Thoughts from the Last Mile Welcome to the VillageReach Blog

Category Archives: Malawi

02.10 2014

SaitiBy Saiti Chikwapulo

I believe the work of VillageReach has saved lives.  Our work, supported by generous donors, has changed the way an entire community has approached health and healthcare services by providing access to safe water, improvement of hygiene practices, and high uptake of healthcare services –leading to a healthier and more productive community.

Before VillageReach, Kwitanda was facing quite a number of health challenges as many Malawi communities face; cholera and other diarrhea diseases were common. Many people were getting sick, contributing to an unproductive and unhealthy community.

A major contributing factor to the reduction of these diseases was the implementation of Community-Led Total Sanitation (CLTS) approaches. Previous approaches to human waste disposal in our community were not working because they were not affordable or sustainable. By figuring out ways that the community could lead the effort, rather than depend on, or wait for others to do it, we created sustainable change.

By figuring out ways that the community could lead the effort, rather than depend on, or wait for others to do it, we created sustainable change.

A modification of the CLTS approach called School Led Total Sanitation focused on improving sanitation facilities in schools, coupled with a hygiene education programme in the belief that the children are change agents in their communities to enforce and enhance adoption of the community initiative. In this case, the Kwitanda schools have been instrumental in this community-lead process, working with VillageReach to ensure adequate numbers of toilets and washing facilities are available at all schools.  Every school now has a management committee and Parent Teacher Association (PTA).  These school-based structures are modes of delivering adequate sanitation facilities in schools. Their main purpose is to mobilize communities to take these issues on, with VillageReach encouraging, supporting and advising as needed. The schools and the PTA raised their own funds and organized all of the required labor to build adequate toilet facilities.  The community now has a sense of ownership and pride in being able to provide and maintain healthy sanitation systems for their own schools.

These two approaches have improved sanitation facility availability, use and adoption of positive protective hygiene practices, thereby contributing to fighting cholera and other hygiene-related diseases in Malawi.

Education and promotion of healthy standards and hygiene practices, like providing a tight-fitting pitlatrine drop-hole cover and hand washing facilities, has also contributed to the elimination of Cholera and other illnesses.  Through outreach and education efforts lead by VillageReach, every house has access to health messages and information promoting health and hygiene.

VillageReach has also played a very important role in reducing illness by increasing access to a reliable source for clean water.   Kwitanda is in a low lying area with many streams of water flowing, especially during the rainy season.  We have a lot of pools of water and water pollution is common. People would often drink from these contaminated water sources by drinking from unprotected dug wells, one of the primary ways cholera is transmitted.  VillageReach broke that cycle of transmission by drilling boreholes (40 meter holes with pumps) in order to improve access to protected water sources. In addition, our team worked with the community leaders and health center to greatly improve the supply and protection of drinking water in the home by making available and promote use of chlorine solution, commonly used to kill water-based or water-washed disease-causing pathogens.  This is especially critical during the rainy season, when the rate of transmission is highest. Before VillageReach intervened, availability of chlorine solution was not consistent, stock outs were common, lowering community trust in the supply and decreased use in homes. Applying the VillageReach model, starting at the last mile, working from the end of the supply chain up, greatly improved availability and use. People began to trust the system more knowing that product would be available at their local Health Center when they needed it, and this greatly increased usage in homes.

A report from the Ministry of Health Malawi reports that no Cholera cases were reported in 2013! Read the story here. 

As Cholera has been a major public health concern in Malawi, this is great progress.

If we can make such significant changes in one community of Kwitanda, imagine what could happen if we apply this model on a larger scale?

For more information on our Kwitanda Health Project

 

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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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11.23 2013

We are proud to be featured again this year in SIF’s annual Global Giving Guide. See our profile exerpted below, and visit the Seattle International Foundation.

Rose is a Group Village Head in central Malawi and is responsible for overseeing the well-being of a community of a 32-village community. She has long been concerned with the challenges women and children face in her community when trying to access health information and services. Women and children in Rose’s villages, and in Malawi as a whole, experience high rates of maternal and child mortality as a result of limited health care and lack of reliable information on safe motherhood and child health practices.
SIF.2013_2b

Today, women and children in Rose’s community are getting help from Chipatala cha pa Foni (health center hotline, in English), a toll-free maternal and health hotline that provides health information, advice and referrals. Service users also have the option of signing up for weekly voice or text messages to receive health tips & reminders to access preventive health care services. Village volunteers help women understand and use the service and ensure access for those without cellphones through project phones.

