Where the Health Are We?

By Kampé Health Studios

"Where The Health Are We?", hosted and produced by Chinemerem Ihejirika, is a podcast aimed at giving a complete view of the state of healthcare in Africa through insightful interviews with experts who understand the complex and nuanced issues. We hope to not just provide you with a base on which to build your understanding but also inspire thoughtful reflection on the possible solutions to the challenges that plague healthcare systems across the continent. Available on all podcast streaming platforms every other Saturday.

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Reaching Vulnerable Populations in Rural Areas: Liberia's National Community Health Assistant Program

Where the Health Are We?Oct 25, 2022

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51:53

Reaching Vulnerable Populations in Rural Areas: Liberia's National Community Health Assistant Program

With over 50% of Africans living in rural settings and 83% of the rural population living without basic healthcare coverage, there is a need for African countries to extend healthcare access to vulnerable people in remote areas. Many countries have addressed this issue by implementing community health programs centered around the work of community health workers, sometimes called community health assistants.

CHWs are healthcare providers who live in the community they serve and help to bridge the gap between rural populations and the formal healthcare system. Although they receive lower levels of formal education and training than professional healthcare workers such as nurses and doctors, they assume crucial health-promoting roles in the community. They help deliver diagnostic, treatment, or clinical care, encourage the uptake of health services, provide psychosocial support, and assist in disease surveillance.

In this episode, we look at Liberia's community health assistant program, a program forged in the wake of the Ebola virus epidemic between 2014 and 2016. The Liberian Government’s first attempt at CHW programming came with the 2008 National Policy and Strategy on Community Health Services. But the policy failed to meet its target due to fragmented implementation, lack of financial incentives for community health workers, and little standardized training and supervision. The new National Community Health Assistant program, launched in 2016, was designed to expand healthcare access to rural areas by integrating community health workers into the national healthcare delivery scheme.

Guest: Ruston Yarnko, National Community Health Systems director at Last Mile Health in Liberia.

Additional resources

Oct 25, 202251:53

Training Healthcare Workers to Meet Africa's Healthcare Needs

Fundamental to healthcare are the people who deliver it. The science that underlies medicine would be nothing without the skill, compassion, and bravery of those who bring that science to the bedside. Unfortunately, these people who lie at the heart of healthcare systems are in short supply in Africa.

Consider the fact that despite bearing 25% of the world’s disease burden, Africa only has 1.3% of the world’s health personnel. Or the fact that the WHO projected that by 2030, the world would be short 14.5 million healthcare workers, with Africa’s shortfall making up 6.1 million (about 42%) of that number. And as of 2015, there were 1.30 HCWs for every thousand people in Africa, which significantly lags behind the 4.5 HCWs per thousand people needed to reach the Sustainable Development Goals.

By many measures, there is a mismatch between the demand for healthcare workers in Africa and their supply. And one reason for this mismatch has been the underinvestment in healthcare personnel training. In this episode, I speak to Dr. Bonaventure Ahaisibwe, the Managing Director for Impact and Innovation at Seed Global Health, a non-profit dedicated to building human resources for health capacity. We discussed Seed’s approach to building health workforce capacity, the need for information exchange in building capacity, and more.

These conversations are essential to keep having because, realistically, there is no healthcare without the people. As such, African countries must empower healthcare workers if they aim to achieve universal health coverage and meet the health needs of their people.

Aug 14, 202201:06:24

Leveraging Existing Resources with Technology to Solve Africa's Emergency Response Problem

Growing up in Nigeria, I was always fearful. Part of that fear was due to this lingering feeling that I was one emergency, mishap, or accident away from losing my life or losing someone I love. I’ll admit that some of it was irrational but a huge part of that fear was justified. I read about stories and observed incidences where people, Nigerians, couldn’t access care in emergencies. Sometimes it was a case of people being unable to get care at the scene of the accidents and the lack of access to ambulances. Or if they got to the hospital by the kindness of bystanders, hospitals didn’t have the capacity to deliver emergency care. Or when the hospital did have that capacity, they refused to deliver care until the patient paid. This dysfunctional sequence of events is what we’d ordinarily call the emergency care system. The World Health Assembly resolution 72.16 defines an emergency care system as “an integrated platform for delivering accessible, quality, time-sensitive health care services for acute illness and injury across the life course”. But as we can see, what exists in Nigeria and in many parts of Africa is not much of a system.

