Category Archives: Mozambique

Chimbonila: A district committed to fighting malaria

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The district of Chimbonila in Niassa province has a high malaria burden, which can be difficult to manage for a number of reasons.

The district itself is very large. It is located about 30 km from the city of Lichinga and covers an area of ​​8,075 km² with a population of about 87,000 inhabitants. Despite its proximity to the capital city, however, Chimbonila has the typical challenges of the other districts of Niassa: poor roads and high poverty rates, as well as a remote, mostly rural population which relies on an economy based on agriculture (population density of 15.8 inhabitants per km²).

Since 2014, the National Malaria Control Programme of the Ministry of Health and its partners (World Vision and Malaria Consortium) with funding from the Global Fund, has been implementing the Malaria Prevention and Control Project within local communities.

The project in Chimbonila District involves 22 community structures, 428 volunteers, 23 schools, 72 teachers, 14 health facilities and one community radio in a continuous effort coordinated by Health, Women and Social District Services to ensure the prevention and treatment of malaria.

Since 2014, Gabriela Nazaré has been the Malaria Consortium Field Officer assigned to this district. Her role is to coordinate the activities of all project stakeholders, ranging from health facilities to community volunteers.

Every day Gabriela visits the villages by motorcycle, ensuring that all project’s participants have the necessary tools for mobilisation work and that they have a correct understanding about how to prevent malaria and that they know what to do in the occurrence of malaria symptoms.

After three years as Field Officer, Gabriela feels integrated in the community: “I was born and raised in Lichinga. I moved to Chimbonila to work and today I feel at home. Despite the complexity of the job, knowing that I am contributing to the improvement of people’s living conditions is rewarding.”

Rain or shine, her activities don’t stop. Owing to the large number of beneficiaries, her schedule is very busy. “I try to spend as much time as possible in each community. My routine in each village is to visit schools, health facilities and work with community structures.

“Over the years we have been establishing work mechanisms and today it is amazing how communities are engaged in the project in such a way that they now bring in their own initiatives and suggestions for new approaches.”

 

Text and photos: Xavier Machiana

Distribution of LLINs in Niassa Province: mission accomplished

After a year of intensive work, Niassa Province in Mozambique, an area with a high malaria incidence rate, has successfully completed its mass long-lasting insecticidal net (LLIN) distribution campaign in its 16 districts.

The Malaria Prevention and Control Project is part of the Universal Coverage Campaign (UCC),  a national initiative led by the Ministry of Health.  It is funded by the Global Fund, and implemented by World Vision as the recipient partner, with Malaria Consortium, Food for the Hungry and Community Development Foundation as secondary recipients.

The UCC aims to ensure that every Mozambican has access to a LLIN to protect themselves from malaria. In Niassa Province, the campaign has reached approximately 415,000 households in the 16 target districts, amounting to a total of 1,058,750 LLINs. Niassa Province covers an extensive area of ​​approximately 123,000 km², with around nine inhabitants per km² in some of the more remote areas.  Access roads are lacking and most are not tarred, which renders the UCC implementation a complex process.

To overcome these challenges and to meet the high demand, the campaign was cascaded down from the central level, on to the provincial level, and finally expanded to the districts, towns and villages. In a combined effort of thousands of people involved.  The local government, the Provincial Health Directorate, District Directorates, support teams, trainers, distributors, registrators and different service providers were all critical to the success of the mass distribution.

According to Dr. Inês Juleca, focal point of the National Malaria Control Programme of the Ministry of Health of Mozambique for the province of Niassa, “The distribution of LLINs is an activity that includes several steps and high-quality coordination, from the consultation of guiding documents, planning, procurement, transportation and packaging, to communication, engagement, mobilisation, training, population registration and distribution itself.”

In this process, the National Malaria Control Programme is responsible for the acquisition of LLINs and led overall planning and implementation through the decentralised structures of the health system. Malaria Consortium is responsible for operational support, which includes financial management, transport, logistics, training, management of service providers, efficient use of resources and effective coordination at provincial, district and field levels.

On the challenges encountered on the ground, Joaquim Chau, Interim Coordinator of the Malaria Consortium in Niassa province, says: “The challenge of coordinating processes is largely to achieve the commitment of all those involved, even with different procedures or practices, sensitivities and institutional hierarchies, to bring together an understanding of the common vision of what is to be achieved. This makes a difference in the process, and in the professional and individual expectations of all the actors involved.”

