Tapestry 2030

Episode 8: No Woman or Girl Left Behind in Malawi & Sierra Leone


Safa (intro): You are listening to the Ontario Council for International Cooperation’s ‘Tapestry 2030’ podcast series, focused on the future of international cooperation and global solidarity, and the partnerships needed for gender transformative, sustainable development.

My name is Safa, and I’m your host. 

In this series I’ll be in conversation with diverse development actors and leaders from across Ontario and around the world, learning how they are working together to address some of the most pressing sustainable development challenges of our time.

You’ll hear stories of partnership; approaches to ‘Just Recovery’ in the context of the COVID-19 pandemic; and insights on ways you can make a difference in our collective work to ‘leave no one behind’. 

Isata: No woman or girl left behind – to me, this means that every woman, every girl who comes to us, and who is out in the community, who needs our help, would know that we are always there for them. We are always there to offer them the service that they need and that they are important to us, they are treasured, they’re valued and we will treat them as such.

Basimenye: No woman or girl left behind for me means that there’ll be nothing that we will not do as an organization to ensure that the health needs of our adolescent girls and women are met, because we believe that their lives matter, that their lives are as valuable as any person, irrespective of where this woman is coming from or what circumstances surround around her. They deserve quality care, for all their health rights to be met.

Ian: For me, no woman or girl left behind means standing in solidarity around the world and not stopping until every single woman and every single girl has the support to not just survive, but to thrive and to be in control of their own futures.

Safa: Today, we are in conversation with Partners In Health Canada and their colleagues from Partners In Health Sierra Leone and Partners In Health Malawi. They support each other in various ways, including through a recent 5 year long Global Affairs Canada funded initiative named “ No Women or Girl Left Behind”. 

Isata: So my name is Isata Dumbuya and I’m the Reproductive, Maternal and Newborn, Adolescence and Child Health Manager at Partners in Health In Sierra Leone. I’ve been working with Partners in Health for two and a half years now. And we work mainly out of Kono district, which is in the Eastern region of Sierra Leone.This district was also the district that was mainly devastated as a result of Ebola and the Civil War. So it’s the diamond mining area. And for both of those, Ebola and the Civil War, This area was totally devastated, including the health system and the health services. So we’re working there to build that system up, to put in processes, procedures, buildings, facilities, as well as people in place to ensure that it can be able to offer the best possible services for not just mothers and babies, but adults, children, whoever comes within that center.

Basimenye: My name is Basimenye Nhlema, I’m the Community Health Director for Partners in Health In Malawi. I joined Partners In Health in 2017. I work supporting three programs. The first one is in the community health worker program, where we have a team of over 1,200 community health workers who are working as volunteers in their respective communities. I also oversee a program on social support, social and economic support to patients – providing things like food packages to patients, as well as transportation and any other support that would support them in accessing critical clinical services. I also oversee the implementation of an outreach screening program for sexual and reproductive health and chronic conditions among adolescents, women of childbearing age and the general population in their remote areas.

Ian: So my name is Ian Pinnell, I’m the Development Coordinator at Partners In Health Canada. I’ve been with the PIH Canada team for three years now in Toronto, and I support in all different areas from communications to programs and working with our amazing field colleagues. 

