Maternal, Newborn, & Child Health

Community Health Workers Making a Difference for Pediatric HIV Clients in South Sudan

rgoodwin — Wed, 27 Mar 2024 17:44:30 +0000

Community Health Workers Making a Difference for Pediatric HIV Clients in South Sudan rgoodwin March 27, 2024

April 01, 2024

During World Health Worker Week we’re paying tribute to the wide range of #SafeSupportedHealth Workers who are making a difference in tough situations.

In South Sudan, community outreach volunteers (COVs) like Lawrence Monday play a key role in the HIV response—linking health facilities and communities to extend services and acting as peers to people living with HIV. Under the supervision of an adherence nurse, Lawrence supports 160 clients on HIV treatment, including 15 children.

One of the children Lawrence helps is Timo*, who had a rough start in life. He was born in 2017 into a low-income family in Juba. His biological father was never around to help him as a baby, and his 25-year-old single mother had no job to support him or his two older siblings. She often went to the market to dance with Timo wrapped on her back, and well-wishers would give her some money or food items, which would help feed them for a few days.

Diagnosis and struggle

Timo’s mother knew she was HIV-positive. Although she had been receiving antiretroviral therapy (ART) from Nyakuron Primary Health Care Center (PHCC), when she became pregnant with Timo in 2016, she refused to take treatment and didn’t attend antenatal appointments. She feared she would be stigmatized at the health facility because she knew people who worked there.

When it was time for Timo to be born, his mother had a home delivery without a skilled health care provider. When Timo was three months old, both he and his mother became very ill. He couldn’t breastfeed well, became restless, and started bleeding from the navel. His 60-year-old grandmother rushed him to Nyakuron PHCC where he was assessed and diagnosed with HIV, and immediately enrolled on ART.

With the help of his grandmother, Timo successfully attended treatment for the following year. However, his ailing mother was often intoxicated. She would leave the children with her mother and dash down to a local spree to drink.

Timo’s mother continued to refuse treatment, and in 2022 succumbed to complications of HIV. At the time, Timo and his siblings were already fully under his grandmother’s care and they largely depended on the support of well-wishers.

Home visits from a community outreach volunteer

Nyakuron PHCC is now one of 14 health facilities supported by the Advancing HIV/AIDS Epidemic Control Activity (AHEC). AHEC is a four-year USAID-funded contract led by IntraHealth International building local capacity to provide comprehensive HIV services and free ART to people living with HIV in South Sudan. By partnering with the health facilities and local organizations, the South Sudanese government, and communities, AHEC helps train health workers to deliver high-quality HIV services and adapts evidence-based HIV prevention, care, and treatment interventions for people living with HIV.

In 2021, early on in the project, AHEC trained 160 COVs, including Lawrence Monday. The project provides a stipend and mobile phone airtime for communication to the COVs. In 2013, AHEC attached Lawrence to Timo to monitor his treatment progress through home visits and offer emotional and psychological support.

“It’s a challenge to keep children on treatment but the regular home visits are paying off,” Lawrence says. “I visit all my clients twice every six months, and I visit children at least once a week, because they easily forget to take their medication, to ensure that they adhere to medication. Within the last month, I’ve registered only 5 out of 160 clients with high viral loads, whom I’m closely following up for adherence counseling.”

“It’s a challenge to keep children on treatment but the regular home visits are paying off,” Lawrence says.

Timo was one of those who needed extra follow-up. In February 2023, when Timo was five, he lost weight and became very weak. When health providers at Nyakuron PHCC assessed him, his viral load was too high and unsuppressed. He seemed traumatized by the absence of his mother, lacked enough food, and sometimes refused the bitter taste of the medicine. The health providers developed a monitoring action plan, and after four months of Enhanced Adherence Counseling, his viral load was suppressed. The health provider transitioned Timo from Lopinavir to Dolutegravir and guided his grandmother on how to prepare and give him the medication. Lawrence helped link Timo to a nutrition center within the health facility where he received food portions monthly until his health improved by June 2023.

However, in October 2023, Timo developed swollen lymph nodes and a cough and was losing weight. During a home visit, Lawrence noticed Timo’s symptoms and immediately rushed him to Nyakuron PHCC, where he was referred to Al-Sabah Childrens’ hospital. Health workers at the hospital diagnosed Timo with opportunistic infections, including tuberculosis (TB). Timo was put on anti-TB treatment for six months, which he successfully completed with the help of Lawrence.

Lawrence Monday walks to visit Timo. The Advancing HIV/AIDS Epidemic Control Activity (AHEC) trained 160 COVs like Lawrence to monitor HIV clients' treatment progress. Photo by Achan Gladys for IntraHealth International.

Timo's grandmother brought him to Nyakuron PHCC. It is now one of the facilities supported by the USAID-funded Advancing HIV/AIDS Epidemic Control Activity (AHEC). Photo by Achan Gladys for IntraHealth International.

Going the extra mile

Lawrence visited Timo’s home every two days while he was on anti-TB treatment. He walked two kilometers each way to Timo’s house to ensure he took his medications consistently. “I had to pay more frequent visits to monitor Timo’s treatment progress, especially because he was on both HIV and TB medications. I used to count the tablets to keep track of his medication consistency,” says Lawrence.

