LIVES SAVED
— L AO T Z U
uganda drc
AN N UAL R E PORT
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 jcalegre@msh.org.
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.
2013 A N N UA L R E P O RT · M A N AG E M E N T S C I E N C E S F O R H E A LT H
G O TO T H E P EO P LE / LIV E W IT H T H E M / LOV E T H E M / LE A R N F RO M T H E M / STA RT W IT H W H AT T H E Y H AV E / B U I LD O N W H AT T H E Y K N OW. / B U T O F T H E B E ST LE A D E R S / W H E N T H E I R TA S K I S AC C O M P LI S H E D / T H E WO R K I S D O N E / T H E P EO P LE W I LL A LL SAY / W E H AV E D O N E IT O U R S E LV E S .
ethiopia
tao of leadership
A MESSAGE FROM THE CEO
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 healthrelated 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 evidencebased 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, MPH pr esident & chief ex ecutive officer
Ethiopia MSH FIRST ARRIVES 20 03 STAFF IN COUNTRY 432 ACTIVE PROJECTS 13 HEALTH WORKERS TRAINED IN 2013 5 ,4 49
LIVES SAVED
PHOTO: WARREN ZELMAN
Ethiopia: Lives Saved FOUR MSH PROJECTS CONTRIBUTE TO SAVING AN ESTIMATED 177,000 LIVES IN FIVE YEARS
“We are the talk of the town. Now pregnant mothers EXPANDED ANTIRETROVIRAL REACH
Antiretroviral provisions continue to grow through the Ethiopia Network for HIV/AIDS Treatment, Care and Support (ENHAT-CS) program.
come to the health facility for delivery because it’s like
pregnant women in 2011, not a single baby from the town
their homes,” says Jember Alemayehu, an MSH-trained
has been born with HIV. The mother mentors are now
mother mentor in Korem town. In 2013, Alemayehu
the talk of the global health world as well: they have
and three other HIV-positive mothers—Teberih Tsegay,
been honored with 2014 REAL Awards, a global award
Almaz Haile, and Yeshi Derebew—began an innovative
created by Save the Children and the Frontline Health
project to perform a highly valued traditional Ethiopian
Workers Coalition to develop greater appreciation for
birth ceremony at the local health center, encouraging
health workers everywhere.
at-risk women to deliver there. The US Agency for
Current ART Patients
Newly Enrolled ART Patients
International Development (USAID) Ethiopia Network 71,007
for HIV/AIDS Treatment, Care and Support (ENHAT-CS) program, funded by the US President’s Emergency Plan
56,694
for AIDS Relief (PEPFAR) and implemented by MSH, has helped train 340 mother mentors at 85 health centers
45,071
in three years. The mother mentors facilitate mother support groups and provide individual counseling to 16,678 11,311 F Y11
baseline
F Y12
HIV-positive mothers to teach them how to prevent HIV in their babies and how to live healthy, positive lives
11,668 F Y13
Since the mother mentors in Korem began supporting
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
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.
receiving antiretroviral therapy in supported HIV clinics by 57.5 percent. M A N AG E M E N T S C I E N C E S F O R H E A LT H · 2013 A N N UA L R E P O RT
Democratic Republic of the Congo MSH FIRST ARRIVES 20 0 8 STAFF IN COUNTRY 14 6 ACTIVE PROJECTS 5 HEALTH WORKERS TRAINED IN 2013 5 , 311
PHOTO: WARREN ZELMAN
LIVES SAVED
Democratic Republic of the Congo: Lives Saved THE INTEGR ATED HEALTH PROJECT CONTRIBUTED TO SAVING AN ESTIMATED 68,000 LIVES OF YOUNG CHILDREN IN T WO YEARS
Justine Mbombo is a seamstress in a village of roughly
MSH’s Integrated Health Project (IHP) in DRC, funded
520 people. More than 100 are children under five,
by USAID, is active in more than 1,500 health facilities in
and her village has no doctor. In 2010, the village lost
80 health zones, reaching more than 12 million people
17 children to measles. Two years later, an MSH project
with high-impact interventions in child survival; maternal
trained local residents, including Mbombo, to promote
health; reproductive health and family planning; water,
good family health behaviors and practice community-
sanitation, and hygiene; and HIV and AIDS, tuberculosis,
based management of childhood illness. Mbombo now
and malaria. In the past year alone in DRC health facilities,
educates families on the warning signs of illness; cares for
the project treated more than 650,000 children under
nearly 20 children each month with uncomplicated cases
five for malaria. Between 2011 and 2013, IHP increased
of pneumonia, diarrhea, or malaria; and refers children
preventive malaria treatment in pregnant women from
with critical symptoms to a health facility. “I realize that
26 to 74 percent. In the same period, the project
my small gestures and my commitment save lives,” she
increased treatment of pneumonia (62 to 86 percent)
says with pride. “Epidemics used to be frequent; today
and diarrhea (29 to 57 percent) in children under five,
we no longer have outbreaks.” The engaged community
exceeding IHP’s goals.