Ian: So Partners In Health at our core, we are both a social justice organization and a global health organization. So our work is both medical and moral. And at our core, what we are about is working towards building a future where high quality health care is accessible to all. Partners In Health works in 11 different countries around the world. And we as Partners In Health Canada joined the movement in 2011 to kind of help connect Canadians to this movement for global health and health for all. Our role as Partners In Health Canada is very much to accompany our implementation sites around the world. So our colleagues in Sierra Leone, our colleagues in Malawi and all the other countries where we work. They know what is needed, they’re the ones who are close to the patients, they’re the ones who are close to the Ministries of Health, who they partner with and accompany. So our role as Partners In Health Canada is very much to provide support and to provide the financial resources that our teams need to be able to provide the critical health care services that they provide. In each of the countries where we work, it’s a deep partnership with the Ministry of Health. And our work is long term – trying to build and strengthen the health care systems in each of these countries. And we will stay and support and work with them for as long as is needed to build health care systems that are able to truly provide high quality care to the most marginalized. The No Woman or Girl Left Behind project is a five year program that we have partnered with Global Affairs Canada to be able to provide. And so it’s running from 2019 to 2024. And the idea was very much to build on and strengthen the already incredible services that both Partners In Health Sierra Leone and Partners In Health Malawi were already providing – to improve access to sexual reproductive health services, strengthen prevention and treatment for survivors of sexual and gender based violence, and increase the availability of high quality maternal care in Kono in Sierra Leone, and Neno in Malawi. So again, it’s a five year program to really strengthen and build on the maternal and sexual and reproductive health work that both of these implementation sites were already doing, through this long term health system strengthening. We expect it to impact over 80,000 people across both countries.

Basimenye: Neno, where PIH predominantly implements its work, is located in the southwest region bordering Mozambique. The district has a population of 138,000 people, so it’s relatively small compared to other districts in the country. The majority of the people here are subsistence farmers – very poor and struggling, like really living on less than a USD $1.90 cents in a day. It’s one of the hardest to reach and underdeveloped districts. There’s no proper pipe water and less than 4% of the population has access to electricity. The place is very hilly, which makes general travel even more difficult, especially when you have to travel to health facilities, schools, markets, predominantly people travel on foot, and it becomes very tough, especially in the rainy season when the roads are muddy, slippery or cut off completely by rivers. As Partners In Health, we work very closely with the Ministry of Health, and we support them in the delivery of their mandate. And from the time that PIH started its work in 2007, one of the main things that we have focused our efforts on is systems strengthening, as Ian mentioned. Working with the Ministry’s leadership to ensure that the challenges of human resources are addressed in all the 14 health facilities. We support the Ministry in recruiting well trained and qualified staff members and volunteers to provide quality service delivery to the district’s population in a number of disease areas. We also look at actual resources and supplies that are required for care delivery, both at the facility and community level. We are also supporting actual space where these health providers can provide the services. We are providing and strengthening health leadership and governance. And lastly, we are providing basic social support packages, as I talked about earlier on. In terms of the key challenges that girls face in Neno, I would say they are many, despite the fact that there has been some notable strides in reducing overall maternal mortality and in increasing facility based delivery over the years. Our maternal mortality rate still remains very high. And access, as well as utilization of modern contraceptives, especially among adolescents is also a challenge and some of the factors that are contributing to this situation are lower knowledge levels about sexual and reproductive health and rights among adolescents, the difficulties of accessing such services in an environment where sex among young women is highly, highly stigmatized, – but also because of the beliefs that contraceptives are meant for those who are married and those who have had enough children. In addition to that women and girls in Neno further experience high levels of sexual and gender based violence. And unfortunately, we are seeing a rise in these incidences, even in recent times. So they are experiencing all forms of violence – physical, sexual, emotional violence and many of the survivors who experience these unfortunate incidents, even when they do want to come out to seek help, many times they don’t have information of where exactly to go and seek the help they need. Even if they know, you will find that the health system, the social welfare system, the legal system is either too weak to adequately support, protect the women or simply they don’t have the resources to provide the required help. So this whole situation is made worse by cultural norms that promote silence and vilify the victim while covering up the perpetrator. So these are just some of the disparities that are faced by girls and young women where PIH Malawi is working.

