Namibia

Namibia Improves HIV Care through Training and High-Quality Services

kseaton — Fri, 16 Oct 2020 17:10:10 +0000

Namibia Improves HIV Care through Training and High-Quality Services kseaton October 16, 2020 October 16, 2020

Between 2015 and 2019, IntraHealth International’s USAID HIV Clinical Services Technical Assistance Project (UTAP) helped 42,578 HIV-positive clients in Namibia begin antiretroviral therapy (ART), conducted a nurse training program, increased the number of community adherence groups from 40 to 484, and helped roll out an electronic patient management system for the country.

In 2018, an estimated 200,000 people were living with HIV in Namibia, with regions in the north and capital city having the highest burden. Now Namibia is one of three sub-Saharan African countries that have achieved the UNAIDS 90-90-90 fast-track targets; still HIV/AIDS remains the country’s number one cause of death and disability.

With support from the US Agency for International Development, UTAP worked in eight districts and 77 sites, testing 461,020 individuals for HIV and connecting HIV-positive clients with ART within seven days of diagnosis.

By September 2019, 42,578 individuals were receiving ART and the rate of same-day ART initiation for new HIV-positive patients in eight high-volume facilities had increased from 15% in 2016 to 82% in 2019. 

A breakthrough in client-centered HIV care

UTAP focused on client-centered HIV care to better address clients’ preferences and reduce costs associated with frequent visits to health facilities at a time when such client-centered service delivery approaches were rare.  

Community adherence groups brought together people living with HIV who are on ART so they could offer each other support, advice, and encouragement to stay on their treatment regimens. The groups also helped health facilities retain their clients. Between 2017 and 2019, UTAP helped increase the number of community adherence groups (CAGs) from 40 to 484, serving 4,154 clients.

In 2018, UTAP started providing HIV testing services in the emergency room in five hospitals. Between 2018 and 2019, 2,598 individuals were tested for HIV in emergency rooms.

UTAP conducted districtwide trainings for health workers in all eight districts on provider-initiated HIV testing and counseling (PITC) and HIV rapid testing in hospital departments and facilities. The project shortened the training curriculum from five days to two-and-a-half and conducted trainings at district hospitals rather than at offsite venues. These changes reduced training costs, increased the number of health workers trained, and improved testing and diagnosis of new HIV positive cases from 60% in 2015 to 90% in 2018 and 2019.

In addition, the project trained a team of district trainers who now conduct ongoing training and mentorship.

Digital technology for better data

UTAP supported Namibia’s Ministry of Health and Social Services in rolling out IntraHealth’s redesigned electronic patient management system (ePMS) to provide the ministry with current and accurate patient data. ePMS now measures the continuity of care—from HIV testing to initiation on ART and continuous adherence on treatment.

By July 2020, the system was being used in 180 health facilities by 225 staff and is continuing to expand. 

A new training technique

To build health workers’ skills and make ART services more widely available, UTAP began conducting districtwide trainings in nurse-initiated management of ART (NIMART), certification, and ongoing mentorship for nurses based in primary health care facilities and various hospital departments. UTAP provided facilities with technical assistance to prepare and maintain NIMART sites for long term ART management.

UTAP also contributed to these successes:

Three district hospitals provided cervical cancer screenings to 1,413 women on ART in 2019.
Between 2018 and 2019, project-supported sites initiated 6,551 individuals on preexposure prophylaxis.
During 2016-2018, 72,838 pregnant women attended antenatal care visits in UTAP-supported health facilities.
By September 2019, 91% of clients on ART were screened at least once for TB within a six-month period.

IntraHealth’s USAID HIV Clinical Services Technical Assistance Project (UTAP) in Namibia was funded by the US Agency for International Development (USAID) through the President’s Emergency Plan for AIDS Response (PEPFAR).

Namibia HIV & AIDSA patient holds antiretroviral medications at a health facility in Northern Namibia. Photo for IntraHealth International by Morgana Wingard.USAID HIV Clinical Services Technical Assistance Project

A Nurse’s View from the Front Lines of COVID-19 in Namibia

mnathe — Mon, 11 May 2020 19:43:15 +0000

A Nurse’s View from the Front Lines of COVID-19 in Namibia mnathe May 11, 2020

May 12, 2020

Irine Chelag’at Birir tells us how the pandemic is changing work for her and her fellow nurses.

