Written by Richard Ofori-Asenso, ComHIP Technical Advisor, FHI 360, Ghana Country Office Irina Ofei, District Health Director, Lower Manya Krobo District, Ghana
Hypertension is a serious public health issue, with nearly one billion people across the world currently hypertensive. And the numbers are increasing every day. In Ghana, where we are based, the number of reported new cases in outpatient public health facilities increased more than tenfold between 1988 and 2007. A recent estimate of the prevalence of hypertension in Ghana was 27.3 percent.
If hypertension is identified early, it can be treated and managed to prevent life-threatening diseases such as stroke and heart failure.
In the Lower Manya Krobo, a district in the eastern region of Ghana with a population of nearly 100,000, there is a growing recognition of the increasing burden of hypertension. Unpublished 2014 data from the Lower Manya Krobo District ranked the disease as the eighth leading cause of mortality in the district, accounting for 3.8 percent of all deaths. This figure underestimates the overall impact of hypertension because it has a role as a risk factor for other, potentially fatal diseases, such as cardiac diseases, congestive heart failure and cerebrovascular disease. When combined, these conditions would rank as the leading cause of death (25.4 percent) in the district.
Written by Kim Green, Chief of Party, Ghana, FHI 360
In Ghana, men who have sex with men often fail to access critical HIV information and services due to deep-rooted fear of social stigma. The Ghana Men’s Study, conducted in 2011,1 revealed a high level of HIV prevalence among men who have sex with men in five sites in Ghana (17.5 percent), with the highest rates in the Greater Accra and Ashanti regions: 34.4 percent and 13.6 percent respectively. This study also found that less than half of the men who have sex with men population surveyed had been reached with HIV prevention services.
Since 2010 year, the Strengthening HIV/AIDS Response Partnership with Evidenced-Based Results (SHARPER) project, funded by the U.S. Agency for International Development and implemented by FHI 360, has worked to reduce HIV transmission among men who have sex with men and other most-at-risk groups. The project operates in 30 districts with high HIV prevalence, with the goal of reaching 178,000 individuals with health behavior messages and improved access to health services by June 2014.
Before 2012, SHARPER relied on peer education alone to reach this key population. We found, however, that less than 10 percent of the men in this group referred by peer educators for HIV testing were positive. Clearly, new strategies were needed to identify those most at risk of HIV and link them with prevention and care services.
An Interview with Sandy Remancus, Project Director, Food and Nutrition Technical Assistance III Project (FANTA), FHI 360
This year’s World Food Day focuses on sustainable food systems for food security and nutrition. What is the relationship between food systems and nutritional outcomes?
Through various initiatives — such as the U.S. Government’s Feed the Future Initiative, the Scaling Up Nutrition (SUN) movement and the 1,000 Days Partnership — the international community has made a significant commitment to improving nutrition around the world. To meet the goals of these efforts, we need to focus not only on clinical interventions to address malnutrition, but also on safe, healthy food systems that can lead to more sustainable, scalable results.
A focus on food systems means making investments that put the right information and resources in the hands of communities and households to prevent malnutrition in a number of areas: improved dietary quality and food consumption (especially during the 1,000 days from conception to a child’s second birthday), better child-feeding practices, increased access to and availability of higher quality water and sanitation services, and healthier and more diverse agricultural production choices. Food systems should also include equity considerations, such as offering women and other economically disadvantaged groups greater opportunities to grow and earn from the production of nutritious food.
Most of the world’s population at risk of malnutrition either grows its own food or buys it in local markets. In the past, agricultural programs focused on increasing the amount of food available. We now understand that healthy food systems should also focus on the production and availability of diverse foods that provide the nutrients needed for adequate nutrition and health. This is particularly important in order to prevent malnutrition in populations most at risk — children under two and pregnant and lactating women. Issues about food safety, which emerge all along the value chain — from the choice of inputs to the processing of foods — are also crucial to consider if we are to protect consumers’ health and nutrition.
Written by Olivia Aglah-Dotse, CVD Project Coordinator, Ghana, FHI 360
A section of attendees, including some members of the Police Wives’ Association (POLWA) and Policemen during the aerobics exercise.
