Nurses and Stories Are a Powerful Combination

By Cecilia Amaral, IntraHealth International and Frontline Health Workers Coalition

This blog was originally posted on Vital, the IntraHealth International blog.

Samalie with a small group of clients. Photo courtesy of Samalie Kitooleko.

Samalie Kitooleko wants you to know that nurses are independent professionals who undergo years of education and do not simply take orders given by doctors. She should know. She’s one of them.

In fact, Samalie is “changing the face of nursing leadership in Uganda to one of a confident, critical thinker who takes initiative and leads by example.” Those are the words of her supervisor, Dr. Chris Longernecker.

Samalie is also one of twelve women who will be honored tomorrow ahead of the World Health Assembly in Geneva at the Heroines of Health Gala Dinner. Samalie will add storyteller to her resume as she shares the story at the gala of her endless support for her clients.

She is one of several health workers trained by IntraHealth International and Medtronic Foundation in effective storytelling.  Policymakers need to understand what is actually needed to support health workers’ roles in health service delivery, and powerful storytelling can help convey just that.

Samalie’s nursing journey started over two decades ago. For the last 15 years she has worked at the Uganda Heart Institute, rising through the ranks from a smart and conscientious nurse taking care of clients with chronic cardiovascular illnesses to a leader and trainer of health workers—and a strong advocate for patient-centered care.

She understands that care is not just about the treatment, but also about building relationships with her clients, being there for them, listening to their stories, explaining their conditions and treatment, welcoming calls at 3:00 in the morning, or making follow-up calls when they miss an appointment.

“The best thing about being a nurse is seeing someone coming to the hospital very sick and seeing that person going home with a smile on their face,” Samalie says.

Resolutely seeking these smiles, she championed the formation of a national patient support group for young women living with rheumatic heart disease and also holds leadership positions on other projects at the Uganda Heart Institute.

Being a nurse, particularly in a resource-limited setting, comes with challenges. Cardiovascular diseases require a lot of medication, which poorer clients often can’t afford. Though Samalie can’t help them financially—and doubtless she would if she could—she does provide the social support her clients need, even if that requires showing up at their houses. Somewhere, somehow Samalie finds a way to care for them.

“There’s always something that you can do for a patient,” she says.

At the World Health Assembly, Samalie aspires to convey the crucial role that nurses can play in bridging communication gaps between health workers and clients. Often, clients have difficulty understanding their illnesses or treatments, which can hinder the condition. By sharing her story she hopes to inspire stronger policies that facilitate access to the medical treatment women from poorer social backgrounds deserve.

Working with Jeff Polish, a storytelling coach, taught her to translate her experiences into carefully crafted narratives that will touch and stay with her audiences. “Samalie is pretty incredible, if you ask me,” he says. We completely agree, Jeff.  

Hear Samalie Kitooleko speak at the Heroines of Health gala and reception hosted by Women in Global Health and GE Healthcare on May 21 ahead of the World Health Assembly. Co-sponsors of the event include IntraHealth International, the Frontline Health Workers Coalition, Global Health Council, the United Nations Foundation, Women Deliver, and the Global Health Centre at the Graduate Institute, Sweden. 

Through the Pharmacy Window

by Margarite Nathe, IntraHealth International

Elina Nantinda, an assistant pharmacist dispenses ARVs for a patient at the antiretroviral (ART) clinic at Omuthiya District Hospital, Namibia. Photo by Morgana Wingard, courtesy of IntraHealth International.

“When I was in grade 8, I was into two things: fashion and medicine,” says Elina Nantinda, a 25-year-old pharmacy assistant in rural Namibia. “So I decided to study hard. I thought, ‘It would be so nice to work with medicine and to know more about yourself and how medicine works in your body.’”

Today she runs the pharmacy at Omuthiya District Hospital’s HIV clinic in northern Namibia, dispensing antiretroviral medicines to a hundred clients per day, on average. People come from miles around—most on foot—for HIV services at Omuthiya. And most come to see Elina at some point.

When she started this job at Omuthiya last year, Elina spent two days working with a senior pharmacist. But then that person was moved to the main clinic, and she’s been on her own ever since.

“Being alone, you learn more and faster,” Elina says. “But we need another person in our pharmacy, so that when one is dispensing the medications, the other is entering data into the computer.”

Like all the other health workers at Omuthiya, Elina is constantly busy. Yet she’s always on the watch for clients who look lost or in need of help, and her watchfulness helps the whole clinic run more smoothly.

“I watch their facial expressions,” Elina says, particularly those of clients who come to pick up their medications—and especially when they don’t ask questions. “If they look confused or uncertain, I know I have to find a way for them to understand. I know any error on their part is going to be my fault. And sometimes patients don’t want to hear instructions about their medications because they think they’ve been taking them so long, they already know everything.”

