By Bianka Patsalos-Fox, Touch Foundation

This story was originally published on the Touch Foundation blog on October 20 2017.

Dr. Harusha Simplice is the only obstetrician-gynecologist at Sengerema Designated District Hospital, serving over 700,000 people. After becoming a general practitioner Dr. Harusha secured his specialist training through Touch’s Treat & Train program, which improves medical education and patient care in the Lake Zone.

A Burundian refugee forced to flee to Tanzania as a teenager, Dr. Harusha Simplice always knew he wanted to be a physician. According to his mother, at the ripe age of two he used to comfort his friends and family by reassuring them that one day he would be a doctor. His father also wanted to be a doctor, but he was never able to practice as he died in an accident two months after graduating from medical school. When Dr. Harusha was in his final year of schooling his mother was diagnosed with cervical cancer and died just a year later. It was his mother’s death that cemented his desire to help women and strive to one day become an obstetrician-gynecologist.

After graduating, Dr. Harusha began practicing medicine at Sengerema Designated District Hospital. Five years later, Dr. Harusha, now a father of two boys with another one on the way, decided he needed to find a way to receive specialized training to become an obstetrician-gynecologist and pursue his aspiration of helping women. At this point Dr. Harusha encountered Touch Foundation, just as we were in the process of expanding our Treat & Train program to Sengerema Designated District Hospital. Through Dr. Harusha’s perseverance and partnership with Touch, he was able to receive the education required to specialize in Obstetrics and Gynecology.

Today, Dr. Harusha is the only trained OBGYN at Sengerema Designated District Hospital. This 300-bed hospital serves over 700,000 people and delivers about 25-30 babies per day. For Dr. Harusha, it is not uncommon to attend to multiple women giving birth in the same room with the help of just two nurses. In fact, in Tanzania the shortage of healthcare workers is a main contributor to the high maternal death rate.

In early October, Dr. Harusha completed a training held by our partner MeduProf-S on SonoSite ultrasound machines in order to perform heart disease and obstetric ultrasound screenings during maternity checkups. For all of the clinicians present at the training, this was their first experience with an ultrasound machine. In the United States, women usually receive an initial screening at the beginning of their pregnancies to confirm a viable pregnancy. Most women in the United States will receive numerous ultrasounds throughout a pregnancy, and at least 1 anatomy screening at 20 weeks to ensure healthy development. Most Tanzanian women have never received an ultrasound screening during their pregnancy, but this is changing as women are increasingly requesting them and the technology is becoming more widely available. Dr. Harusha’s training, and others like it, will not only give women access to ultrasounds to ensure the health of their developing babies, but will also screen them for any heart anomalies, which can go undiagnosed until delivery, putting the mother at risk during labor. Following the training, the SonoSite ultrasound machine installed at Sengerema hospital, and three additional machines were installed in other high-risk area health centers.

Dr. Harusha truly believes in the sustainability of the unique education model of Touch’s Treat & Train program. He continues to learn new skills which are valuable for him and also valuable to the medical students he is training and to the women he is attending to. For Dr. Harusha, continuing his education and partnership with Touch empowers him to achieve his goal of saving the lives of women and children.

Advocating for Health Workers: Interview with Vince Blaser

By Daisy Winner, Seed Global Health

This interview was originally published by Seed Global Health on October 18th 2017.

Health workers are the backbone of strong health systems and thriving communities. Yet by 2030, there will the world will face a shortage up 18 million providers – hurting primarily those in low- & middle-income countries. That means mothers will go without necessary care, newborns will go without the assistance often needed to take their first breath of life, and countless patients will forgo the quality nursing and medical care they need and deserve.

Vince Blaser is the Director of the Frontline Health Workers Coalition (FHWC), an alliance of organizations working together to urge greater and more strategic U.S. investment in frontline health workers in developing countries as a cost-effective way to save lives and foster a healthier, safer and more prosperous world. Seed Global Health is a proud member of FHWC, adding a point-of-view that investments in doctors, nurses, an midwives can create a positive ripple effect across entire health systems and nations.

Seed Global Health Director of Communications, Zack Langway, interviewed Mr. Blaser about the role of the FHWC and why it’s mission is more important today than ever before.

Zack Langway (ZL): Thanks for taking time to chat with us, Vince. The Frontline Health Workers Coalition represents a wealth of experience and expertise in improving health around the world. What is the role of the organization in strengthening the global health workforce, and how do you accomplish that?

Vince Blaser (VB): The Frontline Health Workers Coalition harnesses the collective expertise, experiences, and voice of public and private U.S.-based organizations, outside of government, to advocate for greater and more strategic US and global investment in frontline health workers in low- and middle-income countries.

