Increasing Access to Health Care Using a Community-Based Approach
Community Health Workers (CHWs), health assistants or lay health workers who provide a fundamental level of health care for residents in the community in which they live, have been shown to make a tremendous contribution to public health and community development. The Millennium Cities Initiative’s sister Millennium Villages Project has developed a comprehensive training manual for CHWs that has been rolled out across the Millennium Villages sites in 10 countries and where the CHWs’ impact is being carefully measured. In the Millennium Villages Project, CHWs are not only comprehensively trained and professionalized, but they are also paid for their hard work. In urban settings, and in many developing countries, such professionalization and compensation for CHWs are not yet possible, given budgetary constraints and Ministry of Health priorities. But while the Earth Institute leadership is working at the policy level, both in our project countries and in the global health arena, to institutionalize paid CHWs as an integral, life-saving and cost-effective element in the national health systems of developed and developing nations alike, MCI is moving forward by piloting training models for how most effectively and efficiently to train and support CHWs who can fill the void in underserved urban communities for so many residents whose conditions might not be recognized in a timely fashion, or who otherwise might not have access to any form of healthcare.
In Kisumu, Kenya, residents of Manyatta, an informal settlement with nearly 90,000 people that currently lacks any sort of government-run health facility, will soon benefit from an ongoing, wide-ranging CHW training, led by the Municipal Council of Kisumu’s Health Department, in collaboration with Cordaid Urban Matters, a Dutch development agency, and MCI, ably led by MCI’s Public Health Specialist Beldina Opiyo-Omolo. While other development agencies and non-governmental organizations have organized CHW trainings in Manyatta before, they have all focused on a specific intervention or on disease-specific trainings, such as TB home-based care and prevention, HIV/AIDS, child nutrition or maternal care. This far more comprehensive program, which follows Kenyan Health Workers guidelines, is the first of its kind in Manyatta.
One hundred CHWs, covering the two units within Manyatta, A and B, have been selected to participate in a 10-day training program. The Municipal Council of Kisumu Health Department views this program as valuable and crucial to the existing health system, with the CHWs providing “level 1” – or basic care – at the household level. The Manyatta CHWs were recruited based on requirements stipulated by the Kenyan Ministry of Public Health; for example, CHWs must be literate, permanent residents of the community they plan to serve and committed to the welfare of their community. As volunteers, the Manyatta CHWs will not receive a stipend – although the ultimate goal would be to have trained, paid CHWs integrated into the national health system, as mentioned above – but will nevertheless be rewarded for performance. Many of the CHWs operate small businesses; as such, Cordaid Urban Matters has expressed a desire to bring in organizations to provide micro-loans to those CHWs involved in health-related businesses such as soap-making and selling nutritional aids, to enhance their income earning capacity.
The trainings, which began in October and will last through November, will rely on the Government of Kenya Ministry of Health’s Community Strategy Manual, building the capacity of CHWs to lead their communities in such health improvement initiatives as disease prevention, health promotion and simple curative care. They will be trained to serve the 20 households each has been asked to monitor. They will be taught to collect and analyze data at the household level, to prevent and monitor for diseases, to perform basic life-saving techniques, to recognize danger signs, to refer patients for further care and to advocate on their patients’ behalf. Among their responsibilities: monitoring pregnancies and encouraging expectant mothers to get pre-natal check-ups, ensuring children are getting their immunizations, checking for signs of malnutrition, encouraging families to wash their hands and use toilets, and treating minor wounds and illnesses.
Once the training is complete, Manyatta’s new CHWs will register each of the households under their care, completing a form so they are familiar with the members of that household and any existing health conditions or needs. The Manyatta CHWs will be monitored by a task force, the Community Health Committee (CHC), which will comprise 20 workers, all of whom will be asked to complete additional training and will then help manage health activities for all of Manyatta. The CHWs and CHC members will attend monthly meetings led by the Community Health Extension Workers (CHEWs), trained by the Municipal Council of Kisumu Health Department to administer these gatherings, during which time household data will be reviewed, and the group will discuss how they might address certain issues. The Health Department plans for the CHEWs and CHWs to work together to address health concerns at the community level, setting a standard for “level 1” care.
“The CHWs in Manyatta will provide a tremendous resource for many of the families in the community in addressing their own healthcare from the household level,” said Ms. Opiyo-Omolo. “I hope that, pending funding, we will be able to implement a similar program in the Obunga Slum and possibly the Bandani Slum, both in the Kisumu area.”
MCI is highly optimistic about this pilot program, which we believe will build capacity and greatly improve access to health care in one of Kisumu’s largest slum areas; ultimately, we hope this will lead to an increase in individual productivity, enhanced education performance and a reduction in poverty, hunger, and child and maternal deaths. We are confident that this program will provide great benefits to the people of Manyatta, while also serving as a model to learn from and to apply across Kisumu and well beyond.