Getting to zero

Nurses integrating services to put HIV on the retreat in Kenya

Editor’s note: Part of a special series on the global health workforce, in partnership with the Frontline Health Workers Coalition. Checkout #HealthWorkersCount on Twitter for more from coalition partners. Issue No. 18 of Impact, focusing on the global health workforce, launches next week. Caroline Atieno grew up watching the AIDS epidemic burn through the coastal towns

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The secrets of Starbucks

PSI and MSI Launch Social Franchising eLearning Course

By Christine Bixiones, Technical Advisor, Sexual Reproductive Health & TB Department Twenty years ago in Nepal, the first modern example of social franchising for health – the application of commercial franchising strategies to achieve public health goals – began expanding access to quality health services. This year, PSI and Marie Stopes International, two organizations that have

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Handwashing in Action

By Chris Mallaband, Unilever

Every year, 2 million children don’t live to celebrate their 5th birthday. You can help change that by donating today. Better yet, Unilever will match your donation so it will go twice as far. Go here to donate today and read on to learn more.

PSI 3Every year, 2 million children don’t live to celebrate their 5th birthday. You can help change that by donating today. Better yet, Unilever will match your donation so it will go twice as far. Go here to donate today and read on to learn more.

Chris Mallaband is the Unilever Foundation Global Ambassador for PSI. Chris traveled to Kenya in June 2013 to visit schools participating in the Lifebuoy ‘School of Five’ handwashing program. This is day one of his experience at the schools.

The day I have been especially looking forward to is here. Today we will visit some of the schools in Kenya that follow the Lifebuoy ‘School of Five’ handwashing program. Helping children learn handwashing habits is a noble mission indeed.

Our destination is the Likoni region of Mombasa, stopping off on the way to talk with the Mombasa Ministry of Health before we reach the schools.

After finishing a rapid breakfast, we are off to visit the Ministry. It’s immediately apparent that the Mombasa traffic is just as challenging as that in Nairobi. We spend a lot of time standing still, giving the hawkers plenty of opportunity to stare through our windows and offer us anything from cakes to knives, and fruit to toys. Sadly for them, none of us are up for a deal.

We meet with Dr. Shikily, the Director of Health for the Mombasa region, and her team. Following the recent national elections, Kenya changed from 8 regions to 47 counties; a change in strategic direction perhaps going against the grain of most organizational design you see nowadays. Dr. Shikily explained to us how this has made her life much more complicated to get things done. We then discuss how Unilever, PSI and the Kenyan Government could collaborate further, to enable ever greater positive impact all round.

With the discussions concluded, it is time to tackle the short ferry that shuttles motorists across Kilindini Harbour. The ferry is a renowned bottleneck in the already-suffocated Mombasa transport system and lives up to its reputation. Back on land, our driver Peter skillfully avoids the stray goats and cows on the local roads, and we enter rural Likoni reaching our first school, Bethania Academy.

Bethania is a private school but a relatively inexpensive one. A look around the local community reveals that this is far from the land of milk and honey.

We receive a warm welcome from the headmaster and his pupils, who recited their Lifebuoy ‘School of Five’ pledge to us with wide smiles at an impromptu assembly. Two children in each classroom have the opportunity to be appointed as “Little Doctors” – kind of captains of handwashing practices. The pair has the responsibility to remind their classmates of the key times when they should wash their hands, and how they should do it.

Christine tells me how proud she is to be a little doctor. She kindly walks me from school to her nearby home to meet her family. To my surprise, the house is, in truth, really a few basic rooms within a communal building – certainly a way away from how I might have perceived a private school pupil to live.

Nine dwellings share three basic toilets, and all the rooms are separated with thin curtains. Her father Charles, a salesman, tells me how Christine educated the family on handwashing with soap based on the program that she has followed at school. Now, he, his wife and Christine’s sister all follow the ‘5 key occasions’ rules of washing their hands before the three main meals, after using the toilet and when in the bath.

As we depart, Charles introduces me to his neighbor Patrick. Charles says that he trained Patrick on the benefits of handwashing with soap, and how to do it properly. Here was community transference of behavior change being demonstrated in true community-led style.