We do this by hosting regular coalition meetings to brainstorm and execute joint advocacy activities, implementing education and advocacy outreach to U.S. and global policy makers and influencers, developing policy analyses and recommendations, and conducting communications activities to highlight the amazing impact of frontline health workers and the political imperative to support them.

ZL: Why is the need for health workers so urgent, and how does training and teaching play a role in meeting that urgent need?

VB: Throughout our lives, health workers are central to our health and prosperity. Yet more than 400 million people lack access to the essential services provided by health workers on the frontlines of care. This lack of access to frontline health workers is a central reason millions of children die before they reach age 5, that hundreds of thousands of women die in childbirth, and millions die of diseases and conditions that could have otherwise been prevented by the presence of a trained and supported health worker. Health workforce shortages not only affect the communities that lack access, it threatens the entire world – as we saw from the spread of Ebola in West Africa.

Central to increasing communities’ access to frontline health workers is ensuring health workers have the training and educational support needed to perform their jobs. This holds true both for the training and education aspiring health workers receive, as well as in-service training and education of existing health workers.

ZL: Where can advocacy make a difference, and how are health workers themselves engaging as advocates for a stronger workforce?

VB: Advocacy can make a difference in every single community, every single country, and in every single region. As a result of advocacy efforts, ensuring a robust, fit-for-purpose health workforce is enshrined as a target in the Sustainable Development Goals, the first-ever Global Strategy on Human Resources for Health: Workforce 2030, and the five-year action plan of the UN Secretary-General’s High-Level Commission on Health Employment and Economic Growth (HEEG Commission).

These advocacy wins will only result in sustainable change if advocates around the world push from the community to global levels of effective implementation of goals and strategies to achieve these ambitious yet achievable targets for the health workforce. Frontline health workers themselves are the most powerful advocates for effective implementation, as their direct experience sheds the greatest light on the need for greater and more effective investment in their work.

ZL: What are the major “moments” on your radar where you’re hoping to see progress — announcements, commitments, data indicating some success in closing the gap — in human resources for health?

VB: The forthcoming Fourth Global Forum on Human Resources for Health in Dublin, Ireland this November will be a seminal moment for health workforce experts around the world to come together to assess the state of the global health workforce and initial progress and planning on some of the goals and compacts I mentioned earlier. We are hoping the five-year action plan of the HEEG Commission I mentioned earlier will result in firm commitments by both government and non-government stakeholders for financing country-led plans to address the most acute issues facing their health workforce.

As FHWC has underscored in a policy analysis, we are also hoping that collection of data for all health worker cadres – including community health workers – is urgently prioritized, especially in forthcoming WHO guidelines on community health workers.

ZL: Where have efforts to bolster the health workforce failed so far, and what can we do differently in the SDGs framework than we did in the MDGs framework to improve outcomes in strengthening health workers?

VB: Ensuring a fit-for-purpose and sustainable health workforce is a complex issue involving education, poverty, labor, mobility, access to proper supplies etc. The financing and jurisdiction over health workers is equally, if not more, complex. This complexity has at times left health workers as somewhat of an afterthought even though policymakers and influencers have often agreed about the urgent need for action to strengthen the global health workforce.

The SDGs and compacts unanimously agreed to at the World Health Assembly provide a strong, country-led framework that put strengthening the health workforce as a central component of achieving progress across all health issues. This provides some momentum and optimism that health workers will no longer be seen as a global health policy afterthought but rather the center of sustainable progress on health in the coming decades.

Orthopedic surgeon recounts dangers, impact of working in war-zones and natural disasters

By Crystal Wells, Roving Communications Officer, International Medical Corps

photo courtesy of International Medical Corps

Dr. Santhosh Kumar was in the operating theater, a patient intubated on the table in front of him, when the earthquake hit. It rattled cupboards and shelves to the ground. People screamed and ran out of the building, but he and the anesthetist held their ground.

“All of a sudden the operating theater was empty,” Dr. Kumar said. “I had an intense urge to run. I looked up and saw my anesthetist standing there, holding the ambu-bag (manual ventilator) in his hand. Of course he had to stay—he was holding  a life on that bag. I was still holding the screw driver.”

Dr. Kumar and the anesthetist finished the surgery, which was for a fracture thigh-bone, as a two-person team as aftershocks jolted the room around them. “We thought of running,” Dr. Kumar said. “We talked about it, but we don’t have a habit of going away from a surgery before we finish it. All through my career I was taught you don’t take your gloves off until you finish the surgery.”

Dr. Kumar was in Nepal as part of International Medical Corps’ emergency response team to the devastating 7.8-magnitude earthquake that devastated the country on April 25. Based in Thiruvananthapuram, a city in southern India, Dr. Kumar deployed to Kathmandu the same day the earthquake hit and was on the ground the very next day, working around the clock to establish International Medical Corps’ search-and-rescue and emergency medical teams in some of the hardest hit areas.