In fact, HIV has become a way of life for many in Namibia. Today, according to the Ministry of Health and Social Services, overall HIV prevalence in the country is 17.2%, and slightly higher in Omuthiya.

So Elina asks them, quietly and kindly, to describe to her how they take their meds. This is how she sometimes finds out a client may be taking too many pills at once.

“This is really bad,” she says. “They have heart pains and they don’t sleep, so they usually come back to us within days.”

Or she sometimes finds that clients are taking the pills at the wrong time.

“Today a patient came from Onyaanya,” Elina says, which is 39 kilometers away from Omuthiya. “I could see the patient didn’t look normal. I asked, ‘How do you feel?’ The patient told me, ‘Sometimes after I take my medication, I feel like I’m drunk after two hours, and I want to sleep. I just feel like I’m not normal. It’s not me.’ So I asked, ‘How are you taking this medication?’ I found the patient was taking a tablet in the morning”—which is contrary to current guidance.

So Elina explained that the client should start taking the medication at night before going to bed.

Hard-working lady

Elina at the clinic at Omuthiya District Hospital. Photo by Morgana Wingard, courtesy of IntraHealth International.

I ask Elina why she chose medicine over fashion.

“I’ve always been a hard-working lady,” she tells me. “I used to visit the orphans in Windhoek, and I wanted to help them. I worried that God would feel bad about me if I’m not doing something to help.”

She hopes to become a full-fledged pharmacist someday, but will have to raise money for school.

Then I ask Elina if there are any other health workers in her family. She tells me no, she is the only one. So when any of her relatives is feeling bad, they always come to her.

“I feel so proud about that,” she says.

Elina Nantinda is employed through IntraHealth International’s USAID HIV Clinical Services Technical Assistance Project in Namibia, which is funded by the US Agency for International Development through the President’s Emergency Plan for AIDS Relief (PEPFAR). IntraHealth is working with the government of Namibia to increase the number of health workers providing HIV services and provide the support and training they need to reach the country’s goal of an AIDS-free generation. Read more about IntraHealth’s work in Namibia.

Valery Mwashekele and Cherizaan Willemse contributed reporting to this story.

International Day of the Midwife: Midwives, Mothers and Families are Partners for Life

By Nancy Kamwendo, White Ribbon Alliance for Safe Motherhood Malawi

Midwives everywhere understand that by working in partnership with women and their families they can support them to make better decisions to have a safe and fulfilling birth. Today, May 5, the world commemorates their day – the International Day of the Midwife.

A midwife providing postnatal health education to mothers. Photo Courtesy of White Ribbon Alliance.


In Malawi, midwives are frontline providers of maternity care, safely delivering babies, providing comprehensive sexual and reproductive health services, and playing a critical role in addressing health issues in their communities. Malawi has made progress in reducing its maternal mortality rate to 439 deaths per 100,000 live births, down from 574 deaths per 100,000 live births in 2010. This rate remains far too high – to save more lives of women and newborns, midwives must become even stronger partners with mothers seeking care and their families to best support them.

Neema Uzeni Phiri – Matron at Bwaila Maternity Unit. Photo Courtsey of White Ribbon Alliance.

Bwaila hospital is a maternity facility located in Lilongwe, the capital city of Malawi. “This is the busiest maternity hospital in Malawi and probably in central Africa,” said Nemma Uzeni Phiri a Unit Matron at Bwaila.

Prenatal care from a skilled provider is important to monitor pregnancy and reduce morbidity and mortality risks for the mother and child during pregnancy, delivery, and the postnatal period (within 42 days after delivery). According to Nemma, the fewer than 20 midwives of Bwaila clinic attend to approximately 700 women on Mondays and from three to as many as 400 women the other days of the week. About 50 babies are delivered per 24 hours with two shifts of six midwives per team. Despite the work overload, Midwives at Bwaila hospital work hard every day to ensure mothers and their families receive the quality care that they deserve.

Cecilia Kapheni, a midwife and team leader of one of the midwife teams at Bwaila labor ward, said, “My team of six midwives conducts about 30 deliveries per shift. Women come to the labor ward escorted by their mothers and mother in-laws, we interact with the family members throughout labor and delivery. We involve them to assist us in comforting the woman as labor progresses. We work under very strenuous conditions; we do not have time to rest throughout the 9-hour day day shift or 15-hour for night shift. However, the arrival of the new born in the world is my great motivator and when the baby is born, seeing both the mother and family members happy, makes my day. Despite the poor working conditions, I love being a midwife.”

Cecilia discussing care of a woman with her family member. Photo Courtsey of White Ribbon Alliance.

