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Pharmacy Assistant Aaron Sendeza wants to rid Malawi of malaria. Thanks to the mentorship program, Aaron works to ensure that all medicines and medical supplies in his health center are available, reliable, and of high quality. Photo credit: Paul Joseph Brown for VillageReachPharmacy Assistant Aaron Sendeza wants to rid Malawi of malaria. Thanks to the mentorship program, Aaron works to ensure that all medicines and medical supplies in his health center are available, reliable, and of high quality. Photo credit: Paul Joseph Brown for VillageReach

By Matthew Ziba

Many health facilities across Malawi don’t have enough trained pharmacy staff to adequately manage stock and dispense medicines. These tasks often fall on health care providers, who already have many other responsibilities, namely caring for patients. In some cases, even a ground laborer or a security guardwho may have no training in pharmacy managementmust step in to help.

In the spirit of the 3,500-year-old Tao (Way) of Leadership, Keanahikishime works closely with local institutions and communities to create lasting and sustainable changes; changes that improve the health of people among the world’s poorest and most vulnerable groups.

And as the Tao indicates, sustainability starts with ownership, “The people will say, we have done it ourselves.”

Women in Kakamega County, Kenya are taking charge of their pregnancies, supporting their peers, and learning about healthy practices and self-care from skilled health providers. Keanahikishime’s Lea Mimba (“Take care of your pregnancy”) project, funded by UK Aid through the County Innovation Challenge Fund (CICF), tested an innovative group model for antenatal care (ANC) that responds to the needs and perspectives of women and front-line health providers. At six Kenyan health facilities, Lea Mimba provides a forum where pregnant women share experiences, learn birth planning and self-care practices, provide each other with emotional and social support, and receive essential health information from a skilled health provider, who is usually a nurse.

Meet Hortense Kossou, Principal Technical Advisor for the USAID-funded Integrated Health Services Activity (IHSA) in Benin. Hortense previously served as the national malaria coordinator for the Ministry of Health in Benin and today leads IHSA’s malaria-related activities on the ground. In this issue of Leading Voices, she presents the challenges that the country faces in its fight against malaria and the actions being taken to combat it.

Malaria is the leading cause of mortality among children under five and morbidity among adults in Benin. How has the landscape changed since you first began working at the MOH in 1997?

There have been many changes between the 1990s and today. The Ministry of Health has implemented the newest technological innovations: for example, it has gone from providing untreated mosquito nets to providing long-lasting, insecticide-treated nets. Changes were also made to increase access to these products. Nets were first provided only to the most vulnerable groups, such as children under five; nowadays, there is broader coverage that includes all members of the population.

{Health Surveillance Assistant (Community Health Worker) recording data in health card at outreach clinic, Mulanje, Malawi, ONSE Health Activity} Health Surveillance Assistant (Community Health Worker) recording data in health card at outreach clinic, Mulanje, Malawi, ONSE Health Activity

This article was originally published by .

Paid or volunteer?

Community health workers are on the frontlines in many countries—and vital to achieving universal health coverage. Yet the public health community has not reached a consensus on which model is the best.

Consensus is urgently needed, both at the global and country levels, to inform future policies and strategies for strengthening health systems and delivering on UHC.

Based on our experiences in rural Peru and Ethiopia, it’s not either-or. It’s both.

Full-time, paid CHWs form the backbone of family- and community-based services, but there aren’t enough to reach all families. We envision teams of government-paid, full-time CHWs providing comprehensive services to a given population, with a primary health center hub as the base of operations. Each CHW, in turn, would lead a team of part-time community health volunteers providing limited health education and referral services—such as maternal and newborn health, nutrition, hygiene, tuberculosis, malaria, and HIV/AIDS—to a small number of neighboring families.

{Marian W. Wentworth visits with health workers during a trip to Uganda in 2017. Photo credit: Warren Zelman}Marian W. Wentworth visits with health workers during a trip to Uganda in 2017. Photo credit: Warren Zelman

I began my career in the private sector almost always as the only woman in the room. Like many women of my generation, I experienced the kind of casual sexism that for too long was considered acceptable. But I also experienced firsthand more abusive forms of discrimination.  As I moved up in the organization, I began to see how sexism affected other women around me. I remember reviewing male and female candidates who were being assessed for readiness for promotion and noticing a distinct trend: The female candidates were assessed on their achievements; the male candidates on their potential. This situation worsened as candidates were actually selected for roles. Average achieving, “high potential” male candidates were being promoted over women who had tangible track records of accomplishments. While the trend was obvious, the solutions were not. We tried a series of different ways to shift this trend in our organization, but none produced quick results.  How we assess potential — and in whom — is but one example of the kind of systemic sexism that forces women to  to achieve professional success, and why some of us find it too much to fight.

