Community Oriented, Comprehensive Primary Health Care
Over many years in public health a debate has raged between the merits of delivering a narrowly prescribed set of prevention interventions deemed “cost effective” (ie., vaccinations and oral rehydration solution) and that of high quality health care, which includes treatment of disease and its root causes. VHW believes that these approaches are not mutually exclusive; we incorporate both in the design and execution of our cost effective programs that comprehensively address health promotion, disease prevention and the care and treatment of medical conditions and are driven by community priorities. We also employ a community health worker program that has a long demonstrated ability to achieve effective long-term care for chronic illness and preventative medicine in the world’s poorest places.
Burundi has one of the highest rates of child mortality in the world: 180 deaths out of 1,000 for children under five. Most of these deaths are due to infection, primarily diarrheal disease, pneumonia and malaria. All are underpinned by malnutrition. VHW’s Child Health program addresses these problems by employing both preventative and therapeutic strategies. Working with Burundi’s Ministry of Health and UNICEF, a strong clinic and community-based vaccination program is working to achieve universal vaccine coverage for the children of Kigutu and our catchment area. Similarly, growth monitoring is standard at the clinic as is active case finding for children with malnutrition in the community. Nurses manage the treatment of childhood illness through the Integrated Management of Childhood Illness strategy, while a physician will attend to the more complicated cases that frequently involve pediatric HIV and TB. Read Joseph’s story, an abandoned child who was restored to health.
Malnutrition is a serious and common problem affecting the community of Kigutu. While community members of all ages are affected, children remain the most vulnerable to the dangerous short-term and long-term complications of malnutrition. Paired with HIV or tuberculosis infection, malnutrition in adults as well as children is associated with more rapid deterioration and death, rendering normally lifesaving medical treatments less effective.
VHW’s nutrition program provides effective inpatient and village-based treatment of malnutrition in adults and children. Read one patient's story here. Employing nutritional and socioeconomic assessment algorithms developed by our sister organization Partners In Health, VHW is able to target and offer food supplementation to those most at risk for developing malnutrition. Ready-to-use-therapeutic food, which is provided through partnerships with UNICEF and the Clinton Foundation is delivered directly to the patients’ homes by VHW’s community health workers. As a result, long-term hospitalization is obviated, which in turn decreases stress to the family and lowers the risk of children acquiring infections while hospitalized. Nutritional support of adults is focused on those who have AIDS and TB, as both are “consumptive” illnesses and are associated with increased caloric requirements.
Women’s health, obstetrics & prenatal care
Skilled health care providers attend a mere 25 percent of births in Burundi, and prenatal care is virtually non-existent in rural settings such as Kigutu. As a result, a Burundian woman has a one-in-nine lifetime risk of dying in childbirth. Prenatal and perinatal care is needed to reduce the staggering rates of maternal and infant mortality.
Routine prenatal visits are essential to monitor pregnancies, identify and treating complications early, and to develop trusting relationships between healthcare providers and pregnant women that can facilitate skilled attendance at delivery. Prenatal visits also serve as an entry point into the health care system.
VHW’s prenatal care program provides prenatal care, nutritional counseling, vaccination, as well as TB and HIV prevention and treatment. It offers formula to infants, provides postpartum counseling regarding breast milk, and identifies and treats conditions such as preeclampsia, anemia, malaria and other conditions linked to maternal and infant morbidity and mortality. Active screening for HIV and other sexually transmitted infections (STIs) are also a key part of this program. Long-term consequences of untreated STIs for women include increased susceptibility to HIV transmission, infertility, ectopic pregnancy and cervical cancer. VHW programs provide a comprehensive approach to prevention and treatment of sexually transmitted infections, which involve risk-based screening protocols, and essential medications for treatment. STI training curricula have been provided to community health workers as part of their outreach services.
Though uncommon in the United States and other developed countries, mother-to-child transmission of HIV remains a serious problem in sub-Saharan Africa. Without prophylactic intervention, at least one-third of children born to HIV positive women become infected. In addition to universal HIV screening, VHW is working to provide antiretroviral medicines to all HIV positive women and their infants. These medicines provided before, during, and after delivery, are part of a comprehensive prevention of mother-to-child transmission strategy, which can reduce HIV transmission to fewer than 2 percent.
Thanks to the generous financial commitment of the Pershing Square Foundation and other partners, VHW will break ground on our Women’s Health Pavilion in 2012. The new facility will provide the crucial prenatal and neonatal care that so many Burundian women lack.
HIV, TB and Malaria Programs
Burundi has submitted a successful application to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Moreover, the creation of the National AIDS Control Committee reflects a strong government commitment to scale-up antiretroviral treatment throughout the country. VHW has a close working partnership with Burundi’s National AIDS Control Committee, and is committed to rolling out HIV prevention and care services in the Kigutu catchment area.
The proximity of the Kigutu community to Lake Tanganyika has made it susceptible to high rates of HIV/AIDS and malaria infections. HIV transmission is increased by the constant flow of fisherman and other travelers who use Lake Tanganyika as a means of transportation from nearby countries, including the Democratic Republic of Congo. Such movement has contributed to the region having the country’s second highest HIV prevalence, after the capital. Early prevention activities include community health worker outreach with local leaders and women’s groups to promote universal voluntary counseling and testing. However, these efforts can only succeed if treatment is available to those who test HIV positive. VHW currently offers antiretroviral treatment according to Burundian government protocols and the HIV/AIDS treatment guidelines created by Partners In Health. VHW’s HIV/AIDS treatment program relies on village-based implementation and daily-observed therapy by community health workers. Recruitment and training of Burundian physicians and nurses is ongoing, with the vast majority of primary care services implemented by these local providers.
With respect to malaria, the region’s warm temperatures, constant presence of stagnant water during the rainy season and poor sanitation, have led to high mosquito populations and malaria incidence within the village and surrounding environs. As a result, VHW has dedicated substantial efforts for the treatment and prevention of the disease, which remains a leading cause of illness and death in Burundi. Children under age five, especially infants age 6 to 12 months, are at higher risk for the complications of severe malaria because of their immature immune system. Malaria during pregnancy is associated with premature delivery, low birth weight, and increases in both maternal and neonatal mortality.
VHW’s malaria program employs a combination drug treatment approach advocated by the World Health Organization’s “Roll Back Malaria” program to target these high-risk groups. Prevention efforts also feature prominently in our program. Currently, only 1 to 3 percent of children under the age of five in Burundi sleep under insecticide-treated bed nets. VHW aggressively targets families with children at this vulnerable age along with pregnant women, with the help of insecticide-treated mosquito nets. Vigorous education efforts at the community level stress the need for early treatment of children with fever and reinforce the proper use of bed nets. Community health workers further emphasize and encourage these practices during home visits.