Hundreds of aftershocks followed the main earthquake—including one clocking 7.3 in magnitude. Dr. Kumar was in a Kathmandu hotel with other International Medical Corps colleagues when it hit. This time, he ran outside. “I called the anesthetist to see if he was OK, and he was with his family in an open area outside his house,” Dr. Kumar said. “The fact that we both did not run out of the operating theater is not a heroic act, but rather the product of years of practice to finish the surgeries you start.”

An orthopedic surgeon, Dr. Kumar has responded to conflicts and natural disasters the world over, from Nepal to Haiti, Nigeria, Somalia, and Syria. Dr. Kumar was first introduced to humanitarian work as a medical student in 1993 when he volunteered in the aftermath of an earthquake in Latur district in central India. “I became fascinated with disaster medicine,” he said. “I thought, ‘I would like to do this work if I become a doctor.’”

He first started working with International Medical Corps in 2011 at the height of the civil war in Libya. Over the next six months, he worked in field hospitals, caring for trauma injuries, from Benghazi to Misrata, Tripoli, and Sirte as the frontlines of the conflict moved, work that was made possible with support from the U.S. Agency for International Development’s Office of U.S. Foreign Disaster Assistance.

As he operated on people injured in the war, he trained field hospital staff in orthopedic surgery techniques. He was also part of the first emergency response team to reach Tripoli when the city was under siege. Dr. Kumar and the International Medical Corps team worked around-the-clock to reopen a hospital that had been shuttered by the conflict, restoring care to thousands of Libyans.

“Bullet injuries to the bones are totally different than other orthopedic injuries,” he said. “When a bullet hits a bone, it shatters it into a lot of pieces, which will be really inside the flesh. The bone can’t be reconstructed [from these pieces], so we have to take bones from other places to reconstruct it.”

Other deployments, like to remote corners of South Sudan in 2013, required Dr. Kumar to use old orthopedic surgery techniques because even basic instruments and equipment were not available. Following cyclones, like the ones that hit the Pacific island country of Vanuatu and Orissa, India, in 2013, most of the medical needs are not orthopedic, demanding Dr. Kumar to focus on delivering primary health care services to survivors, rather than providing surgery.  

“In disasters, you need to be extremely flexible and open-minded,” Dr. Kumar said. “You might be an expert in a certain discipline, but survivors should be our primary objective. We need to improvise and mold our knowledge and skills to suit their priorities.”

When at home in Kerala, Dr. Kumar works as assistant professor in orthopedics and deputy superintendent of a 3,000-bed government medical college teaches at a university, a position that he hopes will help inspire the next generation of medical first responders. “Despite what people think, this work is not as dangerous as it sounds. I might be more likely to die in a road traffic accident at home than in a war or disaster—and the impact I can have far outweighs the risks I face in the field.”

To Achieve SDGs, Grow Economies, We Must Invest in the Frontline Health Workforce

By Vince Blaser, Frontline Health Workers Coalition

Four years ago, ahead of the world’s last major forum to touch on the health workforce, advocates gathered at the United Nations General Assembly (UNGA) to plead for a global consensus on how to ensure the world has the health workforce it needs to achieve a compact now known as the Sustainable Development Goals (SDGs).

Thanks in part to those advocates, many of whom returned to New York last week for UNGA, that consensus is now firmly enshrined in the form of SDG targets 3.C and 3.8, the first-ever Global Strategy on Human Resources for Health: Workforce 2030, and the Five-Year Action Plan of the UN Commission on Health Employment and Economic Growth (HEEG Commission). All of these compacts were approved without objection by UN and World Health Organization member states in the last two years.

The consensus – beautifully captured in this video – stirred the emotions of young Iraqi surgeon Dr. Saja Al-Falahi, who told her own captivating story to kick off a UNGA side event on how to finance the frontline health workforce in low- and middle-income countries. The event was sponsored by the Frontline Health Workers Coalition and our members Touch Foundation, ALIMA, FHI 360, IntraHealth International, Jhpiego, Johnson & Johnson, Medtronic Foundation, and Seed Global Health, along with the Global Health Workforce Network. 

The early consensus that emerged: several funding streams need to work in tandem and build off each other, backed by a continually refreshed data set on health workforce availability and accessibility.

WHO Health Workforce Director Jim Campbell laid out the evidence. A 2017 analysis published in The Lancet estimated that $41-$57 must be spent per person, per year on health by 2030 to achieve SDG 3 in 67 low- and middle-income countries. This investment – as the HEEG Commission found – could provide a 9:1 return on investment, catalyzing global economic growth. The dividend for this investment would be felt especially by women, who make up more than 70% of the global health and social service workforce, compared with less than 40% across all employment sectors.

