By Caroline SANG
Empowering Community Health Workers in Bur Abor, Mandera
Islamic Relief is a humanitarian and developmental organization whose mission is to alleviate poverty and suffering of the world’s poorest, vulnerable and disadvantaged communities in the Greater North Eastern Region. As part of the Programmes, Islamic Relief has been supporting the Ministry of Health (MOH) since 2010 to Scale up Nutrition through the implementation of High Impact Nutrition Interventions (HINI) in Mandera County. This has been done through on job training to all health care providers as well as the community health workers. These health workers are responsible for counselling families to take advantage of government health services, and to adopt healthier behaviors.
Community health workers and especially women, despite the challenges faced in the community are in fact in fulfilling a socially valued role. One such community health worker who has benefited from these on job training sessions is Dakane Osman. She is a community health worker attached to Bur-Abor dispensary in Mandera East sub-county. She has been in service since 2004 serving the communities of Bur-Abor and Fikow villages.
“I have always wanted to help my people get health-care, growing up and watching children succumb to complications related to malnutrition motivated me to do more in order to reduce that, I am forever grateful to Islamic Relief for mentoring and empowering me to be able to serve my people” says Dakane
Dakane has been empowered through various trainings supported by Islamic Relief such as Essential Nutrition package training, frequent trainings on IMAM, MIYCN and MNP among others. She is now able to triage a malnourished child, manage, do home visits until the child attains full recovery. She plays the lead role of giving health talks on various issues pertaining health through mother support groups that she initiated with the help of the Ministry of Health and Islamic Relief.
Making A difference
Dakane reports to the facility daily where she goes about her daily chores as the community health worker. She assists the Health facility in-charge in dispensing drugs, growth monitoring, triaging and managing all the nutrition beneficiaries admitted to different nutrition programs within the facility. She is involved in active case findings in the community so as to ensure the coverage of the program. She is enthusiastically involved in defaulter tracing, this translates to low defaulter rates and higher recovery rates.
Being a mother herself, she serves as a role model to the community by implementing proper infant and young child nutrition. She influences the community with the same knowledge by giving regular trainings to the other mothers in the mother support group. Some of the topics discussed during such trainings are exclusive breastfeeding, timely complementary feeding and importance of immunizations, growth monitoring and proper hygiene.
“I have noticed a great behavior change among the women in my
community and I am positive that with this practice no child in Bur Abor and Fikow villages will succumb to preventable child illnesses” a happy Dakane concludes.
By Caroline SANG
The number of the poor health of so many people in Africa as a whole has been widely known for many years. The World Health Organization has characterized Kenya as facing an acute shortage of health workers. Among the reasons for this shortage are an insufficient number of training programs and institutions. The Universities and training facilities are only producing 40 percent of the needed health workforce, and poor distribution and retention is a serious concern particularly in rural areas including Mandera where the need is greatest. This has resulted to lack of skilled workers to meet the basic standards of care. Islamic Relief’s approach to human resources for health has helped to finance critical gaps in the health workforce needs, while strengthening the health systems. Funding from ECHO has ensured that marked improvements have been made. Despite these improvements, the health of the vast majority remains in jeopardy.
Extending the Workforce
Too often, the health workers at these rural facilities do not have appropriate training or access to continuing medical education. In addition, productivity is at an all-time low. Islamic Relief started capacity building of local staff through an internship program to ensure availability of skilled and experienced personnel from the local community while improving local capacity thereby culminating into sustainable programs. Mentoring and training health workers and community members has proven to transform the lives of people we serve in health and nutrition through community health education sessions.
Ms. Hodhan Bishar is among the ladies Islamic Relief has mentored, trained and given opportunity to give back to her community through internship. Hodhan became an intern with Islamic relief in October, 2014 for a period of three months. She was trained in different aspects of health and nutrition among them is Maternal Infant and Young Child Nutrition and Integrated Management of Acute Malnutrition. After the trainings, On-Job-Trainings were done to enable her experience field work accompanied by a Nutrition Officer. Having been mentored she was supported to continue working with the community under the ECHO project.
As she serves the community, Hodhan is grateful to Islamic Relief as she couldn’t hide her joy. She says,
“Islamic Relief has mentored me and given me opportunity to serve my own people. I have been able to attend various trainings, thanks to Islamic relief, am now able to inform the community on good nutrition practices on infant feeding .I am happy to be the one giving this professional information to mothers who depend on local beliefs to care for their young ones.”
Ms.Hodan has been able to work with the mother support groups to enable behavior change in infant feeding especially complementary feeding and diet diversity among the community members. She has also been able to conduct health education sessions with the communities in the villages she has been able to reach through the support of Islamic Relief.
“Having worked with mothers and other community members, Am happy to hear mothers commend the knowledge they have applied especially exclusive breastfeeding for the first 6 months of age and good complementary feeding. Some mothers confess that their children have grown healthy and they do not need to go to hospital often because of diarrhea and colds, had they known of these practices their children would be better and others say that they despised it because they taught it was a western way of life. Now that they are taught by someone from their own community with same believes they practices and apply in their day to day lives and are appreciating the results.”
Be as it may, the necessary changes that must occur to strengthen health systems and make substantial progress in improving quality health care and most importantly to save lives is increased funding, better management capabilities, and better mind-set behavior.
