Contributions_Summer_2022

Newsletter Summer 2022

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Malaria study tour to Mozambique with Members of the Swiss Parliament

Malaria is endemic in Mozambique. The annual incidence rate has dropped significantly in the last twenty years (from 500/1000 in 2001 to 320/1000 in 2021) thanks to prevention and control interventions, in particular distribution of mosquito nets and fumigation, with massive funding from international partners. An impressive North-South malaria prevalence is to be noted: 57.3% in Cabo Delgado compared to 1% in Maputo (2020). Mozambique is a top Global Fund recipient with commitments of USD 744 million for the period 2021-2023 (HIV: USD 466M; TB: USD 108M; Malaria: USD 200M).

Switzerland is recognized internationally as an important player in the fight against malaria. This reputation has been forged over the years through a commitment to applied research, community promotion and awareness programs, and drug development. The main players in the sector have a direct link with Switzerland: multilateral players (WHO, Global Fund, UNAIDS), academia (Swiss TPH), NGOs, big pharma (Novartis, Merck, Roche). The SDC supports specific malaria programs on a bilateral (Tanzania) and global level. In Mozambique, the SDC does not support specific malaria programs but is active in areas with a direct impact, in particular the WASH sector, governance and health sector budget support (PROSAUDE). Several Swiss players - some of which receive funding from the SDC - are active in Mozambique: The Global Fund, Medicines for Malaria Venture (MMV), Innovative Vector Control Consortium (IVCC), Swiss TPH, SolidarMed.

The delegation of members of the Swiss Parliament, assisted by the SDC and Swiss Embassy in Maputo, had the privilege to meet with H.E. Garça Machel, former first lady of Mozambique and then of South Africa, activist for the rights of young people and adolescents, particularly in sexual and reproductive health. Machel is the head of the largest NGO in the country, the Fundação para o Desenvolvimento da Comunidade (FDC) active in prevention and community health. A meeting with representatives of the Ministry of Health (MoH) provided an update on current challenges. The MoH welcomed Switzerland's long-term commitment to sector budget support (PROSAUDE). On communicable diseases (HIV, TB, malaria) government programs are possible only because of external financial support. For HIV alone, the Global Fund ensures safe treatment for 1.5 million patients. The MoH highlights an increase in non-communicable diseases and focuses its interventions on prevention policies. The COVID-19 pandemic has directly affected TB, HIV and malaria programs: reported TB cases for example fell by 18% last year, as PCR analysis infrastructure was redirected to COVID cases. With support from GAVI/COVAX, Mozambique vaccinated 15 million people over the age of 18 with one dose. The vaccine is well accepted by the population. The delegation visited three projects in Manhiça (CISM- Centro de Investigação em Saúde de Manhiça in Mozambique), Biele (SRHR and HIV prevention) and Matola (IRS and larvicinding implemented by Goodbye Malaria).

This one-week study tour on malaria was an opportunity for the five MPs to learn about the methods of prevention and treatment applied, to see the involvement and added value of many Swiss players on this topic and to discuss broader public health and development challenges. The participants return to Switzerland with the following findings:

  • The fight against malaria requires long-term political and financial commitments. Results cannot be measured on short-term interventions;
  • Applied research allows the development of drugs, insecticides and techniques adapted to patients and parasite resistance. In collaboration with local research centers, Swiss players provide a significant added value;
  • Due to limited resources and multiple deficiencies of local health systems, international cooperation is of major importance. National authorities cannot be left alone facing public health challenges;
  • Beyond the supply of drugs, funding from the Global Fund is essential for strengthening local civil society. The Global Fund has enabled the emergence and development of the capacities of local actors carrying out fundraising work at the community level and advocacy.​​

Contact:
Olivier Praz
SDC Health Focal Point, Senior Policy Advisor, Switzerland

Photo: Manhiça Research Center, ©FDFA/SDC/ 2022

Strengthening health and social systems to respond to refugees’ needs​​

Since the beginning of the war in Ukraine, the Republic of Moldova has received the largest number of refugees in relation to the number of inhabitants (1,400 people per 10,000 inhabitants) according to the March UN report. At the beginning of July, there were 77’659 Ukrainians in the territory of the republic for humanitarian reasons. 107 placement centers with a capacity of over 9,000 places were created, but the Moldovan people have absorbed 90% of the refugees, receiving them into their homes and families. 