As of 2016, Africa was the continent with the highest rate of road traffic deaths with 26.6 deaths per 100,000, compared to 18.2 worldwide. What’s worse is that the death rate from road traffic accidents in SSA is expected to be 72% higher than the global average by 2030. We see similar trends in other causes of death that can be limited by emergency care like ischemic heart disease, stroke, and preterm birth complications.

There are several pieces that come together to form an emergency care system and we’ll get to all those pieces in future episodes. But today, we’ll start with the pre-hospital piece, which is how patients are treated on the scene of the accident and transported to health facilities. I speak to Folake Owodunni, the CEO and co-founder of Emergency Response Africa (ERA).

Jul 31, 202244:59

War & Health: How the War in Ethiopia has impacted the Tigrayan health system

TRIGGER WARNING: Please note that the following episode contains mention of violence, sexual assault and trauma. Listener discretion is advised.

What comes to mind when you think of the effects of armed conflicts? I don’t know what the answer to that question is for you but for me, I think of the casualties, both military and civilian. The reality, though, is that most civilian deaths don’t come as a direct result of these conflicts but rather, emerge from the damage incurred to infrastructure, the weakening of health systems, and malnutrition. In fact, in a 2020 study published in the BMC journal, it was estimated that almost 30 million civilian deaths were indirectly attributable to armed conflicts globally between 1990 and 2017. And two-thirds of those deaths were due to communicable, maternal, neonatal, and nutritional diseases.

In this episode, we turn the focus to an east African country that has recently been embroiled in one of these armed conflicts. We go to Ethiopia. In November of 2020, the Ethiopian government, led by Prime Minister Ahmed Abiy, laid siege to the northern region of Tigray, inciting an over 16-month period of violence marked by human rights violations, ethnic cleansing of the Tigrayans and the destruction of key infrastructure by the Ethiopian and Eritrean forces.

Although a humanitarian truce was called in March 2022, the damage has already been done. There are over 2.4 million internally displaced Tigrayan people and millions are unable to access their basic healthcare needs. In this episode, I speak to Hailay Gesesew, Ph.D. Hailay has written extensively in multiple publications about the effects of the armed conflict on the health of Tigrayans, calling for more global attention to be paid to the nightmare happening in Tigray. In his articles, he has described the damage done to health infrastructure, the effects of the war on the health workforce and how key health indicators in Tigray today significantly lag behind their prewar numbers.

Guest: Hailay Gesesew, Ph.D.

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Thank you!

Jul 16, 202201:02:44

Reintroducing "Where the Health Are We?"

New episode out on July 16th!!

Jul 09, 202203:32

The Need for Africa to Start Manufacturing Vaccines

Africa imports about 99% of the vaccines used on the continent. Hence, one lesson that African countries should take away from the COVID-19 pandemic is how unsustainable this over-reliance is. In a scramble for vaccines, as we saw during the pandemic, Africa will always be left behind. This will never change, unless countries boost vaccine manufacturing capacity.

In this episode, you will hear from Dr. Geofrey Makenga, a vaccinologist and epidemiologist. He discusses Africa’s current vaccine manufacturing capacity, the cause of Africa’s over-reliance and give his thoughts on what it would take to boost that capacity.

Guests: Geofrey Makenga of the African Vaccine Manufacturing Initiative

Useful resources:

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Thank you!

Mar 25, 202245:39

Vaccines from Above: How Zipline is Aiding COVID-19 vaccinations in Ghana

Vaccinating people in urban or peri-urban areas is relatively easy. Where things get complicated is getting the vaccine to people in rural and remote areas. For that reason, some governments have partnered with private companies to implement innovative solutions. One of such partnerships has been that between the Ghanaian government and Zipline. Zipline was founded in 2014 to increase access to medical and consumer products globally through the use of drone technology. They have partnered with the Rwandan government to support the country’s blood delivery network and conducted on-demand home delivery for retail companies like Walmart. But more recently, they have partnered with the Ghanian government to help deliver COVID-19 vaccines to remote areas.