With the successful completion of the distribution, the team is planning a post-distribution campaign that will focus on effective messaging about the correct use of LLINs. Highlighting the importance of the post-distribution campaign, Dr. Juleca stated: “Malaria prevention does not end with distribution of mosquito nets. We are ensuring that, after the distribution phase, our beneficiaries are knowledgeable about the use of nets and that this process is effectively translated into behaviour change.”

By Xavier Machiana

Mozambique’s unrecognised malaria heroes

Throughout Mozambique’s Niassa Province thousands of unassuming community members have given up their time to improve community health by volunteering in the distribution of long lasting insecticidal nets (LLINs).

 

The campaign, which is distributing over one million LLINs to 480,000 families in April and May is being organised by the Provincial Health Directorate, District and Community Leadership, civil society organisations, World Vision and Malaria Consortium under the leadership of the Provincial Government of Niassa.

So far, over 3,500 men and women from different ages and backgrounds have volunteered in the campaign, which has been crucial to the organisers efforts to reach all families in the province.

 

These malaria heroes have overcome many hurdles including inaccessibility due to lack of roads. They have walked on foot with bundles of nets on their heads and backs where their vehicles could no longer go. They took boats and canoes to reach remote villages on the islands of Lake Niassa. They have used motorcycles, tractors and all possible means to carry out their work, including crossing dangerous areas, such as Niassa Reserve, which is inhabited by many wild animals.

Community volunteers are essential to the success of many health campaigns. See our #MalariaHeroes webpage and support community health volunteers around the world.

The campaign is part of a national initiative led by the Ministry of Health with the support of the Malaria Prevention and Control Project, a project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as the main partner,  Food for the Hungry, Community Development Foundation and Malaria Consortium.

World Malaria Day 2017: Mozambique’s Niassa province launches mass net distribution

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World Malaria Day ceremony, Metangula Village

To mark World Malaria Day on April 25, Niassa province Mozambique held an official launch ceremony for a campaign to distribute long lasting insecticidal nets across the provinces 15 districts. The ceremony was held at the distribution headquarters in Metangula and was attended by district leaders, provincial leaders, civil society organisations and community members.

Activities included the laying of flowers at Heroes’ Square and a march with different civil society players, delivering speeches to spread the message of malaria prevention.

IMG_0467

District administrator Sara Mustafa

The formal distribution of the mosquito nets was initiated by the district administrator, Sara Mustafa, who stressed the importance of using them correctly to a large audience of community members.

Her statements were echoed by Dr. Inês Juleca from the National Malaria Programme of the Ministry of Health, who said, “The distribution campaign needs to be complemented by ongoing mobilisation and awareness raising activities at the local level so it is effective and reduces malaria among the communities the campaign was created to reach.”

IMG_0294

Monica Saíde, mother of five, collecting her mosquito net

Malaria is a major public health issue in Niassa Province, with over 700,000 registered malaria cases in 2016 giving an incidence rate of 407 cases per 1,000 people. The campaign, run by the Ministry of Health and Malaria Consortium, is part of an effort to reduce this burden through wide spread national and local level programmes.

 

The campaign is part of a national initiative led by the Ministry of Health with the support of the Malaria Prevention and Control Project, a project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as the main partner,  Food for the Hungry, Community Development Foundation and Malaria Consortium.

Text and photos: Xavier Machiana

Technology to save children’s lives

Mobile health coverage is expanding in Mozambique. Following a successful pilot in a few districts of Inhambane province, the Ministry of Health, in partnership with Malaria Consortium and UNICEF, will scale up an innovative mobile health (mHealth) app-based system to all districts of Inhambane and to the northern province of Cabo Delgado, as part of our new upSCALE project.

In recent years, mobile Health, or mHealth, has emerged as an important innovation with tremendous potential to strengthen health systems in low- and middle-income settings. It achieves this by providing better access to knowledge and information by improving service delivery and reducing response time to crises. Mobile phone coverage is growing rapidly across the world, both in terms of network coverage and the number of users.

upSCALE aims to expand an mHealth system using an interactive mobile android application.  The app provides step-by-step guidance to community health workers, or agentes polivalentes elementares (APEs), in running procedures for diagnosing and treating common diseases that are addressed at community level by trained workers. In September 2016, 258 community health workers were trained on this mHealth system.