After high-fives with many of the pupils at Bethania, it was time to move on to another school in Likoni district and, against the odds, to visit a state school. Despite a national teachers’ walkout, the headteacher of the fantastically-named Inspirations Primary School reported for duty so that she and her pupils have the chance to meet us.

We are ushered to the school hall, absent of seating and lighting. The children proceed to give us their Lifebuoy ‘School of Five’ pledge before a few of them act out a self-written play. The characters show how the learning materials come to life.

Another small group step forward to sing a song to us about the hope and potential that children can bring. Hearing these words sung within the surroundings of the basic facilities in which we stood was truly uplifting.

Inspirations by name and inspirations as pupils.

I greet the children with our thanks and stress the need for them to sustain what they learned. I am delighted when the headteacher tells me, as we leave, that the program has helped to increase school attendance by reducing sickness among the pupils.

Our final stop of the day is one particularly close to my heart. Having provided voluntary sports commentary for blind spectators at cricket matches in the UK for a number of years, I was especially keen to visit Likoni School for the Blind. It is one of only two schools for blind children in Kenya, and was founded in collaboration with the British Salvation Army back in 1965.

The familiar Salvation Army badge still adorns a number of the buildings. It presently has around 150 boarding pupils, with around 20% of these being albino children, for whom life in the country in which they live is an extremely tough challenge. The children here also completed the program, and it was great to see the enthusiasm that they had for the characters and the concept. Once more I spent some time with the ‘little doctors’ at the school.

A boy named Rufus tells me that I too must make sure I wash my hands at all the key times. I promise him that I will, and we shake hands on it.

A busy day behind us, we look forward to a straightforward journey back to our hotel. Just under three hours after we started what we thought would be less than an hour’s drive, we eventually reached it. Enough said.

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A Humble Bar of Soap

By Chris Mallaband, Unilever

Every year, 2 million children don’t live to celebrate their 5th birthday. You can help change that by donating today. Better yet, Unilever will match your donation so it will go twice as far. Go here to donate today and read on to learn more.

PSI 4If you happen to have the dubious pleasure of knowing me in person, you will know there aren’t too many occasions which render me speechless.

Today was one of those rare occasions. And then it happened twice.

After a quick bowl of wimby porridge (a brown-coloured Kenyan specialty made from sorghum), it was time to leave the Voyager Hotel and head inland to the Changamwe region of Mombasa.

We had the opportunity today to make two more visits to local primary schools. At just after 9am we pulled into the entrance leading to St. Irene Primary School in Mikindani. Before we could even see them, we could hear the children, singing joyously in Swahili. As we turned the corner, we could see two lines of multi-coloured shirts, hands clapping in time to the beat, which turned to wild cheering as we got out of the cars.

I can kind of imagine now what it’s like for One Direction when they rock up outside a venue. We walked into the school with the children offering us high-fives from their receiving lines. Just incredible.

Within the school, headteacher Sister Masha gave us a gracious and grateful welcome. We signed the visitor’s book, and were invited to come and formally meet the children in the assembly hall. They sat obediently on the floor; at the back it was standing room only.

Anthony Okoth, Deputy Country Representative from PSI and I both addressed the children, talking to them about the ‘School of Five’ program which they were mid-way through. We tested their knowledge of the five occasions and the characters who represented them. Tens of hands flew into the air within milliseconds of me asking each question. And each one was answered correctly.

After our remarks, we were treated to a song the school wrote about the handwashing program. Eight children stepped forward to the front of the room to sing it directly to us. The joy on their faces from such close range was something which I think I will never forget. Huge smiles and eyes wide with joyful emotion as they sang each verse at the tops of their voices.

Kenya’s Got Talent. And no shortage of spirit.

We then went to see one of the handwashing lessons taking place. The year six pupils watched the ‘glow germ’ demonstration created by Lifebuoy to show the impact of not washing hands with soap. This entails four children having a white powder applied to their hands. Two then rinse their hands with water and two wash them with water and soap.

Upon inspection under a special torch, it is apparent that the hands rinsed with water still have various germs, invisible to the naked eye. The hands washed with soap though, have none.