will sustain these results, multiplying health impact.
IHP is one of five MSH projects working together in
In fragile states such as Democratic Republic of the Congo
DRC. In 2013, MSH projects in DRC helped train more
(DRC), evidence reveals that low-cost, high-impact
than 5,300 health workers.
interventions reaching many people are highly effective.
2013 A N N UA L R E P O RT · M A N AG E M E N T S C I E N C E S F O R H E A LT H
SAVING CHILDREN’S LIVES
Proportion of children’s lives saved by interventions in Democratic Republic of the Congo
VITAMIN A SUPPLEMENTATION ANTIMALARIALS
IMPROVED WATER SOURCE
3 % 1 %
38 %
IMPROVED SANITATION
9 % DPT VACCINES
3 % HiB VACCINES
8 % OR AL REHYDR ATION SOLUTIONS
18 % OR AL ANTIBIOTICS
case management of pneumonia in children
17 %
ZINC
for treatment of diarrhea
3 %
NIGERIA
An action plan developed during a leadership training in Nigeria.
20 Years of Health Impact in Nigeria
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.
50,000 Services to nearly 50,000 children in 2013.
SUPPLY CHAIN MANAGEMENT
During 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.
PHOTO CREDITS: NIGERIA: ANDREW ESIEBO SUPPLY CHAIN MANAGEMENT: JIRO OSE/SCMS AFGHANISTAN: DOMINIC CHAVEZ
Delivering Lifesaving Medicines Cost-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 worldclass warehousing and distribution facility.
2,500,000 An estimated 2.5 million patients received antiretroviral medicines through SCMS by mid-2013.
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.
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.
Advocating for Universal Health Coverage 2013 EVENT HIGHLIGHTS
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.
Envisioning a World Where Everyone Has the Opportunity for a Healthy Life: Photography Exhibit and Discussion In 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. PHOTOS: BEN GREENBERG/MSH
A Healthy Future for All: Making Universal Health Coverage a Post-2015 Priority As 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. 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.
PHOTOS: PAULA CHAMPAGNE/MSH
Dr. Ariel Pablos-Mendez, Asst. Administrator, Global Health, USAID led the discussion.
Jeffrey D. Sachs defines UHC.
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.
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.
Videos of both the ICA and UN events are available at WWW.MSH.ORG.
Giving Voice to Women Leaders
“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.”
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 communications@msh.org.
–Therese Bishagara Member of Parliament in Rwanda
M A N AG E M E N T S C I E N C E S F O R H E A LT H · 2013 A N N UA L R E P O RT
Board of Directors
MSH is Growing...
A MESSAGE FROM THE CHAIRMAN
contr act, gr ant, and progr am r evenue
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-ofthe-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.
2013 board of dir ectors James M. Stone boar d ch air Chairman, The Plymouth Rock Company
2009
2010
$177,547,382
2011
$247,618,290
$268,157,220
Barbara Bierer Senior Vice President, Research
2012
Director, Center for Faculty Development & Diversity
2013
$295,194,580 $321,278,525
Professor of Medicine, Harvard Medical School Center for Faculty Development and Diversity at the Brigham and Women’s Hospital Rebeca de Vives President, RdV Consulting
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.
