Child Survival and Development




Feature Stories


Community Health Workers Take a Tough Stance on Child Mortality

© UNICEF/MLIA2009-00247/Pirozzi
Alhadji Kola, a community health volunteer, known in French as “relais”, with his wife and two of his sons in the village of Soufroulaye, Mopti Region, central Mali. He has lost seven out of eleven children to illness.

Inside his small home, Alhadji Kola talks with an extraordinary passion about being a community health volunteer, while trying to occupy his lively seven-month-old son, Yéro, who is bouncing on
his lap.

“My wife and I had 11 children, but only four survived,” he says, kissing Yéro tenderly on the forehead. “We lost most of our children while my wife was still breastfeeding them, apart from one daughter who died during childbirth. The young ones fell sick with diarrhoea and malaria. One was born dead.”

Kola’s tragic story is not so unusual. Mali has one of the highest child mortality rates in the world. Almost one in every five children dies before reaching the age of five years. And like Kola’s children, they die of causes that are relatively easy to prevent.

However, in recent years significant progress has been made in some areas. The under five mortality rate was reduced by 17 per cent nationally between 2001 and 2006. With the help of community volunteers like Kola, UNICEF supports simple interventions that make dramatic differences. One key practice is to vaccinate children. National immunization indicators have shown a steady improvement. Today, 48 per cent of children are fully immunized compared to 29 per cent in 2001. Community health volunteers have played a key role in informing populations and encouraging discussions about key health practices, involving not only parents, but also grandmothers who are extremely influential in family life.

Kola was elected as a community health volunteer, known in French as a “relais”, three years ago by members of his village in Soufroulaye, in the region of Mopti, in central Mali. He received 15 days training, which he says has helped him in his work, although now he would like to have a refresher course. “I haven’t had a high level of education – only four years of primary school -- but most people in my village have never been to school,” he says.

Like the other community health volunteers in his village, Kola is responsible for visiting 35 households once a month to monitor how they are carrying out “essential family practices” which are vital to child survival, including prenatal care for pregnant women, early and exclusively breastfeeding for babies during the first six months of life and vaccinating children under one year. He and the other community health volunteers then report back each month to an elected community health association, which has 13 members – 11 men and 2 women – representing 8 villages.

The president of the association, Kassoum Kamiam, says that many households are changing their behaviour. “Most women deliver their babies in health centres now, and vaccinate their children. It is rare these days that a child dies of a vaccine-preventable disease.” Asked about the lack of gender balance on the committee, he explains that there has been an “improvement” as the last committee had no women.

Kassoum adds, “Our major problem now is that health centre staff cannot reach communities in the remote villages as we do not have money for fuel and our motor bike needs to be repaired.” It is a common problem throughout the country; many of the community health centres run out of money to sustain their mobile units.

However, the key to the success in villages like Kola’s has been the dedication of the volunteers. Kola explains how he works. “I first speak with the man and then other members of the household and explain the reason for my visit. I see a big change in how people behave, although it was not easy at first. I still find it difficult to persuade families to use mosquito nets and to practice family planning.”

Lack of incentives for the volunteers is a problem in some areas, especially as most of them are from extremely poor families. Yet Kola, who is a small-scale farmer and can just about sustain his family, does not focus on this. “Health is the most important thing we need. If you’re not healthy, then you just spend all your time looking for health, but if you are healthy, then you are able to do others things in life. “I like my job as it brings health to my community, and now most of our children are healthy because of the work of the relais.”

And he adds, still playing with Yéro, “My wife and I have the knowledge now to bring up our children differently. Our last four children were born in a health centre and they are fully vaccinated, we sleep under mosquito nets, and we know how to treat diarrhea at home.”



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