Primary Health Care

Strengthening Respect and Recognition for Health Workers: Strategies and Recommendations

mnathe — Tue, 03 May 2022 20:32:39 +0000

Strengthening Respect and Recognition for Health Workers: Strategies and Recommendations 2022 mnathe May 03, 2022

Ongoing lack of respect and recognition of frontline health workers lies at the heart of many of the workforce-related challenges that impede global progress toward universal health coverage. This report explores why respect and recognition matter for the health workforce, as well as strategies and recommendations for increasing both.

This report was produced by IntraHealth International’s advocacy team and Helen Cornman, an IntraHealth consultant, with funding by the Johnson & Johnson Foundation.

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Topics Health workforce development Advocacy Health Workforce & Systems Primary Health Care

Publisher IntraHealth International

Frontline Health Workers Coalition Recommendations for White House Health Workforce Initiative

mnathe — Tue, 04 Jan 2022 16:35:24 +0000

Frontline Health Workers Coalition Recommendations for White House Health Workforce Initiative 2021 mnathe January 04, 2022

IntraHealth joins the Frontline Health Workers Coalition in calling on the White House to launch an initiative focused on strengthening the health workforce worldwide that is bold, ambitious, and comprehensive. Based on nearly ten years of collective advocacy for frontline health workers in low- and middle-income countries, we offer these five top recommendations for structuring and financing this important initiative.

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https://www.frontlinehealthworkers.org/statements-recommendations

Topics COVID-19 Policy & Advocacy Global health security Health Workforce & Systems Primary Health Care Community Health Workers

Publisher Frontline Health Workers Coalition

How Do We Measure the Success of Integrated Health Services?

kseaton — Fri, 10 Dec 2021 15:06:08 +0000

How Do We Measure the Success of Integrated Health Services? kseaton December 10, 2021

December 10, 2021

Here's how our INSPiRE team in West Africa developed new indicators to monitor their progress toward more people-centered and efficient care.

Countries in West Africa have some of the highest maternal and infant mortality rates in the world. Women in this region face a 1 in 34 lifetime risk of maternal death and 34 of every 1,000 infants do not survive their first 28 days. An estimated 24% of women have an unmet need for family planning and only 1 in 5 women are accessing modern contraception.

Achieving universal health coverage—wherein all people have access to the health services they need, when and where they need them, without financial hardship—would turn these numbers around. One way to get there, the World Health Organization says, is through client-centered services integration. This is a way of providing a package of health services during a single visit—such as family planning and nutrition services and maternal care and newborn/infant care. And while it’s more efficient for the client and for the facility, it also means families who have to travel great distances to a health facility are more likely to get all the care they need.

This is a great way to advance universal health coverage in countries where access to care remains a big challenge.

It was in response to these challenges that IntraHealth introduced the INSPiRE initiative. Funded by the Bill and Melinda Gates Foundation, INSPiRE helps national governments in West Africa’s nine Ouagadougou Partnership countries integrate services for family planning, nutrition, and maternal, neonatal, and child health for women and their newborns. This way,

a mother who travels to the clinic for postnatal care with her newborn for a vaccination visit, for example, will also receive counseling about family planning and nutrition information, all in the same visit.

“We have adopted the service integration approach which has enabled us to meet the needs of our clients, especially in terms of family planning,” says Nebenhide Gamba Ouedraogo, a midwife at the Urbain Health Center in Burkina Faso. “It has improved the quality of care and allows us to further reduce missed opportunities which, in turn, improves our indicators.”

Delivering services as an integrated package avoids missed opportunities to provide critical, lifesaving services for mothers and newborns. Through four points of entry—antenatal care, delivery, postnatal care, and newborn care—mothers can receive services they might not have otherwise received.

“I really appreciated the fact that I came to weigh my child and the health worker took the opportunity to talk to me about family planning," says Felicia Kiboro, a client visiting the Niche Health Center in Burkina Faso for a well baby visit. "The health worker welcomes us. He takes good care of our children. He weighs them and gives us a lot of advice, especially on family planning. He also talks about COVID-19."

The INSPIRE model was introduced in 11 facilities across three flagship countries: Burkina Faso, Côte d’Ivoire, and Niger. After two years, the preliminary results in these facilities have been promising:

Approximately 9 out of 10 pregnant women seeking antenatal care services benefited from the integrated care package including counseling on family planning and nutrition.
There was a 96% increase in the number of women adopting a family planning method immediately after delivery.
The facilities offering the integrated services noted an increase of 273% in women adopting a family planning method within six months of delivery in 2019 compared to 2018.
Overall, there was an 84% increase in the use of health services at facilities offering integrated services.

