Engaging with Communities Improves Health Outcomes in Kenya
At a health center in Kenya’s Migori County, a government-led project with support from partners, including the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), has helped revamp community outreach practices and collect more accurate information to improve the health outcomes of the entire surrounding community.
Organizers of the UNICEF -funded Maisha project, named for the Swahili word for ‘life,’ worked with the Uriri Health Center’s clinical and public health staff to establish new connections with community leaders and promote dialogue to address challenges in the fight against HIV.
What began as an initiative to help provide data to determine the facility’s performance in fighting pediatric HIV inspired the Kenyan government’s community health extension workers (CHEW) and community health care workers (CHW) to ensure that information captured is accurate and discussed by the community at large.
Information on facility performance and other health-related data is recorded on white dry-erase boards. This data is used to define targets that help monitor the facilities’ performance. CHWs use the household register and CHW log-book to gather information from each household. The CHEW works with the CHW to summarize the data into reader-friendly health indicators.
Prior to the Maisha project, the CHWs only visited a fraction of the households in their assigned villages. The data collected was often inaccurate, incomplete, and mostly unusable. The CHEW could not therefore prepare health indicators, and the whiteboards weren’t being used effectively.
Upon realizing that the lack of accurate data was a major impediment in determining the facility’s performance in the fight against pediatric HIV, the team behind the Maisha project helped teach CHWs about the function and importance of different treatment and prevention tools. The tools CHWs use include household registers to record demographic, maternal, neonatal, and infant survival information, as well as other relevant health-related indicators such as pit latrine coverage. Other resources included referrals for people in need of immediate treatment to facilities.
The health indicators – commonly referred to as the CHEW summary – are shared with the villages during community dialogue days. Through this process, village residents and health workers can work together to verify data, identify health care problems, and develop solutions.
Through this process, the community has recognized and developed solutions to a variety of challenges, such as access to immunizations and best practices for developing more sanitary pit latrines. And the program has seen great success to date, for example, immunization against measles has reached 100 percent of children in the area, and 80 percent of all youth are receiving all required immunizations, up from 60 percent. Additionally, more pregnant mothers are now attending antenatal care clinics early, and cases of malnutrition are identified before they become severe.
Efforts to trace and follow mothers and children who default from treatment have intensified, with CHWs covering every household in their villages. Communities have become more aware of public health issues, resulting in demand and use of such tools as water treatment tablets.
From minimal documentation and reporting of community activities in 2011 when the Maisha project started, 24 community-facility committees have been established across the pilot districts of Migori, Siaya, and Kisumu. Monthly household visits by the CHWs have increased and are reaching 84 percent of households in the area, a 14 percent improvement in all supported sites.
Recently, the Kenyan government recognized communities as the first level health unit in their Kenya National Health Sector Strategic Plan II , but it needs to strengthen the program to help promote meaningful engagement with communities and improve health outcomes, as the Maisha project has demonstrated.
Eric Kilongi is Senior Communications Officer for the Foundation, based in Kenya.