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Health for all starts with strong health and community systems

By The Global Fund

May 23^rd, 2024

What do we need to achieve good health and well-being for all? To confront new and evolving challenges, and provide health care to everyone, everywhere?

Health and community systems form the foundation of the fight against HIV, tuberculosis (TB) and malaria, and fortify countries so they can beat back diseases and prepare for the future.

The Global Fund invests over US$2 billion every year in more than 110 countries to strengthen health and community systems, partnering with communities and countries to provide reliable, sustainable health care for everyone.

Below are stories about the Global Fund’s work with five countries to strengthen medical oxygen infrastructure, laboratory systems, early disease detection and surveillance, supply chains and human resources for health – investments that are already making an impact.

Medical oxygen helps patients breathe in Kenya

Anne Kinyua, a biomedical staff member at Karatina Hospital in Nyeri County, Kenya, stands beside an oxygen tank that was installed as part of a project to provide medical oxygen to health facilities across the country.

Esther Marigi and her son, Stephen Irungu, at Murang'a Level 5 Hospital. Stephen needed medical oxygen to help him breathe.

Medical students attend to a baby receiving oxygen in a neonatal incubator at Karatina District Hospital in Nyeri County, Kenya.

In the pediatric ward in Murang'a County Referral Hospital in central Kenya, Esther Marigi sits beside her 1-year-old son Stephen Irungu.

Stephen was diagnosed with TB at 8 months old. His health improved with treatment – until one day, he couldn’t seem to take in enough air. “He was in a terrible state when we arrived,” Esther says. “Oxygen saved his life.”

Medical oxygen is essential to health care in all forms: to support mothers during childbirth, treat chronic conditions such as asthma and ease the distress of illnesses linked to AIDS and TB. Oxygen is used in emergency rooms, operating rooms and primary care facilities; it is administered to people of all ages.

When the COVID-19 pandemic hit, medical oxygen saved millions of lives – if and when it was available. According to the World Health Organization, as of September 2023, less than half of all health facilities in low- and middle-income countries had reliable access to medical oxygen.

The Global Fund is working with AMREF Health Africa in Kenya to strengthen and expand the country’s oxygen infrastructure through a multi-layered approach: installing bulk-storage tanks and oxygen-producing plants, introducing or expanding oxygen piping to critical care and maternity wards, and providing medical oxygen devices to health facilities across all 47 counties.

Since 2021, the Global Fund has invested more than US$617 million to ensure medical oxygen is available in low- and middle-income countries, including Kenya.

Today, every patient who comes through Murang'a County Referral Hospital’s doors has reliable access to oxygen.

Uganda’s mobile laboratories are first on the scene to confront outbreaks

Godfrey Pimundu and Tonny Muyigi at the National Health Laboratory and Diagnostics Services (NHLDS) complex in Kampala, Uganda. They manage NHLDS’s mobile laboratory, equipped and prepared at all times to respond to outbreaks.

The Global Fund supports essential infrastructure and equipment for NHLDS operations, from reagents to personal protective equipment to lab information systems.

The sprawling NHLDS complex comprises multiple laboratories, a library of reference samples, external quality assessment facilities, an equipment calibration center and more.

Godfrey Pimundu and Tonny Muyigi manage a small but mighty team at the sprawling National Health Laboratory and Diagnostics Services (NHLDS) complex in Kampala, Uganda.

They wear bright blue disposable smocks over their white lab coats at all times. “We are always ready,” says Godfrey.

Their mobile laboratory is charged with training and preparing for outbreaks – to be the first in the field, collecting and testing samples to diagnose potentially deadly diseases quickly and accurately, and respond to health emergencies where and when they appear throughout the country.

When Uganda declared an Ebola outbreak in September 2022, Godfrey, Tonny and the team were some of the first health professionals on the scene. They brought mobile laboratories packed in black plastic boxes – “trunks,” about the size of a carry-on suitcase – that contain all the equipment necessary to handle and identify the virus.

When assembled, the trunks become portable biosafety hazard cabinets; laboratory technicians move quickly and easily from collecting samples to testing and detecting the pathogen in a safe and contained environment. Speed and accuracy are critical to confirm and isolate cases and administer the correct treatment to those who are ill.

In 2023, Marburg virus disease broke out in Tanzania. Godfrey’s team traveled to Mutukula, on the Tanzanian border, and set up mobile laboratories to test people in affected areas within 48 hours – and supplied results within six.

Global Fund investments provide reagents and other critical tools that Godfrey and Tonny use to conduct laboratory tests and report their results promptly.

The Global Fund is one of the world’s largest brokers of medical supplies, procuring over US$2 billion in health products every year to support laboratories and medical facilities in more than 100 countries, including Uganda.

Emerging and re-emerging pathogens pose a constant and evolving threat in Uganda – and around the world. Godfrey and his team train and refine their practice frequently, working to stay one step ahead.

Wastewater reveals potential health threats in Mozambique

Lab technicians collect samples of wastewater in Maputo, Mozambique.

Dr. Diocreciano Bero processes samples taken from a wastewater facility.

