IPPHL Archives - Page 2 of 5 - Evans School of Public Policy & Governance

Addressing Health Barriers by Adopting ‘One Health’.

Dr. Sandra Maripe (IPPHL Cohort 6) is our spotlight for October 2024. She is a Medical Doctor and the Health Management Team Coordinator for Ngami District for the Botswana Ministry of Health. During her residency following medical school, Dr. Sandra Maripe saw how villagers in Botswana struggled to access health care. That’s when she realized she wanted to dedicate herself to primary health care since the patients were “often coming in when it was too late for us to help them.”

Dr. Maripe, who is the health management team coordinator for Ngami District for the Botswana Ministry of Health and supervises a hospital and 29 clinics, now aims to implement the Ministry’s strategy to revitalize the district’s entire primary health care system. As part of her journey, she participated in the 2023 cohort of the International Program in Public Health Leadership (IPPHL). The program, created by the Evans School of Public Policy and Governance at the University of Washington and funded by the Gates Foundation, has trained 192 public health professionals across 29 African countries over the past seven years. The program’s curriculum now also incorporates lessons from Exemplars in Global Health. Exemplars in Global Health in an interview with the IPPHL alumnus, talked about addressing health barriers by adopting ‘one health’ and her time as an IPPHL Fellow.

Could you tell us about your personal journey? How did you become interested in primary health care?

Dr. Maripe: After I completed my medical studies, I took part in a one-year internship program, rotating through all the disciplines, including surgery, pediatrics, child health, and maternal health. During that experience, I developed an interest in primary health care because of the variety of patients we saw. I also saw how they struggled to access health care, often coming in when it was too late for us to help them.

Could you tell us about your work with the Ngami District Health Management team? What are you currently trying to accomplish, and why?

Dr. Maripe: I supervise all our public health facilities in the Ngami District, including one district hospital and 29 clinics. We try to address our health challenges mainly through stakeholder collaboration and community engagement. Our district is severely impacted in terms of socio-economic status. There is a lot of poverty and unemployment at the community level. We also experience pockets of malnutrition in some small villages and settlements. All this affects their health care-seeking behavior and their ability to access care.

For example, we go into villages and conduct community health screenings. We also engage communities and their leadership. Every village is led by a chief, so we engage the chiefs and the business communities and stakeholders in those areas. By doing this, we address health barriers together, adopting a ‘one health for all’ approach. For example, in one village we identified that malnutrition is an issue so we’re working to establish a community garden.

Additionally, since we’re a tourism hub, we face challenges of human-wildlife conflict. People’s farms are affected by elephants, and they can’t afford electric fencing. We have now engaged the business communities in the same area we intend to create community gardens to support food security.

Could you tell us about your experience with the International Program in Public Health Leadership?

Dr. Maripe: It has been a wonderful experience. It has significantly improved my leadership skills – we covered many topics during the program, such as how to lead people, manage change and transition, and handle conflict in the workplace.

I appreciated the 360-degree tool we used to assess ourselves through the eyes of our leaders and peers. It was an eye- opener for me, showing that people always remember how you treated them, even if they forget the words you said.

I also learned the importance of giving feedback, whether positive or negative, and concepts like the theory of change, which we can use in our daily programs and projects. I’m now also connected socially with people from several countries – I have friends in over 20 African countries that I’m still in touch with.

Have you used Exemplars in Global Health since IPPHL? If so, how?

Dr. Maripe: From the first day we were introduced to Exemplars in Global Health, we started receiving insights from the program to understand and appreciate what other countries are doing.

For example, I recently read about how Nepal reduced maternal mortality and neonatal deaths by engaging female community health care workers and collaborating with donors. We’re also working on a program for community health care workers, and I’ve appreciated how other countries like Liberia and Ethiopia have utilized community health workers to improve primary health care. It helps us to learn from those countries.

Strengthening Health Systems in the Atwima Nwabiagya Municipal District, Ghana.

Dr. Justice Thomas Sevugu (IPPHL Cohort 7) is our spotlight for December 2024. He is the Municipal Director for Health at the Atwima Nwabiagya Municipal District in Ghana. Exemplars in Global Health in an interview with the IPPHL alumnus, talked about strengthening health systems as a leader and how his experience as an IPPHL alumnus has shaped his role as a Health Director.

Could you tell us about your personal journey? How did you become interested in primary health care and health systems strengthening?

Dr. Sevugu: My journey in public health started with a deep-rooted commitment to community health, which I built upon through my studies and experiences. After earning a diploma in community health at the basic level, I began realizing that health care delivery happens primarily at the community level, where households – the primary producers of health – are located. To make a real impact on the health of a population, you have to focus on communities, where families reside.

