Le travail du centre de santé de Kinyami au niveau communautaire

Cyriaque Bimenyimana

Nurse, Kinyami Health Center, Burundi

Propos recueillis par Bède Matituye

Je suis Cyriaque Bimenyimana, titulaire du centre de santé de Kinyami, district sanitaire Giteranyi en province de Muyinga. J’avais participé, en décembre 2013 à une formation sur comment renforcer le système de santé communautaire organisée par le Ministère de la Santé et University Research Co. Y ont également participé un des chefs collinaires, un animateur communautaire et un responsable d’une association locale. Nous avions été invités pour notre formation car notre centre de santé ne faisait pas partie des sites pilotes retenus pour le système de santé communautaire. Au retour de la formation, nous avons pris la décision nous-mêmes d’initier certaines activités pour renforcer notre système de santé communautaire.

Il s’agissait d’expliquer le bien-fondé du test de grossesse, en compagnie des maris, la réduction des naissances et la PTME. Sur les collines visitées, on identifiait  d’abord les organisations existantes avant d’expliquer et de discuter avec leurs responsables et les chefs collinaires ainsi que les agents de santé sur les bienfaits de la nouvelle approche. On a ensuite échangé avec les personnes formées en décembre dernier sur la vulgarisation des acquis à la population.

Pour asseoir le système de santé communautaire, nous avons mis en place une nouvelle structure composée des chefs collinaires, les agents de santé de la colline, les  responsables des organisations communautaires, les animateurs communautaires, les responsables  religieux et les responsables scolaires. Ce comité fonctionne grâce aux réunions d’échange d’informations, de collecte et d’analyse des données et de planification. Ces réunions se tiennent deux fois par mois pour notamment faire l’état des lieux sur les cas de test de grossesse, de consultation prénatale en compagnie des maris, de vaccination des enfants, etc.

Ainsi, les cas de test de grossesse en compagnie des maris sont passés de 79% en Octobre 2013 à 97% en Mars 2014 et ceux de test au VIH de 56% à 72%. L’accouchement dans les structures de soins ainsi que la vaccination des enfants jusqu’à 9 mois ont également augmenté dans les mêmes proportions. Partout où nous avons œuvré, notre constat est que ce système communautaire est bénéfique à la population et mérite d’être étendu à l’ensemble du pays.

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Implementing the community health system approach at Kinyami health center

Interview by Bède Matituye

My name is Cyriaque Bimenyimana and I am in charge of the Kinyami health center located in the Giteranyi health district in Muyinga province, Burundi. In December 2013, I participated in a training on how to strengthen the community health system jointly organized by the Ministry of Public Health and the USAID ASSIST Project. Also in attendance were one of the hill leaders, a community mobilizer and the leader of a local association. During this training, ASSIST technical experts shared results of the baseline study of the current community health system in Giteranyi. Dr Ram Shrestha, ASSIST Senior QI Advisor for Community Health, showed us the technical content and different approaches to strengthening the community health system.

Upon returning from the training, we debriefed the other Kinyami health center staff and members of the center’s health committee. Given that our health center was not selected by ASSIST as one of the pilot sites in its community collaborative, we decided to implement on our own the knowledge acquired during the training. We initiated some activities to strengthen our community health system to tackle some of the known challenges at our health center. Some of these challenges were: how to increase the rate of early antenatal consultations; how to involve partners in maternal and child health services including couple antenatal consultations, delivery in health care facilities, family planning, immunization etc.; and how to involve stakeholders in Preventing Mother to Child Transmission (PMTCT) activities of couple ANC, couples HIV testing, etc.

We proceeded by first identifying on the actors on the hill level of our community. In the hills we visited, we identified the existing organizations before explaining and discussing the benefits of the new approach with their managers, hill leaders and health workers. We then shared the knowledge we had acquired from the December training with the group. To strengthen our community health system, we created two community structures:

  1. A community health committee on the hill level comprising the sub-hill heads, the hill chiefs, the hill health workers, the leaders of existing community organizations, community organizers, religious leaders and the hill school officials.
  2. A central community committee attraction area of the health center comprising the presidents of hill committees, 3 hill heads, 3 representatives of community health workers, and representatives of the health center.

The community committees function through information exchange meetings, data collection and analysis, and planning. These meetings are held twice monthly to provide updates on pregnancies identified in the community and cases of early ANC registrations in health centers, the number of births compared to the number of vaccinated children, ANC with husbands, vaccination of children under 9 months, etc. 

Some preliminary findings after the first three months of the establishment of the community system showed promising results. For example, the perceptage of women that took a pregnancy test in the company of their husbands increased from 79% before the intervention (in October 2013) to 97% three months after the beginning of the intervention (in March 2014). Also, testing for HIV among the general population increasesd from 56% in October 2013 to 72% in March 2014. The delivery in health facilities as well as vaccination of children up to 9 months was also increased in the same proportion.

In summary, although we are in the preliminary phase, we noticed that the introduction of the community health system helps to improve indicators that previously remained at low levels for a long time. We express gratitude to URC for involving us in the training and we ask them to extend the ASSIST project in other health centers.

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