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Produced for LMC-TVbyFran Snedeker |
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Produced for LMC-TVbyFran Snedeker |
Good health is an elusive goal for most people in the West African nation of Guinea, one of the world's poorest countries. Most Guineans depend on a public health system that struggles to provide even basic services in the face of enormous threats from malaria and HIV/AIDS. Because most health centers lack even the simplest equipment and often are poorly run, Guineans who become ill turn to traditional healers or do not seek care at all.
Yet a model partnership between EngenderHealth and an important local mining company has dramatically improved the quality of health care available to the residents of Boké (a mining area in northwestern Guinea), who are now using the health centers there in greater numbers than ever before. Its example of how a for-profit company, a nonprofit organization, and the local health system can work together for the common good.
Guinea faces serious economic and political problems, but the nation does have a thriving bauxite mining industry, particularly in the remote northwestern region of Boké. (Guinea possesses more deposits of bauxite—one of the main components of aluminum—than any other country.)
Yet despite the employment and income that mining offers, the region as a whole remains very poor and has weak public health facilities. While mining company employees live in relatively comfortable company housing, most of Boké's people reside in mud huts or shanties scraped together from tarpaulins and tin. The government-run health centers often lack electricity or running water. And despite the bustling towns that have sprouted up around the
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mining complexes, the majority of people live in remote areas that in the rainy season become largely inaccessible.
The two biggest health problems in Boké are malaria and HIV infection. Malaria is a major cause of death and illness in Guinea and is the leading cause of death among infants. While the official national HIV infection rate is 2.8%, the rate in the mining areas is estimated to be
4.7%. A key factor behind this alarming statistic is prostitution, which thrives in the proximity of the mining complex.
In addition, Boké's maternal mortality rate is a staggering 5.2 times higher than the national figure, which is already one of the highest in Africa. Many maternal deaths can be attributed to complications from abortion, which is illegal in Guinea. This suggests a large unmet need for family planning, reflected in the region's contraceptive prevalence rate of only 3% (far below the national figure of 14%).
Recognizing that the mining communities in Boké are in desperate need of quality health care, the Guinean corporation Compagnie des Bauxites de Guinée (CBG) formed an innovative partnership with EngenderHealth in 2001. With funding from the Alcoa Foundation, a charitable foundation with connections to CBG, EngenderHealth and CBG worked with local public health authorities to improve health services for the high-risk population surrounding the mining complexes.
To meet Boké's urgent health needs, EngenderHealth expanded and integrated available services. In the five health centers, which together serve a population of more than 360,000, EngenderHealth trained staff in a variety of skills, including contraceptive technology updates and malaria control and prevention.
Yet most Guineans seek out traditional healers or do without health care—often because they view established health centers as
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unsanitary, poorly managed, and operated by unskilled staff. For this reason, simply expanding services was not enough: EngenderHealth's mandate was to transform these centers so they could better serve the needs of the community.
Through extensive training in EngenderHealth's quality improvement approaches, including COPE® (which stands for client-oriented, provider-efficient services), the staff learned how to take ownership of and solve problems, resulting in better management, increased efficiency, and a customer focus that respects clients' rights. In addition, the training that staff received in basic infection prevention practices dramatically improved the cleanliness and safety of the health centers. Now that they have learned the skills to protect themselves and their clients from infection, staff are able to care for HIV-infected clients without fear.
EngenderHealth also engaged in an extensive public education campaign to promote healthy behavior across the region. We trained 130 peer educators, who traveled to homes in remote areas spreading messages about HIV/AIDS prevention, malaria, and family planning. And because decision-making power belongs largely to men in Guinea, EngenderHealth applied strategies from its globally lauded Men As Partners program to this project. By working with imams (Muslim religious leaders) and local radio programs, we engaged community leaders and other trusted voices to reach large groups of men with messages that will help them safeguard their own and their partners' reproductive health.
These comprehensive efforts, ranging from the regional to the community level, have yielded positive changes in the health facilities and among the providers. Improved infrastructure, infection prevention, and better clinical care practices have made health centers safer and more effective. Thanks to EngenderHealth's training and assistance, health workers are better supported and exhibit strikingly improved attitudes both toward their work and toward their clients.
The EngenderHealth-CBG project has proven to be a model worth replicating. Mining companies in two other districts recently invited EngenderHealth to help them enhance the health of residents in their surrounding communities. This is good news for the people of Guinea, who stand to reap great benefits from these innovative public-private partnerships.
Moustapha Diallo is Program Manager of EngenderHealth's Guinea program.