Irine Chelag’at Birir is a nurse in Namibia. We asked her to tell us more about her job, including how COVID-19 is affecting work for her and her fellow nurses in the country.

Here’s what she told us.

Why did you become a nurse?

I grew up in a remote village in Kenya. My neighbor’s daughters were nurses and I admired the way they came home in uniform.

When I received my acceptance letter from the nursing school, I was so happy, I was over the moon. The joy couldn't be described. I was admitted in one of the best nursing schools in Kenya and I was so happy.

When I started, I thought nursing was just holding a needle and injecting it, but it’s so much more than that. I’ve learned so much about the diversity of nursing.

For me, nursing and midwifery is not just a profession, it’s a calling. Nurses attend to people who need help when no one else will. They sacrifice their sleep, listen to people’s stories, and attend to extremely sick people, including those with highly infectious diseases. The same person opens the eye of a newborn and closes the eyes of a dying person with dignity.

How has your background prepared you for this pandemic?

Nurses are trained for emergencies like COVID-19. I am privileged to have gotten all the knowledge from the training school, the experience having worked for several years, as well as the frequent updates provided by the IntraHealth national office.

I started working as a nurse in Kenya immediately after I graduated, and then was placed in Lesotho in 2008. I was in a facility delivering antiretroviral treatment services. It was new for me. I didn’t know much, and I had to learn at work, very fast. Then in 2016, I moved to Namibia. Working in different places prepared me for whatever happens, and when a situation like this comes, nurses gets continuous updates on how to handle it.

How has your job changed because of coronavirus?

I work as a nurse mentor for IntraHealth in the Zambezi region in Namibia. Namibia is now in stage two of lockdown, which allows work and businesses to open and operate while adhering to infection prevention and control measures.

As a nurse mentor, I am responsible for providing technical support and mentoring to field workers like nurses, community care workers, and other staff. Since the outbreak of COVID-19, physical gatherings and physical contact are prohibited, and this is a challenge for me in providing onsite mentorship. However, thanks to technology, I am able to do telephonic Zoom meetings, phone calls, and other non-contact mentorship.

As a nurse mentor, I am responsible for ensuring that nurses and other staff provide high-quality services for sexual health and HIV prevention to adolescent girls and young women. Since the outbreak of COVID-19, the main challenge has been to reach the girls for the services, since clients are discouraged from attending the health facilities, except in emergency cases. We are therefore calling the clients and delivering services door-to-door for those who agree. Some of them we meet in a community area where they feel comfortable, considering social distancing of one to two meters apart.

We are doing this to ensure continuity of services for clients who need family planning and HIV pre-exposure prophylaxis, or PrEP. For the clients taking PrEP, we also issue doses for a longer duration of up to six months.

As a nurse, what do you want people to remember?

I advise people to get to know everything about COVID-19. It’s my job to educate people and tell them what happens. We need to share information with them and give them disease-prevention information. We are also telling everyone, not just our clients, about what the symptoms are and what they should do. We are advising people, if possible, to stay at home.

People need to know that they should call the hotline provided by the Ministry of Health and Social Services, and ask questions before they go to a health facility, if they feel they are having COVID-19 symptoms.

Being a nurse is not easy. Nurses have families too. While everyone is advised to do social distancing, this never applies to nurses. A nurse has to be at a health facility or hospital to do what they do best, taking care of the sick, including the patients with COVID-19.

When I started nursing, I didn’t know that. There are things you aren’t prepared for in life. It’s so much more than just holding a needle and giving an injection. You must be strong. Nursing is a sacrifice.

But it’s good to be a nurse. Being in uniform connects all of us nurses, working in the ward from corner to corner, with a drug trolley. I love it so much.

Get stories from midwives and nurses around the world delivered right to your inbox: sign up for our mailing list.

And join the conversation:
#NursesLead #VoiceToLead #IND2020 #HealthWorkersCount

Resources

Investing in the Power of Nurse Leadership: What Will It Take?

By Irine Chelag’at Birir

Nurse mentor

By Katherine Seaton

Former communications manager

COVID-19 International Nurses Day Global health security Nursing & Midwifery 2020 Youth Engagement Nurses Namibia

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The Future of Global Health Starts with Nurses and Midwives

mnathe — Wed, 22 Jan 2020 16:07:04 +0000

The Future of Global Health Starts with Nurses and Midwives mnathe January 22, 2020

January 23, 2020

Here are three things we’re working toward in 2020 to help them gain more power to lead.

