Factors influencing initiation of breast feeding among post
PSI Somaliland Monthly Newsletter - November 2014 Highlights
1. IN THIS ISSUE:
MONTHLY SPOTLIGHT (P.2):
Super Fariid Launch Ceremony
RESEARCH UPDATE (P.3):
DBH Simulation Study Shows Promising
Future for System
CHILD SURVIVAL (P.4):
Infant & Young Child Feeding at PSI
Somaliland’s IPC Sessions
SOCIAL FRANCHISE NETWORK (P.5):
Bulshokaab Upgrades Pharmacies
INSIDE PSI SOMALILAND (P.6):
The Monthly Health Minute, Staff Spotlight,
Upcoming Events, and much more!
KEY MONTHLY INDICATORS:
PSI Somaliland’s monthly impact (October) in
numbers:
9,611 WOMEN REACHED THROUGH IPC
IN 2014 OUT OF 10,000
TARGET FOR THE YEAR
2,113 # OF DALYS AVERTED
(100% OF SEPTEMBER TARGET)
11, 014 # OF SHUBAN DAWEEYE KITS
SOLD (108% OF SEPTEMBER
TARGET)
MONTHLY PROVERB:
Somali:
“Caano daatay dabadood la qabay.”
English:
”Do not cry over spilt milk.”
NOT FROM THE COUNTRY REPRESENTATIVE:
In management, there is this theory of intrinsic versus
extrinsic motivation. In other words, motivations that come
from inwards, such as a desire for achievement, moral
obligations, and ones that are triggered by outside forces
such as money, promotion, acceptance, etc. Normally,
people do get motivated either ways, sometimes getting
motivated in one, sometimes in the other.
True, everyone has their own way of getting motivated,
but for me, it was always the inside “thing” that fueled my
passions, not only in my career, but in everything I do. And I
believe that it has a very lasting effect on the self, compared
to the external effects on your behavior, without which you
no longer feel committed to something you were pursuing.
If you believe in everything but your desires, your passions,
and what your mind tells you to do, then sky is the only limit
for you.
All you have to do is becoming the only thing that can
motivate your inner self, driven by your inner passions,
a story to tell, and a sense of always staying focused on
something you badly need to see come to life. Do not let
outside forces, of which you have a little control, dictate you
what to do, feel, or think. Contemplate and look inwards and
try to set benchmarks, milestones, and a picture for your
own of what you want to do next.
N E A R A D M A S U N I V E R S I T Y | J I G J I G A Y A R
H A R G E I S A , S O M A L I L A N D
P S I . O R G | B L O G . P S I I M PA C T. C O M
V O L U M E 1 , I S S U E 5 N O V E M B E R , 2 0 1 4
Abdullatif Osman,
Marketing &
Communications
Specialist
2. PSI Somaliland, UNICEF and the Ministry of Health officially
announce the launch of new micronutrient product for
children called Super Fariid. Super Fariid is a powder that
contains vitamins and minerals such as vitamin A, B, C, D,
Folic Acid, Iron, Iodine and Zinc. Super Fariid is for children
under five years of age, and it helps children receive
complete nutrition.
A launch event of the new product was held at State House
neighborhood in Hargeisa yesterday, attended by officials
from UNICEF, the Ministry of Health, THET, and others.
Miss Faiza Ibrahim Ahmed, the Head of Planning at the
Ministry of Health, spoke at the event where she talked in
detail about the importance of nutrition for children, and the
need for this new product. She thanked PSI Somaliland and
UNICEF for the launch of this product.
Dr Ahmed Jama, Head of Nutrition at the Ministry of Health,
also spoke at the event where he outlined the benefits
children will receive from Super Fariid and the complete
nutrition it will provide.
H E A LT H Y L I V E SM O N T H LY S P O T L I G H T
N E A R A D M A S U N I V E R S I T Y | J I G J I G A YA R
H A R G E I S A , S O M A L I L A N D
P S I . O R G | B L O G . P S I I M PA C T. C O M
(Clockwise from top left)
Dr. Ahmed Jama, and Faiza
Ibrahim Ahmed, MoH;
Awil Haji Ali Gure, UNICEF;
Abdi Hani Hashi, Super
Fariid’s song writer, and
other celebrity singers and
performers
Dr Awil Haji Guure, Head of UNICEF’s Hargeisa Office, has
pinpointed that the new product will improve the nutrition
levels among Somaliland children. He wished that its
launch will greatly help in the increased efforts to elevate
nutrition levels among children under five years of age.
