VURHONGA - A NEW DAWN:

Driving from Chokwe to Mabalane, you encounter grim reminders, and remainders, of war -- abandoned railway stations; rusting tanks pointing accusingly at destroyed buildings; and small signs discretely warning about the location of landmines.

You are also confronted with the poverty and drought which have reduced food production and prevented families from replenishing their small animal herds which were destroyed during the war. Food security is a continuing problem. And now, El Nino may lead to another drought year.

Yet amid this despair, a new hope has dawned -- the Vurhonga Child Survival project. Vurhonga, which means "dawn" in the local Tsonga language, has trained volunteer mothers to bring Child Survival messages and interventions to every household in the project area.

The beneficiaries of this project are 34,000 women and children living in 38 rural villages in the Guija and Mabalane districts of Gaza Province, Mozambique. This stalwart group is responsible for most of the food production, wood and water gathering, and child care. More than half of the fathers are working away from home in South Africa.

The Vurhonga Child Survival project began in 1995 with goals to reduce mortality and morbidity for children less than five years of age and women 12-49 years; strengthen the capacity of the Ministry of Health (MOH) to implement Child Survival interventions; and empower communities to make decisions that protect the growing minds and bodies of their children.

The baseline Knowledge, Practice and Coverage (KPC) survey in 1995 showed that 37% of children were completely immunized, 30% of women had received at least one prenatal visit, and 11% of children were receiving treatment within 24 hours for suspected cases of malaria. Two years later, those figures are respectively, and impressively, 79%, 80% and 67%. In fact, the project has already achieved or surpassed all of its four-year objectives (see graphs below). Several factors and strategies have contributed to this success.

First, the Vurhonga project built on two other World Relief initiatives. An agricultural project is distributing and promoting drought resistant crops. A water and sanitation project drilled 83 boreholes in Guija and Mabalane districts, and initiated an effective home sanitation component. Having responded to the urgent needs for food and water, World Relief established a reputation and credibility that made the recruitment of volunteer mothers much easier.

Second, the project established a community-based network of Care groups using the existing structure of "block" mothers of the OMM (Women's Organization of Mozambique). Each volunteer mother is responsible for the health care of the ten families in her neighborhood. By building on this existing network the project was more easily accepted by community leaders, was able to "take off" more quickly, and has a better chance of being sustained.

Third, the project groups 8-10 volunteer mothers into Care groups under the supervision of a project-supported animator/trainer who trains them in Child Survival interventions and health messages. Each animator is responsible for Care groups in two villages. While the animators were not recruited from the villages which they serve, because of literacy requirements, they live and overnight in the villages five days a week. The Vurhonga network, which now includes 19 animator/trainers, 141 Care groups, and more than 1,500 volunteers, is in regular contact with every woman 12-49 years old and every child under five with Child Survival interventions and health messages.

Fourth, the project has worked hand in hand with the Ministry of Health to expand its system of health posts from twelve to twenty-two. This has increased population access to primary care within five kms from 54% to 83%. The project also helps the MOH train community-appointed "soccoristas" to staff the health posts and to provide immunizations, nutrition and growth monitoring, oral rehydration treatment, maternal care, malaria treatment, pneumonia case management, and family planning. Soccoristas also serve as the link to the community-based Care groups.

Fifth, the project provides constant "feedback" to health workers. In addition to baseline and midterm KPC surveys, the project has also completed three Health Information System surveys. Each animator is randomly assigned to survey all children under five and all pregnant women in the Care group of another animator. Survey results are compiled manually and cumulatively into graphs. These graphs are an excellent summary of project progress and a provide a visual feedback to supervisors and animators. Six of these graphs are included in this article. The project also uses a drawing of children partially shaded with a colored translucent film to provide "graphical" feedback to volunteers and community members. For example, the drawing below indicates that 80% percentage of children have been completely immunized.

Sixth, Vurhonga has not only successfully implemented a growth monitoring program in collaboration with the MOH, but also provides home-based nutrition interventions. Animators train volunteer mothers to visit each mother whose child suffers growth faltering, and to help her to supplement the child by demonstrating appropriate, inexpensive local foods. For example, Vurhonga is encouraging the use of a weaning food based on the local tradition of dry-roasting and mixing ground peanuts and cereals. Mothers can prepare this in advance as a kind of "instant cereal" to which milk or water, oil and sugar can be added, making it a well-balanced, calorie-dense weaning food.

Finally, the Christian dedication of the project leaders, Dr. Pieter Ernst, the project director, and Linda Nghatsane, the project's nurse-educator must be noted as an important contributing factor. Although South African by birth, both had selected Chokwe as their long-term residence and personal mission field several years before the Vurhonga project began. World Relief's recruitment of these two individuals, who were already well known and respected by the local community, has ensured capable and tireless leadership for the Vurhonga project.

Important health problems still exist. The maternal mortality rate is still quite high. Getting to emergency obstetrical services at Chokwe requires a long ox cart ride and a ferry to cross the river (the bridge was destroyed during the war). The prospect of another drought year also looms heavily in the minds of the population. Not only would this endanger household food security, but it would also decrease the time that volunteer mothers could devote to health activities, since they would need to spend more time in their own fields.

Are the impressive results sustainable? It is interesting to note that according to USAID's Country Strategic Plan for Mozambique:

it is doubtful if the Government of the Republic of Mozambique will be able to even approach minimal sustainability in the medium (10-15 years) term. To this end, the Mission's strategy will focus on ways to 1) empower local communities to take responsibility for determining the level and mix of primary and preventive health care interventions appropriate for themselves; and 2) to integrate effectively and cost-effectively public, private and local community health care resources.

Vurhonga is a good example of putting USAID's strategy into action. Vurhonga has already started to turn over the support and supervision of volunteer mothers from project-paid animators to Care group leaders. They are also linking Care groups to the district's supply line and supervision system. In addition, the project has worked with the district to initiate consultation fees at the health post from which the Seccoristas receive their compensation.

The Vurhonga project, in the words of one of the villagers, means that "we who sat in darkness have seen a new light." Local authorities are also "seeing the light," and now requesting that the project expand the "dawn" of Vurhonga into neighboring districts.

1. This USAID-funded Child Survival project is managed by World Relief Corporation (WRC), Wheaton, IL. WRC is the international arm of the National Association of Evangelicals. Their projects assist whole communities without regard for race or religion. WRC currently has or has completed child survival activities in Haiti, Honduras, Nicaragua, El Salvador, Cambodia, Bangladesh, and Mozambique. For more information contact PO Box WRC, Wheaton, IL 60189 (tel. 708-665-0235).