Tweet us @ScotlandMalawi #SMPhealthforum

Flooding Update

Tweet us @ScotlandMalawi #SMPhealthforum

1.15m people affected

336,000 displaced in the 3 most affected districts (Chikwawa, Nsanje and Phalombe)

104 deaths 645 people injured

172 missing in Nsanje

15 Districts affected

63,976 hectares of land flooded

Flooding Update

Tweet us @ScotlandMalawi #SMPhealthforum

Flooding Update

Tweet us @ScotlandMalawi #SMPhealthforum

Flooding Update

Tweet us @ScotlandMalawi #SMPhealthforum

Flooding Update

Tweet us @ScotlandMalawi #SMPhealthforum

1.15m people affected

336,000 displaced in the 3 most affected districts (Chikwawa, Nsanje and Phalombe)

104 deaths 645 people injured

172 missing in Nsanje

15 Districts affected

63,976 hectares of land flooded

Lessons in Partnership

EMMS International Emergency Flood Appeal

Gary Brough (Comms Officer)gary.brough@emms.org

Impact on Partners

• Loss of power at Mulanje and Nkhoma hospitals

• Damage to hospital facilities

• Increased case load at Mulanje – flood injuries, diarrhoea

• Patients and communities affected

• Anticipate long-term impacts because of loss of homes, crops and livelihoods

Response

• Partner-led • Based on firsthand

information, needs assessment

• Mulanje Mission Hospital – maintaining hospital services, preventing spread of disease

• Palliative Care Support Trust – Practical support through community based organisation

• Health focus

TimelineWebsite Traffic

Wednesday 14th

• 5pm – News from Mulanje

• Contacted partners to assess impact and ability to respond

Thursday 15th

• 10.40 – DfID confirm match-funding

• 13.00 – Agreement that partners and EMMS have capacity to respond

• 14.30 – Initial response and statement agreed

• 14.45 – Appeal launched • Website• Social media including SMS

donate• Shared press release

TimelineFriday 16th

• Article in The National

• E-mail Appeal

Sunday 18th

• Article in Sunday Herald

Monday 19th

• Article in Daily Record

Wednesday 20th

• Confirmation of Scottish Government Funding

Website Traffic

How it was possible

• Strong partnerships

• Loyal supporters

• Good press relationships

• New Website

• Responsive management team

• Two members of staff

• A lot of time on Twitter! #MalawiFloods

Results

• Able to help our partners• Over £53k raised so far• Contribution to long-term

projects through UK aid match funding

• International support• Partnership with Aid &

Development Botswana

• Relationships with diaspora, churches and other supporters strengthened

Lessons Learnt

• Value of being prepared• Local voices matter• Very short window, time

of the essence• Focus on resourcing

others to make the appeal

• Getting information is difficult

• Alternative sources• Pressure on partners• Communication (internet,

mobile phone, whatsapp)

Thank You

gary.brough@emms.org

Flooding Update

Tweet us @ScotlandMalawi #SMPhealthforum

Research in Practice

Tweet us @ScotlandMalawi #SMPhealthforum

ELDERLY CARERS: EXPERIENCES OF THE

ELDERLY CARING FOR ORPHANS AND

VULNERABLE CHILDREN IN CHIRADZURU

DISTRICT-MALAWI

Presented by Blessings Kachale, PhD Student,

QMU, E

(Photo courtesy of khym54/flickr)

Grandmother raising 8 children in Lesotho

RESEARCH PROBLEM

CONTINUED

It is estimated that 52% of the orphans (1, 277,399) in Malawi

are cared for by the elderly (AIDS Orphan report, 2007;

MICS, 2007).

Poverty rates are up to 29% higher in households headed by

older people (HAI, 2007); 65.3% live on less than a dollar/day

in CZ (UNDP, 2004a, .

Sixty-six percent of the EHH are food insecure (Conroy et al.,

2006) most of the HH caring for orphans are FHH.

