Takamol Integrated Reproductive Health Services Project

Achieving sustainable reduced fertility and improved health outcomes for mothers, newborns and young children in Egypt

The Takamol Integrated Model

In March, 2006, a Pathfinder International-led consortium was awarded a contract from USAID to conduct a new five-year project in Egypt known as Takamol. Adopting the Arabic word for “integration”, Takamol promotes an integrated model for strengthening maternal/child health, family planning, and reproductive health (MCH/FP/RH) services. As the culmination of nearly three decades of USAID assistance to Egypt in these areas, Takamol works with the Egyptian Ministry of Health and Population to achieve the project’s overarching goal of sustainable reduced fertility and improved health outcomes of mothers and newborns.

Specifically, the model emphasizes community mobilization and involvement in local primary health care and hospital facilities as driving forces for change, and presents ways to strengthen and sustain mechanisms to support change, such as diverse and capable facility management boards and linkages with other health and non-health services and projects.

Project interventions target 200 primary health care units in 12 Upper and Lower Egypt governorates, selected urban poor areas in Cairo, Giza, and Alexandria, and 25 district /general hospitals in Lower Egypt.

The Takamol integrated model strengthens the capacities of these facilities to better serve the needs of their communities through renovations and the provision of equipment, training, outreach, and community participation. Two cross-cutting themes, gender and social responsibility, have been woven into all of the project’s activities. This allows communities and corporations to contribute to health care improvement.

Disclaimer

The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States government.

The Kafret Nassar health unit in Giza Governorate was renovated by Barclays Bank as part of the Takamol corporate social responsibility initiative, according to Ministry of Health and Population service and facility standards.

Facility Renovation and EquippingProviding clean, up-to-date health facilities for underserved communities

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Clinic and hospital renovation is the cornerstone of the Takamol Project—upgraded skills and knowledge of clinic and hospital staff will only be fully actualized when the facilities in which they work are hygienic, functional, up-to-date and efficient. Renovations signal the launch of the project’s interventions and are a visible reminder of the USAID commitment to improving the health of Egyptian citizens. The renovation and equipping of Ministry of Health and Population (MOHP) primary health care facilities and hospital units represent a significant capital investment in MOHP infrastructure.

The intervention process consists of an initial screening of short listed clinics and hospitals proposed by the MOHP, a community assessment, the physical renovation of the building, and the equipping and furnishing of the facility with state of the art medical equipment and furniture according to existing MOHP service standards. During the screening process site visits are made to a number of facilities to assess physical conditions, interview service provision teams, review health indicators and interview community residents about their health care needs. After evaluating the findings, Takamol selects intervention communities based on a set of specific criteria that measures the potential impact of the intervention and the willingness of the community to collaborate and partner with Takamol to achieve the intended outcomes.

Physical renovation is carried out by engineering subcontractors selected through a competitive bidding process carried out in close collaboration with the MOHP. Renovations are tailored specifically to each individual facility according to MOHP service standards. Takamol further coordinates renovation designs, equipment and supply specifications, and the sequencing of activities with the Health Sector Reform program to prevent duplication of efforts.

Upon completion, a community-oriented celebration is held under the auspices of the governor. This public display of support officially marks the re-opening of the renovated facility.

Takamol Project Training Activities

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Physicians from hospitals and primary health care units receive clinical training on maternal/child, family planning and reproductive health related medicine, enabling them to provide high quality integrated care.

Building capacities to deliver improved reproductive health services

As a fundamental part of Takamol’s efforts to improve the quality of integrated care, the project provides health service providers from intervention primary health care (PHC) units and hospitals with state-of-the-art clinical training in MCH/FP/RH-related medicine and nursing. Takamol trains physicians, nurses, laboratory technicians, and community outreach workers to improve their knowledge and skills so they are able to provide high quality integrated MCH/FP/RH care. Takamol also provides technical assistance to the Ministry of Health and Population (MOHP) to deliver pre-service integrated MCH/FP/RH training to newly graduated physicians in preparation for their work in PHC facilities. Clinical training is followed by on-the-job training to reinforce and further build the capacity of facility staff regarding the clinical and managerial aspects of their work.

