Chimwemwe mu’bereki, (CU), or “Joyful Motherhood”

Chimwemwe mu’bereki, (CU), or “Joyful Motherhood”

Malawi
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
$10,000 - $50,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

We wish to address maternal mortality in Malawi by providing care to women during the perinatal period. With Bwalia Maternity Hospital, we identify women who become gravely ill during labor and deliver. We then train and provide nurses for these mothers' home-based care. We work with women's families and community to support mothers during convalescence and in caring for their newborn children.

About Project

Problem: What problem is this project trying to address?

Mothers giving birth in Malawi face grave risks. They are one thousand times more likely to die from pregnancy related deaths in Malawi than in the United States. One in 7 Malawian women is expected to die during childbirth from bleeding, infections, and diseases that complicate pregnancy or are aggravated by pregnancy, such as malaria, anemia and HIV. Many maternal deaths occur postpartum; and, when a mother dies, her baby often dies as well. Postpartum deaths are intricately linked with the health crisis in Malawi. Not only are the health indicators ranked among the worst in the world, but the health care system is crippled by the lack of clinical staff. Health services are available to the population through a combination of government facilities, facilities of the Christian Hospital Association of Malawi, and a few private for-profit facilities. Yet even the combined resources amount to 2 physicians and 59 nurses per 100,000 population. In 2006, the vacancy rate for nurses at the national level was 65%. In 2002 only 9% of health facilities were capable of delivering all components of the Malawian government’s Essential Health Package, including maternity care.
About You
Organization:
African Mothers Health Initiative
Visit website
Section 1: About You
First Name

Joanne

Last Name

Jorrisen Chiwaula

Organization

African Mothers Health Initiative

Country

Malawi, LLG

Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?

No

Section 2: About Your Organization
Organization Name

African Mothers Health Initiative

Organization Phone

202-494-9823

Organization Address

6808 Belford Drive, Takoma Park, MD 20912

Organization Country

United States, MD

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Your idea
Country your work focuses on

Malawi, LLG

Innovation
What makes your idea unique?

What we do is unique. In Malawi, apart from the overburdened and understaffed government hospitals, there is no organization supporting women and babies in the hours, days, months, and years following difficult births. By identifying high risk women and infants at the time of birth, CU is able to create a safety net filling in the gaps left by the formal health sector. We have threee primary programs:

1. Vulnerable Mothers Project: Trained nurses provide home based care to women who become gravely ill during the perinatal period. We help women's families and community to support them during convalescence and in caring for their newborn children.
2. Vulnerable Infant Project: Trained nurses regularly visit and care for high risk infants at home from birth to five years. These infants include those whose mothers died in childbirth, those whose mothers are critically ill perinatally, premature infants, and those whose conditions at birth may negatively impact their chance of survival.
3. Nurse Training Project: We retain, train, and supply local nurses to care for our client mothers and babies. In line with our commitment to complement services offered by the government, CU ensures that we not poach nurses from the government sector: we contract only with nurses who are employed full time by the Malawi Ministry of Health, and we pay these nurses a per diem. CU nurses will be limited to following two women or families so that CU activities do not conflict with official Ministry of Health duties.

Do you have a patent for this idea?

Impact
What impact have you had?

CU has accomplished a great deal in the past two years. With a single paid employee, Beatrice Namaleu, a retired Malawian nurse midwife with over 29 years of experience, Ms. Jorissen Chiwaula, and several volunteers both in Malawi and the US, we have provided in-home nursing care to over 80 infants and 30 postpartum mothers who otherwise would have gone without care. We have established and monitored three community feeding programs and worked with adolescents to support them in their education and community service. In a testament to the gap we fill, both the Baylor Pediatric HIV/AIDS Clinic and the University of North Carolina Perinatal Mother to Child Transmission Research Program have begun making referrals to our program. All of this has been possible with sub-optimal funding due to the commitment and passion of those involved. However, we are stretched to capacity and cannot continue to meet the needs of those we serve without additional support. With additional funding, and the knowledge that we have gained during our first two years of operation, we believe we can improve the efficacy and reach of our current programs, ensure they meet current objectives, and build organizational capacity for sustained impact. We have a ways to go to ensure that all high risk women and infants receive the support they need in Lilongwe, but we are committed to this work and are encouraged by the impact of our services thus far.

