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GHF 2014 – LS01 – Integrated Solutions or What Does Health System Strenghtening Mean in Fragile Settings?

12:15
13:45
LS01 TUESDAY, 15 APRIL 2014 ROOM: 2
LUNCH
SESSION
Integrated Solutions or What Does Health System Strenghtening Mean in Fragile Settings?
MODERATOR:
Dr. Anne-Claude Cavin
Conflict Prevention Advisor, Swiss Agency for Development and Cooperation, Switzerland
SPEAKERS:
Dr. Marina Madeo
Senior Advisor for SDC Regional Office Horn of Africa
Ms. Bernadette Peterhans
Deputy Head of the Teaching & Training unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
Dr. Mark van Ommeren
Scientist, Department of Mental Health and Substance Adbuse, World Health Organization, Switzerland
OUTLINE:

In this session we will discuss challenges and promising approaches to rehabilitating / strengthening of health systems in fragile contexts where humanitarian aid is not yet, or no longer an appropriate tool.
In such contexts the health system strengthening approach reaches often its limits, as the political will or capacity of the State is lacking for providing essential services to the population. Where to start and how to work when all the building blocks of the health system are in disarray? How to respond efficiently to the acute lack of qualified staff, medicine, equipment and funding; weak leadership and governance; absence of information and management systems?

SDC would like to use the fishbowl format of launching a transparent discussion and experience exchange on particular challenges, successful approaches and empirical evidence on effective interventions in fragile settings.

PROFILES:

Dr. Anne-Claude Cavin

Anne-Claude Cavin has a PHD in law and is mediator, with a specialization on international mediation.

She works for SDC as specialist in governance, mediation and conflict prevention and coaches SDC employees in conflict management, mediation and CSPM (conflict sensitive programme management) in Africa, Central Asia and the Balkans.

She has further a long experience in facilitation national and international conferences and events.

In parallel to SDC, she is co-founder of “Intermédiations” and has mandates for juvenile courts.

 

LS01_Marina_MadeoDr. Marina Madeo

Dr. Marina Madeo is Senior Health Advisor for SDC Regional Office Horn of Africa and has a long standing working experience in the Somali contexts.

Before joining SDC she worked for other multi- and bilateral health programmes. She has a deep understanding of the New Deal in practical terms and a strong personal interest on fragile states.

 

LS01_Bernadetter Peterhans_squareMs. Bernadette Peterhans

Bernadette Peterhans, RN, MPH is Deputy Head of the Teaching & Training unit at the Swiss Tropical and Public Health Institute in Basel.

Bernadette taught already on PHC in fragile contexts at different universities (Geneva, Copenhagen, Edingburgh) as well as at the ICRC. She works further as specialist consultant for PHC in different fragile contexts, as for instance South Sudan (since 94), Horn of Africa or Afghanistan.

 

LS01_MarkVan_OmmerenDr. Mark van Ommeren

Dr. Mark van Ommeren is Scientist at the World Health Organization (WHO) in the Department of Mental Health and Substance Abuse in Geneva.

He is focal point with WHO for mental health during and after emergencies.

He has a particular interest in building back better, that is to convert short-term emergency-related interest in mental health into momentum for long-term improvement, as described in Building Back Better: Sustainable Mental Health Care after Emergencies (WHO, 2013).

 

 

 

Dr. Anne Golaz

Golaz-AnneDr. Anne Golaz

Lecturer and Researcher at CERAH, Switzerland

She obtained her Medical Doctor degree and Doctorate in Medicine at the University of Geneva, and a MPH at the University of Washington. She’s Board Certified in Public Health and General Preventive Medicine. She has over 20 years of field experience in humanitarian work and graduate and post-graduate education in public health. She’s worked as a medical epidemiologist for the US Centers for Disease Control and Prevention; as a senior advisor for UNICEF Regional Office for South Asia in Kathmandu and Geneva Office, and for WHO HQ and Regional Offices in Cairo and New Dehli.

Role at the CERAH:

  • Member of the Scientific Committees of the CAS Health in Humanitarian Emergencies and CAS Disaster Management
  • Coordinator CAS Health in Humanitarian Emergencies
  • Coordinator of the Research Methodology course (MAS-DAS)
  • Co-leader of the course Health Interventions in Humanitarian Crises (MAS-DAS week)
  • Co-leader TS Advocacy for Humanitarian Projects in Health

Fields of interest:

  • Public health and epidemiology
  • Reproductive health in humanitarian emergencies
  • Mental health in humanitarian emergencies
  • Genocide prevention
  • Community capacity building
  • Research and evidence generation in humanitarian contexts

Dr. Doris Schopper

SCHOPPER-DorisDr. Doris Schopper

Professor at the medical faculty of the University of Geneva and director of CERAH, Switzerland

She obtained a medical degree at the University of Geneva (1978), trained as a specialist in Internal Medicine (1986) and completed a Doctor in Public Health at the Harvard School of Public Health (1992).

Between 1982 and 1990 Doris Schopper spent several years with Médecins Sans Frontières (MSF) in the field. She was president of the Swiss branch of MSF (1991–1998) and twice president of the MSF International Council during this period. In 2001 Doris Schopper was asked to constitute an Ethics Review Board for MSF International.

Since then she has chaired the Board coordinating the ethical review of MSF research proposals and providing advice on ethical matters to the organisation.

Doris Schopper also worked as health policy adviser in the Global Programme on AIDS at WHO headquarters in Geneva (1992-95).

Further international work includes two years as senior health policy adviser at the Swiss Tropical Institute and developing several policies and strategies for WHO (e.g. guideline for policy makers on national policies for violence and injury prevention; strategy for mother-to-child transmission of HIV in Europe; WHO-wide strategy on child and adolescent health).

Professor Schopper has also been responsible for the development of health policies and strategies at the national and regional level in Switzerland (e.g. Swiss National Cancer Control Programme 2005-2010; framework to prevent obesity at the national level; comprehensive health policy for the canton of Geneva). She is member of the board of Pro Victimis Foundation-Geneva since 2003, and president since 2010.

In November 2012, Doris Schopper was appointed member of the International Committee of the Red Cross (ICRC).

