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Formative Supervision Improves Healthcare in Angola 

Formative SupervisionWith a population of about 30 million, many Angolans do not have access to adequate healthcare. The limited access to quality healthcare is due to decreased funding due to the Angolan Government’s budget restrictions. The lack of funding affects the quality of public healthcare which people can receive at no cost. The public healthcare sector in Angola does not have enough healthcare providers with proper training and resources. The lack of resources in healthcare reflects in the low ratio of about one health center per 25,000 people and more than 50% of people are without access to healthcare services. In recent years, USAID’s Health for All project, using the Health Network Quality Improvement System (HNQIS), has implemented formative supervision in Angola. Implementing formative supervision in Angola has shown to improve the quality of healthcare by increasing the number of healthcare providers with proper training.

USAID’s Health for All Project

USAID’s Health for All program is a five-year project that began in 2017. It works with the Angolan Government to help improve the quality and access to healthcare in the country. The project’s focus is on addressing the issues of malaria and reproductive health since those are two of the main health concerns affecting the people of Angola. With the current funding being at $63 million, the program has been able to train 1,489 health professionals on how to diagnose and treat malaria and created reproductive health services in 42 health facilities.

The program’s use of formative supervision in Angola has helped in educating and providing healthcare workers with the necessary tools to effectively care for patients. The Health Network Quality Improvement System is the main tool that USAID uses to help improve the quality of healthcare because the system is used to evaluate the performance of individual healthcare providers. By tracking the performance of the healthcare providers in Angola, USAID can more easily determine which areas of the healthcare system need improvement. Under the Health for All program, USAID has been using formative supervision with healthcare providers who specifically tend to cases of malaria and reproductive health.

The Benefits of Formative Supervision

From October 2019 to March 2020, the Health for All project recorded improvements in the quality of healthcare through the use of formative supervision in 276 out of 360 Angolan health facilities with prenatal services. In addition to tracking the performance in maternal and reproductive health, the supervision has also helped in finding the areas in which the management of malaria has been lacking. There are now about 1,026 health providers that have been properly trained in managing malaria cases as a result of the project. This has in turn indirectly improved the quality of care regarding maternity since malaria causes 25% of maternal deaths in Angola.

Besides increasing the amount of funding that goes toward healthcare, the Health for All project has used such funding to be more interactive with healthcare facilities through the use of formative supervision in Angola. Formative supervision has shown to drastically improve the quality of care in the areas of malaria and reproductive health as supervision allows trained health officials to identify and fix integral issues pertaining to healthcare in Angola.

– Zahlea Martin
Photo: Flickr

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Sex Education in the Philippines

sex education in the PhilippinesThe general purpose of sex education is to inform youth on topics including sex, sexuality and bodily development. Quality sex education can lead to better prevention in STDs and unwanted pregnancy. Furthermore, it decreases the risks of having unsafe sex and increases responsible family planning. To help address issues, like overpopulation, high rates of teen pregnancy and the rise of HIV, the Philippines is gradually implementing sex education and accessibility to contraceptives.

Reproductive Health Act

The Philippines passed the Responsible Parenthood and Reproductive Health Act of 2012 (RH Act) after a 14-year wait. Through the act, the government integrated sex education into the public school curriculum for students ages 10 to 19. The Philippines also gave funding for free or subsidized contraceptives at health centers and public schools.

The government passed the RH Act in response to the many health issues impacting the country, such as infant mortality, pregnancy-related deaths and a rise in HIV/AIDS cases. Moreover, teen pregnancies in the Philippines are common, where 9% of women between the ages of 15 and 19 start child bearing.

Lack of knowledge about reproductive health is significantly associated with poverty, especially in regard to overpopulation. Therefore, the RH Act aims to help the population make informed decisions about their reproductive health. It provides more equal access to sex education, while also ensuring that the government reaffirms its commitment to protecting women’s reproductive rights, providing accessible family planning information, and hiring skilled maternal health professionals to work in both urban and rural areas of the Philippines.

