On April 22 the Child Health & Mortality Prevention Surveillance (CHAMPS) network held its annual National Advisory Forum for 2021.
This annual gathering is a fulfillment of commitments in the partnership agreement involving a consortium of six organizations, including the Government Ministry of Health and Sanitation (MoHS), with the goal of cutting down, if not ending Sierra Leone’s high maternal and infant mortality rates.
The one-day forum brought together expert representatives from key stakeholders in the country’s healthcare sector, from the World Health Organization (WHO), to the United States Centers for Disease Control and Prevention (CDC), to the local NGO FOCUS 1000, one of the CHAMPS partner organizations.
The international development specialist, Crown Agents, is jointly heading the consortium alongside the MoHS. The other network members are World Hope International and ICAP/Columbia University.
The CHAMPS projected started in Sierra Leone in 2017, under the leadership of the CDC.
In this interview conducted on the sidelines of the event held at the Radisson Blu Mammy Yoko Hotel, Dr Ikechukwu Ogbuanu, Co-Director of the CHAMPS Sierra Leone project and representative of Crown Agents, explains the expectations of the forum and the next step.
Kemo Cham started by asking the Nigerian epidemiologist to explain the transition of the leadership of the consortium from the CDC to Crown Agents.
Dr Ogbuanu: Crown Agents in Sierra Leone has been around for hundreds of years. But specifically to CHAMPS, Crown Agents is serving as fiscal management and technical partner that oversees the entire project. It’s like a consortium, where Crown Agents leads the others: FOCUS 1000, World Hope and ICAP.
The transition happened around 2018, when CDC was the original technical partner that was funding the CHAMPS project. Their funding kind of ended and they needed another partner to take it up. The Gates Foundation then asked Crown Agents to take the money and deliver the project on the ground.
Kemo Cham: At the top of your presentation to the forum you said sometimes even when all the boxes are ticked, children still die. And you even gave an example for this. Isn’t there anything we can do about that?
Dr Ogbuanu: You have to understand that even in America and in Singapore and in some of the best countries, children still die. What you have to think about as a country is what rate is acceptable. And that’s why today you heard the numbers - 28 and 25 per 1000.
So if we have 2.5 percent of children dying for every 1000, that’s kind of acceptable. If you have 100 of them dying for every 1000, that’s 10 percent in Sierra Leone, that’s not acceptable.
And so even if you check all the boxes, you may still miss that small percentage and in the overall scheme of things, like we know people die for various reasons. That’s why in my presentation I focused on preventable deaths, because there are deaths that can be prevented, and there are things that we do differently to reduce the number of people that die as a result of these preventable causes.
Kemo Cham: Between families (communities) and service providers (healthcare workers and government), what do you think is expected of each in this effort to tackle child mortality?
Dr Ogbuanu: In my opinion, I do think that the government has the central role. The reason is not because they should take care of every single problem in the communities on the services, but to provide leadership and guidance. And that’s what the national policy and strategies that we talk about today would help to envision.
So if the government provides the framework and the policy and the strategy and the guidance for implementation, then we would expect that institutions of learning will take that on and teach it to their doctors and nurses. We would expect that in health services they would have clear guidance on how to treat hypertension, how to treat pregnant women, how to treat people who are malnourished, who don’t have enough food, and how we can identify those, and they will also take responsibility for monitoring. That will mean that if there is a problem in the hospital, who is responsible? We call it supervision. There has to be some strategy to supervise and to monitor what’s going on.
You mentioned communities, which I think is very interesting. I don’t particularly like people who blame communities when things go wrong, because they are doing what they know is best. For some communities were I come from, when children are born they put cow dung on the navel, because that’s what their mothers did and they think it is ok. So you can’t just come in and say that everything they are doing is wrong. And that is why I think the leadership, again from the government and other partners, is in important.
Communities will need to understand the messaging, they will need to adapt their behaviour to the findings. But I think the onus is on us, as the government, as partners, as the health service providers, to provide that kind of training, leadership, guidance to these communities.
I have seen in my practice so far that when you actually come down to their level and hear what they have concerns over and talk to them at their level, they get it, they understand and they do the right thing.
Kemo Cham: At this stage you provide data and share with the authorities to solve problems. In your presentation you cited a story of a woman who went to the health center and there was a delay, primarily from the healthcare providers. We are seeing similar problems outside Makeni. Do you really think action is being taken on this data you generate?
Dr Ogbuanu: I think you and I need to be really careful to understand that we are looking at one district, just two chiefdoms. It is a very small sample. I have heard from other people in other districts that similar stories exist. But I haven’t seen it because I haven’t been there. We are starting work in Bo and we will see if we are going to get similar stories.
Your question is we are seeing similar stories in those districts and what is the government doing about it?
My answer is, they are listening. I have been pleased that people are listening to this data and they are getting angry about the data. But I think the second is what we are trying to do today, which is even though we are listening well, what are we going to do? And what can we do? What do we have the capacity as a government, as partners as individuals for? And I think that’s the big question that we have to start addressing, which is what I am doing this annual advisory forum for. It is to hold ourselves accountable for the data that we have seen, but also for the results that we could see.
So what I am hoping is that there will be a national dialogue starting this afternoon [April 22]. If data tells us something in one district in one hospital, is it going to translate to other places? Even if it doesn’t, like I said towards the end, it’s a story. It’s real. It happens. If it is happening to one mother in one location, why shouldn’t it happen in Moyamba? What’s different in Pujehun? What’s different in Kambia?
Some of these cases are even worse than what we have in Makeni. So I feel like as a national level we don’t have to get data from all 16 districts. We can focus in on what we found and using it as a jumping off ground, to say ok, what can we do? And then for me, by having that dialogue today, and by proposing some interventions, we can start somewhere.
I would propose that we start in Bombali and then we can test some ideas and once they work, let’s scale it up, let’s do it everywhere, because any hospital, any community will do with more. We can’t just say ok, they are fine in Bo because they have whatever. We have to find out what are the challenges the MS [Medical Superintendent] having, the DMO [District Medical Officer] having and how can we support them?
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