The children were suitably impressed by the clever technology. As was I! I am learning myself too on this trip that a quick rinse under a cold tap is never good enough….

We said fond farewells, and shared a few more high-fives with the ever-smiling pupils. Next stop was a state school close by. It soon was clear to us that Kipmevu Primary School is a special place.

First, they stayed open today – risking animosity from their fellow striking teachers – to ensure that they could honor our visit. Second, we received another speech-defying welcome. Two lines of pupils greeted us, this time with more of a Swahili chant than a song. Even the teachers joined in!

Andrea Edwards, Manager of Corporate Marketing, from PSI broke into a short dance with one of them as we made our way through the receiving lines. A special bridge-building moment.

Third, there are more than 900 pupils here, ranging from ages 3 to 14. The school is located next to Kalahari, a well-known slum area within the region, where standards of living are at their lowest. Mr. Kombo, the headteacher, told us that 85% of his pupils are from families who live in Kalahari. Some get home after school to find that their parents are absent through arrest. Older ones often become the ‘parents’ to their younger siblings. Mr. Kombo explained that children often miss school or arrive tired because they have been up late selling alcohol for their parents the night before.

An assembly was organized outside on the barren land in the middle of the school buildings. There were a few parents, many carrying babes in arms, in the audience too. Once more, we were treated to a short performance from some of the pupils, enacting a play where the characters who feature in the Lifebuoy ‘School of Five’ comic book are depicted.

The play was performed with gusto. One child gave a particularly convincing imitation of vomiting (the risk if you do not wash your hands with soap), which amused both her fellow pupils and us.

The Lifebuoy ‘School of Five’ pencil cases which we handed out to those who performed in the play were very gratefully received. Despite the circumstances in which these children live, it was clear to see that their enthusiasm was abundant.

I had the chance to chat to Enoch and Jackie, co-incidentally a local health worker, who were two parents of children at the school, to get their perspective. Both were very positive and believed that what their children learned will remain lessons for life.

Even in her profession, Jackie admitted that prior to the Lifebuoy handwashing program coming to the school, she did not use soap on the five occasions that it teaches, and sometimes didn’t even use water.

We said goodbye, and headed to Mombasa Airport, for a quick team lunch. Our friends and colleagues from PSI and the Kenya Ministry of Health were leaving us at this point. A few short speeches were made, and then it was hugs and handshakes all round amid commitments to various streams of follow-up in the coming weeks and months.

We took a group photo, and then Mallika, Stacie, from the Lifebuoy Social Mission team, and I headed into the terminal to fly to Kisumu, and start the next leg of our Kenyan adventure.

The main reason why I wanted to be a Global Foundation Ambassador was to see the work being done on the ground in places like Changamwe and Likoni. My experiences over the past two days have made a deep impact on me. I feel inspired by advocacy on handwashing such as the Help a Child Reach 5 campaign.

The realities of life in these areas have been very apparent, but so has the enthusiasm and energy of those who live here. I am convinced the handwashing program has scalability, and that the behavior change we are trying to drive can be sustained in the regions in which we drive it.

There is hope in my heart that the humble bar of soap, where Unilever first began its journey in 1888 in my own place of work of Port Sunlight, can genuinely be a lifesaver for many years to come. In the first year alone the partnership has reached more than 1 million people. It will continue to be expanded globally to help achieve Lifebuoy’s mission of improving the handwashing behavior by reaching 1 billion people by 2015. But we all need to play our part to make it happen.

Tomorrow the Kericho tea plantations beckon, as the trip takes a turn back towards my day job as it nears its conclusion.

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I Pledge to Wash My Hands and Just Chill

By Jackie N. Presutti, Assistant, Corporate Marketing, Communications & Advocacy, PSI

Every year, 2 million children don’t live to celebrate their 5th birthday. You can help change that by donating today. Better yet, Unilever will match your donation so it will go twice as far. Go here to donate today and read on to learn more.

PSI 2“Mzungu! Mzungu!” The school children come running from all directions, smiling, laughing, pointing.

“What are they saying?” I turn to ask Bihawa Swaleh, MCH Marketing Assistant, from PSI’s Nairobi office.

