Category: Nigeria

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.

Empowering communities

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 Muhammed, 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.

Kabir Lawal, Market Support Officer under the Support to the National Malaria Programme (SuNMaP) project in Nigeria, interviews Sanni Garba, laboratory technician, in the rural community of Gauraka.

Sanni Garba is a healthcare professional in northern Nigeria. Today he is at the forefront of efforts to bring standardised malaria diagnostics to the people of Gauraka, a local community in which he grew up.

Garba is a laboratory technician at the government’s Gauraka Model Primary Health Centre in Tafa Local Government Area, Niger State. Garba has been working at the health centre for around six months.

Stepping into his small laboratory within the complex, he carefully slips his white latex gloves on to both hands as he prepares to demonstrate a rapid diagnostic test (RDT) for malaria. In the laboratory, he also carries out other tests, including those for typhoid fever and urinalysis.

On a typical day at work, Garba says with respect to RDT testing: “Sometimes, we have three, sometimes we have four, and sometimes we have none.” When asked the reason for the low patient numbers, he responded: “Patients prefer to go to Wuse in the Federal Capital Territory, Abuja or Suleja, a neighbouring town, which possess more equipped and larger hospitals.” But it is also true that through the work of SuNMaP, rural health workers and community care givers are helping to keep down the number of people coming to the health centre with malaria by diagnosing and treating fever in the community, talking about malaria prevention and the importance of mosquito nets, and through the provision of nets through mass distributions and ante-natal clinics.

Garba carefully tears the flexi-pack of the test kit and lays the kit on his work table. He then takes blood from a blood specimen bottle and places a few drops on a rectangular window in the test cassette. When testing an actual patient, he would be required to prick the fourth finger (counting from the thumb) and then collect a very minute sample of blood which he would then drop onto to the cassette.

After this, he adds a few drops of the buffer solution before waiting 15 minutes wait for the test results to emerge. At the Gauraka Model Primary Health Centre, RDTs are not given out for free but are sold for 200 Nigerian naira (US$1.25).

Garba’s role at the health centre has greatly reduced the chances of malaria misdiagnosis. He has also gained a lot of experience in rapid diagnostic testing. He takes a short glance at the RDT kit that had lain undisturbed on his work table, then says with a smile: “Practice makes perfect.” He then holds up the cassette to display the result and gives a short interpretation of the reading.

Proper diagnosis of malaria is an important step in the prevention of resistance to anti-malarial drugs. Professionals such as Garba are working to support better case management of malaria in communities across Nigeria.

SuNMaP (Support to National Malaria Programme ) provides support to the Nigerian government and people in tackling the massive burden of malaria in the country. It is implemented by international and local partners, funded by UKAid and managed by Malaria Consortium. SuNMaP works in close co-operation with Nigeria’s National Malaria Control Programme (NMCP), in selected states and Local Government Areas (LGAs), including Anambra, Kano, Lagos states, Niger, Katsina and Ogun states. Work began in a further four states in 2012.

These positive changes have been facilitated by Support to National Malaria Programme (SuNMaP) and other donors in collaboration with the State Malaria Control Programme (SMCP). In addition to bed nets and drugs for malaria treatment, SuNMaP has provided training to senior management staff at the Local Government Authority (LGA) level, which has been cascaded down through the LGA to staff, like Garba, in health facilities across Nigeria.

Malaria Consortium’s Senior Technical Malaria Officer, Osita Okonkwo, interviews Fatima Abdulwahab from Wuse District, near Abuja, to hear her views on using mosquito nets.

The true value of long-lasting insecticidal nets (LLINs) can only be understood through the invaluable accounts of consistent users in rural communities, such as Fatima.

Fatima Abdulwahab is a 27 year old mother of three children whom she describes as her ‘precious gifts’. Her husband, Musa, is a factory worker, who earns barely enough to sustain the family. Fatima herself has no formal education and looks after her family. Musa and Fatima previously lived for many years in the northern Nigerian city of Kano. Four years ago Fatima relocated with her children to Wuse District, northwest Abuja, to live with her husband’s parents, although Musa still lives and works in Kano.

Fatima’s only sickness since childhood had been malaria, caused by bites from infected mosquitoes. She was hospitalised several times during her first pregnancy and treated for malaria, during which time she almost lost her life. She recalls how one of her husband’s sisters, a mother of five young children, died of malaria during pregnancy a few years back. Her death, she said, was a turning point in the lives of the family and prompted her husband and some other family members to save money to procure mosquito nets. Although the nets were of low quality, they worked and helped to reduce cases of malaria in the family.

In 2010, Fatima’s nearest health centre in Wuse started free distribution of LLINs for pregnant women. Fatima was among one of the first groups of pregnant women to receive nets from the facility. She said that now she and her children all sleep under mosquito nets, they no longer have malaria. Fatima also made sure that all the pregnant women she knew in her village visited the health centre to receive free nets as well.

“Since we started using the nets, my children and I don’t get malaria again. The net is very, very good; it is saving our lives. We sleep under the nets day and night. I cannot sleep without my net. Even when the weather is hot, I must sleep under the net.”

Fatima’s story echoes that of several other women whose lives have been changed by the use of LLINs. All can talk about the benefits of being able to receive and use nets. Their stories demonstrate what can be achieved through sustained net distributions to poor households in rural communities.

SuNMaP (Support to National Malaria Programme ) provides support to the Nigerian government and people in tackling the massive burden of malaria in the country. It is implemented by international and local partners, funded by UKAid and managed by Malaria Consortium.

SuNMaP works in close co-operation with Nigeria’s National Malaria Control Programme (NMCP), in selected states and Local Government Areas (LGAs), including Anambra, Kano, Lagos, Niger, Katsina and Ogun states. Work began in a further four states in 2012.

Following mass distribution campaigns in programme supported states, SuNMaP has successfully distributed about 1,349,356 LLINs through non‐commercial continuous distribution channels. Pregnant women are provided with LLINs during their booking visits as part of the focused antenatal care (ANC) and infants presenting at routine immunization clinics are given LLINs, usually linked to measles immunization or child health weeks. The programme is supporting the state malaria control programme to expand LLIN distribution to more eligible facilities while exploring other viable channels of distribution such as schools and community directed distributors, drawing from lessons gathered from the national RBM partnership.