By Kate Andrews, ChildFund Staff Writer
For 50 days, ChildFund is joining with numerous organizations to demonstrate support for government policies and programs that will allow women and girls to be healthy, empowered, and safe — no matter where they live. Improving the Health of Women and Girls is this week’s theme.
Visiting the doctor is usually a mild inconvenience in the United States. It may entail a drive across town and a sit in a waiting room filled with people coughing and sneezing. But in Senegal, which has only 822 doctors serving a population of more than 12 million, seeking medical attention is a major undertaking.
For some families, it’s too much. Sadio is the mother of 2-year-old twin girls in the village of Pakala, which is often flooded during the rainy season. This makes it difficult to travel 6 kilometers (more than 3 miles) to the nearest health post staffed by nurses. Awa and Adama suffer from respiratory problems, and Adama is especially sickly, having come down with a debilitating cold that required a doctor’s care — a 30-mile journey from home to a hospital.
Sadio and her husband Moussa, a farmer, have experienced loss before; their first child, Matar, died in 2007 at 13 months from diarrhea and a respiratory infection. But today their village has a health hut, which is staffed by a matron, community health workers and birth attendants. They can help patients with basic needs, but more complicated illnesses and ailments still call for a trip to the health post 3 miles away or 30 miles to the hospital.
Sadio reports that her diet improved during her pregnancy with the twins after receiving advice at the health hut, but her girls still face challenges from the respiratory infection; also, they were born underweight.
The health of women and girls is important to ChildFund, as we work with local partners to provide access to health care in isolated villages as well as underserved urban areas in developing nations. In Senegal, ChildFund is leading the implementation of a $40 million grant from USAID to establish community health care services for children and families in great need.
Over five years, we plan to establish 2,151 health huts and 1,717 outreach sites throughout the country, along with a sustainable national community health policy working in partnership with USAID and other key community development organizations. By the end of the project, we expect to have helped more than 9 million Senegalese people in 72 districts.
By Kate Andrews, ChildFund International writer
Last April, ChildFund workforce specialist Ann Latham-Anderson asked the children in her neighborhood an important question: If you didn’t have shoes, what would you miss most?
Then she let them draw on her feet with magic markers, and her husband and daughter chipped in with drawings of children on her toes. The next day at work, she won our foot-decoration contest. “It did take a while to get the ink off my feet,” Ann says with a laugh.
One Day Without Shoes, on April 16, is an engaging day at ChildFund’s international office in Richmond, with contests and music, but it also reminds us about the impact something simple like a pair of well-fitting shoes can have on children’s health, education and future opportunities.
In developed countries, “we have so many options of what kind of shoes to wear,” says Sadye-Ann Henry, a treasury assistant who won the pedicure contest last year. One activity, walking on rocks, showed Sadye-Ann “how tender our tootsies are” and a glimpse of the challenges the children we serve face every day.
Ann, Sadye-Ann and many more of us at ChildFund, including some of our national offices, are preparing to join in on One Day Without Shoes by going without shoes at the office. This event, started by TOMS Shoes six years ago, is meant to raise awareness about children’s education and health and how shoes play a role in helping create opportunities for a better future.
In many developing countries that ChildFund serves, children must have uniforms and shoes to attend school. Also, when children have only flip-flops or no shoes at all, they’re vulnerable to cuts, diseases and hookworm infection, which have long-term implications like stunted growth and compromised health.
Anyone can participate in One Day Without Shoes. Just kick off your shoes and join the rest of us in creating awareness of an important cause.
In Indonesia’s Central Southern Timor region, families have long lacked access to good health care, and 6 percent of children die before the age of 5. ChildFund and UNICEF are working to provide health care services to this population.
By Dirce Sarmento
It was her first midwife training session in more than 10 years, but Maria de Fatima Moniz made it clear she was up for the challenge. She seized a valuable opportunity this past June and participated in a two-week midwife training facilitated by ChildFund Timor-Leste and Instituto Nacional de Saude (National Institute of Health) in the Covalima district.
During her first week, Maria, 38, learned the “55 Steps” — guidelines used by midwives to ensure the safe delivery of newborns and appropriate care for pregnant women. The second week of training, based in Dili’s National Hospital, gave the group of 17 midwives the opportunity to use their practical skills while under close supervision.
“During this training, I felt very fortunate to be able to learn new knowledge about the 55 steps and safe deliveries,” Maria says.
With more than 15 years of experience caring for mothers and newborns, Maria will use the information she learned to improve the delivery process she practices in her community. She is the only midwife for five sucos (villages) in Covalima — a community of approximately 7,500 people — and works at the Tilomar clinic. Tilomar has no running water, so she has to ask families to bring their own to use during and after delivery.
