Mavambo Upenyu Wakakwana (Foundations of Abundant Life) Hygiene and Health Education
In Mozambique’s post-war, impoverished living conditions with limited access to clean water, poor sanitation, and the high prevalence of HIV, malnutrition rates and infectious disease incidence are high, and often life threatening. The organization is non-profit, non-governmental, and seeks to reverse the cycles of poverty, disease and death in Mozambique. The organization’s activities fall under three broad categories: health, education, and community development. In accordance with their mission is the initiation of a hygiene and health education program in conjunction with the current Makomborero Nutrition Program.
The nutrition program currently supports nearly 800 children of HIV+ mothers, and their caretakers through the clinic. In addition to having HIV, many of the children and the caretakers seen are constantly battling infectious diseases such as colds, wound infections, diarrhea, scabies, fungus, and worms, which can be prevented through better hygiene and sanitation practices. The population attending the clinic is also generally malnourished, showing the signs of nutritional deficiencies, such as that of iron and protein. The clinic provides full-cream powdered milk, sugar, oil, crushed peanuts, corn meal, and/or beans, as appropriate, every 2 weeks to improve the health of the children enrolled on the program. Each child’s growth is monitored, and the child’s, siblings’, and caretakers’ health is checked. The clinic treats most health problems presented, providing the prescribed medications, and also refers patients to the hospital when necessary.
The program recently expanded into a larger building with more families enrolling every day. The program is expanding its activities to include a hygiene and health education component for caretakers, a short-term recovery center, and an equine therapy component for mentally challenged children on the nutrition program. Counseling and education are given on an individual basis by the nurses, which is often time-consuming and too late to help. Therefore, an education component of the nutrition program would prevent acute presentations in the clinic and improve the health of the families served by the clinic. The fully operational program is called the Mavambo Upenyu Wakakwana (Foundations of Abundant Life) Hygiene & Health Education Program. Over the course of implementation, the program expanded its reach to include the general population of Manica Province.
The initiation objectives for February 2011 to May 2011 were:
1. Teach hygiene and health principles to at least 360 caretakers of the children of HIV+ mothers who are enrolled on the nutrition program.
2. Train a clinic assistant to teach the curriculum continually and to new audiences in the future, and
3. Write new health lessons, test and modify them, and submit them to the creators of the hygiene curriculum for expansion of their own curriculum and training.
The objectives for April 2011 to December 2011 are:
1. Train at least 6 Community Health Educators (CHE), and
2. Teach the health and hygiene curriculum to at least 18 new audiences within a 100km radius of the clinic.
The hygiene and health curriculum was taught to the HIV+ mothers or other caretakers of the children enrolled in the nutrition program while they waited to be seen in the clinic. The hygiene portion of the curriculum was written by an American NGO called Grace-Connection (now known as Hydrating Humanity), and has been used in Kenya. It employs a participatory teaching style that generates discussion by asking a series of questions and showing pictorial posters. The curriculum includes seven lessons: Introduction to Germs, Discovering Disease Pathways, Blocking Disease Pathways, Water Collection, Water Purification Methods, Water Storage and Use, and Good/Bad Hygiene. Additional health lessons were written according to the international standards of Integrated Management of Childhood Illness and World Health Organization guidelines and employed strategies from “Where There is No Doctor”, “Where There is No Doctor For Women”, and “Helping Health Workers Learn”. These lessons were added to the hygiene lessons to form the more comprehensive hygiene and health curriculum. Topics include: Home Treatment of Diarrhea, Healthy Diets and Anemia, Childhood Nutrition, Family Planning, and HIV/AIDS. Topics were selected based on their relevance to the problems seen in the clinic. The health lessons follow the same format as the hygiene lessons as much as possible, and have subsequently been submitted to Hydrating Humanity for use in their programs. The combined curriculum was taught in 2 week blocks over a total of 8 weeks. Every day that the clinic is open, Tuesday through Friday, for 2 weeks, the hygiene lessons “Introduction to Germs”, “Discovering Disease Pathways”, and “Blocking Disease Pathways” were taught in the morning, as the caretakers wait to be seen in the clinic by the nurses. In these 2 weeks, most of the caretakers came to the clinic once, and some twice, but some came in the morning, and others came in the afternoon, missing the teaching. Block 2 consisted of “Water Collection”, “Water Purification Methods”, “Water Storage and Use”, and “Good/Bad Hygiene”. Block 3 included the nutrition lessons, “Home Treatment of Diarrhea”, “Healthy Diets and Anemia”, and “Childhood Nutrition”. Block 4 consisted of the lessons on “Family Planning” and “HIV/AIDS”. In this way, each caretaker participated in a new block of lessons each time they came to the clinic for four sessions of teaching. The number of participants present for each morning session was recorded and averaged at 28 caretakers per day. Caretakers also received an attendance card upon which was marked in which lessons they participated. A small award of a bar of soap was offered to the participants who had 5 or more lessons recorded on their attendance card at the end of the course.
In order for the education arm of the nutrition program to be sustained, a Supervisor of Health Education was trained. Dorca, a clinic assistant who speaks English, Portuguese, and the local dialect of Shona was ideal for this position. The relationship was mutually beneficial, as she offered cultural insights and translation, while she was trained with new knowledge and skills, which empowered her. For the first week of each block, I facilitated the lessons while Dorca translated. She then facilitated the lessons for the second week, while I provided guidance and feedback as needed. By the end of the 8 weeks of teaching, Dorca had facilitated each lesson herself 4 times. Dorca, being a local national, offered great insight into the effectiveness of the curriculum’s suggested dialogue, including the health lessons. The Supervisor of Health Education is responsible for training new Community Health Educators, scheduling new venues at which to teach, providing the CHEs with all of the materials they need, and reporting the activities of the program. She has the master copy of the hygiene and health curriculum, as well as an administration notebook containing protocol, forms, and reporting documents. All documents, including the lessons, forms, and protocol, have been translated into Portuguese. The Supervisor also maintains two sets of four bags each, containing the demonstration materials necessary for each block of lessons.
The supervisor is responsible for recruiting, interviewing, and orienting 6 new CHEs. Before the training begins for each CHE, the supervisor and the CHE sign an agreement specifying what is expected of the program and of the CHE. After a CHE completes her training, she receives a certificate and a handbook containing the curriculum, translated into Portuguese, with colored posters, all in page protectors. Each CHE is expected to teach 2 courses to new audiences after their training. For each course taught, the CHE will receive an incentive gift commiserate with 4 half-day wages. Courses are taught in venues in nearby towns at churches or other community centers to an audience of women.
The program manager of the Makomborero Nutrition Program, a South African nurse missionary, oversees the education program. All digital documents have been given to her, including a certificate template, forms, the curriculum, and protocol. She is expected to dispense the transport money for the supervisor and the CHEs to travel to the course venue, procure the incentive gifts, print certificates and forms, and help the supervisor to keep accurate and thorough records. During the initiation of the education program, she served as my advisor, and in my absence, she now makes all necessary decisions regarding the education program operations.