By Matthew Ziba
Many health facilities across Malawi don’t have enough trained pharmacy staff to adequately manage stock and dispense medicines. These tasks often fall on health care providers, who already have many other responsibilities, namely caring for patients. In some cases, even a ground laborer or a security guard—who may have no training in pharmacy management—must step in to help.
Photos by: Samy Rakotoniaina/MSH
In Malawi, over 80% of people live in rural areas. For many (10%), the nearest health center is more than 8 kilometers (5 miles) away, making it difficult to access health care regularly. The USAID-funded Organized Network of Services for Everyone’s (ONSE) Health Activity, led by Management Sciences for Health, works to improve quality and access to care in rural communities.
An innovative testing strategy helps more people living with HIV learn their status
“Life can deceive you when you think you feel strong and healthy,” says Godfrey Justin, whose wife, Violet, tested positive for HIV during a routine antenatal visit. After sharing her status with Godfrey, Violet asked that he be tested as well. Godfrey agreed, learned he was also living with HIV and the couple started antiretroviral therapy (ART).
Elimase Kamanga is a mother, a midwife for more than 15 years, and the Senior Technical Advisor for Maternal and Newborn Health for the USAID-funded Organized Network of Services for Everyone’s (ONSE) Health Activity, led by MSH. Chisomo Mdalla, ONSE’s Chief Communications and Knowledge Exchange Officer, talked with Kamanga about her work to improve the quality of care for mothers and newborns in Malawi. This interview was edited for length and clarity.
Elimase, can you tell us about how you got to where you are today?
Photos by Chisomo Mdalla, ONSE Health communications officer.
As the globe marks World Water Day on March 22, the Organized Network of Services for Everyone’s Health (ONSE) Activity has been supporting the Government of Malawi in responding to a months-long cholera epidemic.
After more than 15 years working on women’s health and development issues, I feel hopeful as the growing movement for women’s rights brings us closer to a breakthrough. Everyday, more women around the world -- from Madagascar to Mexico -- are emerging as leaders. They are organizing and demanding justice, equality, and the full realization of their fundamental human rights.
For the past six years, MSH has hosted an internal storytelling contest, where we invite staff to submit stories on how strong health systems are saving lives and improving the health of people around the world. The stories undergo a judging process, and the winners are featured in an annual compendium.
We are proud to bring you these winning stories that demonstrate the power of effective partnerships. Meet health workers, community leaders, pharmacy managers, and patients from 10 different countries, working together across the health system to build healthier communities.
How Countries Can Move toward Building Sustainable Community Health Programs
Universal health coverage (UHC) is increasingly recognized as the best way to achieve the Sustainable Development Goal targets on health. But with 400 million people lacking access to essential health services and a projected shortage of 18 million health workers, it will take unprecedented effort and funding. Community health workers (CHWs) could be an important part of the solution—but without effective investments and sound planning, we will fall short of achieving UHC.
It is early afternoon in the village of Kanjuwale at the foot of Nguluyanawambe Mountain in central Malawi. Charlene Chisema, a community mobilization officer, asks a group of local women about best antenatal care (ANC) practices.
“It should start early – in the first months,” said one woman.
“You need four visits,” said another.
“Great!” said Chisema, who works with the Organized Network of Services for Everyone’s (ONSE) Health Activity. “How many ANC visits did you all have during your last pregnancy?”
Follow the conversation at the Commission on the Status of Women: #CSW61
As we prepare to join the Commission on the Status of Women (CSW) next week, where the focus will be on women’s economic empowerment in the changing world of work, I am reminded of my visit to Malawi last month.
This is the second in a series of four stories about how strong health systems improve the health of women and children.
Nine countries, with support from the World Health Organization (WHO), the United Nations International Children’s Fund (UNICEF), and other partners, launched the Network for Improving Quality of Care for Maternal, Newborn and Child Health last week.
Strong, well-functioning health systems need strong leadership, management, and governance. Over the next couple of weeks, leading up to conversations that MSH is hosting at the Global Symposium on Health Systems Research next month in Vancouver, we will be sharing stories and insights about the role of leadership, management and governance in health systems strengthening. This is the second in a series of four blog posts on this topic. See part one.
On the eve of the 20th International AIDS Conference (AIDS 2014), Rachel Hassinger, editor of MSH’s Global Health Impact Blog, spoke with Dr. Scott Kellerman, global technical lead on HIV & AIDS, to discuss his latest research on prevention of mother-to-child transmission (PMTCT) of HIV and pediatric HIV & AIDS. Kellerman and colleagues will be attending AIDS 2014, July 20-25, in Melbourne, Australia. (Read more about the conference.)