Opposition from the Catholic Church

Around 80% of the Philippine population identifies as Roman Catholic. Accordingly, the Catholic Church largely influences the state of sex education in the country. The Catholic Church opposes sex outside of marriage and fears sex education will increase sexual relations. The Catholic Church consequently remains critical of the RH Act, increasing difficulties in putting the RH Act into concrete action.

Additionally, the Catholic Church opposes implementing sex education in schools as well as the distribution of contraceptives. The Church prefers to rely on parents to teach their kids about reproductive health. However, many families are either unequipped to do so or will not address the subject directly with their children.

The Implementation of the RH Act

In an effort to reduce the country’s rate of poverty, Philippine President, Rodrigo Duerte, ordered the government to provide access to free contraceptives for six million women in 2017. Duerte aimed to fulfill unmet family planning needs. This came after a restraining order was placed on the RH Act in 2015. However, the government appealed to lift the restraining order to continue applying the RH Act and addressing issues due to overpopulation.

In 2019, Save the Children Philippines — an organization with the purpose of supporting Filipino children — advocated for the Teenage Pregnancy Prevention bill. The organization also fought for requiring schools to fully integrate Comprehensive Sexuality Education (CSE) into their curriculum. Save the Children Philippines hopes to combat the country’s high rate of teen pregnancy. CSE in the Philippines includes topics such as consent, sexual violence, contraceptives and others. The bill would also advance access to reproductive health services, further supplementing the goals of the RH Act.

Increased Conversation Surrounding Sex Education

In addition to greater governmental action, there are various organizations that are working to increase access to sex education and services in the Philippines. The Roots of Health is a nongovernmental organization that provides sex education to women in Palawan and Puerto Princesa. Started in 2009, the founders, Dr. Susan Evangelista and Amina Evangelista Swanepoel, initially provided reproductive health classes at Palawan State University in Puerto Princesa and have since expanded into free clinical services for young women. The Roots of Health provides services that assist with birth, reproductive healthcare, contraceptives, prenatal and postpartum check-ups, and ultrasounds. By 2018, they served 20,000 women and adolescents in the Palawan and Puerto Princesa communities, demonstrating that there is a growing grassroots movement towards reframing reproductive health in the Philippines.

Sex education will remain a controversial subject in the Philippines. Nonetheless, it is a developing matter that is expected to evolve with continued conversations between governmental, faith and nongovernmental actors.

– Zoë Nichols
Photo: Flickr

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5 Facts About Menstrual Hygiene in South Asia

Menstrual Hygiene in South Asia
Globally, access to clean water, sanitation and hygiene (WASH) is on the rise, especially in South Asia. According to UNICEF, in India, Bangladesh, Nepal and Pakistan, the percentage of people practicing open defecation—a leading cause of child malnutrition, disease and death—fell from 65 percent to 34 percent. While these WASH initiatives have seen success, they often neglect one important aspect of hygiene that pertains to women, menstruation. The ability for women to menstruate hygienically and with dignity is vital to their empowerment. Here are five facts about menstrual hygiene in South Asia.

