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Selected Category: health systems strengthening

An Important Partnership in Central America

Categories: health systems strengthening

 

Central America

On the streets of Tegucigalpa or San Salvador or Santo Domingo or in the capitals of five other Central American countries, few people would be able to provide an answer to this question: What is the Council of Ministers of Health of Central America’s (COMISCA)?

Dr. Nelson Arboleda, CDC Central American Regional Office Director

Dr. Nelson Arboleda, CDC Central American Regional Office Director

Despite the understandable lack of awareness, COMISCA has emerged as an important—and effective—mechanism for improving public health across the region. It has unified eight disparate nations into a singular force in the fight against leading causes of death and illness. CDC is one of COMISCA’s prime partners.

COMISCA’s mandate and reason for existence, in fact, is both straightforward and crucial: improve public health in a part of the world beset by health challenges, strained budgets, and technical limitations by joining forces and combining resources. The idea is that by locking arms, sharing data and logistics, and agreeing on a public health blueprint, people in every country will be better protected from illness.

That is good news for the member countries: Belize, Costa Rica, Guatemala, El Salvador, Honduras, Nicaragua, Panama, and the Dominican Republic. COMISCA is led by ministers of health from the countries with the Council’s chair rotating every 6 months.

Since its creation in 1991, COMISCA has shown promise almost from the start. Results, in fact, can already be found in each of the member countries. The ethos is captured in the title of a 2009 document outlining the goals and targets for 2010–2015: “United for the Health of Our People.”

Some of the goals are obvious. Consolidating national surveillance systems and sentinel integrated viral and bacterial diseases is one. Joining forces in a unified and comprehensive way in battle against HIV/AIDS is another. Refining the system for detecting influenza and other infectious diseases to make it more sensitive, accurate, and universal is yet another legitimate aspiration.

Its potential for success and capacity to join forces are the main reasons why CDC not only recognizes COMISCA’s promise but why CDC has fully embraced the organization by offering both financial and technical support, becoming CDC’s most important strategic partner.

CDC, in fact, is currently COMISCA’s largest funding partner, providing approximately $1.3 million per year. Laboratories and disease surveillance are two of the major focuses in the partnership. That emphasis is underscored by CDC’s five-year cooperative agreement with COMISCA designed to develop a regional public health surveillance and laboratory network in the region.

The agreement, which was finalized in 2010, provides funding and technical guidance necessary to create a more robust and effective surveillance network and an upgraded laboratory system. It also includes tools to improve emergency preparedness for Central America and the Dominican Republic while enhancing regional cooperation.

At its core, the goal is to build a more comprehensive surveillance platform that can effortlessly share public health information while also supporting the regional implementation of WHO/PAHO International Health Regulations.

Those are lofty but sufficiently vague goals. In real-life, on-the-ground terms, COMISCA has, in recent years, been a conduit for

  • Providing and orchestrating technical assistance and training to better detect and respond to the influenza pandemic in Central America. As part of that effort, it developed the “Guide to Respiratory Disease Surveillance of Nicaragua”; provided critical supplies and inputs to the National Laboratory of Honduras; and produced newsletters and other materials with product information and influenza surveillance results.
  • Working to integrate and harmonize the assortment of surveillance systems for HIV/AIDS used across the region. A key element of this effort is identifying gaps and needs in the surveillance network.
  • Creating a web portal to make it easier to share information.
  • Working broadly to meet International Health Regulations including upgrading tools and systems for detecting disease. These improved early warning tools “allow the use of historical data and…algorithms tailored to the country…[and to] issue alarms on abnormal behaviors of different diseases monitored by the information systems of the country.”
  • Developing protocols and guidelines for updating, strengthening, and standardizing laboratories across the region. A key element is sharing experiences to strengthen the entire systems. For example, Dominican health officials would share their experience and lessons learned in the diagnosis of cholera.

It’s a strong record with numerous and demonstrable achievements. But the challenges are also large and demonstrable which means the work of COMISCA and its partners, including CDC, is far from finished.

The High Stakes in Fighting Ebola: Leave One Burning Ember and the Epidemic Could Re-Ignite

Categories: Ebola, global disease detection, global health security, health systems strengthening, infectious disease

 

This blog was originally posted on the Huffington Post on August 7, 2014.

