Jammeh Sillah, a state-employed midwife with paediatric training, served in virtually every area of the Gambia over 18 years. He thought he’d seen it all until four years ago, when he came to the village of Kwinella. The situation Sillah faced was dire. There was no available medicine for children under five, he says. “Parents would come with the baby, and we had nothing to give them, except to tell them that the child was sick.”

Today, Sillah has supplies, medicine and more support as head of the Kwinella health centre, because the village is an implementation site for the Accelerated Child Survival and Development (ACSD) strategy, an integrated approach to saving children’s lives that encompasses 97 high-mortality districts in 11 West and Central African countries. ACSD, under way since 2002, is one way governments are trying to reduce under-five mortality and improve maternal health by the year 2015.

In the Gambia, by the end of 2005 the project was covering 787 villages – including Kwinella – in two districts. To date, about 300,000 people have been reached. In Sillah’s opinion, the effort is already saving young lives and laying a foundation for sustainable development.

An integrated approach to child survival

In Kwinella, more than 200 women receive antenatal care each month. The programme also registers newborns, encourages exclusive breastfeeding and manages childhood illnesses.

The ACSD package includes immunizing children and pregnant women, delivering life-saving micronutrients and supplying oral rehydration salts for diarrhoea. The vaccination programme has now surpassed the targeted 80 per cent coverage rate. Such an integrated approach helps children enter the world healthy – and stay healthy.

The project also works to protect young children and pregnant women from malaria. Village support groups promote a cleaner environment and ensure the use of insecticide-treated nets supplied by UNICEF. A mother’s club, organized through the local UNICEF-assisted girl-friendly school, spearheads environmental cleaning days, when rubbish is disposed of and the potholes that are breeding grounds for mosquitoes are covered.

“The women in this community understand the importance of reducing the risk of malaria-carrying mosquitoes” Sillah says. “They have meetings and sometimes they even come up with songs on how to fight malaria.”

Hope in the rainy season

As a result of this integrated approach, child-survival objectives are not only being met, but also being felt in the most remote parts of the country.

For the moment, Jammeh Sillah focuses on the immediate needs of the community. “We need the insecticide - treated nets now, before the rains begin,” he says, awaiting fresh supplies from UNICEF.

The veteran midwife has had plenty of experience with the rainy season, a time when many children suffer from malaria. It is also the season of hunger and tremendous hardship. This time, “I will protect all these children,” he says confidently. “I have the medicines, and with a few more insecticide-treated nets, we’ll be all right.”

Note: Some country-specific information was provided by UNICEF country offices or drawn from UNICEF country office annual reports.

Reduce child mortality and improve maternal health(MDG 4, 5)

Saving lives in the Gambia

An integrated approach to child survival

Hope in the rainy season

Reduce child mortality and improve maternal health
(MDG 4, 5)