Functions:

  • Director
  • Member of the Scientific Committees of the CAS
  • Coordinator CAS Health in Humanitarian Emergencies
  • Co-responsible Course Health Interventions in Humanitarian Crises

Fields of Interest:

  • Public health in humanitarian contexts
  • Development and analysis of health policy
  • Research ethics in humanitarian contexts
  • Ethics of humanitarian medical intervention
  • HIV-Aids, Cancer

Dr. Marie-Claude Bottineau

PS12_Dr_Marie_BottineauDr. Marie-Claude Bottineau

Pediatrician, Neonatology, Pediatrics Intensive Care, MSF CH, Geneva, Switzerland

Dr. Bottineau is a French Pediatrician with a DESS in Neonatology, a competency in Pediatrics Intensive Care and a Master Degree in Public Health and Tropical Medicine. She did the first part of her carrier working in General and University Hospitals in France as Pediatrician in Pediatrics, Pediatrics and Neonatal Intensive Care in Nantes, Nancy, Le Havre and Paris and her Tropical Medicine Degree in Pitié Salpêtrière Hospital, Paris, with Pr Gentilini and Pr Duflo. She also studied Bio-Ethics in Paris as free auditor getting an equivalence of Master Degree.

In parallel, she was doing some regular missions around the world with several Humanitarian Organizations including MSF- France in Kosovo; Vietnam (Ho-Chi-Minh); Madagascar (Antananarivo); Nicaragua (Leon and Managua), during civil war; Nepal (Pokhara-Jomoson); India (Calcutta, slums of Howrah-Pilkhana) and Cameroon (Mpoundou, Abong-Mbang district).

From 1990 to 1996, she dedicated her carrier to the humanitarian action working exclusively in expatriation in different humanitarian contexts of which in Benin with Terre Des Hommes-Lausanne and in Angola with MSF-France (Uige and Benguela provinces during civil war).

After an urgent medical repatriation in December 1995, time for recovering, few months in HQ MSF-France in Paris and few years in Robert Debré Hospital (Pediatrics Emergencies and Neonatal SMUR), she was to the United States in order to complete her Master Degree in Public Health (2000). Then, she worked 2 years as Public Health Medical Specialist at CRED (Center for Research on the Epidemiology of Disasters), UCL, Brussels, Belgium. At the same time she made several missions to Cambodia for the Belgium Cooperation and some consultancies as Evaluator within the European Commission for INCO-DEV and INCO-MED programs.

From 2001 to 2003 she made regular consultancies for WHO Geneva in Switzerland (Geneva) on GAVI (Global Alliance for Vaccines & Immunizations); Chad (Tanjile), Mali (Bamako) and Indonesia (Djakarta, Bali and Iles de la Sonde) on Maternal and Neonatal Tetanus Elimination (MNTE) including Lot Quality Assurance Surveys (LQAS).

From January 2003 to July 2007 she worked as UNHCR Senior Regional Health/Nutrition/HIV – AIDS Co-ordinator for West Africa based in Sierra Leone (Freetown) and Ghana (Accra), then the Great Lakes Region based in Burundi (Bujumbura) and at least Chad – Darfour Emergency, based in Chad (Abéché).

Mid July 2007, she was appointed as Pediatrics Referent in MSF-CH to develop pediatrics vision, policy and strategic approach and to give adequate support to pediatrics fields. In April 2011, she took the coordination and leadership of the MSF International Pediatrics Working Group and early 2014 the coordination of the Mother, Neonatal and Child pool including nutrition.

She taught extensively (H.E.L.P Course, in MSF, UNHCR, Universities...) and participated actively in international congresses making some abstracts, publications, posters, and/or oral communications.

She contributed for many years to the work of Amnesty International against Torture, acting with the Medical Commission. After different professional affiliations, she is currently active member of the Target Advisory Group (TAG) of the International Pediatrics Association (IPA) on Children in Humanitarian Disasters, of the Partnership for Maternal, Newborn and Child Health (PMNCH) (WHO, UNICEF, Save The Children...) and of the Group of Tropical Pediatrics (Société Francaise de Pédiatrie).

She got certificates of recognition from CDC Atlanta, H.E.L.P Course and the UNAM of Nicaragua for her action in emergency settings and/or her contribution to the teaching.

GHF2014 – PS14 – Integrating Sexual and Reproductive Health Care in Humanitarian Interventions

16:00
17:30
PS14 TUESDAY, 15 APRIL 2014 ROOM: 18 ICON_Fishbowl
Integrating Sexual and Reproductive Health Care in Humanitarian Interventions
MODERATOR:
Dr. Doris Schopper
Professor at the medical faculty of the University of Geneva and director of CERAH, Switzerland
SPEAKERS:
Dr. Anne Golaz
Lecturer and researcher at CERAH, Switzerland
Ms. Wilma Doedens
Technical Adviser on Reproductive Health in Emergencies, Humanitarian Response, UNFPA, Switzerland
Dr. Lisa Thomas
Medical Officer, Department of Reproductive Health and Research, World Health Organization, Switzerland
Ms. Nelly Staderini
Référente médicale- Santé de la reproduction, Reproductive Health Advisor, MSF, Switzerland
OUTLINE:
Problems related to sexual and reproductive health are the leading cause of death and ill health for women of childbearing age globally. In crises, this vulnerability increases, while access to services decreases. The urgent need for life-saving sexual and reproductive health services has often been neglected and not prioritized in humanitarian responses.  Speakers from UN agencies and INGOs will give a brief overview of some of their sexual and reproductive health programmes, discuss recent achievements, challenges in integrating sexual and reproductive healthcare in humanitarian interventions and ways to advocate for better access to these services during crises.
PROFILES:

SCHOPPER-DorisDr. Doris Schopper
Professor at the medical faculty of the University of Geneva and director of CERAH, Switzerland

She obtained a medical degree at the University of Geneva (1978), trained as a specialist in Internal Medicine (1986) and completed a Doctor in Public Health at the Harvard School of Public Health (1992).

Between 1982 and 1990 Doris Schopper spent several years with Médecins Sans Frontières (MSF) in the field. She was president of the Swiss branch of MSF (1991–1998) and twice president of the MSF International Council during this period. In 2001 Doris Schopper was asked to constitute an Ethics Review Board for MSF International.

