Happy New Year everyone! When I arrived in September 2011, the Healthcare Program staff were functioning as trainers and supervisors for a cadre of government recognized Community Health Workers. As our team observed, we saw this approach was ineffective for reasons including; CHWs unmotivated to perform basic job duties (including home visiting and attending trainings), and the government Community Unit strategy limiting our activities and making monitoring and supervision difficult. In hopes to resolve some of the misunderstandings and communication issues with the government, in November 2011 Nuru Healthcare fully transitioned all CHW interactions back to the designated Ministry of Health (MOH) supervisors, called Community Health Extension Workers (CHEWs).
Nuru intends to uphold a strong relationship with the MOH as we will continue to work alongside CHWs and CHEWs to see health changes happen in the communities we both serve. Nuru will continue to communicate with the CHEWs to collaborate when possible, support MOH initiatives like Malezi Bora, and continue to make referrals to government medical facilities. In an effort to create sustainability, the Nuru Healthcare Program Leader is learning how to write progress reports to be given to MOH concerning the monthly happenings of the Nuru Healthcare Program.
The Nuru Healthcare Program still has the same behavior change foci in our community:
- Full immunization of children under 1
- Children under 1 and pregnant mothers sleeping under an insecticide treated net
- Drink clean water
- Wash hands with soap
- Breastfeed immediately and exclusively for the first 6 months
- Adequate complimentary feeding and Vitamin A supplement for children under 5
- Attend 4 antenatal care visits and have safe delivery
- Treat danger signs quickly
Although Nuru Healthcare will no longer train or supervise CHWs, we will train our Healthcare Field Officers to perform a more effective role that fits into Nuru’s holistic approach. Field Officers will deliver prevention trainings and related responsibilities to help achieve our goal of reducing mortality rates of children under 5 years old in a sustainable and scalable way. Healthcare Field Officers will serve Nuru farmers with homevisits, and the community at large with group trainings at venues including churches, school health clubs, village elder meetings, and other gatherings. Along with communicating clear and correct messages about disease prevention, the Field Officers (FOs) will also give tailored interpersonal behavior change coaching to help Nuru members overcome barriers to change, and make accessible the commodities procured by Nuru Income Generating Activities (Waterguard, Moringa Leaf, soap, sanitary napkins, and solar lamps).
The FOs have been learning skills to help them perform their new role, and interacting with the other Nuru programs to strengthen our holistic approach. This past month they collaborated with the Nuru Agriculture Field Officers to identify the location of all Nuru members’ households to help plan an efficient home visiting strategy. They have also been learning how to translate their monthly targets, like visiting 70 households, into weekly plans. They are also preparing lessons for training the school health clubs, which they attend with our Nuru Education program staff. They are learning more from Nuru Water and Sanitation program about their products and community training strategies in order to identify our cross over and possible integration points between our programs.
They skill based learning is slow going. It’s heart breaking to see the long-term effects of a highly inefficient education system and largely supports only rote memorization. The staff lack simple planning and monitoring skills, and training them well and with appropriate practice materials is a difficult task. If any of you readers have suggestions of possible skill based training that might help develop our staff, I would love your response.
We are looking forward to a successful and healthy New Year. Hoping the same for you all.