Compendium of Christian
Projects Addressing the Diseases of Poverty
Project/
program name:
Country: Mozambique
Church or
denomination:
World Relief Corporation (WRC) is the international relief, development and
refugee services arm of the National Association of Evangelicals, which
represents 50,000 U.S. evangelical Christian churches, more than 75
denominations and a service group of more than 20 million Americans through its
various affiliates.
Project
summary: Rated
as the neediest country on the 1994 International
Human Suffering Index, Mozambique has suffered from years of civil war and
difficult natural calamities. The Vurhonga Project is a five-year Child
Survival Program whose key interventions include immunization, diarrhea
control, nutrition, malaria control, maternal health and family planning. The
project serves the Shangaan people in southwestern Mozambique in the province
of Gaza. The target area includes the
districts of Mabalane and Guijį. All of the target aldeias (villages) in
Mabalane, and Guijį are rural with most clustered along the Limpopo River in
what is known as the "Limpopo Corridor".
Background/
History: World
Relief supports projects in 23 countries and the United States. Their purpose is to enable the evangelical
Christian church to meet the needs of poor and suffering people throughout the
world. It has worked in the Gaza Province of Mozambique for the 7 years prior
to this project and used this experience as well as lessons learned from its 6
other child survival projects to carry out a cost-effective and sustainable
program in Mozambique's Gaza Province. Initially, World Relief provided
emergency food distribution and an emergency water supply program in response
to the worst drought that has occurred in this century.
When the project began in 1995, Mozambique was
emerging from a long war in which much of the infrastructure had been
destroyed. The health needs of women and small children were enormous. The Mozambique Ministry of Health (MOH)
lacked the capacity to deliver basic health services to the rural areas. The
community priorities expressed by men and women prior to implementing the
project in aldeias in the proposed project district included lack of rain,
malnutrition, malaria, anemia, dysentery, lack of contraceptives, pelvic
inflammatory disease (PID) and scabies.
All community groups interviewed were enthusiastic
about implementing a health education project.
The Shangaan people have a proverb that affirms the importance of
prevention, "You must see the snake and kill it before it bites
you". Shangaan also values
cooperation. "It takes two thumbs
to squash a louse" is another Shangaan proverb that helped communities to
understand the value of the proposed project.
Goals: Reduce mortality and
morbidity of 31,764 children under 5 years of age and 23,513 women 15-49 years
through training of mothers in protective health behaviors, strengthening the
capacity of the Ministry of Health, and empowering communities to make
decisions, which protect the growing minds and bodies of their children.
Objectives:
1.
80%
children completely immunized by 12 months
2.
60%
children 0-59 mo. with diarrhea (in the last 2 weeks) who have received Oral
Rehydration Therapy (ORT)
3.
40%
mothers of children 0-59 months who give more food than usual to a child during
recovery (at least 1 week) from diarrhea.
4.
60%
children 0-35 months weighed in the last 3 months
5.
80%
mothers who receive rehabilitative nutritional counseling for children 0-35 months
not gaining weight
6.
35%
children 0-4 months exclusively breastfed
7.
50%
children 0-23 months treated promptly for malaria
8.
40%
mothers receiving at least one prenatal care checkup during the last pregnancy
9.
60%
women who have received at least 2 doses of tetanus toxoid
10. 15% women using modern
methods of family planning
Who does the
work? The Child Survival interventions are
implemented by volunteers and trained traditional birth attendants (TBAs)
living in the community. World Relief
animators assist communities to organize and select their volunteers and also
assist MOH to select practicing TBAs.
These volunteers, (1 per 10 families) along with the trained TBAs form
care groups. The care group structure
has been implemented successfully by the MOH in Gazankulu, South Africa. A care group functions as both a support group
for the volunteers and as a local health committee to solve health problems.
The role of the care group is to:
1.
Disseminate
health messages to members of the community (especially mothers)
2.
Record
progress on the project objectives and follow up on "at risk" mothers
and children
3.
Provide
peer support and motivation for the volunteers
4.
