How community health workers in Kenya are stopping preventable deaths, one home visit at a time
We know how to stop most of the top causes of death for young children around the world – malaria, diarrhea, and pneumonia are all preventable and treatable through medicines, vaccines, and other scientifically-proven tools. Widespread malnutrition makes children even more vulnerable to these diseases, but organizations like Action Against Hunger have the tools, training, and expertise to prevent and treat it. And we’re constantly working together with partners and Ministries of Health to research and collect evidence on how to improve those lifesaving tools.
So why do thousands of children under five years old still die each day? The reasons vary from community to community, but many of the barriers are about access: while treatment exists, health centers and hospitals are often too far away for parents to get to in time for their child to be saved. Practices that would improve the health of children and prevent them from falling ill are numerous, but, much of the time, that knowledge does not get to mothers who would put them to the best use. Lack of resources and local services, and a gap in trust and education for caregivers are also major barriers.
One key way to overcome these barriers is by engaging and building the capacity of community health workers and volunteers. The technical term for this approach is “integrated community case management” or ICCM: at health facilities, community health workers are trained to assess, treat, refer, and check up on children for a variety of illnesses, and then they bring that knowledge to the communities where they live.
Until very recently, volunteers have only been given what they need to diagnose children – but now, more of them are empowered to treat diseases as well. In Isiolo County, Kenya, Action Against Hunger, in partnership with the Ministry of Health and UNICEF, has trained community health volunteers to screen, diagnose, and treat life-threatening illnesses, including severe malnutrition, in addition to teaching families how to prevent diseases.
“This child could have died,” Community Health Volunteer Gladys Mwarania says. “If I hadn’t come here, she could have died.”
In a rural area of Isiolo County, Kenya, Gladys visits the home of Esther, mother of three. Esther’s three-year-old daughter, Promise, became ill with severe diarrhea several days ago and, by the time Gladys was able to perform a health check up, she was very weak. Her mother couldn’t afford a taxi to the health center, and the journey takes more than two hours on foot.
“I kept thinking, when tomorrow comes, my daughter will be okay,” Esther says.
Promise worsened, becoming more dehydrated, but she was lucky to have Gladys as a neighbor. Gladys is one of a select group of volunteers who have been trained not only to detect cases of malnutrition, diarrhea, pneumonia, and malaria, but to treat them. Gladys confirmed that the child was suffering from diarrhea, and provided medicine to help her recover: zinc tablets and oral rehydration salts.
“After two days, Promise was feeling much better,” says Gladys. “Now I come often to check that she continues to improve. If she relapsed, I would refer her to the health center. But at least Promise is being monitored now.”
Magdalene, 38, has been working for the ICCM program since last year, but her experience as a community health volunteer stretches back for more than a decade. Long ago, she won the trust of the mothers in her community – she is now the first person they go to with a sick child.
“I am often called several times a day by mothers seeking help for their children,” she says. “Education and treatment, the two things go together. The best solution is to go to the homes, to speak directly to people, so that they can understand how to improve their health.”
Magdalene is a member of the Turkana tribe, the second largest pastoral community in Kenya. They are known as great survivors, living in harsh and inhospitable terrain, but they can have many difficulties to access the health center when necessary.
“We live in a remote area, where walking distances are enormous, so when a child gets sick, many mothers wait until sometimes it is too late,” Magdalena explains. “This is the work I hold inside my heart. And I do it freely, to save the lives of the children of my community.”
“It is one of the most fulfilling programs I’ve ever been involved in,” says Buke Dabasso, Action Against Hunger Program Manager. Parents are often reluctant to take children to clinics because of the distance involved and the long lines they face when they get there – being treated at home means patients do not have to visit over-burdened health facilities.
“The health volunteer treats the patient in the environment where the disease was contracted,” says Dabasso, pointing out another benefit of home visits. “They can see why the person is sick; maybe there is stagnant water, maybe there are holes in mosquito nets. At the clinic, the person only comes with the sickness.”
Currently a pilot project, the hope is that this community-focused approach will grow into established equitable, effective, and efficient Community Health Services in Community Health Units all over Kenya. Powered by the passion and commitment of community health workers and volunteers, these units would help save lives and improve health for children across the country by providing quality community case management for malaria, pneumonia, diarrhea, and malnutrition.