We think 2020 is going to be our kind of year.

Maybe it’s the optimism of a brand-new decade. Or maybe it’s knowing that despite all the global uncertainty and unrest, humans are in a pretty good place, historically speaking. Today less than 10% of people live in extreme poverty, according to the World Bank—down from almost 36% just 30 years ago.

But it’s more than that. For the first time ever, the global health community is shifting its gaze to a group of people we at IntraHealth International have been passionate about for 40 years now.

We’re talking about nurses and midwives.

The World Health Organization has declared 2020 to be their year. Because as we get closer to our most ambitious global goals—nothing short of universal health coverage, an AIDS-free generation, and the end of extreme poverty—the global community has realized that nurses and midwives will be the ones to get us there.

They’re the fuel that powers the engines of health care.

For decades, they’ve been undervalued, underestimated, overworked. But they care for clients like us from birth to death and everywhere in between. They make up 50% of the health workforce worldwide. In every city, every hospital, every village where they work, they’re the fuel that powers the engines of health care.

So we’re excited to see them in the limelight at last.

Here are three things we’ll be working toward in 2020 to help nurses and midwives gain the power, authority, and resources they need to lead us all into the future of global health.

Gender equality at work

Most nurses and midwives are women. In fact, women make up 70% of the entire health and social care workforce around the world. Yet only 25% of health system leadership roles are held by women.

Last year, we and our partners surveyed 2,537 nurses and nurse-midwives from 117 countries to find out what hinders and helps nurses on their way to leadership roles. The resulting report—Investing in the Power of Nurse Leadership: What Will It Take?—sheds light on the gender-related barriers nurses face in rising to the top of their fields and what it will take to remove them. Respondents described widespread discrimination, bias, stereotyping, and sexual harassment.

“It’s clear this isn’t about the individual nurse who needs to be developed,” said IntraHealth’s Constance Newman at the report’s launch event at Women Deliver 2019. “It’s about the systems that need to be changed in order to raise the profile and improve the status and effectiveness of nurse leaders.”

Also read: Global Survey Suggests Gender-Related Barriers Stifle the Leadership Potential of Nurses

In 2020, we’ll be talking to more nurses and midwives on the front lines around the world and amplifying their voices, stories, and struggles. Check out the first webinar in our new series by IntraHealth, Johnson & Johnson, and Nursing Now on the gender-related barriers to and catalysts of nurse leadership.

Resources

Investing in the Power of Nurse Leadership: What Will It Take?

Stronger policies, more authority

When countries update their policies to give nurses and midwives more authority to use their full range of skills, we see big results. Namibia, for example, is closing in on HIV epidemic control in large part because nurses can now be certified to provide antiretroviral therapy (previously, if you needed these meds, only a physician could help you).

Nurse Shirley Mwellie came out of retirement to treat HIV clients in Namibia. Namibia was the first country to conduct a national assessment using the WHO tool, Workload Indicators of Staffing Needs. Photo by Morgana Wingard for IntraHealth International.

Also read: PrEP and Health Worker Training Are Protecting More Namibian Girls from HIV

This type of task-shifting and -sharing can revolutionize a health facility’s services and make them more efficient and accessible.

Another example is Tanzania, where there’s a shortage of physicians and surgeons. There’s just not enough of them provide the specialized services only they are authorized to provide. At the same time, there’s great demand for a simple surgery—voluntary medical male circumcision—that can reduce men’s risk of acquiring HIV by up to 60%. Until just a few years ago, national policy stipulated that only physicians and surgeons could perform it.

So IntraHealth’s ToharaPlus project worked with the Ministry of Health, Community Development, Gender, Elderly and Children to change policy and train nurses to provide the surgery. Now hundreds of nurses in Tanzania can perform the procedure. Thanks to them, the project helped provide related services to more than 450,000 men in Tanzania in 2019 alone.

Nurses like Flora Kyenche in Tanzania can now provide the simple surgery for voluntary medical male circumcision, which can reduce a man’s risk of acquiring HIV by up to 60%. Photo by Josh Estey for IntraHealth International.