Since then she has chaired the Board coordinating the ethical review of MSF research proposals and providing advice on ethical matters to the organisation.

Doris Schopper also worked as health policy adviser in the Global Programme on AIDS at WHO headquarters in Geneva (1992-95).

Further international work includes two years as senior health policy adviser at the Swiss Tropical Institute and developing several policies and strategies for WHO (e.g. guideline for policy makers on national policies for violence and injury prevention; strategy for mother-to-child transmission of HIV in Europe; WHO-wide strategy on child and adolescent health).

Professor Schopper has also been responsible for the development of health policies and strategies at the national and regional level in Switzerland (e.g. Swiss National Cancer Control Programme 2005-2010; framework to prevent obesity at the national level; comprehensive health policy for the canton of Geneva). She is member of the board of Pro Victimis Foundation-Geneva since 2003, and president since 2010.

In November 2012, Doris Schopper was appointed member of the International Committee of the Red Cross (ICRC).

Functions:

  • Director
  • Member of the Scientific Committees of the CAS
  • Coordinator CAS Health in Humanitarian Emergencies
  • Co-responsible Course Health Interventions in Humanitarian Crises

Fields of Interest:

  • Public health in humanitarian contexts
  • Development and analysis of health policy
  • Research ethics in humanitarian contexts
  • Ethics of humanitarian medical intervention
  • HIV-Aids, Cancer

 

Golaz-AnneDr. Anne Golaz
Lecturer and researcher at CERAH, Switzerland

She obtained her Medical Doctor degree and Doctorate in Medicine at the University of Geneva, and a MPH at the University of Washington. She’s Board Certified in Public Health and General Preventive Medicine. She has over 20 years of field experience in humanitarian work and  graduate and post-graduate education in public health. She’s worked as a medical epidemiologist for the US Centers for Disease Control and Prevention; as a senior advisor for UNICEF Regional Office for South Asia in Kathmandu and Geneva Office, and for WHO HQ and Regional Offices in Cairo and New Dehli.

Role at the CERAH

  • Member of the Scientific Committees of the CAS Health in Humanitarian Emergencies and CAS Disaster Management
  • Coordinator CAS Health in Humanitarian Emergencies
  • Coordinator of the Research Methodology course (MAS-DAS)
  • Co-leader of the course Health Interventions in Humanitarian Crises (MAS-DAS week)
  • Co-leader TS Advocacy for Humanitarian Projects in Health

Fields of interest

  • Public health and epidemiology
  • Reproductive health in humanitarian emergencies
  • Mental health in humanitarian emergencies
  • Genocide prevention
  • Community capacity building
  • Research and evidence generation in humanitarian contexts

 

Ms. Wilma Doedens

Wilma Doedens is the Technical Adviser on Reproductive Health in Emergencies of the Humanitarian Response Branch of UNFPA. She has worked with UNFPA since 2002. Prior to this she worked with WHO.

Wilma is a Medical Doctor with a public health and reproductive health background. She has extensive field experience in coordinating and implementing reproductive health services in both humanitarian and development settings, working within national health systems as well as with NGOs such as Medecins Sans Frontieres (MSF), International Rescue Committee (IRC) and the International Federation of the Red Cross (IFRC).

She coordinated the writing and publication of the Inter-Agency Field Manual for Reproductive Health in Humanitarian Settings and the Inter-Agency Standing Committee Gender-Based Violence Guidelines, and she is responsible for ensuring technical review and quality improvement of the Inter-Agency Reproductive Health Kits designed to support the implementation of priority reproductive health interventions in disasters.

 

Dr. Lisa Thomas

Lisa Thomas, MD is a Medical Officer in the Department of Reproductive Health and Research at the World Health Organization in Geneva, where she serves as the focal point for sexual and reproductive health in humanitarian settings.  She is a U.S. Board Certified Obstetrician Gynecologist with subspecialty training in family planning. Prior to joining WHO, she worked for humanitarian, development and donor agencies in over twenty developing countries including conflict and post-conflict settings. She has covered an expansive breadth of public and private sector projects in maternal and reproductive health policy, program design, training, research and monitoring and evaluation.

 

Ms. Nelly Staderini

Since more than 3 years, Nelly Staderini is in charge of the  Sexual and Reproductive Health and sexual violence in the medical department of Doctors Without Borders in Geneva. After initial training in midwifery and a Public Health Diploma in France, she practiced  in Parisian hospitals and had various functions in humanitarian missions abroad ( Mali , Cambodia, Pakistan, Afghanistan, Guinea , Chad and Burundi ) for non -governmental organizations. She has worked on maternal health issues in general and sexual violence, prevention and treatment of obstetric fistula and the prevention of mother to child transmission of HIV in particular. She is the author of academic works dealing with training of TBAs in Cambodia and midwives in Chad as well as two books: Sage-femme en Afghanistan (Cheminements Editions , 2003) and l' art revisité des matrones, naissances contemporaines en question ( Faustroll Edition, 2011).

GHF2014 – PS12 – Integrating Neonatal Care in Low Income Countries: the Big Place of the Very Small Babies

16:00
17:30
PS12 TUESDAY, 15 APRIL 2014 ROOM: LEMAN
ICON_Fishbowl
Integrating Neonatal Care in Low Income Countries:
the Big Place of the Very Small Babies

MODERATOR:
Dr. Marie-Claude Bottineau
MD, MPH & TM 
Pediatrician, Neonatology, Pediatrics Intensive Care, MSF CH, Geneva, Switzerland
SPEAKERS:
Dr. Anne Pittet, Pediatrician, Hôpital de l’Enfance à Lausanne and MSF CH, Geneva, Switzerland
Dr. Jean-Marie Choffat, Pediatrician, CHUV, Lausanne, Switzerland
OUTLINE:
 Worldwide experience on the way to promote neonatal care in remote settings, humanitarian emergencies, post emergency programs, LIC… including policy and strategic planning, implementation, integration into MoH structures, task shifting, training course and handover.
PROFILES:

PS12_Dr_Marie_BottineauDr. Marie-Claude BOTTINEAU is a French Pediatrician with a DESS in Neonatology, a competency in Pediatrics Intensive Care and a Master Degree in Public Health and Tropical Medicine. She did the first part of her carrier working in General and University Hospitals in France as Pediatrician in Pediatrics, Pediatrics and Neonatal Intensive Care in Nantes, Nancy, Le Havre and Paris and her Tropical Medicine Degree in Pitié Salpêtrière Hospital, Paris, with Pr Gentilini and Pr Duflo. She also studied Bio-Ethics in Paris as free auditor getting an equivalence of Master Degree.

