Action For Health : Empowering Communities in Mali

 
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Community Health Workers using the mHealth app
Community Health Workers using the mHealth app

In 2014, Mali Health launched a new mHealth program to tackle the distressingly high rates of malnutrition among children in our partner communities. In the program, Community Health Workers (CHWs) use a mobile phone application developed by Mali Health in collaboration with D-Tree International during visits with families enrolled in our programs. The app guides the CHWs using a set of pre-determined questions and carefully reasoned options to provide faster, more efficient, and better care for families. Relying on standard metrics set by the World Health Organization (WHO), the app helps to accurately identify the severity of malnutrition among children, and can even detect early warning signs to encourage intervention before the child falls into malnourishment. Our mHealth Coordinator, Emily, recently shared this story of the program in action:

Yesterday, one of our Community Health Workers came across a woman with a malnourished child, so 4 CHWs and I returned to her house today to learn how to do a Malnutrition Follow-up using the mobile application that Mali Health developed last year with D-Tree International. The follow-up requires the CHW to re-check the weight and brachial measurement of the child. The brachial measurement (circumference of the child’s bicep, a common method of identifying malnutrition, indicated by Green, Yellow, and Red levels) was Red and the weight-for-age calculated by the app indicated severe malnutrition. The child weighed only 6 kg. Her mother told us that she had taken her daughter to the clinic this morning to attend the malnutrition program, but the staff sent her home saying the child did not meet the criteria to participate in the program. Essentially, the young girl was not malnourished "enough" to receive treatment.

The CHWs and I collectively decided to take the mother back to the clinic right then because the child was clearly malnourished by all measurements. However, as soon as we arrived at the clinic, we received intense resistance from the staff. One staffer claimed that she remembered the child being examined that morning and that she weighed 10 kg — far more than the 6kg our health workers had measured. The staff measured the girl's height again and then placed her on the clinic’s scale, determining this time that she weighed 7kg. Looking at their weight-for-height chart (a tool developed by WHO to represent universal standards of child growth and development), the clinic staff stated the child was only mildly malnourished. Our CHWs INSISTED the girl be weighed again on their scales, and the staff members agreed.

In doing so, we saw that the child did, in fact, weigh 6 kg based on the scales of two different Health Workers. The clinic staff claimed our scales were not correct, so the CHWs insisted the staff take the girl's brachial measurement, which fell within the red level, clearly demonstrating severe malnourishment. After some resistance, the staffer finally took the measurement but did not fully secure the measuring tape, leaving a small gap between the tape and the child's arm, so the measurement was yellow instead of red. The staff member stated that this was how she was taught to conduct a brachial measurement.

This was all very distressing to witness. Clearly the child was very sick and needed care, but she was being denied access to the malnutrition program. We did not understand the reason for this confrontation, but we did understand the need to fight for the child's health, and I am so proud of our Health Workers for doing so. One CHW even took the child herself to weigh her on the clinic scale and, contrary to the clinic staff's measurements, measured her at 6 kg. At this point, all the CHWs continued to push for the child to be entered into the program, and after several minutes of discussion, the clinic staff relented. A staff member retrieved several sachets of Plumpy’Nut, a highly effective nutrition supplement, and gave these to the girl's mother. Our Health Workers explained to the mother how to deliver the supplement to her daughter most effectively, and instructed her to return to the clinic each Wednesday to have her daughter weighed and to receive more of the supplement until her daughter had reached a healthy weight.

Without our Health Workers advocating for this child's health, she never would have received care. Without care, a child that sick could die. Our CHWs are well-trained and they displayed their knowledge with great confidence today, even going against higher authorities in the medical system when they knew those authorities were at fault. This is why we need a strong team of Health Workers to advocate for their fellow community members. They did that with great skill and integrity today. While it was a distressing event, I am also very proud to have witnessed our Mali Health CHWs doing exactly what they have been trained to do: to make sure every young child in the community has access to the best care possible.

CHW taking a brachial measurement
CHW taking a brachial measurement
CHW taking a brachial measurement
CHW taking a brachial measurement
CHW weighing a child
CHW weighing a child

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Moustaph meets with Awa and her children
Moustaph meets with Awa and her children

In the past year, Mali Health has focused on further improving the already significant impact of its programs.  In Action for Health, this meant training our Community Health Workers (CHWs) in new communication methodologies to improve their skills in adult education and behavior change.  Since the training, we’ve seen more families adopting the healthy behaviors they discuss with their CHW.  