Also read: Policy Changes in Tanzania and Beyond Unleash Full Power of Nurses

In 2020, we’re working to make HIV care more sustainable in all the countries where we work. Through the US Agency for International Development’s Accelerating Support to Advanced Local Partners (ASAP) project, for example, we’re working with sub-Saharan African countries to rapidly prepare local organizations and government entities to serve as prime partners for USAID and US President’s Emergency Plan for AIDS Relief (PEPFAR) programming, including by strengthening their capabilities and resources to address HIV within their populations.

Ongoing training for up-to-the-minute skills

For any of us to succeed at work, we need the right training and strong systems in place to help us get the job done—especially when lives are on the line.

The right training helps midwives like Fatou Mbaye stand between pregnant women and malaria in rural Senegal.

Midwife Fatou Mbaye helps pregnant women in rural Senegal stay malaria-free. Photo by Clement Tardif for IntraHealth International.

In Rwanda, it helped nurses like Esther Mukahabiyambere reduce severe pneumonia cases in children by 50%.

And at midwife Catherine Alinga’s hospital in Uganda, where the survival rate for preterm babies had been under 10%, it helped her boost their survival rate to 100%.

In 2020, we’re committed to training more nurses and midwives around the world. From Capitol Hill to the smallest local clinics, we’re working with our partners to help nurses and midwives lead us into a healthier tomorrow.

Throughout 2020, we’re celebrating nurses and midwives and pushing for changes that shift power and authority to them. You can get involved:

Are you a health worker whose work has been affected by attacks or violent conflict? Share your story with the Safeguarding Health in Conflict Coalition.
Read, share, and contribute to the Frontline Perspectives blog series from the Frontline Health Workers Coalition.
Donate to IntraHealth. We’re working to give everyone everywhere access to the health care they need to thrive—and we focus on nurses, midwives, and other health workers to make it happen.

Join the conversation @IntraHealth #TheFutureof #HealthWorkersCount #NursesLead #MidwivesLead #Nurses2020 #Midwives2020

By The Editorial Team

IntraHealth International

HIV & AIDS Infectious Diseases Maternal, Newborn, & Child Health Policy & Advocacy Gender Equality Nursing & Midwifery 2020 Midwives Nurses Namibia Senegal Tanzania

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Mindfulness: A New Approach to the Nursing Shortage Crisis

mnathe — Mon, 16 Dec 2019 20:13:22 +0000

Mindfulness: A New Approach to the Nursing Shortage Crisis mnathe December 16, 2019

December 16, 2019

Some research shows it decreases burnout and self-reported distress among nurses. Could it do more?

Just outside Windhoek, Namibia, I stood in the maternity ward of Windhoek Central Hospital. Filling the lime green halls were students, nurses, midwives, doctors, clients in motion, and the groans of a mother in labor.

I was there as part of my UNC-IntraHealth summer fellowship to support the Nursing Now Namibia Campaign, building a tool to help identify gaps in compliance to hospital standards on the maternity floor and provide recommendations for areas of improvement. I had the opportunity to visit three hospitals and interview nine nurses.

It is very traumatizing. Very stressful and tiring.

Here’s some of what I asked them:

What are your goals and dreams?

“I want to be a teacher,” one responded. “I want to focus on trying to manage the ward, improve things. I want proper nursing. I see myself going far.”

How does working as a nurse in the maternity ward affect you?

“It is a high-risk unit,” one nurse told me. “It is very traumatizing. Very stressful and tiring.”

“Working in maternity, you find that the ward is full from here to here,” another said. “I was standing for so long that I developed deep vein thrombosis—my foot was so painful, but luckily nothing more developed.”

A theme arose: regardless of the hospital they worked in, it quickly became apparent that although the nurses had immense passion for their jobs, they were stressed, burned out and facing challenges caused by the nursing shortage.

Nursing shortage. This has been a problem since at least the 1930s, when reports of shortages began emerging in the US. Unfortunately, it’s still a problem today around the world. The reasons, however, are different from country to country.

In low- and middle-income countries, the problem often isn’t a lack of nursing recruits but of resources to train and hire new nurses and to pay incentives for current nurses. Often these challenges are compounded by working conditions, lack of equipment and resources, difficult/extreme cases in patients, and lack of support from management. The stress often leads to burnout and negative health effects.