The UN High Commissioner for Refugees and the World Food Program support financial programs for refugees and the families that host them. The Government moved quickly to offer medical assistance to refugees free of charge in cases where the criteria of the case definition for COVID-19 are met, in all cases of medical-surgical emergencies, as well as to ensure continuity of treatment for diseases with a major impact on public health, through all health service providers (pre-hospital emergency, primary, hospital health care).

The medical teams within the Border Crossing Points ensured the provision of emergency medical assistance in case of medical-surgical emergencies, SARS-CoV-2 Antigen-testing to symptomatic refugees, as well as offering them primary psychological assistance and rapid intervention when needed. All medical teams at the Border Crossing Points and Placement Centers are provided with emergency medical kits, continuously supplemented with medicines and medical devices, from their own reserves and/or those received from donations, according to approved standards.

To ensure the continuity of the treatment of refugees with chronic diseases in all institutions medicines, protective equipment and medical devices have been and continue to be distributed according to need. In May, the Refugee Medical Records Platform was organized and operates now with the aim of timely informing all interested parties responsible for planning, reviewing, monitoring and ensuring access to medical services, as well as improving all aspects of prevention, control and response of the health system following the refugee crisis.

According to the information of the Ministry of Health, since February 24, staff from AMP institutions consulted 6’891 refugees, including 2’725 children, 244 pregnant women, and the National Center for Pre-Hospital Emergency Medical Assistance received 5’626 requests and transported 2’445 refugees for hospitalization. Access to vaccination services is ensured for refugees housed in placement centers, as well as people housed in the community, with priority for poliomyelitis, rubella and COVID-19 vaccine.

To support these efforts, the SDC Healthy Life Project worked with the health and social sectors at different levels as well as with the wider population and refugees to make sure the offers were in place and information about them disseminated. 

Training workshops on managing Non Communicable Diseases (NCD) along the migratory cycle were provided for Primary Health Centers (PHC), hospitals, Public Health and emergency care teams in eight districts, with the further plan to cover all 34 districts of the country. Eighty health managers have been acquainted with the provisions of the WHO guideline on the continuum of care for NCD management during the migration cycle, multisectoral coordination mechanisms and responses to NCDs, as well as the consolidation of intra-sectoral coordination.
To support the PHC institutions in working with refugees, 835 family doctor bags were purchased and distributed across the country. 
At the request of the National Social Assistance Agency a guide for social workers on working with refugees was developed. The guide will be embedded in the university curricula of social assistants within the State Pedagogical University to ensure the institutionalization of its provisions.

Working with populations in pilot communities, the spirit of sadness and anxiety, especially among elderly suffering from multi-morbidity, was noticed. In response, the Self-Management of Chronic Diseases Program was adapted to offer psychological support for people with NCDs in crises by focusing on topics such as: hate, panic, dissatisfaction and aggression. These psychological states have somatic manifestations and unbalance the lifestyle of people, especially of those who suffer from chronic conditions and require rigorous drug management. Therefore, 58 patients with NCDs and Chronic Disease Self-Management facilitators in 40 pilot communities were trained additionally on how to provide support to the population affected by the above-mentioned status.  

More information:
Contact: 
Dr. Ala Curteanu
Team Leader Healthy Life Project, Moldova

Photo: 
A teacher of chemistry and biology from Dnepr, Ukraine and her young daughter participate in a How to prepare healthy meals festival in Pelinia, Drochia  ©Healthy Life Project

Training on automated defibrillators for first aiders in Syria​

Swiss Red Cross supports its partner, the Syrian Arab Red Crescent in its process to increase quality of care in their ambulance service. Syrian Arab Red Crescent is the main provider of ambulance services in Syria present in all governorates. Main mortality and morbidity in Syria is linked to cardio vascular diseases. Early defibrillation and swift transfer to adequate health service is key for positive health outcomes in case of cardiac arrest. Whilst cardiology services are available in some governorate capitals and Damascus, defibrillators are not available.

Swiss Red Cross has supported its partner in the development of standard protocols in the use and maintenance of automated defibrillators (AED) and cardio pulmonary resuscitation and has provided AEDs that will be placed in ambulances and first aid centres. Swiss Red Cross has designed a training curriculum for instructors. In a 16 day training, instructors underwent a rigorous training on the use and maintenance of AEDs and the cardio pulmonary resuscitation protocols as well as on teaching techniques. Instructors had then to compile a Training of Trainers (ToT) curriculum and translate all the material into Arabic. Under the supervision of a specialised Swiss Red Cross consultant, instructors carried out two ToTs. Trained trainers will then carry out trainings for the 2500 first aiders that work in the ambulances all across Syria. 

