The Message of Health in Senegal

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By Christine Ennulat, Staff Writer
Posted on 4/15/2016
Omar and his daughter Djina, 9 months.

Omar and his daughter Djina, 9 months.

Oumy, a mother of six in rural Senegal, rests easier these days because she can now stay ahead of her children’s health. Four years ago, a child’s illness could be terrifying.

Back then, if it wasn’t one thing, it was another: The baby might have diarrhea while the 3-year-old spiked a fever. The district-level government health post, nearly two miles away, might as well have been the moon when Oumy imagined making the trek with baby Thiawdo tied onto her back and feverish Babacar in her arms. With her husband away seeking work, Oumy would have to leave the other children in the care of 11-year-old Mohammed, the eldest.

Easier to stay home and hope for the best, to hope that Babacar wouldn’t go into convulsions like his sister had once before.

Oumy is happy to have left such experiences behind ever since the volunteer-run community health hut became active in her village.

Part of the nationwide Community Health component of USAID’s current Health Program (PSSC), Oumy’s health hut is one of  2,553 like it and 1,674 outreach sites (for areas where there are no health huts) throughout Senegal’s 14 regions. These health huts and outreach sites link more than 9 million people — 70 percent of the country’s population, especially those in the most remote areas — to Senegal’s health system. Staffed by about 17,000 trained community health workers (CHWs) nationwide, these locally based efforts are possible through a five-year, $40 million cooperative agreement from USAID that started in 2011.

With this support, ChildFund International leads a consortium that includes partners like Plan International, Catholic Relief Services, Africare, World Vision and two Senegalese organizations, Enda Graf Sahel and Enda Sante to carry out the project. ChildFund and the team of the USAID Community Health component collaborated with Senegal’s government to develop its National Community Health Strategy, which formalized the inclusion of health huts as part of the nationwide health system, and is now working with the Ministry of Health to implement that plan.

Now, Oumy says, “Whenever the children are sick, I don’t delay. I’ve learned to detect symptoms of things like malaria. When a child has a fever, I take him straight to the health hut.”

Aissatou and her five children under the tree in their yard.

Aissatou and her five children under the tree in their yard.

One of many benefits of functioning health huts is that community members seek care earlier than before, giving them a greater chance of surviving illness and injury, as well as preventing other ailments.

Like all of the project’s health huts nationwide, the one in Oumy’s community offers much more than basic pediatric care and management of common illnesses like malaria, diarrhea and pneumonia. The CHWs are also versed in maternal and newborn health, including prevention of postpartum hemorrhage; birth spacing; and nutrition monitoring for ages 0-2 and up to age 5. They know the danger signs that require referring cases to the government health post for professional care. Nurses from the health posts also visit the communities monthly to provide immunizations, basic treatments and educational outreach.

The complementary work of other types of health volunteers further improves community health. Trained traditional birth attendants, known as matrones, work with pregnant women to provide prenatal care and promote safe delivery, whenever possible in a professional setting rather than at home. Additional community volunteers known as relais carry the messages of the health hut to their neighbors, teaching them how to protect themselves from disease and identify symptoms when they arise.

“This is how we help our community,” says Rama, a CHW in Mbour, on Senegal’s coast. “We raise their awareness about the diseases, the danger signs and the signs of illnesses so that they can seek care early for their children. We provide counseling and conduct awareness-raising sessions and home visits to educate communities. As a result, they seek care early. With the health hut, children no longer die at home for lack of care. Women no longer give birth at home. Diarrhea, acute respiratory illness and malaria have decreased.”

In each village, a CHW also works with a complement of grandmothers known as bajenu gox (“paternal aunt of the community”), older women who leverage their leadership role to provide special support and wisdom to young mothers, promoting healthy practices and prevention techniques much as relais do. One of the grandmothers, Maimouna, remembers a case from before the health hut opened — a woman who hid her out-of-wedlock pregnancy and did not seek prenatal care. Without any support, she died from complications. “But since the health hut was created in the village,” says Maimouna, “we know how to prevent these cases. We carry out home visits, we educate people, and we advise them about the services that are available to them.”

Preventing cases like this one, however, is about much more than understanding health and services: The grandmothers have also served to help nurture a level of trust in the CHWs and other volunteers associated with the health hut. People know that they can rely on them, Maimouna says. “They can come talk to them and depend on confidentiality.”

Oumy and her six children at home.

Oumy and her six children at home.

Even men, who in rural Senegal traditionally consider the issue of family health to be a women’s concern, have been encouraging their families to make use of the health hut’s services. When Omar, a father of five, kept hearing from other men in his community about their families’ improved health thanks to the health hut, he took notice. He had been worried for some time about his wife, who had experienced postpartum hemorrhage with every delivery, including two sets of twins who died, and he finally brought her in for care. Now, with basic care and information, Omar’s family is healthier and more stable.

A recent independent evaluation of the overall project found that USAID/PSSC has significantly strengthened access to health care in underserved communities throughout Senegal. In turn, government health posts’ loads have been lightened. Senegal’s nationwide health system is working better overall.

Now the project’s central focus is transferring the ownership of health huts to their communities, and 733 health huts are already operating independently, quickly approaching the 2016 goal of 762. The challenge now is to help health huts and their constellations of volunteers continue building their skills, resources and, thus, sustainability.

The health hut Oumy uses was turned over to her community in December 2014. The village’s imam says, “This village was created in 1947, and since then, no government authority has come to this village — except for the day of the inauguration of the health hut.”

He states his gratitude for all of USAID/PSSC’s support and then makes a request on behalf of Daba, the volunteer who runs his village’s health hut: “More training,” he says. “If you support her, you are supporting the whole community.”