ethiopia
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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
2013 ANNUAL REPORT · MANAGEMENT SCIENCES FOR HE ALTH
MSH FIRST ARRIVES 2008
STAFF IN COUNTRY 146
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
MANAGEMENT SCIENCES FOR HE ALTH · 2013 ANNUAL REPORT
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
2013 ANNUAL REPORT · MANAGEMENT SCIENCES FOR HE ALTH
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.
MANAGEMENT SCIENCES FOR HE ALTH · 2013 ANNUAL REPORT
Uganda: Lives SavedSTRIDES FOR FAMILY HEALTH PROJECT CONTRIBUTED TO SAVING AN ESTIMATED 40,000 LIVES IN FOUR YEARS
Uganda MSH FIRST ARRIVES 2006
STAFF IN COUNTRY 170
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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