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In Benin, health extension workers bring care closer to home, saving lives

By Alex Duval Smith

KETOU, Benin, 17 May 2012 – Malaria strikes one of Lucia Bognonsa's children about twice a year.

When it does, she has a number of options: She can buy a remedy from the village herbalist. She can purchase tablets from unregistered ‘mobile pharmacists’, tradesmen who travel by bicycle or motorbike selling drugs. She can also take the child to a hospital 3 km away, where treatment is free. But her preferred choice is to call her neighbour, a 65-year old subsistence farmer.

UNICEF correspondent Suzanne Beukes reports on health extension workers bringing vital health services to families in Ketou, Benin.  Watch in RealPlayer


Simon Edessou, in Adjozounmè Village, near Kétou in Benin, had been a farmer his entire life. But last year, he hired another man to tend his fields and signed up for a UNICEF-supported course to become a health extension worker.

At the end of the course, he received a kit of rehydration salts, deworming tablets and a tape measure for evaluating potentially malnourished children. He also received a range of basic drugs for treating malaria, diarrhoea and respiratory infections – some of the biggest causes of child mortality in the country.

Providing critical care locally

''My mother-in-law thinks I should go to the traditional herbalist, but I believe that modern medicine works best for malaria,'' Ms. Bognonsa said. ''As for the mobile pharmacist, his stock sits in the sun all day, and you never know where it comes from. The hospital is free, but if I go there, I have to pay for transport and I lose the whole day. These days, I prefer calling Mr. Edessou.''

Mr. Edessou relishes his new-found role in the community. His monthly information meetings in the village square – featuring tips on malaria prevention and hygiene – draw large crowds.

© UNICEF Video
Simon Edessou, a health extension worker in Adjozounmè Village, near Kétou in Benin, conducts a health information meeting in the village square.

Benin is short of health professionals and treatment facilities. But across the country UNICEF-sponsored health extension workers equipped with basic medicines are bridging a massive service gap.

The extension worker system was established with three-party contracts between UNICEF, the municipalities and the health ministry. UNICEF community health expert Ange Meizou says the network– currently in four of Benin's health districts – will be expanded and gradually incorporated into the country's health system.

Saving lives

Local health professionals welcome the system. At Kétou health clinic, Norbert Monlemey, a general practitioner said, ''We used to admit many children suffering from severe anaemia. The mother would say 'I treated my child at home' and we would have to work out what had been given to them. Often, it would transpire that the child had severe malaria. Now we are seeing fewer of these serious cases and also far fewer children in early stages of malaria.

''In terms of prevention, the extension workers' are helpful, too, because they act as an early-warning network. At monthly meetings we look at their ledgers and are able to gain a good idea of potential hotspots for malnutrition.''

He said Kétou's mayor, himself a doctor, had played a supportive role by encouraging the recruitment of health extension workers and spreading the word about their services. ''One of the reasons people turn to mobile pharmacists, even though their drugs are of uncertain provenance and they have no medical expertise, is that they offer credit. But increasingly, villagers are becoming aware of the many advantages of calling the health extension workers: Their prices are fair, they are selected by the community and they live there – which means they are trusted – and they do not just prescribe pills to repress symptoms. They have enough training to know when they need to refer cases to us.''



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