Breaking the rules for women's sake

NEW YORK (March 6, 2009)—Earlier this week, the UN issued a report on the impact of the world's financial crisis on the 390 million men, women and children living in sub-Saharan Africa. Reduced growth linked to the global economic downturn will result in a 20 percent drop in their per capita income. The very poorest families, living on $1.50 a day, will now have to make do with $1.20 to feed a handful of mouths.

The report predicts that an additional 200,000 to 400,000 children will die before they turn five—pushing the children's mortality above 10 million per year. Already, more than half a million mothers die each year from complications linked to pregnancy and childbirth.

More than ever, humanitarian organizations, seeing donations drop, have to do more with less. Concern Worldwide, the international relief and development agency, has been playing a leading role with its Child Survival Program (CSP) that is saving countless mothers' and children's lives in Africa, Asia and the Caribbean at a cost of just $5 per family per year.

"This is one of the best programs that I have ever seen in my 25 years of experience," said Dr. David Pyle, an independent public-health specialist who recently evaluated the program in Bangladesh.

Benefits for women

At the heart of CSP lies a radical departure from the traditional model of delivering healthcare to woman and children in underdeveloped nations. "We broke the rules," said Michelle Kouletio, Concern's Child Survival and Health Advisor: "instead of making mothers take their sick child to a health care facility, we bring basic health care to the household level, saving mothers' time and dramatically increasing the numbers of children treated for basic illnesses." The unique approach puts women in the driver's seat in tackling the deadly but highly preventable diseases that take the lives of so many of their children every year—measles, malaria, diarrhea and pneumonia. "The approach develops their skills and gives women a voice that traditionally was unheard in many cultures," said Kouletio.

How it works

For decades, a mother in Rwanda, for example, had no choice but to bring a sick child to the nearest health facility for care—a hospital or center hours away in most cases. The trip would force her to lose a day's work and neglect house work and the other children in the home.

The burden of such a journey would discourage many, while stubborn beliefs in natural medicine also kept many mothers from seeking proper medical attention. For example, faced with a child suffering from diarrhea, many mothers would stop giving the child fluids—the very opposite of what should be done—causing severe dehydration.

In developing the community-based model, Concern workers considered all the locally available resources and stakeholders and began focusing on them as one team—which can include health providers, volunteers, neighborhood health committees, teachers, community-based organizations, social and religious leaders, government officials, as well as traditional health providers. "It took quite some time to get all of these groups talking and listening, but the results were profound," said Kouletio.

Next Concern began investing in the education and training of the volunteers. Once fully prepared, the volunteers were outfitted with a sturdy wooden box, containing $100 of critical supplies such as artesunate combined treatment for malaria, rehydration salts and zinc to treat diarrhea and dehydration, a timer to measure intervals between a child's breaths to diagnose pneumonia and antibiotics to treat it, water disinfectant, and more. In one fell swoop, the homes of volunteers—endowed with new prestige thanks to their training and equipment—became first-aid posts for their neighborhoods.

Success

The results have been eye-opening. What began as a program targeting 73,600 mothers and children in two towns in northeast Bangladesh has been successfully scaled up and is now available in seven towns, reaching almost 320,000 women and their children.

In Rwanda, CSP began in a remote rural area, serving 59,000 people. In the last few years, CSP has impacted 300,000 children, 20 percent of all Rwandan children under five. In 2007-8, more than 180,000 children were treated for malaria by community health workers.

In Haiti, CSP took the lead from the experiences in Bangladesh and is focusing on five violence-ridden slums in the capital city of Port-au-Prince. Already, 350 youth volunteers have received basic training in treating diarrhea and in alerting families to other health risks.

Overall, in less than a decade, Concern's CSP has provided care to 1.2 million mothers and children and saved an estimated 4,500 children from certain death.

One life saved was that of six year-old Ndayisaba of Nyabiyenzi in rural Rwanda. Finding him struggling to breathe one day, his mother, Francine, turned for help to Arivera Mukantagara, a 27 year-old mother of two chosen by her neighbors to become a community health worker. Using here respiratory timer, Arivera determined that Ndayisaba had pneumonia and treated him accordingly. "I trust Arivera, because I know she was trained," said Francine; "my child could have died on the road to the health center."

What's next

The figures speak for themselves—the model clearly works. And Child Survival Program's community-based approach is gaining traction. Last year, the US Agency for International Development (USAID) awarded Concern a $1.6M grant to expand this program yet again. Work in Burundi will begin in earnest in 2009. The US government has also recently announced an increase of 11 percent in funding available for Child Survival Programs.

What's more, especially in light of their own changing circumstances, donors are paying attention to the kind of programming that allows NGOs to achieve so much for relatively little in the poorest countries in the world. Humanitarian agencies themselves are joining forces to help scale up the program to reach even more people—as is the case today in Rwanda, where Concern US is leading a consortium of three American NGOs now focused on a common goal.

Times are tough around the world, especially for the poor. But there is a silver lining as circumstances spur Concern Worldwide along with its fellow NGOs to become ever more efficient in coming to the aid of the world's most vulnerable men, women and children.

Concern works in 28 countries around the world, including 17 sub-Saharan African nations, and benefits some 12 million people. The organization's goal is the ultimate elimination of extreme poverty and the reduction of suffering in the world's poorest countries. The organization's programs focus on emergency relief and long-term development work in the areas of health, HIV and AIDS, education and livelihoods.

For more information, please contact: Joop Koopman 212.557.8000 Joop.koopman@concern.net