Timo is now TB-free and virally suppressed of HIV, following his last viral load test in October 2023. He now looks jolly, is playful, eats well, and weighs an impressive 23kgs. He is one of the 386 children receiving ART from AHEC-supported facilities in South Sudan, as of September 2023. Overall, AHEC currently supports 12,694 active clients on treatment. IntraHealth also linked Timo to Jhpiego, which enrolled him in their USAID Orphans and Vulnerable Children (OVC) program and plans to consider him for academic support in 2024.

“Timo is very healthy now and helps me around with minor chores, which makes me happy. I don’t want him to contract another disease. I’m doing everything it takes to ensure that he eats well and sticks to his medication,” Timo’s grandmother proudly concludes.

*Not his real name.

By Gladys Achan

Communications Officer

Advancing HIV & AIDS Epidemic Control Activity HIV & AIDS Infectious Diseases Maternal, Newborn, & Child Health Community Health Community Health Workers South Sudan

Is In The Media

Lawrence Monday, a community outreach volunteer (COV), speaks with his young client, Timo, while Timo's grandmother looks on. Photo by Achan Gladys for IntraHealth International.

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Venez à la rencontre de Marguerite Diarra. Son but est de former davantage de sage-femmes et d'améliorer l'accès aux soins maternels au Mali.

cbales — Fri, 08 Mar 2024 13:00:21 +0000

Venez à la rencontre de Marguerite Diarra. Son but est de former davantage de sage-femmes et d'améliorer l'accès aux soins maternels au Mali. cbales March 08, 2024

March 08, 2024

À l'occasion de la Journée internationale de la femme, nous célébrons des femmes comme Marguerite qui nous inspirent à #InvestInWomen.

Par une matinée ensoleillée à l'école Vicenta Maria de Ségou au Mali, Marguerite Diarra démontre la gestion active de la troisième phase de l’accouchement en utilisant un Mama-U, un simulateur obstétrique/gynécologique représentant l'utérus d'une femme.

Marguerite forme des sage-femmes qualifiées prêtes à s'occuper des femmes au Mali, en particulier dans les communautés rurales. Elle a grandi à Beleko, dans la région de Dioila, et est devenue sage-femme en 2016. Aujourd'hui, elle est enseignante permanente et se spécialise dans les soins obstétriques.

Le Mali n'a pas assez de sages-femmes.

Le Mali, comme d'autres pays d'Afrique de l'Ouest francophone, ne dispose pas d'un nombre suffisant de sage-femmes qualifiées ou d'autres agents de santé. Il n'y a que 6,1 sage-femmes, infirmières et médecins pour 10 000 personnes, ce qui est bien inférieur au nombre recommandé, et la pénurie est encore plus grave dans les zones rurales. Cette situation entrave l'accès équitable des femmes aux services de santé, notamment aux soins maternels et à la planification familiale, et contribue aux taux élevés de mortalité maternelle.

Au Mali, plus de 500 femmes sur 100 000 meurent lors de l’accouchement. De plus, la formation initiale traditionnelle n’outille pas assez les agents de santé pour faire face aux conditions de travail réelles.

Le projet Classroom to Care (C2C) d'IntraHealth, financé par la firme pharmaceutique Takeda, aide 12 écoles privées de santé comme Vicenta Maria à adopter une approche de l'éducation basée sur les compétences.

L'approche par compétence est basée sur les besoins de la population.

Alors que la formation initiale classique consiste à élaborer des programmes par matière ou par objectif, les programmes de l’approche par compétence (APC) sont élaborés en fonction des besoins de la population et des compétences requises. Dans la formation classique, l'enseignant transmet les connaissances, tandis que l’APC est orienté sur la facilitation de l'apprentissage de l'élève.

C2C a formé 250 enseignants comme Marguerite au Mali, au Niger et au Sénégal sur cette approche.

Photo par Amadou Iam Diallo pour IntraHealth International.

"Ces formations m'ont vraiment aidée à comprendre mon rôle d'enseignante, à prendre conscience de mes lacunes et à appliquer de nouvelles compétences", explique-t-elle. "Auparavant, les enseignants faisaient tout, mais avec l’APC, nous avons appris à placer l'étudiant au premier plan de sa propre formation. C'est à l'étudiant de prendre les devants, et à l'enseignant de le guider et de l'orienter. Cela a changé notre façon de préparer et de dispenser les cours", explique Marguerite. Cette nouvelle approche a rendu les cours plus interactifs et plus bénéfiques pour les étudiants.

"Nous mettons l'accent sur la pratique, qui est très importante dans leur apprentissage pour devenir des agents de santé compétents."

Marguerite supervise également les étudiants dans les centres de santé communautaires, les centres de santé de référence et l'hôpital de Nianankoro Fomba. "Je suis chargée de positionner les étudiants et de suivre le développement de leurs compétences. De temps en temps, nous nous rendons sur le terrain, car nous mettons l'accent sur la pratique, qui est très importante dans leur apprentissage pour devenir des agents de santé compétents".