Salvador was the oldest among the trainees, demonstrating that age is not a limitation for successfully using modern mobile technology.

“My namAPE SALVADOR PICTe is Salvador Waciquetane. I am 56 years old and I have been doing community health work for many years in Inhambane’s Vilankulo district, community of Chelene. I started to volunteer as a health activist in 2006 and, at the time, I was giving health talks in my community about good health practices. In 2010, I was the one chosen by my community to participate in the training to become an APE, as part of the Ministry of Health revitalisation programme. From the training until today, the people of my community are counting on me to provide basic health care.

Each year, I participate in various refresher trainings; in September, I received a call from my supervisor, Valério, requesting me to come to the district headquarters to participate in a CommCare training, which involves using a mobile phone in my work as an APE. After the phone call, I was curious and I began to imagine that the cell phone would be the same as the ones I saw during the general population census, when I had to map the population of my community. But when the training started, I was very impressed. I saw that the phone is equipped to help me do much more than I had imagined: family planning activities, follow-ups of pregnant women, diagnosing and treating diseases such as malaria, diarrhoea and pneumonia, as well as tracking people with tuberculosis and HIV to refer them to the health centre. I am very happy because this phone is going to help me a lot in my work, as it is easy and it guides the APE well.

“When I return I will meet with my community leader to ask him to arrange a meeting so I can present my new device to the community members. I think they will react very well and this will increase the trust they have. Any novelty is a challenge at first, but as time goes by I will find my way and I will grow to understand it.”

 

By Éder Ismael Zerefos

Voices for better health: Mozambique

View in: English | Portuguese

A large scale long lasting insecticide-treated net (LLIN) campaign was officially launched by President Filipe Jacinto Nyusi in November last year in an effort to reduce malaria in Mozambique. Many Mozambicans are still falling ill or dying of malaria. In 2014 alone, over five million cases of the disease were diagnosed, leading to over 3000 deaths.

The mass LLIN distribution campaign, supported by Malaria Consortium, is providing over 13 million nets across the country, with the first stage distribution taking place in Nampula and Niassa provinces. We spoke with some of the people involved in the first stage of the distribution to find out how the programme was being received by local communities.

Azelio Fulede MCD Ilha de Mocambique (4)Azélio Fulede, Chief Medical Officer

“The health situation in our district was critical because communities didn’t know how to use mosquito nets. Now, through social mobilisation activities run by community leaders, activists, volunteers, and community radio we are seeing behaviour change and the nets are being used properly.

In our regular visits to the communities, we see that families now hang the nets over their beds, on the porch or wherever they sleep. When we meet people who do not know how to hang the nets, we show them and help them. These are encouraging changes; fewer people are getting malaria and positive messages continue to spread within communities. We hope that fewer people will fall ill and that we will eventually eliminate the disease.”

Emília Corela, cEmiliaampaign supervisor

“I can already see changes in peoples’ behaviour. Everywhere you go you can see mosquito nets being aired in the shade, hanging on the balconies and in bedrooms. These are new scenes, really – you would not have seen this before. I believe that the efforts we made to educate the population about the importance of using nets to protect themselves and their families against malaria, such as advocacy events, lectures in schools, information sessions at community level, are beginning to bear fruit.

On a personal level my involvement in this undertaking has been very rewarding. I gained work experience, lost my shyness, learned more about interacting with people and meeting new people; these skills will also help improve my work.”

Nare Luis PF Erati (3)Naré Luis, focal point for malaria in the Eráti district

“This LLIN distribution campaign was a major challenge for us because it was the first time we covered the entire district, providing nets to over 95 percent of the population.

Malaria is a major health problem in the Eráti district, affecting as many as 60 percent of our people. However through this campaign we are already seeing that there is less malaria. We are now working together with the community health workers, local leaders and radios stations to ensure people know how to use and keep the nets in good condition.”

Francisco Eduardo APE (10)Francisco Eduardo, volunteer community health worker in Mucuegera

“Eighty percent of my work is devoted to community health promotion activities, including village health talks to ensure our community understands how to prevent diseases such as cholera, diarrhoea and malaria. The other 20 percent of my time I provide treatment services at either my patients’ homes or my own home.

The net distribution has been an excellent opportunity to show people the correct use of a mosquito net. I notice the difference in my daily home visits. People are hanging the nets and sleeping under them and I have already seen that malaria is reducing! Last year during the rainy season I diagnosed more than 100 malaria cases in only one month, but this year I recorded only 39.