Isata: Where we work, the population there is just over 550,000.  We work in Kono, the main city center of that district. And this is where the main hospital is based. It is also the only hospital that can offer emergency care. It’s the only place where you can get a cesarean  section done  for women needing it.  It’s in the city center, but is also for people who live in the villages. But for people who live in the towns out of the city,  this can be pretty hard for them to reach to – especially in the rainy season, the roads can be very, very difficult to get through.  Hearing of cars and ambulances getting stuck, this is a main and regular occurrence. And several times – for those of us who have to go out to do outreach, you regularly get stuck. And this involves having to get out of the car to push to get it moving somehow. And this also happens with ambulances who are either going to get women for emergency care or taking them back. And within the rural area, what then has to happen is that you have to have a lot of periphery health units. These periphery health units offer basic obstetric care as well as basic care for adults and young children. This includes things like your basic HIV, TB care, deliveries, as well as antenatal care. If anyone within any of these categories needs further support, then you have to transfer them over to the government hospital in Koido city, which is called Koido Government Hospital. Our main remit working within  this area  is to make sure that we’re able to strengthen the health system, we’re able to ensure that people have the confidence  to access health services. And when they get there to ensure that they’re able to get the basic resources that they need to meet their needs. So how and what does that mean? It means that we have ensured that we’ve brought in all sorts of drugs, equipment, we’ve increased the basic infrastructure of the hospital. We’ve also made sure that we’ve, increased the capacity, the human resources capacity in terms of employing more staff to support the government staff that are working there.  And worked at strengthening the skills and the abilities of the hospital staff that work there. In the maternity unit, it’s 41 beds. It’s run and owned and managed by the Ministry of Health and Sanitation of the government of Sierra Leone. But Partners In Health works in conjunction with them. When you go to that unit, you would see that this is a place that is run as a partnership.  There is no difference between the Partners In Health staff versus the Ministry of Health staff. We have five midwives, we’ve got our nursing staff as well. It’s a mixture between Partners in Health and Ministry of Health. In our hospital, we have about 3,000 – 3,5000 deliveries a year.  Within this unit, we’ve gradually been able to chip at and reduce the number of women who die within the maternity department, year on year since 2018. We’ve been reducing those numbers gradually.  But we still have a long way to go.  Sierra Leone is still one of the countries with the highest maternal mortality. There’s a lot of issues and reasons why this is the case. A lot of these maternal mortality deaths are preventable. They shouldn’t have happened. Most of it is about  -one, we’ve talked about access – actually getting there physically, the impassivity of the roads and the network and the transport and  all that. But also there’s the issue of trust. During the civil war years and Ebola, the healthcare system was totally destroyed in a country. It’s taken many years for this to be built up  and for people to develop trust in the abilities of staff, they have been used to a system whereby even when you do get to the hospital, there’s nothing there – there’s no drugs, there’s barely any staff, the ones that are there don’t even have the equipment or the resources to be able to treat you – as well as the lack of knowledge. So people got used to seeking care elsewhere.  Most of the deliveries within the country are done out of a health facility – whether that’s within the PHU’s, the community health facilities or in the main hospital based facilities.  A lot of women still deliver at home. A lot of deliveries are still done by traditional birth attendants because people trust them and people still believe in them. When initial manifestations of illness, of anything wrong with anybody – whether it’s a child, a baby, a pregnant woman, an adult,  people would usually try to self care first and then go to a local pharmacist, a local, a traditional healer –  any and everybody else before finally coming to a hospital. So the hospital is not usually the first port of call for most people.  So we’re working hard at changing that – encouraging them to come to the hospital, come to the hospital  to seek help, come to the hospital to get diagnosed, come to the hospitals to get treatments, come to the hospital to even just get health promotion. And we chip away at this a little bit at a time,  talking to people, not just staying within the hospital grounds, but going out there in small groups to the villages, to the chiefdom  areas, engaging with the people there, trying to find out why they’re not coming in – then  from those responses, working with them to put more things in place that would encourage people to seek primary and secondary health care options within the right settings.

Safa: As health care providers, Basimenye, Isata and their colleagues in the Neno and Kono districts of Malawi and Sierra Leone had to adapt to unique challenges and health care needs triggered by the coronavirus pandemic. 

