Peace Corps Partnership Program Proposal

Health Hut Construction

Madina Guinguinéo, Tambacounda, Senegal

Jamie Anderson, PCV


Summary

Madina Guinguinéo, in the region of Tambacounda, Senegal, is a village of over 600 people, yet at nine kilometers from the main road and nearest health post, access to health care and medicine could be improved with the construction of a health structure. The community has initiated this project, with their vision of a small, 3-room “health hut,” complete with a waiting room and rooms for patient care and maternity care. The village already has a Community Health Agent, Mamadou Dansokho, trained by district and departmental health care providers, as well as a midwife, Ramata Ndiaye, who has received some training and is seeking more. Both are already sought after by the community for health care at their home; building a health structure would give them a legitimate place to work, as well as a place to supply medicine and materials, treat patients with minor health problems in a clean environment, and offer a place for women to give birth. The health hut will continue to be managed by Mr. Dansokho as well as an elected health committee. Mr. Dansokho already gives health talks on preventative measures; the health hut will provide this space and an opportunity to give personalized consultations.


Background and Pressing Community Need

Madina Guinguinéo is a village of over 600 people of Pulaar and Bambara ethnicities in the region of Tambacounda. The village is divided into three small “neighborhoods,” of Madina, Guinguinéo, and Madina Peul. Madina is the Bambara neighborhood while Guinguineo and Madina Peul are separate Pulaar neighborhoods. Bambara and Pulaar are both distinct languages and ethnic groups, with Bambara originating in Mali and Pulaar originating in Guinea. Farming is the only livelihood; the main crops are peanuts and corn to feed their families throughout the year and cotton, the only cash crop. Most families also have a small garden to grow vegetables. The village has one primary school (conducted in French) with over 70 students and two teachers.

Madina is kilometer from a dirt road and nine kilometers from the nearest paved road and larger town, Missirah. Madina currently has an Agent de Santé Communautaire (Community Health Agent), Mamadou Dansokho, officially trained by the district health post in Missirah and also the regional health post in Tambacounda. Mr. Dansokho’s wife, Ramata Ndiaye, has also been trained as a midwife and is seeking an addition six months of training in Tambacounda. Both have also been trained by the American non-profit, Africare, to give community health talks and weigh babies each month. They have been doing so since 2005 and continue to be in contact with Africare monthly for guidance and additional trainings.

During meetings with community members, both men and women expressed their need for a health facility to help them to have better access to health care and improve the quality of motherhood and childhood health management. After many discussions on the issue, they decided to design a project to build a health hut and asked for the Peace Corps’ financial assistance to do so.

Despite the presence of trained health workers, the community does not have a health structure. Those who have small wounds can be treated by Mr. Dansokho at his residence, but for any other medical concern, including obtaining medicine or giving birth, residents must trek the nine kilometers to the health post in Missirah. By building a 3-room health hut in Madina, complete with a small office, a room to dispense medicine, and a maternity room, residents will be able to have better access to medicine and improved health care as well as the privacy and safety needed to give birth. While the 600+ residents of Madina will be the primary benefactors, residents of the neighboring Madjaly (1 kilometer away, 700+ residents) and several other very small villages further from the main road will also be beneficiaries, bringing the number of direct beneficiaries to over 1,300 residents.

Although the nearest health post is only nine kilometers away in Missirah, it can take several hours by foot or by donkey chariot, which are the two primary ways that people travel. As a result, usually a member of a sick person’s family goes to Missirah to buy medicine instead of having the patient travel there to be seen by the nurse practitioner. During the rainy season it can be difficult, if not impossible, to travel to Missirah at all. Last year during the rainy season, a father tried to take his sick child to Missirah for health care, could not get through as the road was flooded; his child died on the third day of malaria. Had there been medicine available in the village, this death might have been prevented. Even during the drier season, the heavy farming schedule prohibits men from taking a “day off” to go to Missirah. Consequently, many people are undoubtedly misdiagnosed and more importantly, it may take days before someone is able to get the medicine they need.

Also, most women who are giving birth do so in their homes instead of taking the risk of traveling. Several women have given birth on a chariot en route to the health post during the last six months alone. While some women will still choose to give birth at home, having a health hut with a maternity room will give them the option and give the midwife a better opportunity to look for warning signs during the pregnancy or the birth (in which case she would refer the woman to the health post in Missirah). Having a health hut in Madina will also give women better control over the health of their families. Given gender roles in Senegal, it is typically the man of the family who goes to Missirah to buy medicine or take a sick child for a consultation. Now women will be able to accompany their children and hear first-hand how to continue treatment.

