USAID initiative brings rural health care closer to home

In Senegal, trained volunteers detect and treat malaria, leading to improved health.

The annual rainy season in rural Senegal brings a blessing – and a curse. Every drop is precious to the country’s farmers, but rains also form breeding pools for malaria-laden mosquitoes. Tens of thousands of Senegalese fall ill, and thousands die every year from the disease. Young children and pregnant mothers are particularly vulnerable. In the immense, sparsely-populated collectivity of Dialocoto in southeastern Senegal, malaria hits hard. Dialocoto has only one professional health worker, a nurse, to serve the health care needs of 14,000 residents spread among 50 villages in a collectivity larger than the state of Delaware.

For many ailing villagers in Dialocoto, a trip to the nurse is an exhausting and expensive ordeal entailing long trips by foot and animal-drawn carts over muddy footpaths and roads. Given such barriers to access, residents needed health care closer to home.

In June 2002, Dialocoto’s rural council, community organizations, health committees, and nurse approached USAID’s decentralization and local governance program for assistance in carrying out a plan to fight the annual wave of malaria cases during the rainy season. They proposed to train community health workers to promote the use of mosquito nets in Dialocoto’s villages, and to detect and treat minor cases of malaria, before residents became seriously ill and had to seek professional care. USAID responded to Dialocoto’s demand by hiring a Senegalese doctor, specialized in malaria prevention and care, to work with the leaders to refine their strategy and evaluate training and material needs. Knowing that one key to the success of the initiative would be the transparent management of medical supplies and proceeds generated by the sale of nets and medicine, USAID helped the collectivity define clear management procedures.

Dialocoto’s council then submitted a proposal to implement a strategy to fight malaria in half its villages. With USAID funds, the community paid for technical and management training activities, educational brochures on malaria, mosquito nets, disinfectants, and medicines. Given the positive results of the first two campaigns, USAID granted Dialocoto more funding in 2004 to extend activities to its remaining 25 villages.

By identifying and treating minor cases of malaria, trained village health workers helped reduce the number of patients who needed to be seen by the nurse from 2,082 in 2001 to 1,234 in 2002. According to Dialocoto’s Nurse, Ibrahima Seck, the number of serious cases of malaria also dropped sharply.

In 2000, Awa Mané, a housewife from the village of Taboto, 50 miles from Dialocoto, had lost a baby and nearly died herself from childbirth complications after being evacuated from her village to the regional capital of Tambacounda. When she became pregnant again in 2002, she visited the new village health worker who counseled her to sleep under an insecticide-treated mosquito net and to make periodic pre-natal check-ups with the nurse. This time she gave birth to a healthy boy, in her own village.

“Malaria and the long distances between our village and doctors’ services are the roots of the difficulties of pregnant women in Taboto. But thanks to the health worker placed in the village, there are fewer evacuations of women to Dialocoto and Tambacounda now,” says Mrs. Mané. “We don’t feel the absence of the doctor as much because we have advice on health matters and medicine. In each family compound, we have nets to protect us from mosquitoes.”

The prevention and early detection and treatment of malaria had important economic benefits as well, saving villagers time and money previously spent on transportation and treatment, and allowing them to tend to the fields from which they derive a livelihood. Between 2003 and 2004, Dialocoto’s success in combating malaria inspired 13 other collectivities supported by USAID’s governance program in other regions of Senegal to develop and implement similar initiatives.