Many factors prevent women in Malawi from getting medical advice or treatment for themselves when they are sick. Barriers that women face in seeking care during pregnancy and at delivery include: getting permission to go for treatment from either their husband or other family members according to their culture; distance to health facility and transport cost; and not wanting to go to the hospital alone. Considering that access to proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that may lead to death or serious illness for the mother, baby, or both, a midwife comes in as an educator, a counsellor, an advocate, and a skilled birth attendant.

Midwives partner with the mother and family members to deal with these barriers. Midwives sensitize the families to allow and encourage mothers to seek care even if the one responsible to provide permission is not available. One man from Kang’oma village said, I don’t have powers to take my wife to the hospital even when we see that she is in labour unless the older women at the household say so. If we leave without their consent, and something wrong happens, I am held responsible. So even if the women are not available, we still have to wait for them. They take labor and delivery as a no go zone for men, a field for women only and only them have to make decisions.”  

Midwives provide birth preparedness education at the prenatal clinic so that families prepare for birth. Mothers are encouraged to come to the clinic with their husbands so that they go through the education session together. Midwives encourage families to save money for transport and to buy other necessities for the delivery. Midwives encourage women coming from very far from the hospital to come to the waiting homes at the eighth month of pregnancy. This way when labor starts, they are close to the hospital and assisted by a skilled birth attendant. Spouses are encouraged to escort their wives to the hospital for delivery together with any female relations. Because the husband is not allowed inside the labour ward due to privacy reasons, female relations are encouraged to come and assist women throughout labor.

All of this promotes the partnership between the midwife, mother and families in taking care of women during pregnancy, labor, delivery and postnatal period.

Happy mothers, happy families, happy midwives; indeed a partnership for life.

The Power of Storytelling: Unlocking Energy for Change

By Michelle Korte, IntraHealth International and Frontline Health Workers Coalition

Albert Medina, a paramedic with the Chicago Fire Department, tells the story of his inspiration to train his community on CPR. Photo by Michelle Korte for the FHWC.

Listening – that’s what I’m here to do at SwitchPoint, IntraHealth International’s annual “unconference” hosted in rustic Saxapahaw, nestled along the Haw River in an arrestingly green North Carolina wood.

Listening is what we’re aiming for in our most recent undertaking with Medtronic Foundation, too. A few months ago, IntraHealth International and Medtronic Foundation recruited a handful of health workers from projects and locations across the globe to participate in a few months of intensive storytelling training – admittedly, a bit of an experimental undertaking. Why storytelling, of all things?

Simply put, storytelling in advocacy is about improving feedback loops. It’s about better ensuring that dire needs and specific proposals are communicated effectively and persuasively to people who make influential policy and financial decisions. While conferences and reports are rife with technical experts and statistics, sometimes these policy discussions lack the critical element of voice – the humanity behind the numbers.

This dearth often frustrated me in quantitative research; the statistics we collect simply can’t manage to convey all the the complexity that exists beyond the page or computer screen. I’m a huge proponent of harnessing data for decision-making (as are IntraHealth and the Frontline Health Workers Coalition). But for messages to be communicated more effectively – meaning they are absorbed, understood, and acted upon – audiences need a fuller picture. Data provides the skeleton to an argument, but human experience fleshes it out to form a whole with which you can empathize.

It’s precisely this notion that drove IntraHealth and Medtronic’s collaboration to enrich dense policy dialogues with real, frontline perspectives. Specifically, we wanted to equip frontline health workers with the skills to present their experiences as a form of advocacy for improved health workforce conditions, at venues like SwitchPoint and beyond.

It’s striking to say that 400 million people around the world lack access to essential health services, or that the world will be short 18 million health workers by 2030. But these figures can be so daunting as to be virtually incomprehensible – what does a shortage of 18 million health workers really look like? Giving a face and personal story to these statistics breathes life and import into them.

Members of the storytelling project meet during the SwitchPoint conference in Saxapahaw, NC. Pictured: Michelle Korte (IntraHealth and FHWC), Vince Blaser, (FHWC), Albert Medina (Chicago Fire Department), Jeff Polish (The Monti), Shawn McKinney (Hennepin County Medical Center), Vania Almeida (Health Rise) Sanele Madela (Expectra 868 Health Solutions), Anne Katherine Wales (Medtronic Foundation). Photo by Cecilia Amaral for the FHWC.

Maria Valenzuela did just that at a Congressional briefing we organized in March. Experts from multilateral organizations began by presenting the facts of the global health workforce shortage. But it was only when Maria, a community health worker from Phoenix, Arizona, presented her personal narrative that the audience was moved to tears. I was so captivated myself that I almost forgot to scan the crowd; when I did, I noticed that her story of a tumultuous childhood and impassioned community service career had utterly enthralled the room of nearly 70 people – congressional staffers, health professionals, students and fellows, government officials, researchers, and more.