“The problem we have now in our community is that we don’t have any materials for delivery, like baby napkins, and no sterile delivery set,” Maria says. Despite these challenges, Maria has successfully delivered countless babies at the clinic. She hopes that conditions will improve.
As a mother of four children, Maria understands how important it is to support pregnant women at each stage of their delivery. “After this training, I hope what I learned will help local women have clean and safe deliveries and that [maternal and infant] mortality in Timor-Leste will be reduced.” Since she began working at the clinic in 2000, she says, eight women have been taken to Suai hospital for caesareans, and two babies have died.
In Maudemo suco, where Tilomar clinic is located, 48.7 percent of births from 2005 to 2010 were assisted by a skilled health provider. Comparing this to Timor-Leste’s countrywide average of 33.5 percent highlights how Maria’s hard work is making a real difference to women and children in her community.
With new skills and support through ChildFund Timor-Leste’s project, Improving Health Outcomes for Children in Covalima District, Maria can improve the level of care for pregnant women and newborns in Tilomar. “I am grateful for ChildFund helping us in Covalima. I hope we can improve the future of this cooperation, because we still confront problems implementing the safe delivery,” says Maria. “I hope next year ChildFund can support us to give us refresher training on safe motherhood and supervision.”
Reporting by Zoe Hogan, ChildFund Timor-Leste
Around the world, little brothers regard their older siblings with a mixture of awe and admiration. In a small town in Timor-Leste, 6-year-old Silvino looks up to his 25-year-old brother, Marcolino, but for a special reason.
A few months ago, Marcolino became a ChildFund Community Health Volunteer, and his new role is to share important health information with his community. He has learned about malaria and dengue prevention, hygiene and the importance of encouraging parents to use the local health clinic.
His training is just one part of a comprehensive maternal and child health project funded by ChildFund Australia and the Australian Agency for International Development. ChildFund is working with local communities and government to enhance health care and knowledge in order to improve the health of children and mothers. In addition to 410 Community Health Volunteers, ChildFund has trained 84 professional health workers and 36 midwives, distributed 6,000 mosquito nets to families and provided vital health training to 312 schoolchildren and more than 21,000 community members.
“What I like most [about being a volunteer] is that I can learn new ideas,” he says. “Before, I didn’t have knowledge about health, but today I do. And I can share it with others who need it.”
Marcolino and Silvino live with their parents and two sisters, Umbelina and Abita, on a small farm near a dry riverbed and a collapsed bridge. Last year, a flood destroyed their house and washed away precious topsoil. Marcolino’s father, Jose, could plant only enough to feed his family. Like others in the area, they simply cannot afford to deal with expensive and debilitating health problems.
So, when Silvino developed a fever, headache and persistent cough in February, Marcolino’s training proved essential. Recognizing that Silvino’s symptoms were potentially serious, Marcolino and his mother took the boy to the nearby government health clinic. With timely access to proper treatment, Silvino recovered quickly and is now back at school. Two mosquito nets from ChildFund are also helping the family to reduce their vulnerability to malaria.
“I worry about my siblings getting sick,” Marcolino says. “It makes me sad.”
His concern is understandable. In 1999, when Marcolino was 12, the conflict preceding Timor-Leste’s independence destroyed many homes and most of the country’s public infrastructure. Without access to health care or basic services, four of Marcolino’s siblings died from respiratory illnesses that year. The youngest was a month old.
“I feel responsible for the children around here and their health,” he says. “They are the same as my brother.”
To date, Marcolino has spoken to 15 local families about how they can prevent common diseases, and he has plans to walk up into the nearby mountains to share the information with another 30 families. Marcolino has also referred about 20 people to the health clinic after identifying symptoms of malaria and dengue. “It’s not too hard to convince people to go to the clinic once they understand [the significance of their symptoms],” he says.
As an older brother, Marcolino looks out for his younger siblings. As a Community Health Volunteer, he’s now helping protect them — and all of the children in the area — from preventable diseases. And it’s obvious that Silvino is pretty impressed with that.
Reporting by ChildFund Honduras
With support from USAID and the Honduran government, ChildFund is implementing a four-year maternal and child health program in Honduras. The goal is to decrease maternal, neonatal, infant and under-five child mortality rates, particularly in rural areas with little access to health services. We’re following the stories of mothers and children, traditional birth attendants and community health volunteers who are participating in the program and will be sharing those with you this week and from time to time.
Meet Betty, a 36-year-old community health volunteer who lives in Lepateriquillo, located 45 minutes away from the municipality of Lepaterique, traveling by bus. This Honduran community doesn´t have electricity, but it does have running water and latrines.