According to Adama K., Coordinator of the Department of Communications & Public Affairs, the greatest achievement this year has been the increase in the number of women giving birth in health centers.  In 2014, 107 women in our Action for Health program gave birth at the clinic, compared to 78 women in 2013.  

Our CHWs are a vital link between our partner communities and the health system, encouraging families to seek professional care at local clinics when they need it.  Moustaph, one of our CHWs, believes in the importance of building strong relationships within the Sikoro community.  “I chose to become a CHW to help my community grow,” says Moustaph, “to meet the people who don’t have access to care and to help them stay safe and healthy.”  

“I was working with a pregnant woman, Sanata, this past year,” he said.  “She was in her third pregnancy, but she was still very afraid of what could happen.  I visited Sanata often, especially in the final months of her pregnancy.  I talked to her about her experience, what she was feeling, and about what resources were at her disposal, and I actually escorted her to a couple of her prenatal appointments.”  Moustaph’s commitment paid off, and Sanata is one of the 107 women to give birth at the Sikoro maternity ward.  She gave birth to a healthy baby girl at the end of 2014.  

Awa, another Action for Health mother, values what she has learned from the program and from Moustaph.   She considers him to be part of the family, and appreciates the honest discussions she has with him about important health issues.   “When my kids get sick from a simple fever, he wakes up even if it is late to accompany me to the community health center,” she said.  “This is very important for me.”  The health prevention information provided through Action for Health has also been valuable to Awa.  “Since I joined Action for Health, my life has changed a lot,” she said.  “Thanks to Mali Health, things are a lot better now because I implement what my CHW has suggested that I do and my family has fewer cases of disease.”

We are grateful for Moustaph and all our CHWs,  as they empower communities with the knowledge and skills they need to improve their own health.

Djibril Recoding Patient Information
Djibril Recoding Patient Information

I was afraid.  When I first heard that Ebola had reached my country, I was afraid.  I have worked for Mali Health for four years, so I have better knowledge than most about diseases like this.  While many people in my community didn’t believe (and still don’t) that Ebola existed, I knew different, and I was afraid.  What if I got sick?  What if my family got sick?  My friends?  My neighbors?  Ebola does not discriminate — we were all susceptible, and I knew it.  

So I volunteered.  I have been supervisor to Mali Health’s Community Health Workers for a long time now — I’ve provided guidance and support as they visit the families in Mali Health’s programs, offering education and health monitoring.  But now, I have joined them.  I am a part of this incredible team, visiting people who have come into contact with Ebola patients, monitoring them to make sure that if they have contracted the disease, we can get them treatment and protect others from infection.  I volunteered because fear moved me to action; I could not stand by, letting others charge into the fray.  I have the skills and the knowledge to contribute, and I knew I had to use them.  

In truth, providing education and monitoring to these Contacts is not much different than providing education and monitoring to anyone else enrolled in Action for Health.  We meet, we talk, I run some basic tests, and we make plans for the next time I will visit them.  

The difference, though, is the stigma around Ebola.  Many people still don’t believe in this disease, but those who do hold the same fear that I feel; Ebola is far more deadly than other diseases we face in Mali. When we started this work, the people we monitored resisted — many faced rejection from their families, born of the fear we all were feeling, and the people we monitored thought that we, too, would stigmatize them.  But we’ve taught them otherwise.  It’s true that Ebola is not like other diseases; it is far more dangerous.  But it can be beaten, if we all know how to prevent it and how to treat it.  

I am still afraid, but I’m proud, too.  Proud of my community for being willing to learn how to protect themselves.  Proud of my fellow Health Workers for taking on this dangerous, utterly necessary work.  And I’m proud of you for the compassion you’ve show, for raising your voice and declaring, “I stand with Mali Health, and we can turn the tide of this outbreak.” 

So I say: Thank you.  Thank you for your support yesterday, today, and tomorrow.  You make more of a difference than you realize.  You may sometimes feel distant from the work that we do thousands of miles away.  But know that every time I pull on my gloves before visiting one of my contacts, it’s like you’re right there with me, holding my hand, keeping me safe while I help my community heal.  

With gratitude,

Djibril

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Mother and Son - Assa and Yaya
Mother and Son - Assa and Yaya

In August 2013, Mali Health and its partner One Day’s Wages inaugurated a new maternity ward built on the campus of CSCOMSiSou, the clinic that Mali Health helped to build in 2010. This maternity ward provides a safe and private space for expecting women to receive professional peri-natal care from midwives and nurses. In the year since the ward’s opening, we have seen promising improvement in maternal health indicators.