Brief Info about Super Fariid:
• Super Fariid is an innovation in home-fortification
to address vitamins and minerals deficiencies
• Super Fariid should be given a children for the age of 6
months to 5 years
• One MNP sachet of 1g contains the recommended
nutritional intake (RNI) of 15 vitamins and minerals.
Benefits of Super Fariid:
• Improves child’s immunity
• Improves child’s appetite
• Improves child’s energy
• Improves child’s ability to learn
SuperFariidLaunchCeremony
3. W
hile the local market has proven to be
receptive to mobile technology and mhealth
approaches (piloted by Somtel, for instance),
PSI Somaliland undertook this market
study to better understand how the DBH
platform should be rolled out to ensure that key components are
delivered efficiently and effectively. This study aimed to answer
the following questions from clients, providers, and program
implementers to determine the viability of the DBH platform and
to learn how to improve upon its design:
1. What is the best method of content and information delivery?
(Voice messages vs. call centers)
2. What value can the DBH platform bring to each involved party?
3. What improvements can be made to the existing process
design?
The results are in from the study and the news is good. The study
revealed, to our surprise, that the majority of our target audience
preferred to receive health tips and information on their mobile
phone in the form of a voice message - not a phone call. This
realization has dramatic implications for our proposed program,
which will result in our development of an automated system
to deliver pre-recorded personalized health messages to each
woman (based on their stage of pregancy or motherhood) on a
regular basis, saving on costs and overhead.
The PSI Somaliland DBH
System - part of our
Bulsho Kaab Network -
offers free personalize
tips and advice to
expectant and new
mothers.
The second major takeaway is that the study proved
an overall acceptance and interest in the DBH system,
coupled with being persuasive and effective in ensuring
mothers attend health facilities when suggested.
There were a few challenges that the DBH system must
overcome as it continues to be developed in the coming
2-3 months, such as:
1. Phone sharing is incredibly common in Somaliland, so
voice message delivery must be done in such a way to
ensure that the clients actually receive the call - perhaps
with a call to action or incentive to track their immediate
behavior after receiving a message.
2. Working with the MCH, despite their enthusiasm for the
platforms potential, will require additional funds as they
see the time saving system as more work.
3. Appointment reminders through the system are
effective but need to be monitored also by CHPs, as
mothers often complained they did not have enough time
to reach the health facility before the system registered a
failed visit.
Stay tuned for more progress updates on the DBH system.
R E S E A R C H
DBH Simulation Study Shows
Promising Future for System
N E A R A D M A S U N I V E R S I T Y | J I G J I G A YA R
H A R G E I S A , S O M A L I L A N D
P S I . O R G | B L O G . P S I I M PA C T. C O M
5. Ahmed Suleiman,
Child Health Officer
C H I L D H E A LT H
Infant and Young Child Feeding
at PSI Somaliland’s IPC Sessions
N E A R A D M A S U N I V E R S I T Y | J I G J I G A YA R
H A R G E I S A , S O M A L I L A N D
P S I . O R G | B L O G . P S I I M PA C T. C O M
In Somaliland health complications for mothers and children
are not uncommon. Less understanding and knowledge
of the value of care for the mother before, during and after
pregnancy is one of the leading health issues women face
and there are no immediate interventions to deal with this.
Children are not exclusively breastfed for the first six months,
thus increasing their vulnerability to child diseases and other
health problems. In addition, due to high levels of poverty in
the country, the health care services are costly and unafford-
able.
Furthermore, owing to high levels of illiteracy among moth-
ers and care givers of children under five, kids do not receive
proper feeding and nutritional diets which caused high levels
of child death during the first five years of life.
