maternal health

Women and child in Tambura, South Sudan. {Photo credit: MSH.}Photo credit: MSH.

Nearly 50 countries, including Afghanistan, Democratic Republic of the Congo, Haiti, Liberia and South Sudan, are considered a fragile or conflict-affected state -- a state that is in conflict, recovering from conflict or crisis, or a state that has collapsed or has a strong and repressive government. Over nearly 40 years of working in fragile states, Management Sciences for Health (MSH) has identified best practices, lessons learned, and appropriate interventions for a myriad of situations in fragile states.

MSH takes an integrated approach to building high-impact sustainable public health programs that address critical challenges in leadership, health systems management, health service delivery, human resources, and medicines. Wherever our partnerships succeed, the positive impact of good health has a ripple effect, contributing to the building of healthy nations.

MSH works collaboratively with health care policymakers, managers, providers, and the private sector to increase the efficacy, efficiency, and sustainability of health services by improving management systems, promoting access to services, and influencing public policy.

Women, men and children stand in line at the St. Joseph's Health Center in Abricots, Haiti. {Photo credit: Gumy Dorvilmar/MSH.}Photo credit: Gumy Dorvilmar/MSH.

It was 11 o’clock one February morning when the Santé pour le Développement et la Stabilité d’Haiti (SDSH) project technical team arrived on site at St. Joseph Health Center.

The center’s activities were well underway. Dozens of people sat on benches or stood in line, waiting for their turn. One person comes to care for her child who has had a high fever. Another comes for contraception. Another just gave birth to a healthy infant.

St. Joseph Health Center is located in Abricots, a remote community in the department of Grande’Anse, Haiti, far from Port-au-Prince. Abricots is nearly inaccessible because of rough terrain and hazardous mountain trails.

Since 2007, with support from the USAID-funded SDSH project, led by Management Sciences for Health (MSH), St. Joseph Health Center has provided a basic package of health services: pediatrics, maternal health, reproductive health, detection and treatment of sexually-transmitted infections, HIV/AIDS, tuberculosis (TB) and family planning.

This free clinic is the only health institution in this hard-to-reach area, serving an estimated 32,000 people.

(Left to right) Aaron Musiimenta, assistant regional behavior change communication officer; Tadeo Atuhura, STRIDES for Family Health communications specialist; Dr. Baseka Yusuf, district health officer; and Kevin Kisembo, principal nursing officer and STRIDES focal person. Kasese, Uganda. {Photo credit: Margaret Hartley/MSH.}Photo credit: Margaret Hartley/MSH.

The Kasese district in western Uganda is nestled between two national parks. Located hours from the capital city, Kampala, the region attracts tourists to view gorillas and mountain birds.

During my recent trip to Uganda, I met with Dr. Yusuf Baseka, the district health officer of Kasese, who described the health challenges his district faces, and his hopes for the future.

Although the national parks are beautiful and bring a much needed economic boost to the area, they also offer a challenge, Dr. Baseka explained.  The population growth and fertility rate of the district are very high. With the two national parks, there is no land for expansion. The town of Kasese is rapidly becoming a slum with unsanitary conditions that are difficult to address.

Another challenge in his district is that children are not going to or staying in school. They are leaving secondary school early and engaging in risky sexual behaviors. He explains, “We’ve seen a dramatic increase in young mothers, under 18 years, some as young as 12.” Their pregnancies offer unique challenges for the health system to address.

Dr. Sima Samar speaking on 'How to advance women's rights in developing countries.' {Photo from World Bank webcast, March 5, 2012.}Photo from World Bank webcast, March 5, 2012.

On Monday, March 5, 2012, everyone from policymakers to students gathered at the World Bank for a Special Event on the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and Women’s Rights.

CEDAW is a treaty that has been ratified worldwide by all but six countries --- the United States, Iran, Sudan, Somalia, and two small Pacific Island nations (Palau and Tonga).

The event was hosted by Caroline Anstey, Managing Director of the World Bank, in conjunction with the Nordic Trust Fund, The Leadership Conference Education Fund, and the United Nations Foundation.

Video that highlights the work of thousands of Tanzanians---mostly women---working as accredited community drug sellers operating in rural areas.Video that highlights the work of thousands of Tanzanians---mostly women---working as accredited community drug sellers operating in rural areas.

Today is International Women’s Day, celebrated around the world as an opportunity to look back on women’s accomplishments and look forward to the realization of their full economic, political, and social rights. The United Nations theme for this year, “Empowering Rural Women,” is one that resonates powerfully with MSH’s work.