5 Facts About Menstrual Hygiene in South Asia

  1. There is a culture of silence around menstruation; discussing it is often treated as taboo. Females on their periods are often excluded from society because they are seen as impure. One study in Nepal found that 89 percent of respondents practiced some form of exclusion or restriction during a menstrual cycle. However, organizations such as WaterAid are working to break the silence through female-led self-help groups. When just a few women came forward to speak, it inspired others to share their experiences and start breaking the taboo.
  2. Many girls do not understand their periods. Because the topic is taboo, it is often ignored in schools. As such, 10 percent of girls in India thought menstruation was a disease, and 66 percent of girls in South Asia do not know anything about periods before their first menstruation. A study of 160 girls in West Bengal found that, though 67.5 percent knew what a period was before their first, 97.5 percent did not know where menstrual bleeding comes from. While schools often neglect to teach about reproductive health, this is beginning to change. UK Aid is creating audiobooks for girls dispelling myths and teaching them about their periods, and non-government organizations are creating extracurricular activities that teach about menstrual hygiene in South Asia.
  3. Menstrual hygiene in South Asia is vital for keeping girls in schools. According to WaterAid, a study done in South India found half the girls in school were pulled out at the time of their first period, often to be married. The girls who stayed in school beyond their first period reported poor performance due to anxiety that the boys in the class would find out they were menstruating.
  4. Access to feminine hygiene products is expensive. According to WaterAid, in a West Bengal study, only 11.25 percent of girls used disposable feminine hygiene products. The most common obstacles to obtaining them are a lack of awareness about them, the high cost, the lack of availability and the need for disposal facilities. Focus group discussions indicated that girls would prefer sanitary pads because they were more comfortable, discreet, and easier to use and carry. WaterAid is working to make low cost disposable sanitary pads as well as facilities to dispose of them. In the meantime, most women and girls rely on reusable cloth, which comes with its own problems.
  5. Maintaining menstrual hygiene in South Asia requires improved sanitation. One of the biggest obstacles to menstrual health is a lack of sanitation practices and infrastructure. Most South Asian women and girls rely on reusable cloth. To sanitize them though, they need to wash them in clean water and dry them in sunlight. However, cultural taboos around menstruation often pressure women and girls to try to dry them in dark places, potentially leading to infection. For those who might have access to disposable sanitary pads, they often lack the facilities to get rid of them. This is especially a problem for girls in schools. However, WaterAid and its partners are working on implementing WASH facilities that are lockable and gender-separated, with at least one toilet or washroom with an opening leading to an incinerator or dustbin for feminine hygiene products.

While countries in the region are making great strides in sanitation, there is still much to be done to improve menstrual hygiene in South Asia. It is vital they do so because the ability for women and girls to menstruate with privacy and dignity empowers them to pursue work, education and gives them the opportunity to have a voice in society.

– Katharine Hanifen
Photo: Flickr

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Reproductive Health App for Youth in Rwanda

Health App for Youth in Rwanda

Tantine is an app that has been developed for youth in Rwanda. It was created by Sylvie and Sylvain Muzungu Uhirwa to tackle the issue of lack of reproductive and sexual health information. A barrier to sexual and reproductive health information has teens in Rwanda vulnerable to unintended pregnancies and diseases, which can hinder their ability to complete their education as well as find stable employment in the future.

Sylvie and Sylvain Uhirwa are twin medical students at the University of Rwanda who originally won the Youth Spark Innovation Grant in 2015. This grant is an initiative from the Resilient Africa Network in Partnership with USAID and the Makerere University School. It has helped them to build a website containing reproductive health information as well as youth mentorship opportunities.

As one of four initiatives chosen at the iAccelerator challenge 2017, the pair received $10,000 to further develop Tantine. Half of the funds went to developing the Android app and website content, as well as to continue to advance and develop the platform.

The app was recently shared in the Mahama camp of 50,000 Burundian refugees. The app for youth in Rwanda, specifically in the camp, gives reproductive health information via the web. Tantine works with a medical professional and psychological team to deliver this education, mentorship and counseling services.

Sylvie has stated that members in the camp do not have consistent access to wi-fi and do not own smartphones, so “…that’s why we thought of bringing those tablets and establishing a centre where they come and then access the internet in the camp. So we are going to equip them with those tablets and then a router with wi-fi.”

Therese Karugwiza, a gender and human rights program specialist at UNFPA, has stressed the importance of Tantine also targeting youth who may not be in school, as it is crucial that they also have access to this information. By taking Karugwiza’s account into consideration, the Uhirwa twins are putting Rwandan youth on a multimodal track to better reproductive health.

– Gabriella Paez

Photo: Flickr

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Family Planning Initiatives in Malawi Help to Stop Population Growth

Family Planning Initiatives in Malawi Help to Stop Population Growth
Malawi is a small, landlocked country, in southeastern Africa, with a population that is expected to triple in the next 30 years. This reality, along with the fact that it remains one of the poorest countries in the world, has led Malawi’s political leaders and health care industry to dedicate time and money into implementing comprehensive access to family planning services (FP). Family planning is defined as a deliberate use of contraceptive methods by a couple in order to limit or space out the number of children that they have.

