From Hot Spots to Holy Places: Group sales of health products contribute to women’s empowerment and better health in Mali

Togo Kadiatou Malle, president of Muso Yiriwa Ton in Mali, is now an ardent proponent of condoms and contraceptives.

This was originally published on the Knowledge4Health Blog on July 1, 2019.

The first five times the sales manager of Keneya Jemu Kan came looking for Madame Togo Kadiatou Mallé to talk about her women’s association selling condoms and other health products, she ran away and hid, so terrified was she of the prospect of having to work with condoms. 

But the sales manager’s persistence paid off. Eventually, they talked, and Madame Togo has become such an enthusiastic condom promoter, she is known as Mama Condom. She laughs about her fear of condoms. 

Madame Togo is president of Muso Yiriwa Ton (MYT), which means “women-empowering group” in the Bambara language, a women’s association based in the very poor Sabalibougou neighbourhood of Bamako, Mali. Her association – as well as other women’s associations – are a major reason for the success of Keneya Jemu Kan (“Communication Around Health”), or KJK, a project funded by the U.S. Agency for International Development and led by the Johns Hopkins Center for Communication Programs that seeks to reduce maternal, infant, and child mortality in Mali. Palladium leads the social marketing component of KJK.

MYT has more than 400 members, and roughly half of them sell the KJK’s male and female condoms, as well as Aquatabs (water purification tablets), Orasel Zinc (zinc tablets and oral rehydration solution to treat diarrhoea), and CycleBeads (a natural family planning method). MYT members sell an average of 107 cartons of Protector Plus condoms per month. That’s 64,200 condoms. The partnership helps to enhance economic prospects of its members. 

“It has become a source of life for many families,” said Madame Togo. “And it is improving health of the areas where they sell, in Commune 5 and beyond.”

Faith groups do more to promote "healthy timing and spacing of pregnancies"

The Reverend Cannon Kabana and his wife Damalie Kabanda talk to their congregation about the benefits of family planning at St. Mark's Church in Uganda. More religious institutions are promoting the "healthy timing and spacing of pregnancies to their members. Photo: Mona Bormet, Christian Connections for International Health.

This was originally published on Oct. 31, 2018 on Global Health TV.

The role of religious organizations in promoting and advocating for voluntary modern methods of family planning – once met with skepticism or derision — is gradually gaining more acceptance both in the religious and secular worlds. However, the faith-based community still does not get significant funding for family planning (or global development more broadly) despite a growing consensus that faith-based organizations (FBOs) are vital and trusted development partners at the community level. 

“When family planning is positioned primarily as a major public health contributor to improved maternal, child, and family health, the trend has clearly been for growing support for family planning in most religious communities,” said Ray Martin, who was executive director of Christian Connections for International Health(CCIH), a membership network of faith and secular organizations that promote global health and wholeness from a Christian perspective (full disclosure: I am a board member of CCIH). “When family planning was seen as a tool for old-style versions of population control, it was harder to marshal Christian support.” 

10 lessons we've learned from AIDS that we can apply to chronic diseases

An assistant at the Etoug-Ebe Baptist Hospital, a subsidiary of the Cameroon Baptist Convention Health Services, takes a blood sample of a patient participating in the Novartis Access program to fight non-communicable disease. Photo: Anne Mireille Nzouanekeu

This was originally published on the Huffington Post on October 30, 2017.

Communicable diseases like HIV/AIDS and malaria have taken a terrible toll on Kenya and other African countries over the last 20 years. In 2010, an estimated 51,000 Kenyans died from AIDS but that number has declined steadily, to 36,000 in 2016. Kenya is now considered an HIV success story. The same is true in many other countries.

Now there is a new epidemic of non-communicable diseases (NCDs) that is rising just as the world is starting to get a handle on communicable diseases, according to the Institute for Health Metrics and Evaluation. The Institute reports that the largest contributors to the loss of healthy life are now high blood pressure, smoking, high blood sugar and excess body weight.

But Dr. Samuel Mwenda, who knows a thing or two about both epidemics, believes there are lessons we have learned in the fight against communicable diseases that can now be applied to NCDs. Mwenda is general secretary and CEO of the Christian Health Association of Kenya (CHAK), a network of Protestant health facilities in Kenya. CHAK now supports 46,000 people living with HIV with antiretroviral therapy, representing about 9 percent of the total number of patients nationally.

