Scaling up community-based interventions to reduce infant and maternal mortality
In Guinea-Bissau, there are large differences in access to health care between urban and rural areas. It is estimated that 66 per cent of the population lives at more than 5 km from the nearest health structure. The national average is one health centre for more than 13,500 inhabitants. Health care services are mostly concentrated in Bissau and the regional capitals.
In 2009, within this context, the government of Guinea-Bissau decided to revitalize community-based health interventions, with the aim of reducing maternal, neonatal and infant mortality. In 2010, the ministry of health developed, with UNICEF support, the "operational plan to scale up high-impact interventions in Guinea Bissau" (POPEN). In 2013, the EU decided to support the implementation of this plan through a project contributing to the reduction of maternal, neonatal and child mortality (PIMI 1) in 5 regions with EUR 3 Million. The project was implemented by UNICEF and was scaled up nationwide later on under another EU funded projects, EU Saude (EUR 5 Million) and PIMI 2 (EUR 6 Million). The PIMI2 project is planned to end in April 2021.
Currently, at the rural level, more than 4 000 community health workers (CHWs) provide access to basic health services visiting once a month each households under their area of coverage. Each CHW is responsible in average for 350 inhabitants or 50 households. As pneumonia, diarrhoea and malaria remain the main causes of death for children under-five years and access to appropriate treatment for sick children remains low in Guinea-Bissau, CHW have been trained to provide treatment for these three childhood illnesses. In addition, they promote 16 key family practices that each family can adopt to prevent the child from diseases: exclusive breastfeeding up to 6 month, nutrition of the young child, handwashing, use of mosquito net, etc. They also promote birth registration.
At the upstream level:
UNICEF supported the government in developing key strategic and policy documents to establish a framework for the community health programme within the national health system:
- The national development plan of the health sector (PNDS II 2008/2017 and PNDS III 2018-2022) which include community health programme;
- Community health policy;
- Community health directives;
- Operational plan for scaling up high impact interventions to reduce maternal, neonatal and infant mortality (POPEN 2010 - 2015);
- Strategic plan for integrated case management in the community (2016-2020);
In order to strengthen the institutional capacity of the ministry of health to implement the community-based strategy, UNICEF provided technical and financial assistance and supported the coordination of the community health programme through monthly coordination meetings and quarterly reviews with all stakeholders involved at national and decentralized level.
At the downstream level:
- The MoH through establishing partnerships with six NGOs (VIDA, IMVF, AIFO, Plan International, AMI and Medicos da Comunidade) to implement community health activities. These NGOs work in the country's 11 health regions in close collaboration with regional authorities and local health services.
- The overall coordination, supervision and monitoring of activities, the training of CHWs, including interpersonal communication training for the promotion of the 16 key family practices. UNICEF ensured the availability of drugs and consumables for CHWs, especially for the treatment of simple cases of diarrhea and pneumonia at community level. UNICEF also provided bicycles, flipcharts and other materials for CHWs.