Through increased service delivery resources, political commitment, improved financial means and communication with receptive communities, Malawians now have more acceptable and affordable options regarding FP services than they did several years ago. The 2015-2016 Demographic and Health Survey reported that 59% of married women were using modern methods of contraception. This compares to only 28% in 2004.

Recognizing that the demand for FP was growing consistently, political commitment to stopping population growth began to reflect in core national policies in the mid-2000’s. The National Sexual and Reproductive Health and Rights Policy of 2009 provided a framework for the delivery of all-inclusive services and encouraged access to information and improved quality of care.

The government of Malawi also recognizes that improvements in sexual and reproductive health correlate directly to the attainment of the Millennium Development Goals. Three areas, in particular, relate: the improvement of maternal health, promotion of women’s empowerment and reduction of child mortality.

In regards to finances, multiple international organizations have contributed heavily to the development of FP services. Financial resources have been put directly into two programs. The first with a goal of establishing and making accessible an Essential Health Package, which includes FP, available for free to all Malawians. The second is working to implement an Emergency Human Resources Program, which focuses on training and deploying certified health professionals.

With the help of these programs, the total health provider density in Malawi increased significantly from 2004 to 2009. Those advocating for FP in Malawi recognize that with most Malawian’s living in rural areas, it is important to bring services and information directly to the people. Awareness of this need is what has allowed for the success of FP in the country.

A culture of acceptance when it comes to the use of modern contraceptives has been indoctrinated in Malawi at a community level. The government of Malawi has made a concentrated effort to emphasize the benefits of FP. Not only does access to FP services increase a woman’s health and economic opportunities, it also goes hand in hand with preventing unplanned births and unsafe abortions, both of which are a common occurrence throughout Sub-Saharan Africa.

The efforts of Malawi’s Government have allowed for substantial strides in family planning. In the past several decades, their commitment has helped tremendously to normalize the use of modern contraceptives and for equitable access to sexual and reproductive health services across the country.

– Peyton Jacobsen

Photo: Flickr

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Tuungane Project Invigorates Population

Tuungane Project
The Greater Mahale Ecosystem in Tanzania is home to rich biodiversity, but an impoverished human population. Pathfinder International, a global nonprofit organization focused on reproductive health, HIV prevention, and maternal health, has launched the Tuungane Project to address reproductive health and natural resource management.

Because Pathfinder sees a direct connection between the health of the environment and the health of the people, they partner with organizations that focus on threats to biodiversity, while they target what they call “improving health of the communities by increasing sustainable livelihoods and increasing access to contraceptives, adolescent and youth sexual and reproductive health, maternal, neonatal, and child health, and primary healthcare services.”

The Tuungane Project’s projects include land and fisheries management, health system strengthening, and reproductive health services. As a result of their efforts, seven new medical personnel have been posted, 66 community health workers have been trained, and 1,106 new latrines have been built by community members. Prior to these improvements, populations of between 3,000 to 5,000 people sometimes had access to only a single health professional.

Key players in sanitation efforts are the beach management units, which have eliminated cases of cholera, a bacterial disease usually spread in water, for the past two years.

The lives and livelihoods of the population depend on the rich natural resources of the Greater Mahale Ecosystem. The Nature Conservancy, a charitable environmental organization, partners with Pathfinder to create a healthy future for this area. By teaching best practices regarding how to best extract resources from their environment, the organization helps villages meet community needs and attain food security. One of the Nature Conservancy’s major efforts aims to enhance fisheries management on Lake Tanganyika, which holds 17 percent of the world’s fresh water.

By uniting conservation efforts with community development, local governance is strengthened, family health is possible and the population can achieve a sustainable livelihood.

– Emily Ednoff

Sources: Pathfinder International, The Nature Conservancy
Photo: Flickr

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Sexual Health of Adolescents in the Developing World

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There are more than 1 billion teenagers worldwide. Seventy percent of them live in developing countries. According to the Demographic and Health Surveys and the AIDS Indicators Survey, the average age that young people in impoverished countries have their first sexual encounter is, at the lowest, age 16 or younger, and, at the highest, 19.6.

