Reaching the most Marginalized through Equity in Sierra Leone
Maternal and Child Health Weeks in Sierra Leone help reaching children with limited access to health care
SIERRA LEONE - January 2013 - Moyamba Town is about 100 kilometers away from Sierra Leone’s capital Freetown, and usually a rather quiet place. Today the stadium of the town is buzzing with school classes, traditional dancers, theatre groups, government health officials. Representatives of all notable health development partners set up a booth to inform the public about life-saving health interventions. Moyamba has been chosen as the main venue for the launch of the Maternal and Child Health Week in Sierra Leone in January 2013. Similar, but smaller events take place at the same time in all district headquarter towns in the country.
“Excuse me please”, says a boy in a blue and beige school uniform very politely to the UNICEF staff present at the UNICEF booth. “Would it be possible for me to get one of these posters, please?” He points at a poster promoting the importance of using proper sanitation facilities and keeping them clean. Mohamed is 11 years old and one of 15 pupils picked by his teacher to attend the launch of the Maternal and Child Health Week. He had had spent his time wandering from booth to booth, trying to learn as much as possible about life saving health interventions and eagerly picking up health messages aiming at protecting people from preventable diseases.
“I wish more people would be as interested in health education as Mohamed,” comments Dr. Nuhu Maksha, UNICEF Immunization Specialist. “That would make it so much easier for us to reach all children, because their parents would know how important it is to bring them to the health centers for immunization and treatment of illnesses.”
Immunization, the regular provision of vitamin A and de-worming tablets are low cost and high impact interventions that in developing countries can save many lives with little effort. In Sierra Leone these interventions are especially important because the country struggles with the highest child and maternal mortality rates in the world. Routine immunization is available in all government hospitals and all 1200 government health centers across the country. Medical treatment for children under five years of age and pregnant or nursing women is free of charge. However, despite all these efforts, pockets of children have continuously been missed and many children still die from preventable diseases with high malnutrition rates as an underlying cause.
To ensure that ALL children are being reached and protected from preventable diseases, Sierra Leone in 2008 implemented the Maternal and Child Health Weeks. Twice a year, the big nationwide campaign calls on the population to come to the health centers, register their children and get them immunized. Health teams go from house to house and give all children under-five Vitamin A, de-worming tablets and a polio vaccination. The children’s vaccination cards are being screened and if they have missed out on a vaccination, the parents are urged to bring their child to the health center to get the needed vaccination. Pregnant women are encouraged to go to the nearest health center for HIV counseling and testing.
“With every Maternal and Child Health Week we reach more children that had been left out before”, explains UNICEF Country Representative Roeland Monasch. “We know which interventions work, how many children we have not reached yet and what we have to do, but we have to accelerate efforts to even reach the last child in the most remote area.”
Mohamed is still at the UNICEF booth, now watching a movie on the prevention of cholera. He had already learnt measures on cholera prevention in school. “I saw a friend of mine who was sick with cholera. He became very thin and almost lost his life. So I always wash my hands with soap before eating and after using the toilet and I have also learnt to cover my food so that flies will not sit on it. I took the message home to my mother. She listened and said it did not seem so long ago that I was born and now I am telling her to wash her hands with soap and water!”
UNICEF is one of the main partners of the Ministry of Health and Sanitation in the Maternal and Child Health Weeks. The organization procures vaccines and other supplies and actively supports the health education team of the Ministry in their social mobilization activities. People’s lack of knowledge about the importance of vaccinations, proper hygiene behaviour, nutrition and other health related issues keeps being a big obstacle for the success of many health interventions. All health weeks are launched with a big health fair and performances around health education to attract as much public attention as possible.
Every Maternal and Child Health Week brings the health development partners a little closer to their goal. “During the last health week the national coverage of polio vaccination for children under five was over 98%”, says Dr. Maksha. “However, we will only be satisfied when we reach 100% of the children with all life-saving interventions and when all children are as knowledgeable as Mohamed in regards to how to protect themselves from illness and disease.”
Mohamed, whose favorite subjects in school are English and Mathematics, wants to become a bank manager when he grows up. With this ambitious goal in mind, it is not surprising that he has no time to be sick and prefers to learn all about effective prevention of diseases.