Private-Sector Approaches

Meet Marguerite Diarra. She’s On a Mission to Train More Midwives and Increase Access to Maternal Care in Mali

cbales — Fri, 08 Mar 2024 11:47:15 +0000

Meet Marguerite Diarra. She’s On a Mission to Train More Midwives and Increase Access to Maternal Care in Mali cbales March 08, 2024

March 08, 2024

For International Women’s Day, we’re celebrating women like Marguerite who inspire us, and donors, to #InvestInWomen.

On a sunny morning at the Vicenta Maria School of Ségou in Mali, Marguerite Diarra demonstrates active management of the third stage of labor using a Mama-U, a training model representing a woman’s uterus after childbirth.

Marguerite is on a mission to produce more skilled midwives who are ready to care for women in Mali, particularly in rural communities. She grew up in Beleko, in the region of Dioila, and became a midwife in 2016. Now she’s a permanent teacher at the school, specializing in obstetrical care.

Mali doesn’t have nearly enough midwives.

Mali, like other countries in Francophone West Africa, doesn’t have nearly enough skilled midwives or other health workers. There are just 6.1 midwives, nurses, and doctors to serve 10,000 people, far below the recommended amount, and the shortage is even worse in rural areas. This hinders women’s equitable access to health services, including for maternal care and family planning, and contributes to high rates of maternal mortality.

More than 500 women die for every 100,000 live births in Mali. And, traditional preservice education has not prepared health workers for real-life work conditions.

IntraHealth’s Classroom to Care (C2C) project, funded by Takeda Pharmaceutical Company Limited, aids 12 private health schools like Vicenta Maria in adopting a Competency-Based Approach (CBA) to education.

The Competency-Based Approach to education is based on population needs.

Whereas classic preservice training involves developing programs by subject or objective, CBA programs are developed based on population needs and the needed competencies for job requirements. In classic training the teacher provides the knowledge, while CBA teaching is based on facilitating student learning.

C2C has trained 250 teachers like Marguerite across Mali, Niger, and Senegal on the CBA approach.

Photo by Amadou Iam Diallo for IntraHealth International.

“These trainings really helped me understand my role as a teacher, become aware of my shortcomings, and apply new skills,” she says. "Previously, teachers did everything, but with CBA, we learned to put the student at the forefront of their own education. It's up to students to take the lead, and the teacher to guide and direct them. This has changed our way of preparing and delivering lessons," Marguerite says. This new approach has made classes more interactive and beneficial for students.

"We emphasize practice, which is very important in their learning to become competent health workers."

Marguerite also supervises students in community health centers, reference health centers in each district, and Nianankoro Fomba Hospital. "I am responsible for positioning students and tracking their skills development. Occasionally we go on field visits, because we emphasize practice, which is very important in their learning to become competent health workers.”

The project found that many health schools were lacking the equipment they needed for students to practice and has already provided anatomical models and other teaching equipment for establishing skills labs at the schools.

“The skills lab will help us a lot,” says Marguerite. “We already have a lot of equipment compared to other schools, but there are still gaps. For example, we don’t have the equipment required to insert or remove an IUD, or for demonstrating to women how to conduct breast self-examinations. There are also mannequins that we don’t have, and we need them to prepare students for their field placement, so when they are providing direct care to patients, they know what to do.”

By the end of the five-year project, C2C aims to have 580 teachers across Mali, Niger, and Senegal trained on the CBA, 9,720 students benefiting from quality training, and a skills lab at each school.

Meanwhile the C2C is also focusing on promoting diversity, equity, and inclusion (DEI) to increase the number of nursing and midwifery graduates, particularly women from marginalized communities. C2C conducted DEI situational analyses, and is using the results to develop school-specific plans that apply DEI best practices. to make all 12 partner schools more inclusive for women students and boost well-being and academic performance.

By Amadou Iam Diallo

Technical advisor for communications

By Carol Bales

Strategic communications manager

Maternal, Newborn, & Child Health Health workforce development Private-Sector Approaches International Women's Day Gender Equality Midwives Nurses Mali Niger Senegal

Is In The Media

Photo by Amadou Iam Diallo for IntraHealth International.

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In Francophone West Africa, 3,000 More Nursing and Midwifery Students Are Benefitting from Competency-Based Training Matching Local Needs

cbales — Mon, 20 Nov 2023 16:19:57 +0000

In Francophone West Africa, 3,000 More Nursing and Midwifery Students Are Benefitting from Competency-Based Training Matching Local Needs cbales November 20, 2023 November 20, 2023

IntraHealth is partnering with Takeda Pharmaceutical Company Limited to improve maternal and child health in Mali, Senegal, and Niger by sustainably increasing the number of skilled nurses and midwives ready to serve rural communities.

Through the Classroom to Care (C2C) project, funded by Takeda's Global Corporate Social Responsibility (CSR) Program, IntraHealth International is improving access to high-quality maternal and child health care in Mali, Niger, and Senegal by strengthening the preservice training of nurses and midwives in 12 private health schools. Now at the end of the second year of the project, more than 3,000 nursing and midwifery students—75% of whom are women—are benefiting from updated curricula adapted to local clinical practice.

The project is responding to several pressing issues. There is a critical shortage of health workers (nurses, midwives, and doctors) available in the three countries, with only 6.1 health workers in Mali, 3.9 health workers in Niger, and 4.3 health workers in Senegal for every 10,000 people. The shortage is even more acute in rural areas. Currently, traditional preservice education curricula have not prepared health workers for real-life work conditions, and many health training institutions are inadequately equipped and unaccredited. Furthermore, women are disproportionally disadvantaged when it comes to enrollment and graduation due to a variety of factors, such as family responsibilities. Discrimination against women and gender inequalities directly impede development of the health workforce to provide equitable and accessible health services.

Meanwhile the maternal mortality rate remains very high in the three countries, with 315 deaths per 100,000 live births in Senegal, and more than 500 deaths per 100,000 live births in Mali and Niger. And in Mali and Niger, approximately 10% of children die before their fifth birthday.

