The United Methodist Church’s Abundant Health Initiative is committed to reaching a million and more children with life-saving interventions, a goal set for the 2016-2020 quadrennium. This commitment is only possible through increasing health access and coverage for many thousands of community members within the reach of United Methodist congregations, health facilities and services. Reaching the most marginalized with healthcare is an issue of justice.
Access to health services is not always simple1
In Liberia, Mardea was carried for two hours in a hammock, during labor, to deliver her baby at Camphor clinic. In Central Congo, the construction crew at Dingele Maternity Center rushed a woman in labor with complications to the hospital in their truck. In Jalingo, Nigeria, the taxi union has been contracted to transport women with obstetric emergencies to UMC health facilities. In Nicaragua’s autonomous regions, a horse or motorboat are on standby.
But there are so many other places around the world where physical access to health care simply isn’t possible. Tragically, women and children die for lack of transport – a bus, a bicycle, a motorbike, a truck – or the money to pay for the service, the confidence or permission to take it, or, finally, the limitations of staff and services available on arrival at a health clinic.
Affordability is at the heart of the matter for many families. Payment for consultation fees or medicines brings about hardship. They must use rent money, miss meals, walk instead of ride, go into debt or lose a day’s income.
For Bhawana, affordability meant a walk of several hours with her husband and mother-in-law in the hills of Western Nepal. She had gone into labor and needed to reach her clinic as quickly as possible. On arrival, the examining nurse found complications that she was not equipped to help with and immediately referred the family to the district hospital. How would they pay for the transport and hospital fees?
It seemed an impossible and life-threatening situation until they realized they qualified, on the spot, for an interest-free loan from a fund created for such emergencies. This fund was initiated through a Global Health grant and, after discussion and agreement, received equal and ongoing contributions from the community and local government.
Health coverage and health access go hand in hand
Health coverage is the actual delivery and receipt of services, but many people are unwilling to seek services near their home because of the attitudes of health workers. True health coverage is access to health care providers themsleves and to quality care offered with dignity in clean facilities. Many women from lower social classes or those simply lacking resources have given birth in poorly equipped and staffed facilities without basic infrastrature, like water or a decent delivery bed, because of years of neglect.
Justice for these women has been realized through the UMC-supported revitalization of their health facilities to provide maternal, newborn and child health care, among other essential serives. Delivery rooms are equipped and medications are available. Health care workers in UMC health facilities are trainied to provide care with dignity, regardless of the indivudal’s background. In Ghana, pregnant women and patients prefer to travel for miles to access the Methodist Health Facilities: “We prefer to come to the Methodist clinic” they say “because God is there.” God is there through the compassion, love and the quality care they receive.
In the United States, there has been great fear linked to the COVID-19 pandemic – fear of infection and fear of passing infection to one’s unborn child. COVID-19 has had a devastating effect on the African American community, in particular.2 According to The National Institute for Health Care Management Foundation, Black people are dying from COVID-19 at a rate 2.4 times higher than white people. This is due to higher rates of pre-existing health conditions, over-representation in frontline and essential worker jobs, unequal access to quality health care and insurance coverage and the greater likelihood of living in hyper-segregated neighborhoods. Systemic injustices impact minority communities in many detrimental ways, including the compromised heath of women and children.
A call for education
Sometimes, even when quality services exist and people have access to them, they still might not be utilized. People may not be aware that they have treatable conditions because their illnesses have become “normal” or have a spiritual or contextual diagnosis. Annual bouts of malaria can just be part of life and HIV may be pronounced a spiritual malady or punishment. People may not realize how their avoidance of health care impacts others, like untreated tuberculosis and sexually transmitted infections, undiagnosed Ebola or COVID-19, hidden depression, alcoholism or anxiety. This calls for strengthening health education and the accompaniment of those with such conditions.
Some years ago, in Zambia, a young woman attending HIV awareness meetings conducted by a Global Ministries partner suddenly stood up and called for the group’s attention. She started by saying “I now know the witches who took my two daughters. Their names are HIV and AIDS!” She had never wanted to learn about the virus before because she had believed it was bewitchment. At the meeting, her mind and direction completely changed, and she went for testing and treatment. She now gives other women the testimony of her life – how she lost two daughters who were born HIV-positive because of her lack of knowledge, but that she now has a beautiful HIV-negative son.