My interest grew as I pursued a PhD in public health, which showed me the profound impact of accessible primary health care on underserved communities. When you look at Ghana’s primary health care system, organized at national, regional, and district levels, you see that policy and guidelines are set nationally, while the region focuses on coordination and monitoring. But the district level is where primary health care operates and policies translate into action – where planning and implementation create a resilient system that serves the population’s needs.

Over the years, as I took on more responsibilities, including serving as a municipal director, I recognized that a strong health care system is crucial to achieving equitable health outcomes. This understanding led me to focus on strengthening health systems. For primary health care to deliver valuable outcomes, the system must be strong.

It’s a dual challenge: we aim to provide access to every population, especially the vulnerable, but we need a robust vehicle to achieve this access. This realization drove me to advocate for system strengthening. Human resources, leadership, and equipment may all change, but the health system remains; it must be resilient to continually serve our population’s needs.

This realization led me to focus more on strengthening health systems, because the output of a system is as good as its strength and what it can do. So, it’s a double-pronged situation where you want to ensure health access for every population, particularly the vulnerable, but in your effort to seek that access, the vehicle must be strong enough to deliver that. Because human beings can change. Leaders can change, health workers can change, even equipment can wear out and be replaced, but the system remains the system and it always needs to be strengthened to ensure you get the best for your people.

Could you tell us about your work as municipal health director for the Atwima Nwabiagya Municipal District? What are your current priorities within the primary health system? What unique problems are you addressing in your district compared to the rest of the country?

Dr. Sevugu: As the municipal director in a district that includes urban, peri-urban, and rural areas, my role involves ensuring high-quality health service delivery, managing teams to achieve this, and setting health priorities to meet the diverse needs of these different populations. I’ve focused on improving maternal and child health services, increasing immunization coverage, and enhancing the accessibility of health services, particularly for mobile populations.

In rural areas, people often move frequently for work, while in urban areas, busy career women may be closer to children than their male counterparts but can be out of reach of health care services. We’ve designed programs that track and follow up with these mobile populations to ensure they receive necessary services. For example, we target career women’s children by implementing school health programs in early childhood centers. We deliver services directly to these children in schools, crèches, and nurseries, rather than waiting for them to come to health centers. This unique approach contrasts with other regions, where we must actively reach people wherever they are to ensure access.

Addressing these unique challenges requires targeted outreach, community partnerships, and engaging the health seekers themselves in planning how to meet their health care needs. This responsibility lies with the municipal team.

Strengthening Kenya’s Vaccine Safety Reporting System: increased AEFI reporting in Kenya

Dr. Lucy Mecca achieved remarkable success in strengthening Kenya’s vaccine safety reporting system. Vaccine safety systems and adequate reporting of Adverse Events Following Immunization (AEFI) are essential as they allow public health officials to enhance confidence in immunization programs. In just under two years, Dr. Mecca and her team improved reporting structures and increased the number of reported cases of AEFI from just twelve cases in 2019 and eighteen cases in 2020, to 861 cases in 2021. Dr. Lucy and her team have continued to strengthen this system with 3,251 AEFI cases reported in 2023.

In Kenya, vaccine safety monitoring systems were inadequate and failed to meet the World Health Organization’s surveillance targets of at least 10 reports of Adverse Events Following Immunization (AEFI) per 100,000 infants, with only 20 reports annually from a population of about 1.5 million infants. This underperformance resulted in a lack of robust data on vaccine safety and heightened the risk of rumors, misinformation, vaccine-hesitancy, and conspiracy theories, especially with new vaccines.

Improving vaccine reporting is critical as new vaccines are introduced but is a complex challenge because it involves a diverse set of entities including regulators, public health agencies and the WHO. Dr. Mecca used the introduction of the malaria and COVID-19 vaccines as a window of opportunity to bring stakeholders together to strengthen Kenya’s vaccine safety. She used her skills in stakeholder engagement to focus first on strengthening collaboration with the regulator. This allowed her team to revise health worker training programs to include AEFI, develop and disseminate AEFI reporting guidelines, conduct active AEFI surveillance, and establish the National Vaccines Safety Advisory Committee. Dr. Mecca, working with the regulator, also oversaw the introduction of a new online reporting system which allowed patients to submit AEFI directly without relying on health workers to report. This was particularly effective during the COVID-19 vaccine rollout. Additionally, Dr. Mecca’s team integrated a specialized AEFI reporting module into the regulator’s existing online system. This enhancement allowed for more accurate and comprehensive reporting of vaccine-related adverse events, addressing limitations in the previous drug-focused system.