“Service providers are seeing remarkable progress in their center’s performance indicators thanks to improved family planning uptake and increased use of prenatal and postnatal services,” says Marguerite Ndour, INSPiRE’s project director. “This is a great way to advance universal health coverage in primary health care services in countries where access to care remains a big challenge and resources are limited to expand health structures.”

Measuring service integration is critical to monitoring progress but also to reinforcing provider behavior change in a sustainable way. In partnership with the Ministry of Health, INSPiRE helped develop indicators that measure service integration. This approach is a regional first, promising sustainable success.

In each country, composite indicators were developed for family planning, nutrition, and maternal, newborn, and child health. They were included in the national health information systems and in the facility-level data collection tools. At each visit, health workers are reminded to report on the services they delivered to their clients using data collection tools, which are then monitored at the district and the national level.

These new indicators provide useful data for decision-making as the integrated service model is implemented and scaled up nationally, but they also provide women and their families with sustainable access to a range of high-quality services that they haven’t had before.

Resources

Developing Composite Indicators for Integrated Family Planning; Maternal, Newborn, and Child Health; and Nutrition Services

By Jen Snell

Former senior technical manager

INSPiRE Family Planning & Reproductive Health Maternal, Newborn, & Child Health Universal Health Coverage Day Primary Health Care Burkina Faso Côte d’Ivoire Niger

A health worker helps a mother and her baby at a health facility in Ouagadougou in 2017. Photo by Trevor Snapp for IntraHealth International.

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7 Questions with Dr. Makasa

kseaton — Fri, 09 Apr 2021 14:08:13 +0000

7 Questions with Dr. Makasa kseaton April 09, 2021

April 09, 2021

Seed Global Health sat down with Mpundu Makasa to talk health workforce training, gender equity, and COVID-19 in Zambia.

Dr. Mpundu Makasa is a clinician and public health practitioner who works in the primary health care setting. She has a Master of Public Health and a PhD in Epidemiology. Dr. Makasa is currently enrolled in the University of Zambia’s (UNZA) Family Medicine Residency Program that is supported by Seed Global Health. Later this year, Dr. Makasa will be the first graduate of the program. She will become a faculty member after graduation, reinvesting her newfound skills and experience to teach for the program. Seed Global Health talked to her about her experience, family medicine in Zambia, and advancing gender equity in the health workforce.

What inspired you to pursue a career in family medicine?

I joined the University of Zambia as a faculty member in the School of Medicine’s Department of Community Medicine. At the time, the school was looking to start a training program in family medicine. I was asked to join and serve as chairperson on the family medicine working group, even though I had no prior training in the field. Fortunately, there was a family physician, Dr. Jim Sanders, from the Medical College of Wisconsin, who was on sabbatical and had dedicated his time to work with the group on developing the curriculum. Collaborating with him to complete this process gave me insight into what family medicine is. As part of our planning, we visited countries in the region that have family medicine programs to learn firsthand the different implementation models.

In addition, I was connected to the Primary Care and Family Medicine Network. I had the opportunity to present at the network’s conferences and talk about the preparatory work for our program. I met marvelous people in this field and got tremendous encouragement and support. Through those interactions, my understanding of and passion for family medicine grew even more. This motivated me to go on to pursue it.

Can you describe your experience in the family medicine MMED program at the University of Zambia?

Having been part of the process of developing the program and moving on to being a learner was interesting. I quickly had to adjust from being the chairperson. It was also quite a transition getting back to clinical practice, but I have enjoyed every bit of it. I found a connection with my previous work—even though family medicine is a clinical discipline, it interfaces with public health, which complements my background.

Through the program, I have received point-of-care ultrasound (POCUS) training. This has equipped me with the skills and expertise to leverage this tool to make immediate clinical decisions that improve care quality and patient outcomes.

I love the discipline’s diversity and holistic, as well as biopsychosocial approach to client care. I look forward to being the first graduate of the program in Zambia and contributing further to its growth and the fraternity in the country.

What is your most memorable experience within the program?

There have been many wonderful experiences. The most memorable is when we, as a program, undertook a five-day outreach activity to a rural part of Zambia. While there, we screened and treated over 700 hundred clients. It was hectic but very fulfilling—we provided care to poor and vulnerable individuals that ordinarily have limited access to health services.

The family medicine team at UNZA.

In your experience, what are the unique challenges that women health workers face within the context of the COVID-19 pandemic?

Women make up a majority of the health care sector. As such, they are disproportionally more exposed to COVID-19 than men, putting them at a higher risk of contracting the virus. In addition, during the pandemic, most health facilities have been overwhelmed with patients, putting providers, who are mostly women, under a lot of stress. This is compounded by their care duties that extend to their homes.

