There’s No Place Like Home (for Receiving Healthcare)

by Stasia Obremskey, Maverick Collective Member

The toddler peaked around the corner to gaze at the strange women sitting with his mother in the unfinished room of his house. His father sat in the adjacent room watching a local soccer match on TV. The toddler went back and forth between the two rooms, as his big brown eyes took in one very familiar scene, and one that was very strange to him.

Marta, the mother of the toddler, had another six-year-old child and wanted the opportunity to choose if and when she had any more children. Her priorities now are the two she already has. Luckily, she lived in a village three hours north of the capital of Mozambique that was served by community health workers (CHWs) who shared information with her on various family planning methods and provided her with a choice of condoms, oral contraceptive pills and, most recently, Sayana Press, an injectable contraceptive that combines the drug and needle in an easy to use cartridge and lasts for three months.

My sixteen-year-old daughter, Grace, and I were two of the strange women sitting with Marta that afternoon. We were in Mozambique to listen and learn about the challenges and opportunities for introducing Sayana Press into several rural and urban areas of the country.

Grace and I are members of Maverick Collective, an international group of women that are committed to investing in women and girls in developing countries with our partner Population Services International (PSI).  Working with the PSI country office in Mozambique, we developed and funded an innovative pilot project to test three key assumptions:

  1. With training and supervision, Sayana Press could be safely administered to women by community health workers rather than doctors or nurses.
  2. Women in Mozambique would be willing to pay a subsidized price for any method of contraception and a service fee for a home visit by the CHW.
  3. This network of CHWs, clients and their transactions could be tracked by two way communications facilities through a proprietary SMS network called Movercado.

That day, Grace and I tagged along with Ilda, a community health worker, as she made her rounds to several villages. All of the clients she saw that day had first been counseled and screened by a nurse at a Tem Mais clinic in a nearby village.  Tem Mais clinics are private-sector family planning clinics where clients pay a subsidized price for health care. After counseling on various family planning methods, the clients I visited that day had selected Sayana Press as their choice of method.

PSI is developing the Tem Mais clinics as a alternative to the public health centers. In Mozambique and other countries around the world, PSI is creating consumer demand for high quality healthcare in the private sector.  As rising wealth allows consumers to purchase goods like flat screen TVs, motorbikes and other “luxury” products, these same consumers will demand high quality health services and be willing to pay for them.

Every Tem Mais clinic has 15-20 community health workers assigned to the clinic. The CHWs are all well respected women in the community who receive compensation for referring clients to the clinic. These women also receive extensive training on counseling for all family planning methods and clinical instructions on how to safely and effectively administer a Sayana Press injection.

As Grace and I watched the toddler dart back and forth between the two rooms, Ilda and Marta talked about her next injection of Sayana Press. Ilda underlined that  this method did not protect against HIV transmission. Marta asked for and received both male and female condoms and Ilda demonstrated the proper use of the female condom. Once the counseling session was over, Ilda washed her hands, swabbed Marta’s upper arm with an alcohol pad and injected the small needle into Marta’s arm, pushing down on the drug-filled well for five seconds.

After safely disposing of the spent cartridge. Ilda picked up her phone and sent an SMS message to the network to record her visit, noting the date and Marta’s telephone number. In a few moments, Marta’s phone buzzed and the network sent back a 4-digit code. With this code, Ilda confirmed the visit and the network automatically recorded when she would need to return to the village to administer the next dose. This SMS network, called Movercado, sends reminders to Marta about when to expect her next visit and allows for Marta and Ilda to communicate between visits if questions come up. Finally, as we were preparing to leave, Marta paid Ilda 30 Metical (20 Metical for Sayana Press and 10 Metical for the home visit). This is the equivalent of about fifty cents in US dollars.

As we departed the little boy ran to his mother and once safely in her arms, waved goodbye to us. During that home visit, Grace and I had seen the three innovative elements of our project in action: administration of Sayana Press by the CHW, payment for a home visit, and the Movercado network recording the transaction.

The addition of Sayana Press to the menu of family planning options for women like Marta should help increase the contraceptive prevalence rate in Mozambique. The government’s goal is to reach 25% by 2020. In order to achieve this goal, additional short and long term methods will need to be available as well as access to public sector and private sector facilities and home visit options for women to receive their care. Most importantly, we need to ensure that a timely and reliable supply of Sayana Press continues to be available for women who have made this their choice of contraception.  The Gates Foundation and others have negotiated a global price of $.85c per Sayana Press injection to select countries.  This affordable option has tremendous possibility for women in Mozambique.

Maverick Collective is an initiative of PSI, a global health non-profit with operations in more than 50 countries. Maverick Collective is a philanthropic and advocacy initiative to end extreme poverty in our lifetime by investing in girls and women. Our mission is to build a community of strategic philanthropists and informed advocates who use their intellectual and financial resources to create change.

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Stasia Obremskey, Maverick Collective Member
Stasia has more than twenty-five years of experience providing financial and strategic planning consulting to organizations in the U.S. and Asia. She joins management teams as an interim Chief Financial Officer to provide finance, accounting and strategic planning expertise to startups, fast growing companies and nonprofit organizations. As a philanthropist, she holds leadership positions with Upstream USA, the Gladstone Institute, Room to Read, and the Chinese American International School.

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