Marcelino Joao MCD Nacala Porto (2)Marcelino Joao, Chief Medical Officer, Nacala Porto district

“Investing in mosquito nets is a guarantee for a long life! Before the distribution campaign, people often used nets for fishing and not for sleeping under. Malaria Consortium trained people from civil society associations and community structures, as well as community health workers, to help mobilise these communities, raise awareness and change behaviour in relation to malaria prevention and the appropriate use and care of mosquito nets. These messages have been reinforced by local radio and television channels which broadcasted the messages intensively during the campaign.

Through these efforts, we have already recorded a decrease in cases of malaria. We are very satisfied with the results and we believe quality of life will improve in the district. We will continue to hold regular meetings with local community leaders and to spread correct information about malaria prevention and the appropriate use of mosquito nets.”

Marcelino Melo PF DPSMarcelino de Melo, Provincial Health Directorate of Nampula province

“For the first time we have managed to distribute LLINs to all districts in the province – reaching a total of 1.3 million families with over 3.5 million mosquito nets. We are now focused on strengthening communication via radio, television, posters and leaflets so that people make good use of the nets we distributed.”

LLIN distributions are a key component in the Malaria Prevention and Control project, a country-wide initiative funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as primary partner, Malaria Consortium, Food for the Hungry (FH) and Foundation for Community Development (FDC).

By Dorca Nhaca, Malaria Consortium, Nampula office, Mozambique

Meet the recipients of Mozambique’s largest ever mosquito net distribution

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By Dorca Nhaca

On 3rd November 2016 the Ministry of Health, Mozambique, launched the largest ever distribution of mosquito nets. In total over 13 million long lasting insecticide-treated nets (LLIN) will be distributed throughout the country – an important step to reducing the burden of malaria.

Malaria Consortium has supported the roll out of this mass distribution in the most populous province of the country, Nampula, located in the north of the country, delivering LLINs to protect over five million people.

As a consultant on the project, I travelled the Nampula province monitoring and supporting distribution efforts. The importance of this project was clear during my visits to various districts. Everywhere I went people converged en masse to the distribution points and were eager to get mosquito nets to protect their families.

I managed to speak with some of the recipients about the project and what it means for their families. This is what they told me:

gracinda-francisco-1

Mrs Gracinda Francisco, Monapo district

“Today I received two mosquito nets and I am very happy because my family will be protected from mosquito bites. The mosquito causes malaria which is a disease that makes us very weak. Before receiving these nets, the situation was very complicated in our home because we only had one old net to share with our son. The net was old and damaged and the mosquitos could easily enter through the holes. We had a terrible time because our home is close to the Monapo River which brings a lot of mosquitoes. People are constantly sick. Last month, my son fell ill and had to be admitted in hospital for treatment. I was worried because he is still very small. He is doing better now and these nets will help a lot to prevent malaria in my family.”

calima-primeiro-1Calima Primeiro, Rapale district
“I am very happy to have received these nets. It will greatly improve malaria care at home. The people in my neighborhood have suffered a lot from malaria and we have also suffered from this disease in our home. We had not used mosquito nets for a long time. A few weeks ago, I myself got malaria and I was very resentful because I was very weak and could not walk or work on the farm. We are currently in the agricultural season where we sow corn, peanuts and other crops, so my sickness caused a difficult situation. The children who live with me could not go to the farm because they had to take care of me. I had to stay home and could not do anything for about eight days. After this, my daughter and grand-daughter became sick with malaria and I had to take them to the hospital for treatment. This was a big learning experience for me: we got sick because we did not protect ourselves.

The government came at the right time to help us fight this disease. I know that malaria is dangerous and a killer disease. Now, if we use the mosquito net we can not only avoid getting sick, but also avoid spending money for the medicines and use this money for other things. So, I and my family will use the mosquito nets so we don’t get bitten by mosquitoes.”

valentim-antonio-cidade-nampula-2Valentim Daniel António, Nampula City
“I started using a mosquito net in 2010 when my wife became sick with malaria. At the time, she was pregnant. Besides not having the financial means to buy a mosquito net, we did not realise the importance of nets, because we thought that if we got sick we could just go to the hospital and get treated. But this time it was different. My wife was so sick that she had to be admitted to hospital while she was pregnant; she became very weak and had to take intravenous drugs. Luckily my wife got better and when she left the hospital, the nurse who cared for her asked us if we had a net at home and we said no. She gave a net to my wife and advised us to always use the net because malaria can be deadly. When we got home, we started using the net, but my kids did not because we had only one.

