Impact: How have health workers had an impact in Senegal?
Awa Coll-Seck: It is often the doctors, midwives and nurses – those who hold diplomas – who are recognized as true health workers. But there are many others, including community health workers and volunteers, who are just as important to our health system.
For example, in Senegal, we rely heavily on Badien Gokh, or community godmothers. Their main objective is to address and resolve reproductive health issues within their communities. They provide counseling to pregnant women and encourage them to give birth in facilities with qualified personnel.
Sixty to 65 percent of women in the country give birth in facilities under the supervision of qualified personnel. This means there are still many women who give birth elsewhere, which contributes to our high maternal mortality ratio.
Badien Gokh talk with women about breastfeeding, encourage mothers to take their children to get vaccinated, and provide advice on family planning. They play a very important role in our health system. But they are not paid – they are volunteers.
ADEMAS, PSI’s newest network member, has been operating in Senegal since 1998. ADEMAS is implementing programs, in partnership with the Government of Senegal, in reproductive health, family planning, HIV and AIDS, nutrition, malaria, and water, sanitation and hygiene. With the support of USAID, ADEMAS has turned its focus toward marketing products and services, using its expertise in consumer and provider marketing to expand the market for contraceptives in Senegal. Through communication campaigns (TV, radio spots and road shows), community mobilization, door-to-door visits and more, ADEMAS is overcoming barriers to family planning use, access and advocacy.
Impact: What are the main challenges that Senegal’s health workers face?
ACS: Senegal has health worker shortages in nearly every professional cadre. For example, we have one midwife for every 2,500 women of reproductive age. Compare this to the World Health Organization’s recommendation of one midwife per 300 women.
We have three main challenges in addressing these shortages. The first is recruiting and hiring adequate numbers of health workers. We have recently recruited 1,000 qualified individuals, 500 of whom are midwives. Nearly all of these recruits will be sent to remote areas.
This leads to our second challenge: geographic disparities. Approximately 75 percent of our health workers are in urban areas, while 60 percent of our population lives in rural areas. We need to create more incentives for health workers to move to those rural regions, including making sure there are good schools for their children. We need to decentralize resources and ensure that rural areas can develop the infrastructures they need.
The third obstacle is the retention of personnel in these remote areas. We are striving to retain health workers by ensuring that they have what they need, they are not overworked, and tasks are appropriately shared and shifted to lessen the burden on all health workers.
Impact: How do international NGOs and other partners help strengthen your health workforce? What are some examples of successful partnerships?
ACS: A perfect example of our successful partnership with NGOs is around family planning. A year and a half ago, the contraceptive prevalence rate in Senegal was about 12 percent. Through the joint efforts of the Ministry of Health, NGOs and our other partners, we have already increased that rate to 16 percent. Our goal is to reach 27 percent by the end of 2015. It is truly a team effort – we work like one big family.
While we could, of course, use more funding – both international and national – to truly achieve our goals, we are fortunate to have partners who are in touch with our realities and who work to support our programs with us, and not against us.
Many of our successful initiatives are based on multisectoral partnerships with a variety of international and local partners.
International NGOs such as IntraHealth International have helped us to recruit personnel, especially in under-served areas; to build the skills of our health workers; and to create online training courses so that health workers can maintain their credentials.
Another great example is the informed push model. This strategy, which is funded by the Bill & Melinda Gates Foundation and Merck, and implemented by IntraHealth, uses the distribution channels of the private sector to ensure that contraceptive methods are always in stock and available in even the most remote health posts and health huts.
This is how we want to continue working. By drawing on the strengths of all partners and sectors and ensuring that the work is well coordinated, we can truly benefit the entire population of Senegal.
The interview with Minister Coll-Seck was conducted by Awa Cheikh Seye Ndiaye, IntraHealth International, Senegal.
Photo: Céline Nataye Sow manages the Sampathe Health Post in Thiès, Senegal, which serves almost 20,000 people. Under her leadership, the post has been renovated and has reduced waiting times. (Credit: © Clément Tardif/Courtesy of IntraHealth International)