Category Archives: Mozambique

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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Before, we had no way to prevent malaria. Now the nets protect the whole family

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It’s the second week of August in Lichinga, Niassa Province in northern Mozambique – not far from the Malawi and Tanzania borders. It is a cold and wintery month with grey skies.

After about two months of preparation, our mosquito net distribution campaign using long lasting insecticide treated nets (LLINS) for universal coverage has finally reached the distribution stage. The teams who have been working to support and supervise the campaign will set out for the Ngaúma, Mandimba, Metarica, Nipepe, Marrupa and Majune districts – the six included in the first stage of distribution. Expectations are high for everyone involved. Finally, the campaign will start.

The main ceremonies of the campaign’s launch will take place in the Chimbunila district village of Lumbi, 15 km from the city of Lichinga. Here, in addition to the distribution of LLINs, a new health facility will be opened.

Alifa Rachide’s family was chosen by the community to receive the first LLINs to be distributed in this province. Alifa, 50, will bring his wife Atuege Jemuce, 43, and their seven children to the event. Their daughter attends fourth grade and another child is in year one. Alifa doesn’t know the exact age of his children, but he says the youngest is less than a year old.

The couple, originally from Lumbi, support themselves by cultivating cassava, groundnuts and beans, ensuring a supply of food for the family and generating some extra income. Alifa says this is the first time that his family will receive mosquito nets. “We never had mosquito nets, and so we had no way to prevent the mosquito bites and malaria,” he said. “At home, someone gets sick with malaria most years, but fortunately this year no one has got sick yet. I’m happy because the nets we receive will protect the family from malaria.”

Alifa and his family received four LLINs – a sufficient number to cover the whole family, since two people can usually sleep under a single net. His wife Atuege lets out a smile because the community will have a closer health facility that will reduce the distance they have to walk – involving crossing a river and the risk of crocodile attacks. She says: “Our family was chosen by God – we have received mosquito nets, and we have a health facility. Community leaders visited our house and informed us that we would receive LLINs at a ceremony held by the Government. And here we are.”

The LLIN distribution campaign was implemented by Malaria Consortium, under a project funded by the Global Fund Round 9. The project is being carried out in nine provinces of Mozambique, partnering with World Vision and the Foundation for Community Development (FDC). Malaria Consortium supported the Provincial Health Directorates of Niassa and Nampula to distribute around 1,000,000 LLINs, benefiting more than 400,000 families. In addition to distributing LLINs, the project involves training volunteers and teachers to educate and engage their communities around malaria prevention and control strategies.

Fernando Bambo is Deputy Project Manager in Mozambique

Supportive supervision: improving the quality of community health services

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Community health workers, when trained and equipped to manage simple cases of pneumonia, diarrhoea and malaria in children under the age of five, can reduce child mortality caused by these three diseases by up to 60 percent.

Funded by the World Health Organization (WHO), the Rapid Access Expansion (RAcE 2015) project in Mozambique is a strategic alliance between Malaria Consortium and Save the Children, to support the Mozambican Ministry of Health’s community health programme. The project is focused on improving the quality of care provided by community health workers (locally known as Agentes Polivalentes Elementares or APEs) by strengthening their ability to correctly diagnose, treat and refer children with common diseases and by ensuring that they receive regular supervision to improve performance and correct errors.

In November, Malaria Consortium staff and Provincial Health Directorate authorities carried out supervision visits in Inhambane province, Mozambique, to assess the clinical skills of APEs. In Inhassoro district, we met Linda Noah, a health worker who had cycled 21km on her bike, carrying her seven-month old daughter and her APE kit on her back, to participate in a clinical supervision session. During this session, Linda provided care to three children, all under the age of five, while being observed by district health technicians.

DSC_8904

“This was a first for me,” Linda said. “I have never had a clinical evaluation session like this. My supervisors observed my work and advised me right away on what I was doing right or wrong.”
This session made Linda aware of the challenges in correctly assessing danger signs and identifying those children that need an immediate transfer to a health centre.

“I enjoyed coming to this session. I faced many difficulties but I managed to fix them and I hope I will have even more of these kinds of opportunities with my supervisor to improve my work.”