In 2015, CHAK turned its attention to NCDs: With the support of Novartis Access, it began offering a portfolio of 15 products to treat cardiovascular disease, diabetes, respiratory illness and breast cancer at a price to governments, NGOs and other institutional customers not to exceed $1.00 per treatment per month. Since then, Novartis Access has also started working in Cameroon, Ethiopia, Pakistan, Rwanda and Uganda.

Kenya starts to shift focus to chronic diseases while not relenting in HIV fight

A patient at a rural health camp in Mwae County, Kenya has his blood pressure checked as part of a full physical exam. If he needs hypertension treatment, he will get it as part of the cost of the camp. Photo: Bedad Mwangi

This was originally published on Global Health TV on June 28, 2016.

For some time, huge disparities between global health spending and the global disease burden have raised concerns that this funding was not being allocated based on the evidence. That is, money was not always going where the disease burden was greatest.

The Institute for Health Metrics and Evaluation (IHME) has pointed out that the disparities are most extreme in HIV/AIDS on the high end and non-communicable diseases (NCDs) on the low end.

As the toll from communicable diseases like AIDS and malaria decline and people live long enough to get NCDs, we need to invest more in fighting NCDs (also called “chronic diseases”) and reduce these glaring disparities between global health spending and disease burden. Countries like Botswana, Eritrea, Kenya Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zambia — all countries that increased their treatment coverage by more than 25% between 2010 and 2015, according to UNAIDS — now have to pivot to NCDs without taking their eyes off of HIV.

Kenya is an excellent case in point.

A Christian warrior for health takes on chronic disease after battling AIDS

Dr. Samuel Mwenda after receiving the award as the 2016 Christian International Health Champion.

This was originally published on the Huffington Post on June 21, 2016.

In Kenya, non-communicable diseases (NCDs) such as cardiovascular and respiratory disease, diabetes and cancer used to be quite rare, because communicable diseases like AIDS and malaria were more likely to kill you first. That is why life expectancy peaked in 1987, and then went down in the 1990s, as AIDS made its presence felt.

But since about 2002, as more Kenyans have gotten AIDS treatment, life expectancy has started going up again and, if current trends continue, Kenya will return to its historic peak of 60 years in 2017, according to a World Bank blog.

That’s great news. But it also means many Kenyans are surviving AIDS only to live long enough to be killed by NCDs. Annually, 28 million people die from NCDs in low- and middle-income countries like Kenya, representing nearly 75% of deaths from NCDs globally. Health programs, therefore, must turn their attention to this new pandemic without losing focus on the existing one (AIDS). This scenario is playing out not only in Kenya but also in Botswana, Eritrea, Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zambia. All of these countries increased their treatment coverage by more than 25% between 2010 and 2015, according to UNAIDS.

Dr. Samuel Mwenda is a seasoned veteran of campaigns against both pandemics. For 13 years, as the general secretary and CEO of the Christian Health Association of Kenya, a network of Protestant church facilities in Kenya, he has led CHAK’s comprehensive approach to HIV/AIDS prevention, care and treatment. Kenya is now considered an AIDS success story, with CHAK making a significant contribution to that success. UNAIDS says that Kenya is one of the countries “showing the most remarkable progress in expanding access to antiretroviral medicines and reducing the number of new infections.”

Faith community steps up its commitment to family planning

Twelve faith leaders read a statement of support for family planning from a larger group of faith leaders attending the International Conference on Family Planning in Indonesia in January 2016.

This was originally published on Global Health TV on Feb. 23, 2016.

NUSA DUA, BALI, Indonesia — To some, it may have been an incongruous image — twelve faith leaders, representing all the major religions of the world, standing on the stage at the closing ceremony of the International Conference on Family Planning (ICFP) here. After all, everyone knows that most religious leaders are against family planning, right?

That was never true, and now it’s becoming even less true. The twelve leaders represented 85 religious leaders and representatives of faith-based organizations (FBOs) who came to Bali from 26 different countries to discuss best practices and scaling up services to help families achieve what they like to call “the healthy timing and spacing of births” during a two-day Faith Pre-Conference.

