Community health workers help save children’s lives in remote areas
By Emidio Machiana
Sofala, Mozambique, 7 November 2013 - Geraldo was only 3 months old when his mother fell gravely ill. Living in a remote community in Nhamatanda, Sofala, and with limited physical and financial means, his aged grandmother could only do so much to care for him, and Geraldo soon became thinner and weaker.
His stepmother Helena Raul finally took pity on him, and when Geraldo’s mother passed away when he was 1, she took him in and decided to look for help. Helena lived in poverty and had 6 children of her own to feed, so the decision was not an easy one. The family have no running water or electricity, and live from hand to mouth off of their often dried up farm.
“It was a miracle that he was still alive when I brought him home,” says Helena. “He was in very bad shape. We couldn’t understand what was wrong with him and even took him to the traditional healer several times, with no results.”
Fortunately one day, on one of his first visits to the village as a community health worker, Samuel Cebola found Geraldo lying on a matt, weak and despondent. He quickly examined the child and, realizing he was critically malnourished, Samuel made sure Geraldo was immediately sent to hospital for emergency treatment. The boy was enrolled in a nutritional programme, which lasted three months and ultimately saved his young life.
“We are thankful to Mr. Cebola,” says Helena. “Geraldo is now healthy, walking and playing as you can see.”
Restoring Geraldo’s health meant feeding him with Plumpy'nut, a fortified food supplement used to treat severe acute malnutrition, and teaching his stepmother to prepare nutritious food at home for Geraldo and the rest of the children in the family. Samuel Cebola has been monitoring the progress closely to make sure the family sticks to the regimen.
Like other community health workers, called agentes polivalentes elementares in Mozambique or APE for short, Samuel Cebola was chosen by his own community to train as an APE. From his vantage point from inside the community he serves, Samuel and other APEs like himself are effective in monitoring their fellow community members’ health. At first, his home visits were not welcome by neighbours and families. But soon doubts began to dissipate.
“My first days as an APE were difficult,” he recalls. “People were not comfortable letting me into their homes to examine them. They felt it was intrusive and didn’t believe I had the necessary skills to treat them. But when they started noticing that their children’s lives were being saved by my prompt interventions, their view changed radically. They are now calling me and anxiously want me to bring health care to their families, particular those living far away from the health centre.”
The training given to community health workers equips them with the ability to diagnose and treat the most common and dangerous childhood diseases such as malaria, pneumonia and diarrhoea. APEs provide health education in their communities and promote behaviour change in areas related to family planning, pregnancy, disease prevention, childhood health and development, and hygiene.
“In the Mozambican context, investing in community health workers is a clear, winning strategy to immediately increase access to basic health services in the country,” says Emanuele Capobianco, Chief of Health and Nutrition at UNICEF Mozambique, in a country where the doctor to patient ratio is very low at 3.95 doctors per 100.000 people.
Launched in eight districts in 2011, the programme trained and deployed 1,215 APEs in 51 districts in the first two years, with an additional 1,580 certified by the Ministry of Health (MISAU) and deployed in early 2013. By mid-2014 a total of 3,450 will be trained and working in 140 of the 148 districts of Mozambique. Data available through the Ministry show that between May 2012 and March 2013 only, APEs performed more than 850,000 home visits diagnosing and treating more than 225,000 cases of malaria, diarrhoea, and pneumonia, all leading killers of children under 5 in Mozambique. Community health workers are vital frontliners in the battle against child mortality.
“I am very glad that I have received this training. I have the appropriate skills to assist my community and save our children’s lives, particularly of those living in remote areas”, says Samuel Cebola, with more than a little pride in his voice.