What would you like to say to Mali Health’s supporters?
Birama: We send our supporters a big greeting. We thank you for your generosity, and we are excited to continue working with you to fight against malnutrition and maternal and child mortality. We need your help to promote the health of our communities – to give our communities high quality healthcare.
How does your work help the community?
Birama: We surveyed families in the community to find those who need help paying for health services. Those who are enrolled in the Action for Health program get financial support when their children are sick, and it is our work as CHWs to find those who are sick and refer them to the health center.
Fatoumata: Our work helps reduce the cost of care for people because we help them pay medical costs and refer their children to the health center so they know when it is really necessary to go.
How has your perspective on health and healthcare changed through your work?
Aminata: Before I started working with Mali Health, I had heard false information about the health center. But now I know it is a good center and does quality work.
Kadidiatou: Before we CHWs started working in the community, many people refused to come to the health center because they didn’t know what kind of services were provided and there were rumors that the doctors only practiced traditional medicine. But now they know those rumors are false and, because of us, the health center is highly attended.
What skills have you learned from your work?
Kadidiatou: I have learned so much about health, including details that I never knew before, like how many prenatal care visits a woman must attend when she is pregnant.
Aminata: I enhanced my public speaking skills as I have spoken in front of large groups of people during health fairs.
Abdoulaye: I learned how to look for danger signs in children’s health and how to communicate with the motive of changing people’s behavior.
Birama: I have become more kind, sensitive, and open to the problems of others. My ability to understand people and know their needs has progressed so much. I have learned to highly value others and put myself at their service.
How has your work affected your relations with your family and your community?
Abdoulaye: My work has greatly enhanced my relations with my family and community. I am respected now in the community; they love my work and support me personally. This job has helped me get to know the people in my community and helped them to know me.
Birama: The community knows now that there are people among them who are very interested in their health and the health of their children.
What is your best experience with a family you visited?
Aminata: I remember at one house I visited there was a child who was very sick and malnourished. The mother was so worried. I sent the child and her mother to the health center for the child to join the malnutrition program there. The girl came to the health center each week for the program and gained weight and got better. If you had seen the girl when she was sick and saw her now, you would say she’s not the same girl because she looks so much healthier.
Birama: There are lots of stories like that! I was at a house once where the maid’s child was sick with malnutrition and a cough. I referred the child to the health center where he joined the malnutrition program and was given nutrition supplements. He recently had a weight and height analysis at the center and has gained weight. I actually just saw him last night and he has grown so much!
Why did you choose to become a CHW?
Aminata: We love our work because we get to help people, especially young children. The projects we work on are very good and help many.
Birama: I chose to work with Mali Health because I support them. They fight against poverty. If you support our programs, that helps us to help our own families and our own communities. I would also like to be a financial supporter of Mali Health one day when I have the means.
Fatoumata: I am very happy to be a part of this team. We work on projects that truly help the poor.
Abdoulaye: I was unemployed, but Mali Health came to our community and now I have a job. At the end of each month, I can go out and buy things for my family that I could not provide before. This job supports our daily lives.
Kadidiatou: Mali Health taught me so many things concerning health—things that will allow me to aid my community and help my own child in the future. Even if there was another job available, I wouldn’t leave Mali Health, because I adore this organization.
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.
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.