Basimenye: The COVID-19 pandemic has generally been a very stressful experience for my team, for my community, pretty much everyone in the district. And while some institutions were closing down and sending their employees home, we like many health based institutions were repurposing and adapting our projects and re strategizing on how best to keep providing essential health services to our clients. On top of designing and implementing a district level response to the pandemic itself. The amount of work itself, I would say quadrupled. The levels of anxiety were off the roof. But in all this, we knew that we needed to stay strong, grounded and coordinated in order to deal with this challenge. And this is how we managed to register some successes, like a story that I would like to share with our listeners of the first confirmed COVID-19 case that we had in Neno district. So this was a young woman aged 19 years old, who was traveling back from South Africa. And upon arrival at the Malawi border she tested positive to COVID. The girl was 30 weeks pregnant by the time she was coming into the country. And she was taken directly into our care at Neno’s Isolation Center, where she started receiving medical care. In the Isolation Center, this patient went into mild depression and was refusing to eat, she was refusing to interact with the team in the Isolation Center. She just didn’t like the idea of being in an Isolation Center. To address this challenge, PIH leadership, together with MOH, engaged the services of our mental health team who started providing psychosocial support and counseling. She was also provided with air time to ease communication with her family, but also just to keep her connected to her friends. As the number of days went by, she was well enough to be discharged. But unfortunately, her family at this time was experiencing a lot of stigma and negativity from fellow community members who were accusing them of putting everyone else at risk of COVID-19. So despite the fact that this family had not met their daughter ever since she arrived in the country, she was in the hands of healthcare workers, the community just didn’t trust this family. And they put them through a lot of pressure to the point that PIH had to go in to provide community education, where we pulled together the chiefs, the community members, the family itself, and this discussion ended up working and she was successfully discharged and welcomed into the community. The clinic as well as the community health teams, they continued to follow up on her and provide support to this lady, as well as a family, up to the point that she delivered a healthy baby. The way we’ve managed to work through the pandemic, there’s been a lot of coordination between MOH and ourselves, but also working very much hand in hand with the community itself, where a lot of negativity was coming Because at that time, people didn’t have a lot of information about COVID. And normally, in a situation where when you are sick, the first thing that your community will do is to surround you and offer you support. But this was the very same thing that was being discouraged. And it ended up creating a lot of stigma around people, a lot of suspicion, which in the end was creating a lot of negative energy, especially for those that were being suspected of COVID-19.

