There are only about 186 miles of paved roads in the entire country of South Sudan. Most of the country is linked only by dirt tracks, which are impassable for up to nine months due to the rain. Some individuals can only access a health facility by walking eight hours through water and mud. Many severely malnourished children will never complete the journey.
Thousands of children are dying because they cannot reach health facilities and the life-saving treatment they need.
This is a reflection of geographic barriers, weak health systems and lack of infrastructure. It also conveys profound humanitarian failure. The truth is that we have the means to stop young children from dying in South Sudan, and other countries where child mortality is unacceptably high. The global community must bring treatment directly to children.
We believe this is possible. In the last decade, there has been a transformation in child health. Integrated community case management has simplified the diagnosis and treatment of three of the leading causes of death in children —diarrhea, malaria and pneumonia. As a result, community health workers with little or no education are providing quality of care in some of the most remote areas.
We have used this model to make treatment for these conditions available at the doorstep of every child where we work. In South Sudan, one community health worker covers 50 households. These community health workers, mostly illiterate and female, are able to diagnose pneumonia by counting breath rates using color-coded beads. They use drug packets color coded by dosage to treat infants and toddlers who test positive. In just one year, 3,000 community health workers brought treatment to 390,000 children.
The results are clear. We found that treatment provided by community health workers in South Sudan increased overall treatments for the three conditions tenfold, as compared to health facilities. The potential implications of applying this community-based model to malnutrition are enormous. Thousands of children would get access to life-saving treatment without leaving their home. We have an opportunity to improve the survival, health and development for an entire generation.
The first steps are ours
We know that community health workers can deliver the full treatment package for malnutrition, CMAM, which is endorsed by the World Health Organization and UNICEF. But to our knowledge, this has never been successfully accomplished through low-literacy community health workers.
To some degree it is unsurprising. Until last year, there has been almost no coordination between the integrated community case management and nutrition communities in the humanitarian sector. But if we are committed to reaching children in all corners of a country and in the most remote places, we can only find solutions together. In our own effort to contribute to these efforts, the IRC is developing new tools and a simplified protocol that will be used by illiterate community health workers to treat malnutrition, in addition to diarrhea, malaria and pneumonia.
But it is only if the global community acts together that nutrition and integrated community case management programs can reach their full potential.
The challenges are real and precedent is limited. But we face tremendous responsibility, potential and payoff. One African proverb states that “If you want to walk fast, walk alone. If you want to walk far, walk together.” We’d like to do both—but we must do it together.
Donors needs to facilitate joint funding streams between integrated community case management and nutrition. Ministries of Health and international agencies should advocate to make this work possible. We all need to work together on the opportunities in front of us. Our path is not impassable. Now is the time for the global community to keep walking fast, and far.
Published: May 26, 2015. By: Casie Tesfai
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