Addressing health barriers by adopting ‘one health’: Dr. Sandra Maripe, IPPHL Fellow

During her residency following medical school, Dr. Sandra Maripe saw how villagers in Botswana struggled to access health care. That’s when she realized she wanted to dedicate herself to primary health care since the patients were “often coming in when it was too late for us to help them.”

Dr. Maripe, who is the health management team coordinator for Ngami District for the Botswana Ministry of Health and supervises a hospital and 29 clinics, now aims to implement the Ministry’s strategy to revitalize the district’s entire primary health care system. As part of her journey, she participated in last year’s cohort of the International Program in Public Health Leadership (IPPHL). This eight-month program for emerging leaders working in or closely with African ministries of health aims to expand their "policy and leadership acumen ... to develop and implement lasting public policy solutions and transform health systems."

The program, created by the Evans School of Public Policy and Governance at the University of Washington and funded by the Gates Foundation, has trained 192 public health professionals across 29 African countries over the past seven years. The program's curriculum now also incorporates lessons from Exemplars in Global Health.

Exemplars News spoke with Dr. Maripe about her journey and the IPPHL program, including the lessons she would share with other aspiring public health leaders.

Could you tell us about your personal journey? How did you become interested in primary health care?

Dr. Maripe: After I completed my medical studies, I took part in a one-year internship program, rotating through all the disciplines, including surgery, pediatrics, child health, and maternal health. During that experience, I developed an interest in primary health care because of the variety of patients we saw. I also saw how they struggled to access health care, often coming in when it was too late for us to help them.

Could you tell us about your work with the Ngami District Health Management team? What are you currently trying to accomplish, and why?

Dr. Maripe: I supervise all our public health facilities in the Ngami District, including one district hospital and 29 clinics. We try to address our health challenges mainly through stakeholder collaboration and community engagement. Our district is severely impacted in terms of socio-economic status. There is a lot of poverty and unemployment at the community level. We also experience pockets of malnutrition in some small villages and settlements. All this affects their health care-seeking behavior and their ability to access care.

For example, we go into villages and conduct community health screenings. We also engage communities and their leadership. Every village is led by a chief, so we engage the chiefs and the business communities and stakeholders in those areas. By doing this, we address health barriers together, adopting a ‘one health for all’ approach. For example, in one village we identified that malnutrition is an issue so we’re working to establish a community garden.

Additionally, since we’re a tourism hub, we face challenges of human-wildlife conflict. People’s farms are affected by elephants, and they can't afford electric fencing. We have now engaged the business communities in the same area we intend to create community gardens to support food security.

Could you tell us about your experience with the International Program in Public Health Leadership?

Dr. Maripe: It has been a wonderful experience. It has significantly improved my leadership skills – we covered many topics during the program, such as how to lead people, manage change and transition, and handle conflict in the workplace.

I appreciated the 360-degree tool we used to assess ourselves through the eyes of our leaders and peers. It was an eye- opener for me, showing that people always remember how you treated them, even if they forget the words you said.

I also learned the importance of giving feedback, whether positive or negative, and concepts like the theory of change, which we can use in our daily programs and projects. I’m now also connected socially with people from several countries – I have friends in over 20 African countries that I’m still in touch with.

Have you used Exemplars in Global Health since IPPHL? If so, how?

Dr. Maripe: From the first day we were introduced to Exemplars in Global Health, we started receiving insights from the program to understand and appreciate what other countries are doing.

For example, I recently read about how Nepal reduced maternal mortality and neonatal deaths by engaging female community health care workers and collaborating with donors. We’re also working on a program for community health care workers, and I’ve appreciated how other countries like Liberia and Ethiopia have utilized community health workers to improve primary health care. It helps us to learn from those countries.

What specific learnings from the program would you share with other global health professionals looking to create new strategies to improve African health systems?

Dr. Maripe: I would start by emphasizing the importance of community health care workers. Many African countries struggle with resources, whether financial, human, or skilled, such as nurses, midwives, and doctors.

One specific case we studied was about how Liberia improved universal health coverage and access to health care, especially for vulnerable and disadvantaged communities. This example helped us understand how to address our own challenges in African health care systems.

Another important concept for me was direction, alignment, and commitment. As a leader, it’s crucial to engage the people you lead in your strategic goals and overall plan to improve the health care system. If everyone is aligned and committed, you can work together to reach your destination.

How do you think the program will impact your work in Botswana?

Dr. Maripe: It will have a positive impact. Through the program, we shared experiences and realized we face similar challenges. It has opened our eyes to ways we can improve care in our communities, especially in hard-to-reach areas, and achieve universal health coverage. It has also influenced our thinking on how to achieve our sustainable development goals and global health targets.

What are you hoping to accomplish in the future?

Dr. Maripe: On a personal level, I hope to have a positive impact on transforming the health care system in our country.

Right now, I work in a rural setting with vast geographic disparities, and we still have communities that struggle with access to health care. My hope is to have an impact on universal health coverage within the Ngami District by revitalizing our primary health care system.

As I mentioned earlier, the Ministry of Health is planning to hire and train community health care workers in my district because we face a shortage of resources. By doing this, we hope to improve and increase access to health care, reaching out to communities and facilitating their access to our health care facilities.

Additionally, I have collaborated with other women in health to form a global health chapter for women in Botswana. We recently registered our society, and we are now working to engage more and mentor younger women in health and leadership skills. This is where my current commitment lies.

Editor's note: The Interational Program in Public Health Leadership is now accepting applications for Cohort 8 through September 29, 2024. For more information on the candidate profile, program description, and to access the online application portal – visit the IPPHL website.