The Canchungo Regional Hospital in the Cacheu Region is one of Guinea-Bissau’s 132 health facilities where PIMI II – Integrated Program for the Reduction of Maternal and Child Mortality: Component for Enhancing Availability and Quality of Maternal and Child Health Care – is being implemented since June 2017. In the maternity ward, we see in the delivery room the weighing scale provided by the project – which contrasts with the old way of weighing babies – and in the postpartum room there are several mothers with their new-born children waiting for a free follow-up appointment.

PIMI directly benefits about 300,000 children under the age of 5, about 400,000 women of childbearing age, and more than 1,200 health professionals working in the country’s 132 health facilities. The action indirectly benefits the entire population of Guinea-Bissau (1,881,005 inhabitants).

Izzet Martinez, a Cuban nurse working with the project since November 2017 – one of the 9 Cuban health professionals included in the project’s clinical team under a protocol signed with the Medical Services of Cuba – directs us to the room where all medicines, provided free of charge by PIMI II to all pregnant women, to women who have recently given birth and children under 5 years of age, are properly stored and organized. In addition to the abovementioned expatriate professionals, the PIMI clinical team includes 28 Bissau-Guinean health professionals, daily working in the various health facilities of the country to train their peers at the workplace.

In addition to clinical training, the free distribution of medicines and medical consumables to the Health Centres and Regional Hospitals is one of the main pillars of the project.  IMVF ensures the permanent availability of 57 medicines drugs and 61 essential medical consumables in the health facilities covered by the project.

Izzet also has an important role in the training of the hospital midwives. Tombom Fati is one of them. “I learned a lot from PIMI II, every month I went to the theoretical training and then gained work experience in the maternity ward”.

We had the opportunity to witness an ultrasound scan procedure, performed with the ultrasound scanner provided by PIMI I to a pregnant woman at the end of pregnancy, by the general practitioner, Dr. Jess Rodrigues, who has been at Canchungo Hospital since 2011 and has participated in several training sessions promoted by the PIMI II, namely, Obstetric and Neonatal Emergency Care (CONU) and Obstetric Ultrasound.

 “PIMI II has done many things for my country, for my institution, and for me as a healthcare professional. I have improved a lot with the theoretical and on-the-job trainings that have participated in. I believe that we will continue to improve the country’s indicators, subject of the utmost concern of PIMI and the National Government, especially as far as maternal and child health is concerned, to reduce the country’s appalling maternal and child mortality rates”, says Jesse Rodrigues.

In the first two years of the project, around 1200 health professionals from all health regions of the country benefited from PIMI in-room or on-the-job training in High Impact Interventions (basic training in maternal and child health), Obstetric and Neonatal Emergency Care (CONU), Obstetric Ultrasound, Transfusion Immunotherapy (intended for laboratory technicians), Caesarean Section Practice and Obstetric Anaesthesia.

Jesse followed in the footsteps of his mother, Maria Formosa Gomes, better known as Mana Nina, a midwife since 1982 and responsible for the Reproductive Health area of the Cacheu region since 1996. “With the start of the PIMI project there was a large reduction in maternal and child mortality, with training, and the distribution of medicines and materials”, he says.

Vasco Na Dum, doctor working with PIMI II at Canchungo Regional Hospital summarizes the main pillars of the project and shares with us: “One of the women we received today, who complained of decreased fetal movement, one of the doctors trained in this area by the project did the ultrasound and found that there was a decrease in the fetal heart rate. The patient was referred for surgery. The goal is to deliver a healthy child”.

Guinea-Bissau has particularly alarming indicators of maternal and child health, with the highest maternal and child mortality rates in the world. PIMI II aims to contribute to reducing maternal, neonatal and child and juvenile mortality in Guinea-Bissau, and to ensure better access to quality health care for pregnant and postpartum women and children under 5.

 “PIMI II has arrived at the right time in my land,” says Mário Quadé, a physician who is part of the PIMI II clinical team at Canchungo Regional Hospital. And he adds: “We see the real difficulties the patients face.” It strengthens the capacity of technicians to provide quality services, in-room and on-the-job training, free consultation and medication for all pregnant women and children under 5, and the evaluation of results through quarterly monitoring. “To give an example, during 2018, at this hospital and other hospitals in the Cacheu region, we have seen a significant improvement of the indicators.”

At Cacheu Health Center, Nurse Midwife Teresa Sanha, since 2016 in this health center, observes a pregnant woman who has just arrived. She confirms the baby will be born in 2 hours and starts to prepare the delivery room, gathering all that is needed to bring another baby to the world.

Mothers and children return for the postnatal consultation. “For those who are far away, we have the Advanced Strategy, and we will consult with those who can’t come.” Recognizing the great difficulties of access to healthcare in this West African country that often condition the demand for health services, the project also foresees home visits provided by the Health Centres professionals, to provide healthcare access to the populations living more than 5km and or more than 1 hour away from the sanitary structure concerned.

Vitório Mendes, a 26-year-old male nurse working at the Cacheu Health Center, tells us: “Before, our pregnant women did not come to prenatal consultations, nor did they have the habit of giving birth at the health centre.” “PIMI is not just about distributing medicines and making consultations available for free. PIMI is a program that goes beyond. It helps in the rehabilitation of health centres and the training of health technicians”, thus improving clinical performance and the quality of clinical practice. In this context, blood banks, ultrasound machines, photovoltaic panels were installed in the various health facilities to provide lighting to the to the delivery rooms, paediatrics service and laboratory.

PIMI II – Integrated Program for the Reduction of Maternal and Child Mortality in Guinea-Bissau is implemented by IMVF, in partnership with the United Nations Children’s Fund (UNICEF) and Entraide Médicale Internationale (EMI), with the European Union funding and support from Camões, IP