Antonella Leakono is a nurse at Longewan Dispensary. Sarah Manyeki (M&E Officer for the project in Kenya) spoke to her about the changes she has noticed since the Community Health Workers (CHWs) were trained, and some of the challenges she faces in her work at the dispensary.
When was the community health unit formed?
The unit was launched on 7 December 2013 although the CHWs had started being functional in August 2013.
In your opinion, how many CHWs are active?
Out of the 25 CHWs, only eight of them are active. They are active in terms of referrals, identifying and referring immunisation defaulters, bringing expectant mothers to the clinic and following up on the referrals. Other services that they offer include escorting women to the facility to seek family planning services and growth monitoring for children.
What changes have you noted since the CHWs started doing their work?
Antonella said that hospital delivery before the CHWs started doing their work was at zero but currently, an average of seven women are delivering at the facility per month. The number of women seeking antenatal care services has also increased from 15 to 45 per month, children going to the clinic for growth monitoring has also increased from 0 to 100 and those seeking family planning services have increased from 10 to 40.
She noted, however, that there is a problem because the CHWs are still not able to do formal reporting using the Government’s Ministry of Health (MoH) tools. She feels that the CHWs will perform better once they are in a position to report formally.
She said that latrine coverage in the villages is still low although she has noticed an improvement in personal hygiene from the clients visiting the facility, “those women and their children visiting the clinic are more clean compared to the past,” she said.
What further support do you think the CHWs need to do their duties better?
Currently, the CHWs mobility is easy because people from different villages are living together in one area due to security reasons. There is however a government ultimatum that people should go back to their villages because security of the area has increased. When they finally do so, she feels that it will be difficult for the CHWs to move from one household to the next and therefore proposes that the CHWs be supported with bicycles.
Antonella also said that currently, the MoH has a program for motivating the Health Facilities based on a set of Performance Indicators. For each child who visits the facility for growth monitoring, the facility receives 50 Kenyan shillings; for facility delivery they receive 2000 Kenyan shillings; for a total of four antenatal care checkups, they receive 200 Kenyan shillings; for family planning services they receive 50 Kenyan shillings; and for HIV testing, they receive 50 Kenyan shillings.
Of the money the facility receives, 60 percent is shared between the Nurse, Facility Committee and CHWs within the unit. The remaining 40 percent is spent on facility maintenance. Antonella thought that it could be useful for the project to have a motivating criteria based on performance of the CHWs. In the past, they have shared the 60 percent given by the Ministry with the eight active CHWs.
Antonella suggested more trainings for the CHWs in order for them to acquire more knowledge and skills to enable them perform better. More trainings could be on antenatal care, family planning, HIV testing, growth monitoring and measles defaulter tracing.
Are there any challenges that you have experienced?
Antonella said that she works alone at the dispensary and offers all the services (family planning, antenatal care, delivery, outpatient services etc). Sometimes she is overwhelmed by the number of clients seeking the services and sometimes those clients who are not patient enough leave without being served. In her absence, the CHWs offer the first aid services.
Another maternal health challenge is that the facility has no lighting system. When assisting deliveries at night, she is forced to use a kerosene lamp which does not give sufficient lighting.
Antonella said that she is very happy with the unit and the work being done by CHWs. Their work has resulted in a reduction in diarrhoea cases, and an increase in people accessing antenatal care and other services. She feels that if reporting improves, everything else will be fine.