In addition, management, supervision and leadership training is given to PHC unit and hospital board members, hospital safe motherhood committee members, selected facility staff, financial managers, and MOHP supervisors. This gives actors at the community, facility, and supervisory levels the tools, skills, and motivation they need to constantly monitor and improve performance.

Community-level training to increase knowledge of and change attitudes towards MCH/FP/RH practices within intervention areas covers a broad spectrum of society. Included in the training programs are male and female religious leaders, literacy facilitators, outreach workers from both the MOHP and NGO sectors, agricultural extension workers and peer educators. Functioning as a training of trainers for these agents of change within the community, these trusted community resources go on to disseminate reproductive health messages within their communities and among their families and cohorts.

Coaching and Continuous Quality Improvement

Regular coaching of health service providers in their work environment improves the quality of care provided in health facilities, leading to greater client flow and a healthier population.

Turning new knowledge and skills into habits

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In order to cement positive behavior change among staff in renovated Ministry of Health and Population (MOHP) health units, Takamol has developed a state-of-the-art on-the-job-training (OJT) program that provides health unit staff with follow-up visits to reinforce the application of newly acquired knowledge in their “home” clinic environments and encourage continuous quality improvement.

To build local capacity for future needs, OJT coaches are selected MOHP supervisors. The coaches are trained to serve as role models for primary health care unit staff and to provide follow-up assistance on a broad range of clinical and management skills introduced during Takamol training programs. Structured visits reinforce MCH/FP/RH integration concepts and new management techniques. Areas for follow-up include clinical skills such as client assessment and counseling, infection control, referral, cleaning, and record keeping, and management skills such as action plan development and implementation, meeting skills for clinic board meetings, clinic accounting, and community resource mobilization. In addition to these identified priority areas, OJT teams provide technical assistance based on the needs of the staff at each intervention clinic as identified using the Integrated Supervision Quality Checklist, an MOHP tool developed to measure the quality of integrated services.

On-the-job training, introduced during the TAHSEEN Project, proved to be highly acceptable to the MOHP, and was successful in accelerating behavior change among clinic staff to support integrated management activities and service provision.

Strengthening Government Capacity

The Ministry of Health and Population is the Takamol Project’s primary partner at the national, district and local levels. Collaboration with the Integrated Health Services and Nursing and Population sectors is assisting the ministry to reach its national health goals.

Helping Egypt’s Ministry of Health and Population achieve its reproductive health goals

Takamol works closely with the Ministry of Health and Population (MOHP) to strengthen the capabilities of its staff at national, governorate, district, and facility levels to durably manage high-performing priority programs well beyond the end of direct USAID technical and financial support. The project provides support to the MOHP in developing and implementing an integrated MCH/FP/RH model that demonstrates the successful components and policies needed to help the ministry reach its health goals at a national level.

Takamol provides technical assistance to the MOHP in the area of quality of care through the integration of FP and MCH services at the primary health care (PHC) and district levels. National level MCH/FP/RH curricula have been developed or updated and utilized in support of integrated services and state-of-the-art MCH/FP/RH technical knowl-edge. In addition Takamol partners with central office and district level teams to implement an integrated supervision system at the district level; provides support at central, governorate and district levels to implement clinic manage-ment training; enhances financial systems by increasing the capacity of MOHP and Ministry of Finance governorate-level financial officers; and facilitates the MOHP Integrated Health Care and Nursing and Population/Family Planning sectors’ integrated district planning process. To sustain these efforts, Takamol supports increased management capacity of MOHP clinics, district offices, and governorate offices through an enhanced governorate-level supervisory system and improved financial management systems; and offers management and information systems support at all levels.

At the central level, Takamol works closely with the Popula-tion and Integrated Health Care and Nursing sectors in developing results-oriented workplans, has reactivated the Integration Steering Committee, the platform for decision-making regarding integration in the MOHP, and assists the MOHP in developing public-private partnerships for social responsibility initiatives. As the final USAID Project to address population issues, Takamol also works closely with the MOHP in the area of contraceptive security and increasing contraceptive information.

This girl is making an informative poster to be displayed in her school as part of the Shabab Takamol Week youth empowerment program—one of the many activities implemented by local community development associations in Takamol Project communities.

