World Health Day feature post by Tanya Salewski, Alinea Project Director for Global Health and Gender Equality

Mwanza Region in Tanzania’s western Lake Zone has amongst the highest burden of maternal and childhood mortality and morbidity countrywide. Poor communication and disrespectful treatment by health workers can be a barrier that prevents pregnant women from seeking essential care at a health facility – this is just one example of how gender inequality shapes the experiences and perceptions of patients seeking and providers delivering health services in Tanzania and around the world.

Photo credit: University of Calgary

Often, clinicians do not see gender as “relevant” to clinical practice, or assume maternity care is by definition gender-responsive because it focuses on women. “I treat each pregnant and delivering woman according to her need – it has nothing to do with gender equality,” is a phrase I often heard while working in Mwanza as Field Manager for the Mama na Mtoto Project, which means “Mother and Baby” in Swahili.

We know from the wealth of information in literature combined with extensive program implementation experience that health status and access to quality health services are profoundly gendered – creating a clear link between the issues of gender equality and health inequity.

On World Health Day 2021, I am taking the opportunity to share my experience with the Mama na Mtoto Project and how gender-responsive care can play a key role in addressing equity in healthcare.

Funded by Global Affairs Canada and under contract to the University of Calgary, Alinea led field implementation of the Mama na Mtoto Project. Between 2016 and 2020, we worked in two districts with local governments and academic partners to build capacity of health management teams and health workers to improve the quality of services for mothers and babies, including antenatal care, delivery, postnatal and essential newborn care.

At the outset, many clinicians resisted the idea of integrating a session on gender equality into hands-on clinical training – they did not want to distract from transmitting essential, life-saving skills to frontline staff, and saw gender content as abstract and theoretical. In response, our project team integrated tangible gender issues into clinical simulation scenarios to help health workers identify what disrespectful care looks like, its impact on quality of care and how to deliver equity-focused care at their facilities.

WATCH: Mama na Mtoto – Dignified, respectful maternity care

Photo Credit: University of Calgary

Based on the positive response, we developed a two-day training workshop for health workers from selected rural facilities to work through a process of self-reflection, situation analysis and hands-on planning to apply a gender equality approach in their care delivery settings. The workshops allowed space for participants to share their experiences in order to identify and understand the stresses and issues that drive rude, disrespectful or even abusive behaviour. We focused on understanding the various dynamics at the interface between patient and provider based on examples from lived experience, as well as feedback gathered from women in focus group discussions. We found poverty, age, ability, education, ethnicity and language – layered with gender – all contribute to the power imbalance between patient and provider, and can create an environment that normalizes disrespect of pregnant and delivering women.

Participants identified and planned specific actions they could take in their facilities and the support they would need to practice equitable care and respectful communication. Followed-up with mentoring and on-the-job support, this process saw health workers develop the ability to express the links between the gender-responsive care learnings and delivery of effective and respectful care, improved relationships between patients and providers and, importantly, increased use of health facilities by expectant mothers.

We found that reframing training content on gender equality as “dignified and respectful care” created an energizing, relevant and acceptable entry point to engage health workers in meaningful conversation and concrete action on gender, equity and human rights. Through the Mama na Mtoto Project, we supported more than 30 health facilities to improve communication and provide gender-responsive care to help mothers and babies in Tanzania access quality health services when and where they need them.

alinea’s whistleblower policy

1.1 Purpose

The following Whistleblower Policy has been established to provide guidance to Alinea International employees and sub-contractors on how to deal with known or suspected improper conduct within the organization. The objectives of this Policy are to:

Create awareness of the Policy and available whistleblower protections
Act as a reference guide to potential whistleblowers wishing to make a disclosure
Define the structure of the whistleblower system, including reporting and investigation procedures, whistleblower protections, and confidentiality, among others
Improve the communication and transparency in the processes associated with whistleblowing and assure protection against derogatory consequences, namely reprisals and detrimental action
Complement the current communication channels between employees, sub-contractors and immediate managers, and hierarchical channels flowing to the President and Senior Management team
Provide guidance to all parties involved in either whistleblowing or whistleblower protection.