What must be done to address these challenges immediately and for the long-term?

One measure is to have shortened working hours for health workers and provide them with personal protective equipment to minimize the risk of infection. There is also a need to assess the impact of COVID-19 on mental health among health workers, especially in women, and based on the findings, develop programs to address these issues.

The long-term solution is to have preparedness plans and resources available to support preventative and control programs for COVID-19 and any future health crises.

From your experience, what investments are needed to advance gender equity and women’s leadership within the health system?

Cultivating a leader starts from a tender age. To advance gender equity and women’s leadership within the health system, it is important to empower the girl child through education, especially in rural areas. We need to continue sensitizing our communities against early marriages and gender stereotypes that assume that women are less capable or inferior in any way. We also need to increase role modeling and mentorship programs—both are important for developing more women leaders.

Lastly, what advice would you give to women in Zambia who want to pursue a career in family medicine?

It is a great field. You’ll be trained to become a multiskilled provider who can care for patients across all ages, sexes, and disease groups. It is a specialized discipline but like other disciplines, you can pick an area of concentration depending on your interests. Specialists can work as hospitalists or in outpatient settings in both public and private practice and have very successful careers while maintaining a good work-life balance.

A version of this article was originally published by Seed Global Health. It can be read here.

By Patricia Egessa

Senior Communications Manager

COVID-19 World Health Worker Week Gender Equality Health Workforce & Systems Primary Health Care Health Workers Zambia

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Initiative de sante urbaine pour la lute contre l’hypertension arterielle: Better Hearts Better Cities – Dakar

kseaton — Thu, 17 Dec 2020 15:47:14 +0000

Initiative de sante urbaine pour la lute contre l’hypertension arterielle: Better Hearts Better Cities – Dakar 2020 kseaton December 17, 2020

Le présent kit d’outils a été élaboré par IntraHealth dans le cadre du projet « Better Hearts Better Cities » qui est une initiative de santé urbaine pour la lutte contre l’hypertension artérielle, financée par la Fondation Novartis. Il a été élaboré dans le but d’aider les différents intervenants des programmes de lutte contre les maladies non transmissibles à mettre en place correctement un processus d’amélioration de la prise en charge curative et préventive de l’hypertension artérielle dans un district sanitaire.

https://sway.office.com/s/EfPsJv2O6YXPTC89/embed

Countries Senegal

Projects Better Hearts Better Cities - Dakar

Topics Noncommunicable Diseases Community Health Health Workforce & Systems Primary Health Care Health Workers

10 Women Who Are Shaping the Future of Global Health

mnathe — Fri, 06 Mar 2020 16:09:51 +0000

10 Women Who Are Shaping the Future of Global Health mnathe March 06, 2020

March 06, 2020

They’re helping get the results we need for the future we want.

Today 70% of the health workforce is made up of women. Yet they occupy only 25% of senior roles.

“Leaving the gender balance to equalize on its own is not an option,” according to the World Health Organization. “Unless specific, targeted measures are taken, workplace gender equality is estimated to take 202 years.”

We’ll need to tackle it long before then to reach universal health coverage.

Lucky for us all, women all over the world—from the smallest villages to the halls of global policy—are leading the way to change. Check out these 10 women in global health and development who are helping get the results we need for the future we want.

Catherine Alinga: This midwife is giving babies born too soon a chance at life.

Midwife Catherine Alinga. Photo courtesy of Irene Mirembe.

It was March 2019 when Senior Catherine—as she’s fondly called in her maternity ward at Uganda’s Katakwi Hospital—began training staff on better neonatal care. At the time, the survival rate for preterm births at the hospital was less than 10%. After her training, staff saw those survival rates skyrocket to 73% in June, then to 80% in September—and then to 100% by October 2019. Read the story.

Melissa Bimé: She’s working to end the blood shortage in Cameroon.

Melissa Bimé was just 18 when she founded Infiuss, a digital supply-chain platform that gives hospitals access to ready-to-use blood. At her hospital job in Cameroon, she had seen so much heartbreak that could have been avoided by available, compatible blood. Today her company uses a blood bank management platform to address blood shortages in hospitals across Cameroon. Read her story.

Amy Finnegan: This data scientist is using AI to answer new global health questions.

As a global community, we’re collecting massive amounts of data. “But the real value of data isn’t how much you have, but how you use them,” says data scientist Amy Finnegan.

Machine learning can help us find new ways to improve and save human lives.

