Ministry of Health

A midwife in Wau, South Sudan. {Photo credit: MSH.}Photo credit: MSH.

Josephine, a wife and mother of six living in rural Uganda, tried to soothe her 3-year-old daughter. The girl was suffering from diarrhea and a high fever and her crying filled the home. Recognizing that the girl's health was in danger, Josephine summoned the courage to ask her husband for permission to take their second-youngest child to the local health facility unit -- and pleaded for money to cover the travel and treatment expenses.

Requesting permission from her husband to travel to the facility was not her only choice, however: choosing to take her daughter for treatment also meant leaving her other children -- including her youngest -- unattended at home. Once at the health center, she continued to navigate the challenging road to treatment for her daughter, communicating her situation to the health providers and negotiating the financial and provider aspects of the health center system, without assistance. Relieved and exhausted, Josephine returned home safely with her daughter, oral rehydration salts, and knowledge.

Recognizing women leaders

What makes a person in the health system a good leader? Who determines that he or she is a leader? How do we empower leaders to improve the health of those around them?

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:

Lelo PHCU staff treat the young patient. {Photo credit: MSH.}Photo credit: MSH.

"Diktor! Diktor!" The urgent call for a doctor came from several school boys who had run to the facility. I glanced over and saw a boy about 12 years old tensely sit down in the waiting patio at Lelo Primary Health Care Unit in South Sudan.

"Are family planning methods safe?” wondered Mutombo, a community health worker at the Kawama Village Health Center, in the Democratic Republic of Congo’s Katanga Province. {Photo credit: MSH.}Photo credit: MSH.

Cross-posted on USAID's IMPACT blog.

“Don’t they contain a poison?” he added, directing his question to Isaac Chishesa, a community mobilization specialist with USAID’s Democratic Republic of Congo-Integrated Health Project (DRC-IHP).

Tough question! One Isaac was not expecting, at least not within a discussion among trained community health workers.

An experienced community health professional, Isaac responded with a smile and said, “Thank you, my friend, for sharing your concern,” affirming the participants’ right to ask questions. “Family planning methods are safe,” he reassured the group. “Based on international quality standards, each method is required to go through extensive testing before it is made available to the public.”

The faces of Mutombo and his peers lit up. They sighed, a collective sigh of relief, and burst out laughing to relieve some of the tension. They all recognized that even though they were dedicated to bringing about improvements in health behaviors, they, like most of their fellow community members, harbored misconceptions and rumors about family planning.

The future is indeed bright for public health in Nigeria, judging from what Dr. Muhammad Ali Pate, the Honorable Minister of State for Health of the Federal Republic of Nigeria, said at the Africare House in Washington, D.C. on September 21. The event, Innovative Approaches to Expanding Health Care Services, was co-sponsored by Management Sciences for Health (MSH), fhi360, the Anadach Group, and hosted by Africare.

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. The conference was hosted by the USAID-funded Community Based Family Planning and HIV & AIDS Services project (CFPHS) in collaboration with the Malawi Ministry of Health, Reproductive Health Unit (RHU); Muslim Association of Malawi (MAM); and Quadria Muslim Association of Malawi (QMAM). CFPHS is led by MSH, with Futures Group and Population Services International as key implementing partners.

Danielle Brown is the Program Coordinator of the Leadership, Management and Sustainability (LMS) project in Haiti. She worked with our teams in Haiti from October 24 – November 14.

River Crossers at Rivií¨re des Barres

 

Reeling from Shock

Estama Murat, Director of the Drouin Methodist School, cautiously hopes to reopen: “This obviously will not come easy," he says, "because we have many children still sick and other pupils have fled the village.”

Drouin is in Grande Saline, where the cholera virus was first discovered in the Artibonite department last week. The population of 17,000 is still in shock. Many of them left for the chief town of Gonaives, Mr. Murat explains, or toward Saint-Marc in the Lower Artibonite region.

The Santé pour le Développement et la Stabilité d’Haíïti (SDSH), led by MSH, funded by USAID, has been supporting the Drouin health center for the past three years, to deliver a package of primary health services in maternal and child health and family planning. Through the USAID-funded project, MSH also supports a network of community health workers and traditional birth attendants for community outreach activities, ensuring that the services reach the people in need.

Fragile states such as Afghanistan, the Democratic Republic of Congo, Haiti, Liberia, and Southern Sudan have among the worst health statistics – especially for women and children.  For political, economic, security and other reasons they can be extremely challenging work environments. Despite this, I have been deeply inspired to see what local health leaders have achieved when they have created strong partnerships among government, donors,  non-governmental organizations and where possible the private sector.  The charismatic former minister of health from Afghanistan, the  medical director of an urban clinic in northern Haiti, and the director of Torit hospital in Southern Sudan stand out as examples of local leadership in action under circumstances that would immobilize many of us.

In fragile states, constraints on governments often prevent them from simultaneously building their stewardship role and immediately expanding service delivery. Supporting the Ministry of Health to establish a basic package of health services, train local organizations to implement those services, and provide incentives (such as through performance-based financing) is critical to success. Additionally, the goal should be to move from many plans and actors across districts to one health plan with committed partners. 

The Santé pour le Développement et la Stabilité d’Haíïti (SDSH) project Chief of Party, Agma Prins, and Dr. Serge Conille are in the Artibonite department to support the MSH response to the cholera outbreak. They continue to coordinate with the Ministry of Health and other international and local partners. MSH is working with Pure Water for the World to educate communities about hygiene and provide access to clean water through bio-sand filters.

Additionally, MSH Sr. Technical Advisor, Dr. Georges Dubuche, is working with Direct Relief International to coordinate an air freight shipment of supplies including IV fluids. IV catheters, oral rehydration salt tablets, Pedialyte solution, tetracycline or doxycycline, exam gloves, soap, and IV equipment stands.

The MSH/SDSH project is funded by the USAID.

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