In Pibsé, a small village in the center-south of Burkina Faso, all mothers know the court of Alizeta Congo. As soon as their baby has a fever or a cough, they knock on his door to ask his advice. The young woman is only 26 years old and has her primary school certificate in her pocket, but the inhabitants have already called her “Lafi naba”, the “head of health”, in the Moré language.
Alizeta Congo has been working as a community-based health worker for six years (ASBC). In addition to cultivating the land, she takes care of newborns, children and watches over the mothers of her village. “Sometimes they pick me up in the fields or wake me up at night, I have to be available all the time”explains Alizeta Congo, who was trained by caregivers.
In this country where there was one doctor for 10,000 inhabitants in 2019, the authorities are counting on the recruitment of auxiliaries to compensate for the lack of staff and improve access to care in the most remote villages. To guide these volunteers, who must be able to read and write, Burkina Faso, in partnership with Unicef and the Global Fund to Fight AIDS, Tuberculosis and Malaria, has developed a mobile application for digitizing data, called ” mHealth”. The objective is to improve patient care and follow-up, as well as on-site control of drug stocks.
Some 17,000 auxiliaries recruited
Every morning, Alizeta Congo gets up before the first rays of the sun, around 4:30 a.m. After preparing breakfast for her three children, the young woman sets up her consultation table under the old mango tree in her house, before heading into the fields. She does not count her time.
“I am happy to help my community”, insists this farmer, who, as a child, dreamed of becoming a nurse to “save the babies” of his village. “When they fell ill, we preferred to give them infusions than to take them to the clinic”regrets the latter, who abandoned her studies in 4e.
In Burkina, the infant mortality rate remains high, estimated at 82 deaths per 1,000 births. Malaria, respiratory infections and diarrhea are the three most deadly diseases in children under 5 years old. More than two out of three deaths occur at the community level and a number of them could have been avoided with prompt treatment.
To cope, the authorities adopted a national community health strategy in 2018 and recruited some 17,000 auxiliaries in the isolated villages of this country of 21 million inhabitants. The latter play the role of relay between the nursing staff and their community. They detect and treat simple cases of childhood illness and transfer serious pathologies to the nearest health centre.
At each visit, Alizeta Congo creates a file in the mHealth application and answers a questionnaire. Then the program makes the diagnosis and indicates the treatment to be prescribed
Sitting on a tree trunk in her dirt yard, Alizeta Congo receives her patients amid the joyful ballet of pecking chickens and the tap-tap of drumsticks. Placed in front of her, a medicine box and her mobile phone, which she no longer separates. At each visit, she creates a file in the mHealth application and answers a questionnaire. “Does the child have a warm body? Can he drink or breastfeed? »she reads on her screen. Once the form is completed, the program makes the diagnosis and indicates the treatment to be prescribed.
“Simple malaria, one tablet morning and evening for three days”, advises the platform, in a message illustrated with explanatory drawings of small suns and moons. Children under the age of 5 and pregnant women are cared for free of charge, as part of the policy of free care, introduced since 2016 in Burkina Faso. mHealth also shows the stock of medicines available in her village.
The application, which works offline, then transfers the data collected by SMS to a secure server, accessible to the teams of the health center of the municipality, the health district, the regional management and at the central level. Even if the system is not infallible – Alizeta Congo sometimes encounters problems related to the telephone network or the lack of access to an electrical outlet to recharge its laptop – it represents significant progress.
Eight kilometers through the bush
“Before, patient registers were lost and the paper was missing. With the application, it’s faster and more reliable, we can check the work of the agents in the field and be alerted in the event of a shortage of medication”, explains Arsène Da, the head of health promotion in Kombissiri, the provincial capital. Sometimes Alizeta Congo made diagnostic errors or forgot to ask questions during consultations. As a precaution, she often preferred to redirect certain patients to the health center of the commune, in Gana. Except that, to get there, the villagers have to travel almost 8 kilometers through the bush.
“Most women have to walk or ride their bikes”, says Alizeta Congo, who also makes home visits to monitor pregnancies and provide care for newborns. And during the rainy season, from June to August, when there is an outbreak of malaria cases, the track that leads to Gana is regularly flooded and becomes inaccessible.
“Because of the distance, we lose sight of some patients, others also prefer to practice self-medication, but if they are not taken care of quickly, the patients risk developing complications, sometimes serious”, says Henriette Loué, the nurse in charge of the Gana dispensary, which covers seven villages, including that of Pibsé. Here, some patients have sometimes traveled ten kilometers to consult. The centre’s only ambulance tricycle being broken down, its teams have to call a motorcycle taxi when they have to evacuate a patient urgently, to Kombissiri.
Since 2022, fifty health workers have been equipped with a phone and are using the pilot phase of the mHealth application in the district. In Gana, fourteen ASBCs treat an average of one hundred patients each month in their village. “It relieves us, they allow us to unclog our dispensary a little”admits Henriette Loué, regularly overwhelmed by the influx of patients, up to four hundred per month, for six caregivers.
In twenty years, the prevalence of the HIV epidemic has fallen by 90%, reaching a rate of 0.7% among the Burkinabe population.
Faced with diseases and epidemics, Burkina Faso focuses above all on prevention. In twenty years, thanks to the mobilization of associations and various awareness and screening campaigns, the country, which has become an example on the continent, has succeeded in curbing the number of HIV infections. In twenty years, the prevalence of the epidemic has decreased by 90%, reaching a rate of 0.7% within the population.
Several times a month, Alizeta Congo gets on her bike and goes from hut to hut to lead “educational talks” in families with “picture box”. Modes of transmission of HIV, methods of contraception, family planning, food… We talk about everything, despite the taboos still very present in Burkinabe society. By force, Alizeta Congo has become the “confidante” women from her village. “They come to see me as soon as they have a problem”rejoices the one who treats up to thirty patients a month, for a monthly salary of 20,000 CFA francs (about 30 euros).
Objective: to cover all the villages
It also participates in malnutrition screening, vaccination monitoring, mosquito net distribution campaigns and patient tracing. ” lost “. During the peak of the Covid-19 epidemic, the ASBCs played an important role in providing advice on the barrier gestures to adopt.
By 2023, seven regions should have the mHealth system, representing about 7,500 health workers. The long-term objective is to cover all the villages located more than 5 kilometers from a health establishment. According to Ministry of Health modeled projectionsthe community approach will prevent approximately thirty thousand neonatal or maternal deaths next year.
In addition to saving lives, the digitization of data helps to strengthen the efficiency of the national health system. “Having information in real time makes it possible to detect and prevent the risk of epidemics, and thus to quickly adjust public health programs. We have a health memory that makes the medical picture more precise and improves diagnoses to treat children”analyzes Sandra Lattouf, UNICEF representative in Burkina Faso. “Adults are trusting me more and more and asking me to treat them now too! »laughs Alizeta Congo.
Summary of our dossier AIDS in Africa: the time of hope
This article is part of a dossier produced as part of a partnership with the Global Fund.