Nam’s health beacon glowing brighter

When Magda Hilda Shaanika-Awases commenced training in nursing and midwifery, it was circumstantial and not optional.

Today, the modest World Health Organisation (WHO) Inter-country Support Team for East and Southern Africa, regional adviser has 19 countries in sub-Saharan Africa under her wings.

Prime Focus magazine caught up with Dr. Shaanika-Awases at her Harare headquarters in Zimbabwe to hear how she abandoned the cutting of umbilical cords in the maternity wards of Windhoek, and the hussling and tussling of Namibia’s trauma care centres, to scale WHO’s ladder, where like an eagle, she is perched so high.

A product of Augustineum High School and the then Windhoek College of Nursing which is now under the University of Namibia, Awases regards her decision to choose nursing as “circumstantial”.

“The fact that previously one could earn a salary while undertaking studies in nursing was one of the reasons I chose nursing. This enabled me to help my mother look after the family while continuing to further my education. I wanted to help my widowed mother because the family was too large for her to fend for,” she says.

She completed her training with a diploma in nursing and midwifery in 1982.

Soon, she enrolled for a Diploma in Education and later for a BA Cur in Nursing education with the University of South Africa (UNISA) in 1991 and then an Honours Degree in Bachelor of Education in 1993.

And yet she did not end up teaching, but with the Ministry of Health and Social Services (MoHSS) in Windhoek. She was tasked with setting up the Personnel Development Unit that deals with in-service training and pre-service training for enrolled nurses in the two main state hospitals, Windhoek Central and Katutura.

It is during this time that she started looking at the bigger picture of development as a vehicle for advancing others and herself.

“I needed to flourish and excel not in the hospital’s curative wards but in other health related disciplines and development aspects that would eventually lead to better health of the population we serve. I made a promise to myself way back in 1987 that this is just the beginning of an upwards career path for me.

“In 1990, I was one of the pioneer Human Resource Development Committee members involved in the establishment of the Directorate of Policy Planning and Human Resources Development for the Ministry of Health,” she says.

She was the Head of Human Resources Development overseeing the planning and establishment of the National Training Health Centre (NHTC) which was supported by the Finnish Government with technical input from the World Health Organisation office.

“I am one of the people who virtually laid down the first foundation bricks for the training institute,” Shaanika-Awases boasts.

The NHTC which was set-up to train a critical mass of frontline workers such as enrolled nurses and technicians was eventually strengthened to consist of satellite centres in Otjiwarongo, Rundu, Keetmanshoop, Oshakati and Onandjokwe Hospitals, creating a vibrant network of health training centres in Namibia.

The programme produced nurses, pharmacy assistants, medical laboratory technicians and medical rehabilitation assistants, now scattered around the country.

Her hard work did not escape the watchful eye of her employer who recommended her to go to the United Kingdom for further training at the University of Leeds in 1994 for a Masters Degree in Health Service Management Planning and Policy.

She majored in Health Planning, Health Policy, Health Economics and Human Resource Management.

Awases’ desire to churn out well trained health personnel for her country saw her cashing in on a vital connection she established in the UK. Out of her own initiative and while still a student, she lobbied a UK based organisation, Health Link UK to assist her in developing a proposal to finance the creation of libraries and training materials for the training institutions she had helped set up in Namibia.

Health Link UK dealt with low cost teaching and learning materials, information systems and libraries at schools, and universities and already had projects running in Tanzania and Uganda, before agreeing to come to Namibia.

“I was asked to write a proposal for submission to DiFD-UK, which I did after consulting the then Permanent Secretary of Health. The proposal was approved and we got funding for the Communication for Integrated Learning Project (1997-1999).

As part of implementation, an international consultant from Health Link UK was placed at the NHTC to support the setting-up of resource centres at the training centres as well as to acquire training materials.

At the same she was completing her Masters Degree program while strengthening the Ministry of Health’s human resource development and capacity.

She and her team were instrumental in getting special funding for the Government to train a group of 14 medical students in Ghana and other countries, fulfilling her long term projection and ambition to have the country’s health delivery system equipped with well trained doctors and key health personnel.

It was there that she realised that through hard work she can achieve her vision of focusing on developmental issues within the health systems beyond her own country.

In February 1999, Awases was contracted as a short term professional consultant for human resources for health by the World Health Organisation (WHO) for 11 months.

This was the beginning of a long career as an international civil servant with the World Health Organisation which saw her 11 month short-term consultant confirmed to a fixed-term appointment and to a continuous appointment according to the UN system.

Initially she was based at the WHO Regional Office for Africa WHO/AFRO) in Congo-Brazzaville from March 1999. The Office was later temporary relocated to Harare, Zimbabwe due to the civil war that was raging in the Congo.

By 2002 she worked as a Regional Adviser for Human Resources for Health Development for WHO/AFRO overseeing 46 countries including 21 French, 20 English and five Portuguese speaking countries until February 2009.