Working with Community Development Associations Key partners of change

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Egyptian community development associations (CDAs) are well-integrated and respected at the local level and represent an effective means by which to implement behavior change activities in Takamol intervention areas. They serve as a unique link between the grassroots beneficiaries and government officials. Working with CDAs permits the Takamol team to enrich its menu of activities in response to the health needs of individual communities and to successfully work in hard to reach areas.

CDAs play a major role in Takamol community awareness-raising activities. Their primary focus is to implement a variety of activities targeting women, men and youth that increase MCH/FP/RH awareness within the community.

Working closely with Ministry of Social Solidarity and MOHP representatives in intervention areas, Takamol orients, screens and assesses prospective partner CDAs. Once identified, prospective partners submit proposals, and if selected sign grant agreements to conduct community activities as outlined.

Community outreach workers are the primary channels for conveying health messages. In this regard, joint training is conducted for CDA and ministry raedat rifiat (RR) and mothakef sokany (female and male outreach workers) in order to create a strong bond of cooperation between them. Home visits are the primary means by which RR link and refer families to the renovated primary health care units.

Implementing community activities through CDA partners provides an element of sustainability at the community level. Takamol awards grants to capable CDAs to conduct home visits, health awareness seminars and classes, literacy classes, microcredit activities, social responsibility activities, agricultural extension workers seminars, and the Egyptian Women Speak Out and Shabab Takamol Week empowerment programs for women and youth. CDAs additionally conduct specific monitoring and evaluation functions and serve as positive role models within the community.

Takamol Outreach Activities

Agricultural extension workers conduct reproductive health awareness seminars for farmers, encouraging them to play a greater decision-making role in the reproductive health of their families.

Reaching out to women and men in the community

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Motivated by the Ministry of Health and Population’s (MOHP) successful community outreach worker program, Takamol sought to capitalize on this valuable platform to disseminate accurate MCH/FP/RH information and strengthen the bond between the intervention community and its local primary health care unit.

Female outreach workers—raedat rifiat (RR)—are essential to supporting Takamol’s MCH/FP/RH integration efforts and community mobilization activities in intervention communities. Takamol trains MOHP and community development association (CDA) RRs to expand their knowledge and roles and increase their effectiveness to raise women’s awareness of the project’s main health messages. Their main objectives are to encourage regular visits to the health unit and to promote a sense of responsibility towards one’s own health. In addition, Takamol’s partner CDAs employ outreach workers from local intervention communities to conduct pre- and post-intervention MCH/FP/RH knowledge assessments, hold awareness classes, conduct home visits, and advocate for social responsibility and microcredit initiatives.

Adult males living in rural areas constitute a priority group for Takamol; they often have limited or no knowledge of MCH/FP/RH topics or issues. In order to improve their awareness, Takamol utilizes agricultural and irrigation extension workers to inform farmers about reproductive health topics during their routine agricultural outreach visits. Already accepted by farmers as credible information sources, these valuable experts have become important sources of new information and ideas. Takamol trains the extension workers on communication skills, and reproductive health issues such as breastfeeding, child health, early marriage, healthy timing and spacing of pregnancies, antenatal care, maternal health, gender-based violence, and the ways men can be constructively involved in reproductive health decision-making. The curriculum is designed to both expand the reproductive health knowledge of extension workers and build on their ability to discuss these topics with farmers. It uses simple farming analogies to make topics more relevant to farmers.

As trusted community leaders, Muslim and Christian religious leaders are some of the most effective advocates for transmitting reproductive health messages, among all age groups, within the community.

Working with Religious Leaders Mobilizing religious leaders as advocates for reproductive health

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Religious leaders in Egypt are trusted and respected community members, and have a unique potential to change misconceptions related to MCH/FP/RH and support open dialogue among women and men of all ages. Building on the involvement of Muslim and Christian religious leaders in the USAID-funded Tahseen Project, Takamol utilizes religious leaders from intervention areas to convey MCH/FP/RH messages within their local communities.

Takamol identifies and selects active religious leaders (RL) in intervention governorates to participate in training as MCH/FP/RH educators. The RL program introduces relevant topics and teaches skills with which religious leaders communicate the benefits and risks associated with various behaviors, in a manner consistent with their religious beliefs. The program mobilizes a cadre of religious leaders who are instrumental in breaking the silence on family planning and reproductive health issues, creating a new environment of openness and responsibility to adopt healthy behaviors. Monthly follow-up sessions enable the trained religious leaders to share their experiences as reproductive health and family planning advocates, reinforce and expand religious leaders’ knowledge by introducing new topics, and offer Takamol a mechanism for monitoring the intervention.

