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In Malawi, Health Surveillance Assistants provide a life-saving link between communities and the health care system

By Victor Chinyama

Worldwide, under-5 mortality has declined from more than 12 million deaths in 1990 to 7.6 million in 2010 – yet thousands of children still die every day from preventable diseases. On 14-15 June 2012, the Governments of Ethiopia, India and the United States, together with UNICEF, are convening the Child Survival Call to Action, a meeting to mobilize the world toward one ambitious but simple goal – ending preventable child deaths. This story is part of a series highlighting global efforts to improve child survival.

CHIMPHANGA VILLAGE, Malawi, 11 June 2012 –Blessings Makono has been up since 8 a.m. conducting a ‘village clinic’ outside his house. Ten women are seated on the dusty floor, their babies tightly wrapped on their backs with the traditional chitenje cloth.

VIDEO: UNICEF correspondent Yamikani Maganga reports on the crucial roles village clinics play in saving young lives in Malawi.  Watch in RealPlayer


“What is wrong with your child?” he asks a mother, noting down the information in the child’s health passport. “Two days ago, she had a high fever and started vomiting,” says Mwanaisha Lubaini. “She has also been complaining of stomach aches.”

Four-year-old Awesha shows signs of malnutrition. Mr. Makono places his hand on the child’s forehead and checks for fever. Using the stopwatch on his mobile phone, he counts the child’s heart rate. Pressing his thumb into her feet, Mr. Makono checks for oedema, then looks at the inside lining of her eyes. A pale lining, he later explains, means the child has anaemia.

Mr. Makono diagnoses Awesha with malaria and administers the first dose of an antimalarial drug. He provides Ms. Lubaini with medications to take home, as well as strict instructions about how to administer them. If nothing changes in three days, he says, Awesha should be brought back for further assessment.

“On average, I treat 15 to 20 children a day,” he says. “The most common illnesses are malaria, diarrhoea, pneumonia and eye infections. If the child shows no signs of improvement within three days, I refer them to a health centre for further treatment.”

© UNICEF video
Villagers have come to see Blessings Makono, a local Health Surveillance Assistant in Chimphanga Village, Malawi.

Bringing health care to the people

Mr. Makono is one of two Health Surveillance Assistants (HSAs) in Chimphanga Village in Salima, a fishing district on the shores of Lake Malawi. With his colleague, Mr. Makono holds a daily clinic using a medical kit supplied by UNICEF. The kit contains antibiotics, antimalarial tablets, oral rehydration salts and zinc. In Malawi’s drive to conquer common childhood diseases, HSAs have played a key role in bringing health care closer to the people, thereby saving lives.

“If this clinic was not here, we would have hired a bicycle to take Awesha to Khombedza,” says Ms. Lubaini. “Each trip costs 600 Malawi kwachas [US$2.40], which we cannot afford.”

Khombedza, the nearest health centre, is 14 km from Chimphanga. In a country where nearly half the population lives on less than a dollar a day, 600 kwachas is more than most poor households can afford. It would take Lubaini hours to walk to the health centre, and the effort and time involved means parents are reluctant to seek medical help when their children fall sick. Mr. Makono’s village clinic ensures that treatment is only a few minutes’ walk away.

“I like my job because I am saving lives,” he says, flashing a wide smile. “Since I started working here 15 years ago, no child has died in this village of a disease I could cure.”

When he is not treating children, Mr. Makono conducts house-to-house visits, teaching the community about positive childcare practices including exclusive breastfeeding, use of long-lasting insecticide treated mosquito nets, hand-washing at key times, drinking chlorinated water, and ensuring a clean environment. In addition, each month, nurses from Khombedza Health Centre conduct outreach activities, carrying out a variety of crucial health activities, such as vaccinations, weighing, de-worming, and distributing mosquito nets, micronutrients, iron, vitamin A, folic acid and iodine.

© UNICEF video
A mother brings her child to be evaluated by Blessings Makono, a local Health Surveillance Assistant in Chimphanga Village, Malawi.

Reducing child mortality

In 2011, Malawi had about 12,000 Health Surveillance Assistants (HSAs). These health workers are the vital link between village and the health system. The majority hold only a secondary school certificate and have undergone no formal medical training, but the 11-week course they attend, in the integrated management of childhood illnesses, is enough to enable them to diagnose and treat the most common childhood illnesses.

Malawi’s HSA programme has contributed to a significant drop in the country’s child mortality rates. Under-five mortality rates have declined from 222 per 1000 live births in 1990 to 92 per 1000 live births in 2010. The major childhood killers – malaria, diarrhoea, and pneumonia –– are not only preventable but can be cured with simple treatments like Mr. Makono administers at his village clinic.

The HSA’s work is carefully monitored by the village health committee, which is composed of an equal number of men and women and serves for three years. Mr. Makono says the committee has been instrumental in urging the community to support the clinic.

Mr. Makono says he welcomes patients to his house at any time of the day or night. “They will go to the chairman of the health committee and he will bring the patient to my house. As long as the child is sick, I will treat,” he says.



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