Senegal

 {Photo by: World Health Organization}Part of the poster for World No Tobacco Day. Raising taxes on tobacco is the most effective way to reduce its consumption.Photo by: World Health Organization

This post originally appeared on Devex.com.

When people get sick in Senegal, like in many other low- and middle-income countries, they often find that quality health care services are unaffordable. The majority of health spending is out-of-pocket, meaning people aren’t enrolled in health insurance plans, or their plans’ benefits are limited.

{Photo credit: Rui Pires.}Photo credit: Rui Pires.

We do a lot of things in the name of culture. From our hair to our food to our ceremonies, culture informs our identity, our very understanding of who we are, and how we fit into this world.

In countries where female genital cutting is widely practiced, “culture/tradition/religion” feature prominently among the reasons why the practice began, and why it is perpetuated. In fact, there is no religious reason for this practice, also known as female genital mutilation, FGM, or FGM/C. Yet, those who support the continuation of FGM/C often invoke the name of their culture, or tradition, or religion as dictating their actions.

Culture viewed from this perspective is oppressive—denigrated into a static phenomenon, unchanging, and uninformed by new knowledge. It is only when we accept culture as a dynamic force–one which is ever changing and evolving–that we proudly can identify with, and derive our identities from it.

Culture can be a powerful positive force in our lives if we dare to challenge it.

Women meeting in Senegal. {Photo credit: Galdos/MSH.}Photo credit: Galdos/MSH.

Good governance in health care matters at all levels of the health system—from communities to health facilities to governments. When a community HIV & AIDS association in Zanzibar grew from 40 members to more than 1,000, it needed better governance. When women in Senegal raised concerns about lack of privacy and poor security at a district hospital, it needed better governance. And when the national health insurance program in Kenya was underperforming even after efforts to address its management and leadership, it too needed better governance.

Until recently, governance was arguably the most tenacious but unspoken barrier to achieving widespread, large-scale, sustainable health impact. In the 1990s, global health programs focused on training health managers. In the 2000s, as management improved and the need for stronger leaders became evident, the focus expanded to leadership development. By now, we’ve developed robust practices for building the capacity of health managers and leaders at all levels of country health systems.

Two women hold a banner at ICASA 2011: Where's the Money for HIV? Credit: MSH.

 

Last week I had the privilege of attending the International Conference on Family Planning in Dakar, Senegal, where over 2,200 family planning and global health advocates, funders, and supporters gathered to voice support for family planning.

Over 2,300 delegates, many colorfully dressed, gathered in Dakar, Senegal  at the jam-packed amphitheatre and two exterior tents of Le Meridien President for the start of this week’s 2nd International Family Planning Conference, sponsored by the Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. Monica Kerrigan, of the Bill and Melinda Gates Foundation, said that one third of Africans live in francophone Africa, and yet it has been the most neglected area for family planning services. She praised Senegal for hosting the first family planning conference in French-speaking Africa and urged Senegal to use this opportunity to act boldly and make family planning an urgent priority.

Safoura Amadu and her son Ibrahim

Safoura Amadu is the 19 year-old mother of Ibrahim, who was born preterm on March 8, 2011 at 1.46 kg (3.2 pounds). Baby Ibrahim did not grow well in his first days of life. Safoura was very worried---her first child had died at birth---and she did not want to lose Ibrahim, her second child. Safoura sought help and when Ibrahim was ten days old she and the baby were admitted to the new Kangaroo Mother Care (KMC) center at the Maternité Issakha Gazoby in Niger. Ibrahim’s weight had dropped to 1.07 kg (2.35 pounds).

The KMC center cared for Safoura and her child by showing Safoura how to take two simple, lifesaving measures: provide skin-to-skin contact for Ibrahim, by wrapping his unclothed body directly to her bare chest, and breastfeeding him exclusively. After 47 days at the KMC Centre, Safoura and two month-old Ibrahim were released to go home. Ibrahim weighed 2.12 kgs (4.67 pounds).

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