Author: Lindsay Baldwin

Empowering Young Mothers in Namibia

A young woman learning to weave a basket during the September 9-13, 2019 craft-skills training session.

A young woman learning to weave a basket during the September 9-13, 2019 craft-skills training session.

Young mothers enrolled in the DREAMS program in the Zambezi region of Namibia had the opportunity to learn the traditional art of basket weaving through a series of craft-skills trainings facilitated by the International Training and Education Center for Health (I-TECH) and the Integrated Rural Development and Nature Conservation (IRDNC).

The all day, weeklong trainings taught the young women the basics of basket weaving and also empowered them to create marketable items that could lead to greater economic independence. For the trainings, I-TECH and IRDNC invited a Master Weaver to teach women about the technique, the types of natural fibers and dyes, and the necessary tools used in the craft. All of the women who participated in a training made at least one basket by the end of the week.

“Basket weaving is a traditional craft in this area and it is often a source of income for families,” explains Sharon Zambwe, Program Lead for DREAMS Zambezi. “One of the best parts about this program is that it not only teaches women the skills needed for basket weaving but it also connects them to a market for their works, and with each other for ongoing support and encouragement.”

The baskets that the young women crafted were made available for purchase during an event marking the end of their training. The event was attended by representatives from the Society of Family Health; Zambezi Regional Council; and Regional Ministries of Health & Social Services, Education, Arts & Culture, and Youth and Sport. The special event provided attendees with a background of the DREAMS program and included a keynote address from the special advisor of the Zambezi Governor’s Office who presented the future vision of the DREAMS program.

A basket woven by one of the participants at the September 9-13 craft-skills training session.

A basket woven by one of the participants at the September 9-13 craft-skills training session.

I-TECH launched the DREAMS program in the Khomas region in February 2018 and expanded the program to the Zambezi region in June 2018. Since the launch, I-TECH has enrolled over 20,000 girls and young women aged 9-24 years old in the program. DREAMS is a PEPFAR-funded initiative that aims to shape girls and women to be Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS). The program not only addresses the HIV epidemic through prevention and treatment, but it also focuses on the structural drivers of the epidemic, such as gender-based violence (GBV) and poverty.

“The DREAMS program has been able to provide girls and young women with the mentoring and social support needed to help encourage them to make positive and healthy decisions in their everyday lives,” says Ellen MacLachlan, DREAMS Program Director for I-TECH. “The activities in Khomas and Zambezi have had a profound impact on the girls and young women in the program. Economic strengthening activities such as the basket weaving classes can directly empower women by giving them a way to make their own money so they are less dependent on a male partner, especially one who may put her at risk of HIV.”

Since the DREAMS program first launched in the Zambezi region, it has provided social and health services as well as HIV/GBV prevention education to girls and young women and in August 2019, the program expanded into the field of economic empowerment by providing craft-skills trainings. Since the beginning of the service expansion, I-TECH and IRDNC have trained 82 young mothers, aged 15-24, in the art of basket weaving.

While the craft-skills training program in Zambezi is still in its infancy, there are plans to expand the scope of the training to incorporate other crafts skills such as clay pot artistry, knitting, and needlework. In addition to expanding the scope, DREAMS Zambezi plans to partner with tourism organizations as a way for the women participating in future trainings to showcase and sell their wares.

“We have been impressed with the response from the women who have participated in the program over these past four weeks,” says Zambwe. “We can’t wait to expand this program to incorporate more skills that will benefit not only the young women and their families but the community.”

OpenELIS Selected for Google’s Innovative Season of Docs Program

Google has selected OpenELIS Global, a laboratory information system stewarded by the Digital Initiatives Group at I-TECH (DIGI), as a participant in the first year of its Season of Docs, a unique program that pairs technical writers with real-world open source projects. DIGI implements OpenELIS Global in Côte d’Ivoire and Haiti and manages contributions to the software as a part of the global developer community.

“We rely on talented contributors from the global health software community to ensure that our tools have the biggest impact and are available to the widest audience possible,” explained Casey Iiams-Hauser, Senior Digital Health Specialist with DIGI and the OpenELIS Global Product Owner. “By being transparent about our challenges and triumphs, we benefit from peer-to-peer sharing to problem solve for the benefit of the whole community.”

