Action For Health : Empowering Communities in Mali

 
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Oct 27, 2010

Action for Health Eight Months In

Sifting flour at the malnutrition training
Sifting flour at the malnutrition training

We’d like to send out a big thank you to all of you who joined in supporting MHOP during Global Giving’s matching campaign. If you missed it, you can still donate by October 31st and have your donation matched by 50% by MHOP's own private donors!

As for our work on the ground, Action for Health turns eight months old on November 1st! It’s hard to believe that it has been that long but we’ve accomplished a lot.  We’ve been enrolling a lot of new babies in the program: we are now serving 398 children and 251 mothers.  That’s even before the expansion we will begin in 2011!  As I’ve mentioned before, Action for Health is a complicated program with a lot of moving pieces. It feels like with six months of experience behind us, we have finally gotten all these different pieces into place, which is great news.

Action for Health is based on the premise that community service can be a means of payment for free care.  We hope that when families participate in community service actions, they will mobilize around their own health, while also improving living and health conditions for the neighborhood.  Our goal for the future is to engage families in at least one community service “Action Fee” per month, and so far we’ve organized four. 

Trash and sanitation is a huge problem in Sikoro, especially because there is no transit site where small donkey-cart trash collectors can leave the trash to wait for larger trucks to take it to the city dumps.  The constant presence of trash and the difficulty of getting rid of it  are issues that really attract the attention and energy of Sikoro residents.  For that reason, our first Action Fees were trash clean-up days.  We organized two in May, one at an unofficial transit site and one near the school in Sourakabougou.  People were really pleased to see (and smell!) the cleaned up areas.

As the program moved forward, we realized that there was a serious lack of treatment and follow-up care for malnourished children.  Officially, the government has committed to provide Plumpy’Nut, a nutritional supplement, for free to all malnourished children. Many of our Community Health Workers (CHWs) were finding that they would measure children as falling in the yellow zone of their nutrition status arm-bands, but were not receiving care at local clinics for a variety of reasons. In addition to this problem, we were constantly reminded that clinical treatment for malnutrition cannot prevent the problem in the first place. The CHWs thought that the most important thing was to make sure that the mothers knew how to cook the calorie-rich, nutritious foods that keep children healthy and help malnourished children gain weight quickly.  So we held a malnutrition education day in which the CHWs trained the women to make enriched porridge (millet, bean, fine millet, wheat, rice, and corn flower) and a high calorie milk paste. Twenty mothers of malnourished children attended and each left with a kilo of porridge ingredients and a kilo of milk paste.  In November, these same women will serve as peer educators to the other women in the program, teaching them the same techniques. 

Our last action was proposed by the target families.  They reminded the CHW’s that the tree planting season in Mali is in August and September and suggested that the project put together a tree planting day.  Several families bought trees and protective fences themselves, while others who weren’t able to afford it contributed about $1 to help MHOP buy the trees.  26 trees were planted in the zones of Sikoro where the target families live. 

Thanks to our supporters we are seeing Action for Health progress on all fronts, and are particularly excited to watch the actions grow. Our goal is for the actions to serve as a catalyst for community mobilization around health that will expand beyond the scope of MHOP and our projects. The fact that the families’ and the CHWs’ are already taking initiative towards choosing and organizing the actions is really promising.  There is great potential in peer education and we’ll be sure to send you an update in the coming months on how our first peer- nutrition education session goes.

Making the malnutrition supplements
Making the malnutrition supplements
Reaping the rewards!
Reaping the rewards!

Links:

Jul 27, 2010

A Creative Solution to Children's Health Care

A community health worker measures a child
A community health worker measures a child's arm

As you glance around Bamako, Mali, it is easy to be struck by the numerous ways in which it is different from cities in the United States—the women selling bananas off the tops of their heads, the children running barefoot down the road, chasing tires, and the goats standing lazily in the middle of the street chewing on discarded corn. What is harder, and often much more important, is to be reminded of the ways in which it is similar. The cost of health care, for example, is an issue of similar importance in Bamako, New York, Washington, DC, and other cities throughout the world. And while my country, the United States, was fighting a political battle over health care last year, the organization, Mali Health Organizing Project (MHOP), was developing an innovative, community-based solution to children’s health care in several communities in Bamako, Mali. The program, entitled Action for Health, aims to provide free health care for children in Bamako in exchange for “community action” or days of volunteering on part of children’s parents.

As one MHOP volunteer explained, “people want to invest in their children’s health care; they just don’t have the cash.” So MHOP has given them a free alternative. By enrolling in MHOP’s health care program, children are insured against the five leading causes of children’s death in Mali including malnutrition, malaria, and measles. The organization has even gone so far as to develop a monitoring system in which community health workers conduct monthly house visits for children enrolled in the program, using innovative mobile phone technology to track the growth and health of children ages 5 and under.

By working closely with the Malian government’s health services, and collaborating directly with the local community, MHOP has developed an exciting and impactful program that already serves 385 children and 245 women! Although the organization has hopes of expansion, they are grounded in a desire for sustainability that is refreshing and important. The success that the program has experienced after just 4 ½ months of operations can only be seen as a predictor of even greater accomplishments to come!

