WHO Bulletin features Youth Editorial on the Global Strategy

The May 2016 issue of the Bulletin of the World Health Organization was published today.  The Volume 94, Number 5, May 309 – 404 journal has a special theme devoted to  the health of women, adolescents and children, focused on the implementation of the Global Strategy (2016 – 2030).

South African social justice writer and Girls Globe blogger, Zanele Mabaso’s article is featured amongst the high-level editorial publications, which ascribes the inclusion of adolescent outcomes in the global strategy to young people’s participation titled “Young people’s contribution to the Global Strategy for women’s, children’s and adolescents’ health (2016 – 2030)”   with contributions from co-authors Temitayo Erogbogbo and Kadidiatou Toure.

The issue additionally features young medical doctor from Benin, Dr Joannie Bewa sharing how campaigns for sex education and free contraception are changing reproductive health prospects for young people in Benin.

The Youth Editorial on Young people’s contribution on the Global Strategy for women’s, children’s and adolescents’ health (2016 – 2030) can be found here.

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Improving the health of pregnant women and children in Malawi

An integrated community health facility project to improve maternal and child health.

Pregnancy is such a dangerous time in a Malawian woman’s life that it is considered unlucky to tell people about it.

The majority of women in Malawi live in scattered villages and find it hard to reach health facilities. They lack the information needed to make informed health decisions and facilities struggle to provide the quality services needed to save mothers’ and babies’ lives.

Women and Children First (UK) has supported maternal, newborn and child health (MNCH) projects in Ntcheu District since 2005. This integrated community/facility project, implemented by the Malawi Ministry of Health’s Perinatal Care Project between 2010 and 2014, strengthened both the demand and supply sides of the health system to address maternal, newborn and under-fives’ health issues.

Photo Credit: Women & Children First UK
Photo Credit: Women & Children First UK

Overall, the project was very successful in enhancing the coverage of essential maternal, newborn and child health interventions in the target communities and health facilities.

The final evaluation showed 94% of women were delivering in health facilities, the percentage of newborns getting postnatal care within 2 weeks of birth had increased from 35% to 95% and the percentage of women attending ante-natal care in the first three months of pregnancy doubled. Women’s knowledge of good childcare practices increased from 12% to 96%.

Community women’s groups played a central role in the project. Through these groups. women identified their most pressing maternal and newborn health problems and devised strategies to address them, mobilising locally available resources to do so.   Common strategies were: improving sanitation and village hygiene; village savings and loans associations; kitchen gardens to improve nutrition; drama groups to share MNCH information; and bylaws to discourage early marriages. Led by specially trained local facilitators, the women’s groups raised awareness of the value of antenatal (ANC) and postnatal care (PNC) and delivering with a skilled birth attendant.

“I’m 18, married and have four daughters. There weren’t any problems with the births. Now I use a contraceptive injection. In the group …. we learnt that when you are pregnant there may be problems, such as swelling of the feet, anaemia and nausea, and also that some women may still bleed during pregnancy. We have also been taught about some of the dangers of childbirth, for example eclampsia, blood loss and problems in removing the placenta. I share what I have learnt with other women, and encourage them to join the group.” Regina Ntebe, Daudi Village

Involving the wider community was important and the sensitisation of Village Chiefs, the training and deployment of growth-monitoring volunteers who promoted immunisation and improved nutrition, and encouraged men to accompany their wives to ANC and PNC contributed to the successful outcomes.

“We encourage all the women to join the groups. The … project has really helped us to ensure that almost all women now have their babies in health centres.” Group Village Headman Chipusile

Key interventions for improving the health services for pregnant women and newborns included training healthcare staff on care of women in labour, care of the newborn and emergency obstetric newborn care and the provision of medical equipment. Lack of consistent supervision for frontline staff was identified as an issue during the mid-term review and additional coaching and mentoring was provided to midwives and nurses during the final phase of the project.

group
Photo Credit: Women & Children First UK

The project findings provide a picture of “healthy communities” in Ntcheu, with population coverage indicators recording systematically higher rates than the country-level available estimates. The only indicators showing relatively unsatisfactory achievements were for male involvement in the postpartum period.

