Thoughts from the Last Mile Welcome to the VillageReach Blog

Category Archives: Health Worker Capacity

08.05 2016

Kwitanda HSA Supervision-6_Malawi_2015_CREDIT_Jodi-Ann BureyMalawi has made incredible strides over the past few years to reduce morbidity and mortality, specifically among women and children under 5 years old. Key to this success has been a focus on using community health workers, known in Malawi as Health Surveillance Assistants (HSAs), to push direct healthcare services throughout the most rural, hard-to-reach, quintessential last mile communities. As a result, people who otherwise may not have reached a health facility can now access basic services from their HSA—sometimes even in their own homes. At the same time, however, more HSAs work in isolation or as the only person from their cadre within their area, with little interaction with colleagues, supervisors or other healthcare providers.

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06.23 2016

Untitled designGraduation season is upon us. It’s a time of reflection for those about to embark on a new phase of their lives. For many this means entering the workforce for the first time, a pivotal life moment.  At VillageReach, we recently celebrated the graduation of the second cohort of pharmacy assistants. Once deployed, these 85 graduates will begin careers as employees of the Malawi Ministry of Health and will be placed in rural, public-sector health facilities across Malawi. The 85 graduates will join their previous cohort who are already working in the field and making significant improvements in the quality of medicines management and patient care at the last mile. But this recent event is not the only graduation we’re celebrating.

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12.22 2015

In response to this article by Dr. Mahad Ibrahim on the role of data during the Ebola outbreak, some interesting questions were sparked among our team. The piece evoked a lot of great insights about the opportunities and challenges the piece addresses, as well as how we see those topics evidenced in our VillageReach work. This topic is of particular interest to us, as we and our partners at the University of Washington are actively developing and testing an open-source tool for paper to digital data conversion, ODK Scan.

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08.13 2015
Malawi village clinic
VillageReach HSA, Pemphero Katondo leads Jailosi Village clinic

As a Community Health Facilitator for VillageReach in Malawi, I see the impact of Community Case Management (CMM), a strategy that promotes the early care-seeking behavior, assessment, diagnosis, recognition, and appropriate treatment for childhood illnesses at the community-level.

Over the last few years, CCM has evolved into a more comprehensive strategy that addresses the three main diseases that commonly kill young children under 5

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02.09 2015

VillageReach, in collaboration with D-tree, is proud to announce the implementation of a new mHealth application in Malawi. What an exciting partnership! During the first week of February 2015, 25 health surveillance assistants (HSAs), nurses and other health workers in Balaka District received intensive training on smartphone technology and the capabilities of a new maternal and neonatal health (MNH) assessment application developed by D-tree. Using smartphones to improve the assessment of pregnant women and their children will increase access to health care and improve the quality of care provided in rural villages.

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12.04 2014

The Role of Data Collection and One Community’s Path Toward Change

While working on the Kwitanda Community Health Project (KCHP), based in the Kwitanda catchment area, Balaka District, in southern Malawi, I have seen firsthand how critical the role of data collection is to improving health outcomes. In this rural and remote setting, the news of a maternal death spreads quickly, but quietly, almost like a rumor or story. “Did you hear? Another mother died in childbirth in that village. Another neonatal death occurred last week.” It is difficult to understand the causes of the death, or how often they occur because little information is collected and reported on these events.

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10.10 2014

I am a clinician by profession, serving a population of over 30, 000 in the 25 villages that my health center serves. I am the only clinician at the health facility with a single nurse to assist covering when possible.  We recently lost the only health surveillance assistant that was trained as a drug clerk as she has left to pursue a one and a half year course in midwifery. This leaves me as the only clinician and also the only person to manage stocks in the medicine store (pharmacy).  I undertake the majority of dispensing responsibilities as the hospital attendants that sometimes need to fill this role are not knowledgeable about medicines. When it’s month end, I am also responsible for doing the physical inventory and producing a monthly report.  Each of these tasks requires time away from my primary responsibility of treating patients. This results in less time with patients, and inadequate reporting of essential information required to manage inventory. For example, I am not sure the reports that I send are even a true representation of the situation on the ground due to the limited time I have to devote to this task.

