Category Archives: Mozambique

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

View in: English | Portuguese

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

View in: English | Portuguese

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

View in: English | Portuguese

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

View in: English | Portuguese
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

View in: English | Portuguese

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

View in: English | Portuguese

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.

In Mozambique, teachers trained in the fight against Malaria

View in: English | Portuguese

Fernando Bambo, Malaria Consortium’s Communications and Advocacy Coordinator in Mozambique, writes about a teacher training initiative supporting educational activities in schools for malaria prevention and control initiatives in Nampula Province, northern Mozambique.

We have travelled from Malema District and finally reach Murrupula, in Nampula province, northern Mozambique. It is February, and the rain is falling heavily. In Mozambique at this time of the year malaria is usually at its peak due to mosquitoes breeding in stagnant water.

It is early morning and we have reached the Primary School of Murrupula, 70km from the city of Nampula, where we are giving a training course about malaria education and prevention in schools to a group of teachers.

Despite heavy rains, teachers and students have walked several kilometers to make “school as usual”. Outside the training room, the pupils fill with curiosity and climb the windows to get a glimpse of what is happening inside. It is a rather unusual scene for them to watch their teachers become students, sitting at the same desks where they usually sit. In their eyes, a teacher is a human being who is born endowed with knowledge.

Isabel Ilda Isaac teaches seventh grade students at Murrupula Primary School and has been selected to participate in the training. Isabel lives in Murrupula with her husband and three children, who are all boys. In addition to her role as a teacher, Isabel is also responsible for school hygiene and the machamba (small farm fields where students cultivate to improve their diet).

Before the training begins, we arrange an exercise to help participants understand the burden of malaria in their lives and communities. They are asked to line up, in ascending order, to represent the number of malaria episodes they have experienced in their life. The teacher Isabel does not stand in line, because, as she explains, she has had so many malaria episodes that she can no longer count them. She takes a deep breath and explains, in her soft voice:

“I’ve had numerous episodes of malaria in my life and it is not possible to account for them all. Every year, I suffer about three episodes of malaria. Even now, my three children are not going to school because of malaria. Malaria is a serious problem. This training is an extremely important event for me as a mother and obviously for other families and communities; after this, when I will be educating the pupils, it will feel like I am helping to make the Men of Tomorrow.”

Isabel is part of a group of teachers who are benefitting from training for malaria prevention and control, enabling them to conduct educational activities in the classroom. In addition to the training, the teachers will receive a kit of educational materials with visual illustrations and texts, to stimulate interactive discussion between teachers and students about malaria, including signs and symptoms, prevention methods, particularly the correct use of mosquito nets.

“This training is a good initiative because learning never ends, and this new knowledge will benefit me, my family and my community as a whole. The activity should cover more schools and children” said Isabel.

The training of teachers is an initiative being carried out by Malaria Consortium and other civil society partners, World Vision (WV) as main recipient; International Relief for Development (IRD); Fundacao para o Desenvolvimento da Comunidade (FDC) and Medicos do Mundo de Portugal. This initiative is under the Malaria Prevention and Control Project, funded by the Global Fund. The project also includes mass campaigns for the distribution of free long-lasting insecticidal nets, the training of community-based organisations on malaria prevention, and the promotion of timely treatment-seeking and community activities to encourage people to use mosquito nets to prevent the disease.

Mozambique: “I serve my country”

Volunteer Health Worker, Arnalda, outside her health post in Inhambane, Mozambique

Dieterio Magul is a Field Officer for Malaria Consortium’s ICCM (integrated community case management) 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, with community health workers, called APEs in Mozambique, trained to diagnose and treat simple forms of the three main childhood diseases: malaria, pneumonia and diarrhoea. Dieterio travelled to Lindela village in Inhambane province, to speak to Arnalda Micas Nhassengo about her experience as an APE working in a rural community.

Arnalda decided early on in her life to dedicate her energies to the well being of the community, despite personal challenges. When she was younger, during the years in which civil war badly affected Mozambique, she became a volunteer health worker.

In 2011, she became an Elementary Multipurpose Agent (APE), or volunteer health worker, through the APE programme. Providing healthcare has always been one of Arnalda’s aims in life. Despite getting older, she remains steady, and full of energy and determination. “Now I am both the husband and wife, because I take care of my children and home, I work in the field and also provide homecare to my community. I am working in a large community which has three villages.”

Being an APE has given her life a new perspective. Every day, Arnalda follows a routine: “I clean my house and go to work in the fields. I feed my family; I have three children. Lately, I have had time to make house calls, which allows me to visit families who do not know how to manage diseases. My role as APE is to use what I learnt in the APE training to inform families how to keep a clean house and how to make latrines which are well covered from above.”

