Assessing the fit of RapidSMS for maternal and new-born health: perspectives of community health workers in rural Rwanda

This article examines field results that show the potential for mobile health (mHealth) technologies to support community health workers (CHWs) in delivering basic maternal and new-born services in Rwanda. The fit of RapidSMS, a UNICEF/Ministry of Health (MOH) mHealth technology is examined through focus groups with CHWs. The results highlight the need for more training in the use of RapidSMS, continued upgrading of mobile phones, devising innovative ways of charging mobile phones, and ensuring the availability of ambulances. We suggest that CHW supervision be a two-way process built into RapidSMS utilising real-time communication to enhance effectiveness.     

Network development for non-state health providers: African Christian health associations

ABSTRACT

Substantial effort has been put into forming and strengthening national networks of non-state, non-profit health providers in lower- to middle-income contexts. Christian health associations (national umbrella networks of faith-inspired health providers) were first established in the 1950s, and are currently present in an estimated 23 of the 54 countries in Africa. The establishment of CHAs was equally encouraged by faith-based health providers, governments, and external stakeholders. CHAs look different in each context, but perform similar roles: networking diverse institutions and facilities together into a loose system; and establishing a more cohesive sector to simplify and strengthen advocacy and engagement with the government.     

Utilisation of maternal health services in Ethiopia: a key informant research project

This article explores the application of key informant research to examine barriers and facilitators to maternal health services in rural and pastoralist Ethiopia. The key informants were health extension workers (HEWs) who assist women with birth preparedness and facilitate timely referral to health centres for birth. While women encounter many barriers to giving birth in health facilities, where HEWs are supported by their communities and health centre staff, they can effectively encourage women to travel to health centres to give birth with skilled birth attendants rather than at home with unskilled relatives or traditional birth attendants.     

WaSH as a maternal health issue: three perspectives from rural Uganda

Inadequate water, sanitation, and hygiene (WaSH) knowledge and practices affect maternal and newborn morbidity and mortality. This article describes postpartum knowledge, resources, and practices in three rural Ugandan hospitals. A lack of WaSH resources was problematic for both staff and newly-birthed mothers who demonstrated a lack of knowledge about the appropriate use of WaSH resources and the links between WaSH and health protection. These results suggest that in addition to increasing the availability of medical interventions, basic preventative public health practices should be reflected in policy and practice integrated across the spaces inhabited by pregnant women to achieve improved maternal and newborn outcomes.     

When development breeds contempt: case examples of community-driven health systems initiatives

This article discusses case examples of community-led initiatives triggered by the introduction of an external development programme in Senegal and Mali. These are community initiatives that learn from projects initiated and funded by an external donor organisation, and transform interventions to better meet their own needs. The circumstances leading to the demand for, and successful establishment of, health infrastructure are examined to understand the triggers. These breakthroughs demonstrate unintended benefits of development, and the need to leverage donor-led initiatives. Therefore, community involvement, participation, and empowerment are key in establishing local ownership in development projects.     

A training approach for community maternal health volunteers that builds sustainable capacity

This article examines a training approach for community health volunteers which increased access to maternal health services in rural communities in Zambia. The effectiveness of the training approach was evaluated in an operations research component. Skilled birth attendance rates increased by 63% from baseline over a two-year period in the intervention districts, out-performing increases recorded in control sites at statistically significant levels. As a low-cost, high-impact intervention which shows good sustainability potential, the approach is suitable for national level scale-up and for adaptation for use in other countries in support of maternal and new-born health goals.     

Towards universal health coverage in Zambia: impediments and opportunities

Universal health coverage has been given a prominent place in the post-2015 global development agenda, but there are concerns over its feasibility in low- and middle-income countries. This article assesses successive Zambian governments’ efforts to achieve this agenda. We discuss the recent restructuring of health governance to support policies that re-emphasise the social determinants of health and health equity. This includes a new Ministry of Community Development and Mother and Child Health alongside the Ministry of Health. We argue that recent innovations in policy and practice need to be extended to include ministries which focus on economic development.     