Maria’s story was the subject of audience comments amid lingering exchanges over empty breakfast plates. People could relate to the humanity in her tale – they could imagine themselves as the young child bouncing helplessly from foster home to foster home, or their own daughter who received community nutrition classes and was inspired to become a social worker rather than succumb to the negative influences around her. When you’re prompted to make this sort of connection through a compelling story, it sticks. You care. And ideally, when you pair this with an assessment of the facts, you’re moved to action.

Storytelling ultimately comes down to fostering empathy and establishing trust. Wouldn’t global health as an enterprise be immensely better served with a bigger dose of both of those qualities?

Yesterday at SwitchPoint, Albert Medina presented a moving tale of his 12-year career as a paramedic with the Chicago Fire Department. Over time he learned about the fatal consequences of the widespread lack of cardiopulmonary resuscitation (CPR) training among the community, and now he’s in conversation with his local alderman to institutionalize grassroots CPR training for community members.

Likewise, Vânia Soares de Oliveira e Almeida Pinto spoke of the importance of her patients’ backgrounds and hopes in their decisions to seek care. She now wants to incorporate storytelling techniques into training for medical students as well as patient therapy groups, because the trust to share stories and the willingness to listen to them would strengthen both the provider-patient relationship and the quality of services.

Moments like these here at SwitchPoint remind us just how powerful individuals, and their individual stories, can be. So today, the final day of SwitchPoint, we’re excited. We’re excited that these health workers feel empowered to utilize their stories to influence change in their hometown, their state, their country, and their world.

The project wasn’t meant to “give them a voice;” we’d be remiss to conclude they ever lacked voices in the first place. Rather, we wanted to provide them guidance on how to structure and present their personal stories to drive change. We wanted to seed their confidence to do so proactively, however they see fit according to their community’s needs and their own expertise. While their testimonies here at SwitchPoint may be the culmination of this project, their persisting place within local policy dialogues is the real gem of this undertaking.

As for Maria, the rockstar speaker at our Congressional briefing in March and on the SwitchPoint stage yesterday, soon she’ll be meeting with her Congresswoman’s office to further discuss her role as a community health worker and trusted conduit of community feedback. Maria had met with her representative’s office in Washington during her visit in March, after which the staff followed up with her directly, eager to engage with her in Phoenix to discuss ways to improve healthcare in the city’s varied communities. I suspect they sought to reconnect with Maria because they saw the authenticity in her eyes when she spoke her story; heard the passion in her voice when she described her job and her mission; believed her years of accumulated community experience when she decried the gaps in service provision that still remain. That’s the incredible power of storytelling.

And that’s why I’m here at SwitchPoint – to listen to and absorb the plethora of insights from the frontline experts around me. We’d all be wise, and humbled, to do the same.

From the frontlines of care: Q&A with Ugandan midwife Venny Musasizi

By Gillian Leitch, Jhpiego Uganda

At the 2017 Nurses and Midwives Symposium in Kampala, Uganda, I had the opportunity to speak with Venny Musasizi, an inspiring midwife working in one of the hardest to reach districts in Uganda. The symposium was co-hosted by Jhpiego, Seed Global Health, Peace Corps and Voluntary Service Overseas (VSO) and brought together more than 100 nurses and midwives from across Uganda as well as Ministry of Health officials, academic institutions and international donors.

Could you introduce yourself, and tell us a little about the health center and region where you work?

My name is Venny Musasizi and I have been a midwife for more than 18 years. I studied in Mutolere School of Nursing and Midwifery and trained in Mutolere Hospital. I currently work as a Registered Midwife in Mparo Health Center IV in Kabale District. Kabale is a mountainous district in south-western Uganda, along the border with Rwanda. Given the terrain, it can be difficult to get around in Kabale and many health facilities are located in remote areas, far off the main road. It has made it difficult for us to attract and retain highly qualified health care workers.

What initially inspired you to become a nurse/midwife and what continues to inspire you today?

I was inspired by my grandfather to become a midwife. My grandfather was a traditional birth attendant and he would allow me to watch him while he cared for mothers and delivered babies. I was always excited to see a pregnant woman come in and then leave with a happy, healthy baby. I was also encourage to become a health worker by my biology teach in secondary school. He helped me focus my studies and supported me to pursue a career related to science.

Venny and fellow midwife from Kabale demonstrate how to safely insert and remove contraceptive implants during the “Mini University” segment at the Nurses and Midwives Symposium. Photo by Gillian Leitch for Jhpiego Uganda.

What lessons have you learned through your work?

