Since May, regional health staff, community members, NGO partners, and PCVs have been working together to stomp out malaria as part of Senegal’s Universal Coverage (UC) campaign in Senegal’s Louga region. The past several months have been packed with trainings, bed net distributions, media and awareness events all over the region, and I’ve gotten involved in this work in the Linguere health district, part of the Louga region and about 300 km northeast of Dakar, where I’m serving as an Environmental Education Volunteer.
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Universal Coverage in Linguere, Senegal
UC is part of the President’s Malaria Initiative; its goal is to provide a free long-lasting insecticide treated net (LLIN) for every sleeping space in the country, and to have those nets used every night by every person all year long. 2008 marked the first year of UC in Senegal, and 2013 is set to be the last; the Louga Region hosted the campaign this year. In preparation for the start of the campaign, Senegal’s Dakar-based team of PCVs whose work is dedicated to the country’s malaria program came to visit Linguere to help organize Volunteers’ district-wide strategy for coordinating with upcoming events. We developed a plan to work with area health administrators and other UC partners throughout the course of the campaign. Linguere Volunteers also applied for a grant through USAID’s Small Projects Assistance program. The grant would be designed to complement UC both by funding the last leg of transportation of bed nets to the sites for distribution, and expanding the communication and teaching aspects of the campaign.
At both regional and local levels, meetings and trainings were held in order for health administrators, staff, and volunteers to learn about the logistics of the program, what their roles would be, and how to fill them. Health Education PCV Elizabeth MacAfee and I attended these meetings, and collaborated with Linguere’s Chief of Medicine, Dr. Tidiane Thiam, and his staff to finalize our plan and start working. We also applied for and received the USAID grant, which would make up 3.93% of Linguere’s CU budget.
Local health volunteers then took a census of the area to count the number sleeping spaces in a household and how many usable nets were already in each household. I accompanied volunteers on visits to over 1,000 households in and around my host village. After the census was complete, the information was sent to a validation committee. Once the amount was verified, the required number of nets were transported to health facilities.
The National Malaria Control Program and UC implementing partners paid for nets as well as their transport to the 12 health posts in the district, and the USAID grant provided financing for nets to be moved from there to over 50 distribution points located away from those health posts. I oversaw the transportation of bed nets to 26 sites with one of the health district’s supervisory teams, led by the health district’s programmatic supervisor, Insa Ndiaye. Insa was a great work partner because of his extensive experience in the management and oversight of large-scale health projects, as well as high standards and thorough follow-through. Supervision involved ensuring the proper delivery of nets, labelling each with its owner’s name to ensure that it would not be resold, and teaching LLIN recipients how to care for and repair their nets. We also helped to fix problems such as miscommunication or disorganization. We communicated the UC history and goals and recognized all implementing partners and volunteers who helped make the distribution a success. All in all, there were 69,808 bed nets successfully distributed to Linguere district’s population of 114,273.
A Universal Coverage Campaign requires a remarkable amount of planning, logistics, organization, and teamwork amongst the National Malaria Control Program, implementing partners, health structures, Peace Corps Volunteers, and community health volunteers. NetWorks is a program from Johns Hopkins University Center for Communications and was the primary implementing partner of the distribution. They effectively assisted with transportation logistics, finance calculations, and the general collaboration strategy. Many PCVs coordinated with their local health posts and district hospitals to ensure the arrival of the nets and assisted with distribution efforts. I was consistently impressed with the level of cooperation and coordination by all parties.
Throughout distributions, and for two weeks after they were complete, the communication phase took place. Communication activities aimed to get the message out about what UC is, the importance and advantages of using nets, and to reiterate care and repair information. This was where the most incredible work happened …and the most fun! Health volunteers and staff worked together with NetWorks, radio stations, and other local partners to facilitate radio broadcasts and market day information-sharing events. Village meetings were also organized in cooperation with town and village leaders while town criers and traditional communicators led information caravans through more populated areas. Through all of these events, there was no shortage of music, dancing, and even singing popular songs with the lyrics changed in keeping with the theme of educating on malaria and bed nets.