 

A banner encouraging people suffering from Ebola to go immediately to a health center for treatment is seen on a sidewalk in the city of Freetown, Sierra Leone, Thursday, Aug. 7, 2014. While the Ebola virus outbreak has now reached four countries, Liberia and Sierra Leone account for more than 60 percent of the deaths, according to the World Health Organization. The outbreak that emerged in March has claimed at least 932 lives. (AP Photo/Michael Duff)

(AP Photo/Michael Duff)

CDC and our partners are currently fighting the biggest and most complex outbreak of Ebola virus disease ever recorded.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

There are hundreds of cases in West Africa and now a new cluster of cases in Nigeria is very concerning. The spread of Ebola shows what happens if we don’t have meticulous infection control, contact tracing, and proper isolation of those with symptoms of the disease.

There are two things that are very important to understand about how Ebola spreads.

The evidence suggests that Ebola only spreads from sick people—not from people who have been exposed to the disease but haven’t yet become sick from it. The illness has an average 8-10 day incubation period, although in rare instances the incubation period may be as short as two days or as long as 21 days, which is why we recommend monitoring for 21 days after any potential exposure.

World Cup serving as real-world test for new disease detection technology

Categories: global disease detection, global health security, health systems strengthening, infectious disease

 

World Cup soccer ball

 

With the World Cup underway in all its frenzied glory, you can be forgiven for missing another major effort currently underway in Brazil that represents the first large scale, real-life, real-world test of important new technology.

And no, it’s not the goal-line technology that’s being used for the first time at soccer’s biggest competition.

This technology uses computer tablets, sophisticated software designed by CDC and public health experts from Brazil’s Ministry of Health (MOH) trained in the Field Epidemiological Training Program (FETP) to provide the most complete, detailed and timely information about disease threats and other public health concerns.

FETP Work in South Sudan Benefits the Whole World

Categories: global health security, health systems strengthening

I’ve been with the Field Epidemiology Training Program (FETP) for 2.5 years now, where I am currently the resident advisor (RA) in South Sudan. My epidemiology training has provided me with the opportunity to gain a wide variety of experiences; prior to joining FETP, I served as an epidemiologist with Médecins Sans Frontières-Switzerland (MSF-CH), working in the refugee camp in Dadaab, Kenya, and have also worked in Dawei (Tavoy), Burma . I am glad to be able to pass on my knowledge about epidemiology to future leaders in the field. As an RA I assist with basic FETP implementation for county and state surveillance officers as well as immunization managers and supervisors. I also advise on outbreak response for priority diseases as well as assist with cascade training for the health facility staff who provide immunization services.

Mozambique FELTP fellows evaluate impact of malaria bed net campaign

Categories: health systems strengthening, malaria

One thing is to read a protocol, and quite another to write a protocol, do the field work, and see it through to the end" - Geraldo Chambe, FELTP resident

One thing is to read a protocol, and quite another to write a protocol, do the field work, and see it through to the end" - Geraldo Chambe, FELTP resident

Four Mozambican epidemiologists-in-training spent a month walking up to ten kilometers a day to make sure that one of the most effective malaria control interventions was reaching the poorest Mozambicans. Malaria is the leading cause of death in Mozambique, and insecticide-treated bed nets are one of the key malaria control measures. Since 2007, the U.S. President’s Malaria Initiative (PMI) has supported the Mozambican Ministry of Health and the National Malaria Control Program (NMCP) in efforts to reduce the burden of malaria in the country, not only through distribution of bed nets, but other key components as well: indoor residual spraying, diagnostic testing and treatment with effective antimalarials, and intermittent preventive therapy for pregnant women.

