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Child Survival in Kwale, Kenya: PLAN International adopts a holistic approach

What do malaria nets, water cisterns, vegetable gardens, vitamin A supplements, second hand clothes and surgical gloves have in common? At first glance not much at all, but in reality each one plays a fundamental role in promoting healthy behaviors among children and adults. In a country where malaria is still the number one killer, followed by pneumonia, diarrhea, tuberculosis and HIV/AIDS, child survival is a challenge that must be understood in a wide context. PLAN International recognizes that child health depends on many other factors, like a clean environment, balanced nutrition, community mobilization, access to education and psychological as well as physical well-being. This is why child survival programs supported by PLAN go beyond a strict curative approach to embrace a whole range of services and activities, promote inter-agency collaboration and improve existing health system.

In the southern coast of Kenya, in the Kwale district, the child survival projectfunded 75% by USAID and 25% by Childreach, US member of PLAN Internationalaims to significantly reduce child morbidity and mortality by 2003. "Kwale is known to have the worse child mortality rate in the country", explains Dr. Laban Tsuma, Child Survival Project Coordinator for PLAN International. "With a child mortality rate way above the national average: 189/1000 compared to 130/1000, the government has made child survival a priority". According to PLAN staff in the field, there are several reasons why the child mortality rate is so high in Kwale. Among these are the lack of public health services compared to the size of the population and the fact that 70% of the people still live below the poverty line. "The token payment required to attend a public health facility is unaffordable for many who live here, thus traditional healers are more accessible than the regular health care system but unfortunately they do not always dispense the right kind of treatment", explains Dr. Tsuma.

The Kwale project is based on what is known as the Integrated Management and Childhood Illnesses (IMCI) approach. In Kwale this approach focuses on addressing four main health issuesimmunization, malaria, sexually transmitted diseases and HIV/AIDS, and pneumoniaby adopting an integrated approach to health care prevention and treatment. This approach requires the establishment of an empowered and self- sustaining community based health care system, featuring Community Health Workers in every rural village that have strong links to Ministry of Health service providers. Community Health Workers educate mothers and families on how to care for their sick children, teach them how to recognize danger signs and increase a sick child's chances for survival. The community health worker is the link between the village and the health clinic.

One of the most interesting features of the Kwale project is the connection between health care and income generating activities. Insecticide dipped malaria nets are made by trained tailors from the community as an income-generating project to replenish the supply of drugs given to Community Health Workers. A health clinic/dispensary covers about 10,000 people coming from 10 to 15 villages. Each village has a Village Health Committee whose responsibility is to supervise the work of 3 to 4 Community Health Workers, collect the money from the sale of malaria nets and use it to buy basic medicines and supplies for the community health kit. A standard health kit contains malaria pills, an all purpose antibiotic, paracetamol, Vitamin A supplements, tetracycline eye ointment, oral rehydration salts to treat diarrhea and a set of gloves to avoid direct blood contact. Nutritional gardens provide supplementary food for widows, orphans and other needy families. The surplus is divided among the families that work in the garden and sold as an additional source of community revenue.

By Beatrice M. Spadacini Public Affairs Manager PLAN International USA