In Mandera, community health volunteers offer critical health services to children in their manyattas
By Delfhin Mugo
It’s 38 degrees Celsius at Midday in a village outside of Banissa town, Mandera. Young boys and girls dash across the sand undeterred by the scotching sun while adults, mostly men, rush to a nearby mosque for Juma’a (Friday sermon). Women have taken shelter in their manyattas— traditional family home built of sticks, thatch and mud— while goats, donkeys and camels roam the compounds freely.
At quarter to 1pm, Halima Maalim and Fatuma Ibrahim make their way to the homestead each balancing a baby on the heap. For Halima, another baby tags on her dress as she strides the compound. The two mothers lounge in the shade of one of the Manyattas in the homestead. It doesn’t take long before Aden Alio makes his way to the same Manyatta.
We learn that Halima and Fatuma are here to see Mr Alio, a community health volunteer (CHV) or the village doctor as they fondly refer to him.
A mother of five, Halima has brought her fourth born child, a 2-year-old girl for check-up. She was here the previous day complaining of high fever and a terrible bout of diarrhoea that has persisted for three days. As soon as she is inside the Manyatta, which happens to be Mr Alio’s ‘consultation room’, the CHV inserts a thermometer on the child’s armpit. It reads 37.3°C, a significant drop from the previous day’s 38.2°C.
“The ORS (oral rehydration salt) and paracetamol that we gave her yesterday are working,” announces the CHV, smiling. He advises Halima to continue administering the ORS and the paracetamol and notify her of the child’s progress.
Relieved and happy, Halima leaves the room, making way for Fatuma. A conversation between Fatuma and the CHV ensures as soon as she is seated.
“My child is not feeling well,” says Fatuma in the local dialect. “She has diarrhoea, she has been vomiting a lot and she feels very hot.”
Upon inquiry Fatuma informs the CHV that she has been experiencing the symptoms for the last two days. The CHV takes the baby’s temperature – 37.4°C as per the reading, after which he tells the mother that the baby will need to be put under ORS, a powder mixed with water and used to treat dehydration as result of diarrhoea and some zinc tablets and paracetamol to treat her condition.
A respected member of the community, whose selection criteria involves an endorsement by the village elders, we asked Mr Alio why he does what he does: “I do this to help my people. We don’t have a health facility nearby but people need health services. I do not have any specific day or time for this work, even if you call me late in the night I will come to you.”
Mr Alio explains to the team from Save the Children who are on a routine field visit that diarrhoea cases are on the rise as a result of lack of water due to the ongoing draught. Still, communities in this arid north-eastern part of Kenya face many public health challenges as a result of water and food scarcity, distance from health facilities, and the nomadic culture. But delivery of care through CHVs can increase coverage of specific treatments ensuring that children in poor rural communities do not die from preventable and manageable childhood illnesses such as diarrhoea, malaria, pneumonia and malnutrition.
Save the Children in partnership with Mandera County Department of Health is implementing an integrated community case management (iCCM) programme to treat common childhood illnesses like diarrhoea, malaria and malnutrition for children aged between two months and five years at household and community levels through a chain of 40 CHVs in 25 selected villages across Mandera West and Banissa sub-counties. The project, which is now one year old, is funded by Hyundai Motor Europe.
Apart from training, the CHVs are provided with lifesaving drugs such as ORS and paracetamol. What’s more? Once every month, community health volunteers are joined by a team of government health care providers from a neighbouring health facility in an integrated health and nutrition outreach programme also funded by the iCCM project.
During our visit in Gesrebki village for instance we met a team of health care workers from nearby health facilities offering health services to mothers and babies under a tree. Humphrey Yator, a nurse based at Eymole Health Centre, administered vaccines to children while Abdihashim Yusuf, a nursing officer based in Derkale Health Centre, attended to sick mothers. Yusuf’s colleague Khalid Ahmed, a nutritionist by profession, was screening children for malnutrition assisted by Hussein Ajawa, the designated CHV for this village.
At the end of the day, the report by Ahmed, the team leader, spoke volumes of the need for such an outreach programme. For instance, there were 59 children screened on the day out of which two were found to be severely malnourished, seven were moderately malnourished and 12 were given vitamin A supplement. Consequently, out of 27 mothers screened – both pregnant and lactating— eight were found to be malnourished. Nurse Yator immunized 13 children and 9 ANC mothers while Yusuf treated 34 patients (10 children and 24 mothers) for minor illnesses.
“These outreaches have really boosted service delivery of health facilities. In particular the outreaches have improved two things: hospital coverage and immunization score,” says Mr Yator.
 The integrated health and nutrition outreaches are health services conducted by skilled health care workers with support of CHVs undertaking community mobilization, community level screening and referral of complicated cases for management. Hard to reach communities with no functional health facilities are reached with essential primary health care services (immunization, treatment of illnesses, ANC, nutrition services) on monthly basis.