Thoughts from the Last Mile Welcome to the VillageReach Blog

Category Archives: Health Worker Capacity

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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03.31 2014

By CLIFFORD KANONO
VillageReach Pharmacy Assistants Program Student– Class of 2015

IMG_2681My name is Clifford Kanono.  I am enrolled in VillageReach’s Pharmacy Assistant Training Programme. Previously, I worked as a Health Surveillance Assistant in the rural communities of Nkhata Bay District in the Northern part of Malawi. The health facility I worked in had to serve about 14,500 people in a year—a large number given the resources of the facility.  This, like most other health facilities in rural communities face many challenges, but one of the most problematic is the adverse effects of non-trained pharmacy personnel:

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01.13 2014

A frontline perspective of the CCPF “Health Center by Phone” Program

When I trained as a midwife, I had no idea that I would be helping deliver babies over the phone. Technology has come a long way, especially in the district of Balaka in Malawi.

In September of this year, Mercy, a 24 year old pregnant woman from Dailesi village in Balaka, told her family that she wasn’t feeling well, and set out for Kalembo Health Center seated on the back of a bicycle driven by her neighbor.

Dailesi village is 12 km away from the nearest health center, and is located in a hilly area far from paved roads. The only transport available is by foot, by bicycle taxi, or–in case of emergency–by ox cart or bicycle ambulance.

After an hour of traveling, Mercy started feeling intense muscle contractions signaling the birth of her baby and could no longer sit on the back of the bicycle. Mercy asked the bicycle driver to stop in a nearby village so that the women living there could help her deliver her baby.

With no other transport available, still far from the health center, and without any skilled personnel nearby to help with Mercy’s delivery, her neighbor decided to call Chipatala cha pa Foni for assistance.

Chipatala cha pa Foni (CCPF), which translates to “health center by phone,” is a toll-free hotline that women in rural Malawi can call to speak directly with a hotline worker for information on pregnancy, newborn and child health, and reproductive health issues such as family planning. A VillageReach project, CCPF provides clients with advice they can follow at home, or refers them to a health center or hospital if they’re displaying “danger signs” which require further care. Women in the community can also sign up for CCPF’s “Tips and Reminders” mobile messaging service to receive regular text or voice messages tailored to their week of pregnancy or their child’s age.

Besides information and referrals, CCPF has also linked key services to the community, as in the case of transport. After visiting the CCPF Hotline Room, the Balaka District Transport Officer was so impressed with the potential of CCPF to save lives that he offered to assist in arranging transport logistics for callers in critical condition or in need of immediate care. He gave us his telephone number and requested that we let him know of any emergency transport needs.

Less than one week later, we took him up on his offer when Mercy called the hotline.

Rose Nkupsya, a nurse and CCPF hotline worker, answered the call from Mercy. Rose understood the urgency of the situation and informed the transport officer. He immediately responded by sending the district ambulance to pick up Mercy and bring her to the nearest health facility.

Before the ambulance could reach her, Mercy delivered a baby boy. Mercy was bleeding heavily when the ambulance arrived and needed to be helped by health workers. But she was afraid of being reprimanded by them for delivering her baby outside of a facility and was concerned that the nurses would not admit her. Over the phone, Rose reassured her, and Mercy agreed to go to the health center where the nurse on duty was able to stabilize her condition and successfully stop the bleeding. Had it not been for CCPF and the transport officer, Mercy would have suffered severe bleeding and infection. Fortunately, she and her baby boy received timely and appropriate care, and both are happy and healthy today.

Chipatala cha pa Foni provides an important service to women in four districts of Malawi, but our work is far from finished. I look forward to continuing to help women have safe pregnancies and deliveries and for children to grow up happy and healthy.

Learn More About CCPF

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