The aspect that instructors did not receive a ready-made training package for ToTs but that they had to sit together as a group and discuss how to compile a ToT and translate all the material into Arabic was a main driver for success and ownership of the training/material. The quality of training of the instructors was high and instructors felt confident and comfortable to transmit the knowledge and skills. Participants were all highly motivated and eager to learn new skills. 

Contact: 
Nicole Rähle
Swiss Red Cross
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Photo:
©SRC/Nicole Rähle/2022

Nutrition clubs - experience from the NICE project in Bangladesh

​​​In Dinajpur and Rangpur municipalities of Bangladesh, the SDC NICE​ project and Bangladesh Institute of ICT in Development, support the Nutrition club​ initiative; an initiative to increase knowledge about and demand for nutritious, and agroecologically produced food. Voluntary associations of school students enthusiastically contribute to healthy cities by organizing events such as nutrition boot camps, shopping sprees, school gardening projects, nutri-festivals or debate and cooking sessions.
The Nutrition clubs foster soft skill development and engage interested students in problem tree analyses, leadership and nutrition action plan development. The goal of the Nutrition clubs is to increase young people's capacity in all aspects of healthy diets and nutrition allowing them to become change-makers in their urban communities.  Recent events have promoted the right to nutrition in schools, extending it to families and neighbors.

Within the NICE project in Bangladesh, food systems platforms have been established in both municipalities, and youth from the nutrition clubs are being supported to engage with these platforms to ensure their voices are heard. 

More information: 

Newsletter input prepared by:  
Dr. Mortahina Rashid, NICE Nutrition Specialist, Syngenta Foundation for Sustainable Agriculture Bangladesh
Cornelia Speich, PhD, Swiss Tropical and Public Health Institute

Contact: 
Helen Prytherch
Swiss Tropical and Public Health Institute
Photo:
The Nutrition club at the Dinajpur Collectorate School and College
​©NICE project/SFSA and BIID

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Home healthcare services in Albania open up to chronic patients and elderly people

Luljeta is a 56-year-old health nurse in Fullqet, a remote village located in northeast Albania. She is one of the two nurses in her village (of 1270 inhabitants), thus providing nursing healthcare services, including demand-driven homecare that consist mainly of emergencies and mother and child healthcare. Despite her long experience as a nurse, she used to carry out only basic homecare services, mainly due to the absence of the medical doctor in the health post, the lack of knowledge and skills to perform advanced nursing procedures and the scarcity of equipment and infrastructure. Additionally, as most primary healthcare (PHC) nurses in Albania, she was expected to perform several of her duties usually in the presence of a family physician. 

Recently, Luljeta has been trained to provide a much wider range of home healthcare services to homebound elderly people and homebound chronic patients. Her health centre is among nine health centres in Albania that are implementing a new model of home healthcare, introduced and supported by Health for All, a project of the SDC. Using Karnofsky Performance Scale score (of at least 40 points), these health centres have identified 347 people as eligible for planned home healthcare services. HAP provided medical and paramedical equipment to healthcare centres to facilitate the provision of several home healthcare services - most of which are now provided for the first time by a PHC nurse. 

One of the key elements of the HAP support in implementing home healthcare is empowering family nurses to perform independently from the family physician. On this regard, 92 family nurses have been intensively trained in providing more complex healthcare services to homebound patients, and in properly reporting and documenting their work. The range of services they are now capable to perform includes complex procedures such as nasopharyngeal and oral aspiration, oxygen administration, electrocardiograms, management of tracheostomy, treatment of lymphedema, treatment of malign wounds etc. As a guiding tool to the everyday work, nurses refer to the “Manual of the standardized nursing procedures for the provision of home healthcare”. Moreover, HAP has elaborated a new job profile for homecare nurses, which details their duties as part of the PHC team. 

“I’ve been working as a family nurse for 35 years, but I’ve never been this able to perform many of the procedures I now carry out.” says Luljeta. “I think that the re-dimensioning of home healthcare services is much important for providing high-quality care and is very effective in improving patient health and increasing their self-care and autonomy.”

Following the piloting period, the resized model of home healthcare care has been approved by the Albanian health authorities and will be upscaled at national level as embedded in the “Strategy for development of PHC services 2020-2025”. HAP is therefore providing the needed assistance to health authorities and health centres through a tailored on-the-job training program and related monitoring tools. 

