Community health posts: oases of health care in a desert land
In Niger today, more than half of the population lives at least five kilometres away from any kind of health facility. Providing essential primary health care in more remote communities and to the millions of children living across this vast and arid country is a challenge. To address these important needs, the Government of Niger, with support from UNICEF and partners, is setting up community health posts in underserved areas, aiming to bring high-impact curative and preventive health packages to children during their most vulnerable years.
“Now I can make sure my children are cared for quickly”
The small village of Dama in the Madarounfa District of southern Niger was among the first communities in the country to experience the benefits of such a community health post. Until recently, many people in the village ventured outside their homes only for very urgent health needs. Distance was the main barrier to health-care access. Today, Roukaya Bara and her six-month-old baby girl, Rouzeina, are on their way home from the Dama community health post. Bara gives voice to the positive impact that the health post has had on the survival of young children. “During the night, my daughter was ill. She had diarrhoea and did not breastfeed for two days. I was very worried, because she started to be listless and completely dehydrated. But, look at her now. This morning I took her to the health post, and they gave her an oral rehydration solution that brought her back to life. Just four years ago, I had to walk more than two hours to reach the nearest health centre. I would only go as a last resort. Now I can make sure my children are cared for quickly.”
Two key health packages
According to Dr. Noël Zagré, Nutrition Chief at UNICEF Niger, pneumonia, diarrhoea and malaria are responsible for almost 60 per cent of children’s deaths in Niger. Malnutrition, poor hygiene and limited access to safe water and sanitation all contribute to these deadly yet preventable diseases. “When malnourished children are not treated against malnutrition, they are at a very high risk of death, especially when they have diarrhoea or, say, a respiratory infection,” Dr. Zagré explains.
Addressing undernutrition, while also providing effective treatment and preventive care against these three major diseases, significantly reduces child mortality. In the absence of adequate facility-based care, community health posts and other outreach efforts step in to provide those vital services. Not only do health posts supply antibiotics, oral rehydration salts and other elements of a basic health-care package, but they also offer preventive care such as micronutrient supplementation, children’s growth monitoring and insecticide-treated mosquito nets. Further, community health workers stationed at these posts impart critical information on healthy practices including improved breastfeeding, the adoption of safe hygiene practices and childcare counseling.
These packages are provided under the umbrella of two major integrated child health strategies: Accelerated Child Survival and Development (ACSD) and the Integrated Management of Childhood Illness (IMCI).
In 2004, the ACSD programme covered more than 16 million people in selected districts in 11 countries in West and Central Africa that have high under-five mortality rates, including Niger. Its main components are an expanded programme on immunization, prevention and case management of the main childhood killer diseases and antenatal care. This set of proven, cost-effective interventions focuses on women and children, integrates interventions at the facility, community and family levels, adopts a human-rights-based approach to programming, and accesses the hard-to-reach to ensure a sustainable and equitable impact. As part of the ACSD, the Integrated Management of Childhood Illness (IMCI) strategy emphasizes that key factors in the child’s immediate environment – nutrition, hygiene, immunizations – are as important as medical treatment in improving health.
Community health posts embody the merits of these low cost, high-impact strategies. They show that when messages of good health are communicated clearly and basic caregiving is easily accessible, there is little to deter a community from providing the best care for its children and ensuring their survival.