Their sphere of impact includes reaching large audiences within their mosque or church, participating in public promotional activities and holding individualized counseling sessions with parents and adolescents. Religious leaders participate in various project activities including Shabab Takamol Week in local schools, opening ceremonies for newly renovated health units, health awareness seminars conducted by community development associations, and as advisors following Takamol plays and puppet shows.

Takamol also involves female religious leaders, traditionally overshadowed by their male counterparts, to focus specifically on women’s MCH/FP/RH knowledge and relevant religious concerns. This approach successfully targets women, especially those who seek information and counseling from female religious leaders.

A newfound sense of self-esteem led this 30-year-old mother of four to open a dialogue with her children, which has improved their quality of life.

“ After finishing the EWSO program, I told my teenage daughter, ‘ Consider me your friend. Anything that annoys you, come and tell me about it.’”

-Salwa Nagib Abd Rabu

Egyptian Women Speak Out Empowering women to improve their reproductive health

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Empowered women typically make better-informed, healthier choices for themselves and their families. To promote women’s empowerment and their engagement in social development, Takamol implements the Egyptian Women Speak Out (EWSO) women’s empowerment program in all intervention communities. The EWSO program was successfully implemented in 69 communities under the USAID-funded Tahseen Project, the precursor to Takamol, and has proven to be effective in helping women strengthen their self-esteem, develop negotiating and decision-making skills, communicate with authority figures, strengthen social networks and safeguard their own health.

The central component of EWSO is a series of documentary profiles in which successful Arab women relate their experiences and describe how they have achieved personal goals and assumed greater stature in their households and communities. A training manual provides a tool through which the key factors contributing to the success of the profiled women can be explored and discussed in group settings. The program is implemented by Takamol once in each intervention community with the help of MOHP and community development association (CDA) outreach workers, who select 20 community women to participate. The CDA then replicates the program using the same MOHP and CDA facilitators.

The nature of the EWSO program facilitates greater participation by women in civil society and within the family, and can be witnessed by their increased enrollment in literacy classes, greater participation in microcredit programs and increased participation on reactivated clinic management boards. The EWSO training has the added benefit of encouraging men to support their wives, sisters and daughters in their socio-economic and improved health-seeking behaviors as well as strengthening couple communication and promoting gender equity in the home.

Linking Literacy with Health Breaking the barrier of illiteracy to spread reproductive and child health messages

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Health and literacy professionals and Takamol project staff discuss the new literacy modules on newborn and infant health care to be included in the Adult Education Agency’s national literacy curriculum.

Illiterate Egyptian men and women cannot access MCH/FP/RH information via the usual channels such as newspapers, books or printed materials, and often rely on information garnered from neighbors or relatives; which is not always accurate. The government of Egypt recognizes the problem of illiteracy, and provides free literacy classes to hundreds of thousands of Egyptian men and women. The facilitators of these literacy classes are respected teachers and trusted information sources within the communities, and therefore have an opportunity to disseminate critical information about MCH/FP/RH and healthier behaviors.

Takamol capitalizes on this opportunity by training literacy facilitators from local community development associations and the Adult Education Agency (AEA), Egypt’s national literacy council, to improve their reproductive health knowledge, and develop better communication skills so they can transfer their knowledge to students during literacy classes. The program utilizes a health-focused literacy curriculum consisting of five teaching modules on family planning, early marriage, gender, sexually transmitted diseases and antenatal care, that were developed in collaboration with the AEA under the USAID-funded Tahseen Project.

Takamol took the collaboration with AEA a step further by developing two additional modules on newborn and infant health care. Unlike the previously developed modules, which supplement the national literacy curriculum, the additional modules are being woven into the curriculum. Simple health messages on newborn and infant care are further reinforced with the inclusion of several questions on these topics in the students’ final exam papers.

The integration of these health messages into the literacy curricula of the AEA means the adoption of Takamol messages nationally. The scaling up of this activity by the AEA is a major breakthrough. As illiterate men and women nationwide improve their literacy skills, they will be empowered by their increased knowledge to seek health care services for their families and themselves.