Written by: Adolfo Guambe (Provincial Health Directorate, Inhambane) & Eder Ismael Zerefos (Malaria Consortium)

Community health? There’s an app for that

In recent years, there has been a rapid proliferation of mobile phone applications. There seems to be one for everything, from daily reminders to complex navigation. But while most of us don’t think of phone applications as lifesaving tools, in some remote communities where healthcare access is limited, that is exactly what they are.

In many remote villages in Mozambique, community health workers are the first point of contact when a child gets sick. They are trained to diagnose and treat children under five years for some of the deadliest conditions – pneumonia being chief among them – and provide referrals to health facilities for severe conditions.

Community health workers, or Agentes Polivalentes Elementares (APEs) as they are known locally, have been highly effective at bringing healthcare closer to people living in the poorest and most remote communities. However, they face a number of challenges carrying out their work. They often lack the tools necessary to properly assess symptoms, diagnose and treat childhood illnesses and have had limited contact with their supervisors.

Malaria Consortium has been testing the utility of mobile phone applications as a means to improve the motivation and confidence of community health workers who face these obstacles every day.

How are the phones used?

APEs are given a smartphone that comes preloaded with an app called ‘inSCALE APE CommCare’. This application helps them carry out their daily work.

Firstly, this app acts as an interactive job aid, guiding them through all steps of diagnosis, treatment and referral. For pneumonia, the app asks a series of questions regarding symptoms and uses a special counter that helps to assess the respiratory rate of the child. If the child is found to have pneumonia symptoms, the app provides educational messages and treatment instructions for both APE and caregiver. Recommendations for follow-up visits or referrals are given based on the diagnosis and vaccination status of the patient.

Patient data, including diagnosis and vaccination status, is stored on the phone along with weekly aggregated data and medicine stock levels, all of which are sent to the APE’s supervisor. This is then collated into statistics at the provincial and district levels that provide real-time data available to health officials. After submitting the data, the APEs receive feedback messages thanking them for their work.

Communication with supervisors and peers is also significantly improved through the phones. Each APE receives a monthly automated credit allowance for making calls – an initiative that bridges the gap between health workers and their supervisors, ensuring closer coordination and improved performance. Periodic motivational messages also can help increase a sense of collective identity and purpose.

Has it been successful?

The results have been encouraging. A process evaluation was carried out in Mozambique, which showed that 68 percent of APEs always use CommCare in their work. Respondents reported that the application helped them remember the symptoms to look for.

The three most favoured aspects of the inSCALE APE CommCare app were the job aid for newborns, children and pregnant women; improved respiratory rate timer; and treatment and dosing instructions. Mobile phones were also found to improve the community standing and legitimacy of the health workers.

At the heart of the application’s success was its user-centred design. The Mozambique Ministry of Health and the community health workers themselves were heavily involved in each step of the design process, ensuring that the app remained easy-to-use and intuitive. However, most APEs and supervisors were unaccustomed to using smart phones, so introductory sessions were held in addition to the existing CommCare training. This allowed for efficient use of the phone and its software.

You can learn more about the CommCare app by watching the demonstration video below:

*Malaria Consortium’s inSCALE project is funded by the Bill & Melinda Gates Foundation and carried out in partnership with the London School of Hygiene and Tropical Medicine and University College London.

Read more about mHealth in Mozambique here

Ilya Jones is the Communications Officer in London

Fighting malaria in the classroom

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Fernando Bambo is Malaria Consortium’s Communications and Advocacy Coordinator in Mozambique

One of the most interesting aspects of working at Malaria Consortium for me is tracking its progression over time. It was in December 2005 that I joined the organisation, as Deputy Coordinator of the demand creation component of the project for Sustainable Distribution Systems of LLINs, funded by the UK Government.

This innovative project, initially implemented in Inhambane province in Mozambique and subsequently expanded to Nampula and Cabo Delgado, rested on three pillars. These were:

1)      The free distribution of LLINs to pregnant women at public antenatal care clinics;

2)      Support for the commercial sector to develop a market for mosquito nets that were affordable for all socio-economic groups;

3)      Demand creation for mosquito nets through communication activities, as well as the promotion of proper nets’ use and care.

The communication component had a huge impact on creating demand for mosquito nets in both the public and private sectors. At the time, LLINs were still a novelty in Mozambique, and we all had a lot to learn in almost all areas of implementation. One of our achievements was the development of a communication strategy to promote LLINs using the COMBI approach (Communication for Behavioural Impact) whose principles have since been incorporated in the National Communication Strategy and Advocacy for Malaria (2013-2017).