To implement the overhaul of Kenya’s vaccine safety reporting system, Dr. Mecca drew on policy and leadership skills gained through IPPHL, including stakeholder engagement, team collaboration, efficient resource deployment, implementation analysis and process improvement. The policy memo she developed as part of the IPPHL program played a critical role in analyzing the problems affecting AEFI surveillance and helped her to think creatively about accessing resources. She was ultimately able to implement many of her recommendations.

Achieving 71% HPV Vaccination Coverage in Nigeria

In under two years, Nigeria has achieved a 71% national Human Papilloma Virus (HPV) vaccination coverage rate for girls aged 9-14, resulting in the vaccination of over 12 million girls across the country. The HPV vaccine can prevent more than 90% of cases of cervical cancer, the second deadliest cancer among women aged between 15 and 44 in Nigeria. This translates into potentially preventing up to 10,000 new cases and 7,000 deaths annually.

Dr. Njideka Kanu, an Epidemiologist with the National Primary Healthcare Development Agency (NPHCDA) and an IPPHL Cohort 6 alumna, led the national team to support the vaccine introduction in Anambra and Delta States and played a crucial role in integrating the (HPV) vaccine into Nigeria’s national immunization program.

Dr. Kanu has been instrumental in the vaccine’s integration into the national immunization program. She and her team at the NPHCDA built a massive coordination effort at the national, state, and local levels. National representatives worked closely with state teams to develop strategies to reach girls in schools, places of worship, and communities, with special attention placed on hard-to-reach areas. The team engaged in a public awareness campaign through press engagements, radio jingles, and sensitization sessions. Finally, they developed a uniform micro-planning template that was shared across states for consistency and conducted training at the national, state, and local government levels for health workers, vaccinators, recorders, town announcers, and community leaders. The vaccine rollout was officially launched on May 27, 2023, coinciding with Children’s Day in Nigeria. The launch, led by the first ladies of each state, aimed to maximize visibility and impact. Dr. Kanu and her team followed with a nationwide campaign targeting schools, communities, and places of worship for the next 4 to 5 days.

Dr. Kanu’s skills in stakeholder mapping, advocacy, and communication enabled her team to identify and prioritize key players, secure resources from high-level stakeholders, coordinate the vaccine rollout, and deploy effective advocacy strategies for addressing vaccine-hesitancy.

In an interview with IPPHL , Njideka highlights how her training as a public health physician and a field epidemiologist has helped shaped the way she works now, especially in health system management and outbreak response. She plays a pivotal role in the Department of Disease Control and Immunization where her responsibilities include strengthening primary healthcare systems with a focus on disease control and immunization efforts in Nigeria. Please watch here.

From Isolation to Connection: Lockdown Relationships Inspire New Professional Network

By: Lauren Domino (MPA ’11), Assistant Dean for Advancement & Innovation at the Evans School

2020 was not the easiest year to begin a career as an elected official, but that’s the situation Vanessa Kritzer (MPA ‘17) found herself in as a newly elected member of the Redmond City Council. “It was a challenging time – navigating this new role via virtual council meetings and facing multiple complex policy and budgeting issues. I started reaching out to other leaders that I respected to get a sense of how they were approaching it, and Janice Zahn was at the top of my list,” shared Kritzer. The two met a few years prior while Kritzer was still a student at the Evans School and serving on the National Women’s Political Caucus of Washington Board and connected over their shared Evans School experience.

When Kritzer reached out during the early days of the pandemic, Zahn (EMPA ‘12) had already served on the Bellevue City Council for a few years and had begun a three-year term on the King County Board of Health in January 2020. “I was more than happy to connect with Vanessa and support her in this journey,” shared Zahn, who faced similar challenges of moving into lockdown and leading through the public health crisis. “I think back on this time and wonder, what could have been possible if I was able to dial into the Evans School to navigate this uncharted territory?” She recalled how her EMPA cohort was thirsty to continue working together after graduation in 2012 and self-organized “salons” around different topics – from public safety to affordable housing – to help springboard the work that they were each trying to advance.

Kritzer and Zahn have kept in touch over the years – through the ups and downs of public leadership and reelection campaigns. Now, they’re thinking bigger about what’s possible. The two have come together with support from the Evans School team to launch the Evans in Government Network. The goal is to build a community of Evans Alumni who are working as government staff or elected officials to strengthen professional ties, support one another in addressing the pressing issues of today, and expand pathways to public service by connecting with the next generation of leaders. “I’m thrilled to create a space where we can come together and think about the most wicked problems we want to solve – and how we can work on innovative solutions that cut across cities, counties, and state policies,” shared Kritzer.

Planning is underway for an Evans in Government Network launch event in March 2024. For more information or to sign-up, please visit the Evans School’s Alumni page.