It might surprise some to know that this support is not just for natural family planning, but extends to all forms of modern contraception with the single exception of sterilization, which is not approved by all types of Islam. All other modern methods are acceptable to all the religions represented at ICFP — Buddhist, Christian, Confucian, Hindu, Jewish and Muslim.

West Africa finally starting to embrace family planning

A health worker counsels a client in rural Senegal on family planning options. Photo courtesy of IntraHealth International, © 2014 by Jonathan Torgovnik/Reportage by Getty Images

This blog originally appeared on Global Health TV on March 24, 2015.

BAMAKO, Mali — When my wife and I lived here in the late 1980s and early 1990s, our housekeeper, Korotumu, hid her birth control pills on the top shelf in our kitchen, so her husband would not find out she was using contraception. He was unemployed and they had two children. Koro figured that two was enough, at least as long as her husband was not working.

I didn’t realize it then, but Koro was in a progressive minority of Malian women at that time. The 1987 Demographic and Health Survey of Mali revealed only 1.3% of married women were using modern contraception and the fertility rate (the average number of children a woman has in her lifetime) was 7.1. Koro was part of that 1.3%.

Flash forward a quarter of a century and what has happened in Mali? Use of modern contraception has increased to 9.9% and the fertility rate has dropped from 7.1 to 6.1.

Are donors adequately funding faith groups in global health?

This was originally published by Global Health TV on Aug. 26, 2014.

Last November, at an event associated with the International Conference on Family Planning in Addis Ababa, Ethiopia, I was struck by a public comment from a representative of the U.S. Agency for International Development (USAID): “With almost 90% of people globally professing a faith, it doesn’t make sense to do family planning without the faith community.”

I was bowled over by this statement. I checked up on the claim, and found that, according to the Pew Research Center, 84% of the 2010 world population of 6.9 billion is considered “religiously affiliated.”

So the point was valid, and I would go even further: We in global development should be partnering more with the faith community in all areas of global health. After all, if the faith community can work on family planning – fraught with all of its social, cultural and religious baggage – it should also be able to work effectively on less controversial issues like malaria, diarrhea, water and sanitation. Especially in places like Africa where people have a high level of confidence in their religious institutions.

What are the keys to family planning success in Africa?

This was originally published on the Global Health TV website on June 24, 2014.
 
In the last 20 years, Ethiopia has emerged as a family planning powerhouse. In Studies in Family Planning, I reported that, from 1990 to 2011, modern contraceptive use increased ninefold, from 2.9% to 27.3%, and the total fertility rate (the average number of children born to a woman in her lifetime) dropped from 7.0 to 4.8.

Now Ethiopia’s reputation has been further burnished by the results of a report released May 27^th by Performance Monitoring and Accountability 2020 (PMA2020) that show an increase in the use of modern contraception from 27.3% in 2011 to 33.3% in 2014 and a drop in the fertility rate from 4.8% to 4.4%.

Four Central Determinants of Success

This prompts the question: What are the factors that lead to family planning success? And what are the factors that stall such progress? Our article in Studies in Family Planning identified four determinants of success in Ethiopia. I suspect that many, if not all of these, ring true elsewhere in sub-Saharan Africa:

Global health needs more strange bedfellows, unorthodox partnerships

Puppets walking into the audience at the SwitchPoint conference in Saxapahaw, North Carolina.

The was originally published on the Huffington Post on July 14, 2014.

In Tanzania, the non-profit group IntraHealth International works with a cotton gin to provide circumcision services to their male employees and collaborates with local police to bring together 400 motorcycle taxi drivers to learn about road safety and HIV prevention. Both projects are funded by the U.S. Centers for Disease Control and Prevention.

The African Christian Health Associations Platform, based in Kenya, is working with Novo Nordisk and Johnson & Johnson that provide Christian health associations in several countries with technical support, training and drugs to combat diseases like diabetes, HIV and opportunistic infections.

Those are examples of an increasingly common approach to development. It used to be that a donor would sit down with the ministry of health to work out the design and implementation of a new global health initiative, with no significant input or involvement of other stakeholders. Those days, thankfully, are long gone.

