Health

President Joyce Banda on women’s health and empowerment in Malawi

Jan 14th, 2013 12:41 PM UTC
By Guest Blogger

The Center for Strategic and International Studies recently created a video featuring Malawi’s first female president, Joyce Banda, talking about the importance of women’s health and empowerment. Blog and Video by Janet Fleischman and Julia Nagel

When Joyce Banda unexpectedly ascended to the presidency of Malawi last April, after the death of President Mutharika, many in her country and around the world wondered what her impact would be as Malawi’s first female president. Among the many challenges, her government faces high rates of maternal mortality, high total fertility rates, and high HIV prevalence among women and girls, combined with low levels of women’s economic empowerment and widespread violence against women.

CSIS wanted to learn more about how women leaders in Africa are bringing new attention to women’s health and empowerment in their own countries, and to bring those voices into the discussion about US policy priorities for women’s global health. To do this, we sent a small team to Malawi and Zambia in December 2012.

During an interview with President Banda in Malawi, which we have turned into this short video, we were able to ask her about these issues. Her response underscored the exciting prospects raised by her tenure as well as the daunting challenges ahead.

President Banda was especially passionate that the economic empowerment of women is an essential step to ensure that there is effective family planning: “it is only when a woman is economically empowered that she can negotiate at household level with her husband about the number of children that body of hers can have.”

President Banda went on to describe her own compelling personal story of the vital link between education for girls and economic empowerment for women, against a backdrop of violence against women. “I had three children, in an abusive marriage. And then finally I said, no. I have to walk out. For the sake of my children… So for me when I talk about the importance of economic empowerment of women, it’s because I tried it.”

In Malawi, we saw a woman wearing a T-shirt celebrating the first 100 days of JB’s presidency. Banda’s supporters expressed hope about the positive changes underway, from public works projects to the re-engagement of key international donors, to a new initiative on maternal mortality. But even her most ardent supporters acknowledge that real change will take time. Their optimism is being sorely tested by Malawi’s tough economic and social and realities, including a legacy of corruption, autocracy and mismanagement.

Yet President Banda made clear to us that she will “stay the course.” As she explained: “while I’m trying to bring the country back on track, I’m also very mindful of my mission – to make sure that I continue to empower women… So for me, that is what being a leader is all about.”

2012 ONE Africa Award Finalist: Eliminating the Barriers to Girls’ Education

Dec 4th, 2012 1:15 PM UTC
By Nealon DeVore

Our next 2012 ONE Africa Award finalist is an inspiring organization from Uganda called Supporting Orphans & Vulnerable for Better Health, Education and Nutrition (SOVHEN).

As an orphan raised by his grandparents in rural Uganda, Richard Bbaale looked up to their daughter as an older sister as he learned to navigate this big wide world. When she was in her teens, he noticed that she began staying home from school for a week at a time, usually once a month or so. He even noticed that his sister used mud and leaves—to control the bleeding he’d later find out—since their grandparents couldn’t afford the expensive sanitary pads that would have helped her stay in school, prevented infections, or saved her from embarrassment. Years later, that feeling of helplessness and regret for his sister’s missed education haunted Richard.

Fast forward to Martyrs University Nkozi in the early 2000s. Richard is a student and starts a student club with his friends that focuses on supporting orphans and other vulnerable groups in rural communities with tutoring, encouragement, extra-curricular activities and more. The university students take turns to volunteer and go out to the communities in the four districts on which they have focused. They raise money at times to buy food, school supplies and maybe a football or two so the children have a distraction. The volunteers increasingly notice that young girls, once they became of age, continued to increasingly miss school until they no longer bothered to attend. With Richard advancing in his studies of science and engineering, the thought of his sister still nagged at him. While visiting a village one day, he noticed the discarded stem of a banana tree, its bananas freshly plucked from it. These stems littered the roads and paths of these rural areas. Surely there had to be a use for them.

And with that thought, Richard and his group of friends, which had formally registered as SOVHEN, set their minds to finding a solution for these girls. They soon set upon developing a sanitary pad that is affordable and created from sustainable and bio-degradable materials. The discarded banana stem, when pressed and processed, provided an absorbent fiber that when placed into sheaths of special paper and shaped, could provide the solution to help keep girls in schools. As they refined the idea and tested prototypes, SOVHEN began soliciting partnerships that could support the roll out.  Now after about four years of manufacturing the sanitary pads in SOVHEN’s rural facilities, SOVHEN has developed a distribution network that employs teams of women to sell the pads. These pads are readily distributed in the four rural districts of Uganda in which SOVHEN operates through a close-knit network of women who earn money by selling the pads. SOVHEN has also created employment in these rural districts by locating the banana stem processing and manufacturing facilities there so that local women and men are paid salaries for their work. The individuals that manufacture, distribute and sell Bana-pads go through extensive business development training and coaching. SOVHEN’s Bana-pads are not the sole source of income for these people, but by participating with SOVHEN, they are learning important skills that can translate into their own enterprises.