Knowledge, attitude, and practice (KAP) study on infant &
young child feeding and health seeking practices study found
that knowledge, attitude and practice on breastfeeding are
mainly controlled by culture through maternal grandmothers
and other elderly women in the community and are generally
unsatisfactory.
Most children are breastfed 2-3 days after delivery and the
colostrums is not fed to children by majority of mothers as
they consider it heavy, thick, course, dirty, toxic, and harmful
to children’s health. Breastfeeding is, however, acceptable to
all mothers and their networks and almost all children breast-
fed on demand. (Source: 2007, Food security analysis unit
of Somalia (FSAU), managed by UN’s Food and Agriculture
Organization.) To address this health burden, PSI Somaliland
included in its Interpersonal Communication (IPC) program
curriculum sessions on best practices for infant and young
child feeding (IYCF).
Last month, Somaliland’s Ministry of Health carried out super-
vision of 9 IPC sessions around Somaliland, aimed specifically
at evaluting at at evaluating the at evaluating the nature and
quality of IYCF content of the sessions, guidelines used, and its
overall impact on mothers.
During the supervision trip, we met Umulkhayr Mohammed,
a 32 year-old mother of 3, who lives in a tin sheet house at
Sheikh Ali Jowhar village, northwest of Borama village. She
recently gave birth to a baby boy at the village’s health center,
and she reported that this was the first time for her to breast-
feed in the first six months after delivery.
When asked why she did exclusively breastfeed and where
she first knew about it, she said that Fadumo (a community
health leader in the area who also mobilizes women at the
neighborhood and brings them to the counseling sessions)
who lived not far away from where she lives visited her at the
house and explained the importance of breast milk.“Her wise
rationalization encouraged me to exclusively breastfeed. My
participation of this session was because of her invitation I
received at that day.”
When I asked if she can now recognize any differences
between her previous children and her new born baby, she
narrated that there is a significant difference.“I am very happy
with my new baby. Now he is at the age of 5 months, and he
is gaining weight. In the first days of breastfeeding, it was dif-
ficult to breastfeed. Then, I remembered advices from Fadumo
and what doctors used to tell me when my older children
have diarrhea. My husband also used to encourage me when
I feel I should start bottle-feeding. But then I draw on my
strength and continue to exclusively breastfeed my child,”she
says.
7. T
hroughout the years, we realized
that we have limited control of
what is going on in the pharmacy as
providers only sell 5 PSI products out
of hundreds sitting on the shelves.
The fact that providers are transient or work
elsewhere made some pharmacies perform at
below the required standard in many occasions.
As such, we changed the thinking on how to
win back control of our franchise approach
- and we have decided to focus less on the
primary pharmacy operations and more on the
consultation experience. We feel we have more
control over the consultation, as we train our
providers on how to provide excellent counseling
and consultations - whereas trying to focus on
offering quality products in a sea of unregulated
medicines detracts from the value offering of
our brand name. As this ought not to happen
overnight, we took two steps that would pave
the way for the successful implementation of the
shifting strategy.
1. Provider Performance Improvement
Panning Session
In March 2014, we conducted a two day provider
PIP sessions. The outcomes of the workshop were:
defining vision for success for BulshoKaab;
defining behaviors to maintain and behaviors
to change among the pharmacy providers;
Abdirahman Ali Hirsi,
Former SFN Manager
defining the requirements of clinical-
grade consultation rooms for all of our
pharmacies.
2. Helping National Health
Professionals Association (NHPC)
in Regulating Pharmacies.
The private sector is not regulated.
Health facilities are not licensed and
there are no registered and accredited
health professionals. To address
this, PSI closely worked with NHPC
to influence them to speed up the
process of regulating the private health
sector, both facilities and professionals.
Several workshops were conducted
to adjust regulations to the private
sector health facilities, and to ensure
that PSI is incentivizing and building
the capacity of the pharmacies that
conform the national standards.
The Transition Plan
Smooth transition plan is developed
in which the current high performing
pharmacies will be upgraded in to
“gold standard”pharmacies. By the end
of the 2016, the number of facilities will
be reduced from 220 pharmacies to
143 Bulsho Kaab consultation sites.
H E A LT H Y L I V E SB U L S H O K A A B
BulshokaabUpgrades
Pharmacies
BULSHOKAAB
SPOTLIGHT:
Vision for Success:
“By 2016, Bulshokaab will
provide standardized,
quality health services
and counseling through
qualified, competent
health workers and
proper drug dispensing
and management.”