Competency-Based Approach

Competency-focused preservice education is critical for the provision of high-quality maternal and child health services that meet local needs. Since 2006, the West African Health Organization (WAHO) has pushed to harmonize training curricula for nurses and midwives in the Economic Community of West African States (ECOWAS) region that addresses current disease patterns as well as intra-regional migration. The curricula use a competency-based approach (CBA) that considers population and student needs to replace classic training. Many health schools in the region, however, have still not started the process of implementing the WAHO standardized curricula or been able to train a critical mass of teachers on CBA.

From 2017-2020, the USAID/Mali Human Resources for Health Strengthening Activity, led by IntraHealth, supported the use of competency-based curricula in 10 schools and strengthened policies and practices related to recruitment and retention of students, leading to improved performance of health workers.

The five-year C2C project builds on this work and supports four private schools in each country to strengthen preservice education of nurses and midwives through enhanced competency-based curricula; train teachers and others in the CBA, achieve the appropriate accreditations; and promote diversity, equity, and inclusion (DEI) to increase the number of nursing and midwifery graduates, particularly women from marginalized communities and vulnerable groups.

C2C partners with a diverse set of stakeholders, including WAHO, government bodies including the ministries of health and education in each country, government units such as the Human Resources Division and the Division for Mother and Child Health, private school associations, health professional associations, and Empower School of Health.

Preliminary results

C2C conducted an in-depth needs assessment to identify the baseline for each school, then developed capacity-building plans for all 12 schools to address gaps in national accreditation standards, purchased essential teaching equipment for competency labs, and digitized eLearning modules harmonized with the WAHO curricula.

At the end of Year 2, the project has:

Supported the development and validation of CBA teacher training documents at the national level, including a reference manual, trainer’s guide, and participant workbook.
Through updated CBA training programs, improved the skills and knowledge of 3,721 students, teachers, and school management staff:
- 398 teachers acquired skills and knowledge in adult teaching techniques.
- 250 teachers and clinical supervisors received training on competency-based curricula.
- 3,073 students (2,361 women) benefited from updated curriculum content with tools adapted to clinical practice.
Developed an Accreditation and Quality Assurance Roadmap for all three countries, established internal quality assurance and accreditation units in each school, and oriented 62 educational advisors on quality assurance—laying the groundwork for the accreditation process.
Digitized 33 maternal and child health teaching modules and developed an eLearning platform in collaboration with Empower School of Health. This platform is a comprehensive learning management system tailored to each country, and the modules cover topics such as pediatrics, anatomy, community health, and obstetrics. The eLearning platform incorporates DEI considerations in its design, audio and visual features, and mobile and offline options.
Established inter-ministerial technical working groups in the three countries and initiated a regional private sector community of peers and a community of practice on medical sciences training.

What’s next

C2C is currently conducting DEI situational analyses in all three countries, and in the next year will use them to develop school-specific DEI plans that apply DEI best practices, such as providing nurseries and lactation rooms, to make partner schools more inclusive for women students and boost well-being and academic performance.

C2C will launch the eLearning platform and over the next three years will expand the platform to also include management and leadership courses and solidify it as the standard in health care education across West Africa. C2C will ensure each partner school receives the necessary equipment and technical support to set up competency and computer laboratories. C2C will deepen engagement with stakeholders, from government bodies to local communities, ensuring that the project's impact is sustainable and far-reaching.

The project will also continue its Private Sector Community of Practice, strengthen public-private partnerships through the technical working groups, and oversee implementation of action plans in each school.

By the end of the project, C2C aims to have 580 teachers trained on the CBA, 9,720 students benefiting from quality training, and all 12 private health schools accredited.

Learn more about the Classroom to Care project in three short videos produced by IntraHealth’s Mali team for a virtual visit this month with Takeda.

Mali Niger Senegal Maternal, Newborn, & Child Health Education & Performance eLearning Private-Sector Approaches Midwives NursesPhoto by Amadou Iam Diallo for IntraHealth InternationalClassroom to Care: Training to Expand Access to Maternal and Child Health

New Urban Health ‘Accelerator’ Aims to Transform Cardiovascular Population Health Globally

ihadmin2 — Mon, 22 May 2023 13:37:17 +0000

New Urban Health ‘Accelerator’ Aims to Transform Cardiovascular Population Health Globally ihadmin2 May 22, 2023 May 22, 2023 Geneva

The CARDIO4Cities Accelerator by Novartis Foundation and IntraHealth International aims to replicate the successful CARDIO4Cities approach in 30 major cities within three years to transform cardiovascular population health and equity globally.
Results of initial programs in São Paulo, Dakar and Ulaanbaatar show the cost-effective approach averted up to 13% of strokes and 12% of heart attacks during implementation.
Experts say public-private partnerships are key to address the growing burden of cardiovascular disease, the world’s leading cause of death, according to the World Health Organization (WHO).

Geneva, May 22, 2023 — Today, at the sides of the 76th World Health Assembly, the Novartis Foundation and IntraHealth International launch the CARDIO4Cities Accelerator. The accelerator aims to replicate CARDIO4Cities, the cardiovascular (CV) population health approach pioneered and validated by the Novartis Foundation, in 30 major cities within the next three years.

As a neutral broker between city governments, health experts, industry, implementing partners, funders and investors, the accelerator pledges the global community to direct action and funding toward transforming CV population health and equity.

Projections based on initial CARDIO4Cities programs in São Paulo (Brazil), Dakar (Senegal) and Ulaanbaatar (Mongolia), published in PLOS Global Public Health, revealed that CARDIO4Cities was highly cost-effective, increased blood pressure controls by three times or more, and averted up to 13% of strokes and 12% of heart attacks within one to two years of implementation.

Based on global hypertension estimates, replicating this impactful CV population health approach in 30 large cities within the next three years could save and improve millions of lives around the world.

