A. KEY STEPS TAKEN FOR THE IMPLEMENTATION OF APPROPRIATE HEALTH INTERVENTIONS ON BOBI GRAZING RESERVE, NIGER STATE, NIGERIA
1. We Identified the Local Government Areas, Mariga and Mashegu, and wards where the reserve communities are located.
2. There were no on-going interventions provided by WHO in these reserve communities.
3. We liaised with Malaria consortium (grantee on RACE,) to find out if they are providing intervention in the Niger State reserve to avoid duplication. They were not.
4. We assessed the total population of these reserves and the target population, children up to 5 years of age and pregnant women. We found the following:
225 pregnant women
1,420 under 5’s
Total population 10,645
5. We visited the Federal Ministry of Health and received authorization to train women on the reserve to be Community Resource Persons.
6. With the reserve leaders, we mobilized the communities by sensitizing and creating the appropriate awareness around the interventions that will be provided.
7. Since the reserves are remote communities, integrated community case management of childhood illness, promotion of key household and community practices and hard-to-reach interventions will be the most appropriate interventions for impact.
8. We identified functional Primary Health Clinic’s (PHCs) nearest to the communities and potential community resource persons that reside within the community that can read and write for training and provision of commodities to commence case management of sick under five children as well as promote the key household practices. We found NO women on the reserve who could read and write.
9. The women who had been chosen by reserve leaders for the training were immediately placed into an on-going literacy course, taught by three teachers working for Schools for Africa and living on the reserve. These teachers will also be trained as supervisors to the trainees, to provide supportive supervision and ensure the quality of care provided by these women. The women were given their first, one-month literacy course, with good results.
10. Health training will also be in given in small segments over the next few months, to ensure complete comprehension and ability. Supplies and commodities will be provided when the Health Team instructors are confident in the trainees’ abilities to provide care in their communities.
11. The trainees will be supervised weekly and monthly for case observation, mentoring and data collation to ensure the quality of care.
12. There will be regular reviews of the intervention to assess outcome and impact.
13. Two health personnel from Mariga Local Government Health Team, who have previously trained and are supervising Community Resource Persons OUTSIDE of the reserve, have been engaged to train the target, reserve women and the supervisors, and to do follow up. Their names and qualifications are as follows:
a. Hauwa Shehu, Health Educator Mariga LGA.
- Higher National Diploma in Community Health, University of Ilorin 2013
- Diploma in Community Health, School of Health Technology, Minna, Niger State, 2007
- Secondary School Certificate Maryam Babangida Science College, Minna, Niger State, 1992.
b. Isah Shehu, Health Educator Mariga LGA.
- Higher National Diploma in Community Health, University of Nigeria Teaching Hospital Enugu, Enugu State, 2015.
- Diploma in Community Health, School of Health Technology, Tungan Magajiya, Niger State, 2007
- Secondary School Certificate Gov’t Science College, Kagara, Niger State 1997
B. FIRST WEEK TRAINING OF COMMUNITY RESOURCE PERSONS, BOBI GRAZING RESERVE, NIGER STATE, NIGERIA APRIL 30, 2018 – MAY 4, 2018
PRESENT THROUGHOUT THE WEEK WERE: twenty-three women, both Fulani and farmers living on the reserve.
Three Schools for Africa primary school teachers, Christian teachers, working on the reserve: Rev. John Raji, Faith Tunde and Hauwa Aiki.
Two Mariga LGA Health Team instructors: Hauwa Shehu and Isah Shehu.
Rev. Phyllis Sortor, Director Schools for Africa
Each day, before and after the session, we prayed, as a group, that God would bless and provide for the needs of the program, the women and their families. The three Christian teachers continue to have daily, close contact with the trainees.
- Importance of environmental cleanliness
- Personal and family hygiene
- Signs of illness
- Review of Day 1 topics.
- Definition (watery stools more than 3 times)
- Causes, (dirty food, water.)
- Medical intervention: rehydration, how to prepare and contain the ORS.
- When to treat, when to refer.
- Medication – Amoxicillin. Quantities to administer and length of treatment.
- When to treat, when to refer.
- Review of Day 2 topics.
- Rapid test
- Treatment, medication
- When to treat, when to refer.
- Care of umbilical cord of newborns.
- Women were asked what their experiences were.
- They were then instructed in the correct procedure.
- When to refer.
- Danger signs to look for in cases of diarrhea, cough, malaria, and care of umbilical cord. These were listed on the board and explained in detail. Women copied the list into their notebooks.
- Review of Day 3 topics.
- Description of forms to be used: patient intake card, referral forms, patient register and record of drug dispersal. Trainees were informed that until they could fill these forms correctly, they would not be given the approval to begin. Supervisors, (John Raji, Faith Tunde, and Hauwa Aiki,) were given the responsibility of working with the trainees until they fully understand, can read and complete the necessary forms.
- Trainees were told to exchange phone numbers with both their instructors and supervisors, for support and emergency intervention. If they don’t have phones, to buy them immediately.
- Role play. Women were directed to practice how to receive a patient, ask and look for symptoms and recommend treatment. There was enthusiastic participation all round!
- Review of Day 4 topics.
- The instructor, Hauwa Shehu, continued practical role play with the trainees, with close supervision, instruction, correction, etc.
- The instructor, Isah Shehu, worked with the 3 teachers/supervisors on a full understanding and use of the forms – patient’s card, referral forms, patient register and log of drug dispersal.
- Isah Shehu explained the supervisors’ responsibilities: weekly availability and meetings with the trainees, monthly meeting with the instructors and trainees to evaluate all records and verify drug dispersal. The supervisors will inform the Director of drugs needing to be restocked.
- The Director met with the instructors and supervisors and arranged for 3 weeks of further training of the women in understanding and filling the forms. After this time, the trainees will be evaluated for readiness to begin as first responders to the three medical conditions, diarrhea, cough and malaria, and care of the umbilical cord. Those who are ready will be given a medical kit containing the necessary drugs and an id card, and be given authority to begin. Those who are not ready will continue more training.
- The Director was instructed to buy 500 of each: Rapid Tests for Malaria, Anti-malarial drugs, O.R.S with Zinc, Amoxicillin and Paracetamol, in preparation for the upcoming rainy season when malaria is so prevalent.
The next week of training for the entire group is scheduled for September, 2018.