Create
an active group at the aldeia level that will be empowered by the end of the
project to take action when necessary to solve health problems in the community
Main
activities: When
a new intervention is to be introduced, the animators establish a
"training camp" near an aldeia where the animators are to be trained.
The proximity to the aldeias allows the animators to take the care groups into
the communities to practice their skills.
Training camps are cost-efficient because they avoid the high
transportation, lodging, food and facility costs of more conventional training
approaches. Animators normally visit
each of their 8 care groups (with 10-12 volunteers/group) at least twice a
month during the beginning of the project and once a month during the last 2
years.
Project animators train care groups and volunteers
to visit assigned families once a month to follow up on "at risk"
women and children. The health educator
trains animators and assists them to train their care groups. The Child Survival curriculum utilizes
highly interactive educational techniques focused on behavior change. Stories, drama, songs, games and discussion
questions are used to capture the mothers' interest and engage them in active
problem solving to remove the barriers to more productive health
behaviors. These educational sessions
are held weekly at the health posts, biweekly in the aldeias and at the monthly
mobile health team visits.
Food security is a major problem in the proposed
project area. World Relief addressed this problem by implementing a pilot
animal husbandry project in the first year of the program. This small animal
husbandry project bred and loaned female goats to poor families. After these goats give birth, the farmers
return the female goats to the project and keep the offspring. The project then breeds and loans the female
goats to other families. This enables
poor families to develop greater food security by providing them with animals
to sell when the harvest is not good.
Project staff will work with MOH staff to increase
its ability to manage its immunization program. Headquarters Child Survival personnel will train the project
staff in how to conduct 30 cluster random sample surveys, focus groups, and in
growth monitoring and nutrition rehabilitation, health information systems,
interactive learning techniques, curriculum development, community
participation techniques and evaluation techniques.
Monitoring and evaluation (known as M and E) and the
development of a health information system (HIS) were two major components of
this project. This was done both
internally and externally.
Expected
outcomes:
§
Knowledge
and Practices (KAP) Survey (3)
§
Animators
trained in diarrhea control, maternal care, Essential Program for Immunization
(EPI), nutrition, malaria control and family planning (19)
§
Health
volunteers trained in diarrhea control, maternal care, nutrition, EPI, malaria
control and family planning (1600)
§
TBAs
trained (45)
§
Care
Group members trained in family planning (70)
§
MOH
personnel trained (40)
§
Care
Groups established and functioning for at least 1 year (142)
§
Children
immunized (8550)
§
Consultations
received from HQ (6)
§
External
evaluations (2)
Results: During the course of the project the percent of the population
with access to a health post within 5 km increased from 55% to 92%.
With respect to malaria, the major disease of
poverty addressed within this program, the project achieved 89% of children
with malaria receiving treatment within 24 hours. This was above and beyond the 35% target set at the start of the
project. The mortalities due malaria in
children 0-5 years also declined from 63 during the peak month of March 1996 to
19 during March 1999.
Lessons Learned: The interventions selected for the project address the expressed
priorities of both the community groups and the MOH staff interviewed. Addressing felt needs is an important
strategy for ensuring sustainability.
Communities have few tangible resources due to the recent war. However, community members have
organizational skills, marketing skills and livestock care skills that can be
used to increase basic household income.
Furthermore, training volunteers and TBAs at the community level in
Child Survival Project are empowering the members of the community to make more
informed decisions in the future about their own health practices.
Funding and
other resources: This project was funded by USAID (75%) and WRC (25%). The church is another community resource. At
a meeting in Mabalane, church representatives expressed their interest in
recruiting volunteers from their congregations to do work within the community.
Further
readings or documents: N/A
Contact information:
Melanie Morrow.
WorldRelief Corporation
7 E. Baltimore street,
Baltimore 21202
USA
Fax:
(410) 347 0014
E-mail: mmorrow@wr.org
Field Contact Person:
Pieter Ernst
Child Survival Program Dir.
Mozambique
E-mail: pernst@wr.org