In addition to health promotion for disease prevention, APEs like Arnalda also receive four month training on how to diagnose and treat simple diseases that affect children; malaria, pneumonia and diarrhea. This enables Arnalda to bring health care closer to the home, ensuring access to health care, especially for a community living significant distances away from formal health facilities.

“The training I received has been helpful – it has enhanced my knowledge. Before this I only knew that malaria, tuberculosis and HIV existed. Now I have learned about respiratory diseases. Despite still having difficulties in providing treatment because we don’t have enough medication, we do our best to help people and encourage them to go to the health centre when we cannot provide treatment.”

“I haven’t lost a single child that I have treated for malaria. When a parent brings their child to me, sick and vomiting, or with diarrhoea, I prepare the mixture at that moment and I give it to the child. If I test and confirm that child has malaria, I give the first dose here at my home. Children usually come with a high fever. I have a thermometer to confirm if the temperature is high. If it is, I cool down the child’s body by wrapping the child in a wet cloth. I give the child medication and ask the mother to keep giving the medication until the last day. They then need to come back to tell me if the child is better. Until now, no one has ever told me that a child hasn’t recovered after I treated them. If I transfer the child to a health centre it is because I don’t have the correct and adequate medicine I need to treat that child.”

Arnalda has the necessary skills required to continue working as an APE, as well as motivation and conviction. “I will continue to work as an APE until the end of my life, because I am Mozambican, and I must work for my country.”

Malaria Consortium’s ICCM programme in Mozambique has been supported by the Canadian International Development Agency and the Planet Wheeler Foundation since 2009. Malaria Consortium’s support includes recruitment and training of APEs 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 the implementation of health promotion activities to increase awareness of malaria, pneumonia and diarrhoea management and prevention within the communities.

In addition, through funding from the Bill and 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 expansion of community health worker programs and support these programs to provide access to timely and appropriate treatment for common childhood illnesses worldwide.

Mozambique: A community leader’s perspective on the impact of community health workers

Fenias Angelo Benhane, Project Officer at Malaria Consortium Mozambique, interviews Augusto Edi Guivala, a community leader in Lindela, Inhambane province.

Augusto Edi Guivala, is 70 years old and has been the community leader for Lindela village for over 35 years. Part of his role, having been elected by the community to address their interests, is to support the in the management of a number of health-related challenges, with malaria the most common cause of illness, followed by tuberculosis and diarrhoea.

Key to this support is the community health worker, locally known as an Agente Polivalente Elementar (APE). The APE for Lindela, called Mrs Arnalda, was appointed after the community was contacted by the local health centre. “We were asked to select someone for the role of APE who could live and work here,” explained Augusto. We had a meeting and chose Mrs Arnalda. Her name was sent to the health centre and she was trained.”

Community health programmes have been running for over 30 years in Mozambique with government support. In 2009, revitalisation of the programme was begun by the Ministry of Health. In addition to health promotion and first aid, APEs in Mozambique are now trained to diagnose and treat simple forms of the three main childhood diseases; malaria, pneumonia, diarrhea. Since 2010, Malaria Consortium has been working with the Inhambane provincial health team providing training, equipment, supplies and supervision for community health workers to carry out these new tasks.

“When someone is sick, they go to Mrs Arnalda’s house and if she is able she will treat that person,” said Augusto. “If she is not able to help, she takes that person to the health centre. This is the way she deals with health problems in our community.”

A major concern for the community in Lindela is that the APE does not have a permanent office or space to treat patients. “The community has said that they would like to have a central place where they can meet the APE, rather than Mrs Arnalda always having to go to their homes.”

Despite this, however, the impact of her work is already starting to be felt by the community. “After Mrs Arnalda came back from her training, we noticed a significant improvement in her treatment of community members. Another positive aspect is that she sensitises the community on disease prevention by communicating the importance of the construction of latrines, cleaning hands after using the latrines, and on the use of mosquito nets.”

In Mozambique, malaria is the leading killer of children, with 3,500 dying every day. The achievement of universal coverage of mosquito nets through distribution to households is now a national policy being rolled out across the country. The fight against malaria is changing with APEs at the front line, educating families on the importance of sleeping under mosquito nets and bringing basic health services closer to people’s homes.

Mrs Arnalda’s role as an APE in Lindela has had a positive effect on the community – by shortening the distance patients have to travel for treatment (the nearest health center in Jangamo, is approximately 20km away) and by emphasising the importance of using mosquito nets for protection from malaria, instead of using them in farms, barns or for fishing. Strong links between the APE and the community continue to ensure health problems are identified and dealt with.

Following the creation of a community health committee, the benefits of building and proper use of latrines, sensitisation on health matters and other improvements are beginning to show in the community. According to Augusto: “The number of malaria and diarrhoea cases have reduced. Also money spent on transport is saved and the time lost travelling to hospital now can be used for other activities.”