Community Health Workers in Kenya Stir Broad Changes
This article appeared in the January-March 1996 issue of One Country.
Active in more than 200 communities, a project to promote vaccinations has also helped to build a new level of intersectoral and interfaith collaboration - collaboration that has paid off by stimulating the construction of latrines and helping create better access to clean water
As the mother of seven children, Judith Soita is well aware of what it means to worry over a sick child. One day they are out playing happily by the road with other children, the next they are lying down quietly inside, their eyes glazed with hurt. And in this remote village some 1,000 kilometers from Nairobi, there is always doubt over whether they will get up to play another day.
At the Menu Bahá'í Institute, a refresher course is offered for community health worker trainers.
"As a mother, I always have been worried: will my children survive?" the 35-year-old mother and vegetable farmer said in a recent interview. "And how about my neighbors' children?"
There are many childhood diseases to which children here fall prey. From simple diarrhea, which takes so many infants in Africa, to tuberculosis and malaria, which threaten the young and the old, the day-to-day risks are high. Some 10 percent of the children in Kenya never see age five, according to recent statistics from the World Bank.
But Ms. Soita's worries have been lightened considerably since she became a community health worker, a process she started nearly 10 years ago when she attended a training session at the nearby Menu Bahá'í Institute.
"When I attended the first community health worker training, I did not know that I would find my answer there," she said. "But since the training program, I've been able to help my family, my neighbors, all the village and the surrounding villages to understand what is primary health care and how easy they can improve their health. And I feel there is an answer to my question, that we all can do something to improve our health."
At a one-day health seminar in Vihaga, Western Kenya, a district nurse from the Ministry of Health explains to community health workers how to store vaccines.
Ms. Soita is one of some 98 community health workers trained at the Menu Institute as part a primary health care project sponsored by the national Bahá'í community of Kenya. Started in 1986, the project now reaches more than 200 villages in Kenya's western provinces.
Designed in part to support the national Kenya Expanded Programme on Immunization (KEPI), the project has a goal of 100 percent immunization in the districts it serves. These are the Bungoma, Kakamega and Vihiga Districts in Western Province; the Siaya, Kisumu, and Kisii District in Nyanza Province; and the Transnzoia, Nandi and Uasin Gishu Districts of the Rift Valley Province.
While the project has made steady progress towards achieving its goal for immunization, many say that its real success has been the way it has helped to build a new level of intersectoral and interfaith collaboration in many communities of the region. This collaboration has paid off by stimulating the construction of latrines and helping create better access to clean water. Some say that the project has even helped reduce ethnic and religious prejudices in the region, prejudices that have been a major stumbling block for development.
"This project has meant a dramatic improvement in the way people live," said Chief Shadrack Wabomba Kibaba Namwela of Bungoma District, Western Province. "Because of the project's community health workers, we have a regular visit from mobile clinics. The death rate of children has decreased and malnutrition is also less due to the Bahá'í health project. More homes have latrines and are putting good hygiene and sanitation into practice."
The project follows a model used with great success by Bahá'í communities in other African countries. (Similar projects exist in Burkina Faso, Chad, Uganda and Zambia.) Drawing on a strong base of local Bahá'í communities in a region, volunteers for the program are sought. They are then given several weeks of training in basic health care techniques at a regional Bahá'í institute. Based in part on the UNICEF/WHO/UNESCO "Facts for Life" program, the training focuses on simple things like promoting hygiene and breast-feeding, understanding elementary nutrition, the importance of immunization, and stopping infantile diarrhea.
After the training, the volunteers are sent back to their communities, having been asked give 10 hours a week of their time as community health workers. Project administrators continue with regular visits to give encouragement and support; follow-up training is also offered.
While many other non-governmental organizations and government agencies run similar programs to train and support community health care workers, the Bahá'í-run programs have been especially effective because of their low dropout rate, the emphasis on service to everyone in the community, and the manifest volunteerism of the workers.