Natalie Campbell and Elizabeth McLean of MSH and colleagues co-authored a new journal article, "Taking knowledge for health the extra mile: participatory evaluation of a mobile phone intervention for community health workers in Malawi," in the latest issue of Global Health: Science and Practice.
This post originally appeared on the K4Health blog.
The World Health Organization (WHO) made waves at the International AIDS Society conference in Kuala Lumpur when it issued revised guidelines for HIV treatment. The new guidelines—WHO’s first major update since 2010—recommend an earlier start to treatment, from a CD4 threshold of 350 cells/mm3 to 500 cells/mm3.
This week’s Lancet returns the spotlight to Option B+, an innovative strategy for preventing mother-to-child transmission of HIV which was first developed in Malawi with technical assistance from MSH. Four letters respond to the concern that international organizations have too quickly endorsed the Option B+ approach of providing lifelong triple antiretroviral therapy (ART), irrespective of CD4 count, to pregnant women with HIV in high-burden countries.
I got a call from the resident doctor to come to exam room 6. As soon as I entered the room, I prepared myself. The little girl, 7- or maybe 8-years-old, didn't look well; she was “floppy,” combative, and not entirely aware of where she was or what we were doing to her. She was HIV-positive, and my colleague needed to get an IV line in her arm to test the latest in experimental treatments for kids with HIV– and needed the four of us interns to help hold her still.It was 1993 during my residency in pediatrics in Cleveland, Ohio.
Cross-posted from the K4Health blog. No matter which health system building block you are trying to improve, you need specific data, information, and knowledge to inform your decision-making process—this is where good knowledge management comes in handy.“The Intersection of Knowledge Management and Health Systems Strengthening: Implications from the Malawi Knowledge for Health Demonstration Project” provides an interesting case study of the connection between improved knowledge management and health systems strengthening.Even though the K4Health Malawi project was f
The Ugandan government launched a new prevention of mother-to-child HIV transmission (PMTCT) strategy on September 12.
Uganda will transition from an approach based on the World Health Organization's (WHO) Option A --- which is contingent on an HIV-positive pregnant woman’s CD4 count --- to WHO's newest PMTCT strategy, Option B+.
Each year over 10 million men, women, and children in developing countries die as a result of our collective failure to deliver available safe, affordable, and proven prevention and treatment. A recent analysis of innovations in products and practices for global health, from the Hepatitis B vaccine to use of skilled birth attendants, revealed virtually none of these life-saving interventions reaches much more than half their target population—even after as many as 28 years of availability.
It's been nearly two weeks since former President William J. Clinton closed the last session of the XIX International AIDS Conference (AIDS 2012) and delegates returned home.
This year's conference featured commitment and calls for an AIDS-free generation, a growing interest in Option B+, and new research towards a cure. Here are some reflections from what we learned at AIDS 2012, where we truly started "turning the tide together".
Clinton calls for a blueprint toward an AIDS-free generation
Cross-posted from the Global Health Magazine blog.How did Malawi control its brain drain?The British Medical Journal issued a report last month estimating that nine African countries have lost $2 billion worth of investment in training and educating doctors who have subsequently migrated abroad. It needn't be this way. Doctors, nurses and other health professionals do not have to give up home, family and country to earn enough money to give themselves and their children a future, even a modest one.
At a satellite session at the 2011 International Conference on Family Planning on November 30 in Dakar, MSH asked five panelists to discuss successes in family planning, and what still needs to be done. The conversation was moderated by MSH’s Issakha Diallo and held in conjunction with a celebration of MSH’s 40th anniversary.
This year is not only MSH’s 40th anniversary; it is also 30 years since the first reported cases of HIV. Thirty years ago HIV was considered a new, always-fatal disease. ...Today 6.6 million people—nearly half of those in need—will take life-saving antiretrovirals.
I am fortunate. I know this from years of experience of reporting about people who have poor or no access to quality health care, from rural areas of West Virginia to Afghanistan to Zambia. But today I feel this deeply, in large part because of an email that I just received.
In Kasungu District, Malawi, trained Community-Based Distribution Agents (CBDAs) gather for their final and perhaps most challenging training: couples counseling.With HIV, couples often do not freely discuss issues and concerns.
Picture trees, water, mountains, mud, birds and fish. This is Lake Chirwa -- the second largest of the five lakes in Malawi and the main habitat of small fish called Matemba. The lake offers a trading opportunity for fishermen from many walks of life.Lying in the southern region of Malawi, Lake Chirwa is a wetland for people of three districts: Phalombe, Zomba and Machinga. All these people have frequent contact with Mozambique as they lie near the bordering frontiers.