Le projet a constaté que de nombreuses écoles de santé manquaient d'équipements de première nécessité. Il a donc déjà fourni des modèles anatomiques et d'autres matériels didactiques pour créer des laboratoires de compétences dans les écoles.

"Le laboratoire de compétences va beaucoup nous aider", déclare Marguerite. "Nous avons déjà beaucoup d'équipements par rapport à d'autres écoles, mais il y a encore des lacunes. Par exemple, nous n'avons pas l'équipement nécessaire pour faire l'insertion de DU, le retrait ou encore l'examen d’autopalpation des seins. Nous n'avons pas non plus certains mannequins, et nous en avons besoin pour préparer les étudiants aux stages sur le terrain, afin qu'ils sachent ce qu'il faut faire lorsqu'ils prodiguent des soins aux patients".

D'ici la fin du projet de cinq ans, C2C vise à ce que 580 enseignants du Mali, du Niger et du Sénégal soient formés sur l’APC, que 9 720 étudiants bénéficient d'une formation de qualité et qu'un laboratoire de compétences soit installé dans chaque école.

Parallèlement, il se concentre également sur la promotion de l'équité, de la diversité, et de l'inclusion (EDI) afin d'augmenter le nombre de diplômés en soins infirmiers et de sage-femmes, en particulier les femmes issues de communautés marginalisées. C2C a effectué des analyses situationnelles de l'EDI et utilise les résultats pour élaborer des plans spécifiques aux écoles. Ces plans permettront d’appliquer les meilleures pratiques de l’EDI afin de rendre les 12 écoles partenaires plus inclusives pour les étudiantes, d'améliorer leur bien-être ainsi que leurs résultats scolaires.

By Amadou Iam Diallo

Technical advisor for communications

By Carol Bales

Strategic communications manager

Maternal, Newborn, & Child Health Health workforce development International Women's Day Gender Equality Midwives Nurses Mali

Is In The Media

Photo par Amadou Iam Diallo pour IntraHealth International.

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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

USAID and IntraHealth to Expand Locally Led Development in Zambia

cbales — Tue, 08 Aug 2023 16:07:29 +0000

USAID and IntraHealth to Expand Locally Led Development in Zambia cbales August 08, 2023 August 08, 2023

Through a new contract from the US Agency for International Development (USAID), IntraHealth International will implement the Zambia Leading Organizational Capacity and Localization Development (LOCAL) Activity. This project will build on IntraHealth’s 24-year history in Zambia, and our successful local capacity-strengthening work, to enable local implementing partners (LIPs) to independently secure, manage, and monitor USAID programs to carry out the country’s development agenda and deliver results for the Zambian people.

Locally led development is the best path toward sustained improvements in health and development outcomes around the world. In Zambia, USAID has made tremendous progress in establishing direct awards with local organizations to lead HIV programs. Yet gaps in local partners’ organizational capacity must be addressed to strengthen their operations and ensure sustainability.

Since 2019, IntraHealth has worked with 101 local implementing partners in 18 countries.

As implementer of the USAID Accelerating Support to Advanced Local Partners (ASAP) and ASAP II contracts in sub-Saharan Africa, IntraHealth brings extensive expertise in rapidly preparing local organizations and government entities to develop the capabilities and resources to serve as prime partners for USAID programming. Since 2019, IntraHealth has worked with 101 LIPs in 18 countries, including Zambia, with 98% of LIPs documenting capacity improvements.

Through the five-year Zambia LOCAL activity, IntraHealth and partners SustainAbility Solutions and Ku-Atenga Media will provide LIPs the support they need for success in operations, income generation, and advocacy, building on lessons learned from ASAP and other local partner capacity-strengthening initiatives. Specifically the project will:

increase LIPs’ capacity for risk identification, mitigation, and compliance to financial and operational best practices
enhance LIPs’ resource mobilization and funding diversification capacity for the purpose of organizational sustainability
increase networking opportunities; improve communication, monitoring, evaluation, and learning capacities; and enhance understanding of integrated programming.

The activity will initially focus on health-related LIPs that are expected to greatly expand in scope and implement development programs at national and provincial levels. It will also support LIPs that implement non-health-related program activities.

Zambia LOCAL will incorporate local voices into all aspects of its work—a key for successful localization—and create space for local leadership and for local communities.

Annie Banda, a Zambian global public health professional, will serve as chief of party. Banda has significant experience assessing and strengthening the capacity of local organizations. She will manage a pool of Zambian experts and technical advisors to provide technical assistance that meets LIPs’ needs.

"I am so grateful and excited for the opportunity that IntraHealth has given me to lead and champion USAID Zambia's agenda of empowering local organizations to sustainably deliver health services to targeted communities," says Banda.

"IntraHealth is a longstanding partner of USAID in Zambia," says Maqsoda Maqsodi, president and CEO of IntraHealth. "Since 1999, we've partnered with the Zambian government and others. Together we've strengthened the Zambian health workforce and improved health services for Zambian communities. Now we're honored to be helping local organizations prepare to lead USAID programs and drive the country's development agenda."

Also read: Toward Sustainable Locally Led Development, IntraHealth's 2022 annual report

IntraHealth partnered with 6,616 local entities worldwide in 2022, including health facilities, governments, civil society groups, religious leaders, youth advocates, and more.