Just like in developed nations, with sexual activity comes the risk of sexually transmitted diseases and unwanted pregnancies. Unlike wealthier nations, these impoverished countries lack adequate healthcare. In places such as Sub-Saharan Africa, AIDs is an epidemic. Two-thirds of those infected are adolescents.

Adolescent girls run the greatest risk for sexual and reproductive health threats. A young girl that becomes pregnant who lacks access to healthcare faces many serious health risks. Pregnancies, child-birth and abortions are all perilous. The likelihood that a 15-year-old girl in a developed nation could ultimately die of maternal complications is 1/3800. Compare this to just 1/150 in the developed world.

Meet Reem: she is a 15-year-old girl living as a refugee in a camp. Her two-month-old baby is underweight because it was born prematurely and because Reem was never taught how to breastfeed. She has no one to help her, her husband was killed before the baby was born, and her mother was separated from her in the national conflict.

In other instances, girls marry older men. Hibo is a 13-year-old girl living in a Somalian refugee camp. The oldest of five children, she is responsible for helping her mother care for the family. Her parents are planning to marry Hibo to a wealthy landowner that will bring the family much-needed money and honor. She has been told that it is her duty to marry, serve her husband, and bear him children.

Married women like Hibo are encouraged to have children as soon as possible. Their social status and identity are associated with raising children. Being childless is frowned upon. Unfortunately, wedding older men who have had previous partners bring the potential for STDs.

Young people also face the danger of sexual violence. A national survey in Swaziland revealed that one-third of girls aged 13-24 suffered sexual abuse before the age of 18. Boys face abuse as well but are reported as being less likely to reach out for help from healthcare providers.

Although young people are getting married at an older age, the amount of premarital intercourse is increasing. At the same time, contraceptive use for all teens is low. In Sub-Saharan Africa, contraceptives are used by a low of 3% of sexually active adolescents in Rwanda and a high 46% in Burkina Faso.

Due to the U.N.’s Millennium Development Goals, more youth have greater access to formal education. Health officials decided that school-based sexual/reproductive health programs were the perfect way to educate adolescents. Yet, a survey of these programs and their effects have produced varied results. Not all adolescents attend school, and the funding for these programs is not always there.

The Save the Children organization understands that if there are no programs that specifically reach young people with sexual health programs and education, they will never access the care and knowledge they need. The organization has set up teen-accessible places to teach them about safe sex and offer health services.

Their methods and the continuation of school-based programs have been yielding promising results in places like Mexico, Nigeria and the Dominican Republic. Young people are taking more measures to prevent STDs and unwanted pregnancies.

– Lillian Sickler

Sources: Guttmacher Institute, Women and Children First (UK), Alliance for International Youth Development
Photo: The Times

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Why Are Chadian Women Dying?

why_are_chadian_women_dying
With the second highest maternal mortality rates, Chad falls drastically behind the fifth United Nation Millennium Development Goal in diminishing the mortality ratio by three quarters. There are approximately 1,100 maternal deaths for every 100,000 live births, illustrating a dire need for solutions.

The nature of the problem varies, with deaths ranging from hemorrhage, HIV/AIDS, limited access to health care and obstructive labor. There is also a high Total Fertility Rate in Chad, with women averaging about 5 children.

Many disparities exist between Chadian women who live in urban and rural areas, where the latter averages a much higher TFR. This is partially due to the lack of access to antenatal care as well as limited availability of contraceptives.

Similar to many other patriarchal societies, men play a big role in hindering women from receiving family planning services, consequently endangering their spouse.

High maternal mortality rates pose serious social and economic repercussions for Chadians, further sinking affected families in poverty and decreasing the nation’s economic growth.

A mother is the foundation of a family and research has shown that when a mother passes, there is a greater likelihood for a child to drop out of school, in addition to becoming malnourished.

To address the problem at hand, the Chadian government should focus on increasing access to health facilities, strengthening family planning services and educating young mothers on proper antenatal care. Establishing clinics with trained health professionals  increases the rate of women with medical supervision during childbirth.

Chad has witnessed inadequate human resources for health; thus, more midwives and physicians are in need of proper training. In addition, 20 percent of women have an unmet need for contraceptives, indicating that family size is out of their control.

