When Christine meets Akiru, she can immediately see her distress. Akiru delivered her child a week ago after a prolonged and difficult labor. She lacks sufficient milk to breastfeed her child while she is still recovering from strenuous childbirth. Akiru is also overwhelmed by the advice from family members as it conflicts with what she was taught at the health facility. Christine, a community health worker (CHV) has been trained on how to support women through pregnancy and after birth. Her love, commitment, and passion for this course are purely from volunteering.
Drawing up a low stool Christine reassures Akiru, shows her how to cradle the baby’s head and attach him to the breast. She also gives gentle but firm instructions to the family members crowding the new mother. Over the next few days, Akiru founds a rhythm to breastfeeding and begins to attend to her light chores when her baby sleeps. Only a month later, Akiru joins a mothers’ group that Christine has set up in the area to help women gain strength and insight from their peers about childrearing.
Christine is an unpaid community health worker whose passion is working to respond to the challenges experienced by mothers in remote regions Koibatek, to the southwest of Kenya. She encourages pregnant women to seek care at health facilities during their pregnancy. Through the Baby Friendly Community Initiative, CHVs have been seen to influence women’s attendance to skilled delivery, improve breastfeeding practices and improve immunization attendance for children.
The work of CHVs such as Christine is made possible through the Community Health Strategy (CHS). This community-based approach to health care was adopted in 2006 by Kenya and many African countries to improve community access to health care. Volunteers in the community are trained and equipped to be an accessible first line of contact for healthcare within the community. This has been seen to improve productivity and reduce poverty, hunger, child and maternal deaths across all stages of life.
Community health services have not been without their share of challenges. An analysis in 2013, showed fundamental weaknesses in the supervision and reporting mechanisms for the volunteers. CHVs even though willing to work are dissuaded for the lack of remuneration and retain the volunteers. It is still unclear on how the volunteers are evaluated for their knowledge and work and how communities can sustain these volunteers.
Kopeto, in the arid, drought-prone west of Turkana county, is a perfect illustration of both the potential and the challenges inherent in Kenya’s community health strategy. The absence of proper infrastructure in such a vast community unit makes difficult the access to food, water, and medical aid. Young children here are highly susceptible to malnutrition.
Once a week, CHV Lokol routinely checks for children with malnutrition by visiting households. He advises the households on how to get into feeding programmes to supplement the household’s food. Lokol has been trained on how to treat common childhood diseases like malaria and diarrhea. If a sick child requires urgent medical attention, he arranges for quick transport to the nearest medical center, avoiding further delay and saving the life of the child. Once a month, CHV Lokol endures the five-kilometer walk to the health facility to record his contribution. When he is not attending to his community in this way, CHV Lokol is a casual worker handling odd jobs.
As he walks back home from Kopeto health facility, Lokol has a reason to smile. The county government of Turkana has assented into law the Community Health Services Bill. This new bill has given structure to the efficient operation of community health services and has provisions for the establishment of community health units and the appointment of CHVs. It has also put into place a fund to support all these activities and a committee to oversee to the delivery of these community health services.
Over and over again, APHRC registers evidence on the potential difference that CHVs make in the delivery of health services in their communities. The Baby Friendly Community Initiative, PAMANECH, and the MIYCN-Urban project have demonstrated the potential return in health that counties stand to benefit by strengthening the work of CHVs. In taking this step, Turkana becomes the first county government in Kenya to register its commitment to healthcare in this way. While it is an obvious win for the CHVs, this is even a greater win for the communities in Turkana.