Tanzania-Evaluation of Integrated Maternal and Newborn Health Care Program
The students will be working on a Monitoring and Evaluation study in its second year. The goal of this project is to significantly improve maternal, newborn and child health outcomes in Tanzania by identifying optimal strategies for implementation and sustained delivery of evidence-based, cost-effective, culturally acceptable, and integrated maternal newborn and child health (MNCH) interventions with attention to both HIV positive and negative mothers and infants. The proposed monitoring and evaluation activities have the following objectives: 1. Monitor and document the implementation of an integrated MNCH intervention package in Morogoro Region. Provide timely feedback about access, coverage, and quality of essential MNCH interventions. 2. Provide feedback on the implementation of the MNCH package to allow adjustment of program strategies, and carry out evaluation of the effectiveness and cost of the final intervention package; and 3. Disseminate lessons learned and provide policy support to facilitate scale up of tested strategies to other Regions of Tanzania. In summary, the project is an evaluation of a maternal and newborn health intervention strategy in Morogoro region, established by the Tanzania Ministry of Health and Social Welfare and its intervention partners, with Jhpiego in a lead technical role. Providing feedback to the program and helping strengthen the intervention has the potenital to help improve maternal and newborn health, not just in Morogoro region, but throughout Tanzania.
GHEFP Narrative Report
I’ll admit that I headed to Cote d’Ivoire probably a little over-confident. After spending nearly 3 years living in Senegal (and traveling to Mali and The Gambia), West Africa feels like home to me. I speak French fluently and am comfortable with the West African accent, understand the West African franc probably a little better than I understand US currency, and dually appreciate and get annoyed by aspects of both the locals markets and the public transportation system. Going back was natural and everyone who knows me knew it. With only a few months abroad scheduled, I knew that my time would fly by. I also had a sneaking suspicion that things might not be as smooth sailing as I was anticipating them to be.
After dealing with some technical and logistical issues with the rest of my ambitious Master’s Practicum, I was glad to be finally board an Air France plane bound for West Africa. My destination was the metropolitan economic capital of Abidjan. My task? Prepare and assist with 2012 Leadership and Strategic Communication workshop and the formative research for a television series about HIV/AIDS. I arrived in Abidjan excited to experience as much of the culture and people as possible while doing awesome work, and discover what this beautiful country would share with me. Professionally, I hoped to meet leaders in HIV prevention and improve my training skills while developing experience in formative research. Personally, I couldn’t wait to check out the local cuisine, wander the markets, learn a bit of the local language, and get my feet dirty walking through the rainy season mud. I looked forward to meeting Ivoirians as well as expats with whom I could develop professional as well as personal relationships, go hiking, visit the beach, and learn everything possible.
As with any trip abroad, expectations and reality can vary greatly. I knew that Cote d’Ivoire had recently been in conflict, but had not considered the lasting effect that the conflict had on the community in Abidjan, or how its unexpected re-occurrence in early August would color my experience. I soon discovered that while the United Nations (UNOCI) is everywhere and the US President’s Emergency Plan for AIDS Relief (PEPFAR) is quite active in the country, the international community is still nervous about Cote d’Ivoire and entire parts of the country are basically “off limits” for my organization. My colleagues talked about the 2003 civil war, the 2010 post-electoral crisis, and the current attacks on an almost daily basis at lunch, showing that recent history is still very much part of la vie quotidienne. When tensions heated up over the summer and broke out in Abidjan, they remembered the days of fighting in the streets and understandably wanted nothing more than to make sure their loved ones were safe, indefinitely postponing group outings around and outside of the city.
Because of the civil war and post-electoral crisis, basic things such as the university and the post office had been shut down and were only starting to reopen during my time there. Public transportation to go to the beach or somewhere to hike for the weekend was extremely dangerous alone, meaning that I mostly had to stick to my quartier on the weekends. This was a disappointment for the independent, active adventurer and traveler in me, but it gave me a better taste of the more than twelve years of conflict and uneasy peace that Ivoirians have been living in, as well as the solitary and sometimes lonely life of an expat in a recovering country. Walking down the street in the early afternoon as enormous military cavalcades forced their way down busy boulevards, I gained a deep appreciation and understanding for Ivoirians and what has happened to their country. I also understood the frustration and fear in my colleagues’ voices when we would hear about another attack in the city or talk about what Cote d’Ivoire “used to be” before all of the unrest. It’s the type of existence most Americans cannot even imagine happening in their country.
The role of conflict in public health has proved to me to be one of the most interesting things to come out of my placement and something my prior experience in West Africa had not yet shown me. Within the first several weeks of my time in Cote d’Ivoire, the preliminary DHS 2012 results were released for the first time since 2005, covering the span of time after the civil war and during the post-electoral crisis. Abidjan may have been quick to repair buildings and roads destroyed in the crisis, but the years of unrest had long-reaching impacts. Traveling into the countryside, I saw vestiges of the conflict: abandoned hotels, destroyed roads and highways, groups of soldiers just hanging out, and other things that due to their location far from the economic or political capitals of Abidjan and Yamoussoukro, are not noticed or repaired. Formative research participants spoke openly to us about the horrors of the conflict and how it impacted their lives, including adolescent girls recounting stories of their classmates’ relationships with soldiers, both willing and coerced, and how families were torn apart due to wartime economic insecurity. Medical services, including PEPFAR-sponsored HIV/AIDS prevention and treatment services, were temporarily shut down, risking even more lives than the conflict itself. When the HIV seropositive rate is finally released later this year, the Ivoirian government, UNOCI, PEPFAR, and other organizations may need to reevaluate their approach to HIV prevention and treatment programs in Cote d’Ivoire in a way that is sensitive to the country’s recent history. This aspect of my experience will serve as a jumping off point for my Master’s Practicum paper.
Although my time in Cote d’Ivoire was not quite what I expected, professionally or personally, it served as a good life learning experience and I appreciated having the opportunity to visit and work in such a beautiful and fascinating new country. As the country moves forward from the conflict, I will continue to follow their political and public health advances. I have developed a greater understanding of the lives of both locals and expats in recovering conflict nations and have also made some important professional realizations as well. Communication is critical in large-scale public health issues, especially in a recovering country such as Cote d’Ivoire, but my calling in public health may be in a different arena, though West Africa will still be home. I want to spend more time on the clinical side of public health, empowering community health workers and midwives, instead of just focusing on communication and health campaigns. This is something I may not have discovered had it not been for my experience in Cote d’Ivoire. To the Center for Global Health and the Center for Communication Programs, thank you for this opportunity. Merci beaucoup.