Mateusz Plucinski, PhD, MPH, Epidemic Intelligence Service Officer, Division of Parasitic Diseases and Malaria, Malaria Branch

Mateusz Plucinski, PhD, MPH, Epidemic Intelligence Service Officer, Division of Parasitic Diseases and Malaria, Malaria Branch

In 2013, with PMI support, the NMCP launched a universal bed net distribution campaign in six districts in Nampula Province, located in the northern region of Mozambique. The goal was to provide access to a bed net to the entire population living in the 250,000 households within the target area. The definition of “universal” varies somewhat by country; in Mozambique it means one bed net for every sleeping space. Mass distribution campaigns meant to achieve universal coverage are ambitious, complex, multi-step activities. They involve visiting all households in the distribution area to perform a census, determining how many bed nets to distribute per household, and organizing the logistics of delivering hundreds of thousands of bed nets to remote areas. It is therefore important to evaluate their performance and determine how successful they were in achieving their goal so that lessons learned can inform planning for the next campaign. And for the NMCP, it is important to document how increased bed net ownership and use made possible by campaigns affect malaria transmission.

CDC Supports the Ministry of Health in Guatemala in the Creation of a National Public Health Institute

Categories: health systems strengthening

 

Guatemala National Public Institute Director, Ministry of Health Guatemala, Mayari Centeno MD, MPH (left) and CDC - Central American Regional Office Director, Nelson Arboleda, MD, MPH (right) meet with CDC Director Tom Frieden, MD, MPH (center) in CDC-Atlanta, February 2014.

Guatemala National Public Institute Director, Ministry of Health Guatemala, Mayari Centeno MD, MPH (left) and CDC - Central American Regional Office Director, Nelson Arboleda, MD, MPH (right) meet with CDC Director Tom Frieden, MD, MPH (center) in CDC-Atlanta, February 2014.

Big things often start small. So do success stories.

Nelson Arboleda, MD MPH, Director - CDC Central American Regional Office

Nelson Arboleda, MD MPH, Director - CDC Central American Regional Office

For proof, simply look to CDC’s work – and history – in Central America. From a single field station established more than 40 years ago in El Salvador by CDC’s Division of Parasitic Diseases; CDC today has a broad and respected presence across Central America and other countries in the region.

As in other parts of the world, we are working closely with public health colleagues across the region to strengthen the capacity of Ministries of Health to prevent, detect, and control disease. We work collaboratively to strengthen countries’ abilities to respond to public health threats by providing technical expertise and evidence-based foundations for a wide array of public health programs.

Improving Disease Surveillance and Outbreak Response in the Latin American and Caribbean Region through the Field Epidemiology Training Program

Categories: global health security, health systems strengthening, infectious disease, noncommunicable diseases (NCDs)

 

FETP residents taking water sample to test for cholera (2013)

FETP residents taking water sample to test for cholera (2013)

Dr. Victor Caceres, CDC Field Epidemiology Training Program Branch

Dr. Victor Caceres, CDC Field Epidemiology Training Program Branch

With increased global travel, everyone is more vulnerable to emerging and reemerging public health threats. This vulnerability is why every country needs a team of highly trained epidemiologists that can detect and rapidly respond to outbreaks and is why CDC is committed to working with countries to establish and support Field Epidemiology Training Programs (FETPs) all over the world including the Latin American and Caribbean (LAC) region.

For the last three years, CDC has been working with the Dominican Republic’s Ministry of Health (MoH), in collaboration with the University of Puerto Rico, to strengthen basic and intermediate-level training capacity for epidemiologists and laboratory personnel as part of the three-tiered “pyramid” training model developed and implemented by countries in Central America. 

CDC Collaborations with the Ministry of Health in Dominican Republic Result in Measurable Public Health Gains

Categories: health systems strengthening, HIV/AIDS, malaria, tuberculosis (TB)

CDC Global Health Director Tom Kenyon (right), CDC Global AIDS Director Deborah Birx (second from right), and CDC-Dominican Republic Director Oliver Morgan (second from left) meet with Dr. Miguel A. Gerardino (left), Director of the Juan Pablo Pina Hospital in San Cristobal, Dominican Republic, January 2014.

CDC Global Health Director Tom Kenyon (right), CDC Global AIDS Director Deborah Birx (second from right), and CDC-Dominican Republic Director Oliver Morgan (second from left) meet with Dr. Miguel A. Gerardino (left), Director of the Juan Pablo Pina Hospital in San Cristobal, Dominican Republic, January 2014.

For a relatively small country where CDC established a full-time country office only five years ago, the Dominican Republic is suddenly drawing attention.

