How community health workers are helping fight child mortality

As the scorching sunlight burns through the villages of Muhoroni in Kisumu County, sending the residents to seek shelter, one lady seems undisturbed.

Dressed in a sky blue coat, black skirt and carrying a black backpack, Ms Ruth Otieno walks through the rocky ground and stops in front of a tin roofed rental building in Ziwani Estate, Koru.

She shares a light moment with the occupants of the house before moving with them to a shade.

Today, Ms Atieno, a Community Health Worker (CHW) is here to register and see off to the hospital Ms Sharon Akinyi, 31, who is four months pregnant. It will be her first clinic visit.

“I realised that she was pregnant during my previous home visits and had agreed that she would start her Antenatal Care (ANC) immediately,” says Ms Otieno.

Ms Akinyi, just like any other expectant woman, found herself engaged in household activities with very little time to spare to visit a health facility to check on her unborn baby.

The CHW first engages Ms Akinyi and her husband, Mr Willis Jimbo, on a health talk before taking out a mobile phone from her bag.

The phone which was donated to the CHWs in Kisumu County by the Ministry of Health, has an application that allows the user to enter individual data.

Using her phone, she enters the details of when Ms Akinyi last had her periods, the number of children she has given birth to, family history of illness and if any of her previous pregnancies had complications.

She then takes out the Mid Upper Arm Circumference (MUAC) which she places around the arm of the expectant mother. It is used to identify a case of malnutrition among children and pregnant women.

“Since my client has not attended her first antenatal clinic, I am issuing her with a referral letter with both her details and mine to present to the health worker who will attend to her once she gets to the health facility,” says Ms Atieno.

 For the last 11 years, Ms Atieno has been offering community health services in her rural Muhoroni village, ensuring that primary healthcare is made affordable and accessible.

This involves having a full medical contact and ongoing care for a patient whose symptoms, health problems or signs have not been diagnosed.

She also visits the expectant women and keeps track of all their clinic visits while ensuring they deliver at a health facility in an effort to promote primary healthcare

 The county has also partnered with the United Nations Children’s Fund (Unicef) to train the CHWs on general knowledge around health, nutrition, growth and development.

With the help of the mobile phone, the health workers have been trained to identify any case of malaria, malnutrition and diarrhoeal diseases to reduce the mortality rates.

After seeing off Mr and Ms Jimbo to hospital, Ms Atieno heads to the next household where she meets Ms Maureen Ochieng to check on her 13-month-old daughter.

The health worker has over the last 22 months been a frequent visitor, often checking on Ms Ochieng while pregnant until her delivery date.

For the 13-month-old baby, one of Ms Atieno's major roles is to check on the infant's ANC clinic book to ensure she has received all her early childhood immunisations.

She then examines the baby, checking her body temperature while asking Ms Ochieng questions in relation to the infant’s health.

“Apart from using the MUAC tape, we also check the baby’s feeding programme from the mother to ensure it takes a balanced diet,” says Ms Otieno.

The CHW, who has a target of visiting 130 households in a month, always strives to visit a new home every day.

According to Ms Maureen Owando, the Koru Location Community Health Extension Worker (CHEW), the health workers have been taught basic knowledge on nurturing care for early childhood development, health and nutrition to boost their knowledge on issues affecting expectant women and children under five years.

This has enabled them to make informed decisions when visiting households and ensuring all serious cases get to hospital.

“As CHEW, our main job entails helping the CHWs in planning, supervising and identifying any challenge faced in the field,” says Ms Owando.

The Kisumu county community health workers have been trained to offer primary health services, including diagnosing and treating common child illnesses, including malaria and diarrhoea.

The training guides the workers to make healthy decisions and recommend treatment depending on the symptoms of diseases. Their role is particularly important in the early stages of the disease.

“We have been trained to look out for the possible signs of the illnesses with the guide of the mobile phone application and provide a diagnosis,” says Ms Otieno.

With instructions from the application, the community health providers are also guided on how to administer the right dose of treatment.

“After treatment, we visit our patient within 24 hours to find out how they are faring and refer them to the nearest health facility in case their health has deteriorated,” she said.

 CHWs are, however, not allowed to offer any diagnosis for any suspected case of pneumonia. In such instances, their duties are only limited to issuing a referral letter to the patient to be taken to the nearest health facility.

Kisumu is one of the counties that has often recorded a high number of malaria, diarrhoea and pneumonia infections.

The infection rate has often resulted in crowded health facilities, overwhelmed health workers or a high mortality rate.

“The upgraded system has enabled us to limit hospital visits among young children thus decongesting the facilities,” says Ms Owando.

According to the Unicef Kisumu Zonal Office Health Specialist Camlus Odhus, it is important for counties to invest more in the provision of primary healthcare, which is often the first point of contact among most patients.

He explains that Unicef has been working closely with the Kisumu County Health Department to sensitise and train the primary healthcare providers on the national healthcare guidelines as well as the primary healthcare network guidelines.

“We have also worked with the county to assess the different levels and status of primary healthcare, beginning with Nyando and Muhoroni sub-counties, to understand the gaps and capacities existing to deliver quality and comprehensive healthcare,” said Mr Odhus.

He added: “We have proceeded to work with the county to deliver action plans that are implemented to activate the primary healthcare networks in the two sub-counties.”

The Kisumu Acting County Executive Committee Member for Health Dr Gregory Ganda says that one of the challenges the county has been facing is ensuring all the individuals in need of care visit health facilities.

He explains that the partnership with Unicef has seen the health department shift focus to prevention of diseases at the community level.

 “One of the greatest challenges the health department has faced is having to wait for the patients to visit health centers instead of going for them, but this is no longer the case.

“We have now moved to prevention, we want to ensure that our people receive the best primary healthcare with the help of the trained CHWs and limit hospital visits,” said Dr Ganda.

Since the programme was rolled out early this year, the county has recorded an increased number of hospital births and improved management of malaria, pneumonia and diarrhoeal diseases.

Dr Ganda further explains that the immunisation coverage has improved from 69 to 89 per cent thanks to the effort of the trained workers.

Meanwhile, Mr Odhus has called on the next government to scale up and make operational the primary healthcare networks in the country.

“As Unicef we are also calling on the next government to invest in well trained, motivated, adequately supervised and well supplied community health volunteers to deliver services to households,” said Mr Odhus.

[email protected]