Technical writer Areesha Tariq was paired with the OpenELIS Global project as a part of the initiative. Based in Islamabad, Pakistan, Areesha has a background in software engineering and her writing focuses predominantly on user guides. She will work to improve OpenELIS Global end-user documentation by turning the current user manual into more pragmatic and accessible job aids.

Areesha is excited to join the team, saying, “I feel great to be selected as the technical writer for OpenELIS Global. It will be a new learning experience to work in an open-source community. I hope that I will be able to complete the project and continue working with the team so that I can contribute to a global cause.”

By participating in Google’s Season of Docs initiative, DIGI will not only benefit from Areesha’s contributions, it will also have the opportunity to increase awareness of OpenELIS in the global community by having our projects posted to the initiatives website and reviewed by a large number of technical writers, open source organizations, and contributors. “We are excited to be a part of Season of Docs,” said DIGI Managing Director, Joanna Diallo. “During the application process we met a number of highly qualified technical writers and observed a lot of interest in ‘global goods’ like OpenELIS.”

The idea for DIGI’s technical documentation project grew out of a proposal to PATH’s Digital Square project, which like Google’s Season of Docs, invests in critical technology that can be accessed worldwide. DIGI’s proposal was only partially funded by Digital Square to develop practical designs and generalizable approaches to achieve interoperability among open-source, clinic-level data management systems via the OpenHIE framework. These systems include OpenELIS; OpenLMIS, a laboratory management information system; and OpenMRS, an electronic medical records (EMR) system. However, the OpenELIS documentation scope of work remained unfunded.

“Having focused our thinking already on OpenELIS documentation gaps for the Digital Square application allowed us to pull together our Season of Docs application quickly,” explained Diallo. “It was fortuitous timing – and it is inspiring to see both PATH and Google investing in open source organizations.”

New Digital Group Offers Full Range of Digital Health Services

In winter 2019, the International Training and Education Center for Health (I-TECH) launched a new unit: the Digital Initiatives Group at I-TECH (DIGI). The DIGI team builds upon 15 years of experience at I-TECH designing, developing, implementing, and evaluating health information systems (HIS) around the world.

The group — co-led by Dr. Nancy Puttkammer, Assistant Professor in the Department of Global Health, and Jan Flowers, Clinical Faculty and Director of Global Health Informatics in the Clinical Research Group (CRIG) — provides services to help programs scope and build technical solutions to manage program or clinical data.

“The shared faculty lead role helps the group leverage diverse resources from departments across the university,” said Joanna Diallo, DIGI Managing Director.

By promoting open-source “global goods” that are supported by implementer communities, DIGI helps partners such as Ministries of Health to be able to own and continue to develop long-term solutions.

In April, Flowers received a Digital Square award to lead an online community of practice on open-source lab information systems like OpenELIS, and Dr. Puttkammer received a Digital Square award to design and test practical and generalizable solutions for interoperability between OpenELIS and two other leading open source tools: OpenMRS and OpenLMIS.

DIGI partners with global communities to develop and enhance digital tools and provide technical assistance for effective implementation and sustainability. The team works closely with on-the-ground experts and stakeholders to guide and facilitate governance, capacity building, and continuous quality improvement using a maturity model lens.

DIGI works in the following technical areas:

  • Software Design & Development
  • Health Data Exchange Standards
  • Health Systems Architecture
  • Information Security
  • Evidence-Based Evaluation and Implementation
  • Digital Health Workforce Development

“With investment from the I-TECH center to launch DIGI, we have been able to approach the work in a new way that is flexible and responsive and promotes cross project sharing,” explained Dr. Puttkammer. “We hope this will continue to strengthen the department’s standing as a leader in digital health.”

Cervical Cancer Screening and Treatment Strategy Support in Malawi

Cervical cancer is the leading cause of cancer death among women in Malawi.1 In response, the Ministry of Health (MoH) in Malawi developed the National Cervical Cancer Control Strategy 2016-2020. The strategy outlines comprehensive interventions, including the integration of cervical cancer screening services into HIV care.

In 2019, I-TECH supported the review and update of the National Cervical Cancer Guidelines and the monitoring and evaluation (M&E) framework in partnership with the Department of Reproductive Health and the Department of HIV/AIDS in Malawi. As part of that support, the team conducted a survey to establish which sites in the South West Zone had received equipment for cervical screening and treatment services from the MoH and found that 45 health facilities offer services.

