By: Amiry Abdallah Kaiza

I am a health advocate and I believe in evidence-based advocacy. My name is Amiry Abdallah Kaiza. I live in Tanzania in a district called Kibaha Urban and in the Pwani Region.I am trained youth advocate under the Youth Leaders for Health Program under the leadership of Health Promotion Tanzania- HDT.

Why did I decide to do a survey?

Since the eruption of the COVID-19 pandemic, we have experienced a lot of changes in Tanzania and globally as well. Many countries went into lockdown and nothing was going on. Restaurants and bars were closed, sports games were banned, international travel through ground and airplane became difficult, schools and universities were closed and so many things became stagnant.

Tanzania did not introduce the lockdown strategy as many countries have done to curb the spread of the virus. Tanzania introduced some partial measures including: compulsory quarantine for fourteen days for people coming from outside the country (arrivals), closing of all schools and universities, working from home and banning of all sports activities. The introduction of these measures has brought some changes and difficulties in the country. Some have lost their jobs and income; some s feel isolated and humiliated. Due to the negative impacts caused by the pandemic, the organization I work with, Tanzania Red Cross Society decided to conduct a baseline survey to determine the impacts of COVID-19 on girls in Tanzania with a focus on education, sexual and reproductive health, WASH (Water Sanitation and Hygiene) and child protection. We wanted to determine how children and young girls have been affected since the emergence of COVID-19.

Survey design

The survey is planned to run throughout one month starting from 1^st June and winding up on 30^th June, 2020. We have formed a team of 5 people, composed of two men and three women aiming to perform 600 surveys i.e. 120 surveys each. My survey focuses on Impacts of COVID-19 on education, sexual and reproductive health, WASH and child protection in the rural and urban communities in Pwani, Tanzania.  The survey contains 82 questions and involves the collection of first hand data through phone interviews. My organisations helped me sort out respondents where the main criterion was for the gender status of the respondents to be female. Soon after the selection, I was handed their phone numbers from the organisation database.

So far, I have already interviewed 90 respondents, girls and women. I have interviewed children involved in school clubs and their parents or guardians. I collect both qualitative and quantitative data based on the survey collection tools. The work has been overwhelming but enjoyable. My target is to interview at least nine respondents a day allocating approximately thirty minutes per person. Talking throughout the day has been a bit difficult for me because even though I am a trained health advocate, I am not used to talking to people every day and for many hours. Talking! Talking! Talking! This is my daily routine these days.

On the other hand, I find myself enjoying the experience because I am learning and identifying new things happening in my community daily.  For example, one day I was interviewing a female parent in my region. I posed a question, asking her to tell me the challenges young girls are facing especially this time when schools are closed. She responded by telling me that, in her village at least four school young girls are pregnant because currently they are not busy with studies and find themselves having nothing to do to keep them occupied. I felt so sad when I heard this news. I started thinking about how they are going to continue with their studies, how are they going to cope with the changes in their bodies because they are still young. I had so many questions popping in my head.  I thought about how irresponsible and predatory the men who had caused this were – seemingly taking advantage of the COVID-19 times.

Apart from that, and in terms of education, I have identified that some girls do not have people to help and teach them their school subjects at home making them miss a lot of knowledge and sad enough, they do not have access to radio and television where they could attend programmed classes through listening or watching. Also, many parents and guardians are very shy to educate their young girls on sexual and reproductive health leading to poor self-hygiene.  Families have adapted a new culture of washing their hands with clean water and soap every time taking into the consideration the guidelines issued by the Ministry of Health to avoid contracting the COVID-19 pandemic. Despite the fact there is new adapted way of living, many girls facing the challenge of the availability of sanitary pads in their homes unlike when at school.  On the other hand, child labour has emerged in some families due to life hardships. Some parents think this is a golden opportunity for them to utilize their children in businesses they are involved.

I sense a complex interaction between protection of the girl child, economic survival of households, and availability of items so strengthen hygiene and sanitation and fear of a ravaging disease.

I have been tasked to make sure that I fill all the information captured from the respondents. This is challenging work because I need to be very careful and settled in order to avoid missing data. Soon after completing data collection, our organisation will take the lead to analyse the data obtained through SPSS and Microsoft Excel systems.

The final results of the analysis will be used to influence and advocate for change in the community through the formation of new strategies to address the needs of young girls and children during the time of COVID-19 pandemic.

For sure, this survey has made me think about phone advocacy as a method that could be exploited especially during these times of pandemic. Because it is quite cheap and less time consuming since you only need a phone and the contacts of people you want to deal with

My advice to Youth Leaders, every day and every time is to strive to enjoy and learn from what you are doing. You will find that it is possible to accomplish your goals and became successful.

