Keneya Ciwara District Level Health Project Striving for Excellence

• Program Overview
• Objectives
• Outputs
• Results

PROGRAM OVERVIEW

Begun in October 2003, this five-year project is an integral part of the Malian Government Health Program and is funded by USAID. Keneya Ciwara is being implemented in seven of Mali’s eight regions and reaches about 30% of the county’s population. In total, eleven districts and 2 communes in of the capital city Bamako, are covered by project activities. A consortium of partners led by CARE Mali includes JHU/CCP, IntraHealth International, Action Against Hunger (AAH), and Groupe Pivot/Santé Population (GP/SP).

OBJECTIVES

Health interventions with the greatest impact on child survival address immunization; malaria, diarrheal diseases, nutrition and Vitamin A.

By making high-quality services easily accessible, Community Health Centers can attract clients and ultimately improve maternal and child health. Keneya Ciwara supports health Centers across the country to train health care providers and outreach workers; disseminate client health education materials; and reach households and communities through traditional community networks.

The project seeks to drive up supply and demand for community-based health services by: 1) promoting services through community networks; 2) improving access to services by intensifying outreach; and, 3) enhancing service quality through training. All these services address High-Impact Health Areas—family planning, maternal health, immunization, nutrition, malaria, and diarrheal disease control.

OUTPUTS

Training health care providers at all levels is among the program’s core strategies for improving quality of care. The program has trained master trainers, outreach workers, supervisors and community volunteers. In the course of instruction, participants learned medical content (contraceptive technology, malaria prevention, immunization, etc.), and improved their interpersonal communication skills. An Outreach Kit specially designed for outreach workers helps hold clients’ attention, while disseminating important messages on high impact health services. Packaged in a handy canvas tote, the outreach worker’s kit includes a flipchart, short stories, numerous counseling cards, health center referral slips and a household health practices checklist. Some 3,945 outreach workers and 300 women’s group leaders have taken part in these trainings and 2,000 have received outreach kits. The increase in trained health workers has greatly enhanced community access to health information.

The program employed an innovative approach for strengthening the quality of Community Health Centers—Golden Ciwara accreditation. Through this process, community members come together to assess and further develop their local health center. Golden Ciwara accreditation kits include everything communities need to conduct the accreditation: implementation and community dialog guides, and quality assessment, selection and accreditation tools. Communities recognize excellence by conferring Golden Ciwara accreditation, establishing a standard that clinics are expected to meet. Posters, stickers and media coverage arouse public interest and curiosity, ultimately increasing demand for services at the accredited clinics, and creating a healthy competition between community health centers.

RESULTS

In less than four years, the program has achieved a number of significant milestones:

Vitamin A

• Doubled the proportion of children 6-69 months receiving Vitamin A, from 31% in 2004, to 61% in 2006

Childhood Immunization

• In 2006, immunized 97% of children under age 1 for DPT3, greatly exceeding the 40% immunization target

Malaria Prevention

• More than doubled the percentage of children under age 5 who sleep under ITNs, from 9.7% in 2005 to 23.5% in 2006
• In nine months, distributed 191, 889 ITNs to pregnant women and mothers of young children, nearly double the 100,000 distribution target
• Tripled the proportion of pregnant women sleeping under ITNs, from 6.8% in 2004, to 20.4% in 2006
• Administered 73,695 doses of SP2 to pregnant women, greatly exceeding the 2006 target of 50,000 doses

Maternal & Reproductive Health

• Increased new contraception users
• Increased demand for antenatal services tenfold during ITN campaign
• Nearly doubled Tetanus Toxoid vaccinations among pregnant women, from 30% in 2004, to 56% in 2006
• Increased contraceptive prevalence from 6.9% in 2004 to 8.8% in 2006
• Registered 71% of women for antenatal care (2006)
• 50% of births attended by skilled personnel (2006)

In 2007, outreach workers will ramp up household monitoring of Essential Healthy Behaviors. These include using insecticide treated nets, modern contraceptive methods, and sanitary practices. The findings from these visits will provide an indication of Keneya Ciwara’s impact on behavior at the household level and new ideas for program improvement.