Public-private partnerships like CARDIO4Cities, leveraging real-time health outcomes data, can guide city authorities in designing and targeting public health interventions more effectively, and help them achieve the largest health impact on the greatest number of people.

In São Paulo, for example, where limited data existed on hypertension, which is the prime risk factor for CV disease, authorities offered blood pressure measurement opportunities outside the health facilities, in football stadia, metro stations and samba clubs. Interventions like these made for an effective way to detect this silent risk factor in the local male population, who often go undiagnosed for many years until presenting with an acute event such as a stroke or heart attack.

In Dakar, several companies introduced blood pressure measurement at the workplace, to accelerate detection and prompt management of hypertension in their workforce. And in Ulaanbaatar, information about healthy nutrition and other ways to limit CV risk was included in national school curricula.

CV disease is the world’s leading cause of death, claiming almost 18 million lives every year. 80% of these deaths occur in low- and middle-income countries, often prematurely. Through CARDIO4Cities and the data it collected to monitor progress, local authorities were able to better target interventions and resources to where they were most needed.

"The launch of the CARDIO4Cities Accelerator is a logical next step to enable large scale replication of the CV population health approach the Novartis Foundation successfully pioneered," says Dr Ann Aerts, Head of the Novartis Foundation. "While this simple, innovative approach is scientifically validated and highly cost effective, it proves above all to rapidly improve CV health outcomes. The key success factors of CARDIO4Cities are strong ownership by the local authorities and intervention design based on real time data."

"As CV disease and health inequity are the burning issues of our time, it is urgent to ensure that many more people benefit from this simple yet impactful approach,” Aerts adds. “Today, I call upon the global community to join us in our pledge to roll out CARDIO4Cities in 30 cities within the next three years."

Philippe Guinot, chief technical officer and interim chief operating officer at IntraHealth International, says: "Health is a human right, but for too many, it remains a dream. The CARDIO4Cities Accelerator offers a concrete path toward making that dream a reality, empowering cities to use collaboration across sectors, innovative financing, proven strategies, and real-time data to improve cardiovascular health. Cardiovascular disease is the top cause of premature death. But with the CARDIO4Cities Accelerator, acting together, we can create a more equitable world where everyone has access to the health care they need to thrive."

Further information on the CARDIO4Cities Accelerator can be found online at www.cardio4citiesaccelerator.org.

About the CARDIO4cities approach

CARDIO4Cities applied a simple comprehensive strategy based on six CARDIO pillars – shorthand for quality of Care, early Access, policy Reform, Data and digital technology, Intersectoral collaboration, and local Ownership. CARDIO4Cities are programs developed in conjunction with local authorities, the health sector and private sector partners. These stakeholders work together to explore unmet needs in response to hypertension and other cardiovascular risks. The intervention design was informed by a combination of best practices for hypertension and heart disease management, such as the WHO HEARTS package, the Measure Accurately, Act Rapidly, and Partner With Patients Protocol (M.A.P.) and the World Heart Federation roadmap to reduce high blood pressure, as well as local policies, guidelines and data. A key intervention was standardizing hypertension diagnosis and management for primary health providers. This was rolled out, through clinical decision support systems and online continuous medical education. The program engaged non-traditional health players such as sports clubs, dance clubs, schools and workplaces. This maximized opportunities for hypertension detection and increased opportunities for understanding of cardiovascular risk. In some instances, it even included increasing opportunities for physical exercise or healthy food options in the city.

About the Novartis Foundation

The Novartis Foundation is a non-profit organization based in Switzerland. For over 40 years, we have helped improve the health of low-income populations, initially supporting disease elimination in areas such as leprosy and malaria. Today, we tackle the burning issues of our time, cardiovascular disease and health inequity. We take a population health approach, which means widening the lens from a narrow focus on healthcare delivery to a panoramic vision of improving health in the population at large, ensuring access to healthy lives for all. Our population health approach brings together existing but disconnected data to help authorities understand the root causes of unequal health outcomes and find the best ways and best partners to remediate those. This empowers governments to transform their health systems from being reactive to proactive, predictive, and preventative, and achieve health equity among the populations they serve.

www.novartisfoundation.org

The Novartis Foundation is on LinkedIn at @Novartis Foundation and on Twitter at @NovartisFDN.

About IntraHealth International

IntraHealth International is a global health nonprofit that has worked in over 100 countries since 1979. We partner with governments and local collaborators to improve the performance of health workers and strengthen the systems in which they work so that everyone everywhere has the health care they need to thrive. IntraHealth works in a variety of health areas including maternal and child health, family planning and reproductive health, community health, HIV/AIDS, global health security and noncommunicable diseases. Since 2017, IntraHealth has been a key implementation partner of the Ministry of Health in Senegal to support early diagnosis, treatment and management of hypertension and other cardiovascular risk factors among the population in Dakar. Under the CARDIO4Dakar program, IntraHealth tests evidence-based approaches by leveraging the power of data and digital solutions to accelerate reach and impact throughout Senegal and beyond.

IntraHealth International Communications

Contact: Khadra Abdullahi

Tel:+417 63 76 03 34

Email: kabdullahi@intrahealth.org

Novartis Foundation Media Relations

Contact: Max Rein

Tel: +41 79 240 23 07

Email: maximilian.rein@novartis.com

Global Noncommunicable Diseases Private-Sector Approaches

Big Changes Needed to Recruit and Retain Young Nurses, in Kenya and Beyond

mnathe — Wed, 08 Apr 2020 12:19:36 +0000

Big Changes Needed to Recruit and Retain Young Nurses, in Kenya and Beyond mnathe April 08, 2020

April 08, 2020

Here's what we learned from young Kenyans about what gender inequality in nursing looks like for them.

What does gender inequality look like for nurses in Kenya? How does it affect nurses every day at work? And what does it mean for the country’s response to the COVID-19 pandemic?