Some of the most important lessons that I have learned are about what leads to a successful delivery. First, antenatal care visits are incredibly important. If you encourage mothers to take up healthy practices early on in their pregnancy and ensure they stay healthy throughout, you will get good results at the time of delivery and postnatal. Additionally, it is very important to speak with women about engaging their husbands to ensure they have a safe delivery. I encourage all couples to come in before the birth to discuss and develop a birth plan. And lastly, a careful midwife leads to a successful delivery. If you are careful, you will have a successful delivery.

I’ve also learned about the power of women to carry on positive messages about health. I have seen this with family planning and HIV testing. Once a message is passed on to a mother, it is passed on to a nation.

Describe one of the greatest challenges of working as a nurse/midwife.

Unfortunately, the biggest challenge is that midwives are not appreciate for what we do. Despite all of the work that we do, we still lack the support. From the national level, to the district level, to the facility level, we do not get the same recognition as other health providers for the work that we do.

What advice would you give to nursing and midwifery students today?

I would advise nursing and midwifery students today to stick with the profession and take it to heart. While it may not be the highest paying profession, you are rewarded everyday doing the job by saving the lives of children and mothers.

The health needs of populations and communities are constantly evolving and new issues continue to arise. How do you stay up-to-date and aware of the latest technologies and innovations in the health sector?

I typically get information about updates in reproductive, maternal and newborn health practices from the implementing partners who we work with. Especially the organizations that are working closely with our facility, like Jhpiego and the Elizabeth Glaser Pediatric AIDS Foundation. They provide us with job aids, trainings and email updates.

How do you think nurses and midwives in Uganda could be better supported to provide quality health services to their communities?

Nurses and midwives should be supported more to continue their education once they are practicing. There should be more opportunities for them to go back to school to gain more knowledge and skills and be exposed to the latest approaches to health care delivery. Even in school, midwifery must be better prioritized and appreciated.

Meet four African Women on the Frontlines Fighting Malaria

By Spencer Crawford, ONE Campaign

Filumba, Judy, Bertha, and Sule are protecting their communities from the world’s deadliest animal — the mosquito.

They work for a US-funded project called Africa Indoor Residual Spraying (AIRS) that helps prevent malaria by spraying the walls of homes with insecticide. And thanks in part to their efforts, this program has protected over 54 million people from malaria.

Here is more about the work they do and why they do it.

Photo courtesy of Abt Associates.

Meet Filumba, pictured here with her son Richard. As a Team Leader, Filumba manages a team of seven spray operators in the Samfya District in Zambia.

In an interview with the AIRS team, she explains, “As a woman I have experienced what it is like to care for sick family members because of malaria. When I had my house sprayed, my problem was solved. So as a woman, I understand how to explain the benefits to people. Our strength comes from experience.”

And her perseverance has paid off: The income she’s earned from the project has enabled her son, Richard, to attend university.

Photo courtesy of Abt Associates.

Meet Judy, pictured here using her mobile phone that doubles as her bank account. Judy works as a Team Leader in the Mansa District, a neighboring district to Filumba’s.

A single mother of three children, she tells AIRS staff “the project has changed my life. I’ve built a house and sent my children to school with the money I’ve earned.”

“In the future, we don’t want children to be denied access to their rights like women were in the past. The world is recognizing that a woman has a role to play and there is nothing she can’t do.”

Photo courtesy of Abt Associates.

Meet Sule, a 20-year-old spray operator working in the Bunkpurugu District in Ghana, far from Ghana’s capital city of Accra.

Like Filumba, Sule says that being a spray operator is a hard job. She works for hours in the hot sun, wearing layers of protective clothing and gloves. Knowing that she is protecting people from getting sick keeps her motivated.

Photo courtesy of Abt Associates.

Meet Bertha, AIRS’ information, education and communications manager in Bunkpurugu District in Ghana.

She grew up in the district’s capital and speaks the local language, Moar, which is important because many people where she works cannot read.

Communicating in a language familiar with the community, she uses community meetings, radio talk shows and pictures to educate the community about indoor residual spraying.

 

Through strong treatment and prevention efforts – like what Filumba, Judy, Bertha, and Sule do – the world has cut malaria deaths in half since 2000. Still, this preventable and curable disease takes the lives of nearly 50 people every hour, most of whom are young children living in Africa.

We shouldn’t let the progress we’ve made stall now. Call your elected official today and ask him or her to #DefendAid.

Let’s celebrate nurses and midwives, the superheroes of our health system

By Emily Katarikawe, Jhpiego Uganda

Nurses like Jackline are the backbone of Uganda’s health system and play a critical role in improving health outcomes and the overall cost-effectiveness of care. Photo Courtesy of Jhpiego.

Step into a health center anywhere across Uganda and you’ll likely find a talented team of nurses and midwives, running around in pink and white uniforms delivering babies, providing immunization, treating injuries and helping patients manage illnesses. These health workers are the backbone of our hospitals and clinics, providing essential day-to-day care to keep our communities healthy. These positions are also overwhelmingly filled by women.