In this episode, I speak with Zipline Ghana to understand the nature of Zipline’s contribution to the covid-19 vaccinations. I think it's important that we highlight this partnership with the Ghanian government bc it further emphasizes the promise that public-private partnerships hold in successfully carrying out large-scale vaccinations and other public health interventions.

Guests: Kwaku Amoatin and Sammy Akufuo of Zipline Ghana

Useful resources:

To keep up with the podcast, you can follow us on Instagram, Twitter and LinkedIn. You can also check out the podcast’s Anchor page.

Thank you!

Mar 14, 202234:21

How VillageReach is Aiding the COVID-19 Vaccination Campaigns in Malawi

When we think of the response to health crises, such as the COVID-19 pandemic, we often think about governments and the responsibilities that public institutions have. I mean to protect the health of their people is an implicit function of governments. But an endeavor with the urgency and scale of the COVID-19 vaccination campaign requires more than just the public sector. Healthcare stakeholders across the board would have to be mobilized to drive the success of the campaigns. Public-private partnerships would need to be leveraged and maintained to ensure that vaccines are rolled out efficiently. So far, we’ve seen companies like mPharma assist in sourcing and providing vaccines in Ghana. We’ve seen private companies in Nigeria leasing their commercial refrigerators to the government for vaccine storage. We’ve seen some other private companies helping deliver vaccines to remote areas using drones.

In this episode, we explore one instance of these public-private partnerships. You’ll learn about the non-profit called VillageReach. VillageReach was founded in 2000 to increase access to vaccines and medical equipment in Mozambique by solving supply chain challenges. Since then, the organization has expanded its geographical reach and its mission. I speak with Dr. Alinafe Kasiya, the Country Director for VillageReach Malawi. We discussed VillageReach’s mission, its approach to fulfilling that mission in Malawi and in other parts of Africa and the nature of future public-private partnerships that can help African countries cope better with future pandemics.

Guest:

Dr. Alinafe Kasiya, Country Director for VillageReach Malawi

Some additional resources:

To keep up with the podcast, you can follow us on Instagram, Twitter and LinkedIn. You can also check out the podcast’s Anchor page.

Thank you!

Mar 03, 202232:29

COVID-19 Vaccine Financing

It’s no secret that vaccinating a large number of people will require a lot of money. In fact, it has been estimated that sub-Saharan Africa alone would require $10.3 billion to get 60% of people vaccinated by this year, 2022. The problem is that many countries have strong fiscal constraints created through years of debt accumulation and relatively low gross domestic products. Not to mention the fact that on average, only 7% of African domestic government spending in 2019 was devoted to healthcare, compared to the 14% among the high-income countries of the world. So you see how it could have a problem when the pandemic emerged and African governments had to suddenly deal with the economic impacts of the pandemic and the subsequent vaccination demands. Nevertheless, some vaccination has happened on the continent and is still happening, which means that funds were made available somehow. But how? What sources of funding have African countries turned to? In what ways can the continent ensure sustainable vaccine financing in the future?

Guest: Danielle Serebro, Acting Programme Manager at the Collaborative Africa Budget Reform Initiative.

In this episode we discussed several key points including:

(3:50) Costing uncertainties when it comes to vaccine financing
(5:35) The budgetary responses of African government
(7:39) External sources of funding
(8:17) The nature of the African Vaccine Acquisition Trust
(8:59) Debt-related instruments as sources of financing
(10:14) Domestic sources of funding
(16:32) How African countries can finance vaccine manufacturing projects
(19:37) The role of the private sector in vaccine financing

Mentioned in this episode:

Useful resources:

Feb 25, 202227:14

We Must Pay Attention to Vaccine Inequity

A hallmark of the pandemic has been this unequal access to vaccines across the globe. Some countries, by virtue of their power and wealth, have had almost exclusive access to the vaccines, at the expense of less wealthy countries, many in Africa. High-income countries have hoarded vaccines at critical moments and in effect, delayed the return of African countries to their pre-pandemic socioeconomic conditions.

The impact of the COVID-19 pandemic has been grave but the consequences of a prolonged unequal access to vaccines will be worse. The threat of a new, deadlier variant will continue to loom. Resources in African countries will continue to be diverted away from other essential health services, negatively impacting the health of populations. African economies will continue to struggle, as growth opportunities are forgone in favor of COVID-19 related expenses, and commercial activities hindered. That’s why it is important that we not lose sight of vaccine inequity and its ongoing consequences.