The women’s groups were highly regarded by all sectors of the community as key interventions contributing to improvements in maternal and newborn knowledge and care-seeking practices. Many of the community interventions have became embedded within the community infrastructure.

Whilst the demand for services increased, quality of care at the health facility level was often compromised due to staff shortages, inadequate emergency transport systems and poor facility infrastructure and resourcing. The supportive supervision and mentorship programme was rated very highly by health facility staff.

There was a positive improvement in women’s satisfaction with care received at facilities, resulting from education and empowerment of women in regards to their healthcare rights through the women’s groups, respectful care training for healthcare providers and the combined community/healthcare facility interface meetings.

“Nowadays women are supposed to report any bad treatment they receive at a health facility to the village leaders.” Village headman

However, maintaining high levels of satisfaction will be a challenge if health services cannot reliably provide the expected level of care.

Advancing Maternal Health: A multifaceted approach to complex problems

By Samantha Bossalini, Communications and Development Associate, Kupona Foundation

The Challenges We Face:

In Tanzania we lose approximately 22 women1 and 106 newborns2 every day due to childbirth and pregnancy related complications. These deaths are, for the most part, preventable. For every woman that dies, 20 more will develop an injury, infection, or debilitating impairment like obstetric fistula3.

In Dar es Saalam, Tanzania’s largest city and one of the fastest growing cities in Sub-Saharan Africa, booming population growth puts a huge demand on the healthcare system. Unable to withstand the pressure, hospitals are left with severe staff and resource shortages. In some of the busiest maternity wards in the city, up to 5 women in labor can be found in a single bed, and in some cases women have no choice but to give birth on the floor. One-third of maternal deaths are a result of post-partum hemorrhaging, but access to a safe blood supply is severely limited. Equipment is often broken, or unavailable, and there are not enough trained professionals to give each mother and newborn the attention they need.

Understaffed, under-resourced, and overwhelmed, medical teams cannot meet the demand for high quality healthcare, resulting in staggering maternal and newborn mortality rates.

This is a complex issue, without a single, simple solution. In collaboration with our sister organization, CCBRT, and the Government of Tanzania, Kupona mobilizes resources and funds to support a comprehensive program designed to tackle Tanzania’s maternal healthcare crisis from many different angles. Through our collaborative, integrated approach, we are making critical improvements to the quality of care, and are seeing encouraging results.

Watch to learn more about CCBRT’s Maternal and Newborn Healthcare Program

 

Strengthening What We Have

Frontline healthcare workers in Dar es Salaam’s public health facilities bear the brunt of staff and resource shortages. In 2010, CCBRT began work to build the capacity of 22 public health facilities in the region. By placing highly skilled doctors to train, mentor, and empower medical workers at these facilities, CCBRT has equipped them with the skills and confidence they need to provide high-quality care. Since 2010, CCBRT, in partnership with the Regional Health Management Team, has trained hundreds of frontline healthcare workers in Basic Emergency Obstetric and Neonatal Care (BEmONC). The team has also conducted critical renovations in 5 facilities, and distributed life-saving equipment and resources.

Since the beginning of the program we have seen a marked decline in maternal mortality and stillbirth rates across the region, and an increase in the quality of care being provided across the 22 sites. In 2014 alone, colleagues at CCBRT supported facilities served over 105,000 mothers with higher quality care during delivery, trained 1,693 frontline healthcare workers, and saw the average quality of care scores4 increase from 9% in 2010 to 78% in 2014.

 

CCBRT’s Maternity and Newborn Hospital has entered the final stage of construction Photo Credit: Sami B.
CCBRT’s Maternity and Newborn Hospital has entered the final stage of construction
Photo Credit: Sami B. 

Building Something New

Recognizing the need to increase capacity to treat emergency and high-risk cases in the region of Dar es Salaam, CCBRT began construction on a 200-bed facility which, at full capacity, will conduct 15,500 deliveries per year, The facility will be a beacon of best practice, and will provide quality services across the entire spectrum of care, from family planning to treating sick newborns. The CCBRT Maternity and Newborn Hospital is in its final stage of construction, and is scheduled to open its doors to patients in 2017. The hospital will also be home to one of the few dedicated blood banks in Dar es Salaam, providing safe blood to mothers and newborns in need of emergency transfusions.

