Tanzania, United Republic of

Real lives

When small investments reap exponential improvements in children's lives

© UNICEF/2003/Accone

Rehema Mbaruku, 4, stands in front of the bed draped with an insecticide-treated mosquito net she shares with her grandmother, Aisha Salos, 51.

MSANGANI VILLAGE – The Omari family’s store in Msangani Village in the district of Kibaha in east central Tanzania is a hub of village activity. Not only is it the place where villagers buy their staples, but the shady tree in front is the site of meetings of the village elders and the place where Msangani’s children and women gather once every three months for Child Health Days.

Asha Salum is married to village elder, Omari Athman. They have four grown children. Nurdin Omari, their youngest son, runs the store which is located in the front portion of his parent’s house.

Mrs. Salum takes care of two of her grandchildren, Asha Athman, 3, and Rehema Mbaruku, 4. The impact of UNICEF’s efforts in partnership with the government of Tanzania is evident every day to Mrs. Salum.

“There is great difference in the care,” she says. “My one son used to get fever so frequently that the healthworkers said he had chronic malaria.”

Great gains over a generation

Rehema and Mbaruku have managed to avoid the growth- and development-halting effects of anaemia caused by malaria because they sleep under an insecticide-treated bednet with their grandmother every night. Widespread use of treated nets has been shown to reduce deaths from malaria by about one quarter.

But most families can’t afford the $3.00 it costs for a bednet, so UNICEF and the government of Tanzania is implementing a subsidized system where all pregnant women receive a $2.50 voucher towards the purchase of a bednet and sachet of insecticide.

Malaria kills a child somewhere in the world every 30 seconds and 90 per cent of those who die are in Africa, where malaria accounts for about one in five of all childhood deaths. Yet the cost of saving a life by providing a bednet is equivalent to that of a hamburger in North America or Europe.

Diarrhoea remains a significant child killer. About one in every 200 children who contract diarrhoea will die from it. “All my children would often have diarrhoea,” says Mrs. Salum. “But with [my grandchildren] it is different. We have learnt new ways and they are hardly sick compared to my own children when they were young.”

These new ways include boiling drinking water, the family’s pristine latrine and teaching the children to wash their hands and food before eating. (Although, as Mrs. Salum explains, diarrhoea is still a problem in mango season when the young children can’t resist picking up the ripe fuits that have dropped off the trees and consuming them on the spot!)

These are just two tangible ways in which the lives of Msangani’s children have been exponentially improved by small investments. But the secret of success is the way that all these different elements – from malaria prevention to breastfeeding to immunization and early childhood care – are being delivered to children and women in an integrated and cost effective way: Child Health Days.

In earlier years, different teams ranging from immunizers to health workers and water and sanitation educators would visit different villages on different days. Today, the children and women in of a specific village gather on well-advertised Child Health Days to receive an integrated package of services.

© UNICEF/2003/Accone

Public health nurse, Loveless Mbaga, hands Asun Abadala an expectant mother who is 8.5 months pregnant, her bednet at the Kibaha District clinic.

Integration: secret to success

“A typical Child Health Day is set up as a series of stations that children and women move through,” explains Dr. Suleiman Kimata, UNICEF Tanzania’s project officer for health and nutrition. “This approach is much more time- and cost-effective for the community and for the health workers. Everyone gathers at one point on one day and the community develops a clear and comprehensive picture of how these separate issues come together to ensure a child’s best start in life.”

The stations consist of areas with tables, records and the equipment needed for each task that is being conducted at that specific station. Newborns are registered in the village register and in the follow-up forms at the first station, gaining an officially recognized identity and ensuring that they are able to access their basic rights to services such as healthcare, immunization and schooling.
Children are weighed and measured at the next station, so their growth and health can be monitored. Here healthworkers are able to offer mothers advice on breastfeeding and the preparation and feeding of complementary foods to ensure the optimum health of their children.
Next is routine immunization against seven childhood killer diseases – polio, diphtheria, tuberculosis, pertussis (whooping cough), measles, tetanus and Hepatitis B. In addition, children receive a dose of Vitamin A, which increases their resistance to disease and improves their chances for survival, growth and development.
One-on-one counselling with mother and child follows. Here healthworkers are able to advise mothers on specific areas of concern relevant to their child and family situation. Any issues that have been brought to light in earlier stations can be addressed, such as ways to ensure young children receive adequate stimulation.
The last stop is the treatment bank where any specific illnesses can be treated and necessary medication dispensed.

Once all the mothers and children have been through the various stations, they gather together for a demonstration. The Omaris, like other families in Msangani, learnt how to re-treat the bednets every year and about other ways of preventing malaria infection at a Child Health Day demonstration. Healthworkers cover a wide range of topics such as how to prepare nutritious foods from traditional ingredients; explaining the construction of latrines; good sanitation and hygiene practices; and the home treatment of sick children.

“This way saves us time and money, in aspects like training, transport, working with the children’s caretakers and being able to deliver a number of things to them at once,” says Dr. Mariam Ongara, Kibaha District Medical Officer, testifying to the benefit of leveraging this comprehensive approach.

Dr. Kimata agrees, adding, “It gives us maximum impact if you take a whole package to a child. All these things are needed to give full impact for a child. These are all essential, not just one, for the whole wellbeing of a child.”

Tanzania is a leading example of the benefits and effectiveness of this integrated approach and that integration is evident on the shelves of the Omari’s modest store. Along with essentials like rice and sugar, families can purchase iodized salt and mosquito net treatment packs.

NOTE: all costs in US dollars unless otherwise specified.