The potential power of investing in health workers for women was underscored when Hon. Dr. Jean Kalilani, Minister of Gender, Children, Disability, and Social Welfare in Malawi, outlined Malawi’s first National Community Health Strategy – which aims to channel its investment in the health workforce to the front lines in rural and underserved communities where access to health services is hardest to come by.

USAID’s efforts across global health programming are exploring innovative ways to spur greater and more strategic investment in the frontline health workforce. USAID Acting Assistant Administrator for Global Health Irene Koek outlined the agency’s strategy at last week’s event. Frontline Health Workers Coalition members shared several of their own innovations – many of which are supported by the US government – to bolster domestic, private, and philanthropic sources of health workforce funding.

As health workforce advocates, practitioners, policymakers, and thought leaders head to the Fourth Global Forum on Human Resources for Health in Dublin, Ireland, November 13-17, the framework of health workforce plans by all nations, backed by the data they need for better decision making, provides a concrete path forward to ensure healthy and more prosperous communities around the world.

However, as it became patently clear in New York last week, we need to continue to push hard across all sectors and in all countries to procure the upfront investment, and to get it where it’s needed most.

Strengthening the Health Workforce to Achieve the SDGs

By Daisy Winner, Seed Global Health

Established in 2015, the Sustainable Development Goals (SDGs) were adopted by all member countries of the United Nations focused on ending poverty, protecting the planet, and ensuring prosperity for all as part of a new sustainable development agenda. Each goal has specific targets to be achieved over the next 15 years

SDG 3 seeks to ensure health and well-being for all, at every stage of life. Immense strides have been made in improving health around the world. Since 1990, there has been an over 50% decline in preventable child deaths globally. Maternal mortality also fell by 45% worldwide. New HIV/AIDS infections fell by 30% between 2000 and 2013, and over 6.2 million lives were saved from malaria.

Despite this progress, there is still a long way to go. To avoid preventable deaths, reduce maternal mortality, decrease HIV/AIDS prevalence, and achieve SDG 3 a robust, qualified, and motivated health workforce is essential. The health workforce plays a critical role in the resilience of health systems to respond to crisis and overcome health challenges.

However, the shortage of health workers is growing and is projected to more than 18 million by 2030. The World Health Organization estimates that the 4.45 health workers per 1000 people are needed to achieve universal health coverage.

Last week, thousands gathered in New York City for the United Nations General Assembly. Bringing together diplomats, political leaders, NGOs, academics, students, and other stakeholders, the week motivated discussion on what needs to be done to achieve the goals by 2030 in parallel with the UN General Assembly.

But we need more than discussion – we need action. In the months and years ahead, it’s essential for policy makers and civil society to prioritize strengthening the health workforce if we are to reach the goals set for 2030. A health system is only as strong as its frontline health workforce. As leaders conclude their time in New York and return to our home cities, countries, organizations, and institutions, we must all continue our investment in and advocacy for the health workers that are saving lives around the world.

Pandemic Preparedness: African Solutions to Global Problems

Written by Clement Jaidzeka

Ebola has a case fatality rate of approximately 50 to 70 percent. Although it has been more than 40 years since the first-ever case of the Ebola virus in humans was diagnosed, there is still no licensed, specific treatment for the disease. The 2014 Ebola outbreak in West Africa took the lives of thousands, left many children without one or both of their parents, and devastated health-care systems which were already reeling from a dearth of medical professionals.

Across Africa, limited capacity to harness and deploy technologies in key areas such as health, agriculture, and industrial development exacerbates the socioeconomic challenges posed by such outbreaks. For instance, during this outbreak, samples collected from patients in Guinea had to be flown to either South Africa or Senegal to be tested because Guinea did not have any laboratories with the capacity to accurately test for the Ebola virus. While this is understandable given the competing priorities for the resource-strapped governments of Guinea, Liberia, and Sierra Leone, including food insecurity, maternal and child deaths, lack of safe drinking water, and more well-known infectious diseases such as malaria, these limits in capacity can seriously hinder pandemic response.

When the World Health Organization (WHO) declared this outbreak a public health emergency of international concern, naturally the WHO turned to familiar physicians and researchers who responded to previous outbreaks in different parts of the world. But about 5,000 miles east of Guinea, in Democratic Republic of the Congo and Uganda, were hundreds of local experts who had been involved in stopping several Ebola outbreaks from going beyond local villages. Most had even been trained at the Centers for Disease Control and Prevention (CDC) field epidemiology programs across the continent. At the outset of this outbreak, however, the WHO did not immediately turn to these local experts as the first line of response. Additionally, in far-flung cities in Europe and the United States, there were thousands of trained physicians originally from the affected countries of Guinea, Liberia, and Sierra Leone who had practiced medicine there before emigrating. They were not looked to either as a source of local experience and expertise to help fight the outbreak. On the contrary, as many of them were not practicing as physicians in their adopted countries, they didn’t meet the WHO requirements to go back and help in their home countries even though many wanted to.

