In the dusty heat of the midday sun, a group of women gathers in the shade in Kolda, southern Senegal. The reason for their meeting is held in their hands - each one carries a healthy newborn child, shrouded in a rainbow of colourful fabrics with only their sleeping faces visible. “We are waiting for Coumba!” they inform us happily.
Coumba Diassy is a community health volunteer, designated by the villagers to teach, assist and monitor the health of new mothers and babies as part of the PINKK project - a ground-breaking initiative to scale up nutrition, strengthen local health systems, and support income generation in some of Senegal’s most vulnerable communities, particularly women and children.
Launched in December 2015 under the leadership of Nutrition International (NI) and funding from the Government of Canada, the Integrated Nutrition Project for the Kolda and Kedougou Regions has been working to improve the lives of 5550 households, using an innovative, multi-sectoral approach which tackles the varied causes of malnutrition on all fronts.
Community ownership of nutrition and health activities is one of the defining features of PINKK, and that’s where health volunteers like Coumba are starting to attain visible results, serving as a link between remote villages and health information and delivery.
With health clinics and hospitals located up to 40km away, few people in the village had the capacity and information to access them. Transport by motor bike or horse-cart along unpaved roads is arduous and expensive; in the rainy season, many roads are flooded for months on end. The impact on mothers and children was especially severe – the area suffered one of the highest maternal and infant mortality rates in the country, with treatable illnesses and malnutrition major contributing factors.
In response, PINKK has brought health delivery directly into to the community by training and equipping 2,800 community health workers, nurses, midwives and local health professionals to implement a network of maternal and newborn health and nutrition packages.
The results speak for themselves. Child mortality rates have fallen from 71 ‰ to less than 45‰ since the start of the project.
Today, Coumba has come to teach a group of 20 young mothers about best practices in newborn care. Using an illustrated manual, she takes them through the importance of exclusive breastfeeding and hygiene practices. She explains the importance of iron and folic acid tablets and makes sure they take them. If she spots instances of poor health in either mother or child, she is able to refer them for further treatment and monitoring at local health posts.
Coumba also ensures that all newborns attend the growth monitoring sessions coordinated by World Vision Senegal, one of PINKK’s key implementing partners. One of the reasons behind PINKK’s success lies in bringing on board a range of development partners, thereby harnessing the greatest complementary expertise required to attain results.
Children up to the age of 24 months are assessed monthly to ensure that they are receiving the nutrients they need to grow.
“Growth monitoring is a crucial platform for promoting nutrition at the community level,” explains Cheikh Tidiane Samb, Regional Nutrition and Public Health Coordinator at Nutrition International. “It allows us not only to monitor closely the growth of children, but also to promote good nutrition practices through one-on-one interviews with mothers, cooking demonstrations, and verification of compliance of children’s immunization records. Community health workers are also able to provide related services such as routine vitamin A supplementation, deworming, fortification of domestic food, community management of diarrhea, and to refer any children showing signs of under-nourishment or illness for further treatment, ensuring that cases do not become severe.”
Thanks to PINKK, mothers and children are enveloped in a full circle of care and information to ensure no one slips through the cracks, no matter how poor. 95,685 women and newborns in Kolda have been reached by the project to date.
Towards this end, PINKK has also harnessed informal practices and traditions to ensure greater uptake of health interventions, including community radio and social circles for pregnant women. Older women and grandmothers were also identified as playing a key role in the health of young families, and in respect of their traditional status, PINKK created grandmother associations who received training and information on health and nutrition.
“In our village many grandmothers take care of children since parents are busy working, that’s why we are happy that the PINKK project has trained us” says Fatoumata Kande, who has 18 grandchildren. “Since the PINKK project has started, I see fewer children getting sick.”
Grandmother associations meet regularly in Kolda to share knowledge and experience, and pass these lessons on to younger women. Bringing the entire community onboard in caring for mothers and children is key part of the project’s sustainability.[nm1]
“I am very happy with my work because I have seen people feeling better since PINKK started” says Coumba, “good nutrition will help the children in our village achieve a good future.”
“When I walk through the village I feel proud. People come to me to ask questions and make tea just to talk to me.”
PINKK’s low cost, community-based solutions can be used as a model for other communities faced with similar challenges for pregnant women and their newborns.