In parallel, she was doing some regular missions around the world with several Humanitarian Organizations including MSF- France in Kosovo; Vietnam (Ho-Chi-Minh); Madagascar (Antananarivo); Nicaragua (Leon and Managua), during civil war; Nepal (Pokhara-Jomoson); India (Calcutta, slums of Howrah-Pilkhana) and Cameroon (Mpoundou, Abong-Mbang district).

From 1990 to 1996, she dedicated her carrier to the humanitarian action working exclusively in expatriation in different humanitarian contexts of which in Benin with Terre Des Hommes-Lausanne and in Angola with MSF-France (Uige and Benguela provinces during civil war).

After an urgent medical repatriation in December 1995, time for recovering, few months in HQ MSF-France in Paris and few years in Robert Debré Hospital (Pediatrics Emergencies and Neonatal SMUR), she was to the United States in order to complete her Master Degree in Public Health (2000). Then, she worked 2 years as Public Health Medical Specialist at CRED (Center for Research on the Epidemiology of Disasters), UCL, Brussels, Belgium. At the same time she made several missions to Cambodia for the Belgium Cooperation and some consultancies as Evaluator within the European Commission for INCO-DEV and INCO-MED programs.

From 2001 to 2003 she made regular consultancies for WHO Geneva in Switzerland (Geneva) on GAVI (Global Alliance for Vaccines & Immunizations); Chad (Tanjile), Mali (Bamako) and Indonesia (Djakarta, Bali and Iles de la Sonde) on Maternal and Neonatal Tetanus Elimination (MNTE) including Lot Quality Assurance Surveys (LQAS).

From January 2003 to July 2007 she worked as UNHCR Senior Regional Health/Nutrition/HIV – AIDS Co-ordinator for West Africa based in Sierra Leone (Freetown) and Ghana (Accra), then the Great Lakes Region based in Burundi (Bujumbura) and at least Chad – Darfour Emergency, based in Chad (Abéché).

Mid July 2007, she was appointed as Pediatrics Referent in MSF-CH to develop pediatrics vision, policy and strategic approach and to give adequate support to pediatrics fields. In April 2011, she took the coordination and leadership of the MSF International Pediatrics Working Group and early 2014 the coordination of the Mother, Neonatal and Child pool including nutrition.

She taught extensively (H.E.L.P Course, in MSF, UNHCR, Universities...) and participated actively in international congresses making some abstracts, publications, posters, and/or oral communications.

She contributed for many years to the work of Amnesty International against Torture, acting with the Medical Commission. After different professional affiliations, she is currently active member of the Target Advisory Group (TAG) of the International Pediatrics Association (IPA) on Children in Humanitarian Disasters, of the Partnership for Maternal, Newborn and Child Health (PMNCH) (WHO, UNICEF, Save The Children...) and of the Group of Tropical Pediatrics (Société Francaise de Pédiatrie).

She got certificates of recognition from CDC Atlanta, H.E.L.P Course and the UNAM of Nicaragua for her action in emergency settings and/or her contribution to the teaching.

 

OLYMPUS DIGITAL CAMERADr. Anne Pittet

After a pediatric specialization in Switzerland, I joined MSF OCG in 1999 for several field missions in Africa and Asia. I participated also to clinical studies in South Sudan and Myanmar. In 2005 I worked one year in Vietnam to help in the development of a neonatal project and I continue to follow up these activities.

Since 2006 I’m working 6 months a year with MSF and 6 months a year in the Pediatric Department of the University Hospital of Lausanne. Since 2011 I work with the Medical Department of MSF in Geneva and the Training Unit, performing formal training sessions, coaching, supervision and field visits in different countries of Africa, Asia and Haïti.

Improving Global Health by Leveraging Corporate Value Chains.

Author(s) Asher Hasan1
Affiliation(s) 1Executive, NAYA JEEVAN, Karachi, Pakistan.
Country - ies of focus Global
Relevant to the conference tracks Advocacy and Communication
Summary NAYA JEEVAN collaborates with MNCs such as UNILEVER to cascade its "global health plan for the marginalized" up and down their Corporate Value Chain (CVCs), enrolling low-income stakeholders (suppliers, distributors, micro-retailers, informal domestic workers such as maids, drivers, etc) in a market-based retail incentive/loyalty program that can potentially serve the needs of 660 million lives globally.
What challenges does your project address and why is it of importance? In Pakistan and India, at least 800 million earn less than $3 a day. Like other developing nations, South Asian governments spend just 1.7%-3% of GDP on an under-resourced and overwhelmed public health sector. Consequently, 97% of all health care expenditures occur out-of-pocket and ‘catastrophic’ medical expenses (e.g. for heart attacks, pregnancy complications, etc) are a major precipitant of generational poverty. The three priority issues that low-income, marginalized populations have to contend with are: (i) Access, (ii) Affordability and (iii) Quality.
How have you addressed these challenges? Do you see a solution? NAYA JEEVAN’s accessible, affordable, quality healthcare plan for underserved communities has been cascaded by UNILEVER to over 2500 sales distributors nationwide and 400 microretailers (ice-cream wallahs) who lie at the end of UNILEVER's supply chain. UNILEVER has financed the annual health insurance program costs ($30/life/year) of these microretailers and their dependents in a tiered loyalty/incentive program in which the corporation pays a contribution for health insurance that is prorated to the performance of the retailer. This model can be replicated globally with a varying degree of Corporate co-financing/subsidy which is contingent on: (i) the strategic value of these supply chain partnerships (ii) the cost of the health plan in that specific market and (iii) the impact on their bottom line – i.e increased revenue/sales per dollar invested in this loyalty program. NAYA JEEVAN’s accessible, affordable, quality healthcare plan for underserved communities has been cascaded by Kansai Paints (a Japanese industrial/residential paint company) to over 200 small business painters who lie at the end of Kansai’s supply chain. Kansai has financed the annual health insurance program costs ($30/life/year) of these painters and their dependents in a tiered loyalty/incentive program in which the corporation has fully subsidized the health insurance plan of their loyal customers. This model can be replicated globally with a varying degree of Corporate co-financing/subsidy which is contingent on: (i) the strategic value of these supply chain partnerships (ii) the cost of the health plan in that specific market and (iii) the impact on their bottom line – i.e increased revenue/sales per dollar invested in this loyalty programNAYA JEEVAN’s health insurance plan includes:• Annual medical check-up, which promote the early detection of disease
• A 24-hour telemedicine helpline managed by doctors and available to all beneficiaries to handle any concerns or emergencies that may arise.
• A Health Rescue Fund, which assists beneficiaries for uninsurable conditions or when their hospital management/health care exceeds the maximum annual insurance coverage.
• Preventive Health workshops that detail the causes, symptoms, treatments and prevention against most common maladies to allow individuals to be better able to protect themselves and their families. Our workshops include: Healthy Heart – Keep your Heart Happy & Nutrition – How to Eat Right.
How do you know whether you have made a difference? NAYA JEEVAN has successfully enrolled over 23,000 low-income workers across more than 20 corporations into this incentive program. We have already enabled over 200 critical, life-saving interventions and over 5000 urgent medical consultations by mobile phone that would ordinarily have led to hospitalisation (the aversion of hospitalization has a major impact on worker productivity and health system costs that are saved.In addition to the above, we have conducted a baseline health risk assessment and are monitoring our members for the following outcomes:• Poverty alleviation – by reducing the financial impact of catastrophic medical expenses
• Reduction in Maternal/Child Mortality - through timely intervention and 24/7 access to ambulances, medical doctors, ERs, trauma centers, etc.
• Improvement in Primary Health Outcomes - through preventive health education and behavioral change workshops

