“People don’t want to suffer,” says Emile Namsemon N’Koa, national director for ChildFund Senegal. “When they learn from their friends, it is more sustainable.”
That nugget of wisdom is the cornerstone of ChildFund’s approach to promoting community health in Senegal, where we’ve worked since 1985. Now, with a recent grant of $40 million — the largest we’ve ever received — from the United States Agency for International Development (USAID), we are poised to expand our work to provide access to health care throughout the country.
Senegal’s formal health system consists of several hundred doctors for the whole country, most of them based in the capital city, and a loose network of health posts that are as far as 20 miles from the nearest village. Health care is thus inaccessible for most rural communities. In a country where 54 percent of people live in poverty, this means that preventable illnesses and deaths are all too frequent, especially among the most vulnerable: children.
To try and bridge this gap in care, various international development organizations built health huts, which are small, community-based facilities designed to provide basic health care. After a while, though, many of those health huts were understaffed, underutilized or even closed.
Although Senegal’s government understood the importance of community-based health initiatives, it could not justify putting its limited resources into supporting health huts, with their disparate array of services and organizational philosophies. Community health remained disconnected from Senegal’s health network.
But things began changing in 1998, when ChildFund started refurbishing health huts with funding from a small child survival grant from USAID. The work grew over the next decade. Then, in 2006, USAID funded a five-year cooperative agreement with a consortium of six international organizations led by ChildFund. Its goal would be to strengthen primary health care at the community level. Existing health huts would be central to what would be called the Community Health Program.
Another piece of wisdom central to ChildFund’s work: To accomplish big things, build on what’s already in place.
In addition to ChildFund, the partners in the 2006-2011 project initially included Africare, Plan International and World Vision, joined in 2008 by Catholic Relief Services and Counterpart International. Right away, ChildFund led the partners in standardizing the services offered in their health huts, targeting maternal and neonatal child health, care for diarrhea and respiratory infections, malaria prevention and treatment, HIV/AIDS prevention and more.
“We developed strategies and standardized tools that all the partners used,” says Mamadou Diagne, ChildFund Senegal’s national health coordinator.
And, soon after, the unified effort began to pay off. The impact of harmonizing the services across all health huts in the five areas the project covered was to lessen the overall incidence of disease, according to Diagne: “From 2006 to 2011, there was a very noticeable impact within a small geographic area.”
By the end of the five-year term, the five regions the consortium served would expand to 13, and USAID’s initial $13 million in funding would double.
And it was the community members themselves who carried out the work through the network of health huts, which were supervised by the Ministry of Health’s health post staff. ChildFund and other consortium members trained community health workers, traditional birth attendants and outreach workers — all of them volunteers — in basic health care and healthy practices. These volunteers in turn spread their knowledge throughout their communities.
The goal has always been that communities ultimately take ownership of the health huts, and in five years the Community Health Program will have transferred the facilities to community management. Villagers will pay nominal fees for care, and those fees keep the health huts running. Another very important goal is for the Ministry of Health to adopt community health as an integral part of the national health system rather than an appendage of it.
Now, with the new 2011-2016 USAID grant, ChildFund is on track to build on and expand this work throughout Senegal. This time around, the consortium includes all the original organizations except for Counterpart International and adds two Senegalese partners. The partners will establish 2,151 health huts and 1,717 outreach sites nationwide, not only in rural areas but also in underserved urban areas. The project will also add a focus on neglected tropical diseases and educate communities about the health dangers inherent in the cultural practice of female genital cutting.
The community-level health huts will be linked to the national health system by way of the district and regional medical teams. The communities themselves will own the management of the health huts.
And more than 9 million people in Senegal will have access to primary health care.