COMBI was the strategy that gave rise to the popular interactive radio programme ‘MozzzKito.’ In addition to MozzzKito, we also developed a new tool, the “net hat”:  this was an exercise and games worksheet specifically designed for primary school children to help them learn about malaria in a fun way.  The ‘hat’ consisted of a poster with six learning exercises and games, including brain teasers, and “malariamática” (math on malaria). With support from teachers, children solved the exercises in the classroom and afterwards folded the poster into a ‘hat’ with the message – “I am protected, sleeping under a net.” This symbolised the participation of children in the fight against malaria.

Upon leaving the classroom, the children went out onto the street in groups showing their hats, and interacting with the community about malaria. At home, the children read the poster aloud to their parents, and in the end, the parents signed a paper that indicated that they had seen the poster. Finally the children took the “hat” back to school and gave it to the teacher.

Even today, I still think of those earlier projects and look at how far we have come as an organisation. Since I first joined, each project has built on experiences from the last – in this way we have improved our work and generated new ideas. Currently, Malaria Consortium is working on the Malaria Prevention and Control Project – a project that I am a part of. The project aims at engaging communities in defeating malaria through school activities, radio programmes, and capacity building of community-based organisations in conducting behaviour change communication activities. The lessons learned and the accumulated experiences all contribute to better and healthier lives.

Mafalda’s commitment to her community

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Mafalda, a community health worker trained by Malaria Consortium in southern Mozambique

Fernando Bambo, Malaria Consortium’s Training Manager in Mozambique, recounts meeting Mafalda José Ngonhamo, one of almost 800 community health workers who received training in case management of childhood diseases from Malaria Consortium and partners in Mozambique in July and August 2013

The weather forecast said that the southern part of Mozambique would be hit by a heat wave, with temperatures reaching around 36 degrees celsius. True to the forecast, the temperature is scorching. It is our “spring” here in Mozambique, we are still transitioning from winter to summer and it will be cool again tonight.

We arrive at the Eduardo Mondlane Resource Center for Inclusive Education, a centre in southern Mozambique providing day care and access to education for children with disabilities. We are here to conduct a refresher training course for local community health workers. We will be reviewing prior training that the health workers have had in health promotion and the case management of malaria and other simple childhood diseases in the community.

The children at the center welcome us with curiosity. Interacting with them, I realise my relative illiteracy. They are using sign language to communicate with us but we are unable to understand.

Mafalda José Ngonhamo, 37 years old, is one of the community health workers participating in the training. She lives in Bilene District in Gaza province. She has four children: two girls and two boys, the oldest 15 years old. She is pregnant and expecting her fifth child soon.

The coordinator responsible for community health workers in the district had informed Mafalda about the training and suggested that because of the advanced stage of her pregnancy, she need not participate.

But Mafalda did not agree. She felt she should do her best to participate in the training and uphold her responsibility to her community.

She takes short breaks often but actively participates in the training, always raising her hand to answer questions. She is clearly motivated and determined to be on an equal footing with the other trainees. When I asked her why she decided to come she replied:

“When I heard about the training and that I was not expected to participate, I really felt very sad. Then I gathered forces, I gained courage and communicated that I was willing to participate because I love the work I do as community health worker. I committed to help my community and could not miss this opportunity to learn.”

As we are chatting, Mafalda shows me a poster on the danger signs during pregnancy. It is a new communication material that district authorities have distributed to community health workers to support them in their efforts to improve maternal health.

“This is very useful to me now as I am pregnant, but I will use it in my work to educate other pregnant women about danger signs and the importance of seeking immediate care at the nearest health unit…”

As part of the Project for the Prevention and Control of Malaria funded by the Global Fund to fight AIDS, Tuberculosis and Malaria, Malaria Consortium and partners including World Vision, International Relief for Development and Fundação para o Desenvolvimento da Comunidade, held a series of training sessions in disease prevention, health promotion, proper management of cases at the community level, monitoring and evaluation and proper medicines management.

Mafalda José Ngonhamo, is one of the 785 community health workers who were trained between the months of July and August of 2013. Training was given to both district trainers and community health workers and took place in the provinces Inhambane, Sofala, Manica, Tete, Zambézia, Gaza and Maputo.

Find out more about Malaria Consortium in Mozambique here.