Can cardiovascular disease (CVD) prevention be entertaining, fun and educational? If you ask attendees of FHI 360’s community CVD prevention events, you’ll hear a resounding “Yes!” An inaugural event, held on May 26th, took place in the barracks of the Police Hospital in Accra, Ghana. The program offered women, men and children an afternoon of upbeat music, dancing, cooking demonstrations and energizing aerobics exercises.
Several community events are offered within FHI 360’s pilot cardiovascular disease prevention, screening and referral program. The facility-based screening program was launched in August 2011 in partnership with the Ghana Health Service and the Ghana Police Service, and focuses on the communities surrounding the Police Hospital in Accra, the capital, and Atua Hospital, a semi-rural district in Ghana. Through the facilities, we have screened approximately 14,000 clients so far. Our preliminary results indicate that in Atua Hospital, 55 percent of those screened were either pre-hypertensive or hypertensive. In the Police Hospital, 75 percent of clients were either pre-hypertensive or hypertensive. We have also found that the proportion of overweight or obese clients was 48 percent in Atua Hospital and 59 percent in the Police Hospital.
In order to strengthen prevention activities – and address the high prevalence of CVD risk factors in the pilot communities – we recently complemented the facility intervention with a community-based behavior change campaign to promote healthy lifestyles. The campaign targets female heads of households. The slogan, “from your heart to theirs,” reinforces the position of women as the primary decision makers on what the family eats as well as their health-seeking behaviors.
Actress and Caterer Akorfa Edzeani-Asiedu at her stand during the cooking demonstration at the Launch.
The central component of the community campaign lies in monthly community events, which provide a range of entertainment and educational activities. During the first event in May, physical activity was promoted through music, dancing and group aerobics instruction from a professional trainer. Cooking demonstrations and taste testing were led by a local celebrity, Akorfa Edzeani-Asiedu, to promote a reduction in salt, unhealthy fats and oils, sugar and alcohol. Additionally, health care workers were on hand to screen 125 attendees for behavioral and biomedical CVD risk factors. Prevention counseling was provided and referrals were made as necessary. Additionally, health care workers were on hand to screen 125 attendees for behavioral and biomedical CVD risk factors. Prevention counseling was provided and referrals were made as necessary. The positive response to this initial event is an encouraging sign that these educational social gatherings can engage communities in making healthy lifestyle changes.
“We are learning a lot. This program is very good for us. We will try to eat healthy and stay active so that as Policemen, we will be healthy enough to maintain security and protect life and property in this country” Police Constable Ofei, Cantonments Police Barracks, Accra.
Written by Dustin Andres, Communications Specialist, FACET Project, FHI 360
A version of this post originally appeared on USAID’s Blog, “IMPACT”. Reposted with permission.
Inexpensive video production has become a viable way for agricultural organizations to communicate with beneficiaries, donors, and the public. And it’s not just posting on YouTube. Devices such as handheld projectors and tablet computers have come down in price, enabling practitioners to disseminate to farmers in rural areas with minimal technology. Social networks – just a few years ago only the purview of wealthy countries – are now truly global. In regions with electricity, a well-executed video can now go viral – and become more impactful than the slickest behavior change campaigns of decades past.
It is exciting, but that doesn’t make it simple. Organizations continue to make low quality videos that fail to engage their audience or reflect the core objectives of their project.
To help users learn the ropes, the Fostering Agriculture Competitiveness Employing Information Communication Technologies (FACET) project has developed an online toolkit that can help one through every stage of planning, producing, and disseminating agricultural videos. It is called “Integrating Low-Cost Video into Agricultural Development Projects: A Toolkit for Practitioners,” and is available for free download.
The toolkit is also the basis for a series of four workshops offered this month to USAID implementing partners by toolkit author Josh Woodard and myself, in Kenya, Mozambique, and Ghana. The first of the trainings was completed last week in Nairobi.
The workshop focuses on implementing your low-cost video vision, which requires skills beyond playing Spielberg: strategically thinking about message, storyboarding narrative concepts, planning dissemination, troubleshooting inevitably buggy software, and personal perseverance, all play a role in a video’s success or failure.
One participant, Victor Nzai, program assistant for USAID-funded Agricultural Market Development Trust of Kenya (AGMARK) project focused on agro-pastoral development, felt the training would improve his project’s ability to encourage farmers to efficiently integrate grazing range land and food production in Kenya.
