The role of Community Health Workers in the heart of crisis

By Iffat Nawaz, FHI360

Community volunteers conduct hygiene promotion in Dikwa, Borno State, Nigeria. Credit: Henry Omara, IHANN project

2017 began with a new momentum for FHI 360’s Crisis Response Initiative as we launched the Integrated Humanitarian Assistance to Northeast Nigeria (IHANN) program funded by the Office of U.S. Foreign Disaster assistance (OFDA). IHANN is delivering integrated services in health, water sanitation and hygiene (WASH) and protection to victims of gender-based-violence in Borno State, where 1.3 million people are internally displaced due to the Boko Haram insurgencies.

The average length of conflict-induced displacement is 17 years, which means communities in displaced situations require support that are not just effective in the short-term but will pave a path towards resiliency for the long-term. Entering the humanitarian space, as FHI 360 does, with a robust development background can offer new insights for how to approach humanitarian problems. We are combining methods which hold the possibility of bringing sustainable solutions to traditional humanitarian delivery models that usually tackle problems with emergency in mind.

IHANN is working in Internally Displaced Persons (IDP) camps and communities in Dikwa and Ngala in Borno state. For the last few weeks there has been a constant daily influx of displaced persons in Dikwa, who are arriving with dire needs. This increase in total population of IDPs has overstretched health and other services. Many are living in congested environment in camps and host communities which hold public health risks- especially of disease outbreak. Currently disease surveillance and monitoring of the health situation as well as, expanding the delivery of health services are high priorities.  For the IHANN program health workers, specifically Community Health Extension Workers (CHWs) and Environmental Health Assistant Volunteers (EHWs) from the IDP population are engaged with just that in mind

For many decades, CHWs have been playing key roles in improving the health status of people especially women and children in rural and remote areas, where skilled Doctors, pharmacists, and midwives are absent. CHWs in the IDP camps in Dikwa and Ngala are contributing to the health sector response by providing health outreach services; treating minor ailments in the communities and IDP camps, making referrals for patients who require facility-based services like antenatal care, labor and delivery or family planning services. The CHWs, who speak the local languages, are also providing health education to change behaviors on risky practices. As many of the CHWs are part of cultural and religious groups they can encourage men and women to accept family planning and immunization in a culturally acceptable manner.

On to EHWs, the IHANN WASH sector Environmental Health Officers are working with community volunteers in the host communities and IDP camps to ensure adequate sanitation and promote hygiene. The EHWs are carrying out hygiene promotion, social behaviour change and camp clean-up campaigns to decrease the chances of a cholera outbreak, minimize environmental conditions that promote disease:  like standing water, for mosquito breeding, and unmanaged garbage which attracts rats that can carry Lassa Fever- a hemorrhagic disease like Ebola.

Since EHWs and CHWs receive trainings in same institutions and often work together in parallel settings in Nigeria, integrating health and WASH services show a direct enhancement in delivery. In the IHANN program, the CHWs and EHW work in the same communities and IDP camps. One of the roles of CHWs is to work as community health monitors. If there are a surge of diarrhea and vomiting cases it may be an early warning of fecal oral disease that could be cholera. Because diseases can spread fast in a close packed IDP camp it is important to identify these outbreaks quickly before they become severe. CHWs and EHWs work together in providing health education on communicable (air, water- or food -borne) diseases, skin diseases, and general infections prevention and control within the camps and the communities.

Similarly, as the WASH sector advices on building new tents on higher surfaces/areas, away from drainage systems or potential water-logged areas, EHWs are working with camp members to clear water paths and drainages to prevent flooding of the IDP camps during the rainy season. The health sector of the project, on the other hand, is working with health partners on cholera outbreak preparedness, and is also collaborating with Malaria programs to provide Insecticide-Treated Nets (ITN) for distribution to the IDPs by CHWs and EHWs.

In these situations, keeping close coordination is a high priority and the health and WASH sectors are working to have a forum where CHWs and EHWs share information, work together and engage camp leaders in health promotion campaigns and activities.

While IHANN’s doctors, pharmacists and midwives are working together with the Ministry of Health, WHO and UNICEF in delivering lifesaving health services at the facilities, the CHWs and EHWs are building capacity by taking leadings roles in health and WASH activities in their communities. The IHANN program is funded by OFDA for one year, but our hope is the knowledge, capacity building and awareness that are being woven into the communities through the CHWs and EHWs will increase the chances of saving more lives in the future and what could be a better ask than this, as a community volunteer, a humanitarian aid worker and most of all as a human.

Please help us continue this conversation in the forum:

Have you seen other projects where development expertise was applied to humanitarian response?  What we were the advantages?  What were the drawbacks?