In addition to the work surrounding the development and manufacturing of the pad, SOVHEN is still active in its communities by providing additional services to orphans and the vulnerable. With a presence in these communities’ schools, SOVHEN raises awareness of the specific challenges girls face in their educational development. SOVHEN, working with other community groups, has been responsible for changing the attitudes surrounding girls as they become of age and reducing the stigma of the menstrual cycle. SOVHEN also works hand-in-hand with Uganda’s government to ensure its national strategies for youth unemployment and gender empowerment are fully implemented. In fact, representatives from the Ministry of Gender, Labour & Social Development had nothing but praise for SOVHEN’s efforts to keep girls in school while also creating employment with innovative, sustainable solutions.

SOVHEN directly impacts MDG 3 (gender equality) while also creating employment (MDG 1) and keeping girls in school (MDG 2). We’re proud to recognize SOVHEN for their work and hope you enjoy learning their story!

ONE Africa Award 2011: Demanding the right to health care in Ghana

Nov 2nd, 2011 9:52 AM UTC
By Edith Jibunoh

It’s time to announce our second finalist in the 2011 ONE Africa Award.

After Togo, we went on to Accra, Ghana to meet the Alliance for Reproductive Health Rights (ARHR). The alliance was established by a group of NGO’s in 2004, and evolved from a defunct Save the Children program on sexual and reproductive health. ARHR Executive Director, Ms. Vicky Okine, is the former Save the Children program manager, and recognized the importance of the continuation of this program. It builds on the potential of community health organizations to empower their communities and drive the demand for better access to sexual and reproductive health care. The alliance coordinates the community organizations, arms them with the patients rights charter, and provides training in the area of reproductive health care. Through the alliance, local organisations have been encouraged to come together and share their experiences in the community, learn from each other and organize.

ARHR works from a rights based approach, which is their basis for empowering communities to demand for health care services from the government. Ghana adopted a free maternal health policy that was generally disregarded at the village level where the lack of information allowed health officials to get away with low levels of service delivery in many communities. With the assistance of the alliance, organizations have hosted advocacy and training at a grassroots level to get people to understand their rights, complain about poor health services and organize themselves to agitate for change. In a recent advocacy effort, beneficiaries were able to secure a meeting with the district health officers to demand better service delivery.

ARHR’s model is unique because this rights based approach provides a response to the demand and supply side of delivery of social services. It provides the information that people need to demand for services and it also influences public health policy. ARHR also develops materials to help educate people on government policies and works with the Ministry of Health to feed back information gathered at the grassroots level to influence policy modifications.

ARHR has used the media, including radio and television, in their advocacy work and stakeholders are now more aware of Ghana’s progress in efforts to meet the health Millennium Development Goals. Earlier this year, ARHR produced a documentary called “The Lights Have Gone Out Again”, which was aired on Ghanaian television and popularly drew mass attention to the problems associated with sexual and reproductive health care service in the country.

Through all of their efforts, ARHR has successfully influenced the way government is doing business and improvements can already be seen in the health service with increased access to health care. Community residents, armed with information from the alliance, are no longer turned away from health centres when refused service. They stand their ground and demand their right to health care.

Good luck to the Alliance for Reproductive Health Rights!

Nigeria’s quiet revolution

May 24th, 2011 6:39 PM UTC
By Edith Jibunoh

This post was first published on 23 May on the Mail and Guardian’s Thought Leaders blog

I woke up to horrible news this morning and I’m angry. John has worked for my family for years. I’ve known him since I was a little girl when he used to take me to school every morning. This is an African story. The one big happy extended family that blends employees with relatives, where birthdays and holidays are celebrated together.

This morning John’s wife died during childbirth. Now she’s just another statistic you hear from Nigeria, a country that produces two million barrels of oil a day but where one in 18 women, or 144 women a day, die during childbirth because there aren’t enough doctors, nurses or equipped hospitals. What number is John’s wife in that list of 144?

My family has an electricity generator that provides us with light when there’s no power from the national authority (this is most days). We drilled down miles to create our own water borehole to provide us with consistent water because the water authority has not provided water in years. My sister and my brothers’ wives all fly to the UK or US when they are about two to three months away from giving birth so they can be attended to by capable medical staff, in an environment that almost guarantees the safety of mothers and their babies.

