By Sharon Atieno
For 39-year old, Caroline Ochieng, a resident of Ambira village, Siaya County, the journey to motherhood has been smooth, thanks to the help of the community health volunteer (CHV) in her village.
Her walk with 53-year old Elizabeth Were started long before her now two-year old daughter Mariel was born. She would regularly visit Were, for her monthly shots of the Depo-Provera contraceptive. When she was ready to have another baby, the mother of four, informed Were about it.
Were, armed with knowledge on family planning guided her on what to do and in no time, Ochieng became pregnant. Through the pregnancy journey, the CHV did follow ups to ensure that she was registered at the nearby health facility and attending antenatal care.
When her time was due, Ochieng safely delivered at the hospital. Were continues to visit and encourage her on the best practices to enable her raise Mariel well, including exclusive breastfeeding in the first six months, good nutrition and vaccination.
“Even when Mariel falls sick before doing anything else I go to Elizabeth or I send someone to call her so she can direct me on what to do. She constantly emphasizes that I go to the hospital and not just give the baby any medicine,” she said.
For Elizabeth Were, a CHV locally referred to as nyamrerwa, a typical week involves going from one household to another checking on pregnant women and children under five years, defaulter-tracing of HIV clients, and conducting malaria and pregnancy tests. She also gives family planning education.
According to the Community Health Strategy 2014-2019, a CHV is an individual chosen by the community and trained to address healthcare issues of individuals and communities in their respective localities, working in close relationship with health facilities. A CHV acts as a catalyst and a change agent to enable people to take control and responsibility of their own health achievement efforts.
The Community Health Strategy launched in 2006 was adopted to shift the emphasis from burden of disease to the promotion of individual and community health. It is a key component of the Kenya Essential Package for Health (KEPH), which focuses on the health needs of individuals and emphasizes strong community involvement in health care.
The CHVs deliver services in a defined geographical area location called a Community Health Unit, which are composed of approximately 5,000 people (or 1,000 households).
The CHVs are supervised by Community Health Extension Workers (CHEWS), now called community health assistants (CHA) who are government employees mandated to provide health services at the household and community levels and make referrals and linkages to health facilities.
In Siaya County, the community health program has been changing the health narrative in the region, especially in early malaria detection and treatment, HIV, skilled delivery, immunization outcomes of under-fives and diarrhea.
Purity Awuor, a cereals vendor at Alego-Usonga sub-county, has first-hand experience of the benefit of having CHVs in her community. When her three-year old daughter fell sick at 9.00pm, she did not have any means of getting to the hospital as she had no money. She visited the area CHV who conducted a malaria test on the child.
“The test returned a positive result for malaria and she gave me drugs which helped my baby. Within two days of taking the drugs my baby regained her health,” narrates Awuor.
She adds that the CHVs also helped her neighbor who was living with HIV but had defaulted medication.
“My neighbor had refused to take her medicine and every effort we had made to advise her to take her medicine fell on deaf ears. She was becoming weaker by the day and since she would not listen to us, we decided to involve the CHV. We called the CHV who apart from counselling her got professional help from IMPACT, an NGO to tend to her. My neighbor is now doing well and adhering to her medicine,” she recalls.
Though the community strategy has been in place since 2006 it still faces various challenges.
Awuor attests that at times she has visited the CHV in search of treatment only to find that there is no medicine nor test kits.
A reality lived by Janet Akoth, a mother of six who lives in Ugunja sub-county, when she recently fell ill with malaria. She laments that not only did she have to spend so much time at the hospital but also money (USD 6) for tests to be conducted on her yet she did not get the kind of help she anticipated.
“I only went to the hospital that day because our CHV did not have the rapid test kits for testing malaria, if she had I would not have gone there. A week later after taking the prescribed drugs I wasn’t feeling any relief. I went to the chemist bought malaria drugs and now I am fine,” she noted.
Were, notes that they don’t get regular supply of commodities, making it difficult to tend to the needs of the villagers as malaria is a very serious issue in the area. In such times, the most she can do for the sick patient is to write a referral letter which assists them at the hospital.
But Lilian Akoth of Karapul village in Alego-Usonga Sub-county says that even after they are given the referral letters when testing is conducted by the CHV some of health officials still conduct a test on them to confirm if it is really malaria before administering treatment.
According to John Opundo, a CHV at Tingari East village, “When there is low supply of medicine, priority is given to the infants. He notes that when the adult sees you giving medicine to the child yet you’ve also tested him or her for malaria but have not given him or her the drugs, it becomes a challenge when you refer him or her to the hospital as the person thinks that you’re neglecting or discriminating them.”
Since household visits are done during the day, Were says that sometimes they don’t find people in their homes. “Some residents are not welcoming and don’t give the CHVs time to address them, claiming that they are busy or telling us to go and come back some other day,” she says.
Currently, the Siaya county government is working on a Community Health Services Bill that if approved to become law will strengthen the services of the community health program within the county.