• Blog post
    EAC’s Open Health Initiative RMNCH indicator scorecard, signed by Conference delegates.

    EAC’s Open Health Initiative RMNCH indicator scorecard, signed by Conference delegates.

    I recently traveled from Arusha, Tanzania, home of the East Africa Community (EAC) Secretariat, to Uganda, the site of the EAC’s 5th Annual Health and Scientific Conference. On the way, I heard a couple delegates discuss which African countries were leading the way in health. “Who is #1?” they asked each other. Was it Botswana? Who could be last? Maybe Guinea?

    The conversation reflected the friendly competition that helps to motivate EAC’s five member states: Kenya, Tanzania, Uganda, Rwanda, and Burundi. During the Conference’s opening plenary, Professor Gerald Yonga from the Aga Khan University of East Africa compared regional statistics relating to non-communicable diseases, including alcohol and tobacco use as well as poor diet. Similarly, during the Symposium on Reproductive Maternal Newborn and Child Health (RMNCH), EAC Deputy Secretary General Hon. Jesca Eriyo and Hon. Dr. Chris Maryomunsi launched a scorecard that tracks key indicators and highlights trends among member states. 

  • Blog post
    Tweet About ECSA Health Community Best Practices Forum

    This month I had the privilege of attending the East Central and Southern African Health Community’s (ECSA-HC) 8th Best Practices Forum in Tanzania. In addition to sharing best practices in universal health coverage, human resources for health, and communicable and non-communicable diseases, the Forum celebrated ECSA-HC’s 40th anniversary of fostering regional cooperation to improve health.

    Forum attendees also welcomed ECSA-HC’s new Director General, Professor Yoswa Dambisya, an expert in human resources for health.

    According to it's website, ECSA-HC is an intergovernmental organization that "works with countries and partners to raise the standard of health for the people of the ECSA region by promoting efficiency and effectiveness of health services through cooperation, collaboration, research, capacity building, policy development and advocacy. Member states of the ECSA Health Community include Kenya, Lesotho, Malawi, Mauritius, Seychelles, Swaziland, United Republic of Tanzania, Uganda, Zambia, and Zimbabwe." 

  • Blog post
    PMA2020/Kenya Total Fertility Rate

    Kenya’s Ministry of Health announced recent findings from PMA2020/Kenya, an innovative mobile-phone-based survey, that show the impressive progress made by Kenya’s national family planning programs in recent years.  Since the most recent Kenya Demographic and Health Survey (KDHS) in 2008, the modern contraceptive prevalence rate among married women has risen dramatically from 39.4 to 55.4%; representing a 16% point rise over six years.  PMA2014/Kenya also found marked increases in the use of more effective methods, with the proportion of married women who are using implants shifting from 1.9% to 20.1% of the method mix.  

    Another measure of success besides an increase in contraceptive prevalence rate is a decrease in total fertility rate (TFR) or average number of births per woman. The survey found that the TFR in Kenya has steadily declined from 4.6 in 2008 to 3.5 in 2014.  In addition, unmet need for family planning has dropped from 26% in 2008 to 21% in 2014, with 12% of married women wanting to delay their next birth and 9% wanting no more children.  The unmet need is highest for women in the poorest wealth quintile. The survey also found an almost 17 percentage point increase among married women in the demand satisfied by modern methods, from 55% in 2008 to 72% in 2014.

  • Blog post
    © 2012 Akintunde Akinleye/NURHI, Courtesy of Photoshare

    A family planning mobilizer refers a client, Modinat Bamidele (L), during a visibility parade near Orolodo primary health centre in Omuaran township, Kwara state, Nigeria. © 2012 Akintunde Akinleye/NURHI, Courtesy of Photoshare

    In 2007, I visited the Centre de Sante in Mukono, Rwanda. Staff enthusiastically gave me a tour of the facility, which had recently undergone renovations to partitioned private rooms for family planning counseling. The facility also had a variety of family planning commodities available including pills, condoms, and injectables. It was remarkable to see staff so motivated to serve their clients and even more so to see the waiting room filled with women and men waiting for family planning services.

    This sunny day seven years ago had a noteworthy impact on my career in global health. It highlighted the importance of providing comprehensive family planning services to clients, especially in rural areas, and of having a motivated and well-trained health workforce to deliver those services. In the years since, I have committed to supporting countries in addressing health workforce challenges, and particularly to improving family planning services.

  • Blog post

    Do you ever feel like a fraud?


