By Mandy McAnally, PSI
At Fortune’s Most Powerful Women Summit earlier this month, Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, said, “When we invest in women and girls, we are investing in the people who invest in everyone else.”
We were there to highlight the importance of health workers just as the Ebola outbreak forced the world to recognize the massive shortage of health workers — 7.2 million worldwide, according to WHO. In Tanzania, it’s about 90,000. A 2007 United National Human Development Report showed there were only two doctors per 100,000 residents. By comparison, there were 2.4 physicians per 1,000 people in the U.S. in 2009.
In Tanzania, PSI provides family planning, as well as maternal and child health services, through a franchise of clinics called Familia. When most of us think of franchising, we think restaurants like McDonald’s. Social franchises are a similar business model as restaurant and retail franchises, just applied to health care. PSI recruits privately owned health facilities into its Familia network, improves and standardizes their services, and provides recognizable branding that people in Tanzania trust.
Health workers are the backbone of health systems, and from what I saw on my trip, women are the backbone of the health workforce in Tanzania. I met four women who inspired me in the quiet yet powerful ways they are making their communities stronger for future generations.
Blandina: community health worker, adviser, entrepreneur
Blandina’s roots run deep in her community of Salasala, about 20 kilometers from Dar es Salaam’s city center. When her husband died last year, she and her three daughters felt lost. His death ended a loving 38-year marriage. The quiver in her voice reveals a wound that will never fully heal. But she smiles recalling the unexpected outpouring of support from her neighbors and friends at his funeral. Many were the families she had counseled as a community health worker with the Familia franchise.
When I met Blandina, she talked earnestly about her work. She is a vital part of Familia. She goes into the community and educates women about their family planning options and other health issues. Some days she meets a family at their house, others she hosts sessions at Mico Salasala, her local Familia clinic. I sat in on one of these sessions with about 20 other women, men and babies.
You could call Blandina a feminist. She was a champion and early adopter of family planning in the 70s. She raises chickens as a side business – she showed us the coop in her front yard. She says her biggest advice to her daughters is to remain economically independent. And she is in her element when she’s wearing the orange Familia tee shirt and helping a woman plan her future.
Joyce: nurse, male circumcision provider, friend
Joyce puts people at ease. She speaks better English than she gives herself credit for, and she is an adept nurse and manager. A normal day for her is spent at Shinyanga Regional Hospital, a government-run facility where she has worked as a nurse for several years.
When I met her she was the site supervisor for IntraHealth’s HIV outreach clinic, and providing around 10 voluntary medical male circumcisions per day. These mobile outreach clinics are set up in remote areas for several weeks to raise awareness about and provide free voluntary medical male circumcision services. Males age 10 and older can receive the procedure.
Joyce personally walked me through each station, explaining how it all worked. All clients join a group education session to inform them about the procedure and answer any questions. Then, they go through a one-on-one HIV counseling and testing session (testing is optional). Finally, they undergo the 15-minute circumcision procedure in a tent large enough for four clients at a time. While the procedure is short and simple, the implications are enormous. Male circumcision can reduce a man’s HIV risk through heterosexual sex by 60 percent. Joyce and her staff are providing a critical service to people with no access to a health center for miles.
The days are long and the heat will drain anyone, but Joyce tells me she makes herself available to run the mobile clinic whenever she can. As I leave site, she makes me promise to return to Shinyanga. I tell her I wouldn’t miss the chance.
Lucy, community health worker, mother, teacher
My favorite photo of Lucy, a community health worker in the Mbgala area of Dar es Salaam, catches her in a moment of thought. She’s standing on the porch of a modest apartment building, having just explained to an audience of 10 women the benefits of family planning and the options available to them through PSI’s Familia franchise.
My colleagues and I are having an entertaining conversation with group of women who attended Lucy’s session. They tell us how many children they have and whether they want more. One of the women asks me if I’m married and how many children I have. Another tries to guess the age of my colleague. The first guess comes in at 60 to dismay. He’s a young 47. Most of our new friends have two to three children and a couple of them want at least one more. About half of the group is using family planning techniques.
Lucy was recruited by Familia when she was working on a committee to support vulnerable children and orphans. She has worked with the nearby Mbgala Mission, a privately owned clinic that is part of the Familia franchise, for several years.
She tells me about a couple she counseled to use family planning. The husband agreed that it was a good decision for his wife to get an intrauterine device (IUD). She saved some money. But an unexpected expense came up, and the woman spent it without telling her husband. When she got pregnant again, her husband didn’t believe it was his child and forced her to leave. When Lucy met her, the woman was on the edge of suicide, but Lucy wouldn’t let this happen. She got in touch with a social worker who counseled the woman. In the end, she had the baby and today she has the long-term method she intended to get.
I wonder how many stories like this that Lucy could tell me. They drive her to keep doing what she is doing. At the end of the day, she wants her community to be healthy and that will only happen if the women around her are healthy, she says.
Sophia: mother, convener, advocate
Most Tanzanians, I learned, really appreciate when you try to speak Swahili – even a few broken sentences get a big smile and laugh. It’s the effort that counts and it unlocks their warmth and exuberance.
The most outspoken of the women we met through Lucy was Sophia. She told us how she got a hormonal implant just a few days before, because of what she learned from Lucy.
Sophia is quick to laugh. She’s 32 with two daughters. Her husband is a truck driver and is on the road most of the time. He was working when we visited. They live in an apartment building with a dozen or so rooms separated by concrete walls with curtains as doors. There is a little courtyard where laundry hangs across ropes strung from roof to roof.
Before she got the implant, Sophia used oral contraceptives. She has been an outspoken advocate for family planning and often lends her front porch to Lucy for small group education sessions. But she admits a long-term method wasn’t an easy sell because the upfront cost seemed high. IUDs and implants cost about 5,000 shillings, or $3. However, these methods are effective for three to 10 years, with no monthly refills. Lucy kept dropping back by Sophia’s apartment, giving more information to her and her neighbors. Finally, Sophia felt comfortable and informed. When she did get the implant, the owner of her local Familia clinic recognized Sophia’s role in motivating others to consider family planning and gave her the service for free.
If I had an opportunity to chat with Lucy, Sophia, Blandina and Joyce one more time, I would say thank you. Tanzania faces its share of health challenges but seeing what these strong women are doing makes lofty goals feel within reach.