By Estelle Monique Sidze, Associate Research Scientist, APHRC
Seeing 100 community health workers (CHWs) in action at their monthly meeting was an eye opening experience for those of us from APHRC (and other partner organizations) lucky enough to attend site visits hosted by Tupange early this month as part of the Urban Reproductive Health initiative annual meetings. The experience revealed just how much work CHWs are doing in Kenya, and also how much farther we have to go to fully support their important family planning work, and tell their story.
In Kenya, community health workers, as envisioned in the document, Taking the Kenya Essential Package for Health to the Community: A Strategy for the Delivery of LEVEL ONE SERVICES, are the frontline resource persons for community-based health services. CHWs play a critical role in the overstrained health care system, filling the information and distribution gap between people wanting health options and the clinics that provide a range of health services to huge populations, particularly in urban poor communities. CHWs must be respected literate members of the community, hardworking individuals, and should be willing to volunteer for a period of five years.
Tupange’s work in urban poor communities
The Kenya Urban Reproductive Health Initiative, “Tupange” or “Let’s plan” is a five year (2010-2014) project funded by the Bill and Melinda Gates Foundation to address the issue of maternal mortality by increasing women’s access to as use of reproductive health services. The project mostly targets urban poor women.
CHWs are used in the Tupange project for demand creation in the disadvantaged population of the intervention sites. (Photo left: CHWs discussing lessons they learned.)
What are the CHWs roles?
– Educate households on family planning and other health issues, – Attend community meetings-dialogue days and offering health messages, – Participate in the community action days, – Provide pills and condoms to clients in need of these, – Refer clients to the health facility for services and tracing defaulters-TB, HIV to ensure they are back for services,
– Function as link person between communities and health facilities, to ensure continuum of care from the household to health facilities.
Jane Otai from Tupange explained to us the CHWs extraordinary role. First Otai explained that Community health workers are on duty all the time. They can be called upon by the community any time of day or night although they are advised to spend only two full days per week on the work. This may seem like a huge commitment for volunteers, but she emphasized that with the current high rate of unemployment in the country and lack of education, many CHWs find it difficult to get employed. Many CHWs are vendors and self-employed while others support themselves through the informal labor market. Masons, Painters, and Fundi’s are common in such communities. Therefore the opportunity to serve as a CHW is an honor and helps build the capacity of the CHWs through individual trainings. Each of the Tupange CHWs is responsible for community units of over 1000 households.
The Monthly CHW Meetings:
The CHW’s working under the Tupange project meet every month. The purpose of this monthly meeting is to review the CHWs activities for the month and draw a plan of activities for the coming month. During the meeting, achievements, challenges, possible solutions and best practices are shared. The meeting is usually planned by the District health Management Team (DHMT) in liaison with the facility in-charges. The meetings enhance a close working relationship between the CHW, CHEWs, facility-in-charges and DHMT members. (Photo right: Tupange team members high-five CHWs at the monthly meeting.)
Our CHW Meeting Experience:
Jessica and I participated in many of these meeting activities as part of the site visit. The CHWs we had the pleasure to visit worked with people living in Mathare slums, Huruma, Babadogo, Korogocho, Kariobangi, and Ngara. The meeting took place in Mathare Slums at the Mathare polyclinic.
We were warmly welcomed at our arrival and introduced to the whole group. We also had the opportunity to have each of the CHWs introduce themselves to us.
When we arrived, the CHWs were being presented with a refresher presentation of critical information on family planning. This was followed by a breakout session were groups reported their commodities totals and discussed major challenges and lessons they were learning as they travel door to door discussing family planning, providing health information, and passing out and demonstrating how to use family planning commodities like condoms.
Following the breakout sessions the CHWs shared their group discussions with the full group.
The main challenges CHWs seemed to face included persistent community members’ myths and misconceptions on the effects of family planning methods on health, stock out issues—which is when contraceptives are not available for distribution by the CHWS from health facilities, and proper weather gear such as boots and umbrellas. (Photo left: A young CHW presents her team’s challenges.)
Lessons learned from our visit
Aside from gaining a better understanding of the Tupange sites and how Tupange works on the ground we also learned the hard work and resilience of the volunteer CHWs, and the importance of involving men in the entire family planning process.
It was really remarkable to see these women and men of different age groups, and from different backgrounds, sharing their successes and challenges in achieving the common goal of educating their community members on family planning and other health issues.
We left convinced that incentives and motivation are vital to keeping CHWs involved and engaged in the work. For CHWs to be able to make an effective contribution, they must be appropriately trained and supervised, but also adequately and continuously supported. Something that we saw as a major challenge moving forward would be retaining volunteers for a long period of time because most community health workers are poor and require an income. However, we were happy to learn that the Tupange CHWs receive transport allowance to attend the meetings, and that discussions about remuneration possibilities for CHWs is underway at the national level.
Background on URHI Project
APHRC was present at the URHI/MLE meeting early this month as the African MLE evaluation arm of the 6 year Bill and Melinda Gates Foundation funded project which is working to address major challenges in Family Planning and Reproductive Health specifically facing urban informal settlements. The project is currently on its third year and APHRC and MLE partners are about to kick-off the midline evaluation survey in Kenya, Nigeria. Senegal will follow later this year [the project is also being evaluated in India by the International Centre for Research on Women (ICRW)].