Family Planning & Reproductive Health HIV & AIDS Maternal, Newborn, & Child Health Noncommunicable Diseases Health workforce development Health Workers

Community Advocacy Leads to New Maternity Unit at Rwanda Health Center

cbales — Tue, 11 Jul 2023 14:21:08 +0000

Community Advocacy Leads to New Maternity Unit at Rwanda Health Center cbales July 11, 2023

July 11, 2023

An innovative approach is helping community members, health workers, and local leaders improve maternal care.

For years, maternity services at Gashaki Health Center in Rwanda’s Muzanze District were hindered by poor infrastructure, congestion, and a lack of community participation.

“We had such a small delivery room that we couldn't accommodate more than two women at the same time,” says Sylvain Ndagiwenimana, the health center manager. “This lack of space contributed to an increase in home deliveries.”

Now clients and community members have a say in the type and quality of services they receive.

Lack of space contributed to an increase in home deliveries.

The USAID-funded Ingobyi Activity, led by IntraHealth International, used a Patient Voice Program–Citizen Voice and Action (PVP-CVA) approach to enhance service quality at the health center. PVP-CVA gives health facity leadership and districts insights into how the community views the services they provide and offers community members the opportunity to participate in efforts to improve service delivery.

After a January 2019 data review and analysis showed the health center was consistently under-performing in most indicators related to reproductive, maternal, newborn, and child health (RMNCH) and malaria, Ingobyi targeted Gashaki Health Center with the PVP-CVA intervention.

In May 2019, Ingobyi organized a “scorecard meeting” with community members, health workers from the health center, and some of the district leaders. Community members listed services they received at the health center and ranked their quality. One of the issues that stood out was the old maternity unit, which didn’t provide a comfortable place for delivery or postpartum stay.

Women are now happy to deliver in the new maternity unit.

The meeting participants agreed the facility needed a new maternity unit and formally advocated to district leaders to provide the funds for a new building. In December 2019, district leaders promised to allocate funds in the next fiscal year budget to build a new, modern maternity unit at the health center.

Construction began in November 2021 and the new maternity unit opened its doors in August 2022. Since completion, 330 women have delivered their babies in the new maternity ward.

“The new maternity unit offers much space and ensures privacy to our clients,” Ndagiwenimana says. “Women are well received and are happy to deliver in this new unit. The average quality score for maternity services has increased from 81% in 2021 to 100% in 2023.”

A nurse (right) and Ingobyi Activity staff member (left) visited the new maternity unit while it was under construction. Photo by Bosco Bazimaziki for IntraHealth International

More than a maternity unit

This is just one result of the PVP-CVA approach, and shows what can be achieved when communities, health workers, and local leaders come together.

The approach came into being back in September 2018. That was when the Ministry of Health introduced the Patient Voice Program (PVP) initiative in administrative sectors to promote interaction between health workers and patients to ensure continuous improvement in quality of care. Around the same time, Ingobyi introduced the Citizen Voice and Action (CVA) approach with an added aspect of engaging local government and community members in dialogue with health workers to find solutions to health system challenges. The ministry and Ingobyi integrated the two initiatives with the aim of strengthening community participation in improving the quality of RMNCH and malaria services.

When Ingobyi applies the PVP-CVA approach, community members learn about health as a basic human right, and work collaboratively with leaders and health workers to compare their reality against the government’s commitments to universal health coverage. The approach enables joint action planning to address structural, policy, and service delivery gaps.

Four elements of the PVP-CVA approach

Ingobyi created a PVP-CVA user manual and has used it to orient more than 850 district leaders across 20 districts on the approach and to establish and train 245 PVP-CVA working groups with 4,827 members. The working groups have supported 267 health centers, under the supervision of Ingobyi staff and district health leaders, and have facilitated community meetings involving 17,527 community members to gather community feedback on RMNCH and malaria services.

At least 64% of the gaps identified from the community meetings have been resolved, including absence of nurses during break hours, uncleanliness due to insufficient sanitation materials, poor customer care, lack of privacy in maternal units, and delay in receiving patients and offering services. Ingobyi is urging district and central leaders to address the remaining issues that have been raised by communities.

Read more about Ingobyi Activity’s PVP-CVA approach here.

By Betty Murerwa

Community health engagement specialist

Maternal, Newborn, & Child Health Policy & Advocacy Quality of Care Rwanda

Is In The Media

The new maternity unit at Gashaki Health Center. Photo courtesy Mathieu Niyonkuru

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5 Approaches to a Brighter, Healthier Future for Zimbabwe's Women and Girls

cbales — Wed, 21 Jun 2023 16:26:05 +0000

5 Approaches to a Brighter, Healthier Future for Zimbabwe's Women and Girls cbales June 21, 2023

June 21, 2023

IntraHealth’s Esther Tumbare takes a sobering look at her home country’s health system and envisions a brighter picture.

I often have this image in my mind: a young girl I saw the last time I went to my village. It’s late morning and she’s carrying a bucket of water on her head, having just drawn it from the village well. She’s just nine or ten years old, but I know it will not be long before she, or another girl she knows, will be forced into womanhood.

