“NarSarah Clinic”. An integrated approach to child survival and economic opportunity.

“NarSarah Clinic”. An integrated approach to child survival and economic opportunity.

Sierra Leone
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
$10,000 - $50,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

The first change is to reduce the degree of malnutrition among children less than 5 years and secondly to create economic empowerment for poor women in rural Sierra Leone.

About Project

Problem: What problem is this project trying to address?

SIERRA LE SEED International came to Sierra Leone in the wake of the decade-long civil war that ravaged the nation from 1991 to 2001. During the war, rebel forces criss-crossed through the country, abducting, amputating, and killing thousands of innocent civilians. Child soldiers were forced to fight on the front-lines, often while under the influence of cocaine or other drugs. Over that decade, half the population was displaced, 50,000 killed, 100,000 were maimed or mutilated, 200,000 babies born to victims of rape. Hospitals, clinics, home, schools, and whole villages were destroyed. Infrastructure was directly targeted, and much of the nation was left without the basic needs for human life. Sierra Leone is in West Africa and is the size of South Carolina with a population of 5 million. They received independence from England April, 1961. English is the official language with more than 15 tribal languages spoken. The rainfall is approximately 170 inches to 195 inches in a year (comes during a 4-5 month period). Rice is the main food with an abundance of fruit throughout the year. Sierra Leone is a beautiful country and it is filled with people that continue to strive to rebuild their lives so that they can give hope and dreams to their children. KOINADUGU DISTRICT: Koinadugu District is by far the largest District in Sierra Leone in geographical terms. The District's capital and largest city is Kabala, which is also one of the main cities in Northern Sierra Leone. The District of Koinadugu had a population of 265,765 in the 2004 census. Situated in the far north-eastern corner of the country, was the vegetable garden and agricultural center of the country in the 1960/70’s. With the coming of the war, the district was left in ruins. Kabala, the headquarters of the district and the site of NarSarah Clinic and now SEED’s headquarter office, faced recurring attacks and was held under rebel control for a portion of the war. Half-burnt remains of buildings still remind of all the work that must be done to reach even a minimal standard of living required for day to day survival. Koinadugu faces all the obstacles of rural poverty in a developing country. Most villages have no healthcare beyond traditional medicine while the district has among the worst health indicators in the nation. Recent research conducted revealed HIV prevalence of 6% among the hundreds of patients tested. Health remains a huge concern in Koinadugu and in Sierra Leone as a whole. The Koinadugu District is the poorest district in the entire country. The district also faces major challenges in education and gender equality, which are fundamental components of development. Many villages in the district lack even a single school; the district literacy rate stands at 21%. Women’s literacy rate is less than half that of men’s and gender issues merit special attention in light of harmful traditional customs and practices. Women’s empowerment has become a core aspect of the SEED’s work in the district. Food security also remains a major problem, with agriculture largely limited to subsistence-level farming and lacking the necessary expertise that could improve cultivation practices. The district faces among the highest levels of agricultural and asset poverty in the nation. Agriculture and animal husbandry is a significant part of the SEED program, not only in the district headquarters but also in the villages, where the need is most acute. With the excellent soil and climate conditions, this district will hopefully return to being know as the richest area for agriculture in the nation. Life in the rural regions is incredibly hard for those who live there, and such struggles have become a pressing issue in Sierra Leone as the country endeavors to stem the flood of people moving into the overcrowded capital city. In the districts like Koinadugu, tiny isolated villages are spaced miles apart. Transportation is both costly and dangerous and the roads are in a constant state of disrepair and during the rainy season completely impassable. Electricity and clean water are nonexistent. Banks, shops, computers - all the conveniences of "modern" living are incredibly rare. The district is mainly Muslim (95% of the population) and Islam dominates the religious and cultural practices in the district. Most schools in the district have Islamic religious affiliation. Christianity accounts for about 5% of the population. Government: The District of Koinadugu is governed with a district council form of government, which is headed by a District Council Chairman, who is responsible for the general management of the district and for seeing that all local laws are enforced. The District Council Chairman is elected directly by the residents of Koinadugu District. The Council Hall of Koinadugu District located in the district capital of Kabala. The current chairman of Koinadugu district council is Peter Bayuku Conteh of the All People’s Congress (APC) . Demography: Koinadugu District is by far the largest district in Sierra Leone and with an estimated population of 265,765. The major ethnic groups in the district are the Madingo (who predominate in the district's largest city of Kabala), Kurankos (Controlling 5 of the 11 chiefdoms), Fula and Limba and Yalunka (predominant in Musaia and Falaba areas) Areas bordering the republic of Guinea (Conakry). Economy: Diamond and gold mining iare major economic activities in the contry and district respectively, as well as agricultural production of rice, mango, cacao, groundnut and coconut.