Eventually the international community started to mobilize African expertise from the affected countries as well as from all over the continent, such as Democratic Republic of the Congo, Uganda, Cameroon, and Mali, but this happened after the outbreak was already out of control; too late for these doctors to make a significant difference.

To prevent such a situation from happening again, there are four major steps that could be taken continent-wide to ensure preparedness against outbreaks in the future.

Convene African experts and institutions on emergency preparedness

Now in its third iteration, the African Conference on Emerging Infectious Diseases and Biosecurity was founded to bring together experts in the field of infectious diseases, from pathologists to government administrators; as well as specialists in other relevant fields, from bioinformatics to community engagement. Under the leadership of the Global Emerging Pathogens Treatment Consortium (GET), the goal is to share experiences on preparedness and health systems strengthening, collaborate on research, and build collective, continent-wide capacity. This will allow better cooperation among countries in times of need, make it easier to identify experts to call on, and contribute to preventing such outbreaks from ever happening again. To improve collaboration beyond the annual conference and in response to the ongoing menace of endemic Lassa hemorrhagic fever, several African academic institutions, civil society organizations, and their international collaborators came together to form a coalition. This coalition, whose research mandate was conceptualized by GET at the 2016 conference in Lagos, has emerged into the African Biosafety and Genomics Network or ABG-Net. Supporting and expanding these kinds of platforms are crucial to allow stakeholders to showcase their research and improve the readiness of African countries to deal with major disease outbreaks.

Organize regionally to pool health expertise and resources

By taking a regional approach to preparedness, African countries could more effectively prepare for and fight outbreaks of emerging and re-emerging infectious diseases. African countries have already self-organized into regional economic and political communities such as the Economic Community of West African States (ECOWAS), the Economic Community of Central African States (ECCAS), and the Common Market for Eastern and Southern Africa (COMESA). Due to huge operational costs, it’s unrealistic to expect Guinea, Liberia, or Sierra Leone to each have level 3 biosafety containment laboratories like the ones the CDC has in Atlanta, which can house and treat patients with hemorrhagic fevers like Ebola or other infectious diseases with the potential to cause international chaos. However, the 15 member countries of ECOWAS have a combined gross domestic product (GDP) of 1.3 trillion dollars, and the 11 member countries of ECCAS have a combined GDP of 735 billion dollars. Organizing regionally and combining resources would allow for a regional laboratory system in which one country houses a high-level biosafety containment laboratory while the other countries strengthen existing laboratories to test for other less dangerous, more common diseases. One state-of-the-art laboratory per region might not be enough, but it is a step in the right direction. This will also allow regional experts to work together more closely, and improve readiness by consulting and sharing knowledge.

Divide and conquer to research and tackle diseases

While the regions above have many diseases in common, there is regional variation in the prevalence of re-emerging diseases. The Ebola zone was confined to Central Africa (Democratic Republic of the Congo, Angola, and Uganda), until the 2014 Ebola outbreak in West Africa. Similarly, most cases of Lassa fever and Dengue fever are in West Africa (like Nigeria and Togo). Regions could focus on diseases most prevalent in their area to foster specialized expertise in research and development on particular diseases, becoming hubs to share across the continent while similarly receiving expertise from other regional hubs. This would maximize the limited resources available.

Close the health information gap between experts and the local population

The gap in health information communication is huge across most of Africa. In major U.S. cities, there are often public health posters in frequently trafficked areas warning about the flu or HIV/AIDS, with directions to a website or phone number for more information. Health campaigns use similar methods in Africa, as most health information is shared in the form of flyers and posters. Yet this usually takes place during vaccination campaigns or other annual health drives, with little follow-up. Developing African strategies to share health information, which could take advantage of the popularity of social media and mobile phone applications such as WhatsApp, would go a long way in letting local people know that experts and resources are available and how to seek them out. This should go beyond just alerting the population about outbreaks, to include sharing basic hygiene reminders with people, especially those in rural areas, more often and more consistently.

Hopefully there will never be a similar outbreak of Ebola or any infectious disease across the continent again. However if there is one, the continent will have African-led organizations that can quickly mobilize local expertise to respond, before calling on outside experts as reinforcements.

Clement Jaidzeka is an associate in Chemonics’ Global Health Division and a co-chair of the emerging infectious diseases sub-faculty within the Global Emerging Pathogens Treatment Consortium (GET).

Improving Health Services and Facilities through WASH

By Lisa Bos, World Vision

In 2015, the World Health Organization (WHO) and UNICEF released the first multi-country review of water, sanitation and hygiene (WASH) access in health facilities.  The report looked at 54 low- and middle-income countries.  The results were staggering.