In Zimbabwe, 34% of girls are married before the age of 18.

The school holidays are not due for another month, so I wonder why she is not in school. I’m flooded with thoughts about the disadvantages girls here in Zimbabwe, and in many low-income settings around the world, still face. They are expected to grow up too quickly, often when they are not psychologically ready, and when their little bodies are physically not ready to carry babies.

In Zimbabwe, 34% of girls are married before the age of 18 and 5% before their 15th birthday, and almost a quarter of women ages 20-24 gave birth before they turned 18. The fertility rate stands at 3.5, and about 15% of girls and women 15-49 are living with HIV.

I have worked as a medical practitioner all my adult life. I started as a young doctor interning at Harare Central Hospital, and then my career turned to public health—which took me from thinking about how to provide the best care for that one patient sitting in front of me to thinking about the bigger picture, asking myself, “What will be my contribution toward health for all?”

All girls need access to preventive health care and information.

The girl in the picture inspires me to help all girls have access to preventive health care and information so they can grow up strong and healthy, go to school, and only settle down to family life if and when they are ready.

Providing high-quality health care requires skilled health workers, who have the skills and the tools to do their work, and who are fairly compensated and motivated to provide the best care for their patients. Zimbabwe’s public health system has suffered a tremendous exodus of critical health workers, not just to the region but to higher-income countries—doctors, midwives, nurses, laboratory technicians, all seeking better opportunities for themselves and their families. More than 4,000 health workers have left Zimbabwe since 2021.

When a country has a fragile health system, the loss of its workforce has the potential to bring the whole system to collapse, with significant consequences: people lose their lives.

Brain drain has left an already fragile health system severely strained.

In Zimbabwe, brain drain has left an already fragile health system severely strained. Girls and women have little access to health workers who can provide essential health services, such as family planning, antenatal care, or HIV prevention and treatment. Maternal mortality is high at 362 deaths per 100,000 live births, according to the 2022 Housing and Population Census, and there has been little if any improvement in child mortality in the past five years. In order to improve these and other key public health indicators, Zimbabwe must address multiple challenges, but the health workforce is the epicenter of any improvement.

The situation with Zimbabwe’s health system is dire, and without nearly enough funding available from donors, calls for a triaged and systematic approach to make the most impact toward building and supporting a productive workforce that can deliver lifesaving, people-centered care.

With smart interventions like these, we could see a different picture.

Since 1979, IntraHealth International has focused on strengthening health workers and systems to support them as essential to meeting global health needs. Just like I can see an end to HIV/AIDS, with smart interventions like these, I think we could see a different picture for girls and women in Zimbabwe:

Keep girls in school; educate them about family planning, sexual and reproductive health, and child marriage; and connect them to health workers and services. In francophone West Africa, IntraHealth is helping take the taboo out of menstruation and normalizing sexual and reproductive health education for adolescent girls. Increasing knowledge within communities about the consequences of child marriage to promote behavior change, and facilitating coordination between schools and community health centers to ensure access to affordable youth-friendly services, could have a huge impact in Zimbabwe.
Produce more health workers. In Mali, IntraHealth’s partnership with the government led to the accreditation of additional nursing and midwifery schools that more than doubled the number of nursing and midwifery students, and ensured the training curriculums were competency-based. Now more newly trained nurses and midwives have the skills and confidence to handle the reproductive health needs of women in their communities.
- Also read: New Program to Train More Student Nurses in Francophone West Africa, Bring Care to More Communities
Build the capacity of health workers to care for women and girls. In Rwanda, the USAID-funded Ingobyi Activity goes beyond regular classroom training to ensure health workers have the confidence to provide high-quality services for women and girls. Ingobyi strengthens health worker competencies through clinical mentorship and low-dose, high-frequency training, including for family planning counseling and administering long-term and short-term contraception methods. This also allows for cascading down of training by mentees to other health providers hence creating a culture of continuous learning. Participating health workers report increased skills, including improved follow-up of women in need of antenatal care.
Use data to make decisions about health worker training and deployment. In South Sudan, IntraHealth builds the Ministry of Health’s capacity to collect and use integrated, high-quality data—including health workforce data—to inform evidence-based HIV programming and strategic planning. We established and conduct routine antenatal care surveillance to respond to HIV service needs and deploy the right number of health workers, with the right skills, at the right place and time.
Integrate services. Person-centered health services are designed to ensure clients accessing health facilities do not have to go from one department to another, but are able to have all their needs addressed in one sitting. IntraHealth’s INSPiRE project works in nine West African countries to provide clients with a comprehensive package of essential health services during each visit—such as family planning and nutrition services and maternal care and infant care—to eliminate missed opportunities and encourage mother baby pairs to come to seek care when they need it.

If we take approaches like these in Zimbabwe, I can imagine a much brighter, healthier future for that little girl—and all women and girls in Zimbabwe.