Better access to family planning allows births to be spaced out and reduces unwanted pregnancy. Furthermore, education is key in developing countries. Teaching Chadian women about reproductive health will ensure that women are making choices that are best for their bodies and will give them a sense of empowerment.

– Leeda Jewayni

Sources: CIA, Safer Birth in Chad, World Bank
Photo: The Guardian

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Astellas Pharma Donates $2 Million

Astellas Pharma
About 75 percent of women with obstetric fistula have gone through labor that has lasted three days or more. Obstetric fistula affects mostly the poorest women who live in the poorest countries of the world because they do not have access to proper medical help. When a woman’s labor is obstructed she most likely could have intense pain for days before she actually has the baby.

So what exactly is an obstetric fistula?

“The soft tissues between the baby’s head and the pelvic bone are compressed and do not receive adequate blood flow … Her baby likely dies and she is often left with obstetric fistula, a small hole created by constant pressure from the fetus, which renders her incontinent.”

An estimated one million women get obstetric fistula and only 20,000 of those get treated a year. The surgery that these women would need takes under an hour and costs around $450. The need is there for these women to receive medical help and that is why Astellas Pharma EMEA decided to dedicate $2 million to help the cause.

Over the course of three years, Astellas will be partnered with the Fistula Foundation and put that $2 million to work. This is believed to be the largest and most focused effort ever against fistula according to Kate Grant, CEO of the Fistula Foundation.

The money will allow 1,200 women to get surgery in Kenya for this life-changing condition. As part of Astellas heritage, one of the key things that this organization wants to bring to communities is hope.

“Astellas knows the difference good medicines make to peoples’ lives. That‘s why we focus on providing treatments that are a genuine advance on the current standards of care – particularly in disease areas where options are limited.”

Here in the United States, the obstetric fistula was a common term that most people knew about, until the early 20th century. Since the U.S. has the resources for great medical care, there are procedures like a cesarean section, that we can use to prevent fistula. Kenya doesn’t have what the U.S. does, so companies like Fistula Foundation and Astellas are doing something about it.

– Brooke Smith

Sources: ONE, Astellas, Fistula Foundaiton
Photo: Flickr

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Improving Access to Reproductive Health Services

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Improving access to reproductive health services in the developing world is critical to poverty alleviation. Pregnancy and childbirth-related complications are a leading cause of death of girls, aged 15 to 19, in developing countries. An estimated 7.3 million girls under age 18 give birth each year, and a great percentage of births occur in Africa. To counter this, the United Nations Population Fund (UNFPA) has announced it will partner with eight African countries to improve access to reproductive health services for millions of girls. The programs will span over the next three years, and will hopefully make a difference in lives of millions of young people.

“We are working specifically to ensure that the continent’s adolescent girls, between the ages of 15 and 19 – some 45 million of whom live in sub-Saharan Africa – get a good education, are able to decide whether and when to marry and have children, are protected from HIV, remain safe from violence, and have their fair share of opportunities to work and contribute to the economic development of their countries,” said UNFPA Executive Director Babatunde Osotimehin.

UNFPA will partner with the Democratic Republic of the Congo, Ethiopia, Mozambique, Niger, Nigeria, Sierra Leone, South Sudan and Tunisia. The programs will deliver comprehensive sexual and reproductive health services for young people. The hope is to reach disadvantaged and impoverished girls who are most at risk for poor sexual and reproductive health, violence and exploitation.

UNFPA programs will ensure young people have access to age-appropriate sex education, whether they are in school or out, to prepare them for adult life. The programs will bring together governments, young people, the private sector and other stakeholders to access the needs of young people.

UNFPA is the lead United Nations agency that promotes sexual and reproductive health services. They are at work in 150 countries, ensuring that young people have the information, services, and supplies they need to make safe and healthy decisions.

“Over the next three years, in partnership with governments and young people themselves, we will commit to making a tangible difference in the lives of millions of young people right across the continent. It is their rights we must uphold and it is they who are our best hope for a prosperous and peaceful Africa,” said Dr. Osotimehin.

– Catherine Ulrich
Sources: UNFPA, UN News
Photo: Join Tokyo