During the rainy season from July to October, when malaria affects almost every household in Madina, at least 2-4 people seek Mr. Dansokho’s advice each day. While throughout the year people come to have minor injuries cleaned and dressed, during the rainy season they also come to get quinine shots for malaria (after purchasing the medicine from Missirah) and also for explanations on when to take their medication. The community already looks to Mr. Dansokho as a local health care provider; building a health structure will give him a better space to do so than from his household. Also, by having a more formal health hut, it will be clear that people are not just going to their friend for his advice, but that they are going to a credible, trained source who has access and means to run the health structure. This will thus give more authority to the health care system already established in Senegal.

Finally, the health hut will also be a space to teach preventative health care. Most health prevention talks are currently held under a large “meeting tree” as you come in to the village. The health hut will be built near it, allowing for space for the health talks. The budget includes money for two benches and four chairs which would also certainly be utilized for these various functions. In addition, the physical walls will provide a space for murals and informational posters, as is the custom at most health structures. During consultations, Mr. Dansokho will also reiterate how to prevent certain ailments from reoccurring.

While the government will encourage and help with the training of community health workers, they do not provide funding for village health huts. Instead, communities must find the funding to construct a health hut themselves. Many communities find funding from non-governmental organizations or raise the money from their family and friends who are living abroad. Madina currently has four of its former residents living abroad; they will undoubtedly help with the 30% of the community’s contribution, but they alone cannot fund the total construction.


Community Initiated and Directed

This project was completely initiated by the community. After being at my site for two months, I held separate meetings with both the men and the women of my village. The men expressly asked for help in funding to build a health hut, especially since Mr. Dansoxo is already trained as a Community Health Agent. The women agreed that their top concern was having medicine available for their children.

The enthusiasm of the residents of Madina has continued to impress me. During my first meeting to discuss funding options, community leaders sat down and decided upon the budget. They elected on a committee representational of the different ethnicities of the village. The committee will oversee the construction of the health hut as well as its continuing management. This committee includes:


President: Phili Sissoxo (Madina - Bambara)

Vice President: Mamadou Aliou Diallo (Guinguinéo - Pulaar)

Treasurer: Allisan Mara (Madina Peul – Pulaar)

Secretary: Mariama Diallo (Guinguinéo - Pulaar)


Indicators of Sustainability and Success

Once construction is completed, the health hut will be self-sustaining. Continuing supplies of medicine and building up-keep will be bought with Revenue generated from medication and consultation fees (50 CFA for adults, 25 CFA for children) will pay for continuing supplies of medicine (60%), repairs and future rennovations (15%), and a small stipend for the community health workers (25%). At half of price for a consultation at the health post in Missirah, seeing the Community Health Agent in Madina will be affordable. Mr. Dansokho will also purchase medicines directly from the regional center in Tambacounda and can then sell them at the same price as medicine in Missirah, generating a small amount of income. If even more additional funding is needed for future rennovations not covered by the 15% alloted from the total income, the community will seek external resources from community members living abroad, non-governmental organizations, and/or the Senegalese government.

This project will include the following beneficiaries:


Plan for Implementation

Once funding is received, the total construction should take no longer than three months. The village workers will begin making bricks as part of its contribution, which will take three weeks. Purchasing the materials and transporting them to the site will take no longer than three weeks. I will accompany the committee President, Mr. Sissoxo, and Mr. Dansokho to Tambacounda to purchase the materials. Finally, construction of the building, overseen by the mason, Mamadou Samake (the son of the village chief) will take six weeks. Given that more people in the U.S. generally donate around the time of the holidays, we hope that this project will be funded by January 2008. This would be an ideal time to begin construction as it will still be the cool, dry season. With this timeline, construction should be completed by April 2008. If funding is delayed, completion may be May 2008.

Budget

The community will provide the labor in-kind (except for the mason, who will be paid) and will raise the rest of the money to contribute a total of 30%. There are four former residents of the village who currently live in Europe and send money back on a regular basis. With their help and with money the village earns from selling cotton, I am confident that they can meet this goal. They are aware that once submitted, this budget cannot be changed and they cannot request additional money. The exchange rate used is: 1 USD = 455.80 CFA as of October 26, 2007.