Nigeria is unlikely to experience the birth that comes after the rage against injustice, similar to what is being experienced by our brothers and sisters up north. We too have bottled up our frustrations for decades. Our survival instincts have made us self-centred and led to apathy in our expectations from governments and institutions. We have created our own little havens of sanity, insulated ourselves from this harsh world and the failures of our government. Meanwhile corruption continues to thrive, health systems have collapsed and education decays. It’s in this decay that we find the minds of most of our population. Where no-one demands services any more because they don’t know that they can. Without education how can my people know to demand electricity, health, water or roads. My people are more likely to believe a hex was put on John’s wife by an evil neighbour than blame the government for this tragedy. Churches have replaced community centres and with limited access to the internet, organising capacity is extremely low. So, a North African style revolution is not coming to Nigeria. That’s not our story.

Instead, our story will resemble a quieter change that will only come about when we start thinking beyond ourselves. When we recognise that these walls we cocoon ourselves in are actually made of glass, and when those that can, start doing more for communities, our extended family, for John. Solutions for countries like Nigeria lie in our hands. And this story doesn’t have to be about building another hospital or other such daunting projects that you and I are unlikely to take on. It can just be about distributing mosquito nets to pregnant women in your community to tackle malaria, Africa’s biggest killer. Or it could be exercising the strength of your voice by advocating for women to take advantage of prenatal care in their communities. Our quiet revolution will only follow the demand for and real address of the poverty that has chained people’s minds. Our quiet revolution will mean rejecting corruption in all forms because we cannot fight poverty if we are corrupt ourselves. If we stay silent we are just as complicit.

We have all heard this story.

I am angry and I refuse to be silent. Can you really stay silent? It’s a long road to change but we must begin the journey to create our new African story.

Rwanda takes on cervical cancer

May 14th, 2011 12:00 PM UTC
By ONE

Dr Agnes Binagwaho, Minister of Health of Rwanda and Dr Fidele Ngabo, Director of Maternal and Child health in the Ministry of Health in Rwanda and Ms Cynthia Kamikazi of the GAVI Alliance discuss a comprehensive new program to eliminate cervical cancer in Rwanda.

In 2002, the Rwandan government set up a strategy to tackle priority diseases that were the major killers of both adults (HIV/AIDS, tuberculosis and malaria) and children (gastroenteritis, pneumonia, malaria, meningitis and HIV).

For the past few years, anti-retroviral coverage for HIV patients in need of treatment has increased from 10 percent in 2003 to 82% in 2010. The rate of coverage for prevention of maternal-to-child transmission services has reached 78% of pregnant women. Malaria incidence has declined by 70% between 2001 and 2010. In 2010, the cure rate for tuberculosis treatment was 87%. For multi-drug resistant tuberculosis, the cure rate was 91 percent.

During the same year, 98% of TB patients were tested for HIV. Other indicators of progress include 94% of children vaccinated against pneumococcal disease, and community health workers treating gastroenteritis without delay at village level.

Having met most of the targets set in regards to infectious diseases, as well as achieving improvements in the heath system more generally, Rwanda has noted an increase in life expectancy. As the population has begun to live longer, chronic, non-communicable diseases, such as cancer, rheumatic heart diseases, diabetes and hypertension are becoming more visible. And as a result, the Ministry of Health has initiated a new strategy of tackling priority chronic and non-communicable diseases, so as to continue to provide a better and longer life to the Rwandan population. Cervical cancer is one of such diseases.

According to research conducted in Rwanda, cervical cancer accounts for 27% of all the women’s cancer in the two university hospitals. The World Health Organization has reported that the incidence of cervical cancer in Rwanda is 49 per 100,000 in the population.

Knowing the magnitude of cervical cancer, and the fact that cervical cancer is one of the few cancers that can be fully prevented through vaccination and screening, and treated in its early stages, the Government of Rwanda decided to start their fight with a comprehensive program against cervical cancer.

In light of this, the Ministry of Health, in collaboration with its partners, has developed a national plan for prevention, screening and treatment of cervical cancer in Rwanda. This comprehensive plan includes HPV vaccination of girls aged 11 to 15, early detection of women aged between 35 to 45 years, as well as building in country the capacity to treat any stages of cervical cancer according to different levels of the health system. Through the work of the first lady, the Ministry of Health has negotiated with partners to support this first ever national comprehensive plan for cervical cancer. As a start, MERCK has donated 2 million HPV vaccine doses while QIAGEN has donated 250,000 HPV DNA-tests for screening.