I am grateful, to Dr Sylvia Anie, a mentor, who instilled in me the need for data, for evidence to guide advocacy. In her words, “When you are able to collect and use evidence, your message as a health advocate becomes sharper and more acceptable” unquote.

Thank you.

By: Aliu Iddrisu

I am a self-motivated person who aims for positive change.

I strive to contribute to a world of respect and gratitude.

My name is ALIU IDDRISU.

I live in the Northern Region of Ghana and I am currently a student at the Tamale Technical University studying Computer Science.  I am a trained Youth Leader for Health. The youth leaders for health program is a one year leadership development program put together by Results UK alongside Hope for Future Generations (Ghana), CISMAT-SL (Sierra Leone), Health Promotion Tanzania – HDT and WACI Health which seeks to support 25 young campaigners based in Ghana, Sierra Leone and Tanzania develop their skills and knowledge to advocate for accelerated progress to end malaria and strengthen health systems in their countries and globally.

Why do Governments exist?

Why should we allow children below 5 years old, pregnant women and vulnerable people die just because of a common disease that can be prevented, just because of the malaria?

Reflections

On the 11^th March 2020, I was admitted at the hospital because I had malaria. On the third day of my admission, I went to the hospital pharmacy to get my medications. Something strange happened when I was at the pharmacy.

A man came in with his sick pregnant wife. There was a nurse at the Hospital entrance who takes every patients or visitors’ temperature as you entered the Hospital. When she checked the pregnant woman’s temperature, I think it was hig

When the nurse came out and he asked what was going on, the nurse said she suspected his wife was infected with COVID-19. The husband said; “It can’t be true. I am a nurse too and I know very well the signs and symptoms of COVID-19. She only has a high fever and I suspected malaria and did a home test which turned out positive. So I had to quickly rush her here for treatment and you are telling me you suspect COVID-19. How can that be possible?

her than the normal temperature. The nurse quickly put on her gloves and face mask and asked the pregnant woman to follow her. I drew closer to the husband and asked what had happened? He said he did not know.

The husband went angrily to the room where his wife had been asked to wait. The room had no lighting and no fan. He escorted his wife out of the room and realized all the nurses were pointing to his wife and shouting, she has CORONA VIRUS run. Then everybody, including me, started running helter skelter. Yes, even me as a youth leader and health advocate run upstairs and peeped through a window.

The man drove away with his wife.

Eight weeks later, I met this man again on a motor bike at a traffic light on my way home from work. I asked him what’s up now with his wife. He said; “Oh she’s fine and we even had a new bouncing baby girl.  It was not COVID-19. Look at how the nurse caused panic, driving patients away and immediately creating stigma for my wife. Let us talk later when we meet again”.

People tend to jump to wrong conclusions.

If the husband had not intervened and insisted his wife had malaria, his wife would have been isolated in a COVID-19 ward and taken through many tests whilst the malaria parasites increased in number putting his pregnant wife at high risk of serious illness and possible death.

In my world as a health advocate I need to have correct facts and figures especially in this present time where there is fear. Just because one symptom of the COVID-19 is high temperature should everyone with a high temperature be quarantined?

WHY SHOULD THAT BE SO?

Before COVID-19, over thousands of pregnant women, children below five years and other innocent vulnerable people died globally and are still dying  from malaria but our leaders don’t look out for that but are concentrating mainly on COVID-19.

I titled my piece “Why sentence pregnant women and children below five years to death” because seeing and allowing innocent people to die from a common disease that can be prevented is equally sentencing them to death.

This can be stopped if we allocate more funding to strengthen our health systems. Together we can live. As I mentioned earlier on, I am a self-motivated person who derives satisfaction through positive change and I strive to contribute to a world of respect and gratitude. Therefore I pledge to advocate for more resources to be allocated to our health system especially to fight against malaria.

GOD BLESS OUR HOMELAND GHANA

By: Ahmed Uzairu

I bring you greetings from the Nandom District in the Upper West Region of Ghana where we are experiencing a meningitis epidemic alongside the COVID-19 pandemic. I am a registered general nurse and a trained youth advocate under the Youth Leaders for Health Program. I live in the Goziiri community.

The Youth Leaders for Health Program is a joint initiative being implemented by Results UK in partnership with WACI Health, HDT-Tanzania, Hope for Future Generations -Ghana & CISMAT – Sierra Leone. We advocate for increased domestic resources for malaria elimination and strengthening of health systems.