The maternity ward significantly increased the number of beds and health professionals available to help women during delivery. It also provided a space separate from the rest of the clinic, away from patients with contagious illnesses, where women could give birth in privacy. Since the ward’s opening, the number of clinic-based births has risen slightly, and we expect to see that number continue to rise as the ward’s capacity continues to improve.

Critically, prenatal consultations (which are essential to a healthy pregnancy) have also risen since the maternity ward’s inauguration. The number of women who are attending their first, third, and fourth or more consultations, has increased significantly. The ward also offers crucial vaccinations for mothers and newborns, and the rate of vaccinations, too, is rising. The next challenge we aim to tackle is to increase the availability of particular vaccines and the variety and quality of equipment available to the ward’s staff. The most significant improvement is in the rate of family planning consultations – the availability of professional midwives has led many more women to visit the ward to speak with midwives about their options.

Community Health Workers in the Action for Health program meet with over 900 expecting mothers on a regular basis to monitor their health and development. Since the opening of the maternity ward, the health workers also encourage these mothers to seek consultations at the clinic, where they can receive counseling, as well as most of the necessary medications to ensure a healthy pregnancy.

The impact of the maternity ward is perhaps best represented by the story of Assa. One year ago, Assa fell ill and decided to go to CSCOMSiSou, As soon as the clinic's doctor informed her that she was pregnant, the midwives gave Assa helpful advice about her pregnancy and prescribed her the medications she would need at the clinic's newly constructed maternity ward. A Mali Health Community Health Worker ensured that Assa received pre-natal consultations and met with the clinic’s midwives, from whom she received constant support and valuable assistance. In June of 2014, she gave birth to a son, Yaya without any complications or difficulties. Yaya is now a healthy and happy three-month-old boy, and Assa still receives regular visits from Oumou. In her words, “I am so grateful for the support of the clinic’s midwives and my community health worker throughout and after my pregnancy.” She continues to go back to the maternity ward when her son falls ill and for his vaccinations.

Total Births at Clinic
Total Births at Clinic
Family Planning Services at Clinic
Family Planning Services at Clinic

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Ali at 3!
Ali at 3!

In early 2011, Djeneba, a resident of peri-urban Sikoro, became pregnant. Identified as eligible through a local survey, Djeneba was recruited and enrolled in Mali Health’s Action for Health program. Impoverished and isolated, Djeneba would not have had access to vital health services without the help of our program, but through it, she received counsel, education and monitoring by one of Mali Health’s Community Health Workers, Fanta.

That November, Djeneba gave birth to a healthy boy, Ali. Mali Health continued to monitor and aid Djeneba and Ali after birth – Fanta made frequent home visits and ensured Ali was immunized against the preventable diseases that all too often keep Malian children from reaching their fifth birthday.

Six months after Ali’s birth, Djeneba left Sikoro to spend several months in her family’s rural village. Immediately after she returned, Fanta made a visit to their house to check on mother and child and was met with an alarming sight: Ali had lost significant weight during his time away and exhibited signs of severe malnutrition. Fanta took action immediately, rushing Djeneba and Ali to the closest health center.

Through Action for Health, Ali received lifesaving medical care and access to qualified health workers. He remained in the hospital for 10 days, during which time he regained enough weight to be returned to his mother’s care. Though Ali was no longer in immediate danger, Mali Health’s work was far from over, knowing Ali would continue to require close monitoring to ensure his complete recovery.

Even after his release, Fanta observed that “Ali was so weak initially that he could no longer support the weight of his head.” Neither Djeneba nor her husband had jobs at the time, however, so Ali’s recuperation was in jeopardy. In response, Mali Health provided Djeneba with milk, grains enhanced with vitamins, fish, fruits, and legumes for Ali for the next two months. Fanta continued her close care, sometimes visiting Djeneba every day to check on Ali’s progress.

Today, Ali is 3 years old. He is no longer malnourished and lives a happy and healthy life with his mother in Sikoro. Djeneba is enrolled in our Health Savings program, where she can borrow pooled money for future health expenses or to earn a small income. Mali Health’s Action for Health program has helped 2,000 children like Ali, employing community-based solutions that not only provide for short-term health successes but also long-term improvements in education and care. Mali Health believes that everyone has the right to experience childhood without the looming threat of illness or death. Ali’s mother thanked Mali Health, stating, “I think God has sent Mali Health to help poor persons like us… May God accompany those who fund Mali Health’s activities.” 

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Organization

Project Leader

Kris Ansin

Executive Director
Westminster Station, VT United States

Where is this project located?

Mali   Health
Map of Action For Health : Empowering Communities in Mali