“We want financial accountability”: deconstructing tensions of community participation in CHPS,Ghana

This article reports on the ways and factors that facilitate or constrain community participation in the Community-based Health Planning and Services (CHPS) programme in Nsanfo, a village in Central Region of Ghana. We found that the community made an important step through mobilising the necessary resources in establishing the CHPS compound, which has resulted in improved access to health care. Yet maintaining the facility did not matter most to community members, owing chiefly to unmet demands for financial accountability pertaining to the running of the programme. Failure to clearly identify various actors and their roles potentially explains this state of affairs.     

Harvested rainwater: quality,adequacy, and proximity in Ghanaian rural communities

This article presents a study that aimed to assess the accessibility, use, and quality of harvested rainwater in three rural communities in Ghana where the government of Ghana and local and international development organisations have sponsored domestic rainwater harvesting. The results showed that rainwater storage facilities were within the recommended distance of 1000m from each house. The amount of rainwater per person per day was below the recommended amount. The majority of the respondents therefore depended on other sources of water. Though the physico-chemical quality of rainwater met the WHO guideline limit for drinking water, the bacteriological quality did not. The majority of common water-associated infections experienced prior to the project have not been experienced after the project.     

A comprehensive approach to providing services to survivors of sexual and gender-based violence in Democratic Republic of Congo: addressing more than physical trauma

ABSTRACT

The eastern Democratic Republic of Congo (DRC) is impacted by a prolonged conflict and humanitarian crisis. Sexual and gender-based violence (SGBV) affects an estimated 39.7% of women and 23.6% of men in the region, and is associated with serious medical, psychological, and socio-economic outcomes for survivors and communities. IMA World Health, a faith-based non-profit organisation, implements a USAID-funded project, Ushindi, which is a collaborative effort with three national NGOs and one technical partner in response to SGBV in eastern DRC. The consortium provides a comprehensive package of services to SGBV survivors, focusing on medical, emotional, psychological, legal, and socio-economic needs.     

Strengthening public health supply chains in Ethiopia: PEPFAR-supported expansion of access and availability

When the US President's Emergency Plan for AIDS Relief (PEPFAR)-supported Supply Chain Management System (SCMS) programme began working in Ethiopia in 2006, the estimated population of people living with HIV exceeded one million, while only 24,000 were on treatment and only 50 treatment sites were in operation. SCMS and other key partners entered into this context to support the Ethiopian government in significantly strengthening the public health supply chain system, with the aim of increasing the availability and accessibility of pharmaceutical products. The country now has 1,047 treatment sites and is nearing complete treatment coverage. This article discusses how priorities were set among many competing challenges from 2006 until 2014, and how the four-step strategy of build, operate, transfer, and optimise has resulted in a successful partnership.     

Using Rwandan traditions to strengthen programme and policy implementation

Implementing change is far harder than making policy pronouncements that call for change. Rwanda, in the 20 years since the 1994 genocide, has made substantial progress in turning around its economy and in meeting key Millennium Development Goals (MDGs). Real GDP in Rwanda grew at a rate of over 8% per year in the past years, the percentage of the people living in poverty has dropped by 14%, and UNDP reports that Rwanda is on track to meeting many but not all MDGs by 2015. Rwanda's progress in economic and social spheres stands out in Africa, where many countries, despite commitments to the MDGs, lag behind on performance. The difference in Rwanda is the leadership's attention to implementation, and the incorporation of endogenous practices, particularly into planning and accountability. This article is based on observations of practice at national and community levels and of policy design and implementation. It is a by-product of a study of the impact of different approaches to community health delivery systems in Rwanda, completed as part of the author's doctoral dissertation, and also of the author's experience working within the government in Rwanda.     

