In African countries including Kenya, contraceptive use, fertility rates and other reproductive health indicators in rural areas lag behind urban areas. Even though Kenya's fertility rate declined from 8.1 in 1978 to 4.6 in 2008, the figures are much higher in rural areas, 5.2 compared to an urban rate of 2.9. The persistent high fertility rate has been attributed to many factors including inadequate provision of family planning services.
In Kenya, primary healthcare (PHC) providers (mainly clinical officers and nurses) at health facilities and community health workers (CHWs) in the field are required to integrate oral care of HIV patients into the PHC system. However, these health workers have not been educated on oral diseases. Detecting Human Immunodeficiency Virus (HIV) related orofacial lesions (HROLs) as part of their community duties would increase the probability of early identification of HIV-infected people and those developing highly active antiretroviral therapy (HAART) resistance.
Sub-Saharan Africa faces a severe health worker shortage, which community health workers (CHWs) may fill. Task shifting - the reassignment of clinical roles by transferring suitable tasks from higher- to lower-skilled healthcare workers (HCWs) - is one of the strategies proposed to mitigate the effects of the HCW shortage. Community health workers (CHWs) are a unique cadre of HCWs and are well suited to help address the HCW gap.
The varied performance of Community Health Worker (CHW) programmes in different contexts has highlighted the need for implementation of research that focuses on programme delivery issues. This paper presents the results of process evaluations conducted on two different models of CHW programme delivery in adjacent rural communities in the Gem District of Western Kenya. One model was implemented by the Millennium Villages Project (MVP), and the other model was implemented in partnership with the Ministry of Health (MoH) as part of Kenya’s National CHW programme.
Several African and South Asian countries are currently investing in new cadres of community health workers (CHWs) as a major part of strategies aimed at reaching the Millennium Development Goals. However, one review concluded that community health workers did not consistently provide services likely to have substantial effects on health and that quality was usually poor. In addition, it suggested that all stakeholders need to focus on weak points in the functionality of the CHW program and ultimately the CHWs’ performance.
The Millennium Villages Project (MVP) implemented in Western Kenya a mobile Health tool that uses text messages to coordinate Community Health Worker (CHW) activities around antenatal care (ANC) and Prevention of Mother-to-Child Transmission of HIV (PMTCT), named the ANC/PMTCT Adherence System (APAS). End-user changes in health-seeking behavior in ANC and postnatal care (PNC) were investigated following registration of 800 women into APAS.
Though HIV can be transmitted from mother to child through breast milk, studies have shown that women living with HIV are less likely to pass the virus if they breast-feed their babies exclusively for at least four months. Breast milk contains nutrients and essential antibodies that can help babies fend off dangerous infections.
The Kamwimbi family in Kenya, where EGPAF and its partners are leading efforts to help women living with HIV have happy, healthy babies through maternal and child health programs. Courtesy EGPAF.
April and early May are bookended by World Health Worker Week (April 7-11) and International Day of the Midwife (May 5) -- two opportunities to recognize the invaluable contributions of health workers in saving and bettering the lives of our communities. The women and men who have been on my mind are the innumerable hard-working, selfless, often heroic frontline health workers I've worked alongside while training nurses and midwives in the last 15 years.