By Esther Tumbare

Senior global technical director for HIV

Maternal, Newborn, & Child Health Health workforce development Zimbabwe

Is In The Media

Photo by Esther Tumbare

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How Can We See More Smiling Babies in Rwanda and Around the World?

ihadmin2 — Mon, 15 May 2023 13:53:58 +0000

How Can We See More Smiling Babies in Rwanda and Around the World?

ihadmin2 May 15, 2023

May 08, 2023

Health workers are key, says Kayinamura Mwali Assumpta, along with ensuring they have the training, support, and equipment they need.

We’re almost at the halfway mark for meeting the Sustainable Development Goals, including dramatically reducing maternal mortality, ending preventable newborn and child deaths, and ensuring universal access to sexual and reproductive health services. But new reports show that many countries are off track.

I sat down with Kayinamura Mwali Assumpta, a pediatrician who serves as IntraHealth International's deputy chief of party and technical director for our USAID-funded Ingobyi Activity in Rwanda. We talked about her work and research to improve maternal and child health in Rwanda, including helping health workers scale up evidence-based practices, and what she thinks needs to happen next.

1. What motivated you to become a pediatrician?

During my medical school internship in the pediatric department, I had very good mentors. And what moved me is the way you can see a baby coming in very sick and then when you give them the right treatment, in a few days—or even a few hours—the baby will start to smile and to play. It's a personal satisfaction to see the progress of a baby in a very short time.

2. Why did you decide to go from clinical practice to working in public health, and focusing on maternal and child health?

After finishing my master’s degree in pediatrics, I led the neonatal service in CHUK, the teaching hospital in Kigali. A colleague working with the Ministry of Health saw my work and asked me to help pilot the first neonatal unit in a rural district hospital, in Rwamagana. That was around 2009, and at that time only teaching and referral hospitals could admit babies.

So we planned, designed the program, developed neonatal protocols, trained health workers, and started a small unit. Then we published the results. The ministry's head of maternal and child health was very happy and asked me to lead the scale-up. Now all the district hospitals have at least a Level 2 Neonatal Unit.

Through my work I saw how newborns are linked to mothers—you can't achieve good newborn health outcomes if you’re not also working on maternal health. So that's why I started also focusing on maternal health, and began working at nongovernmental organizations implementing maternal and child health projects.

Dr. Assumpta Kayinamura Mwali helped pilot the first district neonatal unit in Rwanda at Rwamaganda District Hospital. Photo by Innocent Ishimwe for IntraHealth International.

Janviere Bamushima, a maternity nurse, examines a pregnant woman in Ngoma District. Photo by Innocent Ishimwe for IntraHealth International.

A health worker examines a pregnant woman in the maternity waiting room at Kibungo Referral Hospital. Photo by Innocent Ishimwe for IntraHealth International.

Nurse Cecile Mutuyimana cares for a newborn in an incubator at Kibungo Referral Hospital. Photo by Innocent Ishimwe for IntraHealth International.

Uwimana Jeanne, a health worker, poses outside of Nyanza District Hospital. Photo by Innocent Ishimwe for IntraHealth International.

3. Rwanda has made great strides in improving maternal and child health through its commitment to universal health coverage. What are some of the remaining challenges?

Rwanda is implementing all the high-impact maternal and child health interventions, from antenatal care to childbirth up to adolescent care, but we still have some problems with the quality of care. First, the shortage of staff in maternity, pediatrics, and in health centers and primary health care is a big challenge. When the workload is too high, health workers become stressed and of course this affects their motivation and the quality of care they provide.

Another problem is the lack of sufficient equipment, like CPAP (continuous positive airway pressure) machines, ultrasound machines, incubators, etc. We have basic equipment, but not enough, and it is not well maintained due to the lack of spare parts in the country.

4. What studies or interventions are you most excited about for further improving maternal and newborn health in Rwanda?

The Ingobyi Activity uses training and clinical mentorship to build the capacity of health workers and improve maternal and newborn care. Last year we designed a neonatal nurse mentorship program with over 25 mentors and 80 neonatal nurses in district hospitals, to improve the use of neonatal equipment, infection prevention and control, and family-centered care. For example, a recent study in Rwanda revealed that respiratory distress syndrome was contributing to most preterm deaths, but pediatricians were not using CPAP machines to save babies. So mentors trained neonatal nurse specialists on those machines. Now neonatal nurses in the district hospital are using that equipment. Overall we’ve seen improvement in health outcomes–neonatal mortality has reduced.

Through the USAID-funded MOMENTUM Safe Surgery in Family Planning and Obstetrics project we are leading a learning agenda on the active follow-up of pregnant women who have already had a cesarean delivery, to prevent them from having an emergency c-section. We know that an emergency c-section increases the risk of complications, such as risk of uterine rupture. So we are identifying these women in antenatal care, and immediately referring them to nurses at health centers to follow up and make sure they reach the hospital and receive a delivery plan. So this helps ensure they have an elective c-section, instead of waiting until they have signs of labor to come to the hospital. With this intervention, we are already seeing almost a 50% reduction in emergency c-sections.

Ingobyi conducted research on compliance and utilization of the right package of antenatal care. We found that, although ANC coverage has improved in Rwanda, provision of the recommended ANC package is inconsistent—health workers are not screening many women for malnutrition or syphilis or testing them for anemia. We also identified challenges health workers were facing, like stockouts of blood collection tubes. And with these data, we advocated to the Ministry of Health to avail those kits and reagents. We are beginning to see improvements in the delivery of the recommended package of ANC services.