Oliver Morgan, MSc PhD FFPH, CDC Country Director for Dominican Republic

Oliver Morgan, MSc PhD FFPH, CDC Country Director for Dominican Republic

It’s easy to see why. The Dominican Republic is a popular vacation destination with 1.4 million Americans visiting each year. The country has a unique relationship with its neighbor, Haiti, the poorest country in the Western Hemisphere, where CDC also supports many programs. 

Earlier this month, Dr. Tom Kenyon, Director of CDC’s Center for Global Health and Dr. Debbi Birx, who leads CDC’s Division of Global HIV/AIDs visited the Dominican Republic to review, with Dominican authorities, CDC programs to protect public health. Kenyon and Birx are the highest level CDC officials to visit the DR since CDC’s country office officially opened in 2009.

The Value of CDC’s Work in Thailand

Categories: global disease detection, global health security, health systems strengthening, HIV/AIDS, infectious disease, noncommunicable diseases (NCDs), refugee health, tuberculosis (TB), violence and injury

 

Thai monk

 

When I became country director in 2013 the relationships between Thailand’s public health officials and CDC were already strong and well established.

Mitch Wolfe, MD MPH, Director, CDC-Thailand

Mitch Wolfe, MD MPH, Director, CDC-Thailand

That wasn’t surprising. CDC’s collaboration with the Ministry of Public Health, after all, began 30 years ago and the partnership has been prospering  – and expanding – ever since. And there is a strong history between the two countries – this year Thailand and the US are celebrating 180 years of Friendship.

The reasons are well established too. And numerous.

Last summer, while visiting family, I was asked by a U.S. border guard, “Why is America working abroad for public health?” I was happy to get this question, as it was an opportunity to deepen understanding for why CDC works abroad – to protect Americans from health threats, to build important relationships with strategic partners, and to learn lessons that can be expanded to other parts of the world.

Fresh Voices From the Field: The Value of Our Global Health Work

Categories: child health, health systems strengthening, HIV/AIDS, noncommunicable diseases (NCDs), violence and injury, water, women's/maternal health

 

Chelsey Beane is pictured near the home of a traditional healer in Andruvu Village, in the Arua District of Uganda.

Chelsey Beane is pictured near the home of a traditional healer in Andruvu Village, in the Arua District of Uganda.

This is the fourth in our ongoing “Fresh Voices From the Field” series, where we hear from ASPPH (Association of School and Programs of Public Health) Global Health Fellows working throughout the world. Global Health Fellows are recent Master of Public Health or Doctoral graduates placed in CDC global health offices in Atlanta and abroad. They work on a range of priority public health issues and bring a fresh perspective to CDC’s efforts in the field. (See other “Fresh Voices” blogs.)

 

Chelsey Beane, MSPH, ASPH Fellow

Chelsey Beane, MSPH, ASPH Fellow

Working at CDC headquarters in Atlanta is an amazing experience. And yet, sometimes, you can feel disconnected from the real world impact of the science that we spend all day discussing, refining, communicating, and implementing. So I was extremely grateful to have the opportunity recently to travel to Uganda to assist the CDC country team with preparation for a visit by CDC Director Dr. Thomas Frieden.

Although I had read the statistics, knew about our programs, and had become familiar with the major health issues in the country, I left impressed and humbled by what I experienced. I visited a rural village that had a recent outbreak of plague, where I met a small girl who had been diagnosed with diabetes, desperately in need of care and treatment, but miles from the nearest health facility. I was welcomed into the home of a family living in a tiny enclosed hut, filled with smoke from a cooking fire by which two toddlers quietly sat, and truly understood the urgent need for clean cookstoves. I saw people living in rural villages, without access to clean water. But I also saw how efforts by CDC and its partners are making a huge impact, not just for the health system as a whole, but for individuals whose lives have been changed. I saw the implementation of growing laboratory systems in the country, that are improving diagnoses of diseases, such as early infant diagnosis of HIV, and more accurate diagnosis for tuberculosis. I heard the story of a young woman who was raped and became infected with HIV, but who later had two children, both of whom were born healthy. I saw an eRanger, or motorcycle ambulance, rush into a maternal health clinic, carrying a pregnant woman whose delivery would be attended by skilled health workers.

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