Bringing medication to the door step
By Felix Malamula
Mzimba, March 22, 2011: It is 5:30pm and darkness is starting to set in but Bydon Mughogho is not bothered. He continues to work, attending to one sick child after another.
A child comes in with fever and Mughogho, a Health Surveillance Assistant (HSAs) at Thoza Village Clinic in Mzimba district, checks his breathing, temperature and other vital signs.
In Malawi, one in every 13 children dies before their first birthday and one in seven will not make it past their fifth. These children die mostly at home from diseases that, like malaria, are both preventable and curable. Other main child killers are neonatal diseases, diarrhoea, and pneumonia. Half of all child deaths are nutrition related.
These tragedies could be prevented simply and cheaply by people like Mughogho, who is not a doctor, but part of a cadre of 12,000 health extension workers commonly known as HSAs. They undergo 11 weeks of training in the integrated management of childhood illnesses (IMCI), which emphasises treating the child in a holistic way and not just focusing on the illness. Thus the home - where most children die - is a key place to start. Their brief is to take primary health care as close to communities as possible through village clinics.
“We receive patients any time. Even if it is midnight, I wake up to assist the child,” he says. “The idea is to encourage parents to rush their children to the clinic anytime they detect trouble.”
It takes Mughogho approximately fifteen minutes to attend to a child. As the women keep streaming in, Mughogho knows it will be dark before the last child walks out of his clinic.
“I am not worried. I love my job. I am always happy to see children getting better with my assistance,” he says.
Apart from reducing the distances people travel to access health care, village clinics have introduced a degree of efficiency in service delivery. Where people queue up for long hours at health centres because of limited personnel, the same cannot be said of village clinics where the waiting time is relatively shorter. Some HSAs conduct clinics from their homes, making it easier for patients to be attended to at any time of the day or night.
Being a predominantly hilly district, Mzimba has some of the hardest-to-reach areas in Malawi, making village clinics a welcome necessity. Bosco Sinkhonde, a clinical officer responsible for integrated management of childhood illnesses at Mzimba District Hospital, says there is still a need for more village clinics to be established.
“I am pushing for that. We need more clinics since we have so many hard-to-reach areas. If we could reach out to all those areas with such facilities, I think the survival of our children would be guaranteed.
“The impact of village clinics is amazing. The demand for these facilities is just too big for us and we need assistance. Women want their children assisted within walking distances,” he added.
UNICEF provides financial support for the training of HSAs in community case management and supplies essential drugs for the treatment of common childhood illnesses like malaria, pneumonia, coughs, and diarrhea, among others.