Nearly half (49%) in FHH (Ainsworth &Filmer, 2006; FHH

are the most poor households (IHS, 2010; Nhongo, 2009;

Ngwira, 2001; OXFAM, 2001).

There is growing body of evidence that physiological changes

that come with old age can affect the capacity to engage fully

in livelihood activities (Barrientos, Gorman, and Heslop,

RESEARCH PROBLEM

continued

This study aimed to find elderly’s day to-day

experiences and livelihood survival strategies they

are employing to meet their basic needs in their

households to care for orphans in Chiradzuru district

where the population of orphans was over 45,000 in

2010 (CZ Development plan, 2008-2011)

Although all the carers may face similar challenges,

it is the dependence on able household members by

most elderly that make them vulnerable.

Research Methodology

Qualitative Case study design

Methods- Individual in-depth interviews and

Participant Observation with 10 Elderly Carers

(ECs)of Orphans and Vulnerable Children (OVC)

ages between 55-90+

Focus groups, 3 (1 with ECs not included in PO, 1

with ADC , 1 with

SSI with Key Informants (3) , and (11) stakeholders

(working in the study area)

FINDINGS

Age-based discriminatory policies

1. pro-poor policies - farm input subsidies,

2. village loans, goat revolving loans,

3. PWP, and community activities

4. HIV Awareness, SED,

5. Lack of social security - elderly friendly health services, old age pension/grants

Lack of support for organisations targeting the elderly -lacking funding to support ECs

Elderly abuse- within households and community,

FINDINGS CONT’D

Livelihoods

Low capacity to care between 75-90 years-mobility, old age disability affecting their role to care- Food and Income insecurity, poor housing structures and congestion,,

Income insecurity-High school-drop-out after primary school

Limited survival safety-nets, ganyu, small scale business contested- gender bias

Implications for policy &

practice

Hard to address poverty when the elderly are

excluded in strategies to attain food security and

poverty reduction

Gap between the well-offs and the poor as high

school drop-out among OVCs.

Both the elderly and the OVCs inadequately cared

for- health, nutrition,

Teenage pregnancy, high HIV/AIDS infections,

Recommendations

Govt to put in place comprehensive strategies

and well-managed pro-poor policies that can

reach all population groups including the

elderly

Speedy roll-out of Social Cash Transfer

programme

Govt to put in place policies and strategies for

support for Orphan carers- education

bursaries, childcare grants,

The youth should be part of the solution to

solve the food insecurity and livelihood -NYVC

Photo courtesy of khym54/flickr

A grandmother caring for 6 OVCs in

Tanzania

References

AIDS Orphan Report Orphan Statistics, 2007 available at http://www.avert.org/aidsorphans.htm Accessed

on 14/11/09

Aisworth M., Dayton, J., 2003 The Impact of the AIDS epidemic on the Health of older persons in the

North-West of Tanzania. World Development, 31 (1), 131-148

Barrientos A., Gorman, M. and Heslop, A. 2003. Old Age Poverty in Developing Countries: Contributions

and Dependence in Later Life. World Development, 31 (3) pp.555-570.

Demographics Life expectancy at birth in Malawi available at

http://www.indexmundi.com/g/g.aspx?c=mi&v=30

Chiradzuru District Development plan 2008-2011, June, 2008 Chiradzuru District Assembly, government

of Malawi

Cook, P.H., Ali, S., Munthali, A., 1998. Starting from strengths: Community care for orphaned children in

Malawi. Malawi: The International Development Research Centre, UNICEF Malawi and World Vision

Malawi.

