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- Dr. Tonny Kapsandui, an Amref program director in Uganda
“Amref’s approach works because we are deeply rooted in communities,” says Kapsandui, “because we are focused on mothers, on children, and on young people in particular.”
- Dr. Tonny Kapsandui, an Amref program director in Uganda
" ... there is a huge number of preventable medical conditions that strain an already weakened health system which is underfunded and under-resourced.”
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he challenges are significant. One of the biggest problems that African governments face when it comes to providing adequate healthcare is inadequate
This approach, integrating COVID-19 vaccinations into broader primary care and screening is part of a bold, community-focused project that seeks not only to increase COVID-19 vaccination rates but to strengthen healthcare systems across sub-Saharan Africa.
“When we first came here,” she says while nursing her baby, “there were no medical services.”
Dawa, 37, is originally from neighboring South Sudan. As that country’s brutal civil war swept through her village, she and her loved ones fled across the border to Uganda, finding safety in an archipelago of camps that is currently home to some
120,000 people.
The nearest medical center was many miles away. Visits by people with medical training were infrequent, and the services they offered were limited. But slowly, that began to change.
Earlier this year, a team of locally recruited health workers came to provide Dawa and her community with COVID-19 vaccines. While there, they offered an array of other primary and preventive healthcare services too: routine immunizations, dietary help for malnourished children, screenings for other diseases, and guidance on maternal and neonatal care.
hen Mary Dawa and her family arrived at the sprawling
Rhino Camp Refugee Settlement in northwest Uganda
seven years ago, something critically important
was missing.
W
T
A 2022 World Health Organization study of 47 African countries showed that, on average, there were fewer than two doctors, midwives, and nurses per 1,000 people across the region. That’s less than half the density in Latin America and more than 10 times lower than the average in the advanced economies of the OECD. And, critically, that’s nowhere near the ratio of 4.45 per 1,000 that the WHO has set as a bare minimum target to ensure that people have access to essential health services.
Part of that is because training programs are limited, but it’s also because of low pay compared to opportunities abroad. Each year, for example, thousands of nurses leave Zambia, Uganda, and Kenya for better-paid opportunities in the United Kingdom and the United States.
Given the limitations of health systems, says Dr. Tonny Kapsandui, an Amref program director in Uganda, it’s critical to train and mobilize members of local communities to act as frontline health workers.
“Funding for healthcare is so small in Uganda and other sub-Saharan African countries,” says Kapsandui.
resources. Ministries are often underfunded, and health systems are frequently understaffed.
doctors, midwives, and nurses per 1,000 people across the region
By providing basic preventative care and information, locally recruited health workers act as a bridge between overtaxed health systems and the needs of marginalized areas, while also reducing the burden on those systems themselves.
n the front lines of that effort are people like Michael Banda, a 44-year-old farmer from the Fhumba Zone of eastern Zambia. Banda, a father of six, has been a
Community Health Worker for more than 17 years.
O
When he is not tending to his crops of maize and sunflower during the rainy season, Banda travels among the zone’s dozen villages as one of 15 CHWs who help to treat conditions like malaria and other primary care needs, while also providing other information about how to prevent illnesses.
For Banda that means explaining the benefits of vaccines, the importance of maternal and neonatal care, and the benefits of voluntary medical male circumcision, a procedure believed to reduce the spread of HIV.
Banda sometimes has to make multiple visits to change people’s views, but he has worked hard to earn the confidence and respect of the people he meets with.
“They trust me because I am open to them,” he says. “When I bring information, we sit down and discuss it, and they follow me, and they support me.”
So far, the impact of the project has been substantial.
>200,000
COVID-19 vaccines have
been administered
9,000
people have been reached directly with integrated healthcare services so far
2,000
local leaders have been engaged to work with communities to understand their health needs and provide important information about best health practices
Nearly
About
2,500
new local health workers have been trained
The key to the success of the project is that it puts local communities in charge of understanding and determining their own healthcare goals. That’s true all the way from the national health ministries that set broad priorities, to the district hospitals that monitor local data to assess their immediate needs, to the Community Health Workers who are recruited from the communities they live in.
In the end, the most important thing that these programs achieve isn’t a particular vaccination rate or certain number of people trained. It’s something more fundamental – a new faith among local communities that their health systems can deliver quality care.
“There is a need to believe in our health systems,” says Dawa, from the Ugandan refugee camp. “And I am so proud that these interventions worked.”
ooking ahead, Amref is now working with the national health ministries in Malawi, Senegal, Uganda, and Zambia to expand this work. The goals are to
accelerate the training of nurses, midwives, and community health workers, to bolster maternal and neonatal care, and to advance the digitization of health records at the local level as part of the existing integration approach.
L
*The Pfizer Foundation is a charitable organization established by Pfizer Inc.
It is a separate legal entity from Pfizer Inc.
“There is a need to believe in our health systems,”
says Dawa, from the Ugandan refugee camp.
Amref Health Africa, Africa’s largest health development organization, is leading this work thanks to a grant from The Pfizer Foundation*, the philanthropic arm of the global pharmaceuticals manufacturer.
Mary Dawa at the Rhino Camp Refugee Settlement, August 2023
Photo credit: Ambrose Watanda
A community receives testing, immunization, and medications through Amref’s outreach efforts in Arua, Uganda, June 2023 Photo credit: Ambrose Watanda
Working to build better community health systems in Africa
Need to believe.
Amref reaches communities in the most remote areas, by any means necessary. Uganda, June 2023
Photo credit: Ambrose Watanda
lower than the average in the advanced economies of the OECD.
>10x
A community receives healthcare services through Amref's program in Arua, Uganda, June 2023
Photo credit: Ambrose Watanda
Patients receive COVID-10 vaccinations in Arua, Uganda, June 2023
Photo credit: Ambrose Watanda
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Senegal
Zambia
Malawi
Uganda
of the population of sub-Saharan Africa
10%
Roughly
million people
100
Together they are home to more than
Hover over map for more facts
Since last November, the project has focused on four specific countries:
hen Mary Dawa and her family arrived at the sprawling Rhino
A community receives testing, immunization, and medications through Amref’s outreach efforts in
Arua, Uganda, June 2023
A 2022 World Health Organization study of 47 African countries showed that, on average, there were fewer than two doctors, midwives, and nurses per 1,000 people across the region.
That’s less than half the density in Latin America and more than 10 times lower than the average in the advanced economies of the OECD. And, critically, that’s nowhere near the ratio of 4.45 per 1,000 that the WHO has set as a bare minimum target to ensure that people have access to essential health services.
In the end, the most important thing that these programs achieve isn’t a particular vaccination rate or certain number of people trained. It’s something more fundamental – a new faith among local communities that their health systems can deliver quality care.
Click on map for more facts
