It is a Tuesday morning in the quiet village of Kanamai in Mtwapa, Mombasa. The village hall, which evidently is still under construction, is filled with a group of about 50 men and women dressed in the local buibuis. They are cheerfully chatting and murmuring together with an occasional high pitched laughter from one corner. I approach them and casually greet them in the local Kiswahili language, and they heartily respond.
It is not long before we are deeply engaged in a very exciting and insightful discussion with this group. These are the community health workers ‘Madaktari wa nyanjani’ as they are commonly known- loosely translated as ‘the field doctors’ from the Community Unit (CU) of Kanamai B. They are gathered here courtesy of Ministry of Health (Kenya), Kilifi Kids, and Medic Mobile.
Community health workers (CHWs) are volunteers with little or no knowledge on health. They are democratically elected by the community during barazas’, the community’s official meetings with its leaders, to act as their health representatives. They are trained by the government and other health related organisation on varied basic health preservative and promotive activities that range from ensuring proper sanitation in the area, handling gender based violence, to encouraging pregnant women and children to seek health services. The community health workers thus educate their fellow community members and encourage them to make and maintain healthy choices. They form the extreme front line ‘health care providers’ in the health system.
Each community health worker is in charge of 20 households, i.e. 100 people are assigned to him depending on accessibility and convenience and they work hand in hand with Community Health Extension workers (CHEW) who are government employees in charge of 25 CHWs. The CHEWs link the health facilities and the communities. A cohort of 50 CHWs, 1000 households make a Community Unit (CU), which is directly headed by a highly trained health personnel based at the nearest health facility.
My goal on that day was to facilitate training on antenatal care (ANC) and immunisation and how mobile phones will help the CHWs to carry out their duties more efficiently and effectively. But before then, let us get back to our discussion with the CHWs about the joys and challenges of a CHW.I lose myself to the joy that these CHWs exhibit as they share their rich experiences in the group. It is clear that they derive deep pleasure and satisfaction from their work. They are excited about the positive effects attributable to their work, like fewer reported deaths of children which were earlier associated to dysentery secondary to poor sanitation, increased number of pregnant women and children seeking health care services at the health facilities and a community better informed in matters of their health.
However they cite a number of areas that they have not been able to address appropriately because of a number of challenges and hindrances. Some of the areas that they felt they could do better were to prevent deaths of mothers and their children that occur during delivery by encouraging mothers to deliver their babies at the health facilities and to take their children for immunisation. Most women in this community still give birth at home, under the help of the traditional birth attendants (TBA) who cannot handle the life threatening emergencies that occur during deliveries. Children die of preventable diseases like pneumonia, measles and malnutrition.
In a very interactive session the participants highlighted ignorance as the main cause of this and unanimously agreed that as ‘Madaktari wa nyanjani’ education and constant insistence to the community members on the importance of attending ANC clinics, delivery at health facility and immunisation is the way to go, and is to continue for as long as it takes to bring about a positive behaviour change!
By the time my colleagues Mativo of Medic Mobile, Lydia of Ministry Of Health, and I started the actual training we were confident this particular training and project had come at the most optimal time and also convinced beyond doubt that it will meet the highest priority need for the users. The CHWs were certainly ready.
‘It feels like being given wings to soar to heights that would otherwise have taken a really long time to attain,’ one of the CHEWs present remarked. I am glad that Kilifi kids found this community ‘need’ and Medic mobile provided the tool that will lead to undeniably positive and great health impact to the local communities of Kenya.