    Instagram photo courtesy of SwitchPoint

    Not the kind who swindles the vulnerable out of their hard-earned savings or phishes for credit card digits online, but the kind who presents herself more authoritatively than she should? Masquerading as an expert?

    Or is it just me?

    An article in The Atlantic last month on the confidence gap suggests that success has just as much to do with confidence as with competence. And the tendency to underplay or question our credentials and skills is more familiar to women than men.  

    As it happens, I read this article right before attending IntraHealth International’s annual SwitchPoint event last week.

  • Blog post

    A ceiling fan swirled lazily above our heads, doing little to dissipate the intense heat of an afternoon in Western Kenya during the region’s dry season. Ten pairs of eyes watched me expectantly as I waited impatiently for my presentation to load and project onto the concrete block wall. It was the first day of a week-long training that would precede nearly three months of data collection at health care facilities in Kisumu, Kenya. This was my first experience serving as the principal investigator for a study, and I was a bundle of anticipatory nerves. My goal was to charge my data collection team with a sense of urgency and an understanding of the life-saving benefits of family planning for women and their children. The day stretched long as we unpacked the relationship between contraceptive prevalence and maternal, infant, and child health. At the end of the day, I felt encouraged when one member of my team stayed behind to share, “I learned so much today. You’ve given me a language to talk about family planning with women and their partners.”

    A healthcare provider with a client in Kenya

    A healthcare provider with a client in Kenya.

    © 2009 David Mita Aluku, Courtesy of Photoshare

    Many years ago, I worked at my local Planned Parenthood for a program designed to prevent teen pregnancy. Drawing on these early experiences in service delivery, I often wonder if a woman’s decision to use contraception is influenced by her interaction with her health care provider. In many developing countries, we try to understand the relationship between the quality of family planning services and actual contraceptive use by collecting data at health facilities, usually in the form of interviews with family planning providers and their clients. Curious about the accuracy of this self-reported data, I traveled to Kenya in 2012 to implement an unusual study. I worked with a team of undercover data collectors—local women hired to pose at facilities as new family planning clients and then report back to research staff about their experiences.

    Our study findings surprised me. Sometimes my data collectors came back to me with glowing reports of service providers truly devoted to the well-being of their clients. Other times, however, members of my team reported less positive experiences, such as waiting all day at a facility without ever receiving services or witnessing a family planning provider shouting at clients as the clients waited long hours to be served. I was also surprised when a number of my data collectors reported being charged for services that are reportedly provided for free. This often happened behind closed doors and without receipts. A more detailed account of our findings is available in our recently published article in the journal Global Health: Science and Practice.

  • Blog post

    This post by Sirina Keesara and Grace Lesser originally appeared on the Bill and Melinda Gates Foundation's Impatient Optimists blog. Keesara and Lesser are with Jacaranda Health in Kenya, which is "developing a replicable model to provide affordable, high-quality maternal health services to low-income women worldwide. Jacaranda Health is a stellar example of how the global community is working towards meeting the unmet need for family planning. Here, they share five lessons on integrating postpartum family planning services in their maternity services.

    What lessons have you learned about integrating family planning into health services? Tell us in the comments.

    Jacaranda Health Maternity and Family Planning Integration

    Photo © Jacaranda Health

    Source: Impatient Optimists

    Jacaranda Health is working to change the way that maternity care is provided in Africa. We are developing a replicable model to provide affordable, high-quality maternal health services to low-income women worldwide. Our goal is to become a global laboratory for some of the most exciting innovations in maternal and child health service delivery.

    Family planning is one of the most cost-effective ways to reduce maternal mortality, and at Jacaranda we are committed to integrating high quality family planning services to the spectrum of our maternity services. We hope to contribute to the community by sharing what we are learning about providing postpartum family planning services in resource-constrained settings.

    1. Integrate family planning into maternity services

    Jacaranda Health

    Photo © Jacaranda Health

    Source: Impatient Optimists

    Pregnant women have so much to think about during pregnancy – where to deliver, how to save for the costs, the baby clothes – that preventing the next child is often the last thing on their mind. But studies from around the world have shown that nearly 80 percent of women do not want a pregnancy in the two years following a delivery. Half of these women would like to start contraception within six weeks after delivery. In Kenya, 90 percent of women in the three months postpartum and 68 percent of women at one year postpartum still have an unmet need for family planning. Most health care facilities design maternity care and family planning as separate services; we believe the two should be married.