Actions

1. Identify at Bwaila Hospital 60 At-Risk Women
2. Scale-Up by Hiring and Training 10 Per Diem Nurses
3. Provide Nursing Bag and Supplies to Each CU Nurse
4. Visit Homes of At-Risk Postpartum Women and Infants Weekly and Monthly and Provide Needed Nursing Care:
a) assess the general health of the woman;
b)treat chronic conditions and infections that will lead to further debilitation of the mother;
c) identify and assess the general health status of her children, observe child care in the home, and provide care to the children in the home if necessary;
d) engage the woman in the assessment of needs of her home;
e) introduce the nurse to household members and community leaders; and
f) begin building a relationship and trust with the community.

4. Train Families in Recognizing Symptoms of and Referral for Difficult Labor and Maternal Morbidity (infection, malnutrition)
5. Map Community Resources Necessary to Preserve Maternal Health and to Prevent Future Catastrophic Births
6. Increase Contacts with Other Malawian NGOs to Strengthen the Operational Capacity of CU
7. Apply for Additional Grants to Sustain Funding and Activities

Results

• 60 critically ill women in the postpartum period will receive six home-based postpartum care visits by a trained nurse.
• 120 vulnerable infants of ill mothers will receive monthly visits and care by a trained nurse.
• 10 per diem nurses hired and supplied to assist with maternal and infant health activities.
• Liaise with Elizabeth Glazer Pediatric AIDS Fund to provide CU nurses with training in early HIV assessment for all infants in our care.
• 60 communities’ resources mapped and mobilized to better support the care and rehabilitation of postpartum women and children to prevent future catastrophic births.
• Chimwemwe mu’bereki (CU) receives from AMHI institutional capacity building that will result in project sustainability and program development with attention to greater transparency, data gathering, and data analysis and evaluation.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

While CU has short term indicators of success (nurses trained, mothers identified and visited at home by nurses, infants provided care), our ultimate goal is to reduce maternal mortality in Malawi. To accomplish this over the next three years, AMHI will work with the communities in which vulnerable mothers and infants live, to help these communities respond to and care for laboring women and critically ill mothers and newborns. CU aims to strengthen linkages between health facilities and communities. This will be accomplished in the first year through regular contact between the nurses and community members at home visits to mothers and babies. In the second year, our nurses will reinforce in the community need for routine health screening and timely referrals in cases of acute illness and difficult labor. In the third year, nurses will encourage knowledge sharing within the community, inviting participation of community members in interactive teachings on topics such as nutrition, child care, and hygiene carried out within the home of enrolled clients. Those present will be asked to demonstrate skills acquired and will be encouraged to create strategies for peer education within the community.

Over the next three years, CU also aims to associate needy households with appropriate social service programs operating in the catchment area. Likely beginning in year two, each CU nurse will meet with community leaders to learn about available resources (e.g. other community based organizations and community health schemes, cell phones, bicycles, vehicles, village pharmacies, etc.) in order to maximize utilization of available resources.

The success of our activities is based on close collaboration between the health care provider, clients and their communities, to ensure that vulnerable children obtain what they need to survive childhood: healthy mothers. Beginning in year one, when through our activities CU nurses identify children without mothers that the community is struggling to care for, the nurse will provide training, assistance, and supplies to the community in order to support those efforts.
We consider the community an active participant, rather than a recipient, in our programs, and we operate with the understanding that families and communities strive to provide the best possible care for their most vulnerable members.

What would prevent your project from being a success?