As a nurse, I know the struggles and the stress of the job.

“Substantial evidence from studies in the USA, Europe, and other countries relates lower nurse staffing and higher nurse workloads to adverse patient outcomes such as mortality, infections, falls and longer lengths of stay,” wrote Jack Needleman in his BMJ editorial.

As a nurse, I know the struggles and the stress of the job. In Namibia, I began to see how grave the global ramifications of the shortage are.

Many of the nurses I spoke with deal with their stress by going to church, spending time with family, and cherishing the appreciation of their patients when times get difficult. Many of them have goals and dreams of becoming clinical instructors, specializing in maternity and beyond. But sometimes, one told me, they just have to leave their work troubles at the hospital, “go home and come back the next day to care for their patient.”

Given all this, how do we make it easier for nurses to provide the best care possible, even in the midst of the shortage?

One way could be through mindfulness. In the global health field, we don’t often talk about mindfulness as a possible intervention. But according to the American Journal of Critical Care, mindfulness-based stress reduction (MBSR) has been found to increase self-compassion and serenity among nurses and decrease burnout and self-reported distress. The same study also found that those changes were maintained at a three-month follow-up.

In another study, Margo Halm analyzed the impact of mindfulness programs on whole-person (biopsychosocial) outcomes of nurses. The results showed an overall improvement in the nurses’ physiological and psychological well-being. Not only were their salivary amylase (an enzyme that’s a biological marker of stress) levels lower at 8 weeks in one of two studies that measured it, but nurses’ self-reports of negative emotional reactivity to stress, anxiety, depression, or interference with social functioning were also lower at 4 and 8 weeks.

These programs could help equip nurses with new coping mechanisms in the midst of a global shortage.

These effects led to less-frequent reports of secondary trauma, emotional exhaustion, depersonalization, low personal accomplishment, and other components of burnout.

Obviously, these studies were conducted in environments that are very different from a Namibian hospital. And interventions like these won’t erase the critical need for staffing and other resources that are necessary to carry out optimum care. But research that considers the unique settings, regions, and cultures of low- and middle-income countries could lead to tailored mindfulness intervention programs. And combined with including more nurses in all levels of management, leadership, and policy creation, they could help equip nurses with new coping mechanisms in the midst of a global shortage.

Nurses in low- and middle-income countries cannot continue to push the profession forward if they are burnt out. For nurses to continue to work in stressful settings, we must begin to think about their holistic health and how it affects their ability to carry out care.

Resources

Investing in the Power of Nurse Leadership: What Will It Take?

By Ebahi Ikharo

2019 UNC-IntraHealth Summer Fellow

Mental Health Nursing & Midwifery 2020 Nurses Namibia

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HIV Support Groups Help Members and Health Facilities Alike in Namibia

kseaton — Tue, 26 Nov 2019 15:28:54 +0000

HIV Support Groups Help Members and Health Facilities Alike in Namibia kseaton November 26, 2019

December 06, 2019

Community groups keep each other accountable and healthy while living with HIV.

It is a sunny day at Korokoko village in Northern Namibia where the USAID HIV Clinical Services Technical Assistance Project (UTAP) is working to help people who live with HIV reach viral suppression.

Gathered under a tree are seven women and two men, including a community health worker and the district HIV nurse mentor. The members are eager to share their experiences as part of the Kavidi Community Adherence Group. Formed in May 2017, the support group brings together people living with HIV who are on antiretroviral therapy (ART) and helps them stay on their treatment regimens, while helping health facilities retain their clients.

The leader is Enata*. “I’m very proud of each member of the group,” she says. “Since the initiation of the group, no member has defaulted from care. The group has bonded and we are accountable to each other for how we take our ART.” Group members help each other adhere to the medication and achieve viral suppression.

Being part of the group also provides support for people with HIV in some not-so-obvious ways. For example, it reduces the transportation costs of going to collect medication. Now, one person goes to the clinic every three months to collect ART for everyone, freeing up time for everyone else to work to support their families.

Membership and participation in the group are very important to Timo (38) and his girlfriend Mariana (29), who are about to become proud parents. In 2014 they both tested HIV-positive and began ART soon after. Mariana struggled to accept her HIV status and to adhere to her antiretroviral therapy.

