Posted by: vblaser | 08/31/2009

Integrated Child Health Program Launched, but With Challenges

GHC Policy Communications Coordinator Vince Blaser is traveling in Zambia and Tanzania to visit member programs and report on policy connections. This is the second of his reports.

LUSAKA, Zambia – Catherine Mukuka, Josephine Nyambe and their colleagues at the Infant and Young Child Nutrition Project (IYCN) have big plans when it comes to training community health workers and volunteers like Idah Mwansa – but they are still waiting for some of them to get off the ground.

When I traveled today with Nyambe to the Kanyama Health Centre just outside Lusaka, the need for one of the crucial components of IYCN’s plans was quite clear: training community health workers in infant and young child nutrition (and subjects beyond) are of critical need.

Many GHC members and other partners are involved in IYCN across the five (and expanding) countries in which it operates – including PATH, CARE, the Manoff Group and University Research Co. In Zambia, PATH takes the lead and is being supported by University Research Co. and others. According to its latest annual report, IYCN Zambia provides technical assistance to the Zambian Ministry of Health, USAID and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to “integrate nutrition counseling and targeted supplementary foods into clinical services at PMTCT clinics and child health services.”

Today, I looked at IYCN’s training programs for health providers and community health workers in infant and young child nutrition counseling in clinical and non-clinical settings. Mukuka and Nyambe wanted me to see the clinic in Kanyama because this community has really jumped at the chance to undertake the trainings.

IYCN supports one week-long training sessions – the Lusaka version being held at Zambian-based GHC member Kara Counselling and Training Trust. Trainers then identify top trainees that the program can approach to become trainers themselves, Mukuka said. This approach has taken off in Kanyama – nearly 100 community voulunteers have been trained in the program since it began last year, including Mwansa.

Now, the focus of this program is to train workers and volunteers to teach people about proper nutrition “within the context of HIV.” Ostensibly this is because some of the funding comes from PEPFAR. Aha, a potentially good test case to see how President Obama’s new comprehensive global health strategy could play out.

Nyambe said that the program is working with clinics that are providing PMTCT services but added that clinics such as Kanyama do not have a differentiated unit, so the trainings are given to workers who provide the full range of maternal and child health services. It was clear to me while walking through the clinic that the availability of such training for the workers and volunteers here certainly is helpful.

I talked with a couple of the dozens of pregnant women who had been waiting up to seven hours to be seen. Elita Zulu, 21, was waiting for her second visit to the clinic for her first pregnancy. She said she learned of HIV prevention and proper nutrition practices from the staff and volunteers at the clinic – invaluable lessons made even more invaluable because Zulu said she has been able to use skills she learned as a peer counselor in school to disseminate the information to others.

This integrated work and focus on prevention is exactly the sort of thing the Obama Administration has said they would like to see more of. Moreover, IYCN seems very much in line with the Zambian Health Ministry’s plans on nutrition, and Mukuka is working with the Agriculture Ministry on such items as a recipe book of traditional Zambia foods. So what could be missing? Well, I certainly do not have the full answer to that question, but two items seemed to pop up.

The first is lack of adequate health workforce. The Kanyama clinic seemed to provide good care to its patients, but the small staff is overwhelmed by the hundreds that visit the clinic each day. Volunteers help out tremendously – some working basically full time – but Sister Kasonde, head of outpatient services at Kanyama, said they would like to pay the volunteers something for their daily efforts. According to Mukuka, the human resource constraints that exist in the health delivery system at places like Kanyama lead to counseling often taking a back seat.

The other item is bureaucratic holdups and/or lack of resources. Mukuka said she would like to link information and training provided by IYCN with child health programs provided at monthly government health monitoring posts. There are also plans for expansion of male involvement and more programs such as community radio and dramas.

It was certainly interesting for me to see a program that just began in earnest last year and has big plans for the future. Tomorrow, I am going to see a site run by a long-standing, major USAID program in Zambia – the RAPIDS program led by GHC member World Vision.

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