Tragedy to Triumph -- One Community Health Worker at a Time

(Mali Health Organizing Project)

Action-For-Health began with a reputation for innovation.  The program posits an alternative solution to untenable user-fee health systems in Mali while providing critical research for the field of health financing.  Then, Action-For-Health turned heads with its proposal to establish the first integrated SMS text and electronic medical systems in the world.  Now, with increased face-to-face services, individual Community Health Workers (CHWs) make a difference daily.  

Soukeina Ouattara and fellow nurses at clinic

In the past, Action-For-Health has worked closely with families in need of health services through in-home visits and personal follow-ups.  The program seeks to save 150 lives per year by drastically reducing child mortality.  A survey identifies families in need according to poverty levels and health care access.  Once selected, families are assigned one of twelve Community Health Workers.  With extensive training in the prevention, recognition, and care for four major diseases, CHWs visit families between two and four times per month, with one 'health education' visit in the same time period.  Malaria, malnutrition, acute lower respiratory infections (ALRI), and diarrhea are the four diseases targeted, by virtue of their lethal omnipresence.  These highly preventable conditions currently account for 90% of child mortality in a country where one in five children die before the age of five.  CHWs have also been trained to recognize "danger signs" in children under five -- struggle to lift the head and refusal to breastfeed, for example -- and know to bring ailing children to the clinic as soon as possible.

The pilot involves 78 families representing 1837 people and about 600 children under five years of age.  By 2014, MHOP looks to swell its scope to 20,000 people -- the estimated number in families unable to access health care because of financial barriers.  As MHOP expands its services, CHWs have more to offer the families they work with.  Participating families will receive

* SRO (oral rehydration therapy);

* Mosquito nets for all children, as well as pregnant women;

* A free clinic membership card for all kids 0 to 5; and

* Free health care in the clinic, accompanied by a CHW, for the four diseases and anything causing "danger signs."

So basically, if a child is sick enough to be referred to the clinic, we want to pay for everything.

The program has set lofty goals.  CHWs are accountable for monitoring client health, while the clinic ultimately seeks to serve every referred child.  Says Colette Dejong, the summer coordinator for Community Health Workers, "So basically, if the child is sick enough to be referred to the clinic, we want to pay for everything."  For chronic illnesses such as cancer or HIV/AIDS, CHWs refer patients to other local nongovernmental organizations with free treatment in these specific areas.

In exchange for services, families' health actions -- 'action fees' -- will create economic, political, and social value to be re-invested in the clinic and community.  MHOP asks a family to take on 3 action fees for every 3 months.  Action fees might take the form of votes in local elections or attendance at a community clean-up day.  Participants might also help the new clinic with

* Logged work hours or water hauling;

* Clothing donations to the blossoming maternity ward;

* Green thumb contributions to the garden to combat malnutrition;

* Tree planting

Community Health Workers and surveyors gather after enrolling women in the program.

To chronicle progress, each participating mother receives a card with her name and the names of each child in the household.  A hole-punch signifies a completed action.  A raffle will award two families who have gone above and beyond their three actions with prizes and an invitation to participate in a Radio Sigida Joli show.

Action-For-Health will rely on committed Community Health Workers and the long-term payoff of action fees rather than short term cash to sustain the program.  However, this program will need to rely on donor funding for its first two years.

You can help Action-For-Health in many ways! 

            * $1.50 is the cost of one fruit tree for the garden against malnutrition

* $50 funds clinic visits for fifteen children

* $225 purchases teaching materials to train CHWs

* $1800 funds equipment and a fence for the malnutrition garden

With this innovative approach to user fees for healthcare services, MHOP aspires to shift the perception of healthcare towards a preventative, rather than curative model.  The idea builds on a success of Medecins Sans Frontiers.  In 2008, average malaria consultations for an under-5
child per year climbed from 0.25 to 0.38 with the introduction of free Artmesinin Combined Therapy; the average then jumped to 1.28 consultations per year when all care for under-5s was free.  By granting better access quality healthcare for the poor, MHOP hopes to get participants to the target goal of two average consultations per year.