Alexis is an In-the-Field traveler for GlobalGiving. Follow her and her fellow travelers' adventures at www.itfwa.wordpress.com!

Using mobile phone technology to monitor health
Using mobile phone technology to monitor health
Jul 2, 2010

Text us How You're Doing!

Adama Traore weighs an Action for Health patient
Adama Traore weighs an Action for Health patient

Hello from Bamako. My name is Leona Rosenblum, dite Maimouna Diallo, and I am the Coordinator of the Action for Health Program. As Alex mentioned in her last update, Action for Health has been fully operational since March 1st. And a very exciting four months it has been! Action for Health is a complicated program that involves a lot of different pieces, and we’ve been working on getting all those different aspects up and running. Here is an explanation of all the components that make this program what it is:

1) Health in the Home AFH works within the home to improve child health outcomes. We do this with the help of eleven wonderful Community Health Workers (CHWs) who visit the families twice monthly do to peer monthly thematic health education sessions as well as basic health indicator check-ups. The peer education sessions focus on disease prevention, essential understanding of transmission, and key knowledge for in home disease management (protein sources for malnourishment, rehydration for diarrhea, etc.). The checkups focus on indicators of the diseases responsible for 90% of child mortality in Mali: malaria, acute respiratory infection, diarrhea and nutritional status (Malian Ministry of Health. The CHWs are a key resource in the fight against child mortality, not only through their work towards disease prevention but in making sure sick kids get to the clinic FAST. Families are encouraged to contact their CHW in the case of any signs of illness, at which point the CHW either comes to the home to check in on the child right away, or refers them straight to the CSCOM. After the patient is seen by the doctor, it is the CHWs who follow-up at home to make sure that caregivers received all the medications that were prescribed and that they know how to use them. With 383 patients enrolled in the program, the CHWs have been busy. In the last four months, they’ve already done more than 3000 patient visits total!

2) Free Primary Health Care

Every child referred to the clinic by the CHW receives a free consultation and, if the diagnosis relates their symptoms to key causes of child mortality, free treatment. This is the piece of the Action for Health puzzle that has had the most immediate impact within the community. We’ve already treated 200 patients at the local Centre de Santé Communautaire de Mekin-Sikoro, and we’re starting now to treat patients at the Centre de Santé Communautaire de Sikoro-Sourakabougou. That’s the center that MHOP was able to build with generous support from you. 200 patient visits in only four months means that we are on target to reach our goal of at least 2 clinic visits per child per year.

3) Increasing Investment in Health At the Mali Health Organizing Project, we believe that free care is not the end goal. Instead we work to encourage community investment in health care to facilitate community empowerment and ownership over their own health challenges. Families enrolled in AFH invest in their health care through community service action-fees, such as voting on local health clinic boards and community clean up days. Action Fees are designed by the Community Health Action Group to best harness the capacity of the target families to mobilize the community and improve health in Sikoroni. A representative of each family is required to participate in 6 Action Fees per year, and we held our first one last month. Though we had some trouble due to rain and some miscommunications, we got the designated area cleaned up in record time. In the near future, we will be focusing on Nutritional Education Sessions for women with children suffering from malnutrition. After they are trained to make enriched porridge and other highly nutritious meals, they will go on to host trainings for other people in the community. The CHWs are working with the families now to brainstorm more ideas for great actions going forward.

So there you have it, the basic foundation for Action for Health. On top of that, we’ve added a partnership to pilot Frontline SMS: Medic’s new program Patient View. As of last week, the CHWs are now sending in the records of their patient visits via SMS! It is incredibly exciting to watch the flow of information happen in real time. The visit file is sent directly to the clinic, where it is attached to the patient’s file within the program’s computer based medical records system.

Everyone is excited to have this incredibly useful piece of technology finally in place. When children are sick, the information arrives at the clinic before they do, alerting the doctor. When they arrive, the clinician has access to all their prior medical history, and a place to record their consultation notes to add them to their file. Follow up on medical treatment is a huge issue here and Mali, and we’re hoping to see real improvement now that we are using Frontline SMS: Medic. As soon as the doctor finishes his diagnosis and prescription, he or she can send a message straight from their computer to the CHW to tell them what day the patient ought to finish their treatment, and whether they should come back for a follow-up visit.

The rainy season is just starting here in Mali, and this is a time when everyone, but especially children ages 0-5, are the most at risk of catching malaria. We have our work cut out for us in the coming months, but as you can see we are off to a great start. As always though, we can’t do any of this without your continued support. Thank you again for all that you have made possible.

Aminata Keita, Community Health Worker
Aminata Keita, Community Health Worker
Peer Education Materials, What Causes Malaria?
Peer Education Materials, What Causes Malaria?

Links:

Apr 12, 2010

Action for Health hits the ground running

Community leaders celebrate the clinic opening
Community leaders celebrate the clinic opening

The first few months of 2010 have been an exciting time for the Mali Health Organizing Project, and we are looking forward to a great year with a new clinic and community health worker pilot underway!

