Focus on Senegal

April 2011

Improving a Nation's Primary Health Care System

PhotoJapanese volunteer nurse, local health workers and a female patient

Missing: approximately five million primary health care workers, particularly in sub-Sahara Africa.

Their mission: to help tens of millions of the world's most vulnerable people, particularly women and children caught in a vicious cycle of endless poverty, escalating conflict, ageing populations, food crises and victims of some of the world's oldest and newest diseases.

A visit to rural health facilities in Senegal underlines the enormity of the challenge.

The West African country tripled its health budget in the last several decades and people are living healthier and longer lives.

Nevertheless, despite those improvements the country still falls short of the recommended staffing levels of the World Health Organization (WHO) of 23 doctors, nurses and midwives per 10,000 of population. Those five million missing health workers are needed to plug the gap globally.

"We lack everything here," says 53-year-old Boubacar Diallo the nurse at a local clinic in the provincial town of Tambacounda. "I am normally the only one working here. I cannot afford to fall ill myself. I need a minimum of three people" to handle the clinic's 30-50 patients per day.

Its roof sometimes leaks and there are only a few packets of medicine on the shelves of the next-door dispensary. Patients normally pay a small consultation fee but Diallo said he often waives the amount for the very poor.

PhotoA Japanese midwife explains the importance of hygiene to a group of mothers and children

In fact, the nurse does have a current assistant, 27-year-old Japanese nurse and JOCV volunteer Mayuko Utsunomiya who specializes in maternal and child health care but is also trying to implement the well-known Japanese 5S program which aims to make any workplace more efficient and productive through sorting, setting, shining, standardizing and sustaining.

"There are so many problems here," the native of Saga City in Japan said. "Lack of health centers; the difficulty of access to those centers. Transportation difficulties. Women often die in child delivery in their villages."

A major aim of JICA's activities is to support the 2015 U.N. Millennium Development Goals (MDGs) which, among other targets, aims to halt the spread of diseases such as HIV/AIDS and malaria, reduce maternal mortality rates by three-quarters and child mortality by two-thirds among under fives.

To further that aim, the agency regularly dispatches volunteers and experts to support a series of health projects in Senegal and other African countries.

Professional midwife Yuko Saitou had "already delivered a lot of babies" during earlier African visits and she is now back in Senegal for one year in a similar role.

At one clinic women sit patiently with their children awaiting a checkup. For the moment the delivery room is empty, but the center has also been trying to implement the 5S principles and a local worker gives them a lecture on hygiene.

PhotoJapanese midwife confers with local midwives and male health worker

The clinic serves 41 surrounding villages and nearly 20,000 people and the health worker tells them : "You must leave your horses and goats outside when you come for a checkup."

Thierno Diallo attended a health training course in Japan before returning to Senegal and said he had now drawn up a list of improved working practices with the assistance of Japanese visitors such as Yuko Saitou.

"They like the cleanliness today," he said. "When you ask a patient to stay for three days they will do so now. Before, they were reluctant. We are trying to ‘humanize' our health care too, listening to the patients, answering their questions. No more shouting. Service with a smile."

This particular clinic still needs more financial help, more staff and better equipment, but even the more friendly service and the professional guidance of a Japanese midwife is an important step forward.

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