Challenges of Institutionalizing Community Health Workers in the Islamic Republic of Mauritania

The use of Community Health Workers (CHW) is critical in Mauritania since a significant portion of the population lives miles away from health posts and they often cannot afford transport. CHW's are an integral component of Counterpart International's (CPI) USAID Food for Peace Program which seeks to strengthen human capabilities in health and nutrition in order to mitigate the effects of food insecurity. CHW's present Behavior Change Communication sessions, lead Growth Monitoring and Promotion activities, help with commodity distribution, and manage a pharmaceutical box. CHW's are renumerated with commodities which poses a formidable challenge for sustaining the CHW's after the end of the program. While the government has acknowledged the necessity of using CHW's to provide services in rural areas, they have not demonstrated the political will or provided the financial resources necessary to implement a CHW program. Thus, CPI is exploring alternative approaches to compensating CHW's which complement their programming. The profits from the CHW's pharmaceutical box are currently divided to: resupply the kit, provide the CHW a small monetary incentive, and support the community in the event of emergencies. However, CPI is planning on altering the repartition to provide a greater percentage of profit to the CHW and replace expired medicine. Moreover, CPI is promoting other income generating activities such as the production of CereAmine, a porridge with similar nutrition content as Corn-Soy-Blend and traditional soap-making which will simultaneously improve village health and provide an income for the CHW.