Globally there is currently a shortage of over seven million health workers, which will nearly double by 2025.
It is estimated that roughly half of the 5.9 million child deaths in 2015 could have been avoided with sufficient coverage of preventive and treatment measures as well as increased access to health services.
Malaria was the cause of over 430,000 deaths last year, despite good progress in recent years and in sub-Saharan Africa a child dies every minute from the disease.
Pneumonia is the single biggest killer of children worldwide, accounting for nearly a million deaths in 2015. Combined with diarrhoea and acute malnutrition, these illnesses account for three quarters of global deaths of children under five.
The problem is particularly acute for rural, hard-to-reach communities in developing countries such as Uganda.
Catherine Nassiwa, Malaria Focal Person for the Kiboga District, said: “Many children die of pneumonia, malaria and diarrhoea because of being very far away, and not being able to access care within 24 hours.”
Pregnant women and children under five years of age are especially vulnerable – high maternal mortality, low birth weight and maternal anaemia are other consequences of this devastating disease.
Combined with diarrhoea and acute malnutrition, these illnesses account for three quarters of global deaths of children under five.
One of the key reasons why these diseases are still claiming so many lives is because there are not sufficient numbers of trained, supported and motivated health workers available in the regions and communities where they are needed.
Integrated Community Case Management (iCCM) offers an effective and sustainable solution to this epidemic, based on the idea that most common childhood killers can be readily diagnosed and treated by people within the community, including those with limited education and medical training.
“Before iCCM was introduced, the health facility was so congested, especially with young children. There would be queues outside the facility, maybe 70-80 people per day,” added Nassiwa.
Latest statistics indicate that iCCM has the potential to decrease childhood mortality from these three diseases by 60 percent. It also brings skills to the community and reduces the burden on overstretched health facilities.
Community Health Workers (CHWs) are the critical element of successful iCCM and recruited from the communities in which they work, so that they will be accepted and respected. They are trained to educate people about preventive health measures, diagnose and treat common illnesses and provide care for pregnant women and new born babies.
CHWS can also refer patients on to health facilities and hospitals when more critical care is necessary, therefore providing a vital link between remote communities and the formal health system.
Arainaitwe Christine, a CHW in Kibiga sub-county said: “My work involves moving around the community, diagnosing and treating patients, and teaching people how to avoid getting sick.
“Previously parents used to have no time, because one child, then another, and another would be sick, and they would spend all their time in the hospital. Now people are much better off because of the services in the community. Their children are not as sick, so they have time to work, and so have food and money for school fees.”
Malaria Consortium works across Africa and Asia to expand and improve community health delivery by training CHWs, piloting innovative tools such as mobile devices for training and reporting (mHealth), and supporting Ministries of Health scale-up iCCM.
Pauline Latham MP, member of the International Development Committee and Vice-Chair of the All-Party Parliamentary Group for Malaria & NTDs, recently visited northern Uganda, facilitated by Malaria Consortium staff.
She said: “I was inspired to see first-hand the crucial work that CHWs do in their community. Pregnant women and young children are particularly at risk from these diseases, so the CHWs are playing a vital role in educating, protecting and treating people from their own villages.”
Strong efforts to control the disease have meant significant progress in the last 15 years, but this is being threatened by the spread of resistance to antimalarial drugs and to insecticide.
With a recent commitment by the UK Government to give £3 billion to fight malaria, community health workers are a key element in the fight to eliminate this deadly disease.
Nakigude Ruth, a mother from Kizinga Village, explained: “Children used to die a lot; all the time we were burying them. I lost a three year old child myself. He got sick, but while we were trying to get him to hospital, he passed away.”
“Things are so different since we got the CHWs. My youngest is three years old, healthy and in school. I have only had to take him to hospital once in his lifetime. CHWs gave us happiness.”