Health in the field
The last weeks we were regularly in the field, visiting hospitals and health centres to take interviews from pregnant women, women with children, health workers and authorities for a baseline survey. Not an easy task, because of the limited number of cars for the different projects, the distances to the villages, and the state of the road! And also the interviews themselves are quite challenging. Most women have little knowledge of French. When I take an interview, regularly one of my colleagues has to translate into yacouba, malinké, baoulé or another local language, so that they understand the questions.
A few words about the health system here in Côte d’Ivoire. On a regional level, the country is divided in sanitary districts, headed by a DD (Directeur Départemental). In each sanitary district, there is a reference hospital, and there are a number of health centers (Centres de Santé), headed by a nurse, or urban health centers (Centres de Santé Urbaine), headed by a physician. In our project, we are working with 53 of those health centers in 5 different sanitary districts. The interaction with the health authorities (the DDs) is very important. This assures access to the health centers and the cooperation of the health staff. But this helps also for the long-term implementation of the project activities. Do not expect high quality infrastructure. Even in the reference hospitals, equipment is pretty basic, and a big part of the services are covered by unpaid volunteers (aide soignante) with a limited training. Also in the health centers, an important part of the work is done by community health workers (Agents de Santé Communautaire). As these people are not regularly paid, their motivation is not always very high.
In our health and nutrition project, one of the goals is to increase the identification and selection of malnourished children under 5 years of age. This will be done via the community health workers. Therefore, an important part of the project is the training of these health workers. Once this is done, they will focus on the identification of malnourished children, via the organisation of screening days. This will increase the amount of malnourished children supported. However, mothers are not always motivated to take their child to the nutrition center, because it involves costs. Therefore, the project foresees a budget to pay for their transport to and food at the nutrition center.