My work as a clinical nurse in COVID-19 times

I faced daily challenges in my work before and now during COVID-19 and I presume the challenges will persist after COVID-19. These include the scarcity of drugs, diagnostic tests and vaccines, shortage of Personal Protective Equipment (PPEs), thermometers, pulse oximeters etc. This routinely compromises the quality of care and in COVID-19 times this has worsened.

There are patients quite ill referred from other district hospitals such as Lambussie and Sissala Districts and having to travel many kilometers to my hospital for basic care e.g. requiring intra nasal oxygen or pregnant women having to sleep in the open space overnight waiting for an obstetric scan the following day thus putting their lives at risk of contracting other diseases such as malaria, or people been referred to my hospital over many kilometers away for a routine CT scan or MRI or to see a specialist. Travelling can take up to days or a week adding to the cost of treatment, creating avoidable complications, preventable deaths etc.

Now, the patients don’t travel long distances to my hospital anymore.

COVID-19 has introduced fear of travel even for medical care. Therefore, there has been a sharp decline in both outpatients and inpatients. People who are unwell do not report for care and others report late when complications have already set in.

This week, a child convulsed for over an hour because other health facilities lacked anticonvulsants. The child travelled many kilometers to my hospital and by then other life threatening complications such as hypoglycemia and hypoxia had set him. Parents were reluctant to bring him to the hospital because of COVID-19. The child was saved.

A number of children under five years who have presented with malaria over the past 8 weeks had severe anemia as well. The gains made in the fight against diseases such as malaria, TB, HIV etc. could be lost if more investments are not made.

All in all, there are numerous challenges faced by health workers and our already weak and overburdened health systems.

Must governments wait for another pandemic before strengthening their health systems?

The answer is a big NO.

My work as a health advocate

There is much advocacy to do these days but there are fewer patients and fewer opportunities.

Vulnerable patients such as pregnant and lactating women, those with chronic medical conditions have been asked to stay at home for fear of exposure to COVID-19 in the hospital. So my target audience within the hospital has reduced.

As a clinician, it’s sometimes difficult to advocate especially when information and data you put together is confidential and cannot be used to advocate e.g. for increased resource. Sharing such information requires authorization. There seems to be more sensitivity in COVID-19 times with regards to evidence based advocacy.

My life within my community

Community advocacy has come to a halt because I spend long hours working in the hospital. Prior to COVID-19, I would organize small groups within my community and discuss and share ideas of keeping safe from malaria, improving hygiene and sanitation etc.

I am too tired these days.

The lessons learnt

My voice as a clinician, a health advocate and a community member has both conflicting and opportunistic moments.

Conflicting moments because I work in an ideal environment to advocate about health however, COVID-19 has taken away and reduced my target audience.

Conflicting moments because, my long hours at work make it difficult to advocate in my community.

I must think of new opportunities to talk about health. I worry about Health System strengthening.

Moving forward post COVID-19 and Health System Strengthening

What is a health system?

“A health system includes all the organizations, institutions and resources that are devoted to producing health actions whose primary intent is to improve health. A health systems vital functions are; Service Provision, Resource Generation, Financing and Stewardship.

Improved performance in controlling emerging and re-emerging diseases (i.e. malaria, HIV, Meningitis, COVID-19 etc.) in developing countries is dependent on the quality, equity and efficiency of health systems. Rapid progress towards targets for diseases elimination is greatly hampered by weak, poorly functioning or in some cases non-existent health systems.

What do we need to strengthen our health system?

• Investing in science, research and technology

African Governments must at least commit 1% of their GDPS to investing in science and technology as encouraged by the African Union. Investing into health system strengthening by increasing health funding is essential. Priority problems for health systems need to be identified and researched in relation to development goals and in consensus with policy makers.

• Procuring equipment and consumables

Availability of essential equipment e.g. CT Scanners, MRI and X ray machines, and other medical supplies is essential to help health care workers assess properly, diagnose accurately and treat promptly.

• Availability of specialized skilled health care workers

This should be prioritized to ensure people have access to quality health care without the burden of having to travel 1000s of kilometers.

• Domestic funding

Funding should be mobilized from within national health systems budgets rather than relying on donor support.

In conclusion, strengthening of health systems is urgently needed to ensure universal health care for all, particularly as the gains made stand to be eroded by COVID-19.

My voice will be increased in my three roles as a clinician, a health advocate and a community member. There may be conflicting times but I will also look for the many opportunities.

Reference: Strengthening health systems; the role and promise of policy and systems research, Alliance for Health Policy & Systems Research, Geneva, WHO, 2004.