More than 80 per cent of nurses and midwives in Uganda are women, many of whom face extraordinary challenges which can prevent them from doing their jobs effectively. Female healthcare workers often have to deal with health facilities that are understaffed, clinics that lack adequate resources, gender inequities and the pressures of balancing additional familial and societal responsibilities.

Jackline K., a midwife working in Isingiro District, is one of these frontline health workers. For many years, her health center didn’t have proper equipment to resuscitate newborns who couldn’t breathe or even running water in the maternity ward.

Despite these challenges, she worked day in and day out serving her community and providing essential care to help mothers and their babies survive. Female health workers, like Jackline, are critical catalysts for countries like Uganda to reach our national health goals as well as the goals that we have agreed upon as an international community.

The Sustainable Development Goals rightly place women and girls at the center and emphasize how empowering women across all segments of the workforce is critical to ending poverty and improving health outcomes. Women today are playing a larger role in both the formal and informal economy and policies must be in place to support and protect them – policies that empower them as leaders and protect their roles and rights in the workplace.

The responsibilities women have, and the huge amounts of work that they do within their families and communities, often go unrecognized and undocumented. Women’s unpaid work – cooking, cleaning and childcare – is valued at $10 trillion annually. For female health workers, that unpaid work falls on shoulders that are already working more than 10 hours a day caring for patients.

Through my work with Jhpiego, an international non-profit health organisation affiliated with Johns Hopkins University, I’ve had the privilege of getting to know many incredible women, like Jackline in Isingiro, who work tirelessly to improve the health and wellbeing of all Ugandans. I’ve met nurses in health centers across the country serving as the only staff available to provide maternal, newborn, child and reproductive health services. I have met midwives who deliver newborns by the sole light from their small cellphones (katorch). These women inspire me every day with their dedication and perseverance.

Jhpiego is committed to supporting female health workers across the world to build sustainable health systems. We partner with ministries of health to ensure the most underserved communities access life-saving commodities and services. We work with the whole spectrum of the health workforce to build competency and confidence, and provide quality health services. We ensure nurses and midwives have the skills and resources needed to save lives in some of the most difficult and remote locations.

At Jackline’s health facility in Isingiro, we worked to help them procure lifesaving equipment, like resuscitation tables and water tanks, and organized skills building sessions for the nurses and midwives on infection prevention and obstetric and newborn care.

To all of the nurses and midwives in Uganda, many of whom are leaders in their workplace: I applaud you. You make critical, life-saving decisions every day. You make unreserved sacrifices, in challenging work environments. You go above and beyond to give newborns and laboring mothers a chance to thrive.

One of my jobs is to ensure that female health workers are empowered and have the skills needed to take on leadership positions within the broader health system. I believe that if we empower frontline health workers, we are empowering women who will be leaders in their workplaces, families and communities. Let us commit to investing in transformative innovations and applying our expertise to improve healthcare services and health outcomes in Uganda. Together, we are making a difference – a difference that wouldn’t be possible without female health workers.

This piece originally appeared in the Daily Monitor and can be accessed here.

Jhpiego Uganda, in partnership with Seed Global Health, Peace Corps and VSO, will be hosting symposium for nurses and midwives later this month, which will seek to update nurses and midwives on the latest national and global RMNCH service delivery approaches and innovations, and spotlight their exceptional contribution to Uganda’s health sector.

Advocacy to Honor Health Workers for the 5th Annual World Health Worker Week

By Vince Blaser, Frontline Health Workers Coalition

As Maria Valenzuela wound down her story, she held up a necklace with the pebbles from all of the low-income communities in Phoenix she serves, telling the spellbound Capitol Hill crowd she has taken those communities and their voices with her to Washington DC.

Maria has been working as a community health worker for more than 20 years, and her story told at a Congressional Briefing on Wednesday illustrated the universality of impact that frontline health workers have, whether it be in her community in Phoenix or those in Latin America and Africa her organization Esperança serves.

From left: Vince Blaser (director, Frontline Health Workers Coalition), Barbara Stilwell (senior director for health workforce solutions, IntraHealth International), Erick Zeballos (deputy director, International Labour Organization, Washington), Michelle Korte (Global Health Corps Fellow, IntraHealth International), Casper Edmonds (senior programme and operations officer, International Labour Organization), and Jean Damascène Butera (chief of party, Guinea, Abt Associates).

Five years ago, members of the Frontline Health Workers Coalition (FHWC), which I’m proud to lead, wanted to dedicate a time every year to honor and celebrate health workers, and the first week of April around World Health Day seemed the perfect fit. We worked with the Global Health Workforce Network and the World Health Organization, and World Health Worker Week was born.