Getting essential medicines to the community, by bicycle

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Eder Ismail is a Project Officer for Malaria Consortium’s community-based child health programme in the Inhambane province of Mozambique. Malaria Consortium has been training and supporting community health workers in the province of Inhambane since 2009 with funding from the Canadian International Development Agency and the Planet Wheeler Foundation. The project aims to bring life-saving health care to rural communities living long distances from health centres. Community health workers have been equipped with bicycles, enabling them to travel to health centres more regularly, to replenish essential medicines stock and hold meetings with their supervisors.

Bernardo Dongo is a community health worker, trained in 2010 by the Ministry of Health with Malaria Consortium’s support. Since Bernardo was trained in integrated community case management of common childhood illnesses, he has been working in his catchment area to offer front-line health services. He holds regular community meetings to educate families about disease prevention and health practices, and he diagnoses and treats children under five years of age who present with mild forms of malaria, pneumonia and diarrhoea.

Each month, Bernardo, who is 52 years old, leaves his home behind and rides for 18km on his bicycle to reach the health center in Inhassoro.

Two hours later, Bernardo reaches the health centre. There, he meets his supervisor to review his monthly activity report and visits the pharmacy to collect the monthly essential medicines kit that he will take back to his community in Vuca, a coastal area in Mozambique’s Inhassoro district.

He goes back in the late afternoon at low tide, using a coastal shortcut that saves 1 hour off his journey and allows him to reach his community by early evening. When he arrives, Bernardo opens the medicine kit in the presence of the community leader. He can now resume his normal activities, consisting of both health promotion and treatment for uncomplicated diseases. “There are about 700 people in my community, and on average I see about 160 patients per month”.

People need to know more about the importance of breastfeeding

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Dieterio Magul is a Field Officer for Malaria Consortium’s community based child health programme in the Inhambane province of Mozambique. He works with the provincial health authorities to support the community health programme that has been running for over 30 years. Revitalisation of the programme by the Ministry of Health began in 2010. Malaria Consortium’s role has been to help train community health workers to diagnose and treat simple forms of the three main childhood diseases: malaria, pneumonia and diarrhoea.

Teresa has been living for over 20 years, with her partner and their seven children, in Pangaia – a village on the sandy island of Bazaruto, a few kilometres off the Mozambique coast. Although the island is known as a beautiful beach holiday destination by tourists, for local residents, access to basic health services remains challenging.

In 2011, Teresa was selected by her community to receive training to become a community health worker (CHW).

The three months training, supported by the Ministry of Health and Malaria Consortium, equips community members, like Teresa, with the skills and tools needed diagnose and treat common diseases in young children in their community, as well as to recognise the danger signs that signal a need for urgent attention at a health facility.

Teresa, a community health worker now for two years, is working hard to increase awareness of common diseases in her community and provide information on best practices that can help to improve family health.

Her work is challenging. On Bazaruto, many women work in their homes in the morning, before going to the beach to buy fish from returning fishing boats that they then sell to support their families.

“Young children suffer from this because their mothers are very busy and cannot always take them… and do not find the time to breastfeed them; so I have organised discussions on this topic at the very places where women are waiting for the fishermen. I explain to them that breast milk is very nutritious, and very important for the healthy growth of children. I think people need to know more about the importance of breastfeeding, because this can encourage them to schedule time for it.”

But Teresa’s efforts are bringing results and many women in the community have started to breastfeed their children more often and for longer.

Teresa is happy with the impact her work is having on health in the community and hopes that with support from her community and others she will be able to reach more community members with lifesaving information and drugs in her role as a CHW.

Malaria Consortium’s integrated community case management (ICCM) programme in Mozambique has been supported by the Canadian International Development Agency and the Planet Wheeler Foundation since 2009. Malaria Consortium’s role includes recruitment and training of CHWs to diagnose and treat malaria, pneumonia and diarrhoea appropriately, support to national and local health system to provide supervision and monitoring of community-based activities, as well as health promotion activities to increase awareness of malaria, pneumonia and diarrhoea management and prevention within the communities.

In addition, through funding from the Bill & Melinda Gates Foundation, Malaria Consortium is conducting research into innovative ways to improve the motivation and performance of APEs. This research initiative, the inSCALE project, aims to inform the scale-up of community health worker ICCM programmes to provide access to timely and appropriate treatment for common childhood illnesses across the developing world.