Isata: COVID-19 really kind of eroded some of the gains that we had made, especially from a maternal and neonatal health point of view –  because women had started coming, there were more increased antenatal visits, there were more increased facility deliveries all across the board, not just in the government hospital, but also within the PHU’s as well. And not just for maternal care, but also for pediatric care, for neonatal care and for adult care as well. COVID-19 hits the world and what this means was that a lot of people were scared.  These were people that have just recovered their trust in a health care service. After the Ebola pandemic from 2014 onwards –  they knew what happens in the run up to ebola and nobody wanted to live through that again. On the day that we had the first case of COVID-19 within our hospital at Koido Government Hospital,  patients left – patients left in  droves – whoever could walk walked out. There were people walking out with IV cannulas still going, they left anyway with drip stands to say that we cannot live through another pandemic. We cannot stay in this hospital and wait to die. But one of the things that we had done to kind of preempt this was do a lot of outreach work, a lot of radio work, a lot of talking to newspapers, going into schools, going to churches, going to mosques to get religious leaders involved to say that we know this is going to come  – because it’s all over the world and there’s no way we’re going to be exempt from this – but here is what we know about it and here is what we have done to prepare ourselves for it so that we can make sure that when it does come, we’re not going to be taken unaware like we were for Ebola. So the initial reaction was people still ran, but when they ran away, they were met out there with the message we knew this was coming and we are prepared and we are ready – please don’t go, please come back to us, please come and seek help.  And fortunately, a lot of the people who were ill, who were positive within our district, they were not very sick. Many people recovered, many people were seen as asymptomatic. So then the message then got around that, they saying this person has COVID, but they’re well, and there’s nothing wrong with them. And people gradually began to see that COVID was not like Ebola. When you get a diagnosis of COVID, it doesn’t more or less mean certain or gradual death for you, that people were recovering and people looked pretty well with a COVID diagnosis. So they started to come back because our main thing was that, if you run away from COVID, we have much, much more bigger problems than COVID within our region –  we have very high rates of malaria patients, we have a lot of people with HIV, with TB, all of these sort of mimic or have similar symptoms to COVID. So if you’re running away from COVID and you’re not coming to be tested and treated for these other conditions, then these ones are more likely to kill you than COVID.  So that message got out there and gradually people started to respond, gradually people started to come back and, when they came back and they saw that we were able to treat them and we were able to give them the same sort of treatment within different areas within the hospital, away from the COVID treatment center, and they were well, and within the COVID treatment center as well, there were seeing patients around look well, they were walking around, they were cordoned off, but they looked well and they could talk to their relatives  through the barriers, they could see them, they could wave at them  and gradually the message was that you can have COVID and survive and you can have COVID and still be able to come to the same hospital for chest pains. That said, our first maternity case that we had wasn’t as successful as we had hoped it was going to be. On the nights that we had our first suspected case, she was a pregnant woman, she came in the middle of the night. She was very unwell.  She was coughing. She had a temperature, she looked dehydrated, she looked and well, mainly because she had been feeling unwell for a few days and had stayed home because by then the message was, if you come and you have a cough, they’re going to tell you that you have COVID and they’re going to isolate you, which is what happened because she had the symptoms. So we had to follow the policy and procedures for that.  Unfortunately, it turned out that, because of the time that she came in,  we hadn’t actually worked very well on our duty roster and there wasn’t anybody on duty at that time of the night that had been specifically trained to support COVID-19 patients.  And they had to be called in – in the meantime, during our assessment of this woman, it was discovered that  her baby was in a breached presentation and It wasn’t a presentation that lent itself to an easy vaginal delivery. So she would need to have a cesarean section. It took quite a while for the team to organize themselves because the first thing that happened with the first case – considering how ill she was at the time,  the team was scared. The staff were not sure of what to do. The ones that had gone for the more intensive training were not there at the time  and the ones that were there were not very confident about how they should treat this. So by the time we got everything in place and everyone who should be there was there, it was a little bit late because the woman – her labor had progressed quite far, she was in an advanced second stage and she ended up having a vaginal delivery.  And unfortunately the baby died. So this was a very devastating time for our team  because everything that we had done and practiced and talked about  – on the very first time that we were faced with a case, it fell apart. We hadn’t put all the measures in place that we should have.  We didn’t respond as well as we could’ve. And as result, a baby died and this was devastating  for the mother,  for her family.  So we were all upset about this,  but what we then did was have a meeting, we talked about it. We acknowledged what we had done wrong.  And we then proceeded to put measures in place to make sure that this is what needs to change and we worked to make sure that nothing like this would ever happen again – and not just for a suspected COVID case, but for any other woman. We went through various drills and we learnt and learnt and thankfully, from that day on no other patients – and we had quite a number of suspected as well as positive pregnant women that came through our center through the peak of the pandemic, and we were able to treat them all and we were able to manage our maternity cases a lot better.

Basimenye: The COVID pandemic impacted women to a greater extent. The first thing that I would say is just at the beginning hearing about this pandemic and what it takes for one to prevent contracting the virus itself – it placed a lot of stress on women, because women are the ones who have to take care of their households. So for instance, just knowing as a woman, as a mother, that you’ve got small children at home, and in an environment like Neno, where everything and I mean everything is communal, starting from the house that you live in – most of the houses here in Neno are either just one room with the whole family sharing that room,  sharing eating utensils, beddings, pretty much everything. So it placed a lot of stress on women to say, how are we going to support our children from contracting the virus? And fortunately, the pandemic did not impact children as much. Secondly, most of the women are the ones who are supporting their families. And most of them will either have a small business that they have to do on a day to day basis, in order for them to bring back some money and some food at home. You would see that with the restrictions on travel, with restrictions on how close you can be to other people, it just brought a lot of financial stress as well on the women because they were not able to transact and to do business as they normally do, which brought a lot of tension and anxiety on how they were going to support their families. How they were going to keep their families well enough, maybe not just from COVID, but if you’ve got small children, and you’re not providing them food, that’s also a recipe for other health issues. But also schools were closed down. So immediately when the schools closed down, a few months after that, we started seeing a lot of reports of increased pregnancies among girls in the community. It’s something that happens usually, even during the summer holidays when girls go out of school for prolonged periods of time, they are exposed to sexual activities and things that just push them into sexual activity, and they end up getting pregnant. And it was a similar situation this time around. A lot of girls ended up getting pregnant. It’s something that is really difficult. Up to now, a number of girls have dropped out of school because of the situations that they were brought in due to the pandemic.