She’s using machine learning—“an old approach from computer science that has been unlocked for global health,” she says—to answer new questions and find new ways to improve and save human lives. Read her story.

Anne Kinuthia: She’s fighting for better HIV care in South Sudan.

“If you test HIV-positive here, you and your family become outcasts,” says Anne Kinuthia, who leads IntraHealth International’s work in South Sudan. “A lot of people here think that once you get it, you’re dead. I want more people to know that HIV is not a death sentence.” Kinuthia and her team are doing just that—and getting big results despite the war and scarcity they face every day. Read the story.

Aarathi Krishnan: She’s reimagining the future of humanitarianism.

Aarathi Krishnan works on issues of inclusion, intersectionality, power, and privilege—with a specific focus on decolonized and feminist futures. She’s reimagining the future of the humanitarian system and social change. Follow her here.

Pamela McQuide: She’s a nurse bridging the divide between clinic and policymaker.

Pamela McQuide (second from left) talks with nurses at Omuthiya District Hospital in Namibia. Photo by Morgana Wingard for IntraHealth International.

Pamela McQuide started her career as a nurse. Then she was a community organizer, a public health legislative aide, a family planning and reproductive health researcher, an assistant professor, and now a health workforce expert.

Today she uses the power of data and her clinical background to help health officials advocate for the resources they need and make crucial decisions about where to deploy health workers—decisions that affect health and well-being for families everywhere she works. Read her story.

Tembi Mugore: This midwife pushes back against biases and disrespect in the clinic.

Midwife Tembi Mugore. Photo by Ted Richardson for IntraHealth International.

Tembi Mugore knows exactly how much a midwife’s attitude can affect their client, for good or for ill. A midwife by training, she’s seen her share of health workers being disrespectful toward clients—and the health consequences that can follow when those clients choose not to come back.

That’s why Mugore works with health workers throughout Africa to rethink and eliminate their own biases and behaviors that might keep young people from seeking out the health services they need, especially when it comes to contraception and postabortion care. Read her story.

Janet Muriuki: She’s putting education within reach for more of Kenya’s next generation of health workers.

In Kenya, there’s no shortage of young people who want to serve their communities by becoming health workers. But for the 36% of Kenyans who live below the poverty line, higher education is unreachable. Janet Muriuki is working to change that. She helps lead the Afya Elimu Fund, a low-interest student loan program that enables students from low-income backgrounds to pursue careers as health professionals. So far, they’ve helped over 8,500 students graduate. Read her story.

Regina Nadim: From survivor to mentor, she’s there for fellow girls in Uganda.

As a young girl in rural Karamoja, Uganda, Regina Nadim never went to school. She had no social or economic support. “My parents could not afford school fees,’’ she says. “They only saw me as a source of labor and a dowry.” She was abused, humiliated, and worried she might have been infected with HIV. But when an IntraHealth-led training came to her village, she and other girls learned lifesaving skills and began sharing their stories through community dialogue.

She doesn't want other girls to suffer the same way she did.

Today, she’s still recovering from her abuse, but she’s also serving as a mentor for other girls in her community, in hopes they won’t suffer the same way she did. Read Regina’s story.

Zolelwa Sifumba: TB tried to beat her—now she’s beating it back.

Zolelwa Sifumba. Photo courtesy of the Global Fund/Shugo Takemi.

Zolelwa Sifumba, a doctor in Durban, South Africa, contracted tuberculosis after she was exposed to it at work. She struggled through the treatment process, and finally beat it. Ever since, she’s been sharing her story as part of the global fight against TB, educating and giving hope to others. Read her story.

Join the conversation about health workers as we celebrate International Women's Day and the Year of the Nurse and Midwife: @IntraHealth #TheFutureof #HealthWorkersCount #NursesLead #MidwivesLead #IWD2020 #EachforEqual

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Resources

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

By The Editorial Team

IntraHealth International

Tuberculosis Community Health Digital Health Policy & Advocacy Gender Equality Nursing & Midwifery 2020 Primary Health Care Youth Engagement Midwives Nurses Physicians

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To Spur Health Workforce Policy Progress, Listen to Frontline Health Workers

mnathe — Fri, 07 Feb 2020 21:41:28 +0000

To Spur Health Workforce Policy Progress, Listen to Frontline Health Workers mnathe February 07, 2020

February 07, 2020

A community health worker from Kenya inspired global health advocates at the 2020 Prince Mahidol Awards Conference and UHC Forum.

BANGKOK—Community health worker Margaret Odera walked off the flight from Nairobi to Bangkok, her first plane ride, ready to take the mic.