Chipatala cha pa Foni effectively extends the reach of the health system, allowing women and children to access health services from their home without having to travel long distances to the nearest health center. As a mother, grandmother and community leader, Rose has been a strong advocate for use of the Chipatala cha pa Foni in her community. Rose encourages those who have cell phones to lend them to those who cannot afford one, and has even contributed her own phone to those who don’t own phones. As a result, the Chipatala cha pa Foni program has had a vast reach into the community, receiving over 11,000 calls and registering nearly 6,000 women and caregivers of young children for the tips and reminders service.

Since 2000, VillageReach has worked to improve the performance of health systems, serving more than 10 million people in remote communities across sub-Saharan Africa.

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06.18 2013

VillageReach, in partnership with the Malawi Ministry of Health, Malawi College of Health Sciences and University of Washington Global Medicines Programs is supporting a two year Pharmacy Assistant certificate course. The College has enrolled fifty students for the 2013 intake. The project is envisaged to address three main factors that affect overall medical supply chain performance namely; human resources, access to information, and availability and use of commodities. Once trained, the pharmacy assistants will be placed at health centers throughout Malawi where currently no pharmacy trained personnel exist.

In February and March 2013, I was part of a team comprised of staff from VillageReach, Ministry of Health and Malawi College of Health Sciences to conduct an assessment in 12 of the country’s 28 districts that will receive students for practicum from May this year. The purpose of our assessment was to collect district level baseline information and identify gaps and strengths on the part of district pharmacies and the Pharmacy Technicians who will be serving as preceptors to the students.

Overall, we found that all the practicum sites have experienced human resources, systems and infrastructure to serve as quality learning sites. However, challenges also exist.

In terms of human resources for instance, our team found that Pharmacy Technician posts are established in all the districts we visited; on average two per district, however the actual filled posts ranged from one to four pharmacy technicians. We also found volunteer pharmacists in two districts.

One of the key challenges that our team noted was that of storage space. This is contributing to disorderly organization of commodities; in some cases our team noted that commodities were stored in several different buildings or locations making it difficult to control inventory.

We also observed delays in submitting district reports, poor record keeping, and general disorganization of data and records in a majority of districts.

Our team also noted that dispensing was not being done by pharmacy personnel. Instead, Hospital Attendants with no training in pharmacy were responsible for dispensing medicines and providing counseling to patients. An additional challenge noted at dispensaries included late openings due to daily pre packing of commodities into individual dosages.

The deliberately enhanced practicum dimension of the pharmacy assistant program design serves several beneficial purposes to both the students’ academic and professional growth, as well as contributing to improved service delivery at practicum sites. Under the supervision of pharmacy technicians, the students will be getting an on the ground practical perspective into their chosen career at practicum sites including experiencing working in rural areas. This setting also presents an opportunity for students to translate classwork and theory into practice, ultimately enriching their academic stance in the training. While supervision and mentoring of the students will be an additional workload on the Pharmacy Technicians, their presence is envisaged to contribute positively to improved service delivery specifically on information management and storeroom management given pharmacy trained staff shortages. This design ultimately prepares the students to hit the ground running with hands on experience upon graduation and deployment to serve in remote health centers where at the moment have no pharmacy trained staff exist.

Charles Matemba
Monitoring & Evaluation Officer

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04.19 2013

Last week, Patrick Phiri, Senior Technical Advisor, and I had the pleasure of meeting the first cohort of students enrolled in the Pharmacy Assistant TraineesPharmacy Assistants Program training course at the Malawi College of Health Sciences. This group of 50 talented and eager students will be the first trained pharmacy personnel to work in rural public health facilities throughout Malawi. These 50 students were selected from more than 1,200 applicants. Patrick and I were very happy to congratulate the students on their achievement so far and wish them success as they begin their studies.

In Malawi, health facilities and the communities they serve often suffer from a lack of life-saving medicines, primarily due to weak supply chain management systems, poor pharmaceutical management, a lack of data on medical consumption, and inadequately trained personnel. VillageReach, in partnership with the Malawi Ministry of Health, the Malawi College of Health Sciences (MCHS) and the University of Washington Global Medicines Program, is working to accelerate progress towards addressing these key barriers to medicines availability at the facility and district levels by implementing a new approach to the training, deployment, and support of an enhanced Pharmacy Assistant cadre.