Solution: What is the proposed solution? Please be specific!

The NarSarah clinic is an integrated project to child survival. The Clinic has initiated a number of other activities linked to healthcare, the most interesting of which is the 'Women Against Poverty' work—It is such an interesting model which links health care, economic empowerment and livelihoods, along with education, agriculture, income generation and animal husbandry--all in one of the poorest areas of Sierra Leone
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

• Mass sensitization through the local radio and community visits. • The creation of Center in the villages that will become focal point for providing information on food and nutrition for young children through outreach meetings and one on one counselling of mothers. • The Project will employ three full time and one part time staff and train 10 Village Volunteers. Program Manager, full time responsible for hiring project staff overseeing project development and operation, establishing and maintaining links with other NGOs, local government agencies and budget. Center Coordinator full time, responsible for establishing the community Centers, developing working relationships with formal and informal community leaders, establishing links to community women's organizations and scheduling of Center programs. Training Coordinator, full time qualified agriculturist who will be responsible to assist 100 mothers to grow nutritional foods in 10 communities. Project Evaluator, part time responsible for collecting entry level data regarding mother's health and nutrition information and conducting periodic assessment of changes in their level of knowledge comprehension and application of that information. Center Volunteer Assistant part time based in the centers, responsible for maintaining the structure and appearance of the Center and routine correspondence and other forms of communication with mothers in the community. Training of village volunteers (Mother Clubs) as viable form of manpower for the offering of service at the community level. The Project will work to promote a sense of volunteerism at the community level to maximise the chances for future sustainability. Production of nutritional foods by mothers in the communities.
About You
Organization:
Christa Is The Answer (CITA) International
About You
First Name

Dorcas

Last Name

Kamanda

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About Your Organization
Organization Name

Christa Is The Answer (CITA) International

Organization Country

, N

Country where this project is creating social impact

, N

How long has your organization been operating?

More than 5 years

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Innovation
What stage is your project in?

Operating for more than 5 years

Share the story of the founder and what inspired the founder to start this project

NarSarah Project was born of the vision a Sierra Leone native family, the Kamanda and the Law family an American family based in U.S.A.
Soon after the civil war in 2002, Mrs Dorcas Kamanda returned to Sierra Leone and was shocked by the destruction and suffering she found in her community and country at large. She and her brother and sister in Sierra Leone started a health care service from their home in kabala.

Dorcas and her family decided it was time for the early vision to become a reality and NarSarah Clinic was established in 2005.

Social Impact
Please describe how your project has been successful and how that success is measured

• An independent consultant did an evaluation of NarSarah Clinic’s work in 2010 to establish some facts about the clinic’s viability and continuity. After the study, the result revealed the following:

NaSarah Clinic operations. Jan – Dec 2010:
Free medical care for pregnant women, nursing mothers and under 5s was declared by the Government of Sierra Leone on April 27, 2010.
HEALTHCARE:
Pregnant women and deliveries
Before April 27th 2010 the average attendance by pregnant women in the clinic was 32 but this dropped by 50% when free medical care was declared for this group in all government hospitals. The same is true for deliveries at the clinic. Which also dropped by 40%.
This is considered a significant success for NarSarah Clinic for being able to retain 50% of its clients even in the middle of free medical care for the group in question. This is probably because no still birth ever occurred in the hands of the nurses at NarSarah clinic during this period.
HIV/AIDS
In March 2011, 39 pregnant women were tested for HIV/AIDS at NarSarah Clinic and one 25 year old was found positive. This testing exercise is mandatory for all pregnant women visiting NarSarah Clinic and remains very confidential.
Clinic attendances for under 5 years
• It was observed from that before the declaration of free medical care for pregnant women, nursing mothers and under 5s in April 2010, the average monthly attendance for under 5s was 101. By the end of 2010 this average attendance increased 208 slightly over 100%.
• For patients over 5 years the monthly average attendance before April declaration was 286 and by the end of the year that figure dropped to 246 indicating a slight drop of 15%.
• Overall, these figures still show the important roll Nasarah clinic is playing in complementing the the efforts of the only government hospital in Kabala.

