Godefroid Kabuku Kakuni, Supervising Pschologist with the former USAID Ushindi Project, visits a survivor of sexual violence at the Walikale safehouse in Walikale, Democratic Republic of Congo. IMA World Health is building on the successes of and lessons learned from Ushindi in a new project, known locally as Tushinde, to provide holistic care for survivors of sexual and gender-based violence. (Photo by Crystal Stafford/IMA World Health)
IMA World Health strives to provide the most effective and technically sound solutions to the world’s toughest public health challenges. That means we are always learning—examining the data, exploring new innovations and seeking feedback from our partners and the communities we serve to ensure our programs have maximum impact for those in need.
A culture of continual learning is also one of adaptability. New evidence and experience allow us to build on previous success, as we did this year while designing a new program to address sexual and gender-based violence in the Democratic Republic of Congo. Learning also enables us to adapt when challenges mount or a new solution is needed, like the way our team in South Sudan addresses the challenges of a mobile population by moving the clinics with them.
IMA’s ability to adapt to the challenges as they present themselves makes us particularly valuable in regions that experience conflict, political instability, natural disasters or outbreaks of diseases like Ebola or cholera—which frequently impact our programs.
Learning also requires mutuality. Just as we learn from other experts and organizations, IMA is committed to sharing our expertise and experience with our partners and the wider global public health community. This year we released a 50-page report detailing lessons learned from the National Nutrition Communications Campaign in Indonesia so that others can draw from its successes. We also hosted trainings for field staff and partners on communications best practices, procurement and health information systems to continue building their capacity in these key technical areas.
This year was important learning and adapting at IMA—as every year should be—as we worked toward our vision of health, healing and well-being for all.
2018 Learning Snapshots
Building on a Successful Strategy in Eastern Congo
IMA’s USAID-funded Ushindi Project, (2010–2017), was one of the most successful programs to prevent and respond to sexual and gender-based violence in Eastern Congo. In designing its follow-on project, the USAID-IMA Counter-Gender Based Violence Program (known locally in Swahili as “Tushinde Ujeuri”), IMA took key learnings from Ushindi to create a more community-based strategy. The highly effective holistic approach of providing medical care, psychosocial counseling, legal support and economic support services remains a central focus of Tushinde. Using the evidence base from Ushindi, the new program is also transforming the “safe houses” used in the previous project into “Ushindi Houses” that provide expanded services to survivors, empower and support women and community groups, and serve as central setting for forums, dialogue, and social and behavior change communication platforms. All of this is designed to place more engagement and agency in the hands of health zone and other local stakeholders to take assume leadership in the prevention of and response to SGBV at the community level.
IMA World Health is the lead implementer of the USAID-funded Tushinde Ujeuri: Comprehensive Services to Address GBV Project in Eastern Congo. Pictured is the launch event in Bukavu, DRC. (Photo by IMA World Health/staff)
Overcoming Challenges to Urban MDA in Haiti
Diaphka Abraham uses a radio to broadcast messages about the importance of taking medicine during a mass drug administration in Acul du Nord, a suburban area outside of Cap-Haïtien—an effective strategy for urban MDA as well. Her work is part of the communication strategy to inform people about neglected tropical diseases as community health workers go door-to-door to distribute the medicine that will protect people from lymphatic filariasis. (Photo by Kara Eberle/IMA World Health)
Annual mass drug administration is the proven technique for controlling and eliminating neglected tropical diseases like lymphatic filariasis and intestinal worms. For MDA to be effective, it’s important for the medicines to reach the at-risk population annually for 5-7 years. After a number of years of adequate treatment coverage, a transmission assessment survey will show whether the disease burden has declined enough for treatments to stop.
While many parts of Haiti are on track to eliminate LF by 2020 thanks to MDA conducted by IMA and partners through the USAID ENVISION program, the urban areas proved to be the most challenging. Our partners who managed MDA in Port-au-Prince reported that coverage rates in all six communes were declining year by year. Following TAS in 2017, only one commune was able to stop MDA.
To address the many challenges inherent to urban MDA, this year partners and donors agreed to create a new strategy to enhance MDA coverage in the unique context of urban Port-au-Prince. Stakeholder consultations, together with operational research and experience gathered from other countries, identified lessons learned that informed the development of new strategies in Haiti’s five remaining metropolitan communes.
IMA worked directly with the Ministry of Public Health and Population to develop micro-planning activities with groups in each commune. New tactics included increasing community awareness and sensitization activities to draw attention to upcoming MDA activities; boosting the visibility and training of community drug distributors; enhancing public understanding of the drugs’ purpose and safety; extending the duration of MDA to reach more people; and strengthening behind-the-scenes activities such as supervision and data collection and management.
As a result of the new strategy, this year coverage rates significantly improved—putting Haiti’s most densely populated areas back on track for LF elimination.
Sharing Lessons Learned in Indonesia
A midwife leads a mothers’ group to provide information about nutrition and stunting. (Photo by IMA World Health staff)
In April, IMA completed work on the National Nutrition Communications Campaign in Indonesia, funded by the Millennium Challenge Account. The mixed media advocacy campaign focused on behavior change communication targeting Indonesian policymakers and caretakers of children, increasing their understanding of the threat of childhood stunting and the importance of supporting improved infant and young child feeding, hygiene, and health care practices.