... and Offers Value for Money. fiscal year 2013
Gail DeNicola Marketing Strategy Consultant Alan Detheridge Associate Director, The Partnering Initiative Atsuko Toko Fish Co-founder, Japanese Disaster Relief Fund Boston
ADMINISTR ATION EXPENSES
10.88 %
PROGR AM EXPENSES
89.11 %
FUNDR AISING
< 1 %
Trustee, Fish Family Foundation John Isaacson President, Isaacson Miller Paula Doherty Johnson Director, Senior Research Fellow, Harvard University’s Hauser Institute for Civil Society at the Center for Public Leadership Dan Pellegrom Former President, Pathfinder International
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 Roosevelt, Jr. President/CEO, Tufts Health Plan Anjali Sastry Senior Lecturer, Sloan School of Management, Massachusetts Institute of Technology
Statement of Revenues, Program Expenses, and Changes in Fund Balance year ending june 30, 2013 drawn from audited financial statements R E VE N U E S
contract, grant, & program revenue investment income & contributions additional support revenue
$321,278,525 $7,511 $118,355
total $321,404,391 E XPE N SE S
total $319,174,173 C HANG E S I N F U N D BAL AN C E
James M. Stone chair man of the board of dir ectors
balance at beginning of year excess of project support & revenue over expenses
$25,555,119 $2,230,218
balance at end of year
$27,785,337
C O M P O SE D O F:
Sources of Support
*
year ending june 30, 2013
GOVERNMENTS
INTERNATIONAL AGENCIES
Futures Group
Centers for Disease Control and Prevention (cdc)(usa)
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Health Systems Trust (hst)
Government of Brazil
Pan American Health Organization (paho)
The International HIV/AIDS Alliance
United Nations Development Programme (undp)
International Rescue Committee (irc)
National AIDS Commission (nac), Malawi Sida (Swedish International Development) US Agency for International Development (usaid) FOUNDATIONS & CORPOR ATIONS
The Arthur Vining Davis Foundations Robert Charles Pozen, The Ashurst Foundation Bill & Melinda Gates Foundation
ICF International
JHPIEGO
The World Bank
John Snow, Inc. (jsi)
World Health Organization (who)
Kids Included Together (kit)
NGOS/PARTNERS
The New York Academy of Medicine (nyam)
Abt Associates AED (Academy for Educational Development)
2013 expenses by priorit y health ar ea
INTEGR ATED HEALTH PROGR AMS
Pathfinder International
Ford Foundation Foundation for Advanced Studies on International Development (fasid)
Association for Rural Development (ard)
University Research Co., LLC (urc)
The James M. & Cathleen D. Stone Foundation at the Boston Foundation
Biomedical Research and Training Institute (brti)
UNIVERSITIES
Pfizer Inc.
Christian Health Association of Nigeria (chan)
University of North Carolina at Chapel Hill
The Rockefeller Foundation
DAI
TOMS
Elizabeth Glaser Pediatric AIDS Foundation (egpaf)
John Hopkins Bloomberg School of Public Health Center for Communications Programs
FHI360
University of Zimbabwe
2013 A N N UA L R E P O RT · M A N AG E M E N T S C I E N C E S F O R H E A LT H
MSH Works Across Priority Health Areas
PATH Reproductive and Child Health Alliance (racha)
Sources of Support include financial contributions and cost share partners.
$27,785,337
Medical Care Development International (mcdi)
AMREF (African Medical and Research Foundation)
Proctor & Gamble
total unrestricted net assets
IntraHealth International
UNICEF
ACDI/VOCA
cash & cash equivalents $29,619,298 amounts due on contracts $22,898,022 other current assets $2,597,345 property & equipment net of depreciation $1,043,184 other assets $763,458 current liabilities ($29,135,970)
56.10 % MATERNAL,NEWBORN, AND CHILD HEALTH
6.25 %
World Learning
CHRONIC NON-COMMUNICABLE DISEASES
TUBERCULOSIS
< 1 %
5.31 % MALARIA AND COMMUNICABLE DISEASES
3.26 %
FAMILY PLANNING / REPRODUCTIVE HEALTH
5.54 % HIV AND AIDS
23.49 %
Uganda MSH FIRST ARRIVES 20 0 6 STAFF IN COUNTRY 170 ACTIVE PROJECTS 11
PHOTO: RUI PIRES
HEALTH WORKERS TRAINED IN 2013 5 ,4 45
Uganda: Lives Saved SAVING WOMEN AND CHILDREN’S LIVES
The STRIDES for Family Health project contributed to saving almost 40,000 lives.