A roomful of global health leaders from around the world could have been intimidating to anyone, but Margaret was grounded with the confidence of her fellow frontline health workers from the Mathare North Health Center in Kenya, mothers living with HIV like herself, and—most of all—confidence in her own story.

“I’ve lived with HIV for 19 years,” said community health worker Margaret Odera (left) at PMAC 2020. “I’m here speaking for those who are not heard and are suffering." Photo courtesy of Vince Blaser.

She spoke about the difficulties and discrimination she faced after being diagnosed with HIV, her gratitude to the US government-supported program that helped her deliver three babies HIV-free with an HIV-negative husband, and her determination to help other women in her community with their core health issues.

The firsthand stories of frontline health workers like Margaret are too often absent from forums like the Prince Mahidol Awards Conference (PMAC) 2020 and Universal Health Coverage (UHC) Forum last week.

But at a PMAC side session led by USAID, its HRH2030 Program, Chemonics International, and the Frontline Health Workers Coalition, Margaret transfixed our audience of researchers, policymakers, implementers, and influencers and left them more determined to play their role in improving the policies and investments frontline health workers need to deliver UHC.

“I’ve lived with HIV for 19 years,” Margaret says. “I’m here speaking for those who are not heard and are suffering. To be a voice for HIV-positive women and community health workers who do not have a voice in their communities and hospitals.”

Odera traveled to the global event in Bangkok, she said, "to be a voice for HIV-positive women and community health workers who do not have a voice in their communities and hospitals." Photo courtesy of Vince Blaser.

My take-home message from Margaret’s story and from the conference as a whole is we all need to utilize our own roles to enhance the impact of everyone’s work in global health and development.

Take the current health workforce policy rhetoric. The Universal Health Coverage Global Monitoring Report 2019 reflected what we’ve long known but now have fresh evidence to back up: communities with the least access to essential health services are the same communities where trained and supported frontline health workers are the most sparse.

It’s clear there are major gaps our macro policy progress alone cannot address.

At the macro level, there is strong momentum for action to address health workforce gaps, as the World Health Organization’s Tomas Zapata articulated at our side session. As Anne Keeling of Women in Global Health pointed out during the session, the 2019 UHC Political Declaration includes strong commitments to meeting both the health workforce needed to reach UHC and addressing some of the major barriers to gender equality in the workforce.

Zapata noted the WHO Workforce 2030 strategy, the ILO-WHO-OECD Working for Health Five-Year Action Plan and Multi-Partner Trust Fund for the health workforce, SDG 3.C reporting, and the related National Health Workforce Accounts are all major advances just in the last five years.

Yet from what we heard during our session—about Margaret’s work, about Ruth Ngechu’s leadership of FHWC member Living Goods’ work to support and empower community health workers in Kenya, about Lazare Coulibaly’s and HRH 2030/Chemonics’ work in Mali, and from Barbara Stillwell of the Nursing Now 2020 campaign on the experiences nurses face around the world—it’s clear there are major gaps this macro policy progress alone cannot address.

We heard stories of health workers from different cadres not understanding each other, of not getting enough support.

For example, proper skill mix and interprofessional teamwork and collaboration were cited by Rachel Deussom of HRH2030/Chemonics as critical to delivering high-quality, essential services to every community.

On the surface, the WHO’s first-ever guidelines on community health worker programs released in 2018 and its designation of 2020 as the Year of the Nurse and Year of the Midwife—including upcoming release of the first-ever State of the World’s Nursing Report—both seem to bode well for frontline team empowerment and cohesion.

But Margaret, Ruth, Lazare, and Barbara all relayed compelling stories of health workers from different cadres not understanding each other, not utilizing each other’s skills effectively, not getting enough support, and often not having defined career pathways.

And that is one of the reasons why Margaret’s story and her presence at PMAC and other global forums matters for improving and supporting the health workforce.

Attendees rallied behind Ruth’s plea that Margaret’s work as a mentor mother to HIV-positive pregnant women—and the work of all community health workers—should be paid. This call would not have had nearly the same resonance had Margaret not just shared her own perilous and inspiring journey.

It was not enough that Donela Besada of the South African Medical Research Council and colleagues conducted an economic return-on-investment research report of community health workers in South Africa—they needed to work with advocates to convince the South Africa Department of Health that commissioned the study to push for changes in the South African government’s recognition of community health workers.

No doubt universal health coverage is a complex, long-term, politically challenging goal.

It was not enough that Nursing Now called for greater mentorship, leadership, and career pathways for nurses—they proved how these and other gender-related barriers stymie the full impact of investment in nurses by conducting a survey of 2,537 nurses and nurse-midwives from 117 countries and reporting to policymakers and influencers on the findings with us here at IntraHealth, as well as with Johnson & Johnson.

