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In Nias, a beautiful holiday and surfing destination, infant and maternal mortality are significantly above national figures. It is SurfAid's mission to improve the health, well being and self-reliance of people living in isolated areas like Nias, using our "a hand up, not a hand out" philosophy.
Surprisingly, you actually don’t have to look very far to find remote communities in our ever-connected world. Just behind the palms of one of the world’s top surfing destinations are villages that are so off the beaten track that basic government services don’t reach them. No clean water, health services, education or electricity.
With the support of Footprints, SurfAid has been able the increase the quality of the local community health posts, the knowledge on healthy behavior and mother and child health, the health seeking behavior of community members, increase exclusive breastfeeding for babies, and establish nutrition gardens for remote communities.
All these different elements have contributed to a decrease in underweight of children under five, from 23% to 3%!
In this project, groups of community health volunteers work together with the local health department to deliver health messages on nutrition, hygiene and sanitation to their neighbours, focusing on at-risk households. They are our front line, receiving ongoing training and support from SurfAid staff. These health volunteers are the bridge between their own community and the community health services.
Monthly, a health service is run by the volunteers, where children under five and pregnant mothers receive basic health services. These include monitoring, weighing, immunisation and provision of health information. To help the volunteers give clear and correct health messages to families, it is very important that they have training and educational materials.
The basic monthly health service for pregnant women, mothers and children under five is run by health volunteers. Health and growth monitoring, immunisation and provision of health information are the main tasks. At the start of the project, the health posts didn’t have the most basic equipment to perform these tasks; weighing scales, measurement tapes and baby length boards, growth charts, tables etc. Therefore, the first step was to provide the health posts with these basic materials and to teach the health volunteers (kader posyandu) how to correctly use them and record the results. (see also “Increase coaching skills of health volunteers to support the parents in their communities”)
With the training and equipment available, the kader posyandu drastically increased their commitments and availability, from 11% of the health volunteers playing an active role in the health service, to 100%! This had an immediate impact in the service level. When assessed by the health department, all 6 health posts increased their quality level from level 0, the second highest level (as defined by the national government). The village midwives also received a midwife kit and the District Health Office ensured that the midwives and health staff are providing vaccine and medication during the monthly health service. With equipment in place, trained health staff available and knowledgeable active health volunteers ready to support, the visiting rate increased from 10% to 62%!
The visiting rate is important, as the health post provides the important monitoring service and health information. Higher visiting rates means that more women and children receive a health check and a bigger audience for health promotion.
The health volunteers are the front line workers. This project trained 42 health volunteers across 6 communities on mother and child health and specific coaching techniques by SurfAid staff and midwives. In remote areas the mode of delivery is usual very teacher driven, with very little room for creativity. The trining explored different ways of sharing knowledge, coaching and health promotion.
As a result, the confidence of the health volunteers drastically increased, as demonstrated through their ability to involve of all community leaders in the villages to support community health post activities, and to access budget from the villages! 4 out of 6 community health posts currently get supports from the village budget. This contributes to the sustainability of the quality of the health posts.
With the confident health volunteers in place, the quality of the health post increased, and the health promotion sessions for the community achieved remarkable successes.
6 village midwives were trained in a whole series of mother and child health topics so they could train the health volunteers in six remote villages. The volunteers and midwives then trained community groups; mothers and pregnant women, husbands and mothers-in-law. Approximately 180-200 people joined these groups every month. We cannot stress enough how important this is. People in remote areas have less formal education, and have very little access to information. Things that are so normal to us, like using a toilet, washing your hands after toilet use, are sometimes mind bowing concepts for a community. After one of the sanitation sessions, one community member spoke up and said that she never, ever thought about what could possibly be wrong with going to the river or garden to defecate. With the new knowledge on sanitation, bacteria transmission and the link to diarrhea she was immediately triggered into action, and build a toilet for her family…
Next to all sort of education sessions, SurfAid also supported community health volunteers and the village midwives to run monthly cooking classes. The cooking classes are a fun and very practical way translate knowledge on nutrition and child development into good practice. This helps parents or caregivers to prepare a varied menu of simple to prepare nutritious food with cheap, local available ingredients.