In this episode, I sit down with Dr. Saad Omer, the Director of the Yale Institute for Global Health. Dr. Omer is a leading voice in the field of global health and has been especially vocal about the need for high-income countries to aid global access to the COVID-19 vaccines. We discuss the nature of vaccine inequity today and what must be done to reduce the vaccination gap between African countries and the rest of the world. This episode is different from the last two in that you’ll hear the whole interview, without my usual narrations. But I assure you that you’ll appreciate a lot of what Dr. Omer explains.

Guest:

Dr. Saad Omer, Director of the Yale Institute for Global Health.

Mentioned in this episode:

The Go Give One Campaign

Some additional resources:

To keep up with the podcast, you can follow us on Instagram and Twitter. You can also check out the podcast’s Anchor page.

Thank you!

Feb 17, 202246:22

Vaccine Hesitancy in the COVID-19 era: Past and Present

The WHO listed vaccine hesitancy as one of the top 10 threats to global health in 2019. Though it manifests similarly across the globe, its origins differ from place to place. How has Africa’s colonial history contributed to vaccine hesitancy in parts of the continent? Is vaccine hesitancy contributing significantly to the low COVID-19 vaccination rates in Africa or is it being exaggerated? Find out more from our guests in this episode.

Guests:

- Dr. Eduardo Montero, an assistant professor at the University of Chicago Harris School of Public Policy. Co-author of The Legacy of Colonial Medicine in Central Africa.

- Dr. Phionah Atuhebwe, the WHO New Vaccine Introduction Officer for Africa.

In this episode we discussed several key points including:

- (2:59) How the study came about

- (3:37) The nature of the sleeping sickness medical campaigns in former French Equatorial Africa

- (6:51) The effect of these medical campaigns on vaccination rates and trust in health institutions

- (9:52) The effects were largely constrained to medical institutions

- (13:18) How much vaccine hesitancy is affecting COVID-19 vaccination rates in Africa

- (16:47) Closing

Mentioned in this episode:

- The Origin of AIDS by Jacques Pépin

- The Lomidine Files: The Untold Story of a Medical Disaster in Colonial Africa by Guillaume Lachenal

- The Tuskegee Syphilis Study and the Health of Black Men by Marcella Alsan

- Where Profits and Lives Hang in Balance by Joe Stephens

- ‘Responding to COVID-19 in Africa: Finding the Balance (Part IV) and Calls to action’ by the Africa CDC

Some additional resources:

- ‘Claims of vaccine hesitancy in African countries are at odds with the reality on the ground’

- ‘Vaccine hesitancy: Definition, scope and determinants’

To keep up with the podcast, you can follow us on Instagram and Twitter. You can also check out the podcast’s Anchor page.

Thank you!

Feb 10, 202220:14

Where the Health Are We with the COVID-19 vaccinations?

Carrying out large-scale vaccination campaigns, like those for COVID-19, is a complex task. But just how complex? In this episode, we discuss what happens behind the scenes, and what issues and successes African countries are having as the quest to get people vaccinated continues.

Guest: Dr. Phionah Atuhebwe, the WHO New Vaccine Introduction Officer for Africa.

In this episode we discussed several key points including:

(5:02) Obtaining regulatory approvals is the first step in the rollout of the vaccines.
(8:40) The supply-chain and logistical aspects of the rollout come next.
(11:21) Then efforts need to be directed towards micro-planning, to ensure that vulnerable populations receive the vaccine.
(13.08) Community engagement is an essential step in the rollout, to ensure that people understand why they’re getting the vaccines.
(14:31) Continuous monitoring and evaluation needs to be done to ensure that targets are being reached and kinks ironed out.
(16:37) African countries are facing different issues in the rollout of vaccines.
(20:32) Some countries have had success with the vaccine rollouts.
(22:36) Key takeaways from the episode.

Some useful resources:

To keep up with the podcast, you can follow us on Instagram. You can also check out the podcast’s Anchor page.

Thank you!

Feb 03, 202225:03

Introducing "Where the Health Are We?"

First episode is out February 3rd. Mark your calendars!

Jan 28, 202204:52