We’ve found that young people are a key part of the answers to these questions. More than half of the world’s population is under 30, with an even higher proportion in sub-Saharan Africa.

Health systems are fighting the COVID-19 pandemic with only half their reserves if they don’t meaningfully engage young people in health workforce leadership, particularly nursing.

Young Kenyans are looking for careers where they can give back to their communities, but they often aren’t finding the support they need to enter health workforce professions. This is especially true for women, who make up 90% the nursing workforce worldwide but occupy only 25% of leadership roles.

The stereotype was that nursing is only for women because it “requires a big heart and compassionate mind.”

Here are some of the things we’ve learned from young Kenyans about what might help address these issues.

Remove gender-related barriers

Despite increasing recognition of the gendered perceptions of health work (nursing and midwifery in particular), social changes to address these barriers are slow to come.

Nursing student Jane Muthoni Mutegi grew up believing the pervasive stereotype in her community that nursing is a job only for women because it “requires a big heart and compassionate mind.” Meanwhile, male nursing student Samuel Kamau Kuria’s decision to pursue nursing was met with negativity—his friends and family calling him a “coward.”

Another student, Catherine Kimeu, is scared that becoming pregnant will have a huge impact on her job. Unfortunately, she has reason to believe this -- when one of her colleagues was required to be on bedrest for 28 weeks due to a complicated pregnancy, she lost her job while also facing blame from her husband.

Rose Irungu, a fellow student, has also seen recent mothers forced to return to work after only three months (Kenya’s paid maternity leave time) even though the World Health Organization recommends six months of exclusive breastfeeding.

Kenyan health workers are routinely deployed far away from home, which makes many students concerned about whether and how they might raise their own families.

Catherine Kimeu. Photo by by Patrick Meinhardt for IntraHealth International.

There are also difficulties outside of the clinic. Jane has seen multiple female nurses struggle with their husbands not trusting them about being required to work overnight, and their communities often think of nursing jobs as low-skill, simply “cleaning wounds.”

Recruit from local communities

When Samuel was growing up in rural Kenya, there were no doctors or nurses in his community. Today there are just two.

Despite the challenges they face on the job, many students want to return to their home communities once they finish schooling and work for those who supported them (including communities that fundraised for their school fees on their behalf).

This illustrates the benefits of a key intervention often overlooked in the health workforce: recruiting from the most underserved communities, thereby encouraging community trust and ownership of health outcomes.

Samuel Kamau Kuria. Photo by Patrick Meinhardt for IntraHealth International.

Create mechanisms to fund schooling and extend employment periods

School fees continue to be prohibitive for many students in Kenya. Students are routinely sent home if they cannot come up with funding, which can derail their education entirely.

The Afya Elimu Fund, which provides loans to students for educational fees, is one way Kenya is addressing this. Students pay their loans back once they are employed, creating a cycle of support and adding to the pot of funds for the following year’s class.

Without job security in nursing, the shortage of health workers will only continue to grow.

Many young Kenyans are interested in pursuing nursing in part because of job security, as nurses are always needed and demand for their skillset is only increasing. However, contracts are often short-term, Samuel says.

“After that period, you have to renew your license or maybe your contract,” he says. “So your job is really not that permanent.”

If nursing can’t provide the job security necessary to draw in students who need to support themselves and their families, the shortage of health workers will only continue to grow.

Today, health workers everywhere face an extraordinary test in the form of a pandemic that has stretched health systems to their limits and brought the global economy to a halt. COVID-19 is a painful example of what happens when we neglect to invest in resilient health systems and the frontline health workers who keep them running.

As the first line of defense for global health security, health workers, particularly nurses, are needed to help prevent, detect, and respond to outbreaks like COVID-19 in their own communities.

Policies that support these critical professionals are needed to address the major challenges that prevent both women and men from effectively pursuing nursing careers. These include recruiting from local areas to develop community expertise, mitigating gender-related barriers, and adequately investing in training and continuous education to attract young people into this vital sector.

The negative perceptions of nurses and the barriers they face due to gender inequality and societal norms must be removed to make nursing a career that women are able to pursue and that men are encouraged to join to address critical gaps in frontline health workforce.

Without concrete policies that address the intersection of youth engagement and frontline health workforce, COVID-19 and future pandemics could continue to devastate countries around the world.

IntraHealth International’s Carol Bales and Samantha Rick interviewed nursing students and nurses in Kenya as part of a forthcoming case study on nursing leadership funded by Johnson and Johnson. Jane, Catherine, Rose, and Samuel are students at A.I.C. Kijabe College of Health Sciences in Kenya.

This post originally appeared on the Frontline Health Workers Coalition blog.

By Arush Lal

International consultant, PAHO/WHO

By Samantha Rick

Former deputy director, Frontline Health Workers Coalition

COVID-19 Education & Performance Policy & Advocacy Private-Sector Approaches World Health Day World Health Worker Week Key Issues Gender Equality Global health security Health Financing Health Workforce & Systems Youth Engagement Nurses Kenya

Nursing students Catherine Kimeu (left) and Samuel Kamau Kuria (center) care for a client in a health facility in Kenya. Like nurses all over the world, they face gender-related stereotypes and barriers at work. Those challenges keep many young people from pursuing much-needed nursing careers. Photo by Patrick Meinhardt for IntraHealth International.

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COVID-19: Looking for Helpers in the Medical Hardware Community

mnathe — Fri, 20 Mar 2020 19:37:08 +0000

COVID-19: Looking for Helpers in the Medical Hardware Community mnathe March 20, 2020

March 20, 2020

Open source, 3D-printable designs for ventilators and other medical equipment could help health workers respond to coronavirus.

As the COVID-19 pandemic makes its way across the globe, and even well-resourced health systems struggle with the availability of critical supplies needed to treat patients, initiatives have emerged in the hardware community looking to help solve the shortage of physical supplies.