It is in this light that on April, 26, the Government of Rwanda officially launched a Rwandan comprehensive cervical cancer program. The program started with vaccination of school girls in Primary 6, beginning with the Kanyinya sector in Nyarugenge District, followed by 2 days of vaccination in all primary schools in Rwanda, as well as a national summit on women’s cancers.

In collaboration with the MINEDUC, the Ministry of Health has made the HPV vaccine available to all health centers; and because 95% of girls are enrolled in school during the ages targeted, all primary schools have been identified as vaccination sites.

Using the national network of three community health workers per village and the commitment of the local leaders, girls who did not attend schools during the two days of vaccination have been identified at home and vaccinated in the community. As a result, 94% of girls have received their first dose of HPV vaccine while the rest will receive it during the catch-up phase in collaboration with CHWs.

This comprehensive cervical cancer program will avail prevention, screening and treatment for the entire population at risk. All of this will be done for a period of 3 years, while Rwanda works on its sustainability plan after this period.

The parents and community members interviewed during the vaccination days were very happy to have an opportunity to prevent cancer among their daughters, and there was an excellent adherence to this program on a voluntary basis.

Rwanda is the first country in the world to offer a comprehensive plan to eliminate cervical cancer despite social and economic challenges. The Rwandan plan is for the country to be free from cervical cancer within 40 years (by 2050) as a result of consistent vaccination, regular screening and timely treatment.

African health ministers go ‘on the record’ about vaccines

May 13th, 2011 10:21 AM UTC
By Erin Hohlfelder

At ONE we’ve been doing a lot of talking about vaccines this spring, but until now, we haven’t shared the perspectives of those who perhaps most clearly understand the value of vaccines: the ministers of health from Africa who run immunization campaigns in their countries and whose countries benefit from GAVI directly. Our senior Africa Outreach Manager Edith Jibunoh and Africa director Dr. Sipho Moyo recently met up with a number of ministers of health in Togo and Namibia, and they documented the ministers’ on-the-record accounts of just how important vaccines are.

Ghana
“It is unacceptable and against the principles of fundamental human rights that children who are the future generations continue to die of diseases for which there are known cost effective interventions. The introduction of vaccines for the prevention of childhood killer disease has indeed made tremendous positive impact on the health of our children.

Ghana is currently implementing a program of vaccination against nine childhood killer diseases. Three additional vaccines namely, pneumococcal, rotavirus and conjugate meningococcal A vaccines are expected to be introduced in the very near future. Ghana appreciates the support and would continue to strengthen partnerships with GAVI to deliver these essential services to our children”
Joseph Yieleh Chireh (MP)
Minister for Health, Ghana

Nigeria
“The absolute and surest means of disease prevention remains the effective and efficient deployment of vaccines. Key to the reduction of child mortality is an expanded immunization programme. Nigeria needs the continued support of GAVI to impact positively on the health of her children”
Professor C.O. Onyebuchi Chukwu
Hon. Minister of Health, Federal Republic of Nigeria

Rwanda
“The whole of GAVI deserves to be supported for making vaccines accessible and preventing diseases. Prevention is a worthwhile investment because as we know it is cheaper than curing diseases, prevents suffering, avoids the cost of treatment and disrupting families. GAVI’s replenishment therefore deserves to be supported.”
Dr. Agnes Binagwaho
Minister of Health, Rwanda

Sierra Leone
“Vaccination supported by GAVI is an effective and efficient process towards diseases prevention in Sierra Leone. We are very grateful to be in partnership with GAVI, an organization that is making a difference in the lives of a special population, including adolescents and young people. GAVI is a vital organ in promoting health; it needs continued support to strengthen the related health MDGs.”
Hon. Borbor Sawyer
Deputy Minister of Health and Sanitation

The Gambia
“Immunization Campaigns have saved many lives in the Gambia which holds a record 86% coverage. The government of The Gambia is committed to expanding further immunization programs in order to maintain and complete our outreach to meet our nation’s visionary goals. If GAVI is successfully supported in June, we will be on our way to achieving MDG 4.”
Hon. Fatim Badjie
Hon. Minister of Health and Social Welfare

Togo
“Immunization campaigns save lives in Togo and for us to achieve our MDG Goal 4, GAVI must be successfully supported in June. All children have a right to be vaccinated. We commit to doing our part to prioritize immunization programs in our health budgets”
S.E. Komlan Mally
Minister of Health, Togo

Thanks to the French NGO Agence de Medecine and to the leadership at the West African Health Organization for facilitating our access to these inspiring leaders in Togo.

Photo: A toddler and her mom wait at a community vaccination day clinic in Narena, Mali, Credit: 2008 Adrian Brooks/Imagewise, Courtesy of IVAC at Johns Hopkins School of Public Health