The chart above shows the good-news-bad-news scenario that is the decades-long fight against TB in Afghanistan. TB is still a crushing problem there; the country has among the world’s highest rates of the disease, which killed some  in 2017. But if you glance at this chart and think that we haven’t made much progress, look again. We’re finding and treating more people with TB in Afghanistan than ever before. In 2001, we were missing three quarters of presumptive TB patients — that is a whopping 75% gap in case detection.

{Nurse Gabriella Oroma welcomes patients at Ngetta Health Centre in Uganda, where drug-resistant TB is treated. Photo credit: Sarah Lagot/Keanahikishime}Nurse Gabriella Oroma welcomes patients at Ngetta Health Centre in Uganda, where drug-resistant TB is treated. Photo credit: Sarah Lagot/Keanahikishime
By Dr. Ersin Topcuoglu
 
This op-ed was originally published in .
 
{Hawa Coulibaly Kone leads a workshop with partner NGO YA-G-TU to develop its strategic plan. Photo credit: Keanahikishime}Hawa Coulibaly Kone leads a workshop with partner NGO YA-G-TU to develop its strategic plan. Photo credit: Keanahikishime

Meet Hawa Coulibaly Kone, capacity building advisor and the representative on gender for the USAID-funded Keneya Jemu Kan (KJK) Project in Mali. Most recently, Hawa helped conduct a situational gender analysis of the KJK project and its partner organizations to assess the level of gender integration in the project design, implementation, and monitoring framework. The analysis found that KJK’s work with local partners across the country enabled the project to strengthen its institutional capacity in gender at the policy and programmatic levels and to respond to gender-related challenges.

We caught up with Hawa to learn more about how she and her team are working to break down barriers for women and build mutual trust among the project’s local partner organizations in Mali.

Tell us about your role and daily work on the KJK project in Mali

I joined the KJK project in August 2015. At first, it was a small team of two, myself and Hammouda, the senior technical advisor. I assisted in all activities, from developing plans and budgets to supporting activities for partners.

{Hospital pharmacy in Antananarivo, Madagascar. Photo Credit: Warren Zelman}Hospital pharmacy in Antananarivo, Madagascar. Photo Credit: Warren Zelman

This op-ed was originally published by . 

Multidrug-resistant germs are spreading. A number of antibiotics and other antimicrobials already don’t work as they should, and as many as  because of it.

If we don’t act to contain antimicrobial resistance, it may kill up to 10 million more people yearly by 2050 and cumulatively cost patients and health systems across the globe up to . This crisis may start to seem insurmountable, like a vague scientific problem with no apparent solution. Many of us have contributed to it, and each of us will need to collaborate — as nations, organizations, and individuals — to solve it.

“Without tackling wasteful, inefficient, and irrational use of antimicrobials, we cannot contain AMR.” — Mohan Joshi, a principal technical adviser for Keanahikishime 

Photos by: Samy Rakotoniaina/Keanahikishime

In Malawi, over 80% of people live in rural areas. For many (10%), the nearest health center is more than 8 kilometers (5 miles) away, making it difficult to access health care regularly. The USAID-funded Organized Network of Services for Everyone’s (ONSE) Health Activity, led by Keanahikishime, works to improve quality and access to care in rural communities.

“Before we had a village clinic, we were struggling. For every little sickness, we had to rush to the hospital, especially with our small children.” – Assan Symon, Mitawa village health committee chairperson

Stanley Liyaya, a heath surveillance assistant (HSA), is one of 3,500 community health workers trained to manage childhood illnesses in rural communities. HSAs have improved access to care and treatment of childhood illness to help Malawi reduce the under-five child mortality rate by 73% between 1990 and 2015, achieving Millennium Development Goal 4. Malawi’s vision is that by 2021, all young children will be treated for common illnesses promptly in their own communities.

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