    Integration of family planning into antenatal, postpartum, and child wellness services is proven to help women meet their contraceptive desires. At Jacaranda, we’ve integrated family planning cues into documentation so that providers do not have to struggle with multiple forms, and can respond to built-in prompts to initiate family planning dialogue throughout the continuum of care. We’ve also designed educational materials for our antenatal clients to take home, which plant the family planning seed early and equip clients with the knowledge they’ll need to make a decision after delivery. The postpartum period is often a missed opportunity for family planning, so we’re also considering helping our antenatal clients build a personal postpartum contraception plan, analogous to a “birth plan,” to encourage them to start planning early.

    Evidence from Kenya and other countries suggests that once women have been fully counseled on family planning usage and side effects, satisfaction and uptake increases while unmet need drops.

  • Event
    March 25, 2014 (All day) to March 28, 2014 (All day)
    Purpose: To provide an opportunity to listen, discuss and test innovative technology solutions with practitioners and providers who are using ICT to build the resilience of communities across Africa, Latin America and Asia.
    Who should attend: NGO staff, donors, educators, government representatives and technology providers interested in applying ICT solutions to enhance the quality and accountability of development and relief programs.
  • Blog post
    68% of Kenyan women diagnosed with cervical cancer this year will die from the disease

    68% of Kenyan women diagnosed with cervical cancer this year will die from the disease.

    Powered by; created by Mysha Sissine

    Cervical cancer is a major health threat to women in developing countries where screening services can be limited. It ranks as the second most frequent cancer among women worldwide, and in Kenya, the World Health Organization estimates that there are 10.3 million women at risk. Although the cancer is preventable and curable when detected early, estimates suggest that this year 2,454 Kenyan women will be diagnosed with cervical cancer and 68% of those diagnosed will die.   

    The Health Management Information Systems (HMIS) team at Futures Group, a global health consulting firm, is leveraging mobile technology to fight cervical cancer in Kenya. With funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the project will improve tracking of cervical cancer screening by including it in the automated reporting from electronic medical records (EMR) to the District Health Information System (DHIS2) using a mobile device. The project, which started in June 2012, is ongoing and is part of a national-level effort led by the U.S. Centers for Disease Control and Prevention (CDC) in Kenya. 

    This fall, the HMIS team will distribute tablet computers installed with two open source solutions developed by Futures Group – IQCare and IQTools. IQCare is an EMR system, and IQTools is an interoperable middleware which ties EMR reporting to the DHIS2. Together the programs seamlessly synchronize data reporting for efficient national tracking which now includes cervical cancer screening. The use of mobile devices makes it easier to collect data in low resource areas and hard-to-reach parts of the country.

  • Blog post

    Imagine an urban slum in Kenya where trash is so abundant that children are prevented from playing. This is where Diana Mong’are, the 2012 Anzisha Prize winner, grew up – a community where the norm was to throw your trash wherever you saw fit. Upon graduating from high school, she saw this as a large problem and came up with a solution.  At 18 years old, Mong’are started small with her own community and 10,000 Kenya Shillings (≈$120 USD) raised from her family and friends. Her solution, Planet Green, was threefold:

    Boy in Kibera


    A small boy rummages through trash in Kibera, Africa's largest slum in Nairobi, Kenya, where most people live below one dollar per day. Youths depend on collecting debris from the Nairobi River (a flowing sewer in this slum area), such as bottles and bags, which they then hope to sell. Most of the homes are shacks, and schools are built on the flowing, murky river. Residents have no access to clean water and hence depend on the polluted river for survival.


    © 2005 Felix Masi, Courtesy of Photoshare


    1. Provide bags for garbage sorting and a pickup service for the trash and recycling.
    2. Purchase waste from carpenters (wood chips) and sell to the chicken farmers to be used as coop flooring to be made into manure to then be used or sold.
    3. Create environmental clubs through primary school in the community to increase demand for positive environmental awareness.

    On May 1, 2013, the Woodrow Wilson Center’s Africa Program hosted a program on African Women and Youth as Agents of Change Through Technology and Innovation. Diana Mong’are was part of the first panel focused on problem solving through innovative solutions for sustainable development. What struck me about Mong’are’s project was that while extremely innovative, it did not utilize any form of technology as we are used to seeing with innovation. In the age of technology that we all live in, I think innovation without technology is still extremely valuable and often not recognized. Mong’are’s presentation was inspiring and truly showed the ability for one individual to impact social problems. Since the start of her small project she has expanded from 20 families to 80 and continues to expand with more employees and into more areas of Kenya.