I bought two more nets for my children and nephews but after several years they developed holes and I could not replace them, but today, I received three new nets, and I want to thank the government.

I say with great pride that I use the mosquito net to protect my family’s health against malaria. If this net gets spoiled, then I will buy replacements. I am pleased to be a part of those benefiting from mosquito nets and I have been mobilising my family, friends and neighbors to use the mosquito net because it protects us from the mosquito bite that causes malaria – it is really worth it.”

pTrucks loaded with nets are sent to distribution centres around Nampulap
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Dorca Nhaca is a consultant to Malaria Consortium in its Nampula Office, Mozambique

This undertaking is part of a nation-wide initiative lead by the Ministry of Health with support from the Malaria Prevention and Control project, a country-wide initiative funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as primary partner, Malaria Consortium, Food for the Hungry (FH) and Foundation for Community Development (FDC).

Using community dialogues to prevent and control NTDs

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By Eder Ismael

blogNeglected tropical diseases (NTDs) constitute a serious obstacle to socio-economic development, quality of life and reducing poverty. In Mozambique, NTD rates are extremely high; the most common NTDs include schistosomiasis (or bilharzia), trachoma, intestinal parasites, lymphatic filariasis (LF) and onchocerciasis. Mass treatment campaigns have been implemented in recent years, but so far, efforts to involve the affected communities have been limited.

Malaria Consortium has been supporting the Provincial Health Directorate of Nampula to implement an approach that will increase community participation in the prevention and control of these diseases. Community participation is essential in the timely identification of patients and the promotion of preventive practices, such as hygiene and the handling of water. The community dialogue approach is a form of social mobilisation which improves knowledge, attitudes and practices at the community level and promotes ownership of health issues.

The approach has been tested in four districts of Nampula province and has been successful in raising the level of knowledge about the disease schistosomiasis.

The Provincial Health Directorate of Nampula and Malaria Consortium, with support from the Centre for NTDs at the Liverpool School of Tropical Medicine, are also testing how the approach can provide a mechanism to facilitate community initiatives for better home care of people suffering from the disease caused by LF.dr-jive

We interviewed the head of the NTD Programme of Nampula Province, Dr. Solomon Ercílio Jive, to gather his views

on the situation of these diseases in the province and the partnership with Malaria Consortium in the fight against NTDs.

Tell us about your job?
My role is to monitor, evaluate and implement community interventions for the prevention and control of NTDs as a whole, with an emphasis on diseases that are preventable through chemotherapy such as, LF, onchocerciasis, shistosomiasis, intestinal parasites and trachoma. Under the partnership between the Provincial Health Directorate and Malaria Consortium, I am the focal point of the community dialogues for the filariasis project, which is a continuation of the project of community dialogues on schistosomiasis (or bilharzia), which ended in March 2016.

What are the main challenges for the NTD programme?
We have specific targets to control the diseases, and to eliminate some, especially LF and trachoma by 2020. To achieve these objectives we must:
• Achieve greater population coverage in preventive chemotherapy campaigns
• Seek funding and support for the control of other tropical diseases that are not preventable by chemotherapy, as there are 17 diseases in total and so far only four of these benefit from direct funding
• Intensify awareness and social mobilisation efforts so that all rural communities have better understanding of tropical diseases, through radio spots, lectures, debates, community dialogues, and greater distribution of information and educational material
• Extend the community dialogues regarding LF and schistosomiasis to all districts of the province and if possible integrate other NTDs

What are the main challenges for the community dialogues approach?
We believe in the potential of the community dialogue approach to improve community participation in the prevention and control of diseases. However, we need more support and funds to cover more districts and to train community facilitators who will contribute to the intensification of social mobilisation and the dissemination of information on diseases, how to prevent and how to treat them.

blog-4What do you expect to accomplish with this project?
This year, the province conducted a mass treatment campaign for LF in the 23 endemic districts, which saw more than three million people treated. For the treatment of hydrocele cases (complication caused by LF), surgeries are performed in seven operating theatres throughout the province, with financial support from the Centre for Neglected Tropical Diseases at the Liverpool School of Tropical Medicine.