Today, we are about to have an HIV-negative baby. So all things are possible.

“At first, I was in denial, but with my boyfriend by my side, we managed to support each other,” she says. “When I tested positive, the thought of having children never crossed my mind—all I saw was death. I didn’t think it would be possible to get pregnant, but we listened to the advice we got from the health workers about planning for pregnancy while adhering to treatment and keeping our viral loads suppressed and it made me realize that it was possible. Today, we are about to have an HIV-negative baby. So all things are possible these days.”

Mariana was ashamed of her status for a long time. She alienated everyone around her and it almost cost her her life. At one point, she even stopped taking her medication, which caused her viral load to rise. She said that joining the group made her realize that HIV was not a death sentence. It’s helping her and her boyfriend live healthy lives.

I was determined to stay healthy to become a member.

“To join the group, I had to have a suppressed viral load, which is one of the requirements,” Mariana says. “And because I saw the benefits of the group from my boyfriend who joined the group before me, I was determined to stay healthy to become a member. After taking my HIV medication daily for three months as prescribed, my viral load dropped to an undetectable level. I was so happy.”

Pregnant women are not eligible to remain in Community Adherence Groups because they require frequent check-ups at the health facility, so Mariana will rejoin the group after she gives birth and is cleared by her doctor as stable.

Her partner, Timo, says that although discrimination against people living with HIV is better now than it was in 2014 when he was diagnosed, there are still people who look down on them, even if they are on ART. He also thinks men in particular are still afraid and embarrassed to join the group or even talk about HIV.

“Men are leaders in the community and don’t want to be seen taking ART,” Timo says. “But I encourage other men to not be ashamed of this condition and go for HIV testing so that they know their status—it promotes a healthy lifestyle.”

The Community Adherence Groups have improved patient-centered care and peer support for adherence and viral load monitoring. At the same time, the health system has seen a decongestion of facilities, giving health workers more time to treat unstable patients. Plans are underway to evaluate the impact of these groups on clinical outcomes, including sustained viral load suppression and retention in care.

The Community Adherence Group initiative is spearheaded by the Ministry of Health and Social Services in collaboration with donors that include PEPFAR and USAID. IntraHealth International leads UTAP and has partnered with district health teams to equip frontline health workers and people living with HIV with the necessary capacity to establish, expand, and maintain Community Adherence Groups.

*Names have been changed for anonymity.

By Valery Mwashekele

Former communications officer, IntraHealth International

USAID HIV Clinical Services Technical Assistance Project HIV & AIDS Community Health World AIDS Day Community Health Workers Namibia

HIV meds at a clinic in Omuntele, Namibia. Photo taken by Morgana Wingard for IntraHealth International.

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2019 Marks 10 Years of Partnership through UNC-IntraHealth Summer Fellows Program

mnathe — Wed, 07 Aug 2019 13:46:32 +0000

2019 Marks 10 Years of Partnership through UNC-IntraHealth Summer Fellows Program mnathe August 07, 2019 August 09, 2019 Chapel Hill, NC

As the UNC-IntraHealth Summer Fellows Program turned ten this year, it expanded to include, for the first time, graduate students studying not only public health, but also nursing and political science at the University of North Carolina at Chapel Hill (UNC).

Last month, the three 2019 fellows graduated from the program after ten weeks of working side-by-side with global health professionals at IntraHealth International. They analyzed data on family planning in Burkina Faso, created a tool to help health officials in Namibia quickly assess the quality of nursing care at their health facilities, and conducted a literature review of sexual harassment in the health workplace.

Thirty-seven fellows have now completed the program. Each year, they work directly with IntraHealth’s experts, data, and programs around the world. Some of their past projects have focused on:

digital health
HIV
gender
family planning
health systems strengthening
health communications
monitoring and evaluation
respectful maternity care
health workforce data
noncommunicable diseases

The 2019 fellows celebrate with IntraHealth staff. From left: Anna Williams, Rebecca Kohler (chief strategy officer), Cassie Rice, Ebahi Ikharo, and Emily Kiser (strategy and development officer). Photo by Casey Bishopp for IntraHealth International.

All graduate students enrolled at UNC’s Gillings School of Global Public Health are eligible to apply to this highly competitive program. Applications become available each year in the fall.

