Health volunteers key to reducing child deaths

From various parts of Elgeyo Marakwet’s mountainous terrain, women are trickling into a health facility in the county with their babies.

One by one, they take their seats under a tent set up outside the Sego Dispensary in Keiyo South Constituency.

As they await the services, they are keenly listening to Nicholas Kiprono, a community health volunteer who is sensitising the mothers on the importance of good nutrition during and after childbirth.

“You should give your baby breast milk only for the first six months. This is enough and will protect the child from diseases. Okay?”

The women nod in agreement as they regard Kiprono solemnly. They know too well that his counsel, as well as those of other community health volunteers, has saved many lives in the community.

“My first child used to fall sick all the time. But because of the information I got from the health volunteers, I know my second born will be healthy, “ states Nancy Jerotich as she rocks her two-month-old baby.

She is among the thousands of Kenyans living in marginalised or rural communities that are increasingly reaping the benefits of community health volunteers (CHVs).

These special groups of individuals — commonly referred to as ‘doctors’ in communities where they operate — were introduced into the health sector in 2008 with the aim of bringing down maternal and child deaths in Kenya.

The volunteers visit households each morning to pass across key health messages such as the significance of antenatal care visits, hospital deliveries and healthy eating among pregnant women.

Once the child is born, they monitor its growth, feeding habits and vaccination schedules.

“We want to ensure that everything is right and that mothers are following the recommended health behaviours,” says Mr Kiprono.

The CHVs, who are the pillars of the community health strategy, have been instrumental in reducing maternal and child deaths in areas where they serve.

So far, they have contributed to a reduction in the deaths of children under five years old — from 74 deaths per 1,000 births in 2003 to the current 52 deaths.

Similarly, the maternal mortality rate is now 362 deaths per 100,000 live births, down from 488 deaths per 100,000 live births in 2009

However, health experts are concerned that Kenyans risk reversing these gains due to various challenges impeding the smooth roll-out of the community health strategy.

“Even though we are making progress in maternal and child health, the national indicators are still not where they should be. And this won’t change if we don’t focus on the community,” said Daniel Kavoo, acting head of the Community Health Unit at the Ministry of Health during a National Reproductive, Maternal, Newborn, Nutrition and Child Health Conference held last week in Nairobi.

He said insufficient funding is a major threat to the lifeline of the community health strategy.

According to Dr Kavoo, an investment of about Sh11 billion is required over the next four years for the effective roll out of the strategy.

Among other areas, he stated that the finances would enable the government to employ more community health extension workers who are charged with the responsibility of coordinating and supervising the CHVs.

“We have only 1,740 employees yet we require about 20,000. So you can see this is a huge human resource gap that needs to be filled.”

Since the volunteers (about 80,000 in the country) are not trained health workers, they usually rely on the extension workers who provide knowledge and training on key health topics that the CHVs are supposed to sensitise communities about.

John Kutna, a health programme officer at Amref Health Africa, said that the CHVs should be motivated so they can keep offering services to communities.

“Even though they are volunteers, they take their time to do health promotion. They sacrifice time that could have been used to do other things. So we need to come up with innovative ways of compensating them for their time.”

There have been recommendations for counties to pay the CHVs a monthly stipend to help offset costs they incur while offering services to the community.

Only three counties — Bungoma, Makueni and Siaya — have embraced the idea due to the goodwill of their governors.

“We don’t want this pay to be dependent on decisions made by politicians as it will not be sustainable. Instead, it should be anchored in legislation and included in the scheme of service,” said Mr Kutna.

Away from the three counties, health volunteers in other areas have been surviving by the support — in cash or kind — offered by NGOs working with them to implement a myriad of community health projects in different counties.

income generation

To sustain their livelihoods, NGOs not offering cash have empowered CHVs to come up with agricultural projects such as seed production farms, beekeeping and poultry farming that help in income generation.

“You can see that different people are doing different things to motivate the volunteers.

“We need to decide on the approach to take and ensure that it is backed by legislation.”

According to Mr Kutna, Kenya also needs to have well laid down health indicators that the volunteers should track.

“Right now, they seem to be doing everything which isn’t good. For quality services, they need to focus on agreed-upon key areas for various counties.”

As Kenya prepares to roll out the universal healthcare programme, Dr Kivoo notes that the well-being and sustainability of CHVs should be prioritised, as they will be key to the success of the initiative.