Lucia Afiki and Esther Goodson are living positively with HIV. They are counselors for family planning and HIV & AIDS at Salima District Hospital in Malawi, where they openly tell their clients that they are HIV-positive. “When we are open with them about our status,” says Afiki, “people say, ‘Come closer, we want to learn from you.’” Goodson adds: “They say, ‘What should I do to look as good as you?’” The counselors tell them to visit a doctor and join a support group. This is an approach that saves lives.
If you grow up in places like Kasungu district in rural Malawi, you learn that when your wife is pregnant, you should not have sex outside marriage---because you will lose the “expected gift” through miscarriage. Male promiscuity during a partner's pregnancy is a taboo that many believe will bring a curse on the family.Patricia Patrick says that after she miscarried in November 2008 “People talked in the village, and people talked within the household.
From Alima Twaibu’s village in Nhkotakota district, it is 10 km to the nearest Health Center or 16 km to the District Hospital. With more than 80% of the population living in rural areas, the majority of Malawians experience similar challenges to accessing care. People have to walk long distances to receive services when they are sick. And when time away from work or paying for transport competes with other basic expenses, the decision to seek preventive services like family planning and HIV testing and counseling (HTC) is even more difficult.
Malawi leads the developing world as the first to propose an approach to prevention of mother to child transmission (PMTCT) of HIV that addresses the health of the mother. Recently my MSH colleague Erik Schouten and his colleagues in Malawi wrote a commentary in the Lancet about Malawi’s innovative, public health approach to PMTCT.
In June 2011, the CSIS Global Health Policy Center asked bloggers around the world, Do you think it's possible to create a unified social movement for NCDs, akin to the movements that already exist for individual chronic diseases? If so, why? If not, what initiatives can we implement in the place of an effective social movement to move an NCD agenda forward? Dr. Jonathan D. Quick was one of our four finalists.For three years, Lucy Sakala has counseled people seeking HIV tests at a District Hospital in Malawi. A year ago, she was diagnosed with uterine cancer.
Grace Bonongwe is a grandparent. She comes from Zovuta Village T/A Nsamala in Balaka, about 10 kilometers from the nearest health facility. Of the nine children she has given birth to, only one lives to this day. The rest have died over the years from different diseases.Grace is no stranger to disease and affliction considering she has gone through the pain of losing eight of her children. So when her husband fell ill, she dismissed it as a normal occurrence that would eventually lead to his demise.
Over the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.(Part 1 of this story: Introducing Triage in Hospitals, and a Baby in a Coma) SALIMA, Malawi – A child enters a hospital in a coma. Health workers resuscitate him. The child regains his health.
Over the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff.LILONGWE, Malawi – The problem with writing about improvements in Malawi’s health system is focus.
Over the next couple of months, as MSH celebrates it's 40th anniversary, reporter John Donnelly and photographer Dominic Chavez will be traveling to several countries to report on MSH’s work in the field. The stories will go into a book due out in the fall on MSH’s 40 years in global health. This blog entry is a post from the road, to give a flavor of their experiences with MSH staff. SALIMA, Malawi – For three years, Lucy Sakala has helped counsel people seeking HIV tests at the Salima District Hospital.
It’s common sense that a mother who is on treatment for AIDS, pregnant, has a sick child, and is accompanying a sister debilitated by Tuberculosis should not have to visit four separate service delivery points to receive care. Integrated health services not only make the world a healthier place, but also decrease the burden on health systems.Integration is a comprehensive approach to service delivery. It is the transition from a vertical or horizontal approach to a diagonal, synergistic approach at all levels of a health system.
This is a guest post from Olive Mtema, Policy Advisor, from the Community Based Family Planning and HIV & AIDS Services project in Malawi. Olive is an employee of the Futures Group. On March 12, 2011, Muslim Leaders gathered in Lilongwe, Malawi for a conference on Reaffirming Muslims' Positions on Family Planning and HIV & AIDS Issues.
My recent field visit has given me a great perspective on one of MSH’s major activities - the costing of health services. MSH has extensive costing experience in East Asia & Pacific, Latin America & the Caribbean, Southern Africa, and West Africa.MSH developed and has helped manage multiple applications of the CORE Plus (Cost and Revenue Analysis Tool Plus). CORE Plus is a tool that helps managers and planners estimate the costs of individual services and packages of services in primary health care facilities as well as total costs for the facilities.
Malawi has some of the worst health statistics in the world, ranking 166 out of 177 countries. This is the result of HIV & AIDS, food insecurity, weak governance, and many human resources challenges. Health care vacancies range anywhere from 30-80%, and Malawi only has 252 doctors in the entire country. The health system is regularly plagued with stock outs of key medicines and supplies, as a result of poor procurement and distribution practices.
