Sunday, March 17, 2013

In South Africa, an HIV campaign with a personal touch struggles to show its relevance

A Banake field worker talks to a family in Khayelitsha. Photo by Nicole Safker.
NOTE: This was originally published on the Knowledge4Health Blog on March 5, 2013.

Residents of Khayelitsha worry about a neighbour’s daughter who is only 13 but does not go to school because she cannot afford transport. She was raped by an old man. Her mother does not care and drinks a lot, swears at her about the rape and hits her. The child wants to go to school, so she went to stay in a neighbour’s home. The neighbour is also struggling and cannot afford the transport and school fees.  Banake Initiative Field Worker Diary

This is only one of many heart-breaking stories from the notes of field workers involved in an effort to improve communication among families affected by HIV/AIDS and encourage them to use HIV prevention services in Khayelitsha, the largest township of Cape Town, South Africa. The notes reveal shocking callousness and indifference on the part of township residents, but also compassion, like the neighbor who gave shelter to the 13-year-old girl.

The Banake Initiative was started in 2009 by DKT South Africa, an affiliate of DKT International, whose normal approach is focused on getting affordable health products and services to low-income people through the private sector. However, DKT decided that a different approach was required in South Africa, where HIV prevalence of people 15-49 has been stuck at around 17% since 2003 (the fourth highest rate in the world) despite years of work by many well-financed programs and the excellent availability of condoms (In November 2012, UNAIDS announced that the rate of new infections in South Africa had been reduced by 41% between 2001 and 2011).

Monday, March 11, 2013

In Costa Rica, strengthening health systems has a human side

A lab technician at the blood bank of Hospital de los Niños in San Jose.
NOTE: This originally appeared on the Impatient Optimists blog on February 28, 2013.
SAN JOSÉ, Costa Rica — Until I came here, I thought of “health system strengthening” strictly in clinical, technical terms – as a set of procedures for improving HIV testing, disposal of bio-waste, and health data management.

It is indeed all of those things, as I learned during a visit to a program working to improve care for people living with HIV led by IntraHealth International , a non-profit organization that empowers health workers to serve better communities in need,  but it also has a more human side.

Over two days, I spoke with a dozen health workers and managers about IntraHealth’s Central America Capacity Project. Several of them referred to these technical improvements as the calidad (or quality) side of health system strengthening, but they seemed to place equal emphasis on calidez (warmth). Many of the calidez changes can be made without incurring much, if any, financial cost. Virtually all of the health workers I talked to gave me examples of calidad and calidez:
  • A lab technician at Hospital Dr. Max Peralta in Cartago, about 20 kilometers from downtown San José, emphasized improved procedures in handling of bio-wastes (calidad).
  • The head of the blood bank at the Hospital de los Niños (Children’s Hospital) said that one of Capacity’s most important changes was simply securing a room where blood bank staff could talk to blood donors in private (calidez).
  • Dr. Luis Ledesma, former director of Hospital de las Mujeres (Women’s Hospital), says Capacity has improved both types of health care, and he gave an example of each. Calidad: Improving and increasing HIV testing. Calidez: Calling a person by their name.