Join our Collaborative Community

Like any complex problem, we have to approach maternal and newborn mortality from many different angles. Our efforts may feel small at first, but we’ve seen that the impact is exponential. As Kupona and CCBRT advance, innovate, and grow to meet the needs of the population we serve, we’re motivated by stories of lives saved, and healthcare workers feeling empowered for the first time.

If you would like to join our collaborative community of donors, volunteers and advocates, please visit our website to learn more about how you can get involved. Follow us on Twitter and Facebook, or contact us directly for more information at info@kuponafoundation.org

  1. Tanzania Demographic and Health Survey (TDHS) 2010, National Bureau of Statistics, Tanzania, April 2011, Dar es Salaam
  2. In 2013, 39,000 neonatal deaths occurred in Tanzania; the neonatal mortality rate was 21/1,000 live births. UNICEF (2014). Committing to Child Survival: A Promise Renewed
  3. Nanda, Geeta, Kimberly Switlich and Elizabeth Lule, Accelerating progress towards Achieving the MDG to Improve Maternal Health: A Collection of promising Approaches, World Bank, Washington D.C., April 2005, p4.
  4. Measured by Standards-Based Management and Recognition (SBMR) assessments, developed by Jhpiego, an affiliate of Johns Hopkins University.

Calling on Youth to Improve Adolescent Health

The UN Secretary General’s renewed Global Strategy for Women’s, Children’s, and Adolescents’ Health, to be launched in September 2015, will be a roadmap for improving the health and well-being of women, children, and adolescents. The first Global Strategy, launched in 2010, galvanized the Every Woman Every Child movement and achieved significant progress in reducing preventable deaths.

The Zero Draft of the updated Global Strategy was released earlier this month. Adolescent health is a focus area of the Global Strategy for the first time and we are calling on young people around the world to provide their input on adolescent health priorities. Yesterday, together with The Partnership for Maternal, Newborn and Child Health (PMNCH) we hosted the Calling on Youth Voices to Improve Adolescent Health Google+ Hangout to engage youth on their reflections of the UN’s Zero Draft.

The panel was moderated by Girls’ Globe Blogger, Zanele Mabaso. Additional panelists included: Yemurai Nyoni, Founder and Advisor for Dot Youth Organization and former Women Deliver young leader and passionate activist for adolescent health. Tikhala Itaye, Founder of Her Liberty Namibia and Vice President for AfriYAN Namibia.

Watch the full video

Why is motherhood in Tanzania about luck?

Written by Samantha Bossalini, Communications and Development Associate, Kupona Foundation

This past March, I visited our implementing partner, CCBRT, in Dar es Salaam, Tanzania. One humid afternoon, I sat with a dozen ladies recovering from surgery to repair the trauma of obstetric fistula. I was surprised by a common thread weaving through each heartbreaking account: luck. For these women, aged 16 to 65-years old, surviving childbirth and becoming a mother had been a deadly game of chance.

Lucky because she survived
Malela had just turned sixteen. She was petite, shy, and her voice grew quiet when she spoke about the day she lost her baby – one of the 39,000 babies who die every year in Tanzania1. In the US, a 16-year-old girl would be thinking about friends, boys, passing her driver’s test and studying for college entry exams. Malela was telling me about the day she lost her baby. After two days of contractions she passed out from exhaustion. Her now stillborn child was removed with forceps and taken away. When she woke, she remembers feeling her flat stomach, and asking, “Where is my baby?” Her mother told her “Your baby died. Now we are working on your urine leaking problem.” Malela’s traumatic delivery left her with obstetric fistula, and a stillborn child whom she never met.

The fact I wrestled with most after meeting Malela was that in Tanzania she is considered lucky; ‘lucky,’ simply because she survived her complicated labor when thousands of women each year do not.

Lucky because her baby lived
As another woman came forward to be interviewed, I asked the nurse if this patient had also lost her child. The nurse shook her head.

“No, her baby survived. She is lucky.”

Salma was 30-years old. When she went into labor, doctors discovered that she wasn’t dilating even after hours of contractions. An emergency C-section saved her daughter’s life, but the hours of obstructed labor created a fistula. As I sat with Salma and her healthy, 3-month-old baby girl, I just kept thinking, why is this about luck?