Mbambu, a midwife at a western Ugandan health center. {Photo credit: MSH.}Photo credit: MSH.

Mbambu is a midwife who works at Isole Health Center III in rural Western Uganda. When I had the opportunity to visit with her, she was the only health care provider at the center. Trained as a midwife nine years ago, her passion for her job pours out of her. Since primary school, becoming a midwife "was always my mission,” she said.

A little over a year ago, Mbambu was trained in family planning and reproductive health skills by STRIDES for Family Health, a USAID-funded program in Uganda led by MSH. Prior to the training, the health center could only offer education and basic family planning services.

Now Mbambu educates women who are waiting to have their children immunized or receive antenatal treatment about family planning, healthy spacing and timing of pregnancies, and the benefits of delivering at a health center. Her new skills also empower her to administer basic and long-term family planning services.

Mbambu shared a compelling story that I promised I would share with others:

Women learning about family planning at Bikone Health Center II, Western Uganda. {Photo credit: MSH.}Photo credit: MSH.

This was my first trip to Africa working with a development agency. While I had visited the African continent for personal trips previously, arriving in this context felt different. I was immediately aware of the challenges Uganda is facing. From the crumbling road infrastructure and high incidence of traffic accidents in Kampala, to the mobile phone networks that are pretty reliable while internet access is often spotty, to the prevalence of street children --- I can for the first time see what my local colleagues are up against.

I felt a bit overwhelmed in the first few days. Is there any way we can address all these challenges? Can we make a difference?

Visiting communities and health centers in Kampala, Eastern and Western Uganda -- and seeing first-hand the impact MSH is having across the country -- quickly re-inspired me.

I had the pleasure of meeting a particularly passionate and committed Clinical Officer, Rodger Rwehandika, at Bikone Health Center II in Western Uganda. As a health center II, Bikone is an outpatient facility, but the staff of the facility can also conduct outreach programs to educate and serve the community.

Rodger and his two staff facilitate health education programs at the local schools and also host youth-friendly programs on using condoms.

Norah Nakato (right) receiving care from Fausta Nalukwago, midwife at Mpigi Health Center IV in Uganda. {Photo credit: MSH}Photo credit: MSH

Norah, a 21-year-old teacher at a private school in Nansana, Uganda, did not know she was pregnant. Pain in her lower abdomen prompted her to go for a consultation at a private clinic in Nansana, where a urine test revealed the pregnancy. “I was shocked because I had last had my period on the 15th of that month,” Norah said.

At the clinic, Norah was given an antibiotic and a pain killer to relieve abdominal pain. Norah left the clinic excited about her pregnancy. But, two weeks later, the pain persisted and Norah began bleeding. Her mother advised her to go to Mpigi Health Center IV for an ultrasound.

At the health center, Norah saw a problem on the ultrasound screen. “The doctor showed me what was in my uterus and there was no baby," Norah said. "It was swollen with liquid and unclear substances. He said the substance had to be removed. I was very scared."

After counseling from the doctor, Norah was admitted and given medication to induce labor. When the contractions began, she was taken into surgery.

The doctor advised her to wait at least one and a half years before conceiving another child to allow time for her uterus to heal and the abnormal hormone levels to normalize.

All key indicators for SHTP II improve from FY10 to FY11: Diphtheria, Pertussis, Tetanus, third dose (DPT3); Intermittent Preventive Therapy, second dose (IPT2); first and fourth antenatal care visits (ANC1, ANC4); skilled birth attendant (SBA) deliveries; and family planning (FP) visits.

 

All project health indicators for the second phase of the USAID-funded Sudan Health Transformation Project (SHTP II), led by Management Sciences for Health (MSH) in partnership with the International Rescue Committee, have shown improved performance over the past two years.

On the ground, this means that more people are being immunized against diseases, communities are receiving education on HIV, and lives are being improved.

Alice Gune with her son who was treated successfully for neonatal sepsis at the SHTP II-supported Kuda PHCC in South Sudan. Credit: MSH.

Shortly after delivering her baby boy at home, Alice Gune grew nervous for his health. Her baby had a high fever and was obviously uncomfortable and unhappy.

She took him to see Rose Kujang, the Maternal and Child Health Worker, during a community outreach program orchestrated by Kuda Primary Health Care Center (PHCC). Rose examined Alice’s baby and, recognizing the danger signs he presented, immediately referred her to Kuda PHCC for further diagnosing and treatment.

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