15 people are checking and filling records and report cards titled - “Treatment registration (2 to 71 months)”. There are murmurs while they cross-check the different rows and data they are supposed to be filling in their communities in the near future.

Most of them are community health workers who work voluntarily in remote communities of San José de Bocay, in Jinotega, 245 kilometres from Managua. Some of them have to walk for over 12 hours to reach their municipality headquarters. These men and women in their communities follow up babies and pregnant women as soon as they detect disease warnings, especially fevers, diarrhoea and pneumonia.

“We are told how attend children in our communities, how to fill the record and the best way we give appropriate care to girls and boys” explains Javier Antonio Palacios Centeno, a 23-year-old young man from El hormiguero community, who walked 7 hours to San José de Bocay.

During three intensive days of workshop, between February 21 and 23, 2017, they talked about how to gather information with regards to the health of children under 5 years old, alerts and symptoms they should consider to refer pregnant women and babies to the health center, types of medicines and how to provide them if applicable.

A 10-year-old Community Case Management Strategy in Nicaragua

This workshop was on Community Case Management Strategy (CCM). This strategy is promoted in Nicaragua by Save the Children since 2016. In 2007, Ministry of Health (well known as MINSA) allowed to be applied in the communities and from 2012, it has been raised to a ministerial standard along with other community strategies related to health and nutrition.

CCM is being implemented in coordination with MINSA in 224 rural communities with difficult access to health services, in the municipalities of León, Matagalpa and Jinotega. Over the years, health workers from 500 communities have been trained in workshops similar to this, to improve their care of children under 5 years old, especially when they have symptoms of various diseases such as pneumonia and diarrhea.

This workshop attendees are returning in a couple of hours to their communities from San José de Bocay. So that, they should be careful filling out the pertinent information in their reports. Thus, trainer, a MINSA doctor asks his audience "what other things should we share with the community?”

We can see attendees use terms like - "counseling", "diarrhea data" or "monthly report". Trainer asks "What is your machete (tool)?" Finally, they agree that their primary tool is the report cards in which they report records, for example, touching on number of children being treated, info about pneumonia and other serious diseases in their communities.

Accountability in the community

They are gradually reviewing the information that they will take note as soon as they care children in the communities where they live and work voluntarily. They reflect on how the gathering of these data will help them over time to evaluate the initiatives they carry out, if counselling they give works or if they save the lives of children who live in these communities farthest from the health centres.

"Information they are collecting must be shared with the community every 4 months, to finally make 3 reports a year that evaluate not only the performance of the community health worker, but also the involvement of the community in health issues," says Ninnete López, Health Project Coordinator in Save the Children. Thus they identify the weaknesses and they can rethink strategies to avoid preventable diseases and deaths among girls and boys under 5 years in the municipality of San José de Bocay.

Ninnette emphasizes in return of information to the community, because "it serves to seek joint support”. She also says, while discussing, that reports are value for all of them, the community health worker and for the whole community.

More than community health workers

"I have learned about how we have to weight children, how to apply medicines when they have a fever, and about warnings related to serious diseases such as pneumonia, in order to refer sick children to the hospital," said Marlene del Socorro Villegas Rivera, from Agua Zarca community, 3 hours away from San José de Bocay where we are now, "1 hour in vehicle" she adds.

Marlene holds up her 12-day-old baby, and proudly comments, " I can put in practice at home, with my child, and then in the school and community”. This is indeed the commitment we seek in the implementation of Community Case Management strategy. "I am going to take temperature and pressure on children, if it deserves. I will the medication and if it is necessary I will refer them to the health centre" comments young woman. Marlene is a primary school teacher in the school other community. She also take part in the School Health project that Save the Children's Health and Nutrition program is also promoting in the area.

As an incentive, attendees were given a basic health kit, so that they can improve quality of voluntary service they provide in their communities. "I have felt very good," Marlene concludes, "I hope Save the Children continues to support us with training and materials we need in our communities."

"For me everything has been good in this workshop," comments Javier Antonio Palacios and he values other learning spaces promoted by Save the Children such as internships in hospitals, where several community health workers, including him, were able to work for a week in the primary hospital of San José de Bocay. They learned from doctors and health professionals to improve the procedures they usually do in the community. "I learned how to express myself to care for mothers and children, to give them affection," proudly adds Javier Antonio.

Every Last Child 

In addition, during the workshop we have the opportunity to speak with attendees about our Every Last Child global campaign. We want to ensure worldwide that millions of children and adolescents facing poverty and exclusion, can survive, learn and be protected.

"You are the front line to ensure that children living in communities farthest from San José de Bocay have access to health services. That is what the campaign asks for", we explain and then we see how the department of Jinotega concentrates the most vulnerable children in the country, along with Matagalpa and the Caribbean Coast of Nicaragua

To ensure children survive in Nicaragua, it is evident that Community Case Management strategy works. Only during 2016, 8,000 children with pneumonia, diarrhea, and fever received care from community health workers like those attend this workshop, who saved children lives by giving an early and timely response to the situation babies were living.

"I've learned about Save the Children's global campaign, and as a community health worker, I am going to take it to the community," says Javier Antonio. Definitely, if community health workers are committed to the rights of children like these, we will ensure that every last child survives in Nicaragua.