• Mitigation of Child Labor/Sexual/Physical Abuse

Have you or the project mobilized others and if so, who, why and how? NAYA JEEVAN has engaged more than 5000 volunteers and stakeholders across the Corporate sector to sponsor the healthcare of children from NGO schools. Over 250,000 residents in an urban slum (Sultanabad, Karachi) have been mobilized to take preventive health measures (nutrition, child immunization, antenatal care) by visiting our Community Health Center.Over 200 secondary/tertiary care centers have been integrated into our nationwide provider network on a cashless basis.
When your donor funding runs out how will your idea continue to live? Naya Jeevan negotiates a basic inpatient (hospitalization) group health insurance plan from various underwriters (for example Allianz-EFU, Pak-Qatar Takaful, IGI Insurance, Saudi-Pak Insurance etc.) at below-market, discounted rates of about USD $16/person/year. By expanding access to a previously untapped low income working population, Naya Jeevan is creating significant value for insurance underwriters who are able to save substantial resources in associated sales/marketing/business development expenses while leveraging Naya Jeevan’s service delivery platform to provide value-added services (VAS) uniquely tailored towards this customer segment. Consequently, insurance underwriters are able to offer Naya Jeevan the health insurance plan at highly discounted group health plan rates of USD $16/person/year.2. Naya Jeevan forms partnerships with various clients including both international and local corporations and businesses such as: Unilever, Espresso, Cafe Flo, Sanofi, Philips, Haque Academy Group, Deutsche Bank, Haji Group, PICT, etc. The supply chains of these clients include a large number of low-income employees from the service industry and informal sector who do not have access to health insurance at all. As discussed, the ‘missing middle’ population forms the target market for Naya Jeevan and clients like local companies/MNCs in Pakistan form the most efficient distribution channel to tap into these masses. Naya Jeevan sells the health insurance plans to clients at ~ US$30/person/year, representing 1.28 – 4.26% of the employee’s monthly payroll (of USD $50-150 per month).Naya Jeevan currently has 70+ clients through which health insurance is being distributed to its low-income members.

3. As part of their respective corporate and business programs, clients finance on average $24 (80%) of the annual $30 health plan cost, with the remaining $6 (20%) paid by the low-income workers directly through payroll.

The clients see this program as a channel to encourage worker productivity/loyalty among their employees and as part of their corporate social responsibility.

Naya Jeevan has witnessed steady growth in its business model, validating proof-of-concept of its sustainability.

SolidarMed support to Zambia’s Medical Licentiate Training Programme.