According to the report, 1 in 3 health facilities in low-resource settings do not have any access to water at all. When the reliability, safety, and distance of the water supply is taken into account, that ratio increases to 1 in 2.  Nearly 1 in 5 facilities do not have toilets, and more than 1 in 3 do not have soap for handwashing.

Adequate water, sanitation, and hygiene are essential for frontline health workers to provide basic health services. WASH helps prevent infections and the spread of disease, protects staff and patients, and ensures the dignity of those who are vulnerable including pregnant women and those with disabilities. Yet, an unacceptable number of health facilities have massive gaps in WASH access. 

As a result of the findings of their report in 2015, WHO and UNICEF launched a global action plan to ensure that all health facilities in all settings have adequate water, sanitation, and hygiene services by 2030. They launched global task teams established to drive progress in four main areas: advocacy, leadership and policy; monitoring; evidence; and facility-based improvements. Advocacy is often left out of conversations on how to improve health facilities, yet it can be a great driver of change in communities.

Dr. David Mayengo, a doctor at Ntwetwe Health Center IV in Kiboga Cluster, Uganda, has stayed in his community in part because of how advocacy led to improved health services. When he arrived at the health center, there was no power or water. “We cried out through advocacy,” he says. 

And things improved. Through a partnership with the Ugandan government and World Vision, new latrines and a water system were built. Not only have these improvements led to better health outcomes but patients and staff are happier. “Mothers have a better experience here. The hospital is well staffed with 49 professionals. It’s like a different world,” shared Dr. Mayengo.

Having satisfied patients and staff is a key indicator of a well-run and strong health system.  By improving access to WASH, through advocacy and other means, both can be achieved.

Health clinic latrines and water put in by World Vision at Ntwetwe Health Center IV, next to the old system on the left.
Photo Credit – Jon Warren, World Vision, 2016

Happy Birthday! Online library of mHealth Training Materials ORB Turns Two.

By Alex Kellerstrass, mPowering Frontline Health Workers

Photo courtesy of mPowering Frontline Health Workers.

In the summer of 2015, the mPowering Frontline Health Workers partnership launched ORB an online library of mobile health worker training materials, along with support from their network of partners. The rising temperatures of another Washington D.C. summer marks the second birthday of ORB and this milestone serves as an opportunity to reflect on how the online library has grown over these last two years.

ORB launched with a robust platform made up of several health domains including family planning, prenatal/antenatal care, newborn care, labor and delivery, and nutrition. mPowering immediately began an advocacy campaign throughout their global network promoting the open-licensed sharing of content—specifically through the use of Creative Commons Licensing—urging others to share their existing training materials on the platform.

mPowering worked with partners including Medical Aid Films, Digital Campus, Johns Hopkins Center for Communications Programs and many others to adapt and disseminate content on the ORB platform—extending the reach of existing materials for use on community, regional, national or global levels. ORB’s foundation is grounded in several of the UN’s Sustainable Development Goals (SDGs) as it promotes quality education, partnership through content sharing, and improved health. In advocating for ORB, the message became two-fold: promoting the open-license sharing of materials as well as the benefits of using mobile learning tools in training.

All ORB content is not only open-licensed, but also mobile-optimized—meaning the materials are suitable for viewing on mobile devices such as a tablets, laptops, smart phones or feature phones. mPowering has worked with several content creators to facilitate the adaptation of materials to a mobile-ready format. Through these and other collaborations, ORB content has been used in nurse training programs in Zambia, midwife training in Nigeria, and continues to be integrated into mPowering’s country program and advocacy initiatives in Uganda, Pakistan, Sierra Leone and the Latin America and the Caribbean region.

As ORB turns 2 years old, it looks a little different than it did in the summer of 2015. The site is now completely translatable into Spanish. The platform has expanded to include two additional health domains with Zika and WASH materials, there are resources in 44 languages, and is accessed in 155 countries. mPowering has continued to add new features to streamline users’ ability to search and upload content to the site and future plans include additional features that would allow users to build simple exportable courses with ORB materials.

mPowering is committed to using ORB as a tool to train more health workers in an effort to end preventable maternal and child deaths. Frontline health workers are often relied upon for so much within the communities they serve. Supporting ORB through sharing content and using ORB materials in training programs is in turn supporting health workers and those communities they serve. As we look toward the year ahead, mPowering will continue to build ORB and advocate for the goals and principles that formed its foundation. We hope you’ll join us in this effort.

USAID’S Maternal and Child Survival Program serves as mPowering’s secretariat. mPowering is a public private partnership focused on mobile training for frontline health workers. Learn more at

The story of Allan Joel and his drive to save lives in the operating room

This story originally appeared on Touch Foundation’s news blog.