Though this was IMA’s first project in Indonesia as well as our first project targeting stunting, the campaign far surpassed many of its targets and was successful in getting stunting on the President of Indonesia’s agenda. We also conducted Indonesia’s first ever Stunting conference in Jakarta. This included the Vice President along with national and local level government leaders, including governors from all 34 provinces. In total, the conference brought together over 700 participants advocating for the fight against stunting.
IMA produced a Lessons Learned report so that the Indonesian government, other organizations and future programs could learn from and replicate its successes.
Indonesia Vice President Jusuf Kalla closed Indonesia’s first Stunting Summit held in Jakarta on March 28, 2018. (Photo by IMA World Health staff)
Health Care on the Move in South Sudan
As conflict continues in South Sudan, the realities on the ground are ever-changing. Our work involves learning how to serve the needs of some of South Sudan’s most vulnerable populations, which constantly shift and relocate due to insecurity and seasonal flooding in the Greater Jonglei and Upper Nile regions.
With funding from the Office of U.S. Foreign Disaster Assistance, IMA provides emergency and primary health care services primarily to internally displaced persons via mobile clinics that follow the movements of these populations—opening, closing and changing locations as needed. IMA oversees multiple clinics, each comprised of four tents for consultations, antenatal care and delivery, pharmacy/dispensing and a nursing station for procedures such as injections and immunization services. The mobile clinics are also equipped with basic amenities for waste disposal, clean water and security.
Between September 1, 2017, and June 30, 2018, clinic staff conducted a total of 43,587 outpatient consultations, diagnosing and treating thousands of cases of malaria, acute respiratory infection and diarrhea. Clinic health workers also conduct screenings for malnutrition and community health education on topics like water and sanitation, the use of LLINs and the importance of immunizations.
Clinic staff in the pharmacy at a mobile clinic in Aburoc, located in Fashoda County, Greater Upper Nile. (Photo by IMA World Health/staff)
Building the Capacity of Staff and Partners
Senior Communications Officer Kara Eberle shares best practices on conducting interviews with project beneficiaries during the IMA Communications Training in Nairobi, Kenya, in May 2018. (Photo by Emily Esworthy/IMA World Health)
This year, IMA invested in several training events to build the capacity of staff, partners and local health workers across multiple technical areas.
Communications. In May, IMA headquarters staff hosted a training on best practices in communications for 35 Africa-based field staff and partners in the Africa Christian Health Associations Platform. Participants came from Kenya, Tanzania, Burundi, Lesotho, South Sudan and DRC and completed modules on ethics, storytelling, photography, social media, style guides and fundraising.
Procurement. As part of IMA’s commitment to ensure that it is compliant with donor regulations and that the organization is being a good steward of funding, the global staff is routinely trained on procurement policies and procedures. By training the whole staff, IMA ensures that the entire process—from start to finish—is completed in the most effective and efficient way.
Data for Decision-making. Being able to show the impact of IMA’s work in some of the most vulnerable areas of the world is important and lays a foundation to build on for future projects. It improves decision making and guides resource allocation. To that end, IMA has worked with its global staff and Ministries of Health to roll out a web-based data management information system, DHIS2, that allows for timely, accurate and transparent use of data across its projects.
Leadership gathering. At least biannually, IMA aims to gather its field and headquarters leadership for a combined meeting. This year’s effort brought together leadership from five countries for a week of connection and visioning about how to increase our impact, reaching more in need of health, healing and well-being.
End of the New Windsor Era
From the archives: Early photo of a shipment leaving the Brethren Service Center warehouse in New Windsor, Maryland, where IMA maintained a stock of medicines and medical supplies from 1981 until 2018. The old logos on the side of the trailer represent Church World Service, IMA and Lutheran World Relief.
With learning comes adaptation. This year, IMA made the difficult decision to discontinue the storage and shipment of medicines and medical supplies through the Brethren Service Center warehouse in New Windsor, Maryland.
“As the world and its needs change, and as our donors shift focus, so must our approach to assisting those who need it most,” IMA President and CEO Rick Santos said.
When IMA was founded in 1960 as a clearinghouse for supplies to be distributed to member-supported clinics around the world, there was a clear need for a central depot to store and disperse donated items. Over the years, however, regulations for drug donations have tightened, while the availability of medical supplies in our target areas has increased.
“It no longer makes sense for IMA to procure supplies in the US,” Santos said. “Many of the items we used to ship overseas at great expense are now available for purchase in country. This is about both financial stewardship as well as supporting sustainable development and supporting local economies.”
All remaining supplies in our inventory were donated to other nonprofit organizations, and the Church of the Brethren remains an IMA member organization.
“We are so deeply grateful for the generosity, support and partnership we’ve enjoyed with the Church of the Brethren, and especially the staff at the Brethren Service Center, over these years. This partnership has been the Church at work, and though the relationship between IMA and the Church of the Brethren is shifting, our sense of friendship and partnership is not,” Santos said.
As a procurement and distribution organization, IMA strategically distributed well over $1 billion worth of medicines and supplies to hospitals around the world since 1960. IMA was headquartered on the Brethren Service Center campus from 1981 until 2015, when the IMA Board of Directors decided consolidating into the Washington, DC, office was both financially responsible and a better way for staff to collaborate with major public donors and partners in the DC area.