In 2011, I documented a strategy called Integrated Community Case Management (ICCM) for UNICEF. Integrated Community Case Management of pneumonia, diarrhea, malaria and acute malnutrition is a community-based approach to health care. Combining health education, preventative care (such as exclusive breastfeeding and use of mosquito nets) and curative care (such as treatment of malaria), ICCM uses trained, supervised community health workers living in areas without access to medical facilities to deliver life-saving health services to the children who need them the most. The strategy was shown from the perspectives of mothers, children and health workers whom this strategy affects most.
Right now, in the Sahel Region of Africa, which includes Mali and Niger, there is an urgent malnutrition crisis happening. Save the Children just released it’s “State of the World’s Mothers Report†and listed Niger as the worst country in the world to be a mother. Mali recently suffered a military coup d’état and is currently experiencing extreme violence in it’s northern rural regions.
This year, one million children are at risk of dying of malnutrition related illnesses due to massive food insecurity in the region. Severe droughts in 2011 and global economic instability have been contributors. Malnutrition is omnipresent in the region, but this year it is extremely acute and recurrent shocks are reducing communities’ abilities to cope. With respect to economics, politics, health, education and social-norms, West Africa in particular, is a region in turmoil. Globally, diarrhea, malaria and pneumonia are the main killers of children and lack of geographic and financial access to treatment for these illnesses is a major reason why so many children die from these diseases, which often require simple treatments to cure.
Maternal and child health are important indicators as to how well a community is coping with the effects of such difficulties. The average mother has seven children. Mali and Niger have high rates of child-mortality because mothers often cannot afford to get their sick children to a proper facility in time to administer simple inexpensive life-saving treatments. This lack of access to treatment is complicated by deeply rooted social norms, gender inequity, lack of education, and intergenerational negative effects of malnutrition.
Despite this, there is a shift happening, not just in West Africa, but all over the world. Not because aid organizations descend of Africa every year or so to help in a time of crisis, but because community based programs are being born in the poorest regions of the world. These programs help facilitate the changes to social norms and behavior that are needed for these communities to survive in an increasingly complex modern world. Sustainable change is happening in health, education, environment and social awareness.
I traveled to West Africa with UNICEF for the first time in the fall of 2011. I spent two months in Benin, Niger and Mali documenting an example of this sustainable change in a strategy called Integrated Community Case Management (ICCM). Integrated Community Case Management of pneumonia, diarrhea, malaria and acute malnutrition is a community-based approach to health care. Combining health education, preventative care (such as exclusive breastfeeding and the use of mosquito nets) and curative care, ICCM uses trained, supervised community health workers living in areas without access to medical facilities to deliver life-saving health services to the children who need them the most.
My goal with these images was to show ICCM in practice, particularly from the perspective of the mothers and children, in the most deprived communities; to document the community health workers in action and to also reveal how serious the need is for strategies like this.