They rush to us on foot even at night

Boma Health Workers making basic health services accessible to the most vulnerable

Mabior Mach
health worker with mom and child
23 November 2021

Kiir Deng Dut (24) says he has become ‘the doctor’ where there is no doctor. 

A community health worker in and around Malakal, Upper Nile State in northern South Sudan, Kiir walks from house to house in sparse settlements screening children and pregnant mothers for malaria, diarrhea, pneumonia, and malnutrition.  

“I prescribe medication for simple cases and refer serious ones to the health facilities for further diagnosis and treatment,” Kiir says. “I also provide health education on routine immunization, preparation of oral rehydration salt, high temperature management, and proper use of mosquito nets.” 

One of the children he treated a few months ago was an infant born after a long labor in the local health facility. Upon discharge from the facility, the child started having breathing problems. The mother thought it would heal naturally after some time. 

“Kiir came at night with a torch and screened my child for pneumonia,” says Akuol Deng Chuol, the mother. “He provided medication. My child’s health improved quickly.” 

Kiir uses simple tools he carries in a metallic box: a respiratory timer, a string of beads and a test strip to make a simple diagnosis for pneumonia and malaria. 

During one of his routine trips Kiir goes to see Akuol’s now six months old son at the bank of the River Nile in Malakal.  

From his toolbox, Kiir pulls out a respiratory timer, presses it on the boy’s chest, and starts counting beads grouped according to colors on a string.  

The timer sounds an alarm and Kiir says: “The counting has not reached the red beads; your child has no pneumonia.”  

He then starts speaking to the mother about routine immunization, temperature management using a wet cloth and how to prepare oral rehydration salt for a child suffering from diarrhea. 

Akuol patiently listens to Kiir and thanks to him for his work. 

“In the past, we were at high risk. You could lose your child on your way to the health facility when it was too far. Now community health workers can help,” Akuol says. “They rush to us on foot even at night when we have no means to visit the health facility.” 

Kiir is part of a 10-member group of Boma Health Workers in Malakal, once a buzzing city but now a testimony of the devastation caused by an armed conflict that started in 2013 and culminated into a 2018 peace agreement. Armed violence has now subsided. The demand for basic health services is high. Access to these critical services for the most vulnerable is constrained by poor roads and natural disasters such as floods. 

The Boma Health Workers are supported by UNICEF. They have been trained to respond to uncomplicated health emergencies in the villages by ensuring early diagnosis and providing treatment of common diseases. Other cases are referred to the health facilities. 

health worker with mom and child
Boma Health Worker, Kuol Deng Dut, uses a respiratory timer to screen a child for pneumonia.

“Today people in need of health care are giving the right diagnosis and treatment,” says Elijah Riek, the team supervisor. “Here, there are many areas which are difficult to reach. Boma Health Workers cover that gap to manage childhood diseases. They also encourage pregnant mothers to visit health facilities.” 

Five of the thirteen counties in Upper Nile State that are largely inaccessible by roads in the rainy season now have a combined team of 200 Boma Health Workers ensuring access to primary basic health services for the most vulnerable.  

“These community health workers have created a real impact among children suffering from childhood diseases,” Elijah says.

UNICEF works in partnership with the World Bank and the Ministry of Health to train and support the Boma Health Workers in Jonglei and Upper Nile State. The Boma Health Initiative is further funded by the German National Committee for UNICEF. The programmes supported by UNICEF to promote access to basic health services in South Sudan are also funded by Canada, CDC, GAVI, Germany, the Global Fund to Fight Malaria and Aids, Japan and UKAid.