Director, Center for Faculty Development & Diversity

Professor of Medicine, Harvard Medical School

Center for Faculty Development and Diversity at the Brigham and Women’s Hospital

Rebeca de VivesPresident, RdV Consulting

Gail DeNicolaMarketing Strategy Consultant

Alan DetheridgeAssociate Director, The Partnering Initiative

Atsuko Toko FishCo-founder, Japanese Disaster Relief Fund Boston

Trustee, Fish Family Foundation

John IsaacsonPresident, Isaacson Miller

Paula Doherty JohnsonDirector, Senior Research Fellow, Harvard University’s Hauser Institute for Civil Society at the Center for Public Leadership

Dan PellegromFormer President, Pathfinder International

James Roosevelt, Jr.President/CEO, Tufts Health Plan

Anjali SastrySenior Lecturer, Sloan School of Management, Massachusetts Institute of Technology

GOVERNMENTS

Centers for Disease Control and Prevention (cdc)(usa)

Government of Brazil

National AIDS Commission (nac), Malawi

Sida (Swedish International Development)

US Agency for International Development (usaid)

FOUNDATIONS & CORPORATIONS

The Arthur Vining Davis Foundations

Robert Charles Pozen, The Ashurst Foundation

Bill & Melinda Gates Foundation

Ford Foundation

Foundation for Advanced Studies on International Development (fasid)

The James M. & Cathleen D. Stone Foundation at the Boston Foundation

Pfizer Inc.

Proctor & Gamble

The Rockefeller Foundation

TOMS

INTERNATIONAL AGENCIES

The Global Fund to Fight AIDS, Tuberculosis and Malaria

Pan American Health Organization (paho)

United Nations Development Programme (undp)

UNICEF

The World Bank

World Health Organization (who)

NGOS/PARTNERS

ACDI/VOCA

Abt Associates

AED (Academy for Educational Development)

AMREF (African Medical and Research Foundation)

Association for Rural Development (ard)

Biomedical Research and Training Institute (brti)

Christian Health Association of Nigeria (chan)

DAI

Elizabeth Glaser Pediatric AIDS Foundation (egpaf)

FHI360

Futures Group

Health Systems Trust (hst)

ICF International

The International HIV/AIDS Alliance

IntraHealth International

International Rescue Committee (irc)

JHPIEGO

John Snow, Inc. (jsi)

Kids Included Together (kit)

The New York Academy of Medicine (nyam)

Medical Care Development International (mcdi)

PATH

Pathfinder International

Reproductive and Child Health Alliance (racha)

University Research Co., LLC (urc)

World Learning

UNIVERSITIES

University of North Carolina at Chapel Hill

John Hopkins Bloomberg School of Public Health Center for Communications Programs

University of Zimbabwe

Sources of Support*

Board of Directors

I have admired MSH since its founding for its straightforward commitment to saving lives in the poorest and most vulnerable areas of the world. Its philosophy, focusing on health systems infrastructure, working mainly with local staff in the field, and applying readily available state-of-the-art public health tools and knowledge where they are in shortest supply, makes compelling sense. MSH’s strengthening of health systems throughout the world, from Africa and Asia to Europe and Latin America, has had a lasting and positive impact in more than 60 countries.

In the time I have served on the MSH Board of Directors, I have had one major goal in mind: to prepare MSH for transition to a future, under a new generation of overseers, as contributory as its amazing 40-year past. This requires a first-rate Board of Directors, a senior management team capable of running a large and complex organization, and an element of diversity in funding sources. The first two tasks, I believe anyone familiar with MSH will say, are accomplished. I am proud indeed to be associated with our Board and leadership team members. The third task, establishing a more diversified base, is now under way.

As we enter 2014, I remain as optimistic as ever that MSH needs only to continue on its current trajectory to save many more lives and improve many more health outcomes in the years to come. It is a huge honor to work with such fine people and uphold such a powerful ideal.

James M. Stonechairman of the board of directors

year ending june 30, 2013

A MESSAGE FROM THE CHAIRMANMSH is Growing...contract, grant, and program revenue

2009 $177,547,382

2010 $247,618,290

2011 $268,157,220

2012 $295,194,580

2013 $321,278,525

HIV AND AIDS

23.49 %

MATERNAL,NEWBORN, AND CHILD HEALTH

6.25 %

INTEGRATED HEALTH PROGRAMS

56.10 %

MALARIA AND COMMUNICABLE

DISEASES

3.26 %

FAMILY PLANNING /REPRODUCTIVE HEALTH

5.54 %

CHRONIC NON-COMMUNICABLE DISEASES

< 1 %TUBERCULOSIS

5.31 %

Sources of Support include financial contributions and cost share partners.