As part of a two-year certificate training program, these 50 students will spend ten weeks on campus receiving an orientation in pharmaceutics, pharmacology, and medicines and medical supplies management. After ten weeks, half of the students will be deployed to 12 district hospital pharmacies to begin five months of on-the-job training under the mentorship of Pharmacy Technicians while the other half will remain on campus to continue their classroom learning. After the initial five months, the students will switch places. In their second year of studies, the students will continue with the same schedule only instead of district hospitals, the students will be placed at rural health facilities. As a result, the students will be contributing to improving pharmacy management and supply chain needs at district hospitals beginning in their first year, and at rural health facilities in their second year of studies.

Once these students graduate, they will nearly double the existing pharmaceutical work force in the public health system. According to the 2011 Health Sector Strategic Plan (HSSP), there are only five pharmacists in the country’s public health sector to fill an estimated 90 positions and only 24% of the established positions for pharmacy technicians are filled, leaving clinical and frontline health workers responsible for managing pharmacies and logistics duties. Despite the fact that the vast majority of medical commodities inventoried in rural health facilities’ dispensaries are prescription-level medicines within the United States context, the pharmacy positions are not staffed by qualified pharmacists or pharmacy technicians or other experienced staff. Instead, guards, attendants or other community members with no formal training are responsible for this critical work. The demand for pharmaceutical services, particularly with the advent of the HIV/AIDS epidemic, has increased markedly and points to the need for a comprehensive and sustainable scale-up of the pharmaceutical workforce in Malawi.

The Malawi MoH established a target to train and deploy at least 650 Pharmacy Assistants to enable every health facility in the country to have trained pharmacy personnel on staff. These first 50 students mark the beginning of a large effort in Malawi to improve medicines and medical supplies management in the country. We expect that at this time next year, we will be meeting the next 100 students enrolled in the program. For now, we are thrilled to meet these 50 committed individuals and wish them the best of luck in their studies. We look forward to seeing their success in both the classroom and in their work as Pharmacy Assistants.

Jessica Crawford
Program Manager
Health Systems Group

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04.19 2013

A frontline perspective of the CCPF “Health Center by Phone” Program By Novice Gauti Hotline Supervisor VillageReach, Malawi

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 Kalembo, 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.

 

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11.19 2012

In 2012, the Kwitanda Community Health Project expanded into new programmatic areas, increasing its reach by developing new maternal and newborn health activities, establishing the Kwitanda Economic Development Initiative and starting work on filling gaps in HIV care in the community.

As we start a new fiscal year, the Kwitanda Community Health Project team has reviewed the results from our 2012 evaluation. The full report is posted on the Evaluations and Assessments section here. The evaluation has been a key tool for us in reflecting on last year’s progress and areas that need improvement as well as developing strategies for next year. Here are some of the highlights from this year’s evaluation and examples of how we are using these results to inform our planning:

Access to clean drinking water significantly increased in 2011 and 2012.
During the past year, VillageReach constructed and repaired 10 boreholes to increase access to clean drinking water. Eighty-eight percent of Kwitanda residents have access to clean water and 54% have to travel less than 500 meters (< 1/3 mile) to the nearest water-source. We will continue working to improve access to clean drinking water over the next year. Access to sanitation improved between 2011 and 2012. Over the last year, VillageReach supported the installation of 220 sanplats in household latrines to improve sanitation and helped construct 1,045 tippy-taps to provide hand-washing facilities and decrease diarrhea. As a result, we saw an increase in the number of household with sanitary latrines (up to 80% from 72% in 2011) and the number of households with access to a handwashing facility (up to 43% from 14% in 2011). Next year, VillageReach plans to intensify our efforts in information, education and communication around safe water storage and handwashing and improving sanitation through implementation of community led total sanitation (CLTS). CLTS ensures that every household has a pit-latrine (and uses it) and aims to have the catchment area declared Open Defecation Free (ODF).

Malaria rates decreased significantly between 2011 and 2012. Of the households included in our sample survey, 62% reported at least one person with malaria during the last 4 months, compared to 72% last year. Though malaria rates decreased, there was a disappointing decrease in mosquito net ownership and usage. Approximately 1/3 of children who received a mosquito net from VillageReach last year reported not sleeping under a net this year. VillageReach plans to conduct follow-up with a sample of families in order to learn more about what barriers prevent these children from sleeping under a net despite receiving a net in addition to continuing with net distribution to children aged less than five years.

Baseline indicators for maternal and neonatal health highlight a need for new interventions. The maternal and neonatal health indicators from 2012 suggest gaps in current services geared toward mothers and young children, particularly in the area of facility births, exclusive breastfeeding, receiving timely postnatal care, and receiving all four recommended antenatal visits. VillageReach is well positioned to address these gaps next year and has already started addressing these gaps; VillageReach recently supported the training of all 23 Health Surveillance Assistants for Kwitanda in maternal and child health and launched outreach antenatal clinics to better serve women hard-to-reach areas. VillageReach also intends to support chiefs in establishing village models that aim to foster maternal, child health and safe motherhood programs including IEC on the importance of male involvement in maternal and safe motherhood.