Three issues risk CU's success.
First, we run the risk of losing our focus. Our first years of operation have taught us much about clearly identifying the needs to which we can respond. For two years, CU ran two child feeding stations and paid school fees for some of the children in our program. We now understand that we cannot provide these services and simultaneously provide high quality postpartum maternity and newborn care. We have transferred our feeding stations to another NGO, and we have stopped paying school fees. With the savings generated from the elimination of these activities, we have accepted more at-risk mothers into our program. Yet, in Malawi, the need is so great for so much. It is ever a struggle to say "no" to the requests for help we receive.
Second, we risk having too little funding to meet the needs of our existing clients - and to increase our activities. We are lucky that we have consistently raised around $25,000 per year too support our activities. Just when the economic crisis reduced our donations last year, we received a small grant from a foundation to sustain us and to increase our services. But fund raising is ever a tenuous exercise, and we have many mothers and babies who rely on us. CU benefits from the fund raising efforts of AMHI's board.
Last, and somewhat related to the second issue, we are at risk of trying to do too much, too quickly. We must balance with our financial reality our moral requirement to scale up our services to reach as many mothers and babies as possible. We have faith that we can grow responsibly, and we hope our faith is well-placed.

How many people will your project serve annually?

101‐1000

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your project seek to have an impact on public policy?

Yes

Sustainability
What stage is your project in?

Operating for 1‐5 years

Is your initiative connected to an established organization?

Yes

If yes, provide organization name.

African Mothers Health Initiative

How long has this organization been operating?

1‐5 years

Does your organization have a Board of Directors or an Advisory Board?

Yes

Does your organization have a non-monetary partnerships with NGOs?

Yes

Does your organization have a non-monetary partnerships with businesses?

Does your organization have a non-monetary partnerships with government?

Please tell us more about how these partnerships are critical to the success of your innovation.

African Mothers Health Initiative (AMHI) is the sister organization to CU. AMHI exists to raise money for CU and to provide mentorship, advice, and direction for CU's activities. AMHI is a non-profit in the United States, and donations to AMHI are tax deductible under US law. CU is AMHI's only project, and AMHI handles all of CU's administration, grant seeking, and finances.

What are the three most important actions needed to grow your initiative or organization?

1. Obtain additional funding to support current activities;
2. Secure sustained funding to scale up activities to serve more vulnerable postpartum mothers and babies;
3. Connect with other Malawian non-profits to leverage our resources to provide a seamless net of services for our clients.

The Story
What was the defining moment that you led to this innovation?

The death of a laboring mother and her baby catalyzed the formation of US-based African Mothers Health Initiative (AMHI) and the Malawian sister nonprofit Chimwemwe mu’bereki, (CU), or “Joyful Motherhood”. In 2005, Gabriel’s mother traveled 40 kilometers from her village to Bottom Hospital, where she delivered a healthy baby boy, then died moments later. Her body was covered and Gabriel was sent to the nursery, where he waited for his grandmother’s arrival. Soon his grandmother arrived looking lost; a thin film of will holding back her tears and desperation. Shocked, grieved, and overwhelmed, she collected Gabriel in her arms and followed the ambulance carrying her daughter’s body back to the village. Once there, she struggled to care for the baby. No milk was available. No assistance was provided. Soon after, Gabriel was buried next to his mother.

Tell us about the social innovator behind this idea.

Joanne Jorrisen Chiwuala was born in Detroit in 1975. Her mom is black and was a Catholic nun. Her dad is white and was a Catholic priest. As a child, Joanne read City of Joy and felt inspired. She eventually graduated from McCallum HS and went to Brown University. While at university, she spent as much time as possible in Latin America and studied international development. She moved to Washington, DC after graduation and found a job at an USAID contractor. She decided after a few years that life in a cubicle was only one step above death for her. Joanne's friend suggested she become a midwife, and she thus found her passion. She graduated as a nurse-midwife from University of California at San Francisco, and she immediately decided to move to Africa. She came to Malawi, worked as a midwife at Bwalia Hospital, and had her heart broken by watching a mother and her baby die. Joanne founded AMHI and CU in response. Joanne is married to a Malawian who is attending medical school in Ghana.

How did you first hear about Changemakers?

Email from Changemakers

If through another, please provide the name of the organization or company