No doubt UHC and ensuring the health workforce needed to achieve it is a complex, long-term, and politically challenging goal. But if we can connect more of the stories of frontline health workers like Margaret with the implementation experiences, research, and advocacy movements I witnessed at PMAC, we’ll be much closer to achieving that goal.

Margaret Odera’s participation at PMAC 2020 was part of an ongoing partnership between Medtronic Foundation and IntraHealth International to encourage policymakers to hear the stories and recommendations of frontline health workers at major policy forums.

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

By Vince Blaser

Former senior advocacy & policy advisor, IntraHealth International, and director, Frontline Health Workers Coalition

HIV & AIDS Community Health Advocacy Primary Health Care Community Health Workers Kenya

Community health worker Margaret Odera (left) and Vince Blaser at PMAC 2020. Photo courtesy of Vince Blaser.

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Tajik Community Health Volunteers Improve Nutrition, Maternal Health, and Agriculture for Thousands

mnathe — Thu, 14 Nov 2019 14:35:49 +0000

Tajik Community Health Volunteers Improve Nutrition, Maternal Health, and Agriculture for Thousands mnathe November 14, 2019 November 14, 2019

Thousands of people in Tajikistan's Khatlon region now have greater access to health services, nutrition, and sanitation, thanks to Feed the Future Tajikistan Health & Nutrition Activity (THNA), implemented by IntraHealth International.

In the twelve districts where IntraHealth conducts the USAID-funded work, in partnership with Abt Associates, widespread malnutrition leads to stunting, anemia, and poor maternal and child health, while infrastructure for proper sanitation and hygiene remains inadequate.

THNA recruited and trained 1,300 health volunteers and 500 agriculture volunteers.

To mitigate these issues, THNA recruited and trained 1,300 health volunteers and 500 agriculture volunteers who have given families access to health advice, agricultural skills, and necessary referrals.

These interventions mark a significant shift toward healthy behaviors in the communities supported by THNA. Since 2016:

The number of families that treat children with diarrhea by introducing more fluids has grown by from 33% to 80%.
46% more families have soap present at a handwashing station.
The number of women who had four or more antenatal care visits went from 57% to 86%.
The percentage of non-breastfed children 6-23 months who receive a minimum acceptable diet has grown from 16% to 53%.

Volunteers work across maternal and child health, hygiene, agriculture, and advocacy:

Health volunteers regularly visit homes to check for new pregnancies, monitor the growth of young children, and provide counseling on antenatal care and breastfeeding. Volunteers made 420,217 home visits over the course of two years and referred 4,173 women for antenatal care in year four alone.
Volunteers conduct at least one cooking demonstration each month to teach the benefits of agricultural diversity and encourage healthy eating using local produce. In year four, volunteers held 3,895 demonstrations and distributed 4,500 project-developed recipe books to address malnutrition.
Health volunteers refer families to primary health centers and hospitals via a new referral system set up by the project.
Water, sanitation, and hygiene (WASH) volunteers work with village committees to provide guidance on proper garbage disposal, educate community members on disease prevention through handwashing with soap and the importance of hygiene and sanitation in child development, and address the need for ventilated improved pit latrines by training village masons to build concrete latrines at affordable prices. The project facilitated the installation of 1,749 latrines.
Agriculture volunteers train household members in home garden management, household budgeting and entrepreneurship, winter food storage, postharvest technologies, cheese-making, and poultry farming.

46% more families have soap present at a handwashing station.

In addition, new peer-support groups in each of the 500 project-supported communities bring together key groups, including:

Mothers-in-law, who influence how households are run and can encourage healthy habits at home.
Young mothers, who gain insight on antenatal and postnatal care and mother-and-child nutrition.
Men, the major decision-makers in households who have also been influential in the project’s agriculture and latrine-building initiatives.
School peer educators at 12 schools, who disseminate nutrition and agriculture information to their fellow students, which has increased yields and contributed to better food for schoolchildren.

Using these and other project results, THNA conducts quarterly meetings with the Khatlon Department of Health, district primary health center and hospital managers, and community volunteers to encourage data-driven decisions.

The project team advocates for linking community volunteers with Centers for Healthy Lifestyles and government-led public health and health-promotion centers for community outreach in order to make them part of the formal health system and sustain these improvements.

IntraHealth International leads the USAID-funded Feed the Future Tajikistan Health & Nutrition Activity. With our partner Abt Associates, we are working to improve health and nutrition in Tajikistan, particularly among women and children in the Khatlon oblast. The activity integrates high-quality maternal, newborn, and child health care at the family, community, clinical, and national levels, with an emphasis on nutrition, sanitation, and hygiene.