We are thrilled to announce that the grand opening of the Centre de Sante Communautaire de Sikoro-Sourakabougou (CSCOMSISOU) took place on Saturday, April 10, 2010. The community clinic construction began in December 2008, and the doors opened to patients unofficially last month. Located several kilometers from paved road, but right next to the market and school in Sourakabougou, this six-room clinic is located to maximize accessibility to the least served residents of the city. In addition, we have partnered with the Association de Sante Communautaire de Sikoro-Sourakabougou (ASACOSISOU), the clinic's governing board, to develop this clinic as an trial site for innovative health-financing and technological interventions to improve health access and to reduce child morbidity and mortality.

The need for this clinic is clear -- and it has been demonstrated time and again in the few short weeks since the doors first opened in March. Before CSCOMSISOU opened, for example, pregnant mothers of Sourakabougou have often had to walk more than 5km to the nearest health facility, stopping to rest between contractions. To avoid giving birth on the way, mothers are told to carry rocks on their heads or in their skirts! For this reason, many women opt to give birth at home without the presence of a skilled birth attendant or physician, thus dramatically increasing the risk to themselves and their newborn child. Thanks to our clinic, pregnant women will no longer have to face this choice during labor. We welcomed more than twelve babies in our first few weeks of operation, and we expect to see many many more in the weeks to come.

Jointly organized by MHOP, our Community Health Action Group, and the ASACOSISOU, the grand opening was attended by more than 300 community members and included fantastic speeches, a ribbon-cutting, a clinic walk-through, and a traditional folkloric dance performance. In addition to community members, invitees such as the Mayor of Bamako Commune I, the Director General of the Ministry of Health's e-Health office, the health advisor to the President, community dignitaries, and even the clinic's first newborn baby were present to celebrate this incredible achievement. More than twenty-five years after the Malian government approved this site for the construction of a community clinic, we are excited to begin providing health care to the more than 60,000 residents of this under-served community. We would also like to take this opportunity to express our gratitude to all of our generous supporters, without whom this clinic would not have become a reality. You had no small part in making this happen, and we thank you.

MHOP is also very excited to announce the commencement of Action for Health, our innovative health-financing and community health worker initiative that will offer free care and preventative education to more than 220 families (350 children under the age of five) in return for participation in volunteer health activities. Leona Rosenblum, Action for Health program coordinator, gave a refresher training to our 11 community health workers in February and they began visiting our target families in March. At each visit, the health workes evaluate children under the age of five for signs of serious illness or malnutrition, accompanying sick children to the clinic where they receive free treatment for symptoms related to the four major childhood killers: malaria, respiratory infections, diarrhea and malnutrition. To date, our CHWs have made more than 700 home visits.

In the next month, we begin the second phase of the Action for Health program by launching a mobile medical record program that will allow our health workers to send and receive patient status updates via text messages. The SMS data will be organized into a lightweight medical records system at the clinic, allowing the physicians to enter observation and treatment data at the point of care, and send follow-up instructions to the patient's health worker. The program will dramatically improve the current standard of care by offering physicians access to complete medical histories and improving continuity of care between our health workers and clinic staff. Selected by the Ministry of Health's e-Health office as a priority intervention, we will be further developing the system in partnership with their team.

With all of these great achievements already under our belts, 2010 is promising to be a fantastic year for the Mali Health Organizing Project. We are extraordinarily grateful to all of our supporters, without whom this work would not be possible. If you are interested in learning more about our programs, please visit our website www.malihealth.org, or contact Anna Ninan, Executive Director at anna@malihealth.org. Thank you again for all you do!

The MHOP team gathers in front of the new clinic
The MHOP team gathers in front of the new clinic
Our first baby is born at the clinic in March!
Our first baby is born at the clinic in March!

Links:

Nov 30, 2009

Clinic Construction Completed!

The exterior of the new clinic.
The exterior of the new clinic.

This has been one of our dream goals, and we're finally seeing it become a reality. The Sourakabougou area of Sikoro was badly in need of a clinic. High up on the rocky hills, with no paved road access, it is an isolated spot. On several occasions, pregnant women were not able to make it to the Sikoro clinic to deliver, and those in need of urgent care for illness or accidents could not reach care when they needed it. The lack of a clinic was a serious geographical barrier to accessing care.

The Community Health Action Group decided that a clinic needed to be our next project, so we set to work. And now the Centre de Sante Communitaire de Sikoro-Sourakabougou is a reality!

It has been a long road to get this far, and there is still a ways to go. The government has promised to match our contribution by constructing the maternity ward and providing electricity and access to running water for both buildings. We also need your help to fully equip the clinic to get it ready to open as soon as possible.

The clinic is an integral part of all of our future plans. Under the Action for Health program, children and pregnant women in our target families will receive free care at this clinic. The clinic will host a pilot Frontline/SMS electronic medical records program which will provide valuable information on best-practices for both rural and urban clinics in resource poor settings.

In short, the clinic is a huge step for us, but just the first one. We are happy to be finished with construction so that it can start serving the community that requested its services. We hope that you, our donors, can help us reach this new goal.

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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