The Global Health Initiative (GHI) and its approach of integrating health programs with HIV & AIDS, malaria, tuberculosis, maternal, newborn, and child health, nutrition, and family planning and reproductive health is in line with the current approaches and health priorities of the Government of Malawi.Malawi, with a population of slightly over 13 million people, has 83% of its people living in the rural hard to reach, underserved areas. The biggest health challenge facing the country is access to basic health services by the rural population.
This blog post originally appeared on K4Health's blog. The most important item in Amon Chimphepo’s medical kit is a small cell phone. This single piece of technology has proved to be a lifeline for people living in one of the most remote regions of Malawi. Its power to reach and initiate help immediately from the closest hospital is saving lives and improving health outcomes. In fact, I met a woman, alive today, because Mr.
Three months ago, Annie Likhutu, a mother of six, came to Migowi Health Center in Phalombe, Malawi to receive voluntary HIV counseling and testing (VCT); now, she is back at the health center and ready to be tested for a second time.“It is very important to know your status, it is no good waiting until you get sick,” she said.Annie initially learned of the importance of testing through a radio advertisement from Word Alive Ministries International (WAMI), which is aired regularly and encourages listeners to go to health centers for VCT.Although Annie takes pride in knowing her stat
On this World AIDS Day, we reflect yet again on progress made toward global commitments to fight the HIV epidemic. According to UNAIDS, new infections have decreased this past year from 2.7 million to 2.6 million, but, 30 years into the epidemic, only 5.2 million people out of the estimated 15 million who need drugs have access to treatment.
A team of experts from WHO, UNICEF, UNFPA, and World Bank recently published a report on maternal mortality entitled “Trends in Maternal Mortality: 1990 to 2008" (PDF).The document reports some fantastic news about a public health indicator that has until recently refused to budge. That indicator is the maternal mortality ratio, the number of maternal deaths per 100,000 live births. The improvement between 1990 and 2008 is significant and promising.The part of the report that received much less coverage relates to HIV and its strong, adverse effect on maternal mortality.
Blog post originally appeared on Global Health Magazine. Six years ago the Malawi health system was on the verge of collapse due to severe shortages of health workers. Every year the College of Medicine would train 20 doctors and every year, half of them would leave the country. Nurses were overwhelmed by the demand for services.Ratios of doctor and nurses to population were the lowest of all countries in Southern Africa. HIV & AIDS was on the rise and without more health staff, the roll-out of antiretroviral therapy (ART) would remain just a dream.
In mid-June the United States Government continued to show its commitment to global health by announcing the first Global Health Initiative (GHI) Plus countries: Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal, and Rwanda. The GHI is a six-year, $63 billion initiative to help partner countries improve measurable health outcomes by strengthening health systems and building upon proven results.
This article was originally posted on K4Health’s Blog.Twelve months ago the K4Health project began its needs assessment to better understand how the flow of knowledge, information, and communications could be improved with regards to Family Planning and Reproductive Health, and HIV & AIDS, in support of the K4Health project.Seven months ago – in December 2009 – the project returned to disseminate the results of the assessment; to meet with key stakeholders at the national, district and community levels; and to present some ideas for improving the flow of information up an
This article was originally posted on K4Health’s Blog.It’s late in the evening in a hard-to-reach village in the Malawian District of Nkhotakota. There is no electricity in this village, nor in the Bua community health center that serves 11,280 people, including a pregnant mother who goes into pre-term labor.
A common challenge in advancing family planning is overcoming the misconceptions religious leaders have about the use of contraceptives.Concerns from religious leaders are often based on misconceptions about family planning methods rather than their religious beliefs.
At the International AIDS Conference in Vienna, Austria, my colleagues and I gathered to discuss the principles of smart integration and its challenges, successes, and recommendations for implementation. Smart integration means coordinating HIV & AIDS programs with other health programs that have operated independently in the past; providing comprehensive services at all levels of the health system – from households to health facilities and across the continuum of prevention, treatment, and care; and building stronger partnerships between public and private sectors.There are thr
Next month in Vienna, Austria, thousands of activists, community workers, donors, health leaders, and government officials will gather for the VVIII International AIDS Conference. This year’s theme is Rights here, right now: a mandate on the importance of health as a human right for all. While it is easy to talk about health as a human right, it is much more difficult to deliver to diverse communities in some of the poorest countries around the world. Last year when President Obama announced his Global Health Initiative (GHI), he spoke about meeting the health needs of t