Meet the 2019 UNC-IntraHealth Summer Fellows:

Ebahi Ikharo

Ebahi Ikharo is a doctoral student at the UNC School of Nursing and a Hillman Scholar in Nursing Innovation. During her fellowship at IntraHealth, Ikharo worked with Pamela McQuide. She traveled to Namibia to collect data from hospitals in and around Windhoek for a baseline assessment of the quality of obstetric and maternity services nurses there are providing. As part of the assessment, Ikharo created a new tool to help health officials in Namibia quickly assess whether their facilities are up to standards for maternity care.

Cassie Rice

Cassie Rice is a master’s student studying political science in UNC’s College of Arts & Sciences. Working with Candy Newman at IntraHealth, Rice conducted a literature review of sexual harassment in the workplace. Over the course of her fellowship, she explored the shifting global response to sexual harassment and the factors that contribute to it, including inequality and sex segregation, structural vulnerabilities in the workplace, and gaslighting and retaliation.

Anna Williams

Anna Williams is a master’s student at the UNC Gillings School of Global Public Health in the Department of Maternal and Child Health. Williams worked with Schatzi McCarthy to develop a case study using data about contraception use in Burkina Faso. Over the course of her fellowship, Williams explored the factors that predetermine or influence women and religious couples in this West African country—where modern contraceptive prevalence is generally low—to continuously use modern contraceptive methods.

Learn more about the UNC-IntraHealth Summer Fellows Program.

Burkina Faso Namibia Family Planning & Reproductive Health Maternal, Newborn, & Child Health IntraHealth-UNC Summer Fellows Gender Equality NursesNursing grad student Ebahi Ikharo presents data from her fellowship work with hospital nurses in Namibia, where she traveled to learn more about the quality of obstetric and maternity services they provide. Photo by Carol Bales for IntraHealth International.

PrEP and Health Worker Training Are Protecting More Namibian Girls from HIV

cbishopp — Thu, 27 Jun 2019 19:57:44 +0000

PrEP and Health Worker Training Are Protecting More Namibian Girls from HIV cbishopp June 27, 2019 July 08, 2019

In the Oshikoto region of Namibia, the number of adolescent girls and young women taking pre-exposure prophylaxis (or PrEP) increased by over 100% in just three months—an uptick from 82 to 172. That means over twice as many at-risk girls and women are now lowering their risk of infection by using this daily medication. PrEP is highly effective when taken consistently and can prevent people who are HIV-negative from getting infected.

This is one of the early, promising results of IntraHealth International and IntraHealth Namibia's work on the Determined, Resilient, AIDS-free-Mentored & Safe (DREAMS) project funded by PEPFAR through USAID in Namibia. The DREAMS project is implemented by a consortium of partners led by Project HOPE Namibia.

DREAMS is helping Namibia prevent new HIV infections among adolescent girls and young women by addressing the structural factors in health, education, and society that make them more susceptible to HIV infection. These include gender inequality, early sexual debut, teenage pregnancy, physical and sexual violence, and limited access to comprehensive sexual education. Though the country has made significant progress toward epidemic control, Namibian girls and young women are at particularly high risk.

As the clinical partner for DREAMS in Namibia, IntraHealth International is focusing on HIV prevention in three districts in the Oshikoto region. Oshikoto has a youth (ages 15-34) population of 68,733—that’s 8% of the country’s total youth population as of 2016. DREAMS is also building the capacity of independent, local entity IntraHealth Namibia to take on this important role.

Health workers provided clinical services to an additional 235 adolescent girls and young women—a 33% increase.

“We are starting to see the positive impact that DREAMS has on the lives of adolescent girls and young women,” says Lavinia Shikongo, general manager of IntraHealth Namibia.

“IntraHealth Namibia is proud to be contributing to efforts aimed at ensuring that adolescent girls and young women have access to information and services to protect themselves from HIV infection and unwanted pregnancies.”

Both partners have worked together to provide training and ongoing mentorship to dedicated DREAMS nurses in six implementing health facilities, while also orienting other Ministry of Health and Social Services’ nurses in clinical services for sexual health and risk-reduction in seven satellite sites.

During the current quarter, IntraHealth Namibia has trained 24 nurses on adolescent-friendly health services and 21 nurses on the ministry’s new PrEP guidelines. From January to March 2019, these health workers provided clinical services to an additional 235 adolescent girls and young women—a 33% increase over the previous quarter.