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Contact:
Irma Qehajaj 
Health for All Project (Albania)
info@hap.org.al 

​Photo: ©FDAF/Albes Fusha

Motivational Counselling to combat Non-Communicable Diseases in Kosovo​​

Typically, patients are informed about healthier lifestyles, without any personalized approach or measures to accompany them in their personal lifestyle changes and in their experiences with the disease and life changes. Similarly, health professionals are not taught to make efforts to encourage reflection during the learning process. The training of the trainers (ToT) for Motivational Counselling addressed these limitations and fostered autonomy and empowerment in both patients and health workers alike. Graeme Horridge, ToT for Motivational Counselling in Kosovo said that "it was a privilege to see nurses committing to bringing effective change to the health education system for the benefit of the Kosovar population". 

Based on the Kosovo Non-Communicable Disease Cohort Study ‘KOSCO’, 85% of the recruited users had low intake of fruits and vegetables, 70% were physically inactive, 53% were obese and 21% were smoking regularly – all risk factors for cardiovascular diseases and diabetes.

When it comes to preventive medicine and self-care, nurses’ role is even more critical. Not only in providing information but also in facilitating the change. “It is quite satisfactory to be part of the changing process of patients’ health behaviours. We appreciate seeing them frequently and help them to co-manage their health conditions and/or risk factors”, added Besa Obertinca, nurse at Health Resource Center in Main Family Medicine Center, Fushe Kosova.

When visiting the health centre, Vera (a patient with risk factors for diabetes and hypertension) now always meets Besa, the trained nurse on Motivational Counselling. For her, Besa is the person who successfully motivated her to take better care of her health through healthier lifestyle changes. “After meeting the nurse at the Health Resource Center, I started to re-assess my life, and slowly she convinced me that my health shall be my priority. Now, I try to follow her advices so I can prevent getting sick with diabetes or hypertension”, stated Vera Bytyci, a Health Resource Center patient. 

More information: 
Zana Aqifi
Senior Communications Officer at Accessible Quality Healthcare (AQH) project, Kosovo
SDC’s Accessible Quality Healthcare Project implemented by Swiss Tropical and Public Health Institute
LinkedIn | zana.aqifi@aqhproject.org

Photo:
​©AQH Project

​Study to understand barriers and conditions for dietary behaviuor change​​​

Non-communicable diseases such as hypertension and diabetes are a huge burden in Paraguay. Main causes are related to nutrition and physical activity. Behaviour change is a fundamental element in most Swiss Red Cross health projects. However, most activities are related to knowledge sharing. Whilst this is an important part of behaviour change, knowledge alone is not enough. In order to understand why people in rural Paraguay are not eating fruits and vegetables, a doer/non-doer analysis was carried out. In this study, people who do eat five fruits and vegetables per day (doer) are compared with people who do not eat fruits and vegetables (non-doer). According to the COM-B theory of change model (Michie, van Stralen & West, 2011​) there are three necessary conditions for a behaviour change to occur. 
  1. Capability: a person must be physically and psychologically capable to change behaviour; 
  2. Motivation: a person must be motivated to change behaviour; and 
  3. Opportunity: a person must have the physical and social opportunity to change behaviour. 
Through in-depth interviews, questions around capability, motivation and opportunity of eating five fruits and vegetables per day were asked to 30 doers and 31 non-doers. The results showed that physical opportunity (having access to fruits and vegetables) are an important driver for eating fruits and vegetables. Whilst this outcome was expected, it was surprising that motivation, especially emotions linked to satisfaction and happiness as well as psychological capability linked to knowledge how to cook vegetables or conserve fruits where ranked equally important. The results of the study were linked to effective behaviour change techniques and the project was adapted to tackle not only physical opportunity but also motivation and psychological opportunity. The impact of these adaptations to the project on behaviour change of community members can only be seen later on, but it is a first step to go beyond solely sharing knowledge. 

Reference: 
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011 Apr 23;6:42. doi: 10.1186/1748-5908-6-42. PMID: 21513547; PMCID: PMC3096582. 