"The only solution for public health is training of community health workers," said Harold Kodo, national KEPI education officer. "When we talk about improvement in primary health care in a village, we are talking about information and changing behavior. Because community health workers are from the grassroots and they know the culture, they are able to change behavior much easier and faster."
"From what I have seen," Mr. Kodo said, "the Bahá'í health project training was quiet, well-organized and well-conducted. Specifically, the participants were all local people who are learning to help to improve the health of their village. This approach helps the project's sustainability.
"And the Bahá'í trained workers are working as volunteers without any pay and working very hard at that. They all have a very strong spirit which I think comes from their religion. The Bahá'í community health workers' dropout rate is much lower compared with other community health workers because of their motivation, faith and spiritual qualities," said Mr. Kodo.
According to Ethel Martens, a Canadian specialist in social preventative medicine who helped to establish the Kenyan project, the dropout rate has been about five percent on average - versus a dropout rate as high as 70 percent in some government-run projects to train community health workers in Africa.
The project is also distinctive for its effort to involve all sectors of the community in decision-making on and the implementation of local health programs.
Village Health CommitteesOn the initiative of project leaders, local Bahá'í governing councils in the region have been asked to appoint three members to help found a Village Health Committee. By drawing in as many as a dozen other community leaders, including local government representatives from the ministries of health, agriculture and education as well as representatives from churches, these Committees have brought a new level of intersectoral and interreligious cooperation to many villages.
"In some respects, these Committees have become like an interdenominational council, because the various religions come together and talk about how problems in the community can be solved," said Dr. Martens of Canada. The project is funded in part by the Canadian Public Health Association, which has provided about $110,000 to the project over the last three years.
Because of the cross-fertilization from different groups and sectors, the Committees have expanded beyond simple health care to efforts involving sanitation, water supply and solid waste disposal.
The Committees have also acted as a focal point in helping to coordinate visits of mobile health clinics, which are run by the government. Coordination is needed because sometimes the mobile clinics fail to show up on the appointed day, often for want of money for fuel or to pay the nurse. The Committees have occasionally worked to help raise the needed extra funds.
The fact that the Committees are composed of representatives of different religions has also helped to soothe ethnic tensions. Tribal identity is intense throughout Kenya, sometimes leading to prejudice. Individual churches are usually populated by members of a single tribe, and sometimes members of other tribes are excluded from their activities.
Bahá'í communities, however, are usually quite diverse; the concept of unity in diversity is emphasized. Bringing various religious representatives together on one Committee has helped foster cooperation and cut down on exclusion.
Bounaventure Wafula, project administrator, shown on right, presents a package of information to Harold Kodo, KEPI Health Education Officer, during a visit by Mr. Kodo to the Menu Bahá'í Institute.
So far, some 24 village health committees have been established, said Mr. Bounaventure Wafula, the project administrator. "The establishment of Village Health committees have been a source of unity in the villages," said Mr. Wafula. "Chiefs and government officials are recognizing this and they are very supportive of this project."
"Most of the people who are benefiting and participating in this project are women," added Mr. Wafula. "They learn to take interest in their own family health care and actively participate in consultation. This gives them self-confidence."
Ms. Soita, who started with the program in 1986, has now become one of the project's field supervisors. She has seen how the Bahá'í emphasis on inclusion has contributed to the project's success.
"I think that one of the reasons, people in the villages respect and support us, is the way the Bahá'í Community Health Workers serve the people," said Ms. Soita. "During mobile clinic visits and one-day seminars, our community health workers help and serve everybody without any discrimination. It doesn't matter which tribe, religion, young or old, we give them the same amount of care."
"When I started with this project as a community health worker in 1986, most people in my village and nearby villages didn't know the causes of diseases and how they could prevent them," said Ms. Soita. "But today, after attending awareness-raising seminars and through personal contact with the health workers, most of the villagers can and will prevent many sicknesses such as diarrhea and malaria.
"I am a good example," Ms. Soita concluded. "The diet in our family has changed. I learned about nutrition and different food categories, such as carbohydrates, proteins, vegetables, fruits and grains. In my family , I make sure we eat enough of all of them."