Senegal: improving access to health care in the Casamance
In 2008, Dr Joël Lagoutte carried out two evaluation missions for the ICRC in the Casamance, in the south of Senegal. He talks about the adverse repercussions of the security situation on the health of the local population and the steps which the ICRC is taking to improve access to care and to combat malaria and HIV/AIDS.
The health system there is well developed. Almost all the regions of the Casamance have medical centres and health posts. But the system cannot yet function fully everywhere. A lack of security is impeding the work of health personnel, such as nurses and people running AIDS prevention programmes, in some areas of the Fogny region.
Nurses often find themselves on their own in their centres without any medical supplies, access to the necessary records or any possibility of consulting colleagues. And the situation sometimes even stops patients from going to health centres
For all these reasons many children have not still not been properly vaccinated, pregnant women are not receiving the right care and it is hard to combat malaria. The main problem is that people and goods cannot move freely in this area.
The situation in the Fogny region
- Fogny is a region in the north of the Casamance, an area of Senegal which has been racked by armed violence since the 1980s.
- Malaria, HIV/AIDS and respiratory infections are the main diseases with which the population (of between 50,000 and 80,000 persons) must contend.
- The ICRC has been working in the region since 2004, when the first malaria prevention programme was introduced. After the accidental death of a delegate when a mine blew up in September 2006, the organization suspended its on-the-spot presence, although health programmes were continued by means of long-distance support. ICRC teams have been back in the field since March 2008.
What is the ICRC doing to solve these problems?
The ICRC wants to make sure that the population has access to both preventive medical services and medical treatment of the same quality as that in the rest of the country. Our aim is to ensure that the health system works properly or, let’s say, better. We are playing the role of neutral intermediary and facilitator. Our good contacts with everyone locally, with the army and with armed groups, enable us to move about the region. We can therefore give nurses lifts to villages or to the nearest pharmacy and we make sure that medicines are kept cool by taking a refrigerator to a health centre.
The ICRC is likewise conducting three health-promotion programmes in cooperation with the health authorities: the first is aimed at preventing malaria through the distribution of mosquito nets; the second seeks to combat diarrhoeal diseases – this programme is particularly targeted on children and on teaching them to abide by hygiene rules and to drink water that is fit for consumption; the third seeks to warn the public about the dangers of HIV/AIDS.
What is special about the ICRC’s action?
In the Casamance, the ICRC does not need to bring in medical supplies as it does in the Darfur region of Sudan or in Somalia, for example. Medical supplies are already there. We merely facilitate the transport of goods and people. This exactly fits the ICRC’s mandate. What we are supplying is not as important as the fact that we are helping the system to function better.
I met several women who said that they were going to the Gambia to have their children vaccinated – an expensive journey. Now, thanks to the ICRC’s help, vaccination can take place in the villages where the children live.