Department
Restructuring:
The improved structure
includes a salary-
based Social Franchise
Manager, salary/
commission based
Network Developers
(responsible for
identifying new
potential consultation
sites, offering business
consultancy, result-
oriented capacity
building program,
and sales generation
activities) and a Quality
Assurance Officer.
N E A R A D M A S U N I V E R S I T Y | J I G J I G A YA R
H A R G E I S A , S O M A L I L A N D
P S I . O R G | B L O G . P S I I M PA C T. C O M
9. INSIDE PSI SOMALILAND
PHOTO OF THE MONTH
UPCOMING EVENTS/
BIRTHDAYS
WORLD PNEUMONIA DAY (NOV. 12,
2014)
UNIVERSAL CHILDREN’S DAY
( NOV. 20, 2014)
STAFF SPOTLIGHT
FATHIA ALI,
Maternal Health Associate
Fathia Ali has joined PSI Somaliland as an
IPC agent in Maroodi Jeex region in June
2010. She is a dedicated health professional
and a mother of one.
This year, she has been promoted to her new
role as Maternal Health Associate in the MH
department, where she overseas the IPC
Program and Mesoprostol distribution in the
public sector.
N E A R A D M A S U N I V E R S I T Y | J I G J I G A YA R
H A R G E I S A , S O M A L I L A N D
P S I . O R G | B L O G . P S I I M PA C T. C O M
THIS MONTH’S HEALTH MINUTE:
Sickle-cell disease (SCD), or sickle-cell anaemia (SCA), is a hereditary
blood disorder characterized by an abnormality in the oxygen-carrying
hemoglobin in red blood cells that leads to a propensity for the cells
to assume an abnormal, rigid, C-shape (sickle) shape under certain
circumstances. Sickle-cell disease is associated with a number of acute
and chronic health problems, as the sickled cells can block blood vessels
reducing blood flow in many parts of the body. This process results in severe
infections and attacks of severe pain (“sickle-cell crisis”), leading to tissue
and organ damage with an increased risk of death.
Risk Factors
Sickle-cell disease occurs when a person inherits two abnormal copies of
the haemoglobin gene, one from each parent. People at risk for inheriting
the gene for sickle cell descend from people who are or were originally from
Africa and parts of India and the Mediterranean. The sickle cell gene also
occurs in people from South and Central America, the Caribbean, and the
Middle East. The high incidence of the sickle cell gene in these regions of the
world is due to the sickle cell’s ability to make red blood cells resistant to the
malaria parasite:
A person with a single abnormal copy does not experience symptoms and is
said to have sickle cell trait.
Those who inherit both copies of the HbS gene develop sickle cell disease.
They are not protected from malaria, however. In fact, malaria is more
serious in these individuals. An estimated 1 in 500 African-Americans and 1
in 1,000 - 1,400 Hispanic Americans are born with sickle cell disease.
Father Mother
Parents genotype A S A S
Possible genotypes of children AA AS AS SS
Diagnosis is through a simple blood test , individuals with the trait need to be
closely monitored. Common symptoms include fever , swelling in the hands
and feet , pain in the chest, abdomen, limbs, and joints and frequent upper
respiratory infections.
Management include prevention of anemia, infections and any activity that
may increase the body’s requirement for oxygen leading to a “ sickle cell
crisis”.
The only cure for sickle cell anemia is a bone marrow transplant.
MONTHLY QUIZ:
Thanks a lot to our staff Muna Ibrahim, Aden Qodax, and Abdirizak
Osman Askar for answering last month’s quiz. Answer for last issue’s
quiz is : Infant mortality rate in Somaliland is 72 deaths per 1,000 child
births. (MICS 2011)
This month’s quiz: How many pharmacies are in Bulshokaab network?
An on-going IPC
session in Daami
neighborhood,
Hargeisa,
faciliated by IPC
Agent Muna
Mohamed
