Migori's unsung hero empowering pregnant women

Amid downpours, Charles Habuba makes his way to one of the homesteads in the Matarakwa area of Ntimaru in Migori.

The village is 33 kilometres, an equivalent of an hour's drive, to the Tanzanian border at the Sirari Crossing station. Mr Habuba is visiting Vivian Robi, who is due to deliver her second child in a few weeks. During her first pregnancy in 2021, she only attended the clinic four times, but this time the number has improved, with July 4 being her seventh visit. 

The World Health Organisation recommends antenatal visits of at least eight times during pregnancy, and initiating antenatal care in the first trimester. Mr Habuba is committed to ensuring that she attains the recommended eight times.

As a community health promoter (CHP) previously referred to as a community health volunteer, Mr Habuba bridges the gap between healthcare facilities and communities by providing information on where to access maternal health services, such as prenatal clinics, birthing centres, and postnatal care facilities. 

In 2021, he was among 12 other CHPs in Ntimaru who were trained in how to use two mobile applications: M-Jali and Lucy app to educate pregnant women such as Ms Robi on how to maintain a healthy pregnancy to ensure a good start of life for their newborns.

"I had started lessons on the Lucy app on my smartphone, but since it broke down, I rely on Mr Habuba's weekly visits to continue with the studies on the app," says Ms Robi.

"Using the other application, M-Jali, he is able to collect community data, which provides the government and health facilities with access to timely, accurate and complete community health data. He also can begin the registration of pregnant women on the Linda Mama platform, a process completed in health facilities to encourage ANC visits," says Lydia Odek, the project officer, Tekeleza, by Amref International University, which trained Mr Habuba and others. 

Ultrasound services

About one kilometre away from Ms Robi's house, Jackson Nyanamba, a midwife, is in the process of conducting an obstetric screening using a hand-held Lumify Ultrasound machine. 

"With the machine, we can confirm the viability of the pregnancy, visualise and recognise the number of foetuses, to estimate the age of the foetus. And in the event we observe an anomaly, we can refer a mother to a sonographer for an extensive assessment and diagnosis."

He was among 68 nurses and midwives from four counties of Migori, Kisii, Homa Bay, and Kajiado trained by the United Nations Population Fund (UNFPA) in a project funded by the Maternal Health Trust Fund, the organisation's flagship programme on maternal and newborn health, to provide obstetric ultrasound screening services in primary healthcare settings.

UNFPA Sexual and Reproductive Health Advisor Dan Okoro says: “The selected midwives came from health facilities that had poor maternal indicators and were far-flung facilities from the main county hospitals, and facilities without an ultrasound machine."

Over 2,500 mothers, he adds, have so far been screened using the machines.

During her first pregnancy, following information from Mr Habuba, Ms Robi went for two ultrasounds. This time round with the introduction of a Sh500 fee by the county government aimed at ensuring sustainability of the service, she has been reluctant.

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"They told us of the importance of the ultrasound, to know if the baby is sitting properly in your womb, or if he or she has a huge head that would bring complications during birth,” she says.

"I have not gone because I did not have the money for it, but my husband has promised to cater for the cost during my next visit because I am eager to find out if I am having a boy or a girl."

Besides those services, Mr Habuba ensures sanitation is maintained by encouraging homesteads to have a latrine and a rubbish pit. To cover all the households in his community unit, he walks up to 10km a day. Ntimaru is cool and wet. As such, he is often rained on during his home visits.

Demolarising pay

Every month he is supposed to receive a stipend of Sh2,000 from the government. This year he has received Sh4,000 (the sum for the first two months), last month. His next pay he says, going by the trend might be next year.

Due to the inconsistent and low remuneration, many other volunteers selected alongside him during a public baraza in 2011 have dropped out to focus on other income-generating activities.

Were it not for his passion, he, too, would have quit. “Engaging with the community keeps me active, informed and connected with various players. Through it, I am able to relay the challenges afflicting my community to government and non-governmental instruments in the hope that change will come."

In a meeting with the Council of Governors in April, President William Ruto expressed his commitment to improving the working conditions of community health promoters, acknowledging their key role in the delivery of services in the counties. It was as a result of this meeting that Mr Habuba's title changed from volunteer to promoter.

“We have agreed with the counties that we are going to standardise the remuneration of these CHPs. We also need to standardise the kits that will be made available for them to use in the service that they will be undertaking in every village,” Dr Ruto is quoted as saying by The Star.

Mr Habuba hopes that this promise will be fulfilled to ease his work. Until then, he says he will continue to do his best to better the lives of women and other members of his community.

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