Author(s) Anel Bowa1, Uwe Graf2.
Affiliation(s) 1Chainama College of Health Sciences, Chainama College of Health Sciences, Lusaka, Zambia, 2Medical Licentiates Department Chainama College of Health Sciences, SolidarMed, Lusaka, Zambia.
Country - ies of focus Zambia
Relevant to the conference tracks Health Workforce
Summary The Medical Licentiate Training Programme (MLTP), adapted to Zambia’s requirements and circumstances, is one response to the severe shortage of doctors. The MLTP provides training in internal medicine, paediatrics and child health, obstetrics and gynaecology and surgery. It enables Clinical Officers (COs) to upgrade their skills so that they can perform the role of doctors (task shifting) including lifesaving operations. Since 2009 SolidarMed supports the MLTP with the assistance of the LED. SolidarMed’s association with the MLTP and cooperation with Chainama College of Health Sciences (CCHS) has already proved fruitful as intakes and practical sites have successfully been doubled.
What challenges does your project address and why is it of importance? The project supports the training of MLs at CCHS for the Ministry of Health (MoH) in Zambia. The project aims at increasing, in fact doubling, the number of trained Medical Licentiates. The Zambian health sector faces a constant shortage of human resources. Rural areas have been more disadvantaged and, while the population has been increasing, the number of Medical Officers (MOs) has remained constant. As a consequence, CCHS commenced the MLTP in January 2002. The Programme was introduced with a purpose of helping fill the void where there were no MOs, especially in rural Zambia. The purpose was to augment the functions of MOs due to their long standing shortage in rural hospitals. At that time the attrition rate for MOs was said to be at 80 per cent. The MLs are trained to work at Level I Hospitals. The aim of the MLTP is to train a first line mid-level health worker that handles medical emergencies and has skills in all the four major disciplines of medicine which are: Internal Medicine, Obstetrics and Gynaecology, Surgery as well as Pediatrics and Child Health. Therefore ML practitioners are the ideal cadre to address Millennium Development Goal 4 and 5. Candidates to the programme are COs with at least 2 years clinical experience.
How have you addressed these challenges? Do you see a solution? The Medical Licentiates Training Programme, adapted to Zambia’s requirements and circumstances, is one response to the severe shortage of doctors especially in rural Zambia. Clinical officers play an important role in the Zambian health service and are usually employed in rural health hospitals. The MLTP provides further training in internal medicine, paediatrics, gynaecology and surgery, and enables Clinical Officers to upgrade their skills, so that they can perform the role of doctors, and be able to diagnose and perform operations as well as manage and run District (Level 1) hospitals. It opens a career path for clinical officers. An additional focus of the MLTP is on emergency care, which constitutes a big need in the periphery. MLs are able to help those in need of immediate assistance such as those patients who might die if they have to wait for referral and transfer to the next level of care. This training on critical care makes MLs more suitable for rural hospitals. Stabilised patients are then referred to the next level of care if the need arises. Since the inauguration of the training programme, not a single ML has left the country. Available data suggests that brain drain for this cadre is very limited. Neither internal brain drain into the private or Non-Governmental Organisation (NGO) sector, nor external brain drain to neighbouring countries or the region can be observed, unlike with medical doctors. MLs are retained in the rural areas and in areas that are underserved and medical doctors are not to be found. SolidarMed’s involvement in the MLTP started in 2009, with the assistance of the LED. The project aims at increasing, in fact doubling, the number of trained MLs. SolidarMed’s association with the MLTP and cooperation with CCHS has already proved fruitful as intakes and practical sites have successfully been doubled. Acknowledging the professional capacities of the MLs, the MoH in 2012 increased the national ML target from 216 (3 per district) to 600.
How do you know whether you have made a difference? The first step in achieving this was to institute an annual intake of 24 students (instead of one intake every two years as before). To achieve this, the number of practical training hospitals had to be doubled. Out of the 4 new training sites, SolidarMed supported 3: St. Luke’s Mission Hospital in Mpanshya (Obstetrics and Gynaecology); Kafue District Hospital (Internal Medicine) and Livingstone General Hospital (Paediatrics). Support to these training hospitals included infrastructure development like student hostels and staff houses, targeted investments including essential medical equipment, provision of an enrolling fund and the deployment of three consultants (in Obstetrics/Gynaecology, Internal medicine, and previously in Paediatrics for which a Zambian doctor subsequently took over the position). The consultants participate in theoretical training at CCHS and are in charge of the practical training of MLs during their 4 month practical training units. The SolidarMed consultants have a dual teaching/training role. As well as holding lectures for ML students during the theoretical part of their training at CCHS in Lusaka, they are in charge of their practical, hands-on training in Obstetrics/ Gynaecology and internal medicine during their practical training attachment at St. Luke’s Mission Hospital, Mpanshya and Kafue District Hospital respectively. This dual role is unusual in the training programme, where the lecturers have little involvement in practical training and vice versa. However, knowing the demands of both the theoretical and the practical training and being able to meet both has been a unique advantage of the SolidarMed consultants. In 2011 the project underwent a comprehensive Midterm Review which acknowledged the success of the project. As a result there was a creation of a full-time position for a Technical Advisor at the CCHS and the construction of the urgently required new office building for the ML Department. The construction of the additional lecture room is underway.
Having created a database for all the MLs that have graduated from CCHS by the Project, it was discovered that all the MLs were working within the country and over 90 per cent of them were in rural based district hospitals where they are carrying out emergency surgical operations in addition to their routine job requirements.
Have you or the project mobilized others and if so, who, why and how? The Project is working closely and collaborating with various partners. The closest partners include: CCHS, MoH, Ministry of Education (MoE) through the University of Zambia School of Medicine (UNZA/SOM), and the Ministry of Community Development, Mother and Child Health (MoCDMCH). Other partners are: Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPEIGO), Clinton Health Access Initiative (CHAI), European Union (EU) through the Clinical Officer Surgical Training in Africa (COST Africa), the Volunteer Service Organisation (VSO), the Health Professions Council of Zambia (HPCZ), the Zambia Medical Licentiate Practitioner Association (ZMLPA) and the (Pan) African Network of Associate Clinicians (ANAC).
The various cooperating partners have been mobilized to play specific roles in the sustainability of the MLTP, quality assurance of the programme, deployment of the graduates, sponsorship of the students, curriculum review and improvement of the quality of theoretical and practical training. With the help of all stakeholders the curriculum for MLs was upgraded from advanced diploma level to Bachelor of Sciences (BSc) level. Enrolment into the programme is gradually increasing which shows the success of the programme.
The Project uses various strategies to reach and work with various partners. These include: networking, lobbying and advocacy work, collaboration, multilateral meetings and exchange visits.
When your donor funding runs out how will your idea continue to live? The programme is embedded into the Zambian education system. The MLTP is supported and recognised by all relevant Government Ministries (MoH, MoE, MCDMCH and Ministry of Finance (MoF)), policy stakeholders and networking partners. Active political support and recognition of the MLTP by crucial ministries like MoH, MoE, MCDMCH and MoF as well as other policy stakeholders and networking partners are key for the sustainability of the MLTP. Therefore:
 The SolidarMed Project Manager (PM)/Technical Advisor (TA) has been participating in Technical Working Groups at the MoH, in addition to meeting regularly with those responsible in order to advocate for the concerns of the MLTP.
 The SolidarMed PM/TA has pro-actively been promoting networking and exchange with the Zambia Medical Licentiate Practitioners Association (ZMLPA), as well as the Africa Network for Associate Clinicians (ANAC).
 Operational Research on the impact of MLs in Zambia will be carried out in collaboration with the SolidarMed PM/TA and the results of this shared.
The project supports an already existing programme. At the end of the project, it is expected that the programme would be strengthened further, including improvement of quality of training, strengthening of the management of the ML Department and the introduction of a Bachelor of Science degree programme. The infrastructure that has been constructed will leave a permanent mark of the support from the project and will continue to be used to produce the required category quality and number of health workers. It is envisaged that the MoH and other relevant Ministries and partners will sustain the programme.
In addition, after 2015 there will be need for a period of consolidation at all levels of the MLTP - locally within CCHS, nationally with all relevant ministries and all other relevant key stakeholders from the government sector, as well as regionally through the ANAC. The network most likely would need to be focused on with more intensified support and steering. Another key factor in the attractiveness and sustainability of the MLTP will be its ability to confer a degree.

