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.
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
• 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.