She chuckles a little, “Mzungu means ‘whitey’.”

“Well said.” I thought, as I burst out laughing.

Here I am, this short little blonde girl from the States, carrying a backpack full of camera gear and hand sanitizer, standing amid a sea of Mombassa’s school children. My first trip to Africa, my first trip to see PSI’s work in the field, and I kind of feel like a celebrity.

The children of St. Irene’s private primary school in Changamwe line up in front of us, stretching out their hands for high-fives. That’s why I’m here after all. To see these clean hands, the fruits of a growing partnership with the Unilever Foundation, Lifebuoy, the Government of Kenya and PSI, implementing the ‘School of Five’ handwashing with soap program in coastal schools.

Working with outstanding members of PSI Kenya’s team- Bihawa, Aloise Gikunda, Maternal Child Health Officer, and Wandera, I’m on day one of the advance trip, preparing for a visit from Unilever’s Foundation Ambassador Chris Mallaband, as well as our partner leads Mallika and Stacie, who arrive in two days time to Mombassa.

With the Ministry of Health, we’ve outlined four schools to conduct the program visit- two public and two private, split between the Changamwe and Likoni regions. It’s an opportunity to showcase the successes and challenges in the Likoni schools which completed the ‘School of Five’ program, and the Chagamwe schools that are just beginning.

I clutch our itinerary tightly in hand, with instruction that I need to update it with details such as traffic time, time spent at each activity, and driving routes.

Whenever I inquire with the coast team on timing of events, details, personnel, they shake their heads at me, “No problem, just chill”.

We’re on coastal time, Bihawa reminds me, so things will happen as they happen. This advice would turn out to be a serendipitous pep talk. It’s as if she foresaw that the evening news would announce a nationwide teachers’ strike, and we would throw our itinerary out the window.

The next morning, day two of our advance, we all pile into the Tunza truck with team members of the local Ministry of Health, and set out for the Likoni ferry, making a few attempts to stop at schools along the way to deliver Lifebuoy ‘School of Five’ materials. We find most schools deserted or locked due to the strike.

After 45 minutes crossing the ferry, we plan to spend the afternoon visiting unsuspecting private schools, meeting with head teachers, and inquiring if there is any way they could show off their School of Five activities- tomorrow.

At Bethania Academy, our first stop, I was shocked at Head Teacher Peter’s response to our request. “Yes, of course, welcome. Tomorrow is good. We will show you now as well”.

Peter escorts us to classroom full of eager students, excited by the group of visitors. A young girl, Christine (who we would get to know more during our official visit), walks to the front the classroom and begins her ‘little doctor’ duties. The class immediately stands at her instruction and recite the handwashing pledge.

Students bring a jug of fresh, clean water, and a basin to the front of the room. The teacher lays a bar of Lifebuoy soap on the desk. One by one, they come forward and take turns proudly showing off the handwashing method taught by the School of Five program, and talk about how their families now all wash their hands. We are healthier and safer, they tell me.

I stand in the corner amazed, realizing that there was no rehearsal or preparation to what we are seeing and hearing. This is how the Lifebuoy ‘School of Five’ program is helping these beautiful kids remain in school longer and create healthier lives in their communities. I raise my camera to eye in an attempt to hide my ear-to-ear grin – and maybe a tear.

Feeling great about our visit, we head to a well deserved break with an incredible ocean view. Our lunch, while delicious, takes about two hours. It makes me think that the wait staff was actually on a fishing expedition to catch what we had ordered.

I anxiously glance at my watch, remembering again the time table in the car, and imagining the growing traffic lines to board the ferry back to the hotel. Fully satisfied from our meal, I begin my usual tense DC jaunt back to the Tunza truck.

We’re now an hour behind schedule and the team is slated to arrive with more PSI staff in a few hours time.

Aloise laughs in my direction. “Polepole,” he says, resting his hand on my shoulder.

“Huh?”

He reminds me again, “On the coast, we walk polepole- it means slowly. Slow down, no rush here. We’ll get there. Everything will be ok”.