Everyone deserves the best health care
Advocacy and funding for other foundational parts of our lives are also essential to personal, family and community health. For example, safe housing, clean drinking water, affordable fresh food, equal education and employment opportunities, affordable childcare and physical security improve the overall health of families and communities. Global Ministries has funded wells and latrines, small and large nutrition and agricultural projects, scholarships and livelihoods – all to address these underlying needs.
At the heart of The United Methodist Church’s Abundant Health Initiative is the desire to bring the best possible health services with the best possible outcomes to communities, and especially to women and children. Although beneficiaries are counted, the goal is not primarily reaching higher numbers. What’s important is offering quality health care with dignity and compassion, mostly to people who have been marginalized. Reaching them is an issue of Christian care and justice. We long for you to join us through your prayers, giving and by care for your community and the world.
Kathy Griffith is the Global Health team lead and program manager for Maternal, Newborn and Child Health.
By Christie R. House
Patience Zakari, a young mother in rural Nigeria, was afraid to take her children to a clinic when they were sick with fever. She feared the cost of treatment, given her limited budget, which made it difficult to pay for essentials like food and school fees. She preferred, instead, to go to a local chemist to buy cheaper malaria drugs, but they didn’t always work.
When her twins, who were still babies, became ill, she feared they would not survive. She found a clinic operated by the Nigerian United Methodist Church, which was screening for and treating malaria at no cost to the patients. “I, my twins, and my other children all received treatment and are well again. Now that we are receiving free malaria treatment, I no longer fear going to the clinic,” Zakari said.
A strong, integrated health system that families and individuals can trust to give the best care possible is not a given in many parts of the world. In Nigeria, United Methodist health facilities in rural areas are working to improve their outreach into the communities they serve.
The Nigeria Rural Health Program, operated by the Nigeria United Methodist Health Board, oversees 16 rural health clinics in four annual conferences within the Nigeria Episcopal Area. It also supports the newly established Jalingo Hospital, constructed in 2017, thanks to an Imagine No Malaria (INM) Hospital Revitalization Grant.
A Health System Strengthening operational grant from Global Ministries’ Global Health unit supports the operations required to manage the health board’s country office. The grant provides salaries for key program staff, like the health board coordinator, Dr. Godfrey Ogbu. It makes possible supervisory visits and on-the-job training of facility staff at the supported health facilities. This integrated and comprehensive approach to the health needs in Nigeria increases access and improves the quality of services delivered.
A year-long Imagine No Malaria program that began in June 2019 provides long-lasting insecticide bed nets, prophylaxis to prevent malaria, and medications and supplies for diagnosis and treatment. Education encouraging behavioral changes to prevent malaria are included in this outreach to community members.
Reaching patients with services and treatments they need
The Nigeria Health Board team travels to United Methodist primary health-care facilities to equip and empower clinic staff with technical information to increase their response. Moses Alikali, who serves as the INM officer in Nigeria, reports that he and Ogbu visited the 16 facilities to monitor malaria programs four times between June and December last year, despite the difficult terrain. Alikali outlines the details involved in one of these visits: “We are making sure that the beneficiaries are receiving free malaria treatment, that health facility staff are adhering to World Health Organization malaria treatment protocol, and that proper documentation of patients and accountability of malaria commodities are recorded.”
Through collaboration with their Maternal, Newborn and Child Health (MNCH) and INM teams, the Nigeria Health Board works toward quality care for all patients who visit the UMC facilities, particularly pregnant women and children under five, who are the most vulnerable to disease. Women who come for prenatal visits can receive medication that will protect them and their babies from contracting malaria. They can also be tested for HIV and if they test positive, start antiretroviral medications. With proper treatment, HIV-positive mothers have a good chance of delivering HIV-free newborns.
This work is vital because Nigeria accounts for 10% of the world’s maternal deaths and ranks 6th in the world for mortality of children under age five. Malaria infection during pregnancy raises risks for both mother and fetus. Maternal anemia, fetal loss, premature delivery and low birth-weight are a few of the dangers.
But the first step is gaining the trust of families so that mothers are aware of their need for the services and come for prenatal visits.
