Leading Voices: Megan Montgomery

Meet Megan Montgomery, one of two impressive Pfizer Global Health Fellows currently working with MSH in Tanzania. This international corporate volunteer program places Pfizer colleagues in short-term fellowships with international development organizations. Megan is lending her skills and expertise in marketing and business strategy to MSH’s Technical Support Services Project (TSSP) in Tanzania, which provides assistance to the Ministry of Health in key technical areas to help control the HIV epidemic and sustain HIV-related health systems and services. 

How are you supporting the TSSP project in Tanzania?

My main focus while here is partnering with the team to strengthen the health system in Tanzania through human resources for health (HRH) activities, such as the implementation of task-sharing initiatives, recruitment, retention and productivity management, as well as developing communication pieces to share the work being accomplished.  

Can you explain what task sharing for HIV services looks like in this context? 

First, it’s important to understand that Tanzania’s health care workforce is operating with only 44% of the staff required, per its national human resources for health plan. So simply put, there are not enough people on the front lines of the health care system to test, treat, and care for every person who has HIV. Task sharing, which is just starting to be formally implemented in Tanzania, aims to enable lower level health care providers to perform tasks that would typically be outside their scope of responsibilities to help fill some critical gaps. At the same time, thinking upstream about how to develop health care providers through the right training and formal education, to fill priority positions in the health sector and raise the standard of care, particularly for HIV services. 

One of the main initiatives I am working on right now is a task share training plan for health care workers to ensure they receive quality training on the additional tasks they are undertaking (such as lab diagnostics or medicines management), so that patients have access to quality HIV care.  

As you think about the health system there, what has stuck out or made the biggest impression on you so far?

I have been really surprised by how much people have to take on. With such a high vacancy rate of health care workers, I have observed health care workers in rural areas who are responsible for everything at their facility: patient intake, taking blood, running lab tests, diagnosing and then prescribing and dispensing medications. Some facilities can see 100 patients in just one day. When the nearest open facility is hours away, there really isn’t a choice to not work—no matter how tired you get—patients need you. Their commitment to helping their community is really impressive.   

And when it comes to caring for patients with HIV, it can get really complicated. As a provider, you really need to know how to track and manage your patients to help them stay on top of their treatment so that they can live their lives and reach viral suppression, lowering their risk of infecting others. That requires a level of training that many providers just don’t have the opportunity to receive.

Can you give an example of how strengthening human resources for health can contribute to a stronger HIV epidemic response in Tanzania? 

We have to fill those vacant positions. At the same time, we need to invest in those people who are working in health facilities right now. In my conversations with health workers, I see how eager they are for formal training, so that they can appropriately monitor and treat their patients with HIV. 

For example, an HIV Care and Treatment Clinic (CTC) offers the whole range of HIV services, particularly starting people on treatment using antiretrovirals. But not every facility is allowed to offer these services because of the complexity of treatment—you need a certain number of staff, with the right competencies, to become a CTC. 

If your facility isn’t a CTC, you will need to refer your patients to another clinic, which could be up to an hour away. Since many people, particularly in rural areas, don’t have money for transport, you may be diagnosing HIV-positive clients who never make it for a follow-up appointment or get a prescription for medication. 

Currently, national guidelines do not allow nurses to prescribe antiretrovirals, but as more health workers are trained in task sharing—even those in remote facilities and with few staff—will be empowered to become CTCs. In this way, training of health workers through task sharing directly affects patients’ accessibility to quality HIV treatment and services, and makes the health system more sustainable over time. 

You’ve volunteered in numerous countries, including Ghana, Democratic Republic of the Congo, Guatemala, Costa Rica, Russia, and China. What has been unique or special for you, working in Tanzania? 

I have been here for a longer length of time, so I better understand the culture and health care environment, which makes it easier to devise things that will work.  I have great partners in my coworkers and the other stakeholders here, and I have really enjoyed working with them to find solutions.  

I’ve also had the time to make solid friendships. The people here have been so warm and welcoming. I really appreciate what a friendly country Tanzania is.  

How do you think your time in Tanzania will change your work or home life when you return to the US?

The experience has changed me a lot. From a practical level, I think I will live a simpler life when I return.  I have been living out of two suitcases for the past few months, and it still feels like excess! There’s such a focus on relationship here as well. Before every meeting, during breaks, any time with friends, there’s a priority on making sure people are doing ok, on spending time building your relationships.  Living in New York, we have a tendency to be task focused. While that can be good, hopefully I will go back and take that extra time to just connect with people throughout my day.