Djibouti: Expanded Coverage of Essential Health Services (PESCE)
The Djibouti “Expanded Coverage of Essential Health Services” project aimed to reduce maternal and child mortality in Djibouti through increasing the sustainable supply of quality health services. Known by its French acronym, PESCE, the project supported health reform in Djibouti with a focus on community mobilization, primarily in rural areas. The four-year project (2004-2008) was funded by USAID and managed by JSI.
PESCE pioneered community mobilization for health in Djibouti. There was no policy framework for community health until 2006, when Ministry of Health (MOH) officials visited project pilot sites and saw firsthand what community health volunteers (CHVs) could do. The MOH asked for the model to be replicated, and the project delivered in 23 sites. The MOH went so far as to promulgate a National Community Mobilization Policy for health, the first ever in Djibouti.
In each site, the Health Post was linked to a newly established Health Committee and CHVs recruited by the project. CHVs worked with nurses to develop Community Health Action Plans and provide information about immunization and prenatal care needs, advocate for health post use, and provide health education on specific topics. Flip charts and posters covering nine key health subjects were produced for their use. (Photo: Community leader giving working tools to CHV: May 2006.)
PESCE provided clinical training in STI management, HIV/STI prevention, and child nutrition. Along with key partners UNICEF and WHO, the project implemented the Joint Extended Program on Immunization Plan with the MOH. The project showed a rise in utilization rates for antenatal care and immunizations as well as in deliveries in health facilities. PESCE also contributed to a national drop in infant mortality, from 103 per 1,000 live births in 2002 to 67 in 2006. Under-5 mortality also dropped from 121 in 2002 to 94 in 2006.
Community Mobilization in Action
In 2005, bordering nations experienced polio cases and emergency immunization campaigns began. For the first time, the Health Committees and CHVs helped mobilize families, gaining respect and earning MOH supervisors' trust. With both human and avian H5N1 bird influenza cases reported and a deadly cholera epidemic in 2006, the new mobilization structures were critical to the nation’s response. PECSE assisted communities and rural health post staff in preparedness for avian influenza, and CHVs and Health Committee members were trained in prevention and symptoms of cholera. They spread prevention messages, assisted nurses to reach cases rapidly, chlorinated drinking water and educated villagers in safe preparation of foods.