“We have been doing dissemination via field days quite successfully, but with video, we can reach many more farmers than before,” said Nzai. “We shall shoot the videos ourselves, and edit them into comprehensive tools that can be presented by a facilitator.”
Agricultural development practitioners are looking for new ways to leverage video to circulate information and engage local farmers. Video can help them do it – but it is the holistic consideration of concept, design, and execution that will maximize chances for success.
“Not everyone will adopt our ideas,” said Nzai. “But when we multiply the number of farmers we reach, we are able to tune our message with video to encourage farmers and pastoralists to consider better ways.”
Learn more about using information and communication technology in agriculture.
The MAM program – led by FHI 360, GSMF, LSHTM and Health Partners Ghana, and funded by Pfizer – was established in 2007 to help close critical gaps in malaria prevention, treatment and education. Malaria is endemic in all parts of Ghana, with all 24.2 million people at risk. It accounts for over three million outpatient visits annually in the country and 30% of all deaths in children under five. Pregnant women are particularly susceptible to malaria, increasing the risk of severe anemia and death, as well as premature delivery, stillbirth and low birth weight in newborns.
The MAM program educates Licensed Chemical Sellers (LCSs) – the local health authority and main suppliers of medicines across communities in Ghana – on malaria symptom recognition and treatment approaches. The program also involves community mobilization to educate patients, particularly the high-risk population of pregnant women and children under five, and strengthen their demand for quality care. Over 25% of malaria in Ghana is resistant to widely-available monotherapies. Combination therapies that address resistance issues were also cost-prohibitive for most of the population prior to the program.
In addition to the barriers of cost and availability, there were also many common misconceptions held by community members and even LCSs. These included:
The belief that malaria is a common disease, is not dangerous and does not kill
The lack of knowledge that malaria is spread by mosquitoes
The impression that malaria is caused by heat, house flies, dirt, hard work or eating fatty/oily foods or unripe mangoes
To address these issues in a comprehensive way, the MAM program includes health, education and even economic improvement aspects.
A Licensed Chemical Seller explains how to provide appropriate dosing of malaria drugs based on the client’s age and weight, information she learned through the MAM training course.
At the core of the program is reducing malaria-related morbidity and mortality in Ghana’s Ashanti region by improving malaria symptom recognition, treatment and referral. The program contributed to the advocacy that resulted in a declassification of combination anti-malarial drugs by the Ministry of Health. Subsequently, LCSs are now permitted to stock and dispense these drugs, bringing effective treatment into the communities. The program has reduced the time needed to obtain effective treatment by 40%. Through community mobilization, household knowledge of early signs of malaria has increased. Combination therapies are also now the most widely used treatment for malaria, increasing cure rates. The program established links so that community-level data is now being collected, analyzed and fed into the health system, helping to inform decision making at all levels and strengthening the connectivity between LCSs and the District and Regional Health Office.
Robust education programs trained 1700 LCSs in Ghana to recognize the symptoms of malaria, refer complicated cases directly to health centers, and provide proper treatment and dosage for those who do not need a referral. As a result of the trainings, participating LCSs were elevated in the community for their expertise in malaria and are now recognized as part of the health system and a source of community-level data on malaria.
A sign board on the outskirts of Kumasi alerting passer-bys to the dangers of malaria and the importance of prompt treatment.
There were economic benefits to both the program beneficiaries and the LCSs. Following training and education, participating LCSs became area experts on malaria, which increased traffic and built customer trust, often driving business growth. The increased business helps to reinforce the value of MAM training and better customer service, making the program more sustainable. Community members also benefited from the program: the MAM program and its partners worked with the National Malaria Control Program (NMCP) to apply for the Affordable Medicines Facility for malaria (AMFm) from the Global Fund for AIDS, Tuberculosis and Malaria. This approach resulted in a price reduction for combination therapy, thus making it affordable for lower-income members of the community. As a direct result, caregivers and mothers are spending less time at home caring for sick family members and more time at work or in income-generating activities.
Programs like MAM improve lives by addressing more than health. Through the MAM project, LSC program participants have gained powerful expertise and improved their businesses in the process. And program beneficiaries have gained better knowledge of the signs of the disease, while gaining improved access to and lower costs for treatment. Although MAM is a health-centered program, it would not be as successful without a more comprehensive approach.