Polepole, I repeat to myself. After all, this team somehow managed to even get two proud public schools to agree to stay open during the strike. I breathe deep and think, “Yes, they do this all the time; they save lives and host important guests and sweat nothing. Yes, this is the coast, just roll with it.”

I stifle the urge to start belting “Hakuna Matata”, and get ready for our next few days of adventure.

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Pocket Full of Soap

By Andrea Edwards, Manager, Corporate Marketing, PSI

Every year, 2 million children don’t live to celebrate their 5th birthday. You can help change that by donating today. Better yet, Unilever will match your donation so it will go twice as far. Go here to donate today and read on to learn more.

PSI 1This pledge has been playing in my head for weeks since we left Kenya. To demonstrate my sincerity, when I returned from Kenya the Justin Timberlake song, “Mirrors” had just come out. I was in the car singing at the top of my lungs, “Cause with your hand in my hand and a pocket full of soap”. I stopped singing, laughed, and thought ‘that certainly cannot be the lyric.’ And sure enough when I checked later that day I confirmed my suspicions, the line is actually “soul” but after my trip to Kenya, I like my version better.

“I pledge to wash my hands with soap and running water every day, on the five key occasions. High five!”

Rinse and repeat.

But hey, I’m getting ahead of myself. Let me start from the beginning.

Working with Unilever Foundation, Lifebuoy (the world’s number one germ protection soap) and the Government of Kenya, PSI implemented behavior change programs in schools and communities promoting handwashing with soap. Lifebuoy actually started handwashing programs over 118 years ago and created the ‘School of Five’ program using soap and specially-developed communication materials, to help change behavior through fun handwashing programs and activities.

Children learn that handwashing is important by making the process fun. Comics, games, handwashing diaries, reward stickers and posters encourage handwashing with soap practice at five important occasions and provides children with exciting new knowledge to share at home. The balance of education and entertain in this program are working to reduce some of the more than 2 million deaths from childhood diarrhea every year.

Chris Mallaband, Capability Building Manager for the Unilever Supply Chain Academy, was chosen from 1,500 applicants to become a Unilever Foundation Global Ambassador for the PSI partnership through the Unilever Foundation Challenge, a company-wide initiative designed to build employees’ awareness of and engagement with the Unilever Foundation and its global partners. He won the opportunity to visit a partner program and see how Unilever Foundation’s support is making a difference first-hand. He joined a team from Unilever and PSI in Kenya with the goal of sharing his experiences with the Unilever community.

We kicked off our trip in June with a panel Q&A session attended by 50 Unilever Kenya employees. Wanjiru “Ciiru” Mathenge, Child Survival Marketing Manager, represented PSI Kenya, I represented PSI global , Mallika Kaviratne, Global Partnerships Manager, represented the Unilever Foundation and Stacie June Shelton, Lifebuoy Global Social Mission Program Manager represented Lifebuoy Global Social Mission.

We discussed the strong partnership between PSI and Unilever, particularly around the Lifebuoy School of Five program. Chris then spoke about his role as the Foundation Ambassador and his lifelong admiration of Kenyan distance runners.

We then drove – stop and go in the famous Nairobi traffic for an hour – to the PSI Kenya office. Around a conference table we discussed the ‘School of Five’ program, opportunities and challenges and how we were going to take this program to scale. It was invigorating and set the stage for what we were about to see. After several hours we had to pry ourselves away to rush to the airport where we set off for the Mombasa region along the Kenyan coast.

There we saw firsthand how the partnership is promoting health and hygiene to help save lives. Over the next two days we visited five schools in Kenya that adopted the Lifebuoy ‘School of Five’ program, sang the handwashing pledge in English and Swahili, met hundreds of spirited school children and saw twice as many hands being washed with Lifebuoy soap.

Over the next few days you’ll hear from my colleague Jackie on with it means to be polepole and how that philosophy helped her acclimate to an unexpected teacher’s strike. You’ll also hear from Chris, the Unilever Foundation Global Ambassador, on his perspective after visiting five schools in two days and how this experience deeply impacted his life.

As for me, I know one thing for certain; I will never stop singing “pocket full of soap”.