When looking to bring the supply chain for critical goods closer to where they are needed in emergencies, Field Ready comes to mind. It has more certified open source hardware designs than any other organization, and many of the items in its catalogue—like its Air Pollution Face Mask, Oxygen Supply Fitting, Ventilator Connector, and other designs—could be useful for frontline health workers running low on critical items during this pandemic. Some designs are 3D-printable and some come complete with Ikea-style wordless assembly instructions.

One Facebook group is making furious progress toward developing an open source ventilator.

A main cause for concern globally is the lack of available ventilators to meet demand of sick patients. We’ve seen this in Italy. The hardware community is attempting to take on this massive challenge, too, and in surprising ways.

Facebook groups are not a typical platform for collaboration in the hardware community, but the Open Source COVID19 Medical Supplies group includes many of the brightest in the hardware community and is making furious progress toward developing an open source ventilator and other designs. They’re not the only ones. A variety of other ventilator projects are underway.

As of writing, Italy remains a hotspot for COVID-19 cases. Often underappreciated, particularly by Americans, as a center for design and manufacturing genius, Italy is taking on the challenge to minimize the ventilator shortage.

For example, a Milan Fab Lab is leveraging the region’s manufacturing talent and infrastructure to design and produce 3D-printed replacements for a ventilator valve that was in critically short supply. According to reports, 10 patients are currently breathing with the help of these 3D-printed valves.

The Right to Repair movement was already gaining steam in the United State and Europe before the crisis, but in a world where every broken ventilator is likely to result in personal tragedies, it can justifiably expect to build support.

Medical supply chains are about much more than just physical stuff.

In the United States, fears of ventilator shortages are also growing. The open source community is already looking to contribute.

Chai Bio, the creator of the seminal OpenPCR and the far more advanced, but somewhat less accessible Open qPCR, is close to releasing a kit to enable environmental detection of COVID-19.

Shingo Hisakawa, who has many years of experience making open source PCR accessible to more users, has his own project.

And the bio hacker community is also jumping in. You can read more about its efforts on Just One Giant Lab.

I often say that the truly difficult global problems are almost never purely technical ones; they are issues of how we as people organize ourselves to solve problems—or fail to solve those problems. Medical supply chains are no different. They are about much more than just physical stuff: laws and regulations to ensure quality and safety, trade rules, business models, intellectual property rules, workforces, institutions, and many other factors are at play.

The hardware community’s approach to the crisis may hint at what the future will look like.

The Italian team that 3D printed the ventilator valves say they were threatened with a lawsuit by the original design’s manufacturer. While outrage at that response comes easily, it cannot readily be untangled from existing expensive certification regimes for medical equipment and legal standards for enforcement of copyright.

As with the terror attacks of September 11, 2001, the world after this crisis will be different in important ways than it was before. It is hard now to see what those changes will be, but it is a safe bet that it will include changes in the way the world sees supply chains. The hardware community’s approach to the crisis may give hints of what that future will look like.

This post was originally published on Digital @ DAI.

By Rob Ryan-Silva

Global practice specialist and director, DAI Maker Lab

COVID-19 Community Health Technology Private-Sector Approaches Global health security

Image: CDC/Alissa Eckert, MS; Dan Higgins, MAMS

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Trained Supply Chain Workers Are Key to Improving Access to Health Products at Senegal's Last Mile

mnathe — Wed, 08 Jan 2020 20:07:25 +0000

Trained Supply Chain Workers Are Key to Improving Access to Health Products at Senegal's Last Mile mnathe January 08, 2020

January 08, 2020

Intensive, tailored coaching created a more motivated workforce. Here’s how.

We sometimes say, “No product, no program,” within global health programs—because no health program can succeed if the medicines and health products people need aren’t available when and where they need them. It has become clearer than ever that without qualified, well-trained human resources to manage supply chains, health products do not reach the last mile.

For the past seven years, IntraHealth has been working with the Ministry of Health and Social Action and the National Supply Pharmacy in Senegal to make essential health products more widely available at health facilities.

Yeksi Naa (“I have arrived” in Wolof) is a distribution model that brings health products to the last mile. The model makes commodities more widely available at health facilities by combining two approaches: the National Supply Pharmacy’s Jegesi Naa Approach and the Informed Push Model. It contracts with private operators and uses electronic data collection to improve stock monitoring in real time.

Back in September 2018, few supply chain agents (only around 23%) knew about or were applying Yeksi Naa technical procedures. Our goal: to increase these scores to 75% in a year.

So we mentored supply chain workers, including on the Yeksi Naa technical procedures* and the accompanying electronic Logistics Information Management System (eLMIS). This led to better decision-making and increased data visibility. By July 2019, Yeksi Naa rates had increased.

Now, agents have an 87% overall performance score:

How did we do it?

We needed to understand the barriers to optimal performance and find an effective method to assess and monitor their performance in the supply chain system. Six IntraHealth logisticians conducted an initial evaluation in July 2018 and classified the performance of each cadre using the Matri-Model and disaggregating by geography.

Our team developed targeted capacity-building plans based on assessment results and the support needs of each cadre, including how-to manuals and posters highlighting key components of Yeksi Naa and eLMIS. IntraHealth logisticians conducted supportive supervision such as in-person practical guidance to enhance their skills and application. Yeksi Naa project logisticians periodically assessed cadre knowledge levels of technical procedures and eLMIS using the Matri-Model tool.

We encountered several challenges along the way, including:

Insufficient job descriptions and role confusion: The Regional Pharmacy (PRA) logistician focal point job description was insufficient and did not ensure that people recruited could effectively carry out their assigned tasks. Additionally, in some cases, the PRA chief pharmacist performed certain tasks assigned to the accountant, which slowed progress toward gold performance for accountants. We needed to harmonize job descriptions and revise the manual.
Mobility of health supply chain workers: Accountants and private operators moved around, which affected their ability to achieve gold performance. With each staffing change, project logisticians at the PRA level needed to conduct a new initial evaluation and then build the new supply chain workers’ capacity and monitor their performance.
Insufficient governance and institutional capability: There weren’t strong enough to fully operationalize the Yeksi Naa model, including transferring project logisticians to the National Supply Pharmacy as well as contracting and financing the private operators.