INTERVENTION
CHILD HEALTH
MATERNAL HEALTH
FAMILY PLANNING
ESTIMATED LIVES SAVED
17,400 700 21,400
STRIDES FOR FAMILY HEALTH PROJECT CONTRIBUTED TO SAVING AN ESTIMATED 40,000 LIVES IN FOUR YEARS
When village health team members from MSH’s
In Uganda, where malnutrition is responsible for nearly
USAID-funded STRIDES for Family Health project
60 percent of infant deaths, STRIDES works with both
visited Nyantungo, a village in the Kamwenge district
public and private partners to improve nutrition and
of Uganda, one child was healthy while the others were
child survival in 588 health facilities in 15 districts.
malnourished. The team asked the healthy child’s
The project also improves reproductive health and
mother, Tushemerirwe Esparanza, to accept training
family planning practices: between 2009 and 2013,
in child nutrition and then train others in her village.
couple years of protection (estimated protection
When Esparanza began reaching out to other women,
provided by contraceptive methods during a one-year
she faced resistance. Many were skeptical that increasing
period, based on volume of contraceptives distributed)
their use of inexpensive local foods could improve their
increased from 96,105 to 228,473.
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
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.
mothers Esparanza trained now train other women. Sustained nutrition will help these children grow into healthy adults, multiplying health impact.
M A N AG E M E N T S C I E N C E S F O R H E A LT H · 2013 A N N UA L R E P O RT
WHERE WE WORK
73
msh office in country
(73 total countries)
(40 total offices)
COUNTRI ES DURI NG 2013
AFGHANISTAN
GUATEMALA
NIGER
ALBANIA
GUINEA
NIGERIA
ANGOLA
GUYANA
PANAMA
BANGLADESH
HAITI
PAPUA NEW GUINEA
BENIN
HONDUR AS
PERU
BOSNIA AND HER ZEGOVINA
INDONESIA
PHILIPPINES
JORDAN
RWANDA
K A ZAKHSTAN
SENEGAL
KENYA
SOLOMON ISLANDS
KYRGYZSTAN
SOUTH AFRICA
LAOS
SOUTH SUDAN
LESOTHO
SWA ZILAND
BOTSWANA Since our founding in 1971, MSH’s vision of health impact has influenced over 150 countries worldwide.
BR A ZIL BURKINA FASO BURUNDI CAMBODIA CAMEROON
LIBERIA
TAJIKISTAN
CENTR AL AFRICAN REPUBLIC
LIBYA
TANZANIA
CHAD
MADAGASCAR
TIMOR-LESTE
CÔTE D’IVOIRE
MALAWI
TOGO
DEMOCR ATIC REPUBLIC OF THE CONGO
MALAYSIA
TUNISIA
MALI
TURKMENISTAN
MAURITANIA
UGANDA
MEXICO
UKR AINE
MOROCCO
URUGUAY
MOZAMBIQUE
UZBEKISTAN
MYANMAR
VIETNAM
NAMIBIA
ZAMBIA
NICAR AGUA
ZIMBABWE
DOMINICAN REPUBLIC EGYPT EL SALVADOR ETHIOPIA FIJI GEORGIA GHANA
MANAGEMENT SC IENCES FOR HEALTH Stronger health systems. Greater health impact. 20 0 RIVERS EDGE DRIVE , MEDFORD, MA 02155, USA TEL 617. 250.950 0 EMAIL COMMUNIC ATIONS@MSH .ORG
FRONT COVER PHOTO: WARREN ZELMAN
MSH WORKED I N
where msh worked in 2013