By Linda KHABEKO
Islamic Relief Kenya Nutrition Program supports the Ministry of health in Wajir West, Wajir North and Eldas sub-counties in the implementation of High impact Nutrition Intervention programme (HINI).This programme incorporates 11 components from the Scaling Up Nutrition movement (SUN) these include:Exclusive Breastfeeding (EBF)promotion, complementary feeding for infants after the age of six months, improved hygiene practices, vitamin A supplementation, therapeutic zinc supplementation for diarrhea management, de-worming for children, iron folate supplementation for pregnant women, salt iodization, iron-fortification of staple foods, prevention of moderate under nutrition and treatment of Acute malnutrition.
These components of HINI are transformed into services offered to the community through the rural health facilities, outreach services as well as County and Sub-county hospitals. The programme’s success is measured through indicators such as cure rate, death rate, defaulter rate, coverage. Health education is one of the services conducted at all the sites where HINI activities are offered. This is done by the Nurses, Community Health workers, Mother support group facilitators as well as IRK Nutrition Officers and Nutrition Promoters. Various health and nutrition topics are covered through the health education sessions including: Exclusive breast feeding, complementary feeding, hygiene and sanitation, importance of ante-natal and post-natal clinics, care of a sick child, cooking demonstrations, nutrition in pregnancy,nutrition in HIV etc.
Markaba Gelle is a mother of one, Yusuf Bishar 8 months. She is married to Abdiaziz Bishar a casual labourer. The three live in Gurar village in Wajir North sub-county. Markaba and her husband were not privileged to attend school; they rely on Yusuf’s earnings from his casual engagements for their daily needs. It is Monday morning at around 9:00am and I meet Markaba at Gurar health centre amongst the women waiting to be served.Siyaad Mohamed the community health worker calls out loud in Somali “Waa wakhtigh taclinta caafimmadka isu imaadho” meaning the mothers should converge for a health education season. With excitement, Markaba and her friends move closer to the CHW ready to listen with a lot of expectation as I could read from their faces.
The CHW goes on and educates the mothers on complementary feeding specifically on feeding children with variety of foods to ensure their diet is balanced with all the nutrients their growing bodies require. He goes on and invites me for a cooking demonstration exercise. We engage in a participatory cooking demonstration exercise and the mothers enjoy the learning experience. Today we cook “Kunde” an indigenous vegetable grown at the mother support group kitchen garden.
After the session I notice Markaba leaving carrying her son on her back, I quickly call her and ask why she is leaving without seeing the Nurse. She tells me she and her son are all well and Yusuf is not due for vaccination or weighing, all she come for was to listen to the health education session because she has learnt a lot. Markaba says she did not have experience on how to raise a child since she grew up with her grandmother as the only child in the homestead and Yusuf is her first child.
“When I was two months pregnant my husband’s friend Siyaad Mohamed who is the CHW at Gurar health centre visited us one morning and informed us on the importance of visiting the hospital every month during and even after pregnancy. The following morning I woke up early and came to the hospital. The Nurse talked to me about very many important issues like,hygiene,eating a balance diet, taking iron tablets, visiting the hospital not only when am sick but every month for weighing, vaccination and checking on the baby. I was happy to know someone was available to ensure both me and my baby are ok”
Markaba was able to exclusively breastfeed her son for six months, with support from the hospital she was able to handle breast complications and practise breast feeding on demand. Currently she is practising responsive complementary feeding on Yusuf, she is also able to balance the diet at her home, to ensure her family is healthy and Yusuf is able to get all the nutrients he requires. She goes on to explain that every other time she came to the hospital, especially at around 9:00am or 2:00pm; she noticed that the CHW or the Nurse would call everyone to listen to education on health and nutrition.
“This information has changed my life and that of my family a lot” she says.
By Caroline SANG
Health outcomes in remote areas remain poor, including high rates of avoidable complications which could be reduced with better primary health care. According to the Kenya demographic and Health Survey (2009), Northern Kenya continues to showcase poor health statistics. The maternal mortality ratio (MMR) is estimated at more than 1,000 deaths per 100,000 live births, more than double the national average. There are huge disparities in the country in regards to maternal mortality with North Eastern counties having a Maternal Mortality Rate of 1000/100,000 live births against a national average of 488 and under-five child mortality approximated at 142/1,000 live births live births is also far too high, and has virtually remained unchanged.
To this end, Islamic Relief has initiated a health outreach program which is a useful vehicle to deliver maternal and child health care to hard-to-reach women and children and thereby extending medical services to the rural-poor community. The outreaches are regular and done on a single-day visit by qualified staff from a health facility to populations located about 5–40 km from the health facility. 29 Year old Anab Mohamud, mother of five, is one of the beneficiaries of this initiative. She says,
“I am happy that the nurse comes to our community at least four times in a month to treat our children. He /she is able to offer us treatment for minor illnesses and the community is really appreciative of these services. This was not the case before. This place is quite remote and we have no facility here, therefore many women do not access care during pregnancy or child birth, unless during the outreach session when a health worker visits us from Buna facility which is located about 35 km from here.”
Despite the ignorance about the importance of immunizations and other health services compounding the problem of poor health, the strategies undertaken have aimed to deliver the much needed health services to the immediate rural population. Anab tells us that,
“When Adan and Suleiman (two of my children) were born, they used to get ill every so often, but since the nurse started visiting our community, they received drugs and they are now much better. I can see a big improvement with my children’s health status. I never attended Ante natal clinics during my previous pregnancies with Adan and Suleiman and they also received their immunization late; I think that is what used to cause their illnesses.
However, since the nurse(s) started regularly visiting this village, all my other three children have been able to received their immunizations on time. They have not had many episodes of illnesses as compared to Adan and Suleiman. Since having my three children after Adan and Suleiman, I have managed to practise exclusive breastfeeding for them and they have also received Vitamin A; I believe this has contributed to their general well-being”.