Isata: Women and children,  they went through a lot more difficulties and uncomfortable situations, which would not have come across without COVID.  Kono district, it’s a mining area and that’s for the men. So what the women do to  contribute to household funds is they do a lot of trading and they trade across the neighboring border – in some areas there’s a land border, in other areas it’s just a river or water crossing border between Kono district and Guinea, which is the nearest neighboring country to Sierra Leone. So you have a lot of women in particular,  who cross over to buy goods and services to trade within, Kono. With the advent of COVID-19, the border was closed. And that means that, If you do not have enough stock at home, if you don’t have enough supplies at home, you’re not trading , and if you’re not trading, you don’t earn. If you’re not earning you become more dependent upon  your partner, you become more dependent on other people, your relatives, etc. And also if you’re not trading, it means you’re not going out. You’re not engaged in other things that would otherwise keep you occupied both physically and mentally. The men are at home, nowhere to go play card games, because this is usually what they do for pastimes, for leisure times is after work, go to the local bar and go sit and have a drink or two and play games with my friends. This is no longer happening.  So there’s no outlets for anybody,  They’re home. He’s home. The partners are home. The children are home because they’re not going to school anymore. This means that’s a lot of feeding to do in a day with reduced resources, with reduced income.  The tensions and the stresses at home were getting increasingly higher. Some people were finding different sorts of outlets for, for this tension, whether it could be through emotional abuse, physical abuse, to sexual abuse, there was an increase in that.  Children were also getting more abused because if you’re home, you know, you’re not at school  and both of your parents are home under stressful conditions, the tendency to get under foot if you like was increased and there were repercussions for that for some of them. And also for a lot of the young girls, we had an increased rate of teenage pregnancy. More and more young girls, young women involving themselves in  risky sexual behavior. So this ended up with a lot more unwanted and teenage pregnancies. Within Koido city, this is where you have the most and the best secondary schools.  So we had a lot of girls who were sent to the city from their families in the village. But once school closed, once all the schools closed down,  some of these girls were sent back home to their parents in the village.Now what then happens in the village was that a lot of the responses there was, well, if you’re not going to school and we don’t know when school is going to open, we don’t know what the next steps are going to be – and you are a fully grown, fully mature young girl, there’s some young man within the village who is looking for a new wife – they became some of the new wives. And, as a result were not able to come back to the city to continue with their education. So that is another unfortunate outcome of the impacts of COVID-19 on young girls within Kono district.

Safa: In the face of these new challenges, the partnership model that Partners In Health is built on, was a crucial source of support.

Ian: As is evident by our name of Partners In Health, partnership is something that is core and critical to our work. And I think one of the most important parts of how we view partnership is that it’s long term accompaniment. Our PIH implementation sites make long term open ended commitments to partner with Ministries of Health in each of the countries where we work. And this means walking with them as partners for as long as they need. So in the example of this No Woman or Girl Left Behind project, it’s five years with generous support from Global Affairs Canada, but in both of the countries where we as Partners In Health Canada are helping to implement this, this is building on and strengthening existing services and programs that both implementation sites were already doing before and will continue on afterwards. So again, our role as Partners in Health Canada, and as Partners In Health team in the United States, is to provide the resources, any sort of technical support, clinical support, and to also find ways to build other partnerships. I think something that Partners In Health does very well is building partnerships with some of the world’s leading academic organizations to take those resources from Harvard, from Brigham Women’s Hospital, and so many others, and be able to take that clinical expertise, that academic expertise and ensure that it is being put into place in communities and countries where it is needed most. So as our PIH implementation sites stand in solidarity with their Ministry of Health colleagues, we are always going to stand there and support our implementation sites and provide whatever support we can, as they kind of take the leadership and determine what is necessary, what is needed. And then it’s our job as the Canadian team to meet those needs, however we can. We as Partners In Health are trying to find ways to shift around our structure as an organization. This has been an initiative over the past years with a one PIH model, where true leadership comes from the site’s, from people in each of the implementation sites that really have the knowledge on the ground of what is needed. And then combine that with kind of the expertise from the Canadian and US based other global teams. And then how do we make that happen? Always going back to that idea of the long term accompaniment, and the leadership really coming from the implementation sites.