We are excited about the upcoming year and look forward to intensifying our efforts to reduce malaria and diarrhea as well as expanding our reach into new areas.

Patrick Karonga Phiri
Project Manager, Kwitanda Community Health Project
Balaka, Malawi

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07.19 2012

We recently sent out this latest update … here’s our news in case you missed it …

Malawi

  • update on our work to improve maternal and newborn health in Kwitanda
  • the latest on our Chipatala Cha Pa Foni (health center by phone) program, part of the Innovations for Maternal, Newborn and Child Health initiative
  • Mozambique

  • new update to our Mozambique Dedicated Logistics System (DLS) program
  • collaboration with the William Davidson Institute (University of Michigan) Supply chain & logistics study: new research to quantify the logistics challenges for a variety of medical commodities
  • Dr. Seth Berkley, President of the Global Alliance for Vaccines and Immunization (GAVI) visited the DLS program
  • Technology Initiatives

  • ODK Scan: update on our collaboration with the University of Washington’s Computer Science & Engineering to improve the quality of data collection
  • OpenLMIS: new website with updated details on activities and partners
  • Social Enterprise

  • VidaGas: our collaboration with the ghdLABs program at MIT, to evaluate the marketplace for our social enterprise in Mozambique
  • New Additions to Our Team

    Malawi:

  • George Chinkwita – Project Officer, Kwitanada Economic Development Initiative
  • Erin Larsen-Cooper – Program Associate
  • Mozambique:

  • Antonio Gaspar Tomboloco – Field Officer, Niassa Province
  • See here for details …

    Updated Financial Report

  • our recently posted 2011 independent financial audit
  • We welcome your questions and comments,

    Allen Wilcox
    President

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    07.10 2012

    In Malawi, more than eight in every one thousand women die from maternity-related causes, while almost 90 percent of childhood deaths occur during the first year of life. Malawi women have a 1 in 36 chance of dying during childbirth. Reducing the maternal mortality rate in Malawi not only saves the lives of women, but most maternal interventions will also reduce mortality and morbidity among infants. Moreover, saving the life of a mother can protect older children; orphaned children have a three to ten times greater risk of death than those with living parents.
    In October and November 2011, VillageReach conducted a needs assessment to identify the barriers to optimal maternal and neonatal healthcare in Kwitanda, Malawi through interviews and focus group discussions with health workers, health surveillance assistants (HSAs) and women in the community. The results pointed to the major barriers to optimal maternal and child healthcare as long distance to the health facility and lack of transportation for antenatal care (ANC), delivery and post-natal care, perceptions of poor treatment and safety at hospitals compared to delivering with Traditional Birth Attendants, traditional beliefs maternal and infant health practices and when and where to access care, and a general lack of knowledge regarding the importance of early post-natal care.
    To overcome these barriers, VillageReach is implementing the following programs:

    Extend the Reach of ANC services to the community Currently, ANC services are offered at Kwitanda Health Center but women have expressed a great interest in these services being provided closer to home. We will leverage existing structures to conduct ANC outreach clinics by Kwitanda Health Center staff closer the community. ANC outreach is scheduled to begin this month.

    Train Additional HSAs in Maternal and Neonatal Health With funding from The Seattle International Foundation, VillageReach will train and support additional HSAs in maternal and neonatal health to extend the cadre available to visit women in their homes. Currently, five HSAs in the Kwitanda catchment are trained in MNH. The specialized cadre of HSAs can provide home-based postnatal care to all newborns, track the health status of pregnant women, encourage ANC visits and facility-based delivery, and support women in the development of a birth plan. Nine HSAs are currently in training.

    Leverage Existing Maternal and Neonatal Health Services Provided by VillageReach VillageReach’s work with MNH through the Chipatala Cha Pa Foni (health center by phone) case-management hotline service was rolled out in the Kwitanda area in March. The hotline provides health advice and information to pregnant women and caregivers of children under-5, refers individuals to a health center or village clinic if warranted, and registers women and caregivers for an automated tips and reminders service sent to their phones or accessible through phones of community volunteers. The hotline provides direct access to a health worker for community members who may have previously had a poor perception. Thus, in addition to providing direct advice, the hotline serves to improve community trust in the health system.

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