Why Work with Underserved Populations?

Sodzi Sodzi-Tettey, MD, MPH, IHI Senior Technical Director, Africa Region

It’s about impact. It’s about impact, if you want to do what matters. If you want to be able to get measurable results, you have to go to where the problem is. And we’ve done this thing all the time. I mean, do you want to be pretending to be working or do you really want to work? This is what it is about. If you look at all the places that we’ve worked, where you see the skilled delivery rates are really low, where you started with only 5 or 8 percent of newborns having post-natal care. And now in some of those areas, we are having over 80 percent of newborns having newborn access and newborn services.

In all the places in the West, in the U.S., there’s no way you can achieve that level of improvement. Not because it’s impossible, but because you’ve gone past that. You no longer have those huge gaps. So it is all the areas that we are working in. Improvement is just beginning to happen because simply the gaps are so huge. And sometimes it’s about how little the change is that is needed to be able to bring about some of these improvements that we are seeing.

When we started this work, they used an expression about preventable deaths. It was not until we had done some collaborative work in innovation hospitals that I understood this. Because over an 18-month period, mortality had been reduced by about 17 percent, and this translated into real lives saved. But when I matched that significant result with the changes that had been tested, which seemed like very low-cost, very simple changes, then I understood what preventable deaths meant, because maybe these people didn’t need to die at all, but yet they had died because of one thing or the other. So there is a sense that what you think that what you are doing is making a difference, is making an impact.

But of course, it’s not all easy, because sometimes you do this for some time and you realize that what the people need is not process improvement. Perhaps in other areas, where you do not have any resources constraints, where you have all your tools and implements in place, you can afford to focus solely on process improvement. But when I go into districts where they live in places called, so called, “over-seas territories,” because they are beyond the main land, they are separated by a river, and so on and so forth. And the people tell me what we actually need is a bridge. A bridge is what we need, because when a woman goes into labor, there’s no means of carrying her from one part of the land to the other. We are relying on private canoe owners. No lifeguards. No ways of transporting the women reliably. Then you begin to wonder really what is that you are doing. These are bigger system issues. You see that it goes beyond process improvement. One needs to maybe engage in higher level advocacy, politics, and so on and so forth, to be able to bring that kind of transformative event that we are looking for.