5. What more do you think needs to happen to improve the health of mothers and newborns in Rwanda and around the world?

Countries and donors need to invest more in health workers, including community health workers (CHWs), and in the supplies they need. Because if we have enough skilled, motivated, and equipped health worker teams, we'll save and improve more moms’ and babies’ lives.

For example, Rwanda is investing in reforming its community health workforce. Previously we had two kinds of CHWS—the ASM (Agents de Santé Maternelle), all female, in charge of maternal and newborn health, and binomes (female-male teams) in charge of integrated community case management of childhood illness, family planning, and nutrition. Now the country is training all CHWs to deliver a comprehensive package of all community health services (14 modules) to their assigned households in the villages.

CHWs are contributing a lot to improving maternal and child health. So countries should provide comprehensive training for CHWs and ensure they have the equipment they need to do their work. Ingobyi recently piloted an eLearning course for CHWs to replace the current didactic refresher training. Results show it was effective in increasing CHWs’ knowledge, including in community-based newborn health management.

Additional research is also needed, because when we have local evidence and use it to address gaps, we see big changes. In Rwanda, we have a program on maternal and perinatal death surveillance and response, and through confidential enquiry into maternal death survey, we can see the root cause of those deaths, and take appropriate measures to prevent them in future.

Meet Assumpta at the International Maternal Newborn and Child Health Conference, taking place May 8 - 11 in Cape Town, South Africa! She’ll present IntraHealth’s research and work in Rwanda during two sessions:

New research and program learning from Rwanda | Tuesday, May 09, 11:00am
Expanding maternal and perinatal death surveillance and response as a holistic quality improvement approach to accelerate saving maternal and newborn lives | Thursday, May 11, 3:15 pm SAST

By Carol Bales

Strategic communications manager

By Kayinamura Mwali Assumpta

Deputy chief of party/Technical director for the Ingobyi Activity

Maternal, Newborn, & Child Health Health Workforce & Systems Rwanda

Is In The Media

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International Maternal Newborn Health Conference

ihadmin2 — Mon, 17 Apr 2023 15:10:48 +0000

International Maternal Newborn Health Conference ihadmin2 April 17, 2023

May 08, 2023 - May 11, 2023

The International Maternal Newborn Health Conference marks a pivotal moment as we get closer to 2030, the end date of globally agreed upon goals for maternal and newborn health and prevention of stillbirths. IMNHC will convene the maternal newborn health community to drive urgent action for the health of mothers and newborns by collaborating and fostering strong connections, exchanging the most effective tools, sharing best practices and evidence, and investing in proven interventions.

Aligning TOGETHER. Accelerating TOGETHER. Saving lives TOGETHER.

AlignMNH Secretariat

International Maternal Newborn Health Conference | #IMNCH2023

Our Participation

Panel Discussions

New research and program learning from Rwanda

Date(s):	May 09, 2023 11:00am - 12:15pm SAST (05:00am - 06:15am EDT)
More Information:	Two IntraHealth experts will participate in this panel discussion. Kathryn Mimno will deliver a presentation, "Factors associated with labor companionship in Rwanda." Assumpta Kayinamura Mwali will deliver two presentations, "Factors influencing delivery of the recommended service package for first antenatal care visit in Rwanda—a mixed method study" and "Reducing missed opportunities for first ANC visits through linkage of general OPD to ANC services in rural Rwanda."
Location:	Daisy Room
Presenter(s):	Kathryn Mimno and Assumpta Kayinamura Mwali

Every woman everywhere has a right to quality care: Addressing quality gaps in humanitarian settings

Date(s):	May 11, 2023 01:55pm - 02:55pm SAST (07:55am - 08:55am EDT)
More Information:	Onikepe Owolabi will be a panelist during this session and will deliver a presentation, "Improving referral outcomes in eastern Uganda through a social media digital platform."
Location:	Room 1.41-1.42
Presenter(s):	Onikepe Owolabi

Comment améliorer l’accès et l’adhésion aux soins pour une expérience positive de la grossesse (en français)

Date(s):	May 11, 2023 01:55pm - 02:55pm SAST (07:55am - 08:55am EDT)
More Information:	Marguerite Ndour will be a panelist during this session and will deliver a presentation, "Intégrer les soins maternels, néonatals, infantiles, nutrition et planification familiale en Afrique francophone occidentale augmente la résilience à COVID-19 et la couverture universelle en saisissant les opportunités d'offre de services."
Location:	Auditorium 2
Presenter(s):	Marguerite Ndour

Expanding maternal and perinatal death surveillance and response (MPDSR) as a holistic quality improvement (QI) approach to accelerate saving maternal and newborn lives

Date(s):	May 11, 2023 03:15pm - 04:00pm SAST (09:15am - 10:00am EDT)
More Information:	Kathryn Mimno will be a moderator and Assumpta Kayinamura Mwali will be a panelist during this MOMENTUM Safe Surgery in Family Planning and Obstetrics thematic session.
Location:	Daisy Room
Presenter(s):	Kathryn Mimno and Assumpta Kayinamura Mwali

Poster Presentation

To what extent are maternal and child health, family planning, and nutrition services integrated in the national-level policies in Burkina Faso, Cote d’Ivoire, and Niger?