Isata: We are very much aware of our wider team out there and the support that they are able to lend to us, in the sense of technical support, but also in the sense of emotional support and knowledge transfer. There are times that you get home and it can be hard. It can be really very hard – going out there every day, working with people, losing patients from things that you –  if you had been in a different sort of setting, if you’d been in, Canada or Boston, this would not have happened to this woman or this child. And knowing this, you feel that you are constrained in some way because of some resource that just wasn’t there at the time, whether it was an actual physical resource or whether it was a resource in the terms of human resource, in terms of training, in terms of knowledge, in terms of skills, but you lost the patients. And knowing that more could have been done and more should have been done, but it didn’t happen because of whatever reason at the same time. Knowing that there’s the wider team out there that you could reach out to, that you can touch base with, that you can express yourself to – somebody out there who will get you the help and the resources that you need to support you through ,so that the next time, the same thing doesn’t happen again.

And this includes not just in Boston or in Canada, but we have our closer network – our Liberian team, Rwandan team, we are constantly in touch with them, sharing ideas, finding out what works well for them, what have they done? What are they doing that we are able to implement?

And we can be able to  benefit from as well as – at the same time sharing what we’re doing as well. Because it’s easy to feel that you’re isolated within your work –  you need to not just be in your own bubble all the time, but still remember that there’s a wider world out there functioning and connecting and sharing your information with other people. We work as well with the Ministry of Health and Sanitation of the government  and making sure that that partnership remains strong, that they know that we are here to build together, we’re not here to tell them this is how it has to be done, but to ask how or what needs to be done and how would you like us to do it? And what is the best way in which this can be done and then working together as a team. The heart of the matter is we need to make sure that no woman, no girl, no child, no man, none of these people should be left behind and knowing that we’re doing everything possible to care for them at the highest possible level. Recognizing that it is not just about us and our aims in what we want to have achieved at the end, but we need to  think about the whole wider picture.  Think about working together as a team and as a unit  – we know that the Ministry of Health and Sanitation cannot do this on its own. We also know that PIH cannot do this on its own as well. So it’s about recognizing this and working together – not just with the Ministry, but with other partners as well, other donors that contribute and have the same plan and have the same end game so that 1) we’re not duplicating and 2) we’re making use of it all the combined resources that we have to ensure that we can come up with sustainable and workable solutions. doable solutions – not just ones that can tick a box on a report sheet so that it looks like, yeah, we’re doing so well – but deep down at the grassroots, the patients are still suffering.  But coming up with plans and solutions that would really, really have an impact  that will really change the story of maternal mortality, neonatal mortality within Sierra Leone.

