Field Note June 07, 2018

Community Health Workers Can Mean the Difference


It’s just before 9am on Monday morning when Community Health Workers (CHWs) Justin and Hélène arrive to their post in the fokontany of Antafotenina. They unlock the front door of the thatched-roof building that serves as a community health post for the 1,800 people who inhabit the surrounding villages. Next door is a freshly-painted structure recently built by community members with materials provided by PIVOT to create a better-equipped space for health work. The building awaits its inauguration, a celebration which will mark the beginning of a new and improved space for Justin and Hélène.

Mothers and children are already lining up as Hélène and Justin situate themselves for a day of work, sweeping the floor, arranging equipment, and organizing paperwork. As CHWs, they were appointed by community leaders – Justin in 1999 and Hélène in 2001 – to serve as trained volunteers who provide the first line of care in Madagascar’s public health system. PIVOT works with the Ministry of Health (MoH) to ensure every CHW receives training in how to look for signs of the region’s most common killers, such as malaria and malnutrition, with a particular focus on children under 5. They are equipped each month with a stock of essential medicines that they distribute to patients at no cost when they come to this community health post seeking care.

In 2018, Justin and Hélène happen to be a married couple, and were independently named the two best CHWs in Ifanadiana commune, an assessment made annually based on the accuracy with which they diagnose, treat, and refer patients. Part of that assessment comes from observations made by PIVOT’s team of community health supervisors, who visit each community health post in the PIVOT catchment area – some as far as a several days’ walk from the paved road – to observe our CHWs in action on a monthly basis and provide feedback to ensure they are providing the highest quality of care. Justin and Hélène explain that they feel their work has improved since partnering with PIVOT, and they enjoy their jobs more after receiving critiques because they feel more confident that they are delivering the best possible care.

Hélène and Justin’s approach to work leaves no doubt that they are among the best. They manage each patient’s care with warmth and authority, soothing sick babies while providing mothers with thorough instructions on how to care for their children with the medicines provided.

Today, Hélène cares for the first few patients while PIVOT supervisors Erneste and Santatra observe. After she has finished her visit with 11-month-old Bryan, whose mother brought him in for persistent cough and diarrhea, PIVOT supervisor Santatra speaks quietly in the corner of the room with Bryan’s mother to verify that she understood the instructions she’d received about how to administer the medicines provided. She departs looking more relieved than when she arrived, equipped with a follow-up plan that ensures Bryan will be feeling better within the week.

Mothers nod in affirmation as Hélène and Justin matter-of-factly explain that their work never truly ends. They take three days out of each month to visit every household in their fokontany, actively seeking out children under the age of five showing symptoms of common illnesses, and making home visits to those who have been referred to to higher levels of care and returned home with a plan for follow-up care. In addition to making time for their volunteer health work, Justin and Hélène farm rice as their primary source of income, are parents to six children, and are known by the community to receive visits at their home from ailing patients at all hours of the night.

PIVOT is proud to partner with CHWs such as Hélène and Justin, whose patience and generosity can mean the difference between life and death for members of their community.