Five billion people live without access to safe, affordable surgical and anesthesia care. These operating room services are crucial to treating people with cardiovascular conditions, bone fractures, pregnancy complications, and many other health issues. If these services are inaccessible it can lead to an avoidable disability or premature death. This situation is far too common in Tanzania where surgical and anesthesia care is lacking and the country is facing a large shortage of health workers with the needed skills.

Photo courtesy of Touch Foundation.

Allan Joel is an ambitious 29-year-old nurse anesthetist trained to meet all of a patient’s anesthesia needs before, during and after surgery or the delivery of a baby. Allan developed a passion for medicine in 1989, the year his father was diagnosed with diabetes. He witnessed his father suffer from inadequate medical care and decided at a young age to pursue nursing so that he could help his father and others in need. After graduating from nursing school, he applied for a nurse midwifery position at Sengerema Hospital, a 325-bed rural hospital serving 800,000 Tanzanians. Limited funding and resources at the hospital prevented Allan from getting a position and forced him to reconsider his career.

Touch Foundation accepted Allan Joel’s application to work as a medical scribe aiding the Treat & Train program*. While Allan worked as a medical scribe, he was able to spend all of his free time volunteering in the ICU and operating theaters at Sengerema Hospital. In the ICU and operating theaters, Allan was exposed to anesthesiology and realized the impact he could have on patients’ lives in this field. Inspired to learn the skills necessary to provide life support in a safe surgical environment, Allan applied for a one-year nurse anesthetist certification at Bugando Medical Centre. With the help of a Touch-funded grant, he graduated in September 2016 and promptly returned to Sengerema Hospital to begin working in the operating room.

Mortality and morbidity related to anesthesia and surgery are all too common in Tanzania. We recognize the importance of a safe and sterile surgical environment to protect everyone, including patients, health workers and students, from infection, injury, and other harm. Touch, together with hardworking individuals like Allan Joel, is working to improve access to safe surgical care and save lives at Sengerema Hospital and our other partner health facilities.

With Touch’s help, Allan was able to start a career in the field of anesthesiology. Although Allan’s work comes with many challenges, including working with only a limited number of trained specialists and equipment, his dynamic drive to find solutions has made him an integral part of the hospital. He has already devoted seven years of his life to improving the care of patients and aims to return to school next year to qualify as an Assistant Anesthesiologist. Touch is proud to support the ambition of young health workers and improve the lives of Tanzanians by providing greater access to quality skilled providers and safe surgical care.

*The Treat & Train Program is supported by the United States Agency for International Development (USAID), Vitol Foundation, ELMA Foundation, and other partners to improve the education of health students and extend access to health services in Tanzania. Core to Treat & Train is the facilitation of external clinical rotations by nurses, medical doctors, and other health students from the main urban campus to rural health facilities. These rotations provide students with practical experience delivering care to patients in small groups under the supervision of faculty and staff. Touch Foundation develops the Treat & Train Network of healthcare and educational institutions so that scarce resources are shared and the entire health system is strengthened.

Karamoja’s Mothers and Children Reap the Benefits of Health Systems Investments

By Lindsey Freeze, IntraHealth International

This post originally appeared on Vital, IntraHealth International’s blog. 

Veronica Munges, 19, holds her newborn hours after his birth at Nadunget Health Center III in Moroto, Uganda. Photos by Tommy Trenchard for IntraHealth International.

Jane Atim smiles and smooths the skirt of her crisp blue uniform as she ushers us into the maternity ward, excited to share what the night brought.

Morning light warms the walls of the room where Veronica Munges, 19, swaddles her healthy six-pound baby—a boy, named Tatelo. Jane shows Veronica, a first-time mother, how to breastfeed before turning to the two other women who gave birth overnight—Clara, 37, and Paulina, 34. 

The first day of life is the riskiest of all for infants and mothers, especially here in Uganda’s Karamoja region. This vast area is home to a rural, mostly pastoral population of 1.2 million that suffers from high rates of poverty, fertility, and food insecurity.

In 2008, UNICEF called it the worst place to be a child. One hundred children under the age of five died every week, mostly from preventable diseases, and 17% of children would not live to their fifth birthday. Six years ago, only 27% of women in Karamoja delivered in health facilities and the regional maternal mortality rate was 750 per 100,000 live births—among the highest in the world.

The region has lagged behind national progress in improving health care and outcomes, but the joyful scene that morning was not a fluke.

Last year, 73% of Karamoja’s mothers delivered in health facilities, and medical officers say the maternal mortality rate has sharply declined as a result. The percentage of children receiving all basic vaccinations is also now the highest in the country, by wide margins, at 73%.