Erick Zeballos (ILO), Barbara Stilwell (IntraHealth) and Vince Blaser (FHWC).

Health workers like Maria deserve our honor, our support, and our advocacy every day. This week is about them and the heroic work they do. But as organizers of this awareness week – we’re often asked who we are and how we contribute.

Last week’s Congressional Briefing is a perfect example of our work in action. With a new Congress and new Administration here in Washington, the onus looms large to inform policymakers of the tremendous impact frontline health workers have in saving millions of lives, ensuring security from infectious disease threats like Ebola, and enabling inclusive economic growth. The briefing – sponsored by FHWC, IntraHealth International, and Abt Associates – and subsequent meetings with key Congressional offices aimed to do just that.

The impact and huge return on investment of frontline health workers is plainly evident to any regular reader of stories from our member organizations in FHWC’s blog. That evidence is crystalizing into global, country-led action to address the most acute health workforce gaps via global Workforce 2030 Strategy, and the developing 5-year Action Plan of the High-Level Commission on Health Workforce and Economic Growth. Jim Campbell of the World Health Organization and Casper Edmonds of the International Labour Organization strongly underscored the momentum and cross-sector work to make it happen at last week’s briefing.

From left: Barbara Stilwell, Pape Gaye (president & CEO, IntraHealth International), Maria Valenzuela (community health worker, Esperança), Jim Campbell (director of health workforce, World Health Organization), Casper Edmonds, Jean Damascène Butera, and Vince Blaser.

The United States has played a decisive leadership role in the tremendous progress we’ve had in global health in the two decades. Damas Butera of Abt Associates and Barbara Stillwell of IntraHealth beautifully illustrated US leadership and investment in action – whether it be battling and recovering from Ebola in Guinea, jump starting a midwifery training program to drive down the world’s worst maternal death ratio in Afghanistan, or empowering faculty at a nursing school in northern Mali, who later defiantly build back their school after it was razed during an extremist insurgency.

For these stories and that success to continue, robust leadership and investment from the United States to catalyze global action is simply a must. The people at the center of that progress – health workers on the frontlines of care like Maria – must also be the center of policymakers agendas. Our recommendations for how the United States can do that utilizing existing investments are here.

As World Health Worker Week passes, the millions of frontline health workers will continue their heroic daily work. If we are to truly honor them, we must continue to tell our policy makers over and over #HealthWorkersCount.

For more on how to engage in World Health Worker Week and beyond, visit https://www.frontlinehealthworkers.org/worldhealthworkerweek/.

 

 

Tanzania’s New Task Sharing Policy Puts Social Service Workers on the Frontlines of HIV/AIDS Care

By Ronald Nakaka and Kathryn Utan, American International Health Alliance (AIHA)

Stellah Kihombo provides social support services out of a small municipal office in Chanika ward, which is situated about 13 miles outside of Tanzania’s business capital of Dar es Salaam. The 34-year-old social worker serves her own community, along with eight neighboring villages within the ward. In each village, there is a para social worker — a community volunteer who has been trained to provide basic social welfare services at the household level — working under Stellah’s close supervision and mentorship.

As Tanzania looks to task sharing as a way to improve access to much-needed health and social support services, social service workers like Stellah Kihombo (left) play a crucial role in identifying people in need, providing psycho-social support, and linkages to crucial HIV/AIDS prevention, care, and treatment services for high-risk populations across the country. Courtesy AIHA.

“About five months ago, I received a call from one of the para social workers regarding a 16-year-old girl in need of an urgent intervention,” Stellah recounts. “The young girl exhibited what constituted risky behaviors that put her in danger of not only contracting HIV, but also going on to infect multiple people,” Stellah said, explaining that upon counseling the girl, she learned more about her circumstances.

“The girl was in a highly vulnerable situation because she had been a victim of rape at the delicate age of six. She lived in a poverty stricken, broken family and had experienced prolonged abuse,” Stellah said, noting that the girl was now engaged in commercial sex work and had dropped out of school.

“I provided psycho-social support to the girl, encouraged her to get tested for HIV, and referred her to a nearby health facility where she could receive more comprehensive care, including preventive care and other screening or treatment services,” Stellah explains. “I also linked her to a community-based organization that empowers young women to engage in dignified and sustainable livelihoods through training in tailoring and entrepreneurship,” she says, noting that she continues to work closely with the village parasocial worker to provide support to the young girl.

“She no longer lives as a sex worker,” Stellah reports happily.

In Tanzania, social service workers like Stellah have officially moved to the frontlines of the country’s war against HIV/AIDS thanks to a new task sharing policy launched in 2016.

