Engaging Senegal’s Home-Based Care Providers in the Fight Against Malaria

Jun 2014
In 2012, with PMI’s support, the PECADOM program was expanded to include the management of pneumonia and diarrhea in addition to malaria.
Koranic schoolmaster, Mr. Mamoune Diop, with some of the approximately 60 children under his care. Source: Nathaly Herrel/PMI

Despite Senegal’s progressive health system policies, which make malaria diagnosis and treatment freely available to the Senegalese population, geographic, educational, and financial barriers often impede access to these services. As a result, nine in ten malaria cases in Senegal are initially treated at home, and only 50 percent of cases ever receive formal care. To address these barriers, Senegal began implementing a home-based care program, known as PECADOM (Prise en Charge à Domicile) in 2008. As part of this program, residents in remote villages (located at least five kilometers from the nearest health facility) are trained as volunteer village malaria workers or DSDOMs (dispensateurs de soins à domicile). DSDOMs are equipped with malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACTs) and provide testing as well as treatment for cases of malaria at no charge. The PECADOM program is now active in 1,992 villages in 13 regions.

In 2012, with PMI’s support, the PECADOM program was expanded to include the management of pneumonia and diarrhea in addition to malaria. This integrated PECADOM approach was scaled up to 492 DSDOMs in the Kédougou and Tambacounda regions in 2013. The program now includes the region of Diourbel, where Koranic schoolmasters are also being trained as DSDOMs using the integrated PECADOM approach. Koranic boarding schools, known as “daras” in Senegal, attract some of the poorest children in their communities and constitute a particularly vulnerable population. The schoolmasters who lead the daras are in charge of providing for all the needs of the students (known as talibés) who attend their school, including providing clothing, lodging, food, and health care.

Mr. Mamoune Diop records information about patients. He carries a box with supplies to provide care for cases of diarrhea, pneumonia, and malaria. Source: Nathaly Herrel/PMI Mr. Mamoune Diop is the first Koranic schoolmaster in Senegal to receive training in the integrated PECADOM approach. His village, Darou Khadime, is located 15 kilometers along an unpaved road from the nearest health post. Residents of the village often delay seeking care at the facility level because of the distance and logistical challenges involved. However, since September 2012, Mr. Diop has been providing care for residents in his village, including the children who attend his dara. The training and supplies that Mr. Diop received through the PECADOM program, together with his dedication and strong work ethic, have made a substantial difference in his community.

"I am doing this to serve my community and because I feel responsible for all of these children," he says, surrounded by the approximately 60 children under his care. He explains that, in the past, he would take sick children to the health post by horse-drawn cart or by catching a ride from a passing vehicle. Since the malaria transmission season coincides with the harvesting season, carts were often not available because they were being used for agricultural purposes. He notes that care-seeking was often delayed until the child was very ill because of these challenges. However, equipped with training and the correct supplies, Mr. Diop reports that he is now able to test children for malaria as soon as they develop a fever and promptly start treatment with ACTs if the test is positive. Only cases that test negative for malaria and present as neither diarrhea nor pneumonia are referred to the health post. Mr. Diop shares that he used to take almost all of the children to the health post for care at some point during the malaria transmission season. In contrast, over the past year, only a couple of children needed to be transported to the health post.

Staff from the nearest health post in Dankh Sene confirm that the presence of a trained and highly motivated DSDOM in the village has been beneficial. Previously, the health post recorded many severe malaria cases among children from the dara. Since Mr. Diop became a DSDOM, staff report that they see fewer cases of severe malaria from Darou Khadime. Mr. Diop’s commitment has also garnered national attention. On World Malaria Day in April 2014, the Director of Senegal’s National Malaria Control Program (NMCP), Dr. Mady Ba, honored Mr. Diop with a Malaria Champion award in recognition of his work. In line with the NMCP’s new campaign “Zero Malaria! Count me in!” (Zéro Palu! Je M’Engage!), Senegal is enlisting the participation of all its citizens, including leaders in the faith-based community such as Mr. Diop, to move Senegal closer to its goal of malaria pre-elimination by 2018.

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