Rolling the dice.
Fact: 8,000 Tanzanian women die each year due to complications in pregnancy or childbirth2. In Dar es Salaam, one of Africa’s fastest growing cities, women in labor face challenges we can’t imagine in the US. Urban hospitals are so crowded, it is common for four women to share one bed. Mothers deliver their children on the floors of unsanitary, humid wards. Clinics without blood banks lose laboring mothers to hemorrhages. Generators fail, staff are overwhelmed, resources deplete, women die.

It’s impossible for me to reconcile that 8,000 women died last year because they were unlucky. So many of these deaths are preventable. We know what it takes to change that number from 8,000 to zero, and luck has nothing to do with it.

Every mother deserves to meet her newborn child
Thanks to the support of our donors, the dedicated team at CCBRT, and their close partnership with the Government of Tanzania, we are taking luck out of the equation. We are decongesting overcrowded wards, training skilled workers in respectful, high-quality maternal healthcare, and building capacity throughout the Dar es Salaam region. As a result, healthy babies are being delivered to healthy moms.

We invite you to honor the mothers in your life, and help us take luck out of the equation for thousands of women every year.

donate_dkgreen

I have met the women who struggle with the emotional and physical devastation that obstetric fistula leaves in its wake. I’ve heard them share losses, and celebrate the joy of holding their healthy babies – a joy that should be a right, not a privilege. At Kupona, we believe every mother deserves to meet her newborn child. It should not be a game of chance.

As we approach Mother’s Day in the US on May 10th, please take the opportunity to show your support. For every donation made in honor of a mother, her name will be entered into our prize drawing. The winner will receive a gift from the Mabinti Center, winner of ‘Accessories Designer of the Year’ at Swahili Fashion Week 2014! Just type ‘In honor of {insert Mom’s name here}’ in your donation description for her chance to win!

Cover photo: 16-year-old Malela is considered ‘lucky’ to have survived her obstructed labor; c/o Kupona Foundation

[1]  UNICEF (2014). Committing to Child Survival: A Promise Renewed.
[2] Tanzania Demographic and Health Survey (TDHS) 2010, National Bureau of Statistics, Tanzania, April 2011, Dar es Salaam

Let’s Talk About Adolescent Health

​There is a growing conversation among adolescents, communities, organizations, the private sector and other stakeholders concerning the future and health of adolescents around the world. There are close to 1.8 billion adolescents living in the world today. Many are healthy while others lack access to the vital health services and education they need to grow and thrive.  The leading growing issues include but are not limited to complications leading to pregnancy and childbirth, access to sexual and reproductive health services, gender-based violence and the over 2 million adolescents who are living with HIV. In order to ensure young people can transition well from youth to adulthood, these issues must be adequately addressed.

The renewed Global Strategy for Women’s, Children’s, and Adolescents’ Health, set to be launched in September 2015, is a roadmap for ending all preventable deaths of women, children, and adolescents by 2030 and improving their overall health and well-being, and builds upon the 2010-2015 Global Strategy for Women’s and Children’s Health launched by the UN Secretary-General. The Partnership for Maternal, Newborn and Child Health (PMNCH) has been organizing consultations to effectively inform a renewed strategy. Central to this conversation are the voices of adolescents and young people themselves.

Yesterday, we had an engaging conversation with youth and thought leaders addressing global priorities for adolescent health. The discussion included an amazing group of panelists including, Cecilia Garcia, Founder of Espolea and board member for PMNCH, Patrick Mwesigye from AfriYAN and Laura Laski, Chief of UNFPA’s Sexual and Reproductive health branch. The panelists candidly shared the challenges adolescents face in accessing health services, primarily including access to comprehensive sexuality education and SRHR health services. Opportunities related to improving adolescent health were also discussed. Adolescents are being engaged through working groups and various programs including one led by UNFPA in India and a second one in Argentina called program Sumar. There was an overwhelming agreement among the panelists that adolescents themselves must be involved in the conversation. Cecilia and Patrick both urged those watching to participate in the conversation online as well as to rally their national governments and other stakeholders to commit to prioritizing adolescent health and engaging youth in the post-2015 agenda.

Watch the Hangout

You can also read our Storify recap here.

Do you want your questions for adolescent health answered? Join the conversation!