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Community Approaches to Child Health in Malawi: - CORE Group

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Build<strong>in</strong>g on previous successes <strong>in</strong> Rwanda and Mozambique, World<br />

Relief <strong>Malawi</strong> br<strong>in</strong>gs groups of pas<strong>to</strong>rs <strong>to</strong>gether (usually about 50 at a<br />

time) for tra<strong>in</strong><strong>in</strong>g <strong>in</strong> C-IMCI <strong>in</strong>terventions and <strong>to</strong> solicit their support<br />

for C-IMCI-related activities <strong>in</strong> the community. Work<strong>in</strong>g with pas<strong>to</strong>rs<br />

is a natural fit for the faith-based World Relief, which regularly partners<br />

with churches. Involv<strong>in</strong>g pas<strong>to</strong>rs has proved helpful <strong>in</strong> two ways: First,<br />

people often call on pas<strong>to</strong>rs when they or their children are sick. Pas<strong>to</strong>rs<br />

who know C-IMCI messages can refer cases of malaria, malnutrition or<br />

diarrhea and give families good advice. Secondly, pas<strong>to</strong>rs’ support for<br />

controversial practices, such as family plann<strong>in</strong>g <strong>in</strong> Rwanda, is vital for<br />

community acceptance. More generally, public endorsement of Care<br />

<strong>Group</strong> volunteers and their messages <strong>in</strong> religious and other forums lends<br />

credibility <strong>to</strong> the Care <strong>Group</strong> volunteers <strong>in</strong> the eyes of the community.<br />

<strong>Community</strong> networks, relationships and mediat<strong>in</strong>g groups (Care <strong>Group</strong>s,<br />

village health committees) become valuable community-based resources<br />

for other related efforts. World Relief saw evidence of this <strong>in</strong> three areas<br />

<strong>in</strong> <strong>Malawi</strong>: disaster response, <strong>in</strong>come generation and related health<br />

<strong>in</strong>terventions.<br />

Disaster Response<br />

After a drought occurred at the beg<strong>in</strong>n<strong>in</strong>g of the 2002 grow<strong>in</strong>g season,<br />

the M<strong>in</strong>istry of Agriculture estimated that nearly 2700 farm families<br />

(18 percent <strong>in</strong> specific geographic areas of the project) were without<br />

food. <strong>Child</strong> survival project staff assisted with nutrition surveys and<br />

other activities used <strong>to</strong> identify and select 3000 of the most vulnerable<br />

<strong>in</strong>dividuals <strong>to</strong> benefit from ration distribution. Beneficiary selection was<br />

carried out <strong>in</strong> collaboration with the M<strong>in</strong>istries of <strong>Health</strong> and Population,<br />

local village chiefs and Synod of Liv<strong>in</strong>gs<strong>to</strong>nia health staff. <strong>Child</strong> survival<br />

project staff and volunteers also assisted with monthly distribution of<br />

maize, maize flour, likuni phala and coconut oil <strong>to</strong> identified beneficiaries<br />

over a 5–6 month period.<br />

In March 2003, <strong>in</strong> the midst of the food crisis, a landslide obliterated<br />

more than 50 homes and caused 56 villages <strong>to</strong> be evacuated <strong>in</strong><br />

Liv<strong>in</strong>gs<strong>to</strong>nia, also part of the project area. Care <strong>Group</strong> volunteers<br />

conducted assessments, reported <strong>to</strong> the MOH, helped select beneficiaries,<br />

and distributed materials <strong>in</strong>clud<strong>in</strong>g blankets, dishes and food supplies, as<br />

well as chlor<strong>in</strong>e <strong>to</strong> ensure safe water supplies.<br />

Income Generation<br />

Pas<strong>to</strong>ral Care <strong>Group</strong>s <strong>in</strong><br />

Rwanda<br />

Work<strong>in</strong>g <strong>in</strong> Rwanda’s former<br />

Kibogora health district,<br />

World Relief recruited pas<strong>to</strong>rs<br />

from 11 denom<strong>in</strong>ations <strong>to</strong><br />

participate <strong>in</strong> monthly pas<strong>to</strong>ral<br />

care groups for C-IMCI. World<br />

Relief staff tra<strong>in</strong>ed 667 church<br />

leaders <strong>in</strong> family plann<strong>in</strong>g<br />

methods; these leaders <strong>in</strong> turn<br />

helped communities accept<br />

contraceptives. Contraceptive<br />

use <strong>in</strong>creased from 3 percent<br />

<strong>in</strong> November 2001 <strong>to</strong> 18<br />

percent <strong>in</strong> September 2005.<br />

This <strong>in</strong>crease was particularly<br />

notable because birth spac<strong>in</strong>g<br />

was not one of the project’s<br />

orig<strong>in</strong>al <strong>in</strong>terventions. Rather,<br />

teach<strong>in</strong>g on the <strong>to</strong>pic was<br />

added after other C-IMCI<br />

<strong>in</strong>terventions had been covered<br />

and <strong>in</strong> response <strong>to</strong> evident<br />

need.<br />

At the end of World Relief’s<br />

program, Kibogora <strong>Health</strong><br />

District ranked first nationwide<br />

<strong>in</strong> family plann<strong>in</strong>g coverage,<br />

for which the MOH awarded<br />

the district a certificate of merit.<br />

Pas<strong>to</strong>ral teach<strong>in</strong>g <strong>in</strong> Rwanda<br />

also helped people understand<br />

how AIDS is spread, and broke<br />

down barriers <strong>to</strong> car<strong>in</strong>g for an<br />

HIV-positive person <strong>in</strong> his or<br />

her home.<br />

In <strong>Malawi</strong>, World Relief has<br />

applied a similar approach<br />

by tra<strong>in</strong><strong>in</strong>g church leaders<br />

<strong>in</strong> C-IMCI messages and<br />

encourag<strong>in</strong>g them <strong>to</strong> play an<br />

important role <strong>in</strong> endors<strong>in</strong>g<br />

Care <strong>Group</strong> teach<strong>in</strong>g and<br />

activities.<br />

Care <strong>Group</strong>s have become trusted aff<strong>in</strong>ity groups for <strong>in</strong>come generation<br />

activities and have l<strong>in</strong>ked <strong>in</strong>dividuals with<strong>in</strong> the project area with local<br />

18 <strong>Community</strong> <strong>Approaches</strong> <strong>to</strong> <strong>Child</strong> <strong>Health</strong> <strong>in</strong> <strong>Malawi</strong>

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