CHIKHWAWA, Malawi (September 20, 2012) — Simplicious Gift, five months old, has a cough, fever and diarrhea. Ruth Bwanakaya discusses his illness with his mother Margaret, and meticulously notes down details about the child in the health register—his name, age, village and symptoms. As a matter of routine, she checks the child for signs of malnutrition and proceeds to prescribe anti-malaria medication, paracetamol, oral rehydration salts, and zinc for the diarrhea.
Bwanakaya’s makeshift clinic is held outside her house in Mafunga village, Chikhwawa district, in the Shire Valley of southern Malawi. She uses a medical kit supplied by UNICEF. Mothers like Margaret, babies strapped on their backs, stroll into her compound to see the ‘village doctor,’ as Bwanakaya is fondly called.
Bwanakaya is one of a cadre of 11,000 health surveillance assistants (HSAs), or health extension workers, who have played a key role in Malawi’s success in reducing child deaths. With the nearest health center three miles away, having the village clinic ensures that children receive medical attention quickly, and within walking distance of their homes.
“People in this village are being helped,” she says. “As soon as the child gets sick, they run to this place because it is near. If this clinic was far away, they may decide to sleep over it thinking they will take the child the following day, which may be too late.”
The majority of HSAs hold a secondary school leaver’s certificate. They undergo an 11-week course in integrated management of childhood illnesses and are able to diagnose and treat the most common childhood illnesses. With the success of the program over the years, HSAs’ work has expanded to include diagnosing and treating children with severe malnutrition.
The SMS technology RapidSMS has recently been introduced to the nutrition program in seven of Malawi’s 28 districts. There, HSAs can use their mobile phones to send a child’s nutritional data to a toll-free number, which is linked to a national monitoring system. The data are analyzed automatically, and a response is provided to the health worker, with specific instructions for treating the child.
RapidSMS has drastically reduced the time this process of data collection, transmission, diagnosis and response takes—from an average of 2–3 months to mere minutes. With an instant response, the HSA is able to make a quick decision on the child’s treatment, a decision that could save the child’s life.
At Makwira health center, 24 miles from Chikhwawa district, HSA Asharaf Kananji has collected blood samples from 3-month-old Anne. Anne’s mother was diagnosed with HIV several years ago and enrolled in the program to prevent mother-to-child transmission of the virus. The baby’s blood is dried and sent to one of three hospitals in Malawi that can isolate DNA in blood and use it to test for HIV in infants.
Once the analysis has been conducted, the hospital will transfer the test results to the HSA by SMS. Wait times have been slashed from an average of four months to just under one month.
According to assistant laboratory manager Augustine Barnaba, the hospital processes an average of 200 dry blood samples a day. “We are able to process the samples and SMS the results within two days,” says Barnaba. “The challenge, however, is that we receive the samples after two or three weeks because of the lack of transport.”
Malawi’s HSA program has contributed to a significant drop in the country’s child mortality rate. Under-five mortality rates have declined from 222 per 1,000 live births in 1990 to 83 per 1,000 live births in 2011.
In Malawi, major childhood killers—malaria, diarrhea and pneumonia—are not only preventable, but can also be cured with simple treatments like the ones the ‘village doctor’ administers at her village clinic.
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