Resources

Community-based Approaches to Improve Maternal and Child Health and Nutrition in Tajikistan

Tajikistan Maternal, Newborn, & Child Health Nutrition Community Health Health Workforce & Systems Primary Health Care Community Health WorkersThousands of people in Khatlon region now have greater access to health services and sanitation, thanks to the work of community health volunteers. Photo by Khosiyatkhon Komilova for IntraHealth International.
Feed the Future Tajikistan Health and Nutrition Activity

Health Worker Training Is Improving Hypertension Care and Prevention in Senegal

mnathe — Thu, 31 Oct 2019 13:43:45 +0000

Health Worker Training Is Improving Hypertension Care and Prevention in Senegal mnathe October 31, 2019 October 31, 2019

During interviews with almost 2,000 health workers and clients in Dakar, Senegal, IntraHealth International found that some 40% of health workers had not been trained to care for clients with hypertension, and 83% of clients who did not have hypertension knew no more than a single warning sign. But a 2019 evaluation reveals significant progress in under two years.

The results from our 2017-2018 situational analysis uncovered gaps in hypertension care and prevention in Dakar, including insufficiencies in equipment, hypertension management skills, and patient education.

Those results helped guide the Better Hearts Better Cities initiative in Senegal—implemented in partnership by IntraHealth, PATH, and the local health authorities—which is part of a global urban health initiative in run by the Novartis Foundation. Its goal is to improve the quality of hypertension management and reduce cardiovascular morbidity and mortality in Dakar.

Hypertension is a dangerous precursor to and prime risk factor for heart disease and stroke, which is now the fifth-leading cause of death in Senegal. The World Health Organization estimates that 42% of all deaths in Senegal are caused by noncommunicable diseases (NCDs) like hypertension. Throughout sub-Saharan Africa, the incidence of stroke has increased 46% since 1990.

In some cities, the prevalence of hypertension is as high as 40%.

“When I was starting out as a young doctor here in Senegal, noncommunicable diseases were thought to be a thing for rich people,” says Joseph Barboza, a physician in Senegal and director of IntraHealth’s Better Hearts Better Cities team in Dakar. “It used to be infectious diseases like measles, malaria, and meningitis that brought people to the emergency room. Now most of those emergencies are caused by NCDs, usually hypertension. In some cities, the prevalence of hypertension is as high as 40%.”

Since its beginning in Dakar in 2017, Better Hearts Better Cities has helped train and provide supportive supervision to 667 health workers across three districts in the city. And it’s paying off. A July 2019 evaluation* found strong improvements in hypertension awareness and prevention among health workers in one of those districts (Dakar Ouest), including:

98% of health workers have general knowledge of hypertension, including the significance of blood pressure readings (up from 76% in 2017).
88% of health workers understand at least three warning signs of complications from hypertension (up from 26% in 2017).

Better Hearts Better Cities Dakar drastically lowered the number of clients who miss follow-up appointments, partly by collecting new data on hypertension screening, diagnosis, and management as part of routine care, and by revamping the way facilities manage their data.

For instance, a simple new filing system modeled on the one used by local midwives has made records easier to find and manage. When a client misses an appointment, her file goes into a special drawer, allowing facility staff and community relays to follow up with her faster.

“It’s made my job much easier to have this clear, easy-to-follow protocol,” says Abdoulaye Ndao, head nurse at the Yoff Ndenatte Health Center in Dakar. “When the community relays follow up with people who’ve missed their appointments, there are sometimes people who still don’t or can’t come to the facility, for whatever reason. For these, I do a house call to provide care in their homes. It’s not something I’m required to do, but I want to help people—and clear out the drawer at the same time.”

Task-shifting is freeing up higher-level health workers to deal with more serious cases.

Better Hearts Better Cities Dakar has helped standardize patient records, created a digital dashboard to show patient and program progress, increased access to hypertension medicines, and helped shift some tasks—such as measuring blood pressure and screening for hypertension—to all levels of care.

“Since the initiative began, we’ve seen no patients with major complications, so that is a sign that prevention is working,” says Kalidou Aw, a nurse and NCD focal point at Philippe Senghor Health Center in Dakar. “It’s also reducing the workload for specialists, who are in very short supply, and who used to get a lot of the emergency cases. The task-shifting is freeing up higher-level health workers to deal with more serious cases.”

Dakar is now one of the only places in Senegal that provides this level of care and accurate, timely advice for hypertension, thanks to Better Hearts Better Cities. Outside the city, high-quality hypertension care remains difficult to find.

