Changing Communities

My second major objective for joining Save the Children seems obvious but sometimes in any large organisation it is understanding the impact of what you are doing directly to the child or the patient. This was a major driver for me and was fortunate to gain this understanding based upon an opportunity to carry out a project field visit in the Northern District of Turkana in Kenya. The focus of the 2-day visit was to review a pilot project in the district reviewing the capability and benefit of community health volunteers and the impact their work is having in the quality of life of children in their community. I will now provide a summary of the 2 days.

Day 1: Meeting with the District Ministry of Health: Meeting was held with representatives from the Save the Children Regional Office and Ministry representation including the Deputy Director of Family Health, Malaria Co-ordinator, Community strategy focal person and the Maternal New Born Health Co-ordinator.

There is a regular discussion with the ministry to maintain the engagement. An overview and status of the projects in the district was provided with a focus on Integrated Community Case Management (ICCM) which a program designed to improve the diagnosis and treatment in Malaria, Diarrhoea and Pneumonia. There was a great call out on best practice for a Save the Children project in the region which is used by the ministry as an example to others. Great to also hear the asks we had from the ministry as well especially in respect to turnover of health worker staff in the region. There was a focused discussion on the recent Malaria outbreak in the region. The key issues that were faced was the availability of commodities, in terms of antimalarial drugs and diagnosis kits. The concern was that it is anticipated that there will be heavy rainfall forecast in the middle of October which could increase the level of malarial cases in the region. Therefore, we need to take clear actions now to ensure we can respond appropriately within the region.

In the afternoon we travelled away from the capital Lodwar, into central Turkana, the landscape is very arid and dry and cannot believe people where living in these conditions. The average temperature for this time of the year is 38 degC. If you then relate this to the fact that most people must travel over 25 -50 km to a health centre over terrain which is uneven and dusty and rocky in areas. Imaging being a mother carrying your sick child to receive treatment. The team visited a primary healthcare centre in the LOIMA region. The health centre served 24 communities. Each community had a community health volunteer (CHV’s) assigned who supports in the region of 80 – 100 households. The team then went to evaluate a mentorship coaching session for one of the CHVs, which is supervised by the ministry health, an official train of trainer and a community health worker who works in the health centre. During this session the CHV conducted a session with on a young girl in terms of overall nutrition status following key ICCM standards and criteria. Various measurements where taken with respect to the mid upper arm circumference which is indicative of the nutritional status of the child. In addition, the first signs of malnutrition are fluid build-up in the feet and ankles. In addition, the measurement of respiration rate using respiratory beads was carried out. The measurement is very visual and is based upon higher respiratory rates in children under 12 months and 1-5 years of age to help with referral for any cases with Pneumonia.

The last CHV we saw during day 1 was taking part in the trial for not only referral but also treatment of malnutrition in the community. The team reviewed the status of the save the children toolkit that is provided to each CHV. Reviewing stocks of commodities available in terms of nutritional sachets, malarial diagnosis kits, but also packs of Amoxy DT and rehydration sachets available to treat diarrhoea.

Day2: Meeting with National Drought Management Authority (NDMA): The NDMA is a government agency monitoring the drought status nationally and providing co-ordination of support and reviewing drought status over the different regions based upon certain criteria including rainfall, nutrition availability and access linked to also market prices. The average rainfall is 80 mm in a year. We reviewed the current alert level which is a mean measure in response across the different regions.

There is also a move to use automatic cash transfer to the people that need it the most which is a value of 2,700 KSH/month (£21 /month) per household. Food distribution is given at a level of 4 kg of Maize and 1 kg of beans per household for a month independent of how many people live in the household. In addition, we saw a mum shifting through the maize and removing any that was unsuitable which was around a third. It makes you think about how people can survive on so little food as a family.

In the afternoon we carried out an assessment with two CHVs who as part of the trial was also to provide treatment in the community, interesting that for the first CHV there was a question mark with respect to the age of the child and the importance of making sure it is appropriately documented. The child was confirmed as malnourished and it was established that the child was 6 months old and because of the age would be a straight referral to the health centre.

For the second CHV, she was providing a clinic for the communities in a central location for her community to reach her. Some of the individuals travelling distances for the CHV assessment. On review of the records it was established that she had intervened with 13 children during the trial period with all children gaining weight due to her intervention based upon the capability and tools we had provided as part of the partnership with Save the Children. A resounding success of 100% and one of the takeaways was to understand how is this CHV been able to achieve this success rate which could be shared with other CHVs in the region. It was very humbling to see, where there are many successes there are still too many children dying of pneumonia, diarrhoea and malaria and the work cannot stop. It left me with a feeling of being proud of the field team and work that is done by the CHV. The benefit and impact of saving the lives of children in the region is helping to drive change and difference in a community that has nothing. I met people that despite the poverty and circumstance still manage to raise a smile.

I felt immensely proud of the work that the regional Save the Children are implementing and to be given the opportunity as part of the GSK/Save Partnership to experience the positive impact of the support that is provided to the health workers and the communities on the ground. It was an experience of a lifetime.