Building bridges between community and health clinic
Spread out along the banks of the Nile south of Cairo, Upper Egypt’s picturesque landscape is dotted with small cities and farming villages. These communities are among the poorest in the country. Until recently, because of the prevalent use of traditional remedies and lack of access to high quality health services, few in these communities made use of formal health facilities. Building up the communities’ confidence in locally available health services was, therefore, a priority for the Karamta Family Health Unit, the newly reformed, local government primary health facility.
Khaireya Fahmy Mahfouz is a resident of the village of East Karamta, in Upper Egypt’s Sohag governorate. Khaireya, now well into her 50s, says she has been pregnant 17 times, having lost all except 6 of her babies. “People were poor and times were difficult. Only those who were rich could go to hospital if they got sick. They’d take transportation and go to the doctor,” she explains. “Poor people didn’t go [to the doctor.] They’d stay, and either God let them get better or they’d die.”
Today, Khaireya’s daughter-in-law, Shadia Hassaan Yaseen, tells a different story. Shadia gave birth 40 days ago to a healthy baby boy. Throughout her pregnancy, she was visited by a community health worker and a nurse from the Karamta Family Health Unit. They gave her adequate attention during and after her pregnancy, also passing on information about breastfeeding and proper nutrition. It helped that the community health worker was a woman from East Karamta village. “As we are all from the same village, we know each other,” says Shadia contentedly. “She makes me more aware and I trust her.”
The visits that Shadia received are part of an innovative project to bridge the critical gap between the Karamta Family Health Unit, and the community. This initiative is one element of the larger government health sector reform by Egypt’s Ministry of Health and Population, aiming to achieve a comprehensive development of health services across the country. Under the particular project in East Karamta village, working as a team and travelling from house to house, a nurse from the clinic provides basic health services while a community health worker delivers awareness-raising messages. Since 2003, the project has received support from the Egyptian Ministry of Health and Population and partners, including USAID and UNICEF. These outreach efforts have ensured that a once rarely visited Karamta Family Health Unit is now frequented by villagers seeking reliable health care for themselves and their children.
Community health workers like Warda Taha Mohammed, who attended Shadia through her pregnancy, serve the local population in East Karamta village, its surrounding hamlets and also seven other nearby villages in the Sohag and Qena governorates. The health workers inspire confidence among some 60,000 villagers, spreading health messages and assuring them of the benefits of using the local clinical facility for their health needs.
Dr Essam Allam, a UNICEF health officer, explains the increasing impact of the project. “We realize that it is of utmost importance to change people’s way of thinking and improve their health and awareness on all levels. Also, taking the messages directly to the people was much better than waiting for people to come to the health unit. Once the project got going, the message started getting to them and people came to the clinic to receive health care. I really felt how much the relationship between the people and the clinic had improved, and how people’s confidence in the Ministry of Health’s services through these local health clinics has grown."
Bringing health messages “full circle”
Dr Tafreeh Baheeg Me’aawel, of the Karamta Family Health Unit, comments on how community health workers have raised awareness among the women of East Karamta, changing their attitudes towards maternal and child health. “[People are] conditioned with wrong information and they feel that doctors don’t understand the particulars of the community. When the message has already been conveyed to a woman before she comes to me, by a woman from her own community who knows her and can relate to her, this brings things full circle. I simply reinforce the same message that she’s heard before. I see that this is very important.”
From health clinic to community health worker to village, confidence in the reformed health system is beginning to spread across Upper Egypt. Such a chain of communication is pivotal to addressing maternal and children’s health issues in remote areas of the country. With this project set to expand in the region over the next year to the two districts of Akhmeem and Nagaa Hammadi, covering a population of about 400,000, health awareness in Upper Egypt is on the rise.