Originally published on Medium
Lessons from the field
In the village of Njediko in Nigeria, Kadigiti Mohammad gently calms her young son, who has a high fever. Her son is being seen by the village community health worker, who confirms it is malaria. He is given medicine before mother and child are sent back home.
I met Kadigiti on a recent visit to Njediko where Malaria Consortium is supporting the Rapid Access Expansion (RAcE) programme in Nigeria. She was worried for her child, but assured that he would recover because he was able to get medication quickly.
It was during this visit when I saw what receiving immediate access to care meant for mothers like Kadigiti and how this transformed the communities they live in.
Reaching the most remote populations
The RAcE programme was launched in Nigeria in 2013, pioneering the implementation of integrated community case management (iCCM) in the country. iCCM is now being scaled-up to increase healthcare access through trained community health workers who can treat pneumonia, diarrhoea, malaria and malnutrition among children at community level.
In Niger State, Malaria Consortium is implementing iCCM in underserved communities in six local government areas. The two communities that I visited, Njediko and Etsu Gudu, were among some of the hardest-to-reach.
The journey into these communities involved a two hour drive from the capital of Niger State. The roads were mostly rough and occasionally blocked by small rivers. Another hour travelling along narrow dirt roads led into the communities. Come nightfall, the roads were pitch black.
I thought of Kadigiti having to carry her sick child in these conditions. It was clear that urgent action was needed to reach out to populations who cannot easily access a health centre.
Bringing healthcare closer to the home
Typically, in many remote communities in rural Nigeria, access to healthcare is made difficult as there are no nearby health centres.
Mothers would carry their sick child, often on foot, to the closest health centre which can be miles away and can sometimes take days. During the rainy months, the roads and footpaths can become impassable. Sometimes, upon reaching the health centre, medicines may not be readily available.
One mother who lost a child from malaria said, “if we had immediate access to care and medicine then, my child could have had a chance to survive”.
Such was the challenge mothers faced in Njediko and Etsu Gudu until iCCM was introduced. Today, mothers like Kadigiti no longer need to travel far. Instead, they can immediately take their sick child to a community health worker.
This means that unnecessary deaths are prevented, as children can be treated for pneumonia, diarrhoea and malaria right in their village.
Community health workers are trained, supervised and equipped to provide free and timely treatment of malaria, pneumonia and diarrhoea. And because they are selected by their own community and live in the community they serve, they have become a valuable resource in remote and rural villages that otherwise have no means of accessing healthcare.
The community health workers I met were hardworking, proud of what they do, and deeply committed to the health of their people.
In Ndejiku and Etsu Gudu, village leaders and parents talked about how their community health workers helped improve the health of their children and how they no longer face the burden of the cost of healthcare and making the long journey to a hospital.
Across the community, this appreciation is shown in extraordinary ways.
“When I am treating children all day, the people bring me firewood and help me with the farming,” says Miriam, community health worker in Etsu Gudu.
“The community raised money collectively to build me a house, so I can continue doing my work,” says Muhammad, the community health worker in Njediko.
An effective and sustainable solution
In Niger state, results from the RAcE programme show that iCCM is an effective and sustainable approach to decreasing childhood mortality.* At community-level, one way for iCCM to become sustainable is community support for community health workers.
In Njediko and Etsu Gudu, I saw evidence of all these. I saw progress in reduced child deaths, as a result of access to life-saving health services in rural and remote areas.
But I also saw people owning their own health, community leaders advocating for the health of their people, and communities coming together to sustain the health services they now have.
Portia Reyes is Publications Manager at Malaria Consortium. She recently visited communities in Niger state as part of a project to document the impact of iCCM. Malaria Consortium is working with the Ministry of Health and partners in Niger state to implement iCCM through the RAcE programme.
The Rapid Access Expansion (RAcE) programme is funded by the Government of Canada through the World Health Organization to support the scale-up of iCCM in five malaria-endemic countries in sub-Saharan Africa.