This week, I had the opportunity to finish some of the work started by the previous volunteer at my site. There was room in a grant that she wrote for one more round of Village Health Worker (VHW) and Community Birth Companion (CBC) workshops for 14 of the surrounding villages as well as my village. This is the 8th workshop held since last March, with topics ranging from malnutrition and diarrhea, malaria prevention and pneumonia all the way to warning signs during pregnancy and exclusive breastfeeding. For the last workshop, the participants chose to discuss Family Planning. There are a multitude of family planning options here, but their use is culturally intertwined and therefore usually warrants a conversation with a Community Health Worker. These workshops are run by the Community Health Nurses (CHN) and the Officer-In-Charge (OIC) of the clinic in my village. If you think I just spit out a bunch of acronyms, it’s because I did. Let’s break it down.
The Ministry of Health is a government organization that is in charge of all health care activities in The Gambia. The Minister of Health is appointed by the President and oversees all activities. There is an incredible network of Community Health Workers, mostly at the village level, that work on health promotion throughout the country. Some statistics:
Total Hospitals: 6
Major Health Centers: 8 (There is one of these 11K from me, on the road. Any referral that can’t be seen in our clinic is sent to the Major Health Center)
Minor Health Centers: 16
8-10% of the GDP is delegated to health Usually each visit is 25 Dhalasi (roughly 50 cents)
Under the Minister of Health we have the Director of Health Services. This person oversees all Community Health Workers, starting with the Community Health Nurses.
Community Health Nurses go to school for two years and primarily work in health promotion. Their positions are very similar to that of a Health Peace Corps volunteer. They supervise Village Health Workers and Community Birth Companions, evaluate patients and refer them to clinics. The CHN in my village was one of the main organizers of the workshops. Community Health Nurses usually cover anywhere from 7-10 villages, and never have an “off” day. People are always at their compounds asking for referrals or asking them for medicine at the shop.
Pregnant = ndaikumba = (Women DO NOT like when their pregnancy is pointed out. They will often deny it)
Family Planning = fankanta
Malnourished = lonpon
Workshop = jangale
Each region has specified Public Health Officers that go to school for three years and primarily work in clinics. They administer immunizations, give health talks, and enforce Public Health law. You usually see PHOs at the RCH clinics in each village. RCH stands for Reproductive and Child Health, and once per month they have a clinic day dedicated to Children under 5 and pregnant women. The children are weighed and assessed for malnutrition, the women are counseled, and immunizations are administered. All Community Health Workers work at the RCH Clinics, and they usually let me weigh the babies.
Village Health Workers are a designated member of the community that treats wounds, educates the community, and refers patients to clinics. VHWs are unpaid and are volunteering their time for their community. However, sometimes the VHWs are uneducated. Hence the importance of workshops and other educational opportunities for them.
As well as a VHW, each village has one or two Community Birth Companions (CBCs). These were formerly named Traditional Birth Attendants, but the government is pushing for births at clinics, and therefore changed the title appropriately. CBCs visit pregnant mothers, give advice, and help the woman to a clinic when she is in labor. Then they visit the woman several times after the child is born. Sometimes, CBCs are called too late and need to assist with the delivery. As with the VHWs, they are volunteers and often haven’t been formally educated.
A new Public Health initiative from the government of The Gambia which I think is awesome is called Results Based Financing (RBF). This is a government funded program which rewards villages and individuals for positive health behaviors. RBF targets include, but are not limited to: women attending clinics during the first 3 months of pregnancy, children ages 3-5 attending the RCH Clinics, giving birth at clinics, and villages having dumping sites for waste. The RBF program will give out money to women at the clinic for coming for a check up. Additionally, each pregnant woman is given an antenatal card which serves as her payment for any health visit. The motivation for attending clinics early in pregnancy and until a child is at the age of 5 is catching on, thanks to this initiative as well as the work of the Community Health Workers.
We have some really incredible human resources as well as infrastructure in the field of Public Health in this country. I am not alone in the slightest in the work for a healthier village here on the North Bank. My village has a motivated CHN, a wise VHW, two effective CBCs, as well as the staff at our local clinic. Through continued education and by using the network of Community Health Workers in our area, we can tackle the health problems that are affecting our homes and families.