Community Based Primary Healthcare

AMOS Health and Hope partners with the communities we serve to improve health using the strategy of  of community based primary health care (CBPHC).  CBPHC is a holistic approach to health - it begins before a person ever gets sick.  When we wash our hands, eat good food, contain our waste and prevent it from contaminating our water, many preventable illnesses can be dramatically reduced.  If we add to this good hygiene education and medical training, we can identify and avert problems before they become crises and our capacity grows even greater.  Eventually, by cultivating an environment that fosters good health, we can prevent unnecessary disease and death.  

How does community-based primary healthcare work ? 

Primary healthcare is about treating and preventing illnesses, while also promoting good health (nutrition, sanitation, hygiene, etc.).  “Community based” simply means healthcarefor the community, and by the community.  AMOS walks alongside rural communities, helping them to identify local leaders who will take up the cause of good health.  These local leaders then form a health committee, which works in conjunction with a health promoter.  The health promoter is an individual who receives basic medical training in order to provide treatment, medicine, and preventive care.  Together, the committee and the promoter help to care for every individual in their community.  

How do local leaders care for their community?  

It all begins with a census and the belief that: “Every one counts and every one must be counted.”  The health committee and health promoter go to each house in the community, noting the number of people in each family, with special care for mothers, infants and those with chronic diseases.  Using this data, they create a map of their community and identify the most vulnerable people.

Often when aid is given, it goes to the strongest and most able-bodied – those who have the resources to ask for help or travel to a distribution point.  This can magnify the disparities in a community, with certain families receiving an inordinate amount of goods and services while others are left in the dark.  By taking a census, the health committee can help to ensure equity and fairness.  They can ask, “Who is missing here and what can we do for them?”  When special care is given to the most vulnerable people, it makes it possible for all boats to float - ie. the entire community benefits.  

Communities making a difference with their own data

A vital part of successful change is community ownership and knowing whether our efforts are bearing fruit.  With the accompaniment of AMOS staff, health promoters collect information on the health of their communities. By teaching communities to create and maintain their own records, AMOS builds capacity in communities to track their own health indicators including child death rates, diarrheal disease rates, malnutrition rates and respiratory infection rates. This knowledge gives communities the power to act and make a difference to improve community health.

For example, an average community clinic gets 2 or 3 cases of diarrhea a month.  If the cases suddenly increase to 15, the promoter knows there is an epidemic and can mobilize the health committee to take concrete actions, such as making home visits to teach families how to prevent and control the epidemic.  The data collected by health promoters not only gives a current picture of the community, but also allows them to plan for the future.  Each year, the health committee meets to set goals - areas of growth that they will emphasize in an effort to continually improve the quality of life.  All of this is part of the ultimate goal of empowerment: communities standing together, identifying their own issues and taking actions that are meaningful and effective.  

Accompaniment – walking with communities 

It’s been said that supervision and accompaniment are the frontier of public health.  Time and numerous studies have shown that it’s simply not enough to provide training and medicines for a community and then leave.  Ongoing supervision and care must be an integral part of any primary healthcare program to ensure that local healthcare providers receive the proper support and ongoing training.  Accordingly, AMOS maintains a regular supervision circuit where trained doctors and nurses visit the 27 communities and their health promoters, providing medicines, checking records, and helping with any questions the promoters may have. 

Health and hope for all 

AMOS is founded on the idea that all people deserve access to adequate healthcare.  We believe that the best treatment is prevention – helping people to avoid sickness in the first place.  This is the foundation of community based primary healthcare: walking alongside communities as they move toward a place of knowledge and strength, training local leaders to provide education and treatment, and eventually raising the level of understanding and ownership to create a place where there can be health and hope for all.  

If you resonate with this mission of bringing health and hope to those who lack access to adequate healthcare, we invite you to consider a donation, which goes directly toward providing these vital services: 

http://www.amoshealthandhope.org/Health_for_all/Donate.html

water filters

The problem: Lack of clean drinking water leading to disease and suffering

The majority of communities that AMOS serves suffer from contaminated water, which translates to a high prevalence of diarrheal disease and other water-borne illnesses.  Frequent sickness means that children miss many days at school, while also facing malnutrition and a host of other dangers.

The need: Clean water is an integral part of good health.

While the search for clean water is not new, it is a continual challenge to find solutions that are appropriate for each community.  For example, a well can provide potable water for hundreds of people who live in a centralized location, but this option will not work in a community where each house is separated by miles of rugged terrain. 

