Community Spirit

The most impressive thing I have seen over the year in Ghana has been the hard work of the community members for the benefit of their friends, family and peers. The most impressive program I have witnessed is called Community Case Management (CCM). The program is a Ghana Health Service program, with funding from UNICEF. It focuses on the biggest childhood killers in Ghana; 1. Malaria, 2. Diarrhoea and 3. Pneumonia. These are so common in children under 5 that this one intervention, if implemented universally, would reduce the number of under 5 deaths by 63%.

It is a program that is used in many countries, with the difference in Ghana being that the people running the program, assessing the children, going from house to house, being on call 24/7, and administering the treatment are all community volunteers. The community can nominate 2 people, who are then trained and equipped with educational cards, medications and reporting forms.

These volunteers are mostly women, which in the rural areas, means illiterate with no, or very little education. The volunteers diagnose and treat children using the skills taught to them in annual training sessions, a challenge in itself when you are trying to educate without the use of written tools. Role plays are a large part of the training, yet I never quite understand how the volunteers manage to remember the amount of information they do.

Volunteers attending training. Often with their own children. They are in charge of their supplies - in the white boxes, they carry these around on their heads, or if they are lucky, on a bicycle.

The main thing about the program, I have learnt, is that it increases the use of health services by poor children. Due to location, lack of services, lack of roads or transport or other factors, health facility-based services alone do not provide adequate access to treatment (in many countries, not just Ghana), and, not within the crucial window of 24 hours after onset of symptoms. So CCM brings the treatment to you.

It is affordable, treatment is cheap, and if you can’t afford even the recommended amount, it is given for free. Oral rehydration salts for diarrhoea costs a parent about 5c. Of which, 2c goes to the volunteer as ‘motivation’ – the only form of payment these hard working people receive. They are not officially identified as Ghana Health Service employees, and must keep other, sometimes multiple jobs to make ends meet.

The volunteers are given a large workload. Treating, screening and providing follow up care to the whole community. They must report to the closest health clinic once a month with the statistics of who and what they have treated, and re-stock their medication boxes. No transport is provided, these volunteers may have to walk kilometers, with no reward at the end. However how do you fill a report form when you cannot read or write? One health worker I met created a system to help him get reports from the volunteers. In a large jar put a grain of maize for every child 6-11 months treated for malaria. A grain of rice for every child 6-11 months treated for diarrhoea, and a grain of sorghum for every child 6-11 months treated for pneumonia. In a small jar do the same thing for children aged 12months – 5years. Genius.

It is innovations, cooperation and programs like these that makes this country so interesting. Yes, you get many volunteers who do not report, or health workers who demand written forms, but bit by bit Ghana is adapting its programs and building up its people to create something that will one day be a solid health system, built firmly on the strength of its amazing communities. This is dedicated to all the volunteers who give their time to the program, I am so proud of them, and continually hold them in such high esteem. I wish for them to be recognised and given employment entitlements, better status and the thanks that they deserve. 

Meet one of the volunteers - click here.

The 'Forgotten Killers'

Have a guess at the world’s biggest infant killer? Something scary, something unpredictable, something out of our scope to help with???

Pneumonia.

Closely followed by Diarrhoea.

In Ghana the problem is the same. Diseases that don’t really scare you at the thought, or make you think of death. But they are killing children in Ghana and the rest of the world, yet have such simple solutions.

You can  prevent pneumonia by washing your hands before eating. It’s not expensive, out of reach or ‘innovative’. To cure pneumonia you take some antibiotics. In Ghana they can cost as little as AUD$1.00 or if you can’t afford that, it’s free.

Diarrhoea can similarly be prevented and easily treated, again, hygiene and sanitation is key. But these diseases reflect more than just the diagnosis, it shows the living conditions, poverty, and healthcare accessibility of those severely affected. When you think about #1 cause of death in Ghana (or Africa in general), the cliché is to blame HIV/AIDS, maybe conflict, or some obscure disease like Nodding Disease. These are all difficult things to tackle, with big social impacts, or costs involved. But HIV rates in Ghana are 1.8%. The percent of children with suspected pneumonia receiving antibiotics is just 24%. The percent of children with suspected pneumonia taken to an appropriate health care provider is 51%. It is clear where the biggest impact can be made in health.

Ghana has just introduced 2 new vaccines to help prevent both diarrhoea and pneumonia. There has been much media coverage, and here is a great video about it.

Other things that are being done are;

1.  Promoting exclusive breastfeeding – by giving nothing but breast milk for the first 6 months in life it prevents infection, contamination and malnutrition. A simple, but effective way to ensure good health for your under 6month old. The problem lies in the following years where food is introduced, and it is often inadequate or insufficient.

2. Sanitation and hygiene. Ensuring all households have access to safe drinking water.

3. Community-based treatment of childhood illnesses. A program where volunteers in the community bring diagnosis and treatment to hard to reach places.

4. Promoting handwashing with soap. Massive campaigns and strategies are in place to improve handwashing. A study I worked on recently found that just 6% of people use soap. And then it mostly was for washing clothes rather than hands.

Wash those hands!

And for the final say, here is a news story on the current situation.