Contact: 
Nicole Rähle
Swiss Red Cross
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Photo:
©SRC/Nicole Rähle/2022

New Research Findings on Health Insurance and Medicine Supply Management

Annual Joint Scientific Conference (AJSC) of the National Institute of Medical Research (NIMR)
The Health Promotion and System Strengthening Project (HPSS) participated in the recent Annual Joint Scientific Conference (AJSC) organized by the National Institute of Medical Research (NIMR), which took place in Dar es Salaam from May 17th to 19th, 2022. Under the motto “A Multisectoral Approach for Health: An Agenda for Health Systems Strengthening Towards Achieving Universal Health Coverage”, the conference presented scientific research on elements of health system strengthening. In his opening remarks at the AJSC, Vice President of the United Republic of Tanzania, Dr Philip Mpango, said the theme was relevant and timely for Tanzania as the global health community reiterates that in order to achieve universal health coverage, there is need to strengthen the countries’ health systems while also improving coordination of efforts and initiatives.


This conference topic aligned very well with the work of the HPSS project, which for the last 11 years supported the Government of Tanzania with innovations in the areas of health financing, medicine supply a​nd management, health technology, and community health promotion. HPSS contributed to the conference through the presentation of eight different papers and through organizing a symposium on the reform of health insurance for the informal sector.

The symposium informed the participants on the experiences on implementation of the Improved Community Health Insurance Fund - CHF Iliyoboreshwa (iCHF) to date. The iCHF provides affordable health insurance coverage specifically for the informal sector and the rural population with a premium of approximately 15 USD for a 6-member household for a one-year coverage. All 26 regions and 182 district and municipal councils in mainland Tanzania today implement the iCHF health insurance scheme, operated by the Government of Tanzania through the President's Office - Regional Admnistration and Local Government (PORALG). Nearly 6,000 health facilities including 28 Regional Referral Hospitals, 182 District Hospitals, 640 Health Centers and 5,107 dispensaries are accessible to 1.3 million iCHF members with active insurance policies (May 2022). They are connected through “IMIS", an innovative IT system developed by HPSS, which is available as an open source software and in use internationally.

The Deputy Director of the Directorate of Health, Social Welfare and Nutrition Services at PORALG, Dr. Paul Chaote, outlined the progress of the iCHF and the importance the government places on it as part of an envisaged future mandatory health insurance regulation. He informed participants that 7.4% of the Tanzanian population are registered in the iCHF scheme (about half with active policies) and that TZS 27.5 billion have been collected as premium so far (approximately 12 Mio USD).

​The Project Director Mr. Manfred Stoermer gave an overview on the support provided by the Government of Switzerland through the HPSS project since 2011, and outlined innovative features introduced, such as the option to pay membership through mobile phones.

The HPSS project further contributed to the conference discussion through the presentations on experiences on strengthening the health commodities supplies through the Jazia-Prime Vendor system. These papers informed participants on areas of accountability improvement, hospital procurement practices from private suppliers, and rational use of medicines.

Read the news article: HPSS project clears way for universal health coverage



10th African Pharmaceutical Symposium (AfPS)
Tanzania Pharmaceutical Students Association (TAPSA) in collaboration with Pharmaceutical Society of Tanzania (PST) and Pharmacy Council of Tanzania hosted the 10th African Pharmaceutical Symposium (AfPS) from 16 to 21 July, 2022 in Dar es Salaam, Tanzania under the theme “Pharmaceutical evolution in the era of technological advancement, the present and the future.”
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The Health Promotion and System Strengthening (HPSS) project, a Swiss-Tanzania Cooperation Project implemented by Swiss TPH was one of the main sponsors of the symposium, which brought together over 200 delegates from 13 African countries to discuss the impact of advancement of technology in the pharmaceutical sector.

At the symposium, the HPSS project presented its research findings concerning rational medicine use and factors affecting pharmacy practice in Tanzania. One of the findings is that public primary health care facilities face critical shortage of qualified staff, resulting in inefficient use of resources.
 
Read the following press releases:
About HPSS:
The Health Promotion and System Strengthening (HPSS) project is funded by the Swiss Government through the Swiss Agency for Development and Cooperation (SDC). The project is implemented by the Swiss Tropical and Public Health Institute (Swiss TPH). It is mandated to develop innovative solutions in partnership with the Government of Tanzania and support their integration into national institutions, systems and policies. The HPSS project strives to improve access to, utilization and quality of health services in Tanzania.

Contact: 

Manfred Stoermer
Senior Health Financing Expert, Swiss TPH, Switzerland
LinkedIn | manfred.stoermer@swisstph.ch​

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Photo:
​​©Swiss TPH

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