Full IPPHL Community Convenes for first ever Summit in Nairobi, Kenya

This Summit represents the first ever gathering of more than 150 alumni of the IPPHL program, representing 29 African countries and spanning all areas of public health. Our Summit theme, “Leadership, Policy, and Action for Resilient Health Systems in Africa” reflects IPPHL’s mission of expanding the policy and leadership acumen of public health leaders to develop and implement lasting public policy solutions and transform health systems.

To date, six cohorts of fellows have completed the program, but the Summit is our first in-person gathering of all cohorts and the first time our all-virtual Cohorts 4 and 5 are convening in person. Over the past year, alumni worked collaboratively with the IPPHL team to plan and develop the Summit agenda in response to your goals. Deep thanks go to all alumni who contributed time and expertise to developing this transformative program.

Over the three days of the Summit, participants deepened relationships across cohorts, built robust networks to deepen impact, and welcomed other global health experts. Together the community co-created a shared strategy for future action to amplify our work to strengthen public health systems and population health and well-being.

The COVID-19 pandemic underlined the critical role of resilient country-level public health systems in supporting the health and security of their populations. The pandemic also underscored the importance of regional and continent-wide strategies for global health security. The growing network of over 150 IPPHL Alumni are well positioned to lead the next generation of public health strategies to build more equitable and resilient health systems across the African continent.

Watch the short clip below from the Summit, and check back often as the team reports out on this momentous event.

Public Health Leadership During COVID-19

In November 2021, four IPPHL alumni took a moment of pause to discuss how they have been leading and sustaining themselves and their teams through the pandemic.

Panelists included Selorm Kutsoati, Ikrama Hassan, Joel Mubiligi, and Lucy Mecca and the conversation was facilitated by Nosa Orobaton.

Our four panelists discussed their challenges in response to COVID-19, including managing the changing work environment and skepticism surrounding the novel pandemic and vaccines. The group’s greatest successes included the resilience of staff and health systems, the maintenance of routine immunization services, and the mobilization of health workers.

Across the board, leadership skills have been crucial to their response, especially in uncertain and constantly evolving circumstances. The public relates better to a leader who communicates transparently, refrains from overconfidence, speaks with an honest and humanistic approach, is able to adjust their leadership style, and includes input from others.

Joel highlighted the importance of collaborative leadership in caring for geographically dispersed chronic care patients during the lockdown. His team partnered with other organizations to coordinate drug delivery to high-risk patients. This specific challenge forced his team to work effectively through uncertainty, make decisions quickly, and center the human in all of their decisions.

The pandemic highlighted the inequities both within the panelists’ health systems and globally. Dr. Kutsoati shone a light on how large cities have generally received better access and better care during COVID and more rural areas lacked funding and operational support. On an international scale, Dr. Ikrama discussed the world as a globalized village. The hoarding of vaccines and other resources by western countries and the limitations of vaccine intellectual property is resulting in the prolongation of the pandemic globally. “Whatever the rich world is doing, they are not likely to succeed in getting rid of COVID-19 until the poorest part of the world is safe.” – Dr. Ikrama Hassan

Broadly speaking, COVID has revealed what has been happening on the ground for centuries and has reinforced the need for primary health care and universal health coverage. The pandemic has also given us a window and opportunity to use the resources that we do have to change our health systems. Panelists recommended looking inward at what is already being started and practiced in Africa, such as a burgeoning vaccine development program and nurturing relationships with local health organizations.

The Public Leadership During COVID-19: Conversation with Public Health Leaders from across Africa panel was a collaboration with the International Program in Public Health Leadership (IPPHL), the Bill and Melinda Gates Foundation, and the Public Health Initiative at the University of Washington. Panelists included Dr. Selorm Kutsoati, Dr. Ikrama Hassan, Joel Mubiligi, and Lucy Mecca and was facilitated by Nosa Orobaton.

Leading COVID-19 Response in a Conflict Zone

Earlier this year, the IPPHL team spoke with Hentsa Haddush Desta, a Cohort 1 fellow from Ethiopia, working as an Epidemiologist/Rapid Responder for Africa Center for Disease Control and Prevention (Africa CDC) COVID-19 Preparedness and Response.

We talked about his recent work handling COVID-19 in the Tigray region of Ethiopia, and how he had to pivot from COVID response to wartime emergency management nearly overnight. He shared his experiences, challenges in leading during a multifaceted crisis, and how previous work and his time at IPPHL shaped his response.

You had mentioned you were engaged in the COVID-19 response in the Tigray region of Ethiopia in November, when the war began. Could you tell us a little about your work prior to November, and how the war affected this work?

The war broke on November 4 at midnight. My team had been there supporting the COVID-19 preparedness and response for the regional state. We were five health workers with different skill sets such as surveillance, case management, infection prevention and control, and community engagement. I was the team lead; three were deployed by the Ministry of Health and two of us by the Africa CDC. We were the ones who engaged with and where deployed by the federal ministry of health and EPHI/Africa CDC, to support the regional, zonal and district teams to scale up the COVID-19 preparedness and response down to the grassroots level.