The community dialogue project can complement these efforts by triggering community mobilisation to improve the therapeutic coverage of preventive chemotherapy campaigns against LF, as well as identify patients with chronic conditions caused by LF. Community support for those with life-long conditions caused by LF can help alleviate suffering and possibly stigma . However, there is still no community based system in Mozambique to identify and provide appropriate assistance to patients in their villages. This requires identification of viable and affordable solutions at community level that the Ministry of Health could implement in a sustainable way.
The Memorandum of Understanding between the Provincial Directorate of Nampula Health and Malaria Consortium aims to provide one of those solutions, through the creation of community dialogues on LF, representing a commitment to support the Ministry of Health in efforts to fight communicable tropical diseases. The lessons drawn from this project will help to develop more effective interventions.

What is the most valuable part of this project?
Community dialogues serve to fill information gaps on health among community members, identifying problems and helping communities to take collective decisions for improvement of health practices. These help in the formation of new habits, particularly in relation to timely care-seeking, and thus contribute to achieving the goals outlined in the economic and social development plan of the province.

Meet the members of a community health committee in Inhambane Province of Mozambique

A facilitator of a community dialogue in Mozambique shows an illustration that demonstrates how to hang up an insecticide treated net.

Felismina lives in Inharrime, a region in southern Mozambique. She has been a member of her community’s health committee since 2013. “The committee meets twice a month: once with the whole community, and once with just the members of the committee. We talk a lot about hygiene – how to take care of latrines and keep your home clean so that people can stay healthy. We also discuss things like how to avoid getting malaria.”

The Ministry of Health has put community engagement at the forefront of its efforts to improve healthcare in remote areas for years. Given the high prevalence of malaria, pneumonia and other infectious diseases, they have encouraged the creation of these community health committees as a way to help spread awareness and offer a platform for discussion. Consisting of elected members, religious leaders and community health workers amongst others, these groups are promoted as an effective means of mobilising communities and getting them to talk about health problems and identify solutions.

“There are 15 regular members of our health committee,” says Adolfo Nhamize, who was elected president of the group. “I am responsible for leading our meetings. I make the reports and conduct dialogues with the community.”

Daimanhane Mausene, Secretary of the Health Committee (2)The committee’s secretary Daimanhane Mausene tells me what topics they cover at their meetings. “We discuss malaria, diarrhoea, pneumonia, HIV. We also educate women on pregnancy,” he says. “We sometimes go house to house and talk to people about the use of latrines, how to boil water so they don’t get sick, and how to take some medicines. Then we come back later and see if they are following our advice.”

Resources for these committees are often scarce, and the lack of attention they receive means that members do not always receive proper training. Malaria Consortium’s Rapid Access Expansion (RAcE) project began working with the committees in 2013 to address some of these obstacles and to apply participatory learning methods within communities. Our team worked with the committees to introduce the community dialogue approach in order to get communities talking. The dialogues focus on increasing demand for (and use of) health services available within the community as well as provide a platform for discussing health problems and identifying solutions. As part of the approach, community health workers and community leaders receive a two-day training to organise and lead the dialogues, using a repeatable 10-step process and focus on the three major childhood illnesses.

“We talk about all sorts of things during the dialogues,” says Felismina. “Sometimes we discuss mosquito nets, because some people don’t use them or don’t have them. Other times, people talk about diarrhoea because of the dirty water.”

“People used to complain a lot about getting malaria,” says Fernando Machapene, a religious leader and member of the committee. “So we told them to go to the hospital and take medicine.” Residents also talk about practical problems and put forward recommendations. “Some people said that we only had one community health workers serving five communities and that we needed more – maybe two or three.”

Community dialogue discussing malaria (54)When I arrived in Inharrime earlier that day, a community dialogue was taking place. The topic was malaria. Gathered under a tree, the health committee fielded questions, gave advice and walked around the group showing illustrations and other educational materials. These included pictures that showed how to effectively tuck in a mosquito net as well as other methods of protection. Unfortunately, the session was interrupted after about 30 minutes by a sudden and unexpected downpour. Some people ran home, while others huddled together under the tree in an attempt to stay dry. It was clear, however, that the dialogue could not continue.