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Handwashing in Mombasa: Making an Impact with Unilever

This originally appeared on the Unilever website.

In 2012, the Unilever Foundation launched the Unilever Foundation Challenge, a global initiative designed to build employees’ awareness of and engagement with the Foundation and its global partners.

Chris Mallaband, Capability Building Manager for the Supply Chain Academy at Port Sunlightin the UK, was chosen from 1,500 applicants to become a Unilever Foundation ambassador last year.

Along with five fellow global ambassadors, he won the opportunity to visit one of the Unilever Foundation’s partner programs, see how our support is making a difference first-hand, and share his experiences.

In June of 2013, Chris visited the Mombasa region of eastern Kenya, where he learned how the Unilever Foundation, Population Services International (PSI) and Lifebuoy’s partnership is promoting health and hygiene to help save lives.

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Kenyan Condom Ad Sparks Debate

A television advertisement in Kenya led to a public outcry against it and a national debate over how to encourage condom use.

The ad features two women who are gong about their daily routine. One of the women is having an extramarital affair. The second advises her to use a condom in order to prevent the spread of sexually transmitted infections, such as HIV.

Critics decried the ad saying that it promoted extramarital affairs rather then condemning them. The government responded by taking down the ad.

“There are better ways of passing useful information to society. This one has certainly failed,” said the Kenyan Anglican Church’s Bishop Julius Kalu to the Daily Nation.

“It openly propagates immorality, especially when all family members are gathered before television sets, waiting to watch news,” he continued.

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How We are Preventing Cervical Cancer in Kenya and Zimbabwe

By: Alexandra Steverson, Program Assistant for the Southern Africa Region*

Globally, one woman dies every two minutes from cervical cancer. As the second most common cancer among women, there are 530,000 new cases every year. The developing world is disproportionately burdened by this disease - 86% of cases occur in developing countries where prevention services are limited or unavailable. In some environments, the mortality rate is as high as 52%.

We know that infection with one of many strains of the Human Papillomavirus (HPV) is a leading cause of cervical cancer. The good news is that it can be prevented. Screening and treatment of pre-cancerous lesions is the most cost effective method of preventing the disease and creating positive health impact in low-resource settings. However, less than 5% of women in developing countries have accessed screening services. With simple, low-cost interventions, organization like PSI can improve health outcomes for a population that is often neglected, women around the world.

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Measuring the Impact of PSI/Kenya and DfID's LLIN Partnership

PSI/Kenya and the UK Department for International Development (DfID) have collaborated on the social marketing of insecticide treated bednets since 2001 through grants totaling £90 million. An analysis of the first 9 years of the program finds that PSI/Kenya distributed over 17 million Long Lasting Insecticide Treated Bednet (LLINs) and sold 2 million LLINs in urban markets under the Supanet brand.

A review of the program from DfID earlier this year finds exciting results.

The impact of these efforts on malaria in Kenya has been dramatic. Malaria admissions to hospitals in sentinel districts halved between 1999 and 2006, while under-5 mortality has fallen by 44%. Experts agree that most of this impact can be attributed to nets (most of which have been funded by DFID), complemented by the government’s US-backed IRS campaign. The project has thus achieved its goal to ‘Reduce malaria related morbidity and mortality among vulnerable populations’…This is one of DFID’s most successful health programmes, thanks to PSI’s tight management and efficient distribution, as well as to its skills in communication.

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PSI/Kenya Partners to Provide Fortified Food to 27 Million Kenyans

Last week, PSI/Kenya joined the Kenya Ministry of Public Health and Sanitation and the Global Alliance for Improved Nutrition (GAIN) to launch a national behavior change communication campaign that will seek to educate Kenyans on Fortification and its health benefits. PSI/Kenya has worked with The Ministry of Public Health and Sanitation, The Kenya National Food Fortification Alliance (KNFFA) and partners  in the design of the consumer awareness and education campaign that will teach Kenyans about the benefits of food fortification and how to identify the fortified foods by looking out for the Food Fortification Logo (attached). The fortified staples include; Maize meal, Wheat flour, Sugar and Edible oils.  GAIN is providing financial and technical support to the overall Fortification program.

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