This is my first slide.
There is no picture because I’d like to start by relying on
in very powerful alternative technology,
words.
Imagine, if you will, a young woman somewhere in Africa,
she’s on her way to a medical clinic but she’s very happy and excited.
She thinks she’s pregnant with her first child.
She sees a doctor who confirms her good news and then he asks her
if she knows she has HIV.
And whatever else the doctor can say after that, all she can hear
is I have AIDS, I’m going to die, my baby is going to die.
In Africa each year nearly 1.3 million babies
are born to mothers with HIV/AIDS and more than a third of the infants
will have the virus themselves.
Meanwhile, new drugs developed over the last decade have resulted in
pediatric AIDS being virtually eliminated in the developed world.
Looking at why, you saw a map of population dispersion.
There’s HIV prevalence and there are doctors.
Now, I could do the same thing with any other kind of health provider,
you’d see the same thing.
Health systems in the developing world were struggling to provide adequate care
even before the AIDS epidemic, but now, even that basic capability
is compromised.
But in spite of these odds the drugs to prevent mother and child transmission
have become available throughout Africa.
They are remarkably simple to administer,
cost free and very, very effective,
but most of the women who could access this treatment simply don’t.
Frequently, less than 75 -- excuse me -- less than 25 percent.
And that’s where "Mothers to mothers" comes in.
Now, why don’t women access treatment when they can?
Well, it’s because meds don’t equal medical care.
The hurdles are psychosocial, lack of information, fear of disclosure,
stigma attached to HIV/AIDS and the general disempowerment of women.
So the health system, which is straining just like me,
can never catch up.
"Mothers to Mothers" is our response to these seemingly intractable challenges.
We’re creating a new tier of professionalized caregivers
drawn entirely from new mothers living with HIV.
We hire, train, and employ them. That means paying them.
Mentor mothers, as we call them, working clinical settings,
providing education, counseling, and support to their peers.
They strengthen the basic services by shifting tasks away from the
overburdened staff.
And who could be more effective in overcoming barriers that prevent women
from accessing treatment than someone just like her?
Now, empowered with knowledge, responsibility, independence,
a professional or resource or role model,
a source of hope, words, women talking to another woman,
that’s the simple model of the core of what we do.
It’s inherently replicable and thus infinitely scalable, at least in theory.
But moving from theory to practice is an entirely different thing.
So from the start we decided that we had to design a system which would
apply private sector best practices to public health challenges.
We put in place sophisticated infrastructure and management systems
that would enhance our ability to scale strategies, allowing us to be consistent
but remain adoptive, develop our management reporting capacities,
measurement systems, curriculum and design and training methods
while we kept the program itself focused to avoid mission creep.
In only five years the slide you saw before this showed our growth.
We’ve gone from a simple program in the local townships around Cape Town
to a multinational organization, 600 locations employing 700 women
in seven, soon to be ten, countries all across Africa,
delivering HIV services to over six -
excuse me -- 200,000 clients every month.
Working in these seven countries, in the process of launching three more,
we’ve got a simple model that we’ve shown can scale and adopt
and it seems like this was the easy part because now we’re on the radar.
We have no shortage of opportunities to continue to scale
but now they come with strings.
Change your delivery model, add different services,
take on more but save money. Why not use volunteers?
Generally, adopt what you do to make it more like the way things
have always been done.
Going this route wouldn’t be hard since essentially it’s in line with
the public health status quo.
Provide TA or training the existing health staff,
do things the way they’ve been done before,
work within the system that structurally isn’t working,
and we don’t exactly see how we add value in that context.
More importantly, we fear that not only won’t we recognize
what our program will look like but
worse, it will come together in a way that is neither effective nor sustainable.
We’ve always been working in a crisis, in a raise against time.
So it’s only -- we’ve always challenged our self to do more, better, faster.
Change in adaptation are part of our DNA.
And we know that what people are really asking us is how can we scale our impact
to meet their particular needs?
We think we can do this by adopting the roadmap that’s worked for us so far,
applying a private sector approach to a simple health care interaction.
And we’re developing a portfolio of models to respond to these new demands.
This means trying something different in a sector where often,
if something hasn’t worked before, the response is let’s just try it again.
But we’d rather continue to bring about improvement and change
and we think they have some answers,
for instance, ways to adopt both our programs and our systems
and implement them through affiliations that commit both us and our partners
to working together for long term results.
But we’re working in a system that isn’t very amenable to change
and we all know that no matter what, change is hard
even when you share clear commitments and goals.
Not surprisingly, our suggestions then are met with skepticism, anxiety, inertia.
So my question to this group is, what’s the best way for us,
the new kids on the block, he upstarts essentially,
to convince people to let us give a different approach
in the health care sector?
I try.
Thank you.