One person’s waste is another’s goldmine. Nobody knows this better than Dr. Diocreciano Matias Bero, who leads the Wastewater Environmental Monitoring Program at Mozambique’s National Institute of Health. “Smelly samples [have] the most precious information,” he says.

COVID-19 showed the world the importance of early warning and surveillance systems to quickly identify and respond to diseases which emerge suddenly and spread quickly.

Wastewater holds critical information about how germs circulate within both human and animal populations: a cost-efficient, non-invasive tool that provides a community-wide picture of bacteria and viruses – and reveals health hazards well before they begin to impact the community.

When Dr. Bero and team catch a glimpse of a virus or bacteria, they act quickly – alerting health officials and helping decision-makers pinpoint the threat and prevent the disease from spreading.

Rain and floods – which are becoming more extreme as the climate changes – increase the risk of illnesses like cholera and diarrhea. In the wake of cyclones, which are common in Mozambique, Dr. Bero and team test for bacteria that can make people sick and help identify communities that might be at risk.

Most wastewater testing programs collect samples two to four times per week, compiling detailed and up-to-date health data at a relatively low cost. These programs are powerful tools, particularly given health threats posed by climate change, antimicrobial resistance and new and recurring diseases.

The Global Fund has invested more than US$200 million in surveillance systems worldwide, including US$4.6 million for wastewater sampling programs in Mozambique, Tanzania, Zambia, Ethiopia, Kenya and Uganda.

In the coming years, support will broaden to three additional countries: Ghana, The Gambia and Nigeria.

Nigeria delivers lifesaving mosquito nets to millions

Bales of mosquito nets are offloaded before distribution throughout Kano State, Nigeria.

Salisu (right), Basira and their two children in Sabon-Gari, Nigeria. The couple’s 2-year-old son died from malaria in October 2022.

Net distributor Yau Mustapha in Mazangudu explains the use of a mosquito net to a member of the community in Mazangudu.

Nigeria bears the world’s largest burden of malaria. The disease kills more than 190,000 people across the country every year – including Salisu and Basira’s 2-year-old son, Maila.

“Many things remind me of him. He comes to me in my dreams,” says Salisu.

We have the tools and technology to prevent malaria, including insecticide-treated mosquito nets. But supply chain challenges – flaws and weaknesses in systems that move medical supplies and products from manufacturers to patients – can prevent lifesaving tools from reaching children like Maila.

In 2022, the Global Fund collaborated with Nigeria’s government, nongovernmental organizations and local communities to build and reinforce a supply chain that delivered insecticide-treated nets to millions of people across Kano State – overcoming challenges including COVID-19-related restrictions, displacement, conflict and difficult terrain.

A team of logisticians sourced vehicles to transport the nets; conveyors allocated nets to various locations based on demand; warehouse workers performed quality checks; trainers helped community-members prepare to distribute nets door-to-door.

Health officials, administrators, community health workers, educators, rickshaw-pullers, religious leaders and many more worked together to distribute about 8.8 million nets to more than 18 million people in just two weeks.

The campaign – one of the largest and most complex net distribution efforts in the world – represents what is possible when individuals, governments and other committed organizations collaborate to meet each specific community’s needs.

Every year, the Global Fund invests US$400 million worldwide to support supply chain management and procurement, bringing lifesaving health products – including new dual ingredient insecticide-treated mosquito nets – to remote clinics and villages.

Cameroon’s community health workers vital in the fight against malaria

Melissa (left), Tomnjong (right) and their children Gabriella and Tony-Jason receive regular home visits from community health worker Amélie.

Community health worker Amélie on her way to visit a home in her community in Soa.

Amélie plays with Tony-Jason at his home in Soa.

Early in her pregnancy with her second child, Melissa was diagnosed with malaria. Soon after, her toddler, Gabriella, fell ill with the disease and couldn’t seem to get better. “She had a high temperature and was vomiting,” says Melissa.

Eventually, Gabriella recovered – but Melissa worries that any of them could get sick again at any time.

Melissa and her family live in Soa, about 20 kilometers north of Cameroon’s capital city, Yaoundé. Malaria is endemic in Cameroon; according to the World Health Organization, the country recorded more than 6.4 million cases of the disease and over 12,500 deaths in 2022.

In Cameroon, community health workers like Amélie are essential to fight back against the disease.

Amélie visited Melissa throughout her pregnancy, monitoring the family’s health and ensuring they had access to a complete package of tools to safeguard against the disease. This included intermittent preventative treatment – a medication used to prevent pregnant women from getting malaria – and new dual active ingredient insecticide-treated mosquito nets.

Cameroon is the first country in the world to include the malaria vaccine in its routine child immunization program. So, when Melissa’s son Tony-Jason was 6 months old, Amélie recommended he get vaccinated. Melissa agreed: “I trust her,” she says.

Community health workers play a central role in fighting malaria and other infectious diseases and conditions, such as diarrhea, pneumonia and malnutrition – some of the leading causes of death in Cameroon. They are the beating heart of health systems, a trusted confidant that can reach more people in more places with essential care.

“What motivates me in this work is, above all, my love for people,” says Amelie. “We do our best to keep people healthy.”

The Global Fund has invested over US$1.5 billion in community health workers across more than 100 countries, and is investing US$900 million more over the next three years.