Models of engagement between the state and the faith sector in sub-Saharan Africa – a systematic review

ABSTRACT

In sub-Saharan Africa many individuals rely on non-state health providers, and engagement between state and non-state providers is increasingly common. Little analytic work has been done on the varied models of engagement, resulting in a lack of clarity about the promises and challenges of public–private engagement (PPE) for health. Despite their prevalence, PPEs often fail. Faith-based health providers (FBHPs) form a significant proportion of the non-state health sector in sub-Saharan Africa, and the number of partnerships with FBHPs is increasing. Building on a prior systematic review project that developed a typology of organisational models for PPE for health, this article reports on a secondary analysis, highlighting PPE initiatives with FBHPs.     

Roles of religious actors in the West African Ebola response

ABSTRACT

More than 11,000 people died during the 2014–15 Ebola epidemic. It devastated the communities concerned and set back progress in building health systems and socio-economic development more broadly. Concentrated in three poor West African countries, Guinea, Liberia, and Sierra Leone, the tremors reverberated worldwide, spurring mobilisation of vast human and financial resources. The epidemic highlighted contemporary challenges for public health, particularly in fragile states, with lessons extending far beyond health sectors. Religious actors played distinctive roles at various points and across different sectors. This article focuses on religious responses to the 2014 Ebola epidemic and implications for public health practitioners.     

Increasing access to rural maternal health services in Zambia through demand-side interventions

This paper examines a demand-side intervention that significantly increased access to maternal health services in rural Zambia in a context where skilled birth attendance rates had been stagnant for over two decades. Aspects of the intervention design that were crucial to the programme's success were the participatory and adult learning-centred approach used to mobilise intervention communities, the use of a community volunteer model, and the design's sensitivity and responsiveness to underlying social factors and problems. The demand-side intervention is already being scaled up in six districts, and is highly suitable for national level scale-up.     

African solutions to African problems and the Ebola virus disease in Nigeria

Africa grapples with the world's most serious public health crisis, but this article shows that there are public health solutions that work in the African setting. When the Ebola virus disease outbreak was announced in Nigeria in July 2014, some public health specialists worried that an apocalyptic outbreak would sweep through the vast slums of Lagos. The words “Ebola” and “Lagos” in the same sentence were viewed as a dangerous combination, due to the large population of Lagos and the inefficient health care system in the city. Contrary to this view, the outbreak of Ebola virus disease was successfully contained in Nigeria. This article focuses on the factors that were responsible for this success. It examines strategies developed within Nigeria that help to ensure the successful containment of the disease. The paper identifies lessons that can be learnt by other countries from the Nigerian experience.     

The percentage of HIV treatment and prevention services in Kenya provided by faith-based health providers

ABSTRACT

Although the percentage of health services provided by the faith-based sector in sub-Saharan Africa is often cited along a range from 30% to 70%, depending on the country, such citations tend to be anecdotal and without reference to actual analysis of health service data. This article reports on a secondary analysis of health service data in Kenya to determine the percentage of HIV services provided by faith-based health providers. It then discusses the contributions of faith-based providers in light of these data, identifying opportunities and challenges involved in efforts to ensure that the resources of the faith-based sector are maximised.     

The unfinished village police unit: a contested local development initiative

Community self-help has been the principal strategy for creating social infrastructure in rural Malawi since independence. One rural community in Balaka district, southern Malawi, embarked on a project to construct a police unit as a response to rising incidents of crime. Begun in 1999, the project remains unfinished. There seems to be no interest in completing the work. This paper finds the explanation in the manner the project was initiated and how the village community was involved in its execution.     

Reconciling cultural practices and progress: childbirth in Dove,Ghana

Women are forbidden from giving birth within the community in Dove, Ghana because it is against their culture. Such cultural practice is scarce in contemporary societies so studies on the impact of the practice are currently limited in development literature. This article uses key informant interviews and focus group discussion guides to gather data. Findings reveal that the Chief, the Queenmother, and other community members maintain that the practice is not negatively affecting the socio-economic development of Dove as they have strategies to mitigate the practice.