Basimenye: Isata puts it really well, in terms of how we work and how we deal with the aspect of partnerships. We are working in an environment that is resource limited. So working in partnership with other implementing partners, with government, with the community itself is something that is really critical in ensuring that there is value for the money that we get. At national level, we also as Partners In Health are participating in a number of technical working groups, but also are a member of the International NGO forum to learn what organizations are doing, where they are doing the different activities and how best we could coordinate and share information, tools and the support among other things. At district level, as I mentioned earlier on that we work through the Ministry of Health, who is our main partner. So most of the work that we do, including our response to COVID-19 was done jointly with the Ministry of Health. I remember we used to have a lot of meetings with what is called the District Health Management Committee, which is a leadership forum for the local Ministry of Health and strategize together to say what do we need in order for us as a district to respond to COVID-19? And there were a lot of discussions, a lot of plans being put together, bringing in all the stakeholders that were coming into the district to provide response, we would rope them in and say what do you bring and inform them of where the gaps were and how they could best support the response for the district. So we worked very much hand in hand with the Ministry of Health, we’re also working hand in hand with other implementing partners like Save the Children. And also apart from working with external partners, we’re very strong at encouraging even internal coordination among the different departments and program units. So I’m in the community health department, but my department works very closely with all the clinical programs that are being implemented in Partners In Health. We’re working very closely with the social welfare department as well in the provision of social support to vulnerable members in the society. As I’ve said, the community forms one of the biggest partnerships, it is one of our biggest stakeholders in terms of planning and implementing the programs that we do in the district.

Ian: One of the most important things that I’d want people to take away from our work is what we’ve spoken about, what Basimenye and Isata said around the critical importance of partnership in all of our work. And this idea of the long term accompaniment and Basimenye spoke very well to the idea of partnership and accompaniment at all levels, from the very community level, where our community health workers, who are from the communities in which they work, standing side by side and walking with their patients to the health centers, to our accompaniment from the local, regional, and national levels of Ministries of Health in this long term accompaniment, that’s really focused on strengthening health care systems for the long term. So it’s not an idea of doing a two year project or a five year project. In Canada, our health care system was not built in two years or five years. We’re not going to be able to build and strengthen the health care systems in Kono or in Neno to be able to provide high quality health care and to support women, girls, children and men and everyone who needs high quality care and deserves high quality care. We’re not going to build that in two years or five years, it means we need to be there for as long as it is needed and not stopping until we’re able to reach there.

Basimenye: My reflections would be that dealing with health challenges, like the Covid 19 pandemic, or improving sexual and reproductive health outcomes for girls and women, can only be effective and sustained if they are comprehensive and integrated into functioning health systems. So this means focusing on both community and facility based platforms of care, promoting education, empowerment, and care seeking behaviors for the target people that you are working with. Accompanying the public sector, the health institutions and all the actors that are involved to increase their service delivery capacity. And so just to echo what my colleagues just said, these are things that cannot be achieved using short term vertical programs. These require long term investment, they require long term commitment. And so these are some of the things that can only be made possible with the support that we’ve been getting from partners, from different institutions that are touched by the challenges that our communities go through and are experiencing and have the desire to see that there is a change in these areas. 

Isata: So if you think, in whatever part of the world you happen to be listening to this from – what can I do to contribute to this? What can I do to change this? How can I, how can I make a difference? How can I be a part of this? How can I  also do my thing within this? You need to just think that yeah, everybody has got something that you know, everybody has got something that you’ve seen that can make a difference and sharing that with us, letting us know that this is what you’ve done, this is what you’ve seen, this is what you know has worked elsewhere. These are the sort of things that we want to hear, that we can then consider: but how can we adapt this?  How can we learn from this? How can we use this to make sure that it makes a difference? To make sure that the outcomes that we’re trying to achieve really do happen? Because sometimes you can get some tunnel vision if you’re in a place on your own for too long, and everybody out there who has something to contribute, please come, come and share with us. It’s not just about financial contributions.  It’s also about your knowledge, even your well-wishes and your lov and your warm regards and just your words of encouragement is something that we need as we continue on with this battle to make sure that, you know, women, those young, people out there all get the services and the care that they deserve and they need as well.

Safa (outro): To connect with Partners In Health Canada, Partners In Health Malawi and Partners In Health Sierra Leone, you can visit their website, https://pihcanada.org/  , https://www.pih.org/country/malawi and https://www.pihsierraleone.com/  , follow them on social media and feel free to send them a message of support. 

Thank you to all our wonderful guests for sharing their story with us today. And thank you to all our listeners for tuning in!  This is the last episode of our first series. To connect with our team and our OCIC membership community, visit our website www.ocic.on.ca and send us a message!

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