As of November 3, 2020, we had tested about 87,787 samples and there were 6,738 positive COVID-19 cases and 47 deaths reported. At that time, there were also 353 active cases in treatment centers. And when the war broke out, we didn’t know where all those individuals with positive cases went. They probably escaped to their homes, so they would have been mixing with their families. We don’t know what the spread looked like after that. Even until today (09 March 2021), no one knows the COVID-19 status of the region.

At that time, all the COVID-19 activities and other health service delivery activities were interrupted or totally stopped because of the war. So, it seriously affected our work. We were supporting the region in surveillance, contact tracing, case management (especially the home-based isolation and care services), sample collection, and transportation as well. All of these services had been interrupted because of the war. It seriously hampered our active engagement in the health sector of that region.

How did you work around or overcome some of these challenges?

After the war broke in 04 November 2020; all the COVID-19 cases in treatment and isolation centers dispatched to their homes. Not only the COVID-19 cases, the health workers also escaped or fled from the treatment and isolation centers, health facilities, and surveillance sites. We tried to reach some of the critical COVID-19 cases. Some of them were elderly. We searched for them by visiting house to house, as there were no means of communication. The interruption of communication modality seriously affected the health facilities and major hospitals to provide care to delivering mothers and other people in need of emergency care. We brought some health workers from their homes to treatment centers and hospitals using our own cars to support the critical patients suffering at their homes, taking life or death risks by passing warring forces. We also brought supplies from private pharmacies to refill the out-of-stock medical stores at big hospitals. Even when they were officially closed, we negotiated with the pharmacies and store owners to bring us essential medicines for critical care patients. Because of our team’s engagement and support, we saved several lives who were at the brink of death. But our support was tip of the iceberg comparing to the scale of the crisis. Our movement was limited in the Capital City of Mekelle. We were never allowed to move out of the capital because of active war and security issues.

We don’t know the status of COVID-19 cases and contacts under follow up, where they went, or if they recovered or died. There was a complete black- out of internet and phone services and electricity. Mekelle is a big city and you could not track individuals at night; the patients came from the outskirts of the city, countryside, other zones and towns, and nearby soundings, so it was challenging for us to identify them and know their status.

The other issue is we were also supporting the emergency services of the major hospitals in Mekelle. Because of the war, the COVID-19 labs, logistics, and testing kits weren’t available. Even the sample collection kits and laboratory staff were not available. Since we could not operate at that level, we stopped working on COVID-19 shifted to support the other health emergency and humanitarian services in major hospitals in Mekelle city. We were trying our best to maintain these emergency services, especially for laboring mothers and their children, critical trauma patients, and those that in need of emergency surgery.

We were bringing health workers from their homes with our own cars to provide support for emergency and critical cases. There were also many people coming from the fields and nearby towns, the wounded people who had been affected by the heavy artillery, aerial bombing, and war. These casualties were also being treated in the emergency services. Even though there was a critical shortage of medical services, we were trying to bring any available medications from other stores and even local private stores to find essential emergency medication for those services.

What is the role of leadership and policy in emergency response?

I think during emergencies, the role of leadership is vital. In an emergency, everything is chaotic so no one understands the issues of the people suffering from illness, trauma, different accidents, psycho-social problems, etc. If a good leader comes, you can overcome some of these challenges even in the presence of multifaceted catastrophic emergencies. So the leadership role is especially vital in early warning, emergency preparedness and response, and post emergency recoveries. And in Tigray, in addition to the COVID-19 pandemic, the catastrophic war was also creating unexpected challenges with a complicated health and humanitarian crisis. In both those kinds of emergencies (COVID-19 and catastrophic war), leading health care delivery systems is difficult and needs smart and talented leadership and analytical skills, and knowledge of how to approach people and serve in the middle of catastrophic emergencies when people are struggling to live or die. A leader who can scan, focus, align, and mobilize resources, inspire the health workforce, plan, organize, implement, and monitor and evaluate is badly needed during this type of complex emergency, social and humanitarian crisis.

What types of skills and knowledge did you find the most useful to addressing the situation?

I learned the value of the strategic triangle in dealing with such type of unprecedented situations; negotiation and diplomacy, bridging especially the influence model. We reduced many disastrous factors by just talking to people diplomatically. By understanding their concerns, people will cooperate with you and support you. If you just approach them through honest diplomacy, even rival groups will give you resources and things that you need, as much as they can. For example, in this issue, some of the combatants were arrogant and they were killing civilians. We tried to approach their leader and talked to him politely, asked why they are killing people and after many conversations we convinced him and he ordered his troops to stop killing civilians, especially the young people in the town. He also cooperated with us and gave us one ambulance for the transportation of pregnant women, and allowed the ambulance to move even during the curfew time. In most of my experiences what I’ve learned is health diplomacy is an excellent agenda and should be incorporated as a discipline in our health system.