Date(s):	May 10, 2023 01:05pm - 02:05pm SAST (07:05am - 08:05am EDT)
Presenter(s):	Isabelle Bicaba

Participants

Robert Bambara

Monitoring, evaluation, and learning officer, INSPiRE

Isabelle Bicaba

Family planning/maternal and newborn health specialist, INSPiRE

Kathryn Mimno

Senior technical advisor

Assumpta Kayinamura Mwali

Deputy chief of party/Technical director, Ingobyi Activity, Rwanda

Marguerite Ndour

Project director, INSPiRE

Onikepe Owolabi

Senior global technical director for family planning and maternal, newborn, and child health

Fatoumata Tounkara

Monitoring, evaluation, research, and learning officer, Mali

Burkina Faso Côte d’Ivoire Nigeria Rwanda Uganda Maternal, Newborn, & Child Health Digital Health

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Cape Town, South Africa

These New Pediatric Development Clinics in Rwanda Save Lives

ihadmin2 — Mon, 06 Feb 2023 14:14:33 +0000

These New Pediatric Development Clinics in Rwanda Save Lives ihadmin2 February 06, 2023

January 31, 2023

Thanks to health workers who are now trained to manage birth complications.

The birth of a baby is often a joyous, momentous occasion. For Izabayo Marcel, however, August 2021 was a heartbreaking month. His wife died while giving birth to their baby, Sebastien Duhirwe, and Sebastien suffered from birth asphyxia, which left him fighting for his life.

The doctors and nurses at the Ruhengeri Referral Hospital acted quickly—and their skills saved baby Sebastien.

At-risk infants often don't get optimal support for their health.

Babies such as Sebastien who experience asphyxiated births face greater risk of complications, including cerebral palsy, seizures, paralysis, and slowed mental development. Although advances in technology and greater quality of care have helped more at-risk infants survive the early neonatal period, these infants face more challenges once they leave the hospital and go back to their communities, where they often don’t get optimal support for their health, nutrition, and development. Their chances of survival go down.

To help health workers provide holistic care (including medical, nutritional, and psychosocial support to boost physical and cognitive development of at-risk children), IntraHealth International’s Ingobyi Activity initiated Pediatric Development Clinics (PDCs) in selected health facilities in the Musanze and Rutsiro districts.

Ingobyi used a cascade training approach to train health workers from Ruhengeri and Murunda on the PDC approach and how to implement it, and how to support lower levels of the health system. Ingobyi trained 97 health workers who went on to train other health workers from facilities in their catchment areas. The hospital teams worked with health center providers to establish the PDCs with the Ingobyi Activity, providing the required equipment and materials for each health center.

Sebastien was as the Ruhengeri Referral Hospital PDC. While there, he received continual services, such as family-centered care, nesting, intermittent and continuous Kangaroo Mother Care, and milk fortification.

Marcel also benefitted from the PDC. Since Sebastien’s birth, he has received monthly training and counseling from PDC staff at the hospital on how to take care of Sebastien, including proper nutrition, hypothermia prevention, hygiene, and how to interact with him to boost his cognitive and emotional development. These sessions were crucial for Marcel.

“After my wife died, I didn’t know what to do, how to feed him,” Marcel says. “But when we attended the clinic sessions, I was relieved because the health workers answered a lot of questions on how to raise Sebastien.”

As Sebastien had no mother to breastfeed him, the clinic provided fortified infant formula milk to boost his physical development.

Sebastien has grown into a vibrant, healthy boy.

Now weighing 7.22 kilograms, Sebastien has grown into a vibrant, healthy boy, thanks to the help he received at the clinic.

“When my nephew was born, I didn’t have any hope for him to survive,” says Uwimbabazi Goreth, Sebastien’s aunt. “However, after attending PDC appointments, my hopes were raised. I can’t believe he is this resilient, considering how fragile he looked when he was born.”

Sebastien will continue to receive childhood development services at the PDC until he is two years old.

IntraHealth’s Ingobyi Activity supports PDC services in two hospitals and 26 health centers in the Musanze and Rutsiro districts and aims to scale up the clinics to all supported facilities nationwide.

So far, Ingobyi has trained 48 pediatric development clinic staff for Musanze and 49 for Rutsiro who have cared for 296 at-risk infants, with a 99% survival rate. Some of these infants were born prematurely, while others were born with perinatal asphyxia, failure to thrive, central nervous system infections, or congenital malformation, such as cleft lip, trisomy 21 (or Down syndrome), and hydrocephalus.

By Déogratias Rwangabo Nkurunziza

Communication Officer

By Richard Kalisa

Newborn and child health advisor

Maternal, Newborn, & Child Health Health workforce development Midwives Nurses Rwanda

Photos

A PDC nurse examines baby Sebastien at Ruhengeri Referral Hospital. Photo by Deogratias Rwangabo Nkurunziza for IntraHealth International.

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