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 weighing a child