Addressing these difficulties ultimately led to a new assistant pharmacist position to support the logistician focal point. To sustain the achievements, the project director, Dr. Oumy Ndao, believes it’s critical to create a permanent position for logistician focal points at regional supply pharmacies to more effectively manage Yeksi Naa at the regional level.

Intensive, tailored capacity-building for supply chain workers created a more competent, motivated workforce. This allowed us to more effectively implement the Yeksi Naa model and improve supply chain performance, making more products accessible at the last mile in Senegal.

*Yeksi Naa technical procedures include guidance on: inventory management, distribution plans to service delivery points, using CommCare dashboard to monitor key logistics indicators, financial flow management and cost recovery, and managing expired products.

This project was funded jointly by the Bill and Melinda Gates Foundation and the Merck for Mothers Foundation. It was overseen by Babacar Gueye, IntraHealth's chief of party and country director in Senegal, and by Oumy Ndao, Yeksi Naa project director.

By Batouo Souare

Communications Officer, IntraHealth International

By Melanie Joiner

Senior program manager, IntraHealth International

Expanding the Informed Push Model for Family Planning in Senegal (Yeksi Naa) Family Planning & Reproductive Health Health workforce development Private-Sector Approaches Health Workforce & Systems Pharmacists Senegal

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The Power of One Health Connects Local and Global Health

kseaton — Thu, 14 Nov 2019 20:51:30 +0000

The Power of One Health Connects Local and Global Health kseaton November 14, 2019

November 14, 2019

The future of global health starts with all of us.

What do dogs, HIV care, and the Galapagos Islands all have in common?

They are all integral parts of the One Health approach to improve the future of global health for centuries to come.

Human health doesn’t exist in a bubble. Our world is interconnected in ways we have yet to understand. So we need to learn more about the connections between the health of humans, animals, and the environment.

Current global megatrends may make it seem like the future is daunting. Noncommunicable diseases (NCDs) are rising—the World Health Organization estimates that they kill 40 million people each year, accounting for 70% of deaths worldwide. Urbanization is increasing the prevalence of airborne diseases, causing around 7 million premature deaths annually. And the earth is warming at a much faster rate than expected. Globally, around 1 million animal and plant species are now threatened with extinction within decades, and the rate and size of climate disasters are increasing

“If we don’t get this right, we are in great peril.” - Tim Mastro, chief science officer at FHI360

We can begin to understand how these megatrends are connected and influence each other by first acknowledging that local and global health are interconnected.

“We often stovepipe our species as if they have nothing to do with the global community,” said Dennis Carroll, the former director of the U.S. Agency for International Development’s Global Health Security and Development Unit, at the 2019 Triangle Global Health Conference last month where One Health was the theme of the event.

Take Sentinel Biomedical, for example. A research company in Raleigh, NC, they are studying the connections between humans and dogs. Using the daily movements of dogs—the biological and environmental influences they are exposed to—they are predicting patterns in canine cancer. And since humans and dogs share similar environmental influences, they are also going a step further to use canine cancer patterns to predict patterns in human cancer.

"Our research is making canines true watchdogs in the area of human health.” - Sentinel Biomedical

Connecting humans to the environment, the University of North Carolina at Chapel Hill (UNC) and the Universidad San Francisco de Quito (USF) in Ecuador have partnered to create the Center for Galapagos Studies, which advances conservation efforts in the Galapagos and promotes a better understanding of ecologically sensitive and protected areas worldwide.

Jill Stewart leads a monitoring project at the center that detects and tracks pathogens in the water. Since the islands are mostly undeveloped by people, they provide great research grounds for studying the impact of human development on the ecosystem.

“We learn lessons in the Galapagos that we can apply to North Carolina and elsewhere across the globe,” Stewart said. But without help from USF Quito, none of their work would be possible. “They help open doors for us,” she added. “Having the science center there has been an opportunity to work across departments and with international partners to address the big environmental challenges affecting us globally.”

Diverse partnerships are crucial to improving the global health landscape. This includes our partnerships around the world, of course, but also the partnerships we form in our own back yards. Here in North Carolina, we’re lucky to be surrounded by like-minded organizations that are working to improve global health and well-being.

“We must build trust among our partners and commit time to building them, for without partnerships, we won’t go very far,” says IntraHealth’s President, Pape Gaye. “We need to prioritize cultural competencies and prepare ourselves to accept the reality that we can trust people who view the world differently.”

That’s why IntraHealth International takes a localization approach in our own work. For example, through the U.S. Agency for International Development’s Accelerating Support to Advanced Local Partners (ASAP) project, we’re currently working with local organizations and governments in sub-Saharan Africa to strengthen their capabilities and resources to address HIV within their populations.

But this project is just the beginning because we know that we all need to work as one to turn around discouraging global megatrends and address human and environmental health together.

By Katherine Seaton

Former communications manager

Community Health Private-Sector Approaches IntraHealth's 40th Anniversary Global health security Global

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Hand-in-Hand for Health: How Governments and the Private Sector Can Come Together

mnathe — Thu, 31 Oct 2019 19:52:47 +0000

Hand-in-Hand for Health: How Governments and the Private Sector Can Come Together mnathe October 31, 2019

October 31, 2019

We need the unique expertise of both to solve community health problems.

Last year in Ghana, Anthony Opoku-Acheampon felt dizzy and had a headache. His son and wife drove him to C&J Hospital for help. But instead of examining him, a nurse turned the 70-year-old man away, saying there wasn’t an available bed.

The family visited six more hospitals and heard the same refrain—there were no beds. Opoku-Acheampon died in his son’s car outside LEKMA Hospital, causing an outcry around the country over “no bed syndrome.”