Nowadays, it's widely recognized that more stakeholders need to be consulted, both in the design and the execution of an intervention. Does this make the process more messy and complicated? It sure does, but this messiness is essential to take global health to the next level.

In 2014, will family planning be able to sustain the euphoria of London and Addis Ababa?

Young Ethiopians partake in traditional coffee ceremony at the International
Conference on Family Planning.

This was originally published on the website of Global Health TV on Feb. 19, 2014.

2012 was a watershed year for international family planning, with the UK government and the Bill & Melinda Gates Foundation holding the high profile London Summit on Family Planning where new commitments of $2.6 billion were secured, enough to provide contraceptives for 120 million more women and girls in 69 very poor countries by 2020.

In 2013, this effort morphed into a global partnership dubbed Family Planning 2020 (FP2020). The process received a further moral and financial boost in November at the 3^rd International Conference on Family Planning in Addis Ababa, where five countries made new commitments (Benin, Democratic Republic of Congo, Guinea, Mauritania and Myanmar) and FP2020 released its first progress report on successes realized since the London Summit. Ethiopia was chosen as the conference site because of its status as an emerging family planning success story in Africa.

Faith-based organizations believe in family planning

British Prime Minister David Cameron speaking at the London Summit.

This article was originally published on Impatient Optimists on July 19, 2012.
 
Faith-based organizations (FBOs) were well represented at last week’s London Summit on Family Planning thanks to the summit organizers, the Bill & Melinda Gates Foundation and the British government. Ten faith leaders participated and, like most of the delegates, they thought the summit was a smashing success by securing financial commitments to reach an additional 120 million women and girls with voluntary family planning services.

Gary Darmstadt, head of the foundation’s Family Health Division, made clear his belief that FBOs are “critical to family planning” in a post-summit blog, pointing out that FBOs “provide up to 40 percent of the total healthcare in many countries in Africa.” It may be even higher than that in some countries.

“The only way the ambitious goals in child health and family planning can be reached is to mobilize the faith community along with other stakeholders, an ‘all hands-on-deck’ approach,” said Ray Martin, executive director of Christian Connections for International Health (CCIH) . “Often the hardest-to-reach populations in rural areas and the urban poor are the ones most likely to be reachable by FBOs.”

Faith-based organizations hope to have a positive impact at London Family Planning Summit

Three African presidents and Melinda Gates at Family Planning Summit.

This article was originally published in the "On Faith" section of the Washington Post on July 10, 2012. 

When the British government and the Bill & Melinda Gates Foundation bring together governments, donors, civil society, the private sector and the research and development community in London on July 11 for a major summit that hopes to rekindle the neglected embers of family planning, there will be one constituency there that might surprise some people — people of faith, including Christians (Catholics, mainline Protestants, and evangelicals), Muslims and other faiths.

These religious leaders are working to mobilize the faith community to work with governments, donors and other secular partners to bring family planning back as a major force in maternal, child and community health, something that has been downplayed the past two decades, in part because AIDS and other health issues took precedence, and in part because of the religious and political sensitivities to sexuality and family planning.

This faith support for family planning ranges from progressive Christians to Catholics and evangelicals.

Do you think you know where faith groups stand on family planning? Think again

This husband and wife are World Vision-trained community health workers in India who advocate birth spacing. They began using family planning when their son (right) was born.

NOTE: This blog was originally published on Impatient Optimists, the blog of the Bill & Melinda Gates Foundation, on April 3, 2012.

Religious leaders from a diversity of faiths—Muslims, Buddhists, Christians, and Hindus—have come together to profess support for family planning access around the world. This multi-faith support for family planning is something we simply don’t hear enough about in the United States. But we should.

Last year in Kenya, an interfaith meeting led by Christian Connections for International Health (CCIH) of the U.S., Deutsche Stiftung Weltbevoelkerung of Germany, and Muhammadiyah of Indonesia resulted in an “Interfaith Declaration” unanimously endorsed by well over 200 Catholic, Protestant, Muslim, Hindu, and Buddhist religious leaders.

The declaration expressed clear support for providing couples with the information and means to plan the timing and spacing of their children “consistent with their faith,” and called on others to support this initiative to influence government and donor policies and funding.

The truth is that faith-based organizations have been providing health care and even family planning for decades.