Pauline Muhuhu: Senior Technical Advisor
“People think I’m crazy to be with one organization for so long,” Pauline Muhuhu admits when asked about her nearly three decades with a global health nonprofit. “But there is something at IntraHealth I love.
“The way IntraHealth does business is something I value so much,” she says. “I feel at IntraHealth we don’t take shortcuts; we are honest.... If I have a vision, I’m allowed to explore it. Therefore I feel I can grow, and I can express my potential without feeling sat on.”
An unexpected career with IntraHealth
As senior technical advisor for the Essential Service Delivery Project in Washington, DC, Muhuhu currently focuses on identifying, documenting, and disseminating best practices in reproductive health, with a special emphasis on family planning. But back in 1981, she did not foresee a career working with an international NGO. She had settled into the academic world in Kenya—her native country—at the University of Nairobi, teaching community health and mental health. Having completed a nursing/midwifery degree and a master’s degree, she anticipated returning to school for a PhD. All of a sudden, a director of training position opened up at IntraHealth’s first regional office in Nairobi.
A friend strongly urged her to apply. There was a real desire to see someone from Kenya get the position: “I don’t know that it was really a choice,” she laughs. “It was more peer pressure!”
The friend went so far as to draft a letter of interest for her to sign—which she obligingly sent, then promptly forgot about. Weeks passed. By the time IntraHealth alerted her that she had made an inquiry but not applied, her thoughts had turned away from PhD programs. She made up her mind to try for the position—and she landed it.
A global health champion
Muhuhu cites IntraHealth’s systems approach to training health workers as one way it has developed leaders in communities, equipping them with the skills they need to excel. She says IntraHealth’s approach emerged from lessons she and her team learned during her early days as training director, running family planning trainings: “It started with our trials.”
She explains, “Our work was focused solely on training. When we did the follow-up, we found out the limitations—that skills alone were not enough. We found out that the people were not doing what we trained them to do.”
Thus, IntraHealth created what Muhuhu refers to as a more comprehensive training “roadmap.” It included ensuring facilities had adequate supplies, that supervisors knew what their newly trained supervisees should be doing, that guidelines and protocols were put in place and implemented to support trainees, and that supervisors and trainers followed up together to measure the application of trainees’ newly acquired skills and address the challenges faced at their health facilities and their emerging learning and supervision needs.
The development of this holistic training approach was pioneering work in African countries in the 1980s and 90s, work for which Muhuhu takes pride in having helped create.
Changing health care in East Africa
Another of Muhuhu’s accomplishments is her work to decentralize postabortion care services in East Africa. This meant expanding the types of health workers who could provide these services to include nurses and midwives, and making the services available at health centers and clinics, not just provincial hospitals. “This needed a lot of lobbying with the Ministry of Health,” she recalls, “and with the medical associations, the nurses’ associations, and nurses’ councils.”
Eventually, the pilot program in Kenya—which proved that nurses and midwives could demonstrate the required skills to do the work effectively—and all the lobbying paid off: Kenya, Tanzania, and Uganda changed their policies to reflect these efforts. “The patients were being attended so much at local [health centers],” Muhuhu says, “that it reduced maternal mortality due to abortions.”
Partnership and the value of building relationships
When asked what her employer of nearly 30 years has taught her, Muhuhu points to the importance and necessity of “starting where a country is and building from there. Even if it takes long,” she says, “work it slowly.”
She talks about how at times there is the urge to rush and “try to parachute in and say this is what needs to be done,” but IntraHealth has taught her the virtue of patience.
“You have to establish a level of trust with a country,” Muhuhu emphasizes, “before you can really do something substantial.”
See blog post on Muhuhu's recent award.