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07.17 2014

By Sir Brian Greenwood
Professor, Clinical Tropical Medicine
London School of Hygiene & Tropical Medicine
Advisor, Vitol Foundation

In June I was asked to  visit the Village Reach project in Malawi by one of its funders – the Vitol Foundation.

Dispensing is an important but neglected area and VillageReach is to be commended on recognizing the need for more investment in this area. Malawi has very few trained pharmacists or pharmacy technicians and so much dispensing at the health centre level is done by completely untrained people with a substantial risk that drugs will be wasted and that patients may be given the wrong medication. Pharmacists are trained at the School of Health Sciences in Lilongwe. Fully trained pharmacists undertake a four year course, pharmacy technicians a three course leading to a diploma. A new cadre of pharmacy assistants has been created by the Ministry of Health and VillageReach, with 150 enrolled in the first year. The ultimate goal is to place one pharmacy assistant in each health centre.

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06.17 2014

 loveness By LOVENESS KASIYAMPHANJE                                                 Pharmacy Assistants Training Program- Class of 2015                             

My name is Loveness Kasiyamphanje. I am originally from Ntcheu, in the Central Region of Malawi, but I currently live in Namiyango in Blantyre District. I am pursuing a Certificate in Pharmacy Programme at Malawi College of Health Sciences (MCHS), Lilongwe Campus. The programme was created by VillageReach, the Malawi College of Health Sciences (MCHS) and their partners. The Programme is for two years and I am in the first year.

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06.03 2014

wendy-300x200By Wendy Prosser
VillageReach Program Manager
USA and Mozambique

How many times have you seen “other duties as required” on a job description? It infers any random thing that may not fit perfectly into other well-defined responsibilities but still needs to get done, so there is a high likelihood that it may land on your desk to take care of.

In the Mozambique health system, this has become the catchall phrase for health workers. They are tasked with numerous responsibilities including the supply chain function, resulting in a crisis for human resources for health. A maternal and child health nurse, particularly in a rural area, is responsible for providing antenatal care, assisting with deliveries, vaccinating children, managing data for all health clinic activities, and completing requisitions of commodities to keep drug supplies well stocked.

Basically, a nurse in a rural area becomes a Jack of All Trades and a master of none.

Professor Saracino, the former Minister of Health in Côte d’Ivoire, summed it up well:

“When you use a nurse or a physician as a logistician, you lose the nurse or physician and you don’t get a good logistician!”

In this sense, becoming a “Master of ONE” as opposed to “NONE,” is one aspect of the Dedicated Logistics System (DLS), a different approach to supply chain management that VillageReach is developing, through the Final 20 Project supported by the Bill & Melinda Gates Foundation. The DLS has shifted supply chain management responsibilities to the hands of a few dedicated personnel. The DLS moves supply chain management functions as high up in the supply chain as is geographically feasible, consolidating tasks at the provincial level so that limited resources available can be dedicated. This frees up a health worker’s time to focus on patient care.

When I visit Mozambique and accompany a vaccine distribution, I see the benefits of this system firsthand. The dedicated logistician checks records and manages the stock while the nurse cares for the many dozens of children waiting for her. The DLS has reduced lines and waiting times, enabled the health workers to focus adequately on primary care, and dramatically improved the reliability of the supply chain, thus increasing trust in the health system.

We have documented this approach, and the role of human resource management in improving vaccine supply chains in the Reaching the Final 20 Policy Paper Series, available here.

For more information on the DLS, and VillageReach work in Mozambique

About the Author: As Program Manager, Wendy Prosser is responsible for the design, implementation, and monitoring and evaluation of health system program for VillageReach in Mozambique. Efforts in Mozambique seek to streamline vaccine logistics with an improved logistics management information system and transport services. Wendy has over a decade of global health experience in program development and management, research and analysis, capacity building, and behavior change communications. This experience has taken her to Mozambique, Malawi, Angola, Kenya, and South Africa in various public health settings, starting with Peace Corps in Cape Verde. Wendy holds a MPA in International Development and Global Health from the University of Washington.

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