Khinine is a small village in the region of Thies – approximately 70 kilometres outside of Dakar, the capital of Senegal.
With 1,006 inhabitants, the area is populated primarily by the Sérène people; an ethnic minority of central Senegal whose principal activity is farming.
On this sunny morning in the month of May, the first patients arrive at the health centre. They are greeted by Ndèye Diouf. This young woman is a community health worker. As such, her role is to manage the health centre and provide primary care.
A small woman, she wears a broad smile that puts visitors at ease to approach her. She has been working in Khinine, her native village, since 2009 after having received her training as a community health worker. Ndèye Diouf welcomes patients and guides them through the consultation process.
Among the first patients of the day is Khady, a two-year-old girl who was brought in by her young mother. Khady has diarrhoea.
The mother explains that it all started the previous night.
“I was woken up by the crying of my daughter, who was twisting with pain. She was asking for the toilet pot. She was up three times in the night. The diarrhoea was liquid. I couldn’t wait for morning so that I could bring her here to the health centre.”
Ndèye Diouf weighs the child. Then she proceeds to a cupboard at the end of the room and takes out an appropriate treatment: zinc tablets and small packages of oral rehydration salts (ORS). Using simple words in the local language, she tells the mother how to use these to treat the diarrhoea.
She reviews the steps for preventing diarrhoea, insisting that left-over food be thoroughly re-heated before it is served to children, and that hands be washed well before eating.
Ndèye Diouf recommends that the mother continue to feed her little girl, and to give her water to drink regularly.
In Senegal, diarrhoea is one of the five most common illnesses to affect the population.It has several inter-linked causes. One quarter of Senegalese children under the age of five are affected by diarrhoea, and more than one tenth of children do not celebrate their fifth birthday.
Over the course of the past two years, the Senegalese Ministry of Health has initiated several changes to the country’s diarrhoea treatment policy, adopting the World Health Organization (WHO) guidelines, which include zinc supplementation and an improved formulation of oral rehydration therapy.
The Ministry set up a national zinc steering committee and the Micronutrient Initiative (MI) plays a major supporting and advisory role.
The health centre where Ndèye Diouf works was part of a pilot project financed by MI in 2010. The project’s aim was not only to increase zinc and ORS use in the treatment of diarrhoea, but also increase the number of community members seeking out treatment for diarrhoea for their children.
The success of the pilot has led to a national scale-up program, launched in May 2012 and financed by the Zinc Alliance for Child Health (ZACH), a public/private/civil society partnership between the Canadian mining company Teck, the Canadian International Development Agency and the Micronutrient Initiative.
In Senegal, the ZACH project is led by the Government through the Division of Food, Nutrition and Child Survival (DANSE), as part of the government’s efforts to reduce child mortality.
ZACH is a unique partnership created to develop and sustain diarrhoea treatment programs using zinc supplementation in combination with ORS.
The national scale-up project in Senegal will provide a foundation on which to expand zinc supplementation efforts globally. It will also showcase the results that can be achieved through private-public-civil society partnerships.