When village health team members from MSH’s

USAID-funded STRIDES for Family Health project

visited Nyantungo, a village in the Kamwenge district

of Uganda, one child was healthy while the others were

malnourished. The team asked the healthy child’s

mother, Tushemerirwe Esparanza, to accept training

in child nutrition and then train others in her village.

When Esparanza began reaching out to other women,

she faced resistance. Many were skeptical that increasing

their use of inexpensive local foods could improve their

children’s health and development. Yet as Esparanza

persevered, some mothers took heed and their children

began gaining weight and energy, saving their families

time and money spent on trips to the hospital. The

mothers Esparanza trained now train other women.

Sustained nutrition will help these children grow into

healthy adults, multiplying health impact.

In Uganda, where malnutrition is responsible for nearly

60 percent of infant deaths, STRIDES works with both

public and private partners to improve nutrition and

child survival in 588 health facilities in 15 districts.

The project also improves reproductive health and

family planning practices: between 2009 and 2013,

couple years of protection (estimated protection

provided by contraceptive methods during a one-year

period, based on volume of contraceptives distributed)

increased from 96,105 to 228,473.

STRIDES for Family Health is one of ten MSH projects

working together in Uganda. In 2013, MSH projects in

Uganda helped train more than 5,400 health workers.


Uganda: Lives SavedSTRIDES FOR FAMILY HEALTH PROJECT CONTRIBUTED TO SAVING AN ESTIMATED 40,000 LIVES IN FOUR YEARS

Uganda MSH FIRST ARRIVES 2006


ACTIVE PROJECTS 11

HEALTH WORKERS TRAINED IN 2013 5,445

SAVING WOMEN AND CHILDREN’S LIVES

CHRONIC NON-COMMUNICABLE DISEASES

< 1 %

The STRIDES for Family Health project contributed to saving almost 40,000 lives.

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CHILD HEALTH 17,400

MATERNAL HEALTH 700

FAMILY PLANNING 21,400

INTERVENTION ESTIMATED LIVES SAVED

AFGHANISTAN

ALBANIA

ANGOLA

BANGLADESH

BENIN

BOSNIA AND

HERZEGOVINA

BOTSWANA

BRAZIL

BURKINA FASO

BURUNDI

CAMBODIA

CAMEROON

CENTRAL AFRICAN

REPUBLIC

CHAD

CÔTE D’IVOIRE

DEMOCRATIC REPUBLIC

OF THE CONGO

DOMINICAN REPUBLIC

EGYPT

EL SALVADOR

ETHIOPIA

FIJI

GEORGIA

GHANA

GUATEMALA

GUINEA

GUYANA

HAITI

HONDURAS

INDONESIA

JORDAN

KAZAKHSTAN

KENYA

KYRGYZSTAN

LAOS

LESOTHO

LIBERIA

LIBYA

MADAGASCAR

MALAWI

MALAYSIA

MALI

MAURITANIA

MEXICO

MOROCCO

MOZAMBIQUE

MYANMAR

NAMIBIA

NICARAGUA

NIGER

NIGERIA

PANAMA

PAPUA NEW GUINEA

PERU

PHILIPPINES

RWANDA

SENEGAL

SOLOMON ISLANDS

SOUTH AFRICA

SOUTH SUDAN

SWAZILAND

TAJIKISTAN

TANZANIA

TIMOR-LESTE

TOGO

TUNISIA

TURKMENISTAN

UGANDA

UKRAINE

URUGUAY

UZBEKISTAN

VIETNAM

ZAMBIA

ZIMBABWE

Since our founding in

1971, MSH’s vision of health

impact has influenced over

150 countries worldwide.

WHERE WE

WORK

where msh worked in 2013

(73 total countries)

msh office in country

(40 total offices)

73COUNTRIES DURING 2013MSH WORKED IN

MANAGEMENT SCIENCES FOR HEALTH Stronger health systems. Greater health impact.

200 RIVERS EDGE DRIVE , MEDFORD, MA 02155, USA TEL 617.250.9500 EMAIL [email protected] FRO

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Documents

2013 Annual Report