Mozambique still faces major challenges in reducing maternal and child morbidity and mortality, despite making significant progress over the past decade. Because so many children live beyond the periphery of the health system, primarily in rural settings, there is a need to bring services closer to communities.
The Mozambique Ministry of Health embarked in 2010 on an ambitious programme to revitalise the community health workers (CHWs) programme, with a goal to train and deploy approximately 5,000 new CHWs over the course of five years. CHWs are trained to provide diagnostic and treatment of malaria, pneumonia and diarrhoea for children less than five years old. They also provide first aid to their community members, act as a link to the health services and conduct health promotion activities.
This strategy aims at bridging the access gap and reducing care seeking delays by bringing life-saving services closer to children’s homes. Malaria Consortium has been supporting this effort in Mozambique since its inception, providing technical as well as implementation support in Inhambane province.
Despite the training and deployment of CHWs across the province, the majority of sick children living in CHW catchment areas are still not taken to a CHW for early treatment. Only providing treatment in communities through CHWs may not automatically lead to more timely care seeking, as decisions taken in the home depend on other factors, including caretaker awareness of illness symptoms and perceptions of appropriate treatment.
Malaria Consortium undertook an operational research to better understand the most detrimental bottlenecks in the CHW programme. This study entails interviewing families who have lost a child through illness while living in an area served by a CHW, to collect their stories and understand why some children fall off the “pathway to survival”.
The findings will help us understand whether the delays take place in the home, on route or at the provider, and we will be able to identify the opportunities for intervention and formulate recommendations that will enable policy review and revision and guide decision-making.