Heslop, A. and Gorman, M.., 2002. Chronic poverty and older people in the developing world. Available

at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1754499

Help the Aged We will, 2008 Number of grandparents caring for orphaned grandchildren worldwide

doubles in ten years, September, 2008 Available at

http://press.helptheaged.org.uk/_press/Releases/_items/_Number+of+grandparents+caring+for+orpha

ned+grandchildren+worldwide+doubles+in+ten+years.htm. Accessed on 25/01/10

Contact Bkachale@qmu.ac.uk

Thank you for listening

Roseby Phalula, MSc on male involvement in loss in childbearing in Malawi

Men and loss: exploring Malawian men’s experience during emergency obstetric care and loss

Research questions What is men’s knowledge of

pregnancy complication that led to loss of mother or baby?

What do men do regarding care seeking during obstetric or neonatal emergency complication?

What are men’s perceptions of support:

Women received?

Men themselves received during emergency complication and loss; and life after tragedy.

Study design & sample

• Secondary qualitative analysis of interview/focus group data collected for larger study on loss in child bearing by Dr de Kok

• 7 men

• 11 FGD with….

• Urban & rural area

• Two districts in southern region

Findings

Male response to loss

• worried, • lonely, • helpless, • had anxiety due to the

unexpected problem, • lost trust in health

personnel,• Denial & disbelief• painful, • hard to forget because had

just lost another child

Extracts… I waited but there were no results to tell me whether the child was male or female. They stayed for a long time (inside). I just saw the doctor …but still no results. I saw blood on the gloves, blood in the hands and I thought my wife was not okay (Mr Simango R9 0069).

…..they said my wife was very serious. They made a phone call but they (Ambulances) were in Blantyre, working in Blanytre …… she died. It (the ambulance) didn’t come Until we carried our funeral on an oxcart, …and we brought the funeral here (Mr Simango R9 0069)

Findings cont.

KNOWLEDGE & CARE SEEKING

Men’s narratives alluded to various causes:

•‘Proximate/immediate causes’ eg severe bleeding

•‘distal causes’: e.g lack of transport.

heart to care for women: buy maternity material, escort women to H/C, wait at H/C, stay with children at home (request of wife), prepare porridge for women, phone calls for update

BARRIERS TO MALE INVOLVEMENT

• Lack of privacy in labour wards

• Women attended in isolation (men wait outside)

• Men given no updates

Barriers to men’s participation

Conclusions

• Several indicators point to men’s emotional and practical involvement in pregnancy, labour and loss :

• Various barriers obstruct men from being involved more fully

IMPLICATION

POLICY

• Need for clear policy and guide lines for male involvement in maternity care to guide service providers.

PRACTICE

• Health system need to change in terms of structure and service provision to involve men freely.

• Need to educate men on issues regarding pregnancy , labour and delivery, and new-born care in order to improve their knowledge and participation

• need for continuous staff training on male involvement

Providing the ‘right maternal care’ for rural communities?

Perceived Gains & losses in redefining TBAs’ roles in Malawi

Isabelle Uny, PhD Student

The problem I investigated:

The redefinition of Traditional Birth Attendants role (as a policy through the 2007 Guidelines for community initiatives for reproductive health) and its perceived effects on TBAs, women and their families.

The methodology I used:

A qualitative study using Grounded Theory

Methods: 65 Interviews & Focus groups in in 3 rural sites of Central and Southern Malawi (Mchinji, Nkhoma and Malosa), in villages, rural health centres & district hospitals.

Participants: TBAs (28 ); SBAs (22), Men ( 34), Women (39) , Village Headmen, HSAs ,and other stakeholders (NGOs leaders, Government officials)

[Total: 162 participants]

Brief overview of findings

Perceived Gains in redefining TBA roles:

Health care facilities are perceived as safer by all participants and SBAs more knowledgeable (for complications)

TBAs are perceived (by others )as having experience but not knowledge; possibly unsafe because they “ go beyond their own limitations”) and adhering to traditional practice can be harmful to mothers and babies.