Opoku-Acheampon’s death spurred a government investigation into space allotment at public hospitals that found that hospitals didn’t lack space—the bed management systems were being mismanaged, resulting in out-of-date information for health workers.

The Ghanaian Minister of Health decided the country needed external expertise to help patients navigate the health system and access the high-quality services they needed. He was interested in a private-public partnership.

Barriers to collaboration

This was one story we heard this month at the Africa Health Business Symposium in Addis Ababa, Ethiopia.

IntraHealth International and the Medtronic Foundation hosted a session for government representatives and private-sector stakeholders from across the continent to discuss how we can strengthen community health by focusing on the frontline health workforce and program collaboration.

These four young women are among 22,000 health worker students in Kenya who have received low-interest loans through the Afya Elimu Fund, a private-public partnership, to complete their education. Photo by Georgina Goodwin for IntraHealth International.

Government representatives described barriers to large-scale health worker programs—including an overwhelming number of models, the high risk of selecting an inappropriate model, challenges in making the case for investing in health workers, and limited resources to cover start-up costs.

Private-sector partners noted different challenges. Their organizational priorities often change, so program sustainability is far from guaranteed. And institutional knowledge of what’s been tried before is sometimes missing, so pilots can end up being repeated.

Traditionally, African governments are used to large-scale partnerships with donor countries or international multilaterals where the program is implemented directly by the bilateral partner, covering a large swath of the country and providing commodities and wide-ranging health service delivery. Changing the way they do business to accommodate how private-sector organizations operate can be risky.

Finding documented examples of good partnerships in similar or neighboring countries can help.

Examples of successful public-private partnerships

The following public-private partnerships have demonstrated success in aligning with and complementing government programs:

The Afya Elimu Fund is a partnership of IntraHealth, USAID, Kenya’s Ministry of Education, and the Higher Education Loans Board that leverages contributions from the Family Group Foundation, I&M Bank, Standard Chartered Bank, and the Rattansi Educational Trust to provide low-interest loans to aspiring health workers. So far more than 22,000 students working to become nurses, lab techs, and clinical officers have accessed loans to cover their tuition, and more than 8,000 have already graduated. Last year, the Kenyan government committed its own investments to the fund.

Philips’s Mother is Life (Mama ni Uhai) program helps train frontline health workers in Kiambu County, Kenya, to use ultrasounds and fetal monitoring tools to support mothers throughout pregnancy, increase antenatal care visits, and ensure mothers deliver within the national health system at qualified health facilities. Since 2013, more than 1,000 mothers have been screened as a part of the program.

HealthRise, a five-year global program funded by Medtronic Foundation to expand access to care for cardiovascular diseases and diabetes among underserved populations in Brazil, India, South Africa, and the US, collaborated with local partners to train 3,637 health workers (60% of whom were community health workers) on hypertension and diabetes. HealthRise helped 3,139 patients achieve blood pressure control and 1,034 patients achieve blood sugar control.

“As I grew up, all I wanted was to be a nurse,” says Mercy Wangui Kariuki. She is one of 22,000 health worker students in Kenya who have received Afya Elimu fund loans to complete their education. Photo by Georgina Goodwin for IntraHealth International.

How can we set up future public-private partnerships for success?

The successful public-private partnerships we’ve seen involve using private-sector expertise—not just funding—to solve community health problems.

Governments should recognize that partnerships with the private sector won’t necessarily look like programs they’re used to. Instead, they should tap into the know-how the private sector has built to address community health and health workforce issues and ensure private-sector strengths like staff management, technological innovation, and creative funding mechanisms are applied strategically.

Private-sector partners should recognize the feasibility of a government taking up a program and apply seed funding for specific, focused issues where the ease of transition is higher.

By utilizing the strengths of both partners, we can build a foundation of tangible results to make faster progress toward a resilient and empowered health workforce that can ensure all communities have access to high-quality health services.

By Belinda Ngongo

Senior technical advisor for global health, Medtronic Foundation

By Samantha Rick

Former deputy director, Frontline Health Workers Coalition

Policy & Advocacy Private-Sector Approaches Health Workforce & Systems

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Africa Health Business Symposium

cbishopp — Wed, 02 Oct 2019 17:21:19 +0000

Africa Health Business Symposium cbishopp October 02, 2019 October 07, 2019 - October 09, 2019

Representatives from the public and private sectors, development organizations, investors, and academics will gather for the fourth Africa Health Business Symposium to share knowledge, learn about new technologies, and harness momentum toward the achievement of universal health coverage in Africa.

Stop by our booth in the exhibit area to learn more.

Integrating Africa: Bridging the Health Gap

Africa Health Business

Ethiopian Ministry of Health

https://www.africahealthbusiness.com/register/

Africa Health Business Symposium

Our Participation

Panel Discussions

Patient Centered Healthcare: Innovations from the Private Sector

Date(s):	October 09, 2019 10:30am - 12:00pm EAT (03:30am - 05:00am EDT)
Location:	Skylight Hotel
Presenter(s):	IntraHealth president and CEO Pape Gaye will moderate this panel discussion between Broadreach's Dr. Ernest Darkoh, Kingsley Diores of Ottobock, Chris LeGrand of DAI Global Health, and Isaiah Okoth of Pharmaccess.

Lunch Session

Improved Quality, More Jobs: The Roles of the Private Sector & Technology in the Health Economy

Date(s):	October 07, 2019 12:00pm - 02:00pm EAT (05:00am - 07:00am EDT)
Location:	Skylight Hotel, Meeting Room 1
Presenter(s):	IntraHealth president and CEO Pape Gaye will moderate this session, which will include presentations by Mathew Thuku of IntraHealth's HRH Kenya project and DAI Global Health's Bobby Jefferson.

Hand in Hand for Community Health

Date(s):	October 08, 2019 12:00pm - 02:00pm EAT (05:00am - 07:00am EDT)
Location:	Skylight Hotel, Meeting Room 1
Presenter(s):	Pape Gaye and Mathew Thuku will participate in this round table discussion, co-hosted by IntraHealth and Medtronic Foundation.

