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Malawi
Mozambique
Technology Initiatives
Social Enterprise
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Malawi:
Mozambique:
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Allen Wilcox
President
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.
Read full storyAfter spending nearly two weeks in an intensive course offered by the Institute for Health Metrics and Evaluation for its incoming fellows (and a couple of fortunate UW graduate students like me), I have an even greater appreciation for the role of evaluation in our work in global health and for the complexity and difficulty in doing it well. In her lecture on Evaluating Health Programs, Dr. Emmanula Gakidou, pointed to what is called “The Evaluation Gap” where billions of dollars from international donors and national governments are being channeled into health programs in low and middle income countries but we know relatively little about what programs are working and how well they are working. The reason being is that most of them are not rigorously evaluated.
Even while researchers continue to develop and test new interventions such as vaccines, diagnostic tools, and drugs through thorough clinical research, we don’t know how best to deliver them in countries with weak health systems. The result is an innovation pile-up where proven interventions to prevent and treat disease are available yet millions of people are dying because these interventions don’t reach them.
As a graduate student in public health, it seems to me that the field of global health is turning in this direction and placing a lot more value on measuring impact. As President Obama said in his speech at the MDG Summit; “let’s move beyond the old, narrow debate over how much money we’re spending and let’s instead focus on results-whether we’re actually making improvements in people’s lives.” We need to know what is working and what isn’t so we can better our efforts and get the interventions out to the people who need them.
Unfortunately, evaluation is difficult to do well. As I quickly learned in the IHME course, there are some serious limitations to deal with ranging from poor data quality and availability to the fact that the methodology of conducting a rigorous evaluation just sometimes isn’t possible or is really expensive. As expressed in a Lancet editorial: “Evaluation matters. Evaluation is science. And evaluation costs money. It’s time that the global health community embraced rather than evaded this message.”
VillageReach makes a sincere commitment to evaluation of its programs and has ever since its inception. For example, as we begin to scale-up the Dedicated Logistics System in Mozambique, we are engaged in operations research to inform our program decisions. In addition to routine monitoring, we are conducting baseline evaluations in every province followed by process and outcome evaluations. We want to know what is working and more importantly, what isn’t working and why, so we can ensure that the resources we put into our programs really make improvements in people’s lives and that those interventions make it to the people who need them. We’ll keep you posted on our progress.
Jessica Crawford, MAPS, MPHc
Program Associate
VillageReach
A few weeks ago I traveled to Malawi to work on two projects that use SMS phone technology. One of these projects focuses on providing community health workers (CHW) with an easier and quicker way to communicate with their local hospital, supervisors, and fellow community health workers. I spent an afternoon with 18 of the 21 CHWs in the Kwitanda province to understand how they would utilize such technology, and used that information to develop use cases (e.g. outbreaks, inventory shortages, emergencies, etc.) that will help them provide better health care to villagers in their catchment areas. For the other project, I met with shop owners, assessed the medicines they sell, and discussed the benefits of inventory management with them (which is of personal interest to a supply chain person like myself). The insights I gained through interacting with CHWs and shop owners were then funneled to our technology team, which is working on our upcoming Management Information System (vrMIS3).
I am excited about the potential that these two projects will have for those working in rural and remote areas with poor road and electricity infrastructure and for us, who will be able to collect real-time information about what the needs are in the field and how we can develop programs and innovative approaches to strengthen health systems at the last mile.
Although my time in Malawi was quite busy, I was glad to have had the chance to visit an under-5 clinic, where large numbers of women brought their children to be weighed (for growth monitoring purposes) and to be immunized. In Malawi, like in most of the world, women spend their days collecting water and firewood, washing clothes, caring for handfuls of children, tending to their fields, and preparing meals. Yet these women were willing to put their other duties on hold so that their children could receive vaccines and have a chance at growing up healthy. The health workers in Kwitanda have done a great job at educating these women about the importance of vaccines and health care for their children.
-Jessica, Logistics Manager
Read full storyBack in February, VillageReach purchased bicycle ambulances for a number of communities in rural Malawi. Before they had these bicycles, community members would often resort to making homemade stretchers to carry their loved ones to the nearest health facility. Needless to say, the communities are very excited to have the new bicycle ambulances. In June, I was able to go back to Malawi and visit three of the communities with the new ambulances.
Welcomed by song and dance, I was incredibly excited to learn that the communities had formed committees to maintain the bicycleambulances and regulate their usage. The committees each had an appointed treasurer who gathered and secured funds to ensure that thebicycle ambulances would be well kept as a community resource. Of the three communities I visited, one community had used their bicycleambulance twice, another once, and the third had still not used theirs. While at first this seems like the bicycle ambulances are being underutilized, to me it reflected a real valuing of the bicycle ambulances;the communities were not allowing them to be abused and were reserving them for truly grave emergencies. This was a perfect (and heartening) example of real community buy-in, which at the end of the day is one of the few variables that can really support true sustainability.
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