To ensure that the strategy endorses current evidence-base approaches and M&E frameworks, the team convenes cervical cancer partner meetings to draft standard operating procedures and the M&E framework, revise monitoring tools, and conduct situational analyses.

In addition to contributing to national strategy updates, I-TECH is working with the MoH to ensure same-day treatment or follow-up for all pre-cancerous lesions.

1 Government of Malawi, National Cervical Cancer Control Strategy 2016-2020.

HIV ECHO Tele-Mentoring in the Caribbean

I-TECH facilitates an HIV ECHO® program, a distance-based tele-mentoring program for providers and clinics across the region. Weekly sessions provide access to brief HIV clinical updates along with an opportunity to present and receive consultation on challenging or unusual clinical care issues from a team of multi-cadre HIV experts as well as from other members of the community of practice. In response to an identified need, the program added a monthly mental health and HIV session.

In 2019, I-TECH began supporting the Medical Research Foundation to initiate a similar HIV/STI ECHO® program that will target HIV and STI care and treatment sites in Trinidad and Tobago as well as with in other countries in the region.

Expanding Cervical Cancer Screening in Zimbabwe

I-TECH began the expansion of cervical cancer screening for women living with HIV aged 25-49 in Zimbabwe in 2019. I-TECH initially identified a provisional list of 89 sites for the implementation of visual inspection with acetic acid and cerviography (VIAC). The team then recruited, trained, and deployed dedicated VIAC nurses to 29 sites. Additionally, in an effort to improve service coverage in hard to reach areas without the necessary equipment, district teams carry VIAC equipment to outreach point facilities who have booked client appointments in advance. Random samples of images from clients are anonymized and sent to a gynecologist from the University of Zimbabwe for quality assurance.

Across all facilities, 9,664 HIV-positive women aged 25-49 years have been screened for cervical cancer with 93% testing negative, 6% testing positive for lesions, and 1% having suspected cancer.

HIS Strategic Planning in Cameroon

National strategies, policies, and governance define the implementation environment for health information systems (HIS) and are recognized as a foundational building block for health system goals, including universal health coverage and control of HIV and other infectious diseases. I-TECH is supporting Cameroon’s Ministry of Health (MOH) to develop a national eHealth strategic plan by September 2019. A goal of the project will be to develop governance structures and processes, which can continue onward beyond the strategic planning process under MOH leadership, for on-going strategic direction, coordination, and oversight of investments in the national HIS.

National Data Warehouse and Dashboards in Botswana

I-TECH has worked with the Ministry of Health and Wellness, Centers for Disease Control and Prevention, and other implementing partners in Botswana to develop and implement robust national health information system that enable greater efficiency and accountability and strategic use of information. I-TECH’s work on the National Data Warehouse ensures the availability of strategic information to monitor progress toward reaching epidemic control, with particular focus on Treat All, linkages to care, and HIV clinical cascade for 90-90-90 care continuum.

I-TECH Shares Work at IAS 2019

Yusuf Babaye, MBA, MSc, presents his poster at IAS 2019.

Yusuf Babaye, MBA, MSc, I-TECH Country Representative for Malawi, presenting a poster at IAS 2019.

Representatives from the International Training and Education Center for Health (I-TECH) attended the 10th Annual International AIDS Society Conference on HIV Science (IAS 2019) in Mexico City, Mexico on 21-24 July 2019. The IAS Conference on HIV Science is a biennial conference that brings together approximately 6,000 researchers, advocates, policy makers, funders, and community leaders. It showcases advances in HIV care, prevention, and treatment; explores new directions for HIV care, prevention, treatment, and research; and features the latest in HIV research.

Yusuf Babaye, MBA, MSc, I-TECH Country Representative for Malawi, presented a poster titled, “A Cross-Sectional Study on Levels of Knowledge on Provision of Second-Line Antiretroviral Therapy in Malawi in 2016.” The poster focused on the need to build capacity for providing second-line antiretroviral therapy following first-line treatment failure.

I-TECH’s partner notification services work in Mozambique was also highlighted in an article that was included in the Journal of the International AIDS Society (JIAS) supplement published prior to IAS 2019. The supplement, “The Power of Partners: Experiences from implementing and scaling-up HIV partner notification and index testing services,” shares key lessons learned from programs implementing, evaluating, and scaling up partner notification services.