mAmbulance: An innovative intervention to reduce maternal deaths in rural Uganda

Author(s) Alakananda Mohanty
Affiliation(s) 1Healthcare, Kissito Healthcare, Inc., Roanoke, United States.
Country - ies of focus Uganda
Relevant to the conference tracks Health Systems
Summary Achieving the fifth Millennium Development Goal (MDG5) by reducing maternal deaths remains a significant challenge in Uganda. Uganda has a high Maternal Mortality Ratio (MMR) of 438/100,000 live births with the life-risk of 1 in 27 women dying in pregnancy. One of the many underlying factors that contribute to high MMR in the country is delay in reaching an emergency obstetric care (EmOC) facility. Evidence indicates that access to appropriate health care, including timely referrals to EmOC services, can significantly reduce maternal deaths.
Background Ensuring timely access to quality EmOC for women with obstetric complications are increasingly recognized as priority interventions needed to reduce maternal deaths. To reach EmOC services, one of the vital factors is the availability and accessibility of suitable and affordable transport. Delay in accessing and receiving EmOC is a major predisposing factor for maternal deaths in rural Manafwa and Mbale districts in Uganda. The high prevalence of maternal illnesses, and other emergency obstetric complications suffered by women in these two districts have been linked to their poor access to emergency obstetric services. Earlier studies indicate that motorcycle ambulances reduce the delay in referring women with obstetric complications where health centers have no access to other transport or means of communication. In order to reduce the referral delays in Manafwa and Mbale districts, Kissito Healthcare International partnered with PONT (UK based charity) to implement a pilot project where five specially designed eRanger motorcycle ambulances were stationed at 5 remote health centers for transporting obstetric emergencies to the health facilities.
Objectives The objective of the project was to assess referral time, acceptability, and feasibility of motorcycle ambulances (mAmbulances) for referral of obstetric emergencies to the nearest Health Facility and to compare the referral delays and costs with those of a 4WD vehicle ambulance.
Methodology Five mAmbulances were placed at 3 remote rural health centers in Manafwa (Bubutu, Bugobero and Bushika) and 2 health centers in Mbale (Busiu and Wanale) districts for transporting obstetric emergencies and other emergency cases to the health centers free of cost.
At each health center drivers were recruited and trained over 2 weeks to drive the mAmbulance, to be responsible for its maintenance , and on data recording in logbooks.
Community volunteers were identified, trained , and provided with pre-paid mobile phones to call the mAmbulance in case of an emergency for transport to suitably equipped health centers.
Data was collected over a 17 month period, from January 2011 to May 2012 using logbooks, referral forms, and maternity registers.
Specially designed referral forms were used to record data on all emergency referrals, irrespective of means of transport.
Specially designed logbooks were filled in by the drivers of the motorcycle ambulances recording data concerning all trips, including departure and arrival times for the patients referred.
The maternity registers at the health centers were used to identify all referred obstetric cases and the reason for referral.
Semi-structured interviews were conducted with health workers, ambulance drivers about transport issues, referral procedures, and referral delays
Results The mean duration of referral to reach a health facility for all emergency obstetric cases varied between 1:01-1:09 hrs.
Conclusion In resource-poor Uganda, mAmbulances are a useful means of referral for emergency obstetric care, particularly under circumstances where health centers have no access to other transport or means of communication to call for a vehicle ambulance and they are a relatively cost-effective option for the health sector. By providing on-site, designated EmOC referral transport at rural health facilities, the mAmbulances can fill a critical gap in maternal services. If implemented widely in the country, mAmbulances may also potentially help reduce cost for women and their families to access EmOC.

Predictors of Unintentional Poisoning among Children under 5 years of age in Karachi. A Matched Case Control study.