Adolfo, a provincial coordinator of community health workers (called Agentes Polivalentes Elementares, or APEs in Portuguese) tells me that weather is not the only challenge that the health committee faces. “It is sometimes difficult to get people to come to the meetings,” he said. “People might not always show up. They will say that they have plans, or that they have to go to the field to work. One way we try to remind them is by having teachers tell their students, who then tell their parents when they get home.”

Despite these challenges, the community dialogue initiative has proved a good way to improve the community knowledge of some diseases and wrong behaviours. In his community, Daimanhane has also noticed some changes in behaviours. “They try to follow the advice we give them,” he says.

Check out the photo story below to learn more:

pA health committee in Inharrime Mozambique meets to discuss health problems facing the community Malaria Consortiumrsquos Rapid Access Expansion RAcE project began working with these health committees in order to get communities talking about health through an approach called community dialogues The project provides training and materials to help committees organise and carry out these dialoguesp
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Ilya Jones is the Communications Officer at Malaria Consortium

Agente Polivalente Elementar overcomes tragedy by helping her community

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Caterina Cumbi, a community health worker or Agente Polivalente Elementar (APE) makes a check-up visit to three-year-old  Beldencio who  tested positive for malaria  three days ago; in Jogo, Inhambane (Photo by Ruth Ayisi).

Caterina Cumbi, a community health worker or Agente Polivalente Elementar (APE) as they are known in Mozambique, remembers how in the 1980s she lost three of her eight children to malaria. “There was no health centre nearby, no transport and no APE who could test and treat malaria.”

Today, Caterina, 46, supports her five surviving children, four of whom have gone on to further education. Not only has she been able to provide for her family by selling tangerines and avocados, but since 2010 she also has improved the health of her rural community in Jogo, in Mozambique’s southern province of Inhambane, after being elected by her community to work as an APE.

In 2012 Caterina attended a course supported by the Ministry of Health, in partnership with Malaria Consortium, to learn how to prevent, diagnose and treat malaria, diarrhoea and pneumonia, the three main killer diseases of children under the age of five in Mozambique.

Caterina’s working hours are from 9 am to 2 pm, Monday to Friday, which include consultations and home visits to carry out health promotion activities, including community dialogues around childhood illnesses, their prevention and management. “But sometimes when I return from my home visits I find mothers waiting for me,” says Caterina. “They also come during the night and over the weekends, and mothers from other communities who do not have an APE in their area also bring their children to me.”

Caterina works closely with the health committee, ensuring transparency and involvement of the community. “She always opens the monthly health kit [containing rapid diagnostic tests and medicines] in our presence,” says community leader Pedro Rafael. “We plan our health promotion activities together.” He adds, “Caterina has a lot of influence in our community. Before, most women used to give birth at home, but Caterina has sensitised them to make the journey to the health centre to give birth.”

Her supervisor, Hirondina Bernardo, a nurse at the health centre in Nhancoja, also speaks highly of Caterina and the other two APEs whom she supervises.  “People who did not like coming to the hospital, now come when the APEs refer them, as the APEs are from their own communities and are trusted.”  However, each month Caterina has to ride her bike for 18 kilometres along sandy tracks to collect supplies and deliver her record of consultations and health promotion activities. “The terrain is difficult”, comments nurse Hirondina, “so their bikes had to be replaced, and for a while some of the APEs had to walk each month to bring their records.” Despite the challenges, Caterina too says that she feels she makes a valuable contribution. “I keep the children in my community healthy,” she says.

Malaria Consortium is working with the Agente Polivalente Elementares in Inhambane through the inSCALE project. The inSCALE project is researching innovative ways to increase APE motivation and performance in order to increase the appropriate treatment of sick children.  Since 2013, the APEs in six districts in Inhambane have been using smart phones with an application called inSCALE APE CommCare, which features a multimedia job aid with images and audio to guide APEs through the consultation steps, a closed user group enabling free communication between peers and supervisors, and a data submission tool that enables the APEs to submit their records over the 3G network. To learn more about the work of APEs such as Caterina and the inSCALE project please join us at INSTIDOC – Ciclo do Documentário Institucional on Friday 24th April 19h00 at Centro Cultural Franco-Moçambicano in Maputo, Mozambique to watch our documentary focusing on two APEs “Caterina e Halima”. For further details about the event, please visit the website: https://instidoc.wordpress.com or for more information about the inSCALE project: www.malariaconsortium.org/inscale/.  

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