* Full results from the 2019 evaluation will be available in a forthcoming publication.

Want to know more about the results of our work on hypertension care and the situational analysis in urban Senegal? Follow us at the Pan-African Society of Cardiology 2019 October 31 – November 3: @IntraHealth #HealthWorkersCount #TheFutureof

IntraHealth’s work with Better Hearts Better Cities Dakar is funded by the Novartis Foundation and done in partnership with the Ministry of Health, Secrétaire général de la Société Sénégalaise de Cardiologie, PATH, and the American Heart Association. The 2017-2018 situational analysis included interviews with 443 health workers and 1,546 clients.

Also read: Door-to-Door Hypertension Care in Dakar Brings a Pervasive Public Health Problem to Light

Senegal Noncommunicable Diseases Health workforce development Primary Health Care“Before, when someone would come in with symptoms of hypertension, I didn’t know exactly how to handle it—I would do whatever I could to help the person or just refer them to another facility.” —Abdoulaye Ndao, head nurse at the Yoff Ndenatte Health Center in Dakar. Photo by Clément Tardif for IntraHealth International.Neema

This Is the Sound of 2,500+ Nurses Speaking Out on the Biases and Barriers They Face at Work

mnathe — Sun, 09 Jun 2019 19:41:43 +0000

This Is the Sound of 2,500+ Nurses Speaking Out on the Biases and Barriers They Face at Work mnathe June 09, 2019

June 10, 2019

A new report examines the factors that hinder and help nurses on their way to leadership roles.

Sixty or seventy years ago, when Edna Adan first decided to become a nurse, people would come up to her mother and say, “We’re so sorry. We’ve heard the news.”

In her home country of Somaliland, nursing—giving care to the sick—was not seen as an honorable choice for a young woman.

But Edna did it anyway. Then she went on to become Minister of Social Affairs and Foreign Minister of Somaliland. Then she founded Somaliland’s Edna Adan Maternity Hospital. Then she opened Edna Adan University. At 82, she’s still working to revolutionize health care and the nursing and midwifery workforce in her country.

Nurses find solutions on the fly, drive change in the hospitals where they work.

Nurses like Edna are leaders in their fields. They find solutions on the fly, drive change in the hospitals where they work.

“During the Crimean war, when more soldiers were dying from infection than from battle wounds, it was a nurse who said, ‘Let’s look at our sanitation,’” said Joy Marini, who leads Johnson & Johnson’s global public health and development team, last week at Women Deliver 2019. “And during an early Ebola outbreak, it was a nurse who wrapped herself in trash bags and duct tape and said, ‘We can do this.’”

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

A new report launched at Women Deliver examines the gender-related barriers nurses face in rising to positions of leadership in their fields—and what it will take to remove them.

Resources

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

The authors of Investing in the Power of Nurse Leadership: What Will It Take? surveyed 2,537 nurses and nurse-midwives from 117 countries, and held eight key informant interviews with nurse leaders. The result is an in-depth analysis—punctuated throughout by the voices of real nurses from around the world—of what hinders and helps nurses on their way to leadership roles.

For instance, many nurses reported that challenges balancing unpaid and paid work affect women more than men in nursing, and that gender bias, discrimination, and limited decision-making authority often stand between them and leadership positions.

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

As the global focus on universal health coverage sharpens, eyes are on the nursing workforce.

The report comes at a crucial time for the nursing field. As the global focus on universal health coverage sharpens, eyes are on the nursing workforce. In many countries, nurses and midwives make up more than half the national health workforce. The World Health Organization has even declared that 2020 will be the year of the nurse and the midwife.

“This is nursing’s moment,” said Barbara Stilwell, executive director of Nursing Now, at the Women Deliver launch event. “If we don’t seize it now, we won’t have another one for a very long time. In terms of achieving universal health coverage and the Sustainable Development Goals—this is where nurses shine. And it’s not just because we think we shine, it’s because we have data that show we do.”

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

The authors of Investing in the Power of Nurse Leadership: What Will It Take? are Constance Newman of IntraHealth International, Barbara Stilwell of Nursing Now Global, Samantha Rick of IntraHealth, and Katia Peterson of In Situ Research, LLC. The report is a product of a research collaboration among IntraHealth, Nursing Now, and Johnson & Johnson.

Read more about IntraHealth’s work with the nursing and midwifery workforce.

Resources

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

By The Editorial Team

IntraHealth International

Leadership and Governance Policy & Advocacy Women Deliver Gender Equality Nursing & Midwifery 2020 Primary Health Care Nurses

Photo courtesy of Nursing Now.

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