Author(s) Bilal Ahmed1, Zafar Fatmi2, Rehana Siddiqui3.
Affiliation(s) 1Department of Medicine , The Aga Khan Univesity , Karachi, Pakistan, 2Community Health Sciences, The Aga Khan University , Karachi, Pakistan, 3Community Health Sciences, The Aga Khan University , Karachi, Pakistan.
Country - ies of focus Pakistan
Relevant to the conference tracks Chronic Diseases
Summary Poisoning is one of the main causes of unintentional injury among children. It is the fourth leading cause of morbidity and mortality after road traffic accident, burns and drowning. Majority of these poisoning occur among preschool children under 5 years of age. There is a scarcity of evidence based analytical literature in the area of unintentional injuries, therefore there is need to identify the specific factors in our population in order to provide follow up action that reduces morbidity and mortality in young children and improves the handling of such emergencies by parents and health care workers.
Background Global estimates for childhood unintentional poisoning are not available and most of the existing information is from developed countries. There were an estimated 86,194 child poisoning incidents treated in United States hospital emergency departments in 2004, amounting to 429.4 poisoning per 100,000 children. Since morbidity is comparatively more associated with unintentional poisoning than mortality, non fatal incidents occur more among children of 1-4 years of age. Previous studies identified kerosene, petrol, medicines, insecticides, and household cleaning products as major hazards for poisoning incidents in children less than 5 years. Kerosene oil poisoning is commonly reported from developing countries. For cooking and lighting the main fuel use is paraffin (kerosene) and petrol for power generators, which is often stored under the beds in beverage or other empty containers. Unintentional ingestion of medicines both over the counter and prescription drugs, by young children and toddlers has been often reported. Similarly, household chemicals like bleach, toilet cleaners are also common substances involved in unintentional poisoning. Pakistan is a developing and low income country and, with more than 24 million children under 5 years of age, is highly vulnerable to such incidents.
Objectives There are few descriptive surveys available from Pakistan on unintentional childhood poisoning. However, there is a scarcity of analytical based epidemiological studies that has focused on factors within households that are associated with poisoning among young children. Epidemiological studies investigating the etiology of unintentional poisoning in children have been reported from the developed world or Malaysia and Greece.
As mentioned earlier, the majority of poisoning incidences occur inside home, however factors associated with household environment, behavioral issues of children and storage practices of caregivers have not been studied in our setting before. Monitoring of acute poisoning is important for health authorities because they can identify major factors involved in a particular population to prevent them. There is a scarcity of evidence based analytical literature in this area of unintentional injuries, therefore there is need to identify the specific factors in our population in order to enact follow up action that reduces morbidity and mortality in young children and improves handling of such emergencies by parents and health care workers. Moreover, it would help in designing appropriate strategies and interventions to create awareness in general population to reduce the burden of childhood poisoning.The key objectives are to determine the factors associated with poisoning among children under-5 years of age reporting to Emergency rooms of tertiary care hospitals in Karachi.
Methodology This study was conducted in the ERs of three large tertiary care hospitals in Karachi: the Aga Khan University Hospital (AKUH), the Civil Hospital Karachi (CHK), and the National Institute of Child Health (NICH). AKUH, a private hospital, caters
for 12 000 paediatric patients annually, whereas CHK and NICH are public hospitals, and receive approximately 150 paediatric patients in the ER daily. These hospitals provide services for the upper, middle and lower socioeconomic classes of the Karachi population. The study data were collected from August 2008 to March 2009. The investigation was a matched case control study. All consecutive poisoning cases were enrolled in the study, including gravely ill children or those who died either in the ER or before reaching the hospitals during the study period.The cases were defined as being children under 5 years of age with oral ingestion of any noxious substances. They were recruited into the study after a definite diagnosis of accidental intake of poisoning was made by the attending physician of the respective hospitals. The noxious agents considered for poisoning in this study were any substance that had the
potential for toxic effects and included medicines, insecticides, pesticides, petroleum products, household chemicals, and cosmetics. Children admitted for food poisoning, adverse drug reactions, and poisoning with animal venom were excluded. Controls were selected from the ER of the same hospitals and comprised of children with complaints other than poisoning. Controls were matched for age (66 months) and sex, as these were the known confounders. Three control children per case visiting the ER of the same hospital within 48 h of case identification were enrolled for the study. Children with symptoms of chronic illness such as known cases of cardiac disease, renal failure, chronic pulmonary disease, cancer patients, and road traffic accidents were excluded from the study sample. Children brought from nearby areas outside Karachi were not included in the study. Caregivers were interviewed using a structured questionnaire. Information on the sociodemographic characteristics of the child and caregiver, and the storage practices for medicines and chemicals in their household, were obtained.
Sample size: a total number of 120 cases and 360 controls were required to achieve the objectives of the study. Multivariable conditional logistic regression analysis was done and adjusted matched odds ratios (mORs) were calculated.
Results The data included 120 cases and 360 matched controls. Incidental uptake of medicines was the most common type of poisoning, followed by kerosene oil ingestion. Similarly, the majority of the incidents of poisoning occurred in the bedroom followed by the drawing/dining room, courtyard and kitchen. Among all the subjects enrolled during the study period, only one cased who had ingested medicine (warfarin) died. The majority of poisoning incidents occurred among children 1-2 years of age. Among the cases medicinal users at home, history of previous poisoning incident, and child behaviour reported as aggressive were more prevalent than among controls. Similarly, the proportion of parents living apart and living in a nuclear family system was more in cases than controls. The storage practices of medicines and chemicals showed that the proportion of unsafe storage of chemicals that is not at a height >2 m is greater among cases than controls (30.8% vs 16.7%). Similarly, more households of cases (80%) stored unlocked chemicals compared to controls (56.1%). Among the cases the safe storage of medicine at a height >2 m was 64.2% compared with 75.3% for the controls. Only 8.3% of the caregivers of cases reported that they kept medicines locked, compared to 23.6% of the controls. However, when these variables were combined to make a composite variable it showed that 14.2% of the caregivers of cases reported storing both chemicals and medicine unsafely, compared to 5.8% of controls. Adjusted analysis shows that, accessibility to hazardous chemicals and medicines was significantly associated with poisoning. Unsafe storage of either chemicals or medicines occurred 1.5 times more in cases compared to controls. Similarly, unsafe storage of both chemicals and medicines occurred 5.6 times more in cases compared to controls (mORadj 5.6, 95% 95% CI 1.9 to 16.7). Storage of kerosene and petroleum in soft drink bottles occurred 3.8 times more in cases compared to controls (mORadj=3.8, 95% CI 2.0 to 7.3). Cases were 8.2 times more likely to be aggressive compared to controls (mORadj=8.2, 95% CI 4.2 to 16.1). Similarly, the reporting of a previous poisoning incidence was 8.6 times more in cases compared to controls (mORadj=8.6, 95% CI 1.7 to 43.5). The low level of mother’s education was strongly associated with poisoning in children.
Conclusion In conclusion, we found that accessibility of hazardous chemicals and medicines due to unsafe storage, reported child behavior as aggressiveness, history of previous poisoning, low maternal education, storing of kerosene and petroleum in soft drink bottles, and low socio economic status were associated with increased risk of unintentional poisoning among children under-5 years of age living in Karachi. Some of these factors, particularly storage practices, are potentially modifiable and efforts to reduce the prevalence of unsafe storage could have the benefit of reducing the incidence of unintentional poisoning in this population. To curtail the number of childhood poisoning incidents understanding its related preceding factors in particular settings are necessary. Future directions in the field of childhood poisoning involves a number of strategies including the incorporation of better-tested and more refined educational, legislative, and environmental intervention strategies. As mentioned earlier, there is a scarcity of literature in the area of childhood injuries. The large community base studies, emergency room surveillance system for overall unintentional childhood injuries including poisoning, and population base follow-up studies helps to determine the predictors. Studies of risk factors have to be conducted and analyzed with due regard to possible confounding variables and interaction between factors. Similarly, cost effective and sustainable intervention needs to be launched, to see if it decreases the burden. Qualitative focus group discussions with parents of young children about real and perceived barriers to calling the local poison information center, resources for poison prevention messages, and ideas about public awareness campaigns should also be done.
Intervention and longitudinal studies can further provide the necessary evidence in understanding the behavioral issues of children, parents and other care givers that could lead to unintentional ingestion of harmful substances to further establish temporality and causal association.