I think I benefited from the IPPHL training. I used it to convince these military personnel and heads to let us continue emergency services and avail ambulances for patient transportation. In communicating with them, I practiced leadership, management, and governance skills to convince stakeholders. We worked with the security forces and local people as well in hiring youth volunteers to support patients. We especially used the strategic triangle in identifying the critical challenges and potential support from partners and local communities, and collecting feedback from those consumers to ensure continued emergency and humanitarian services.

Can you tell us a little more about working with the youth volunteers?

The COVID-19 response needed youth engagement. We were training the youth volunteers to provide health education, especially to advocate handwashing and physical distancing practices in large markets and social gathering areas. We were in touch with those volunteers but when the war began, it was difficult to find them; we had to search for them one by one, and if we found one they could call their colleagues. we engaged some of them to support their people in IDP centers in shelter preparation, wash facility arrangement, and food items distribution. They were also supporting their people during the war by bringing pregnant women to hospitals for delivery, and wounded people from hotspots to health facilities, so it was great to engage those youth during that difficult time. Most of them are energetic and eager. Later, in the middle of the war, the military tried to search for and arrest the youth, so most of them had to hide. The youth were instrumental during the early time of war, they supported the system as much as they could and contribute a little to some of the unprecedented emergencies.

How did your team transition to the emergency services work in that time?

At that time we were forced to be compassionate. We were alone in Tigray, our families were in Addis, we had no communication with them, and we had no choice but to face the challenges in Tigray and provide some possible services to our communities there. We were a team. We were staying in one apartment and we were dispatching from that apartment to different facilities. There was a curfew; no one could move after 6 pm. So we had to respect those curfews because the security forces would shoot you if they caught you after 6pm. Even with ambulances you were not allowed to move. So my team was sacrificing just to save lives there taking risk of death at any time by anyone. I think my other team members were also the best of the best, better than me even.

This isn’t your first time working in emergency response. You’ve previously worked in Liberia to combat the Ebola crisis. Were there any lessons that you took from your experience there?

During the Ebola outbreak in 2014 to 2016, every media platform was sharing horrific images of the outbreak in Liberia, Sierra Leone, and Guinea. The United Nations and African Union called for support, and I was one of the volunteers who participated. My team arrived in Liberia in December 2014. And at that time every public and private facility was closed so there were functional health facilities in Liberia. And when we arrived, Monrovia was a ghost city. It was quite a special experience for me to be there, at that time. On our arrival there, no one moved in the streets; it was a horrific city to be in. We were trained by the Africa Union, US CDC, and WHO, and we engaged with the Ministry of Health and other partners operating there to support the response. Eventually we succeeded and contributed in eliminating Ebola in West Africa.

And in my experience there, I found myself in a critical environment with complicated emergency which is the Ebola pandemic. I was thinking only about Ebola, and the preventive and control measures. But during my experience in this Tigray issue, COVID-19 was there, circulating in the community, as well as devastating war. You don’t know who is going to kill you, what’s coming, you don’t know anything. There isn’t any information on what’s going on around you. I learned that policy makers, especially the UN and other international organizations, should think of actions to make emergency areas accessible. It can be war, flooding, or earthquakes; any emergency should be accessible as soon as possible without any limitations with security or other hindering issues. In Tigray we were facing two challenges, disease and the other man-made issue. The system should create some sort of response modality to address both of those issues so human suffering and casualties can be reduced. That is what I learned from this.

What advice would you give others looking to become leaders in emergency response?

Those who are thinking of being engaged in emergency response should be patient, critical thinkers, and impartial and neutral in any circumstance. Everyone can cooperate with you if you are impartial, if you are neutral, if you are honest and genuine, and if you can share genuine ideas to the community during emergencies. We should also develop leadership practices, like inspiring, critical planning, monitoring and evaluation, implementing, being accountable, and being loyal. The other thing is that anyone who is engaged in emergency response must be smart in surveillance and disease intelligence as well as a quick responder and analyzer. Patience is also equally important during emergencies. If you are rushing you may fail to reach the goal you planned. Teamwork is also an essential component, especially creating a functional team that can work under pressure for long periods of time, sometimes even without food, water, or sleep, and in full PPE.

Is there anything else you’d like to share?