The evening before, we visited Nadunget Health Center III in Moroto to talk to Jane, the nurse in charge, and Dr. Abubaker Lubega, the district health officer, about improvements there that are dramatically changing health care in the district and region.

“People don’t believe we’ve done it in just a few years,” says Dr. Lubega, who oversees the seven public health facilities serving 140,000 people in Moroto.

So what happened?

The surge

A hiring surge in late 2012 laid the groundwork for improving health care throughout the country. Five years ago, Uganda’s government budgeted for and hired 7,000 of the most-needed cadres—midwives, anesthetic officers, pharmacy and lab techs, and public health nurses—and approximately 3,000 new workers have joined the country’s long understaffed health workforce since.

Jane, a midwife with 14 years of training and experience, was recruited during the surge, which brought 31 new workers to Moroto and increased staffing levels from 40% to 70%.

But staff shortages weren’t the only problem affecting health care in the region.

Perceptions of poor quality, staff absences, and negative attitudes were among the top reasons within the health sector’s control that women weren’t seeking skilled care at birth, according to a 2013 study on barriers to using institutional delivery services in two Karamoja districts.

Motivation and performance problems plague health centers across Uganda. These are incredibly complex issues with no easy fix. Leadership and supervision, workload, security, infrastructure, and so much more affect health workers’ attitudes and output.

Better performance management and supervision systems

Jane is one of just two midwives at the health center she manages, where nearly 1,000 mothers are expected to deliver this year. On top of that, she supervises a staff of 26. And until last year, she had no formal tools or processes to support and hold them accountable for their duties.

In-charges like Jane are critical to improving the quality and availability of health care in their communities. That’s why, for the past two-and-a-half years, IntraHealth International’s USAID-supported Strengthening Human Resources for Health (SHRH) in Uganda activity has worked with Uganda’s ministries to revise national service delivery standards and supervision guidelines and, at the local level, to support the country’s 112 district health management teams, like Dr. Lubega’s, in rolling out a package of tools to improve individual- and facility-level performance.

It starts with ensuring staff have clear job descriptions and regular appraisals. At Nadunget, and hundreds of other facilities in Uganda, most did not.

Jane attended a series of practical trainings that helped her develop specific scopes of work for her staff, set individual performance targets, conduct appraisals, and implement appropriate rewards and sanctions, while addressing other real problems she experienced at work. She learned the fundamentals of performance management and applied the new approaches at her facility.

“This was really an eye-opener for us,” Jane says of what came to light when she held the past few quarterly performance reviews.

The new approach forced conversations about why one nurse wasn’t adequately documenting women’s antenatal visits, for example, or why another assisted fewer deliveries than her counterparts that quarter.

Previously, there wasn’t a system for tracking attendance, either, or penalties for not showing up. Jane says the appraisal process, combined with public recognition of good and bad performance and withheld pay for unexcused absences has quickly helped establish a culture of accountability.

Districts now host community events to celebrate staff, where they recognize top performers and discipline the chronically absent by announcing and posting their names publically.

It’s working: absenteeism in Karamoja is down to 11%—from 46% in 2015.

District ownership and national coordination

The performance management toolkit is part of a package of interventions that SHRH developed to help districts address their unique health workforce challenges.

“It’s a very bright strategy,” Dr. Lubega says. “The approaches are integrated into our systems, and the district HR department has ownership over the trainings and interventions. They will sustain these changes.”

SHRH has also worked with Moroto staff to strengthen supportive supervision systems so that district health managers can assess facilities’ strengths and gaps—and budget for the resources (including staff) they need to meet national standards and community needs.

So far, SHRH has supported 73 of Uganda’s 112 district health management teams and helped 8,127 health workers in 800 facilities implement the new performance management guidelines and practices, improving health services for millions of Ugandans.

As we finished talking to Jane and Dr. Lubega the day before, the sun had started to set on Mount Moroto. Veronica was in the early stages of labor and the only patient left after a busy day. She walked the 6 miles from her village at the first sign of labor. Beyond a chain fence, children waited at wells to bring water home and cooking fires glowed across the dry landscape, sending stacks of sweet smoke into the dusk.

Jane didn’t know that two more mothers would walk to the health center overnight. Clara and Paulina delivered quickly, but Veronica struggled through a long and difficult labor.

The next morning, no words or translations are needed to understand the joy and fatigue and relief each mother feels holding her newborn. Seeing them stretch and squint in their first glimpses of sunlight is a reminder of the awe and peril of being born—and the long road to raising a healthy child, no matter where you live.

For these families, every milestone to better health care makes the journey safer and the chance of a more secure, prosperous life possible.

5.9 million women have given birth in a health facility since 2012 because of USAID investments. Read more »

To see how health systems strengthening efforts are making a difference for mothers and children around the world, read USAID’s 2017 Acting on the Call Report.