WOMEN AGAIST POVERTY (WAP)
Interview conducted with the executive.
WAP was established in 2006 after most of its members graduated from various skill training from Christian Extension Services (CES) and were later engaged and better organised by CITA.
Their goal is to improve the living standard of its 30 members.
Their objectives include:
1. To cultivate and produce groundnuts for its members and CITA through agricultural support
from CITA
1. To produce 30 suits of Gara clothes through gara tie dying.
2. Add value to the gara materials by sewing them to various outfits needed by people abroad.
3. Weave 12 wrappers and sell abroad
4. Generate personal savings through micro-credit with CITA support.
Achievements:
Agriculture: 13 Women are involved in this component.
During the year under review, only three bushels of groundnut was harvested during the first cropping in rainy season. When sold, the groundnut brought in an income of Le. 90,000. In the dry season a second cropping in lowland swamp yielded groundnut of nine bushels costing, Le. 276,000 when sold. CITA received 52,000 from the group to complement CITA’s support for them. The group plans to cultivate and plant beans on the 2 acres of land owned by CITA come May 2011.
Gara Tie Die and Tailoring. This group had two sets of production. In early 2010, they produced 16 suits which was sent abroad for sales through assistance from CITA. An initial income of 1,100$US was sent for the groups and 100$ was paid to CITA for its support to the project. Sales continue for the remaining suits overseas. The second sets of Gara materials were produced and sewed by the tailors into various outfits for sales in U.S.A.
They include the following:
a. Back Packs 5
b. Neck Wrappers 12
c. Apron 20
d. Skirts 5
e. Purses 8
f. Sponge bags 10
g. Table mats 48
The WAP members are expecting very good returns in cash after sales have been made in the Unites State of America through expatriate visitors who come to Kabala and visit the clinic and the group.
Weaving. These group produced 12 pieces of neck wrappers which is included for sales in the second consignment of the gara tie dye and tailoring group.
Literacy group. This adult learning activity was designed to help all 30 members in WAP to be able to do basic reading and writing. It started with 22 members but later increased to 35 with levels one, two and three. Three of the level two participants now has ability to attempt the National Primary School Examination (NPSE) and hopefully pass to enter into Junior High school.
Micro-Credit. This activity was also set up to help all the 30 members of WAP in generating personal savings at the end of three incremental loan cycles beginning with Le100,000 and ending with Le300,000. Loans from the 30 members were all paid back with 15% interest. The interests generated from micro-credit were used by CITA to purchase the two acre land for agricultural use.
Community /CITA Agriculture
In 2008 CITA entered a partnership arrangement with the village of Bendugu with a vision to create asset in the form of agriculture that will generate income for the support of NarSarah Clinic in the future. During the first year the community “donated” 10 acres of land for the cultivation of oil palm plantation. 5 acres of land were initially cleared and planted with oil palm and mangoes with input from CITA. Meanwhile CITA plans to expand on this project substantially in the coming years. This project will go a long way for the sustainability of Nar Sarah Clinic. A tree of oil palm when mature for production brings an income of 6US$ after production. One acre of oil palm holds 60 trees.
NUTRITION PROGRAM
This feeding programme started in February 2010. The patients were mostly children under 6 months to 5years of age. A total of 41 malnourished children including 19 Males and 22 Females were fed and their weights monitored in the health centre. According to recorded figures during this period, 24 patients had increase in their weight while 11 maintained the same weight, 1 dropped below the original weight and 3 died. In essence, the programme went a long way in helping 35 malnourished children and few adults to survive instead of continue to be malnourished and eventually die.

How many people have been impacted by your project?

1,001- 10,000

How many people could be impacted by your project in the next three years?

1,001-10,000

How will your project evolve over the next three years?

Firstly, NarSarah will expand into new communities in the district.

Secondly, training of the WAP women in basic health services in the area of hygiene nutrition (Mother’s Club) and engage them in the campaign for saving the child and empowering the mother economically.

Thirdly, equip the clinic with surgical theatre in partnership with Blue Star Mariestopes in Sierra Leone.