Takamol Project Youth Activities Engaging youth in reproductive health

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University peer educators increase their knowledge and share ways of discussing sensitive RH information with their peers.

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Youths plant trees as part of village and school beautification activities during Shabab Takamol Week. Youth also participate in health awareness raising sessions, led by trained facilitators and religious leaders.

Egyptian adolescents face a wide variety of reproductive health challenges, especially in rural Egypt. Given that it is culturally unacceptable for unmarried youth to seek out MCH/FP/RH information, Takamol devised a range of youth activities aimed to increase their health awareness.

Shabab Takamol Week (Youth Mobilization Week): During this event, young people participate in health education sessions, engage in community cleanup and school beautification projects, plant trees, and hear from Muslim and Christian religious leaders and health professionals on a variety of FP/RH/MCH topics. The dynamic, six-day program is implemented by local community development associations, with the participation of local schools, community leaders, national councils, the MOHP and the Ministry of Youth and Sports. Youth and their families are also exposed to important health messages through edutainment activities such as puppet shows and plays using familiar Egyptian folkloric characters.

University Peer-to-Peer Program: The peer educator program provides an informal avenue for university youth to increase their knowledge of and discuss MCH/FP/RH topics and issues. Interested youth who have demonstrated leadership and communication skills are selected to participate in a three-day training workshop involving local physicians, religious leaders, and university officials. Participants learn about and debate issues such as appropriate age of marriage, puberty, sexually transmitted diseases, etc. Training also includes communication skills to help youth discuss sensitive topics with their peers, counsel individuals, and link youth to professional counseling services.

Family Life Education: The Family Life Education (FLE) program provides young boys and girls aged 13 to 18 with information on basic life skills and reproductive health topics such as nutrition, vaccination, smoking and addiction, physical exercise; and gender roles and responsibilities. Takamol conducts specialized training courses for MOHP and CDA outreach workers, who are then supported to open FLE classes in their communities for 20-25 participants.

Takamol Puppet Shows and Plays

Puppet shows are an effective behavior change tool utilized by Takamol, and always prove to be a popular community event.

Changing health behaviors through popular drama

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Motivated by international best practices that feature edutainment as a successful approach to knowledge acquisition, and ultimately behavior change on an individual basis, Takamol uses puppet shows and plays developed in partnership with governorate Cultural Palaces to convey reproductive health messages. With the assistance of these state-sponsored cultural and performing arts centers, Takamol reaches diverse members of its target communities with MCH/FP/RH information.

The popular dramatizations have proved appealing and accessible to all major reproductive health decision makers – men and women, youth, fathers and mothers, newlyweds and engaged couples, and mothers-in-law. Because plays and puppet shows are offered free of charge, anyone can attend, regardless of their ability to pay. In many of the remote communities where Takamol works, most people have never experienced a staged production of any kind; this novelty further contributes to the “special occasion” quality of the event and to message absorption. Furthermore, all productions (scripts, costumes, use of local dance or music groups, etc.) are tailored to reflect governorate-specific realities and preferences.

The productions are organized by local community development associations as part of their outreach activities, and are frequently coordinated with clinic openings so that newly renovated clinics are capable of responding to the resulting demand for services. Performances are followed by a panel discussion featuring medical professionals and religious leaders from each community. In this way, respected leaders not only disseminate information, but also immediately endorse the drama’s messages. Equally important, public discussions break the taboo surrounding discussion of certain reproductive health-related issues. Information collected by Takamol staff before and after plays and puppet shows has shown an increase in the MCH/FP/RH knowledge among community members, proving them to be highly effective behavior change tools.

The clinic board of the Kafret Nassar health facility in Giza Governorate posts their quarterly improvement plans on notice boards for all visitors to see. The PHC facility was renovated with contributions from Barclays Bank/Egypt through a private-public partnership initiative facilitated by Takamol.

Reactivating Clinic Management Boards Democratizing health facility management puts communities in charge of their own health

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To sustain improvements in the quality of care at primary health care (PHC) facilities, Takamol helps to reactive dormant clinic boards with strong community representation—and hence ownership—and empower them to address the health needs of the people they serve.