Perceived Losses in redefining TBA roles:

For TBAs themselves: income/ reputation/ low active involvement in SMI (“they stopped us”)

For women, loss of continuous support and interpersonal care in childbirthCaring & welcoming attitude of TBAs ( vs the disrespectful

and sometimes abusive attitude of SBAs) and continuous support ( vs. neglect and absenteeism of some of the SBAs at facilities)

Proximity, familiarity with providers of services

What is the “right care” in rural environments? Facilities -not always well resourced or staffed

Women expectations--------women satisfaction

Linkages between traditional community-based and formal maternal health services

Applying the guidelines is problematic for TBAs, for women & their families at community level

what are “unavoidable circumstance”? Pressure on TBA to help; fear of fines for women and helpers

issues of referrals and escorting

Other Barriers : transport, poverty, family & cultural pressures, negative prior experiences at facility

Lack of linkages between TBAs and facilities( SBAs)may be detrimental to women in hardest to reach rural communities

“To save a life of somebody it needs collaboration” (HSA01)

Thank you ! ZikomoContact: Isa UNY (iuny@qmu.ac.uk;07773808912)

Check out the Institute for International Health and Development (IIHD) at QMU

• http://www.qmu.ac.uk/iihd/Default.htm

• On Facebook: http://www.facebook.com/#/group.php?gid=137290710861

• Twitter: @IIHD_QMU

IIHD. Working for a Fairer and Healthier World.

Updates and

Information

Tweet us @ScotlandMalawi #SMPhealthforum

Tweet us @ScotlandMalawi #SMPhealthforum

• SMP Updates [Paper C]:

– NHS work

– Funding News

– Training:

• SMP Language and Culture Workshops

Organisation Project Manager

(Scotland)

Contact email Project Funding

Christian Aid Scotland Keryn Banks KBanks@christian-aid.org Increasing Citizen's Demand for

Accountability and Transparency

for maternal and child health

£600,000

Meningitis Research

Foundation

Mary Millar MaryMillar@scotland-

meningitis.org.uk

Triage and treatment, training and

engagement. A package for

sustainable healthcare

improvement in Malawi's primary

health clinics

£594,899

NHS Lothian Ewen Brown Ewan.Brown@nhslothian.scot.nhs.

uk

The Edinburgh Malawi Breast

Cancer Project

£185,340

Yorkhill Children's

Charity

Shona Cardle (CEO) shona.cardle@yorkhill.org Improving Eye Health and Reducing

Unnecessary Blindness in Malawi

£173,355

University of Strathclyde Carol Clements and

Sandy Gray

c.j.clements@strath.ac.uk or

a.i.gray@strath.ac.uk

Impact on malaria, maternal health

and the prognosis for AIDS by

Quality Assurance Knowledge

exchange and training

£275,918

Robert Gordon

University

Tracy Humphrey t.humphrey1@rgu.ac.uk Improving Respectful Midwifery

Care in Rural Malawi: A Human

Rights Approach

£432,196

TOTAL: £2,261,708

SG Malawi funding

Tweet us @ScotlandMalawi #SMPhealthforum

NHS Scotland links

Tweet us @ScotlandMalawi #SMPhealthforum

Funding opportunities

THET: Start-Up Grants

• £3000-£7000

• Call for applications 22nd Jan-8th March

• Facilitate the development of new health links

The Global Innovation Fund

• £30,000-£10m

• Grants, loans and equity investments

• Social innovations to improve lives

• Rolling applications

Updates and

Information

Tweet us @ScotlandMalawi #SMPhealthforum

SMP Language Classes

Edinburgh Classes:Dates: Tuesday 10th March, 17th March and 24th MarchTimes: 5.30-7.30pmVenue: Edinburgh City Chambers

Glasgow Classes:Dates: Wednesday 25th February, 4th March and 11th MarchTime: 5.30-7.30pmVenue: Partick Burgh Hall

For further information and to download the booking form visit www.scotland-malawipartnership.org/events.html

Tweet us @ScotlandMalawi #SMPhealthforum