I will add that the situation in the region is still catastrophic. The UN’s security council is in a meeting concerning the Tigray region of Ethiopia, so for me, I think the international and regional community and other organizations should influence the combatants to restore at least the basic social services including health services to avoid the health and nutritional related hunger, deaths, and other catastrophes in the region. Currently (as of 09 March 2021), only 20% of all the health facilities are operational. And even those 20% are not fully functional; only their emergency services are functional. I’ve seen women and children being raped and beaten and having their arms and legs cut by the warring forces. People are suffering while the international community is reluctant to take measures against the warring parties. There are about 6-8 million people in the Tigray region, and they need food, medicine, health care workers, clean water, and shelter and other basic amenities. There is also no transportation to deliver life-saving commodities. The forces are preventing delivery of life saving commodities from reaching those most in need. There is no power, phone, or internet connection in almost all zones, districts and towns. I just want to pass some message to the global community that; these human rights violations, war crimes and crimes against humanity should be addressed as soon as possible before it escalates to the worst scenario. Delays to take swift action may cause unprecedented outcomes and may be one of the most unseen deadliest genocides in human history during the 21st century. ‘May the Almighty God save the people in sufferings and return their peace at the most possible time’

I thank you so much!

National Nutrition and Obesity Week: Good Nutrition for Good Immunity

The IPPHL team recently had the chance to have a conversation with Ms. Rebone Ntsie, a Cohort 2 Fellow, about her work and the influence IPPHL has had on her growth as a leader. As the Nutrition Director at the National Department of Health, South Africa, Rebone recently led the 2020 National Nutrition and Obesity Week, and shared some of her insights on the campaign with us.

Could you give us a brief overview of the campaign and the goals you aimed to achieve?

We have had this campaign every year for at least two decades now. It has been documented on the website nutritionweek.co.za since 2011. And this year it was around June that we started to say look we need to focus on COVID, but what about COVID? Nutrition was very important. People everywhere were talking about boosting your immune system, but not really understanding how to do so, and getting a lot of misinformation. So we wanted to guide the public in terms of what is critical.

One of the issues that came across very strong was that of food insecurity. In our country we have always known that we have food insecurity, but during COVID it became much clearer. Some people could no longer go to work, they didn’t have anything to eat. And what was concerning is that we knew already that those people who are worst affected by COVID are those that have NCDs. We know that unhealthy diet is one of the major risk factors for NCDs. We also know that the immune system is affected by nutrition, hence the theme of the campaign was Good Nutrition for Good Immunity.

We wanted to use this opportunity to assist people in terms of what they can actually do to boost their immune system. We emphasized the health benefits of choosing healthy whole foods from a variety of mostly plant-based foods such as vegetables and fruit, legumes and minimally processed starchy foods, encouraged consumers to make healthy, affordable food choices and most importantly we provided consumers with practical tips when planning, buying, preparing and eating food during and after the COVID-19 pandemic. And we included messages on promotion of breastfeeding, which we know is the most nutritious and affordable food for infants and young children. So those are the tips we focused on. Educating people about healthier food choices, how to buy healthy food with less income. Speaking a lot on home cooked meals, with recipes and tips on how to buy in bulk. We even had a two week menu with a list of groceries, and one of the organizations we worked with had developed nutrient dense recipes with affordable foods. Just to give people practical tips. And I think it resonated well with a lot of people. We wanted to educate them that boosting your immune system is not this thing that you do today; you drink this concoction, and your immune system is boosted. It’s something you need to invest in, that you need to do continuously.

What additional challenges did COVID present?

The campaign is in October, so from January, we were already thinking and starting to prepare. What was different this year? We had prepared the concept document, and already started working on evidence, agreed on what we want to focus on, which was nutrition labeling. Then come March, we realized that COVID is becoming serious. We continued thinking maybe by June it will have ended, but around May we realized we would be appearing stupid, to be honest, if come October we’re still talking about nutrition labeling when people are concerned about COVID. So we needed to be relevant.

We’re also used to having these physical events, and especially in local events, we usually gather people to do demonstrations and exhibitions. So we were not sure about how then to do this campaign. On our own, honestly, we wouldn’t have managed, but because we had different people in the team with different expertise, that helped us a lot. For example, one of the target groups we wanted to reach was youth and through UNICEF we managed to get them involved as well, and to use methods that are exciting to them. UNICEF has 2,000 volunteers across universities, and we prepared material for them to share easily. The material was also sent to dietetics university students to share. And I can tell you that we received a lot of financial support for this campaign. We could actually get organizations that we were working with to invest in our campaign, because they saw it as a benefit for them as well. It was at a time when everybody really wanted to contribute.

What was your role in the campaign?