The method: Reaching out to the most vulnerable people with home filters

AMOS has focused on point-of-use (POU) water filtration technology.  As the name implies, these filters are installed in houses where water is used rather than at the source.  One of the most promising POU filters is known as the biosand filter.  These filters mimic the natural geological filtration process by passing water through several layers of sand, gravel, and charcoal.  Most importantly, there is also a biological layer of bacteria that eliminates many of the smaller parasites, viruses, and pathogens that are not captured by conventional clay filters.

Developed by Dr. David Manz (CAWST - Canada), these filters have proven to be effective in a variety of environments, offering families 10 gallons of clean water per day for up to 10 years.  Other aid organizations such as Samaritan’s Purse have installed over 100,000 biosand filters throughout Africa and Latin America, with great success. 

Through a partnership with Aqua Clara Foundation, AMOS is working to bring biosand water filters to rural communities in Nicaragua.  The Aqua Clara variant of the biosand filter does not use concrete, since these slabs can be prone to breaking and are difficult to transport (each filter weighs 175 lbs).  Also, the construction process can take up to 10 days, raising the logistical cost significantly.  Instead, plastic garbage cans are used along with local materials.  The cost to build each filter – including community training, materials, and logistics – is about $50. 

Challenges of the biosand filter

Despite the incredible promise of this technology, it is not without some obstacles. 

·      The biosand filter does not eliminate all parasites and bacteria. 

·      Testing has revealed that, although there had been a 95% reduction in fecal coliforms, there were still some bacteria present in the purified water. For this reason, it is necessary to chlorinate water before consuming it. 

·      Water can become contaminated at various stages along the process.  If buckets become dirty or people put unclean hands in the water, contamination can occur.  Thus, proper education is one of the most crucial components in the successful implementation of this project.  

Evaluation and Monitoring for Impact: Making sure communities get clean water

AMOS is very intentional about testing the impact of the filter on the health of people living in rural communities.  We start with the people’s own perception of clean water, and then work with the community to see how we can evaluate and monitor the project together to assure that that everyone is getting clean drinking water. Community leaders are trained to test and monitor their water own sources as well as their water filters. Our methodology is systematic, scientific and evidence-based.  It’s about much more than simply installing a filter and walking away – our goal is to accompany the community and stand with them until everyone has clean water. 

Community empowerment: A project for the people and by the people

AMOS has been working to refine the sand filter assembly and testing process, with the goal of empowering communities to build, install and test their own filters. Ultimately, the biggest factor for success lies in the hands of the community members themselves.

·      Clean water must become a value

·      Good hygiene and safe water storage practices need to be taught and reinforced

·      Filters themselves must be well-cared for

Long term sustainability: Health and hope for all

AMOS is committed to offering a long-term solution that is holistic and effective.  We are working to address every stage in the process to improve health, from keeping water sources clean through the use of latrines, to filtration in homes, to hand washing & bacteria education to prevent recontamination.  It is a long journey, but the ultimate goal is to provide the most people with the cleanest water in the most efficient, effective way possible.  This is all part of the broader picture of providing health and hope for all.    

new year

And we're back!  It's a new year and things are ramping up already.  We're excited to have a team from Washington State coming at the end of this week to help install water filters in the community of Sabalete in Matagalpa.

feliz navidad

Merry Christmas everyone!  We hope you have a wonderful holiday with family and friends.  Many staff and volunteers at AMOS are also spending time with family, so we'll be back in action after the first week of January.  Should be a great year - check back here often to see what's happening.

El Obraje

We just recently installed 79 biosand filters in the community of El Obraje. These filters can provide up to 10 gallons of water per day for 10 years, at a cost of slightly less than $0.07/day.

creative energy

It takes creative energy to hold things together. A family, a friendship, a garden, a community. Each one must be cultivated and maintained. You watch for weeds and pull them quickly, otherwise you'll be overrun. But not only this; seeds must be planted. What do you want to grow?

One thing that has captured my imagination this month is the way that AMOS helps to organize communities. In essence, they seek to empower local leaders to love and care for their neighbors. It all starts with a census and the attitude, "Everyone counted and everyone counts." The members of the health committee go to EVERY house in their community, learning names, counting how many people are in each household, and identifying those who are most at risk for illness & disease. This list forms the foundation for preventive care (for example, checking on mothers when their babies are due) and helps to ensure that no one is left behind.

Often when aid is given, it goes to the strongest and most able-bodied - those who can make it to the distribution point. Many times, the most vulnerable are left in the dark, too weak or unaware to get help. By knowing everyone in the community, the leaders can ask, "Who is missing here? Are they ok?"

What a beautiful question for people in every community. "Who is missing here? Who is hurting? Let's go to them and see how we can help."