Ministerial decree 239/1997 of the ministries of Health and Population and Local Administration, sanctions the creation of clinic boards enabling Takamol to implement a sustainable strategy for empowering facility staff and community residents, as members of a reconstituted clinic board, to manage clinic service improvement funds (SIF). These locally generated funds are deposited into the SIF and, in a transparent manner, used to maintain the clinic, provide incentives for quality performance and purchase additional equipment or supplies deemed necessary to improve the quality of services.

In all its renovated clinics, Takamol facilitates the democratic election of a clinic board, comprised of half facility staff and half community members—including equal numbers of men and women. To achieve this Takamol uses a participatory approach in which board member nominations are sought from local schools, local village councils, agricultural extension units, community development associations, and the mayor, leading to a broad cross-section of community representation on the boards.

Once elected, board members are oriented to their new roles and trained to establish a common vision between the health facility staff and the board, identify current community health needs not being served by the facility and find ways the board can intervene to meet these needs. Members also gain the skills with which to source nontraditional support for their clinics by seeking donations from local associations and individuals; and to manage and disburse their funds in a fiscally responsible manner.

Reactivating Clinic Service Improvement Funds Placing clinic financial management in the hands of the community

Reactivating clinic service improvement funds ultimately gives clinic boards and management greater control over the way resources are spent, leading to improvements in the quality of care and responsiveness to community-specific health care needs.

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Takamol invests a great deal of effort in reactivating clinic service improvement funds (SIFs) to allow newly formed clinic management boards to take charge of the financial management of their clinics. SIFs exist by decree in all primary health care (PHC) units as a tool for the clinic board to maintain the clinic and provide for the health-related needs of the community. The funds are generated through client fees, donations from the community or governorate, and contributions from the Governor. This income is used for staff incentives, maintenance, staff training, equipment, commodities, emergencies, and governorate and central-level improvements. In many instances, the funds are meager and/or underutilized. In instances where there is money in the fund, accessing it is often problematic due to lack of knowledge about the system, complex financial procedures, or centralized decision making. By establishing a transparent system for spending from the SIF, the sense of ownership for clinic operations within the community is strengthened.

Takamol is facilitating SIF reactivation and making it easier for clinics to access and use the funds by orienting clinic boards on fund management, and by devolving control of clinic bank accounts to the community level. The training provided to board members also provides practical skills in sourcing SIF revenue from community contributions, and fees for services such as lab tests, and ultrasound examinations. To ensure sustainability, and in close collaboration and partnership with the Ministry of Health and Population and Ministry of Finance, a booklet has been produced that outlines the financial rules and regulations governing SIF use, thus eliminating the need for the future training of new board members, financial clerks and other Ministry of Health and Population and Ministry of Finance officials.

Transparency is a key component of SIF usage, with each facility posting its revenue and spending on the notice board for all to see. The system is self-perpetuating because the larger the fund, the more can be spent on improving services, which in turn encourages the community to use the clinic.

Clinic management training is conducted for staff in all renovated primary health care facilities to create a sense of staff ownership over the quality of care.

Clinic Management and Integrated Supervision Creating well-managed clinics and improving the quality of care

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In order to improve the day-to-day management of clinics, to sustain improvements in the quality of care, and to reconnect clinics with the communities they serve, Takamol implements a system of clinic management training and integrated supervision for clinic staff and district and governorate supervisors.

The clinic management program provides clinic staff with the tools to engage in continuous quality improvement, results-focused management techniques, work planning, and monitoring, while creating an unprecedented sense of staff ownership over the quality of care. The program consists of three workshops over a period of five months, during which clinic teams develop a vision of continuous quality improvement, learn to use a diverse set of quality indicators to measure their progress, and are introduced to new management techniques that encourage an environment of teamwork and individual ownership over clinic success. The clinic management training has been warmly received by the Egypt’s Ministry of Health and Population (MOHP) and is now included in the officially approved pre-service training provided by the MOHP for all newly graduating physicians posted to a primary health care (PHC) facility.

Coupled with the clinic management training is Takamol’s integrated supervision program, through which MOHP district level supervisors are trained and mobilized to provide effective support for integrated clinical services in PHC facilities through new methods of supervision and leadership. The supervisors are trained to work together in teams, and to use the Integrated Supervision Checklist to measure the quality of integrated care. Additional quality measurement tools include a client satisfaction survey and a staff work climate assessment to measure improvements in quality of care and management. This has introduced an unprecedented level of transparency at the clinic level and provided a new platform for goal setting and teamwork among clinic staff.