The trained nurses are already working to decentralize DREAMS services to the rest of the facilities in Oshikoto.

DREAMS health workers act as a critical gateway to the youth-friendly health services adolescent girls and young women receive, including screening for gender-based violence and HIV testing services.

IntraHealth’s work on Namibia DREAMS is part of a larger public-private partnership between PEPFAR, the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences, and ViiV Healthcare to reduce HIV infections among adolescent girls and young women in sub-Saharan Africa.

Namibia HIV & AIDS Gender Equality Youth Engagement Health WorkersAdolescent girls and young women at Omuukwiyugwemanya Combined School, Oshikoto region in December 2018. Photo by Dr. Samson Ndhlovu for IntraHealth International.Namibia DREAMS

Picture It: Would His HIV Status Get Him Fired?

intrahealth — Mon, 22 Apr 2019 19:08:01 +0000

Picture It: Would His HIV Status Get Him Fired?

intrahealth April 22, 2019

New Study Offers Recommendations to End Abusive Maternity Care in Namibia

cbishopp — Fri, 04 Jan 2019 14:23:33 +0000

New Study Offers Recommendations to End Abusive Maternity Care in Namibia cbishopp January 04, 2019 January 04, 2019

Spurred by negative media reports on the quality of maternity care in Namibia, which made health workers the target of popular distrust and animosity, the Namibian Ministry of Health and Social Services (MoHSS) commissioned a study to examine the factors that affect health workers’ approaches when providing maternal and neonatal health care. The results are now available in Provider and Client Perspectives on Maternity Care in Namibia: Results from Two Cross-Sectional Studies.

Through a series of surveys and focus group discussions on the state of maternity care in public hospitals in Namibia, IntraHealth International and our partners found that many clients have experienced disrespectful, rude, or abusive behavior from nurses or midwives. We also found that heavy workloads and understaffing in many facilities contribute to health workers’ negative behaviors—and may lead many women to give birth at home rather than at health facilities.

Clients who participated in the study described health workers yelling, pinching, and slapping women during labor to encourage them to push. They also reported instances of inappropriate care practices—such as women having to clean up delivery rooms themselves after giving birth—and mismanagement of pain.

Nurses who took part in the study described stressful work environments and having to work above or below their scopes of work, often on empty stomachs and with few or subpar resources. But they repeatedly cited their dedication to the health of babies during deliveries (sometimes at the expense of respectful treatment for the mother) and a commitment to their vocation, which many viewed as a professional calling.

"The nurses who participated in the study greatly appreciated the opportunity to relate their experiences and felt sometimes they were persecuted inappropriately,” says IntraHealth’s Jennifer Wesson, who implemented the study. “This study gave nurses a voice, too.”

Health worker focus groups recommended action at various levels, including:

Acknowledgement of society’s role in the creation of a supportive environment, and positive feedback and publicity to recognize health workers’ hard work
Collaborative effort to identify common needs between clients and health workers paired with collective interventions to address these needs
Better preservice training, including on client-centered care and ethics
Establishment of a code of conduct and accountability mechanisms
Further dissemination and community education about client rights outlined in the little-known 1998 Patient Charter of Namibia

Provider and Client Perspectives on Maternity Care in Namibia: Results from Two Cross-Sectional Studies was published in BMC Pregnancy and Childbirth and is a collaboration of IntraHealth International, the Tulipohamba Training and Assessment Institute, and the University of Namibia. IntraHealth’s work in Namibia is funded by the US Agency for International Development.

Resources

Provider and Client Perspectives on Maternity Care in Namibia: Results from Two Cross-Sectional Studies

Namibia Maternal, Newborn, & Child Health Health WorkersPhoto by Morgana Wingard for IntraHealth International.

Provider and Client Perspectives on Maternity Care in Namibia: Results from Two Cross-Sectional Studies

cbishopp — Thu, 29 Nov 2018 20:52:48 +0000

Provider and Client Perspectives on Maternity Care in Namibia: Results from Two Cross-Sectional Studies 2018 cbishopp November 29, 2018 Download

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-19…

Countries Namibia

Topics Maternal, Newborn, & Child Health Health Workers

Publisher BMC Pregnancy and Childbirth

By Jennifer Wesson, Pamela McQuide