1.2 Scope

Alinea requires all employees and sub-contractors to observe high standards of business and personal ethics in the conduct of their duties and responsibilities. All employees and sub-contractors of Alinea are required to comply with applicable laws and regulations of Canada and the countries where we operate. Any allegations of known or suspected improper conduct or mismanagement of organizational resources will be dealt with in accordance with this Policy, and reasonable steps will be taken to protect those who come forward with allegations. Alinea’s Whistleblower Policy covers both internal and external whistleblowing, and establishes the controls and procedures for dealing with allegations of malpractice, fraud and violations of our code of ethics and/or laws or regulations that govern our operations. This Policy is intended to encourage employees and sub-contractors to report known or suspected improper conduct or mismanagement of organizational resources and to enable Alinea’s Senior Management team to address and correct inappropriate action. It is the responsibility of all Board of Directors’ members, the Senior Management team, employees and sub-contractors to report concerns about known or suspected malpractice, fraud and violations of our code of ethics and/or laws or regulations that govern our operations. This Policy is applicable to all employees and sub-contractors of Alinea International.

1.3 Reporting Procedures

Alinea recognizes the value of transparency and accountability in its administrative and management practices and supports the making of disclosures that reveal improper conduct or mismanagement of organizational resources. Our internal controls and operating procedures are intended to detect and prevent malpractice, fraud and violations of our code of ethics and/or laws or regulations that govern our operations. As detailed in Alinea’s Employee Policy and Onboarding manuals, employees and sub-contractors are encouraged to share complaints and/or concerns regarding ethical or legal violations with their immediate managers. If the employee or sub-contractor is not comfortable speaking with their immediate manager or is not satisfied with the response, they are encouraged to speak with the Gatineau or Calgary Office Managers, the Vice Presidents or, as required, the Chief Financial Officer. All members of the Senior Management team are required to report complaints and/or concerns about suspected ethical or legal violations in writing to Alinea’s Ethics Committee who has the responsibility to investigate all reported complaints and/or concerns. In the event that the complaint and/or concern is about the President, it should be raised by the employee or sub-contractor to their immediate manager or the Ethics Committee who will determine how the investigation will proceed. All reports will be promptly investigated and appropriate corrective measures will be taken if warranted by the investigation. Alinea’s Ethics Committee is responsible for acknowledging receipt of the suspected violation and notifying the whistleblower of the outcome of the investigation. Anyone filing a written complaint concerning suspected improper conduct or mismanagement of organizational resources must be acting in good faith and have reasonable grounds for believing the information disclosed indicates a violation. Personal grievances or complaints related to employment are not covered under Alinea’s Whistleblowing Policy. For cases such as this, employees and sub-contractors are advised to first refer to Alineas Employee Policy and Onboarding manuals when considering a disclosure under the Whistleblowing Policy. Any allegations that prove not to be substantiated and which prove to have been made maliciously or knowingly to be false will be viewed as a serious disciplinary offense.

1.4 Confidentiality

Maintaining confidentiality is crucial to ensure reprisals are not made against the whistleblower. Alinea is committed to safeguarding the identity of the whistleblower and to protecting the whistleblower against detrimental action taken in reprisal for allegations of suspected improper conduct or mismanagement of organizational resources. The Ethics Committee is responsible for ensuring whistleblowers are protected from direct and indirect detrimental action, and that the culture of the workplace is supportive of suspected allegations being made. Any employee who retaliates against someone who has reported a violation in good faith is subject to discipline up to and including termination of employment.

1.5 Review

Alinea is committed to implementing ‘best practice’ policies and procedures for dealing with allegations of suspected improper conduct or mismanagement of organizational resources (as defined by this Policy) and the management and protection of whistleblowers making allegation(s). This Policy will be reviewed periodically to ensure it meets the objectives of relevant legislation and remains effective for Alinea, and may be changed at the discretion of the Board of Directors at any time. For allegations of fraud, securities law, or human rights concerns, or when you are not satisfied or uncomfortable with following the Company’s open door policy, individuals should contact the Company’s Ethics Committee directly.

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WORLD HEALTH DAY: Gender-responsive care for mothers and babies in Tanzania

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