My main role was to provide strategy and leadership; guiding all collaborators in terms of what to do, what’s next, and how to get there. What I was doing was mainly coordinating all the activities, chairing all the meetings, and negotiating with different organizations. But it was truly a team effort to bring the campaign to fruition. I would certainly want to recognize my colleague, Ms. Maude de Hoop, who was the secretariat of the whole campaign and played a major role in the creation of essential materials such as the concept document and Q&A.

What were some of the organizations you worked with?

Besides the Department of Health in all provinces in the country and the South African Military Health Service (SAMHS), we had a lot of non-governmental organizations we had already worked with (Association of Dietetics in South Africa, Nutrition Society of South Africa, Heart and Stroke Foundation SA, Cancer Association of SA, Consumer Goods Council SA), and new ones (Grow Great, UNICEF, Clinton Health Access Initiative). We also had two individual volunteers. Ms. Liezel Engelbrecht who volunteered to develop the communications strategy, was involved with us for the first time as well. So, some were new but they did an excellent job.

We also have been working with the Department of Basic Education for some time because school-going children have always been one of our targets. But for the first time this year we also worked with the Department of Social Development, because we knew that food insecurity is an issue and they are the ones responsible for social protection measures. A lot of their clients are on social relief programmes, so these are the people that are worst hit. We thought a lot about how we can package this in a way that’s sensitive to the needs of these people, and about how do we include them in our campaign? So Social Development came in very handy to really reach people that we usually don’t reach and that need us most.

How did you balance all the different organizations?

What was key was to reach consensus, which frustrated some of our collaborators, especially the new ones who were not familiar with how we work. It takes a little bit of time to reach consensus but for us that is important because once all of us have bought in we are all able to move forward on the same page. We needed to make sure we were all aligned and communicating the same messages. We used tested messages, we didn’t just take them from anywhere, so this was very important.

We also created a collaborators checklist because we wanted all collaborators right from the beginning to indicate who they were, what their role would be, what we should expect from them in this campaign, and declaration of any conflicts of interest. And that’s something that worked well and we plan to build on it and make it even better.

Could you tell me a little more about your plans for evaluation of the campaign?

We have always wanted to have a proper M&E framework to look at what it is we want to achieve and check at the end of the campaign if we’ve done that. We lack the resources and capacity to do it, but it’s something we still want to do. However, now on an annual basis we have a feedback meeting to see how the campaign went in terms of material, if things happened on time, and what we can do better next year. For the first time this year we have the informal measures about what we’ve done. We developed a short template that our collaborators can fill out to give us an idea of what happened, how many people we reached, where, and so on. Also for the first time this year a team of experts piloted a tool they have developed to do a Social Behavioral Communication Change (SBCC) evaluation on our campaign. We are hoping this campaign changes behavior, but we don’t have the mechanisms to check if it really does. So the SBCC evaluation will identify opportunities for improving the campaign in the future in terms of planning, designing, implementation, and monitoring and evaluation.

What skills did you gain from IPPHL that you found relevant or useful for the campaign?

Bringing in organizations reminded me of the elevator pitch that we did. Because one had to think quickly to identify the relevant organization and what to say. The stakeholder analysis that we did as well; who are the stakeholders, who are likely to bring progress rather than derail, and defining their role. And then with that I could then be able to explain to them what this campaign is, how it enhances the work that they’re doing, and what type of help we need from them. And they did even more than we could have expected within a very short period of time.

I think more than any one thing that I learned from IPPHL, what IPPHL has done for me was to provide me with the confidence that I needed. In IPPHL I have been given the skills and have been capacitated to lead and influence others. So, I knew what to do, and I was confident in what I was doing. I think because of that I was able to work with others very well and inspire passion in people; really influence them to drive the change that we all want to see. This program really has benefited me; it has enriched me I must say.

Have you interacted with the other IPPHL alumni near you?

I used to work with Mr. Daddy Matthews at the provincial level, and now I moved to national, but we collaborate on a very regular basis. We exchange information and plan activities. And Dr. Eva Mulutsi is my friend; we work at the national level together. We don’t work together closely because she works in forensic mental health, but we support each other in terms of strategy and management issues and leadership; share ideas and draw on each other.

Do you have any advice for women looking to become leaders in public health?

The main thing for me is I think as women we don’t have to doubt ourselves. We have the capacity to lead. And let me mention one thing that came very handy from IPPHL: adaptability. In your mind you know that things are not stagnant; and so you have to think of when you will need to adapt and how to do that. And that’s one thing that’s prepared me. I wasn’t resistant to change and I can tell you that all technical staff in the nutrition directorate have now adapted to working from home remotely. We came up with tools and we actually think that maybe we should continue this way because we have adapted to these new ways of working. One of the things that I still do is I read the articles from CCL, and a lot of material that they post talks about change, adapting in the environment, so that has also helped me. And some of those things I share with colleagues as well.

Category: IPPHL