Marta Sunday, who lives near the United Methodist Taka Wurkum facility, found the treatment she needed after she’d tried others: “I was sick for weeks. Even though I was receiving treatment from another health facility, I didn’t recover. At Taka Wurkum, the doctor checked me and explained the reasons why I was still sick. He said either the malaria drugs I bought from the market had expired or I wasn’t taking the right dose. Within two days, the medication he gave me changed everything, and I am feeling good. My baby is calm and healthy since she was treated in this facility. I thank the mission clinic and the doctor in charge who has taken the time to see that these services reach us.”
The Nigeria Health Board also received essential medications and equipment from a HSS Primary Healthcare grant to support gaps in medications and supplies in the targeted health-care clinics. In addition, funds will support the rehabilitation of seven health facilities in Nigeria.
Along with facility revitalization and provision of essential supplies, the HSS program invests in staff development to improve the quality of care. Through a Global Ministries-funded obstetric training event held in the Philippines, a doctor and nurse team received hands-on Caesarian-section training that they brought back to Jalingo Hospital and are sharing with their colleagues.
Working with communities for health improvement
Alikali says community involvement is key for the successful implementation and sustainability of malaria control intervention. “Already in the communities are infrastructures, like community leaders and church leaders, who provide avenues for entry,” he noted.
In its first six months, the INM project directly impacted the lives of 21,075 people, including children, pregnant women, and others. More than 2,038 people who might have died of malaria were saved. The project made quality malaria medications available in hard-to-reach communities. And, the number of patients that visited the health facilities where the INM project has been implemented tripled to 23,991.
The success of this project has boosted the confidence and enthusiasm of the staff in the facilities and the level of community trust as well. This abundant trust has gone a long way to increase health and well-being in remote areas. Receiving correct diagnoses and effective treatments at little or no cost has increased the number of families seeking treatment. The Nigerian Health Board therefore anticipates a general reduction in morbidity in the communities they serve, especially for women and their babies.
Christie R. House is a consulting editor and writer with Global Ministries.
Ending the AIDS pandemic is a collective responsibility. It is a life-saving ministry and movement in which the church plays a vital part. There are eight projects under the Abundant Health banner that have leading roles in reaching young people who are least aware, most at risk, and perhaps most afraid of stigma.
The United Methodist Church’s Health Board in Zambia joined local partners in Kitwe, and the rest of the world, to organize and commemorate World AIDS Day 2019 in December. It was themed “Communities making a difference, pressing toward ending AIDS.”
The celebration began with a candlelight service, helping participants remember people lost to AIDS and to have renewed hope for life. The district commissioner, Binwell Mpundu, gave an inspiring message. He said, “We are no longer a generation of anguish but a generation of hope. A hope that by 2030, Zambia will have zero new HIV infections.” He declared the goal attainable with collective action from all stakeholders.
The day was filled with activity for the people of Kitwe – aerobics, a march, a fun run and tug-of-war, but also with HIV education, counseling and testing, and condom distribution. Everyone was called upon to participate in the fight against AIDS; everyone can offer a hand to stop it. The general public was encouraged to go for testing, refer others for testing, take preventive measures and take antiretroviral medication consistently.
The church is part of the wider community. It can make a significant difference in this life-saving campaign. The health board actively works with the Zambian Ministry of Health and other organizations in the mining city of Kitwe to spread information to prevent HIV, improve access to testing and treatment, and to work against stigma. It recently trained 74 young people as Peer Educators. They are starting to reach out to their friends at school, college and university, establishing clubs and communicating through drama, song and radio, urging everyone to know their status and to treat each other with dignity. The health board is the only organization there reaching out to adolescents.
The Zambia UMC Health Board is part of a national campaign to pursue UNAIDS’ 90–90–90 target. The objective for this campaign is: 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status access treatment and 90% of people on treatment have suppressed viral loads. In 2019, the health board launched the U=U campaign: The Undetectable virus is Untransmittable.
As the Zambia Health Board, we are proud of being part of this noble cause and making contributions to Zambia’s vision of ending new AIDS infections by 2030.
Betty Tshala, Health Office/Board Coordinator
Kathy Griffith is the program manager for Maternal, Newborn and Child Health, Global Ministries. This article was adapted from a report by Betty Tshala, who serves as the Health Office/Board Coordinator, Zambia UMC Health Board, and as a UMC missionary with the Mujila Falls Project in Zambia.