Betty and her husband have four children between the ages of 8 and 16, all of whom attend school. The family earns a living from working their own land and selling a few cattle. Betty also operates a small store in her house, selling basic products to community members.
So we ask Betty why she decided to volunteer as a health monitor for her community. “It was because of my husband – he was the first to take the training. But when he couldn’t attend due to his work in the fields, he started asking me to attend on his behalf.”
That’s when Betty learned how to weigh children and fill out the children’s growth charts, assessing whether they were developing at a normal rate.
When ChildFund’s partner organization had a new opening for a health monitor, they invited Betty. She has since completed all of the training modules in the USAID AIN-C (Atencion Integral a la Ninez en la Comunidad – Integrated Community Child Health program).
Just ask her about the curriculum: Growth Monitoring, Care for the Sick Child, Care for the Pregnant Woman and the Newborn, Information Systems, Feeding Children under Two Years of Age, Feeding Pregnant women.
What does she enjoy most about being a health volunteer? “The home visits to the newborns,” she says, without hesitation. But one of the things Betty says she doesn’t like is when children in the community “lose weight because the mothers would not follow her recommendations.”
It’s volunteers like Betty who will keep this community on a healthy track.
Guest post by Henry B. Perry
Henry Perry, M.D., Ph.D., MPH, is a senior associate in the Department of International Health at Johns Hopkins University’s Bloomberg School of Public Health in Baltimore, Md.
During the past half-century, there has been a growing recognition that community-based workers can make an important contribution to the health of communities, especially in resource-constrained settings. These workers are known by many names, but most commonly Community Health Workers (CHWs). With initial training of usually 6 weeks or less, they can effectively provide different types of services from community mobilization to health education to preventive screening to family planning education to identifying persons with symptoms of leprosy or tuberculosis to diagnosis and treatment of life-threatening childhood illness, and many more. These persons may work as volunteers or for modest incentives or salaries.
Based on early projects that utilized CHWs effectively in a number of developing countries, the seminal International Conference on Primary Health Care — sponsored by the World Health Organization and UNICEF in 1978 and attended by high-level representatives of almost every country in the world — recognized that in many settings where facilities and highly trained health workers are scarce, CHWs can become an important part of a primary health care system.
The Declaration of Alma Ata, adopted at the conference, called for basic health services — promotive, preventive, curative and rehabilitative — to be provided by “health workers, including physicians, nurses, midwives, auxiliaries and community workers [italics added] as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.” The Declaration also recognized the importance of providing health services “as close as possible to where people live and work.”
A rapidly growing number of studies demonstrate that CHWs make it possible to expand access and improve coverage of essential services, particularly in remote and poorly served populations, thereby improving equity. CHWs have been shown to play critical roles in interventions to
Many countries can benefit by scaling up integrated community case management of pneumonia, diarrhea, malaria and newborn sepsis and promotion of healthy behaviors that can save the lives of millions of children who are dying from preventable causes.
CHWs are one of the essential ingredients for making this possible — along with political commitment, professional leadership, long-term sustainable training, support and supervision from the health system and reliable logistical support of basic medicines and supplies. A strong commitment by the world community to these activities, which are some of the most cost-effective approaches to promoting global equity in health, is a moral imperative for today and tomorrow.
James Grant, the renowned executive director of UNICEF from 1980 to 1995 and champion of what is often referred to as the First Child Survival Revolution, repeatedly reminded us that “morality must march with capacity.”
We now know that CHWs can have the capacity to make a difference between life and death for millions of children. The moral imperative for the world community is to ensure that health systems and underserved communities support CHWs in attaining this capacity.
Berman, P. A., D. R. Gwatkin, et al. (1987). “Community-based health workers: head start or false start towards health for all?” Soc Sci Med 25(5): 443-459.
Haines, A., D. Sanders, et al. (2007). “Achieving child survival goals: potential contribution of community health workers.” Lancet 369(9579): 2121-2131.
Lassi, Z. S., B. A. Haider, et al. (2010). “Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes.” Cochrane Database Syst Rev 11: CD007754.
Newell, K. W., Ed. (1975). Health by the People. Geneva, Switzerland, World Health Organization.
Perry, H., P. Freeman, et al. (2009). How Effective Is Community-based Primary Health Care in Improving the Health of Children? Summary Findings and Report to the Expert Review Panel, American Public Health Association.
Sazawal, S. and R. E. Black (2003). “Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials.” Lancet Infect Dis 3(9): 547-556.
World Health Organization and UNICEF (1978). Declaration of Alma-Ata: International Conference on Primary Health Care. International Conference on Primary Health Care. Alma-Ata, USSR.