Participants

Pape Gaye

President and CEO

Corinne Mahoney

Director, Communications, IntraHealth International

Sam Rick

Advocacy and Policy Officer, IntraHealth International

Wondimagegn Tekalign

Senior Program Manager, IntraHealth International, Ethiopia

Mathew Thuku

Team Lead, Management & Leadership, HRH Kenya

Private-Sector Approaches Health Financing Health Workforce & Systems Health Workers

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Skylight Hotel Ethiopia

Addis Ababa, Ethiopia

When Time Is Critical: How Involving Frontline Health Workers Can Improve Stroke Survival Rates

mnathe — Tue, 09 Apr 2019 18:52:23 +0000

When Time Is Critical: How Involving Frontline Health Workers Can Improve Stroke Survival Rates mnathe April 09, 2019

April 09, 2019

Here are three ways to change a system of acute care.

April 10 started as an ordinary day for Sarah. But while eating breakfast, her husband noticed that her face had started to droop and she was unable to find her words. Immediately he called 911.

Within 10 minutes, the ambulance arrived with emergency medical services (EMS), a segment of the local health system that recently became partners in a new regional model for stroke care in North Carolina.

EMS quickly identified Sarah as a possible stroke victim and called the hospital to alert the stroke team to be ready for her arrival. Ten minutes later, Sarah was at the hospital and receiving scans that confirmed her stroke. Fifteen minutes later, Sarah received medication to dissolve the clot that had caused it. She was taken to the interventional radiology suite, where the neurosurgeon operated.

Survival rates shouldn’t be determined by luck.

Three hours later, Sarah woke up in the recovery room, fully alert and without any neurological deficits. She could speak and her facial drooping had resolved. Her husband breathed a sigh of incredible relief.

Sarah was one of the lucky ones.

Time is critical when dealing with a stroke and other acute events. But survival rates shouldn’t be determined by luck. The best chance for survival requires a coordinated system of care like the one Sarah experienced.

Communities need to be trained to recognize acute signs and, in the US, to call 911. 911 staff need to identify signs of a stroke and cardiac arrest to then send the appropriate EMS ambulance. EMS staff need to be trained to evaluate the patient quickly, notify the hospital, and transport the patient as quickly as possible to the hospital. And finally, hospitals need to provide timely treatment to resolve the symptoms.

Simply put, if Sarah’s husband had hesitated to call 911, she might not be alive today.

At the Medtronic Foundation, our global health work is focused on improving health outcomes for underserved populations around the world through scalable and sustainable models and interconnected systems of care. One of our core program areas is improving systems of care for acute conditions to reduce both inequities in survival and the time it takes to access care for underserved populations.

HeartRescue U.S. is a state-based initiative funded by the Medtronic Foundation that seeks to measure and improve resuscitation care, as well as build a state registry to help community-based programs improve care for sudden cardiac arrest. HeartRescue U.S. partners develop local solutions to systematically reduce barriers to resuscitation care by understanding signs and symptoms, enhance the capacity of health systems, and minimize critical time delays and disparities.

How can programs bridge the gap between hospitals and frontline EMS and community members?

Compared to other emergency health systems around the world, HeartRescue U.S. has achieved among the best results—close to 15% survival-to-hospital-discharge rates (40 million people across five states), compared to 5-10% in other national and international registries.

Building on this success in treatment of acute care emergencies, we’re also proud to partner with the Duke Clinical Research Institute on the IMPROVE Stroke Care Project, aimed at improving stroke outcomes in the Southeast U.S.

Of course, changing a system of acute care sounds like a lot of work. Will a focus like this really make a difference? How do programs like this get competitive health care systems to collaborate? And more importantly, how can programs like this bridge the gap between hospitals and frontline EMS and community members?

Here’s some of what we’ve learned through these partnerships:

Empower frontline responders as leaders and system designers.

Emergency responders are trained to evaluate the patient, triage quickly, make a hospital destination decision based on the patient condition and hospital services, and alert the right team so they are ready for the patient to arrive. Through HeartRescue U.S., we’ve found that defibrillators and thrombolytics are critical mechanisms to decreasing time to care while maximizing survival rates from sudden cardiac arrest.

Involve innovative community partnerships.

Community awareness of signs and symptoms, calling 911, and CPR training are critical, particularly for those who live in underserved areas, both urban and rural. Bystanders must call 911 without hesitation and dispatchers must be trained to recognize cardiac arrest and be equipped with telephone CPR methods. To address this, we’re seeing innovative education models at state fairs, movie theaters, barbershop screenings, social media, pamphlets in prescriptions, geographic hotspot mapping, and even proposed state legislation.

Promote a spirit of learning.

Both HeartRescue U.S. and the IMPROVE Stroke Care Projects use registry data to track performance measures and outcomes of care. Quarterly reports are shared across the regional disciplines. This framework promotes continual quality improvement where lessons and best practices can be identified with the overall goal of strengthening care delivery along all links of the chains of survival.

Transforming health care systems requires a multifaceted approach from all parties involved. Leadership and commitment from experts, local champions, and community and frontline health workers are integral to addressing disparities and building a sustainable system. This system is the reason Sarah is alive today—a mom raising three rambunctious boys.

For more on this topic, come to SwitchPoint 2019 and hear from Dr. Carmen Graffagnino of the Duke IMPROVE Stroke program, who’ll be speaking Thursday at 11:45am.

Register now for SwitchPoint 2019.

By Carmen Graffagnino

Neurologist, Duke Hospital

By Nilima Mehta

Philanthropy program manager, Medtronic Foundation

By Anne Katharine Wales

Senior philanthropy portfolio lead, Medtronic Foundation

Noncommunicable Diseases Education & Performance Private-Sector Approaches SwitchPoint Health Workforce & Systems USA

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