In addition to participating in many UC-sponsored communication events, we were able to fund and organize two village-wide awareness-raising meetings through our USAID grant with the participation of the villages and Aquadev, a Belgian NGO working with other partners in the Linguere area on malnutrition and other poverty and insecurity issues such as malaria reduction. At these meetings, attendees were asked questions about how to use, care for, and repair their nets. Attendees also talked and sang about malaria prevention and watched net-use demonstrations. Youth and women’s groups performed skits about the importance of using nets and the impact that malaria is having in their communities. At the meeting in the village of Doundodji, one of Senegal’s national television networks, RTS, filmed the events and conducted interviews as a part of their coverage of UC in the Louga region. Throughout communication efforts, I took part in three radio and one television broadcast, traveled to 7 of 8 village awareness raising events, and accompanied the two information caravans in the district.
The results were encouraging; about 1600 people were reached during the communication events I attended, in addition to television and radio audiences. Not only was the local population reached during the communication phase, but because of national coverage of UC, people all over Senegal saw and heard from regional and district staff about the goals, objectives, events, and messages sent by the campaign. For instance, the “3T’s” slogan (Toute la famille, toute l’année, toutes les nuits) encourages every family member to sleep under his or her net every night of the year was widely broadcasted. I saw many community members who were excited to use their new nets and enthusiastic about doing their part to help prevent malaria by regularly and properly using and caring for their new nets.
As the communication phase wrapped up, volunteer health workers started a second door-to-door tour of the district; PCVs also helped with this work in their host communities. During these home visits, volunteers verified that homes received the correct number of nets, that they were properly hung, and clarified any confusion about the nets.
Evaluation and Follow-Up
Following the second round of home visits, I attended Linguere’s final evaluation meeting, which took place on June 29th. During this meeting, hospital staff reviewed the UC events, presented statistics, and gave feedback. Everyone was thanked for their hard work by district hospital and health post administrators as well as NetWorks representatives. Peace Corps was also recognized for its role, not only in this phase of UC, but as a founding force behind the campaign as a whole in 2008, when PCVs started gathering resources behind large-scale net distributions in the Southeastern region of Kedougou, where malaria has a big impact on the population. Although our grant only made up a small percentage of the UC budget in the Linguere district, it was rewarding to hear that UC partners are grateful for Peace Corps’ work throughout the history of the campaign, and that our role has continued to play a part in its success.
Post-UC, PCV Elizabeth MacAfee and I continued working with Aziz Ndiaye, who holds dual positions in the preventative health program with the Linguere district hospital and as a zone coordinator for Aquadev, and his supervisor Demba Diack who is responsible for the Linguere health district. Together, we developed visual aids and planned a series of lessons for women’s groups about identifying the signs of malaria, testing, prompt treatment, proper net use and care, mosquito density control, and neem lotion, a natural mosquito repellant. We taught 14 of these lessons, each with a separate group in the Linguere district, where we reached 438 women and 24 men. Aziz Ndiaye and Mame Abdou Coundoul, a volunteer health worker, have helped us facilitate lessons in Wolof-speaking communities while Demba Diack and Sadio Sow, another Aquadev zone coordinator, helped out at Pulaar-speaking sites.
Volunteer health workers present at each lesson have been charged with serving as resource people both informally in their communities, and by re-teaching information from our lessons in the future during Aquadev-facilitated meetings. Following these lessons, we held a 3-day training of local volunteer health workers in collaboration with Demba Diack and Diery Ba, a third Aquadev zone coordinator in the Linguere district, during which we trained 25 volunteer health workers and one elementary school director at three different sites in the Thiel area, over 60km from Linguere where health services and trainings are historically scarce. We also partnered with the local radio station to broadcast about our program, and held community mobilization events in each of the villages, which were related to both our trainings and the prevention of maternal and child malnutrition. Following trainings, attendees were provided with visual aids and materials to make neem lotion and asked to facilitate lessons in their communities. Similar to those we taught with Linguere-area women’s groups, these lessons will relay the information taught to the health workers during their trainings and are designed to promote an increased capacity for malaria prevention, diagnosis, and treatment in their communities.
Beyond Universal Coverage
In January, 6 months after UC wrapped up, routine bed net distribution is set to commence in the Louga region, which means that long-lasting insecticide treated nets (LLINs) will be available for 500 CFA (about $1) to anyone who visits a health structure for a consultation of any kind. Free nets will also be available to pregnant women who go to a prenatal visit. PCVs are planning to work with NetWorks and health staff.
The role of Peace Corps Volunteers has been instrumental in the Louga Universal Coverage Campaign. Throughout the distribution, Volunteers have built new partnership with NetWorks, Aquadev, and local health structures. I’m happy to have been a part of it all, and am excited to see what is to come. This collaboration has provided incalculable knowledge, great friendships, and work partners, and a whole lot of inspiration to do more to stop malaria.