Takamol experts conduct training courses for MOHP district level officials on integrated district planning techniques, leading to increased efficiency and decentralized decision making.

Integrating District Planning Increasing efficiency through decentralized management and decision making

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Takamol builds on the efforts of previous USAID-funded projects—Healthy Mother/Healthy Child (HM/HC) and Tahseen—to integrate Ministry of Health and Population (MOHP) planning at the district level. Prior to these efforts, the Population and Integrated Health Services and Nursing sectors made separate yearly district plans, even though their activities target the same population. As broad integration efforts got underway at the primary health care level, many MOHP workers in clinics and districts expressed the belief that Integrated District Planning (IDP) was essential to the integration effort. IDP reduces duplication of activities between the sectors, increases efficiency, and encourages quality of care by decentralizing management and decision-making within the health sector to the district level.

Takamol utilizes the MOHP-approved Integrated District Planning Manual and Integrated District Planning Training Curriculum developed under the Tahseen Project. All integrated district plans include the integration of service provision, district level supervision and activities to create a stronger link between the community and the facility, including activating clinic boards. More importantly, all district plans include local initiatives to scale up Takamol activities to new clinics and communities within the district, while many include plans to assume responsibility for the management of community-based postabortion and postpartum care programs.

Cutting the ribbon during the inauguration ceremony of the Kafret Nassar health unit in Giza Governorate, that was “adopted” by Barclays Bank/Egypt, brought the governor of Giza, the managing director and chief financial officer of Barclays Bank and the USAID Takamol program manager together to celebrate the results of this private-public sector collaboration.

Takamol Social Responsibility Initiatives Maximizing ideas and resources to create sustainable community assets

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As part of Takamol’s cross-cutting social responsibility (SR) theme, the Project supports the Ministry of Health and Population (MOHP) in adopting a “business mentality” to mobilize resources that help sustain high quality clinical services and expand health knowledge acquisition by partnering with the commercial, NGO, and private sectors. Intervention activities increase the capacity of MOHP governorate and district level management teams to mobilize private sector partners. Local level activities orient facility staff, board members, and community outreach workers about SR concepts, their direct impact on sustainability, and resource mobilization techniques.

Takamol knows that the commercial sector welcomes an efficient, accountable mechanism through which to channel assistance, and therefore, serves as a “broker” for social responsibility partnerships. Transparent mechanisms that provide win-win solutions are key to achieving successful collaboration. An added advantage of Takamol-brokered public-private partnerships is that health facilities interacting with the commercial sector learn how to apply the highly valued principles of good governance and accountability to their management operations. Partnerships with Proctor & Gamble and Barclays Bank/Egypt have been brokered by Takamol.

Linking Microcredit to Better Health Outcomes

Takamol collaboration with the LEAD Foundation empowers women to make positive contributions to their families and communities, and increases their self-esteem and self-worth.

Closing the gap between poverty and poor health

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Microcredit — the practice of providing very poor people, especially women, with access to credit can allow them to transform their own and their families’ lives, providing better nutrition, education, housing and health for themselves and their children. Small loans – sometimes even $75 or less – can allow people to break the cycle of poverty and support themselves by starting or expanding a small business venture in the informal sector.

Takamol has established a first of a kind partnership in Egypt, linking nongovernmental microcredit programs with primary health care facilities. By creating alliances that bring microcredit loan recipients directly to project intervention primary health care facilities, Takamol is creating a community hub, disseminating important health messages and increasing the client base and access to general and integrated reproductive health care services.

Successful microcredit programs improve the financial health of the individual, her family and the community from the bottom up. They also improve the overall living conditions within the community because women, who receive the majority of these loans, reinvest their profits in their families and children. Giving women access to microcredit loans generates a multiplier effect that benefits future generations.

By linking microcredit activities to the programs offered at the health facilities, women are able to address their economic and health needs in a one-stop location.

Takamol is expanding collaboration with microcredit projects and tracking program participants in order to evaluate health outcomes in intervention communities. By implementing an integrated program that addresses health and microcredit, Takamol is closing the gap between poverty and poor health.