The Republic of South Sudan has one of the highest under‐five mortality rates in sub-Saharan Africa: 96 per 1,000 live births in 2017. Preventable illnesses such as pneumonia, malaria and diarrhoea are the leading causes of morbidity and mortality. In half of all deaths, malnutrition is an underlying cause.
Since 2017, Malaria Consortium has been working with the Ministry of Health, local authorities and health departments to trial and roll out the government’s community-based primary healthcare strategy: the Boma Health Initiative.
Community health workers (CHWs) were selected by their communities to form Boma Health Teams. They were then trained by the Ministry of Health to diagnose and treat uncomplicated cases of diarrhoea, pneumonia and malaria in children under five at the boma (village) level, as well as refer malnourished children to health facilities, provide maternal and newborn care, advise on birth spacing and deliver basic first aid.
During the trial, it became clear that low levels of numeracy and literacy unfortunately rendered many women ineligible for recruitment. In addition, some female CHWs were unable to attend training because the transport, food and accommodation allowances did not cover the costs for bringing their children. Female trainees who did manage to attend with their newborns missed parts of the training while breastfeeding, which affected their knowledge and skills.
As a result, only one third of those trained to be part of a Boma Health Team were women. This gender skew was particularly problematic given that male CHWs felt uncomfortable discussing certain issues — such as care during pregnancy — with female community members. This likely lowered the quality of care and advice.
It is essential that the Ministry of Health addresses these gender constraints before scaling up the initiative and makes provisions for women to attend training with their children. We recommend that the Ministry should also partner with the Ministry of Education and education-focused development and humanitarian actors to improve women’s education.
To find out more about how Malaria Consortium is supporting the Ministry of Health’s implementation of the Boma Health Initiative, take a look at our recent learning brief.