Task sharing is a critical mechanism helping Tanzania achieve the UNAIDS 90-90-90 targets of getting 90% of all of people living with HIV aware of their status, 90% of those diagnosed on sustained antiretroviral  treatment, and 90% of those on treatment maintaining durable viral suppression by 2020. It also supports the goals of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to achieve an AIDS-free generation.

The American International Health Alliance (AIHA) supported the roll out of a training program for social workers from more than 40 districts with high HIV/AIDS burden across Tanzania. The training helped these critical frontline caregivers develop unique competencies needed to provide client-friendly, stigma-free services to key populations, including female sex workers. It also provided useful strategies for effectively identifying and reaching out to female sex workers and other key populations.

Stellah reports that many barriers exist for at-risk populations looking to access HIV/AIDS services, including stigma and discrimination in the community and unfriendly political environment.

“I continue to educate my community, starting with village leaders, as a way to raise awareness and break down these barriers,” Stellah says. “I attended AIHA’s Comprehensive HIV/AIDS Services for Key Populations training program in February 2016. The training has made me a role model in my community, where I have received many invitations to share my knowledge about HIV/AIDS, gender-based violence, and child protection through various social spaces and platforms, including local churches,” she explains.

AIHA’s national-level work to strengthen Tanzania’s social work and nursing cadres — both critical to Tanzania’s task sharing strategy — is supported by the American people with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC), Tanzania. Both projects are implemented through AIHA’s HIV/AIDS Twinning Center Program, which is funded through a cooperative agreement with the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA).

From “Non” to “Oui”: How Community Health Workers are Revolutionizing Contraceptive Access, Use in Benin

By Tishina Okegbe, FHI360 and Nancy Pendarvis Harris, JSI

Benin  — a beautiful, small, Francophone West African country with 11 million inhabitants – has a history of low family planning use due in part to conservative cultural and social norms. With a current unmet need for family planning of 36.3%, and a contraceptive prevalence rate (CPR) for modern methods of 16.1%, Benin lags behind its sub-Saharan African peers in key reproductive health indicators.

Sources: Track20, Avenir Health (analysis); 2011 Benin Demographic and Health Survey

Usually, a combination of factors prevents women from seeking family planning services. Many women are geographically distant from traditional health facilities and providers. Many are unaware or misinformed of the benefits of contraceptives. Deeply ingrained cultural norms may prohibit them from seeking contraceptive services.

At the 2013 International Family Planning Conference in Addis Ababa, the Government of Benin pledged to increase its modern-method CPR from 7.9% in 2012 to 20% by 2018. In 2016, the Ministry of Health and the USAID-supported Advancing Partners & Communities (APC) project piloted a community-based access to injectables program in a rural municipality of approximately 80,000 people. Over the nine-month implementation of the program, 24 community health workers (CHWs) were trained to deliver Noristerat, a two-month, progestin-only injectable contraceptive. In a short period of time, more than 450 women received services and adopted Noristerat.

The pilot’s strategy reduced the burden on already overstretched higher-level service providers at health facilities, and leveraged CHWs by training them to provide information and contraceptives to women in communities where sexual and reproductive health services are hard to access, if they exist at all. CHWs can meet women in their homes to provide accurate information, counseling, and contraceptives. This intimate service provision allows women and men to decide for themselves, perhaps for the first time, the number, timing, and spacing of their children.

Relais communaitaire practicing a Sayana Press injection during training. Courtesy of JSI.

Today, Benin is preparing to introduce Sayana® Press, a new contraceptive delivery system that will expand the available method mix. Manufactured by Pfizer, Sayana Press has the potential to revolutionize community-based family planning. A small, prefilled, three-month progestin-only injectable contraceptive, Sayana Press is easy to use by lay health workers and, if properly trained to self-inject, by clients themselves. In collaboration with the Benin Ministry of Health and partners UNFPA, the Beninese Association for Family Planning, the URC-implemented Advancing Newborn, Child and Reproductive Health project, and PSI affiliate ABMS (Association Beninoise pour le Marketing Social), the APC project will train 1,000 relais communautaires, who are the lowest level cadre of CHW in Benin, to deliver Sayana® Press in communities in 10 health zones, covering nearly a third of the country. This high-impact practice is expected to increase access to and use of family planning, thus contributing to Benin’s goal of increased contraceptive prevalence.

Are these advances significant? Absolutely. Nearly 225 million women around the world lack access to modern methods of contraception to delay or avoid pregnancy. Furthermore, complications during pregnancy and childbirth, as well as unsafe abortions, contribute to approximately 300,000 maternal deaths each year. Easily accessible contraception is critical to stem the tide of unintended pregnancies, which contribute to poor maternal, newborn, and child health outcomes. And providing contraceptive and other services in communities gives women, youth, and couples an important chance to meet their reproductive needs.

To learn more about CBA2I in Benin or the APC project, please visit https://www.advancingpartners.org/.