Shaanika-Awases stresses the importance of countries having adequate human resources for health.

“It is recognised that in order to scale up major health interventions, provide good-quality services, and achieve the health-related goals such as the Millennium Development Goals requires a health workforce that is well trained sufficient in numbers, appropriate skill mix, adequately deployed and motivated.

“There is strong evidence that progress in health will not be possible without strong health systems, for which the health workforce is the backbone. There is also a clear correlation between the density of health care providers and the attainment of high levels of coverage with essential health interventions, such as immunisation and skilled attendance at birth,” she says.

A 2006 WHO report identified 36 out of the 57 countries experiencing critical shortages of health care providers (doctors, nurses, midwives, etc) are in Africa due to various factors. The African region is estimated to have only 590 198 health workers against an estimated 1,5 million required.

Shaanika-Awases has focused on providing technical support to member states through strengthening their leadership capacity in the process of development, implementation and monitoring of HRH policies, plan norms and standards; strengthening national education systems, including schools and universities; promote effective management of the health workforce and creating conducive working conditions and workplace environment; contributing to the generation of evidence through research and information systems; and to promote partnership and networking at country and regional levels.

“I have enjoyed visiting countries as diverse as Senegal, Ghana, Guinea Bissau, Benin, Uganda, Tanzania, Democratic Republic of Congo, Seychelles, just to mention a few. Each country in Africa has its own beauty.”

During this period she has completed her doctoral and in 2006 was awarded the Doctor of Literature and Philosophy degree in Health Studies (Dlittet Phil in Health Studies) by the University of South Africa.

She regards her biggest achievement as the 2000 to 2002 study on migration of health workers in six countries (Cameroon, Ghana, South Africa, Uganda and Zimbabwe) which she led.

The results and evidence from this study has contributed strongly to the debate on international migration of health workers and has put it on the agenda of the highest level, the World Health Assembly.

The Ministers of Health in Africa, empowered by the evidence provided by the study and with the support of the WHO/AFRO tabled a resolution on “International migration of health personnel: its effect on health services in developing countries”.

This agenda was taken up by many international organisations and she was part of a Committee that worked on the WHO Code of Practice for International Health Personnel that was approved by the World Health Assembly in May 2010.

Shaanika-Awases was also involved in setting up the first Masters Public Health program with focus on Health Workforce Development at the University of Cape Town, in South Africa with funding from WHO, a first in Africa.

The first intake of students from various African countries took place in 2009. Various publications, papers and presentations at various regional and international forums have been made which include, ‘Migration of Health Personnel in six countries: A Synthesis Report 2002 WHO’; Addressing the human resources crisis: a case study of the Namibian Health Service 2007 Med Central; Development of Human Resources in the WHO African Region: Current Situation and Way Forward 2010, and The African Health Monitor Journal.

She crossed over to the WHO Inter-country Support Team Office for East and Southern Africa in Harare in March 2009 as the focal person for Human Resources for Health.

Here, the issue of technical advice to countries became more prominent, especially Ministries of Health.

She also works closely with priority programs like reproductive and child health care, HIV/AIDS, TB and Malaria and provides input on system issues.

“Ministries of Health are politically sensitive areas and one needs to know how to package the recommendations and the resolutions without stepping on other people’s toes,” says Awases.

The various country offices liaise closely with the WHO.

“I also work closely with partners in the sub-regions such as East and Central Health Community (ECSA) with Southern Africa Development Committee (SADC), organisations like USAID, the World Bank, and International Organisation of Migration,” she adds.

Her regional position is the umbilical cord that keeps her attached to her mother country because Namibia is one of the countries that fall under her jurisdiction.

“I am still in a position to support my country. The WHO supports programs in Namibia on various human resources for health development matters.”

Whenever she is home, she makes it a priority to visit the MoHSS, especially the human resources development division to share information on issues regarding HRH and offer advice.

Shaanika-Awases urges Namibia to appreciate its own people as there are a number of Namibians in the diaspora excelling and occupying prominent positions.

Her message to Namibians in the diaspora is for them to plough back some of the skills to the country.

“That glory is not shining through yet,” she says.

For Shaanika-Awases, the powerful position she holds took away some of the joys of motherhood as her frequent travelling necessitated sending her two children, both boys, to boarding schools. The eldest, Michael, is now 27 while Angelo Dantagob has just matriculated and waiting to pursue further studies in the UK.

She urges fellow Namibian women that it is time to rediscover and strengthen their leadership attributes.

“My message is about positive thinking and to shift from the assumptions that what we want to achieve is not possible and be able to overcome the challenges of succeeding in a male dominated environment.

“We should surround ourselves with courageous and positive people who can inspire us to turn what we perceive as problems into opportunities. Positive thinking helped me to get where I am at the moment.” PF