Finally, NarSarah will expand its HIV/AIDS testing and counselling program to remote communities in the district.

Sustainability
What barriers might hinder the success of your project and how do you plan to overcome them?

Firstly, CITA invests in agriculture - oil palm plantation, guest house for hire by visitors and tourists for revenue and animal husbandry. These are all long term investment which will bring in substantial income in the long run.
Cooperation in the communities. This aspect will be handled using the participatory method of development during our entry point into any community. There will be the need for trust between Nasrah and the community. This happen by involving the people in assessing their state and assisting them in improving that state for the better. Tools like PRA and others can be used.

Poor collaboration and networking. This can be addressed by maintaing good network of partnership with the government, local authorities and other national and international Non governmental organizations.

Tell us about your partnerships

CITA partners with Christian Health Association in Sierra Leone which serves as liaison body for Christian health organizations in the country.

Explain your selections

The Kamanda, and Law family are the primary funding sources for the NarSarah Clinic and CITA International.

Regionally, Individual supporters in American are a key financial contributor to CITA International being an American based Non Profit Organization.

In Sierra Leone, proceeds received from the Clinic operations through customers are also used to strengthen and develop the facilities of the Clinic.

Individuals like the Laws family and their friends in the U.S. are also very instrumental in sponsoring over 60 students in Primary and Secondary Schools.

How do you plan to strengthen your project in the next three years?

Recruitment of additional staff to enhance effectiveness and efficiency and to increase our coverage.
Recruitment of Center Volunteers based in the centers, responsible for maintaining the structure and appearance of the Center and routine correspondence and other forms of communication with mothers in the community.
Training of village volunteers (Mother Clubs) as viable form of manpower for the offering of service at the community level. The Project will work to promote a sense of volunteerism at the community level to maximise the chances for future sustainability.
Establishment of a theatre for undertaking medical operations mainly for difficult deliveries in the near future at the Clinic facility.
Effective networking with other organizations who are engaged in similar activities to avoid duplication of efforts and time wasting.
Fund raising locally and internationally is a priority

Challenges
Which barriers to employment does your innovation address?
Please select up to three in order of relevancy to your project.

PRIMARY

Underemployment

SECONDARY

Lack of visibility and investment

TERTIARY

Lack of access to information and networks

Please describe how your innovation specifically tackles the barriers listed above.

Job Creation:The Project will employ three full time and one part time staff and train 10 Village Volunteers.
Program Manager, full time responsible for hiring project staff overseeing project development and operation.

Training:Training Coordinator, full time qualified agriculturist who will be responsible to assist 100 mothers to grow nutritional foods in 10 communities.
Center Coordinator full time, responsible for establishing the community Centers, developing working relationships with formal and informal community leaders.

Investment:Invest in oil palm plantation, guest house for hire by visitors and tourists for revenue and animal husbandry. These are all long term investments which will bring in substantial income in the long run to sustain the operations of the project.

Are you trying to scale your organization or initiative?
If yes, please check up to three potential pathways in order of relevancy to you.

PRIMARY

SECONDARY

Enhanced existing impact through addition of complementary services

TERTIARY

Repurposed your model for other sectors/development needs

Please describe which of your growth activities are current or planned for the immediate future.

1. Mass sensitization through the local radio and community visits ongoing – Currently a lot of radio panel sensitization has been conducted by NarSara Clinic staff.
2. The establishment of theatre for medical operations is planned for the immediate future.
3. Recruitment of additional staff is planned
4. Cultivation of nutritional foods for next year

Do you collaborate with any of the following: (Check all that apply)

Government, Technology providers, NGOs/Nonprofits.

If yes, how have these collaborations helped your innovation to succeed?

The government grants CITA International the license to operate in the country legally. It also grant the institution duty free concessions for bringing in relevant materials and equipments into the country. At the district level, the Ministry of Health and Sanitation gives Nar Sarah Clinic all the support it needs to carry out its functions effectively.

NarSarah Clinic is working effectively with Solar powered energy. This has reduced the operational cost very significantly as fuel prices have been soaring up in recent months.

Other partner NGOs have in diverse ways assisted Nar Sarah Clinic to carry out functions it would have otherwise not been able to do for lack of materials and training. An example is the family planning activities supported by Blue Star mariestopes Clinic.

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