Strengthening Community Linkage to Family Planning Services in Mombasa County, Kenya
Contributors: Levis Onsase, Njeri Mbugua and Denis Sama
Community health volunteers (CHVs) play a critical role in bringing health information and services to people where they live and work. Various research studies have portrayed them as a means to ‘reach the last mile’ with health information and services. However, in most cities across Kenya, they do not receive a regular salary from the government but instead volunteer, driven by their passion for promoting positive change within their communities.
One of The Challenge Initiative’s (TCI’s) high-impact interventions is working with CHVs to promote family planning as they provide health education, referrals and follow-up on new users. CHVs are often trusted members of the community and therefore have better client engagement than even service providers because CHVs reside in the community and are involved in the lives of the people they serve. Mamu Athman, Mombasa County’s Community Focal Person, shares how the county engaged TCI to help it strengthen the capacity of CHVs to improve its health indicators, especially related to family planning:
TCI helped us to capacity build 350 CHVs in FP methods and community-based distribution to enhance provision of services, information and referral for FP services at the community level. In partnership with Kenya Muslim Development Organization (KYMDO) and the National Council for Population and Development (NCPD), we also conducted religious leaders’ sensitization forums as they are also part of the communities we served. We needed to address any opposition they would have when we went into the community to provide family planning services especially since we were also targeting the youths.”
Veronica Mwashigadi – referred to locally as “Daktari wa Mtaani” (or “The Street Doctor”) – is a CHV that supports outreach efforts for Mla Leo Health Center in Mombasa County. She has benefited from the trainings and coaching support organized by the local government with TCI’s support. Veronica explains how the trainings have enabled her to better serve the needs of the women in her community:
During my visits to the community, I would come across women who had given birth. I would always have to refer them to facilities since most of them suffered from poor nutrition which affected their breast-feeding children. It was even worse in some cases, where a mother would give birth barely before the other one had begun crawling. It was a desperate situation even for me. I shared this experience with our supervisor during our monthly meeting.
When I shared my experience with our Community Strategist, I was told about a training that was being organized by the Ministry of Health for CHVs on family planning. I opted to enroll so that I could see how to help women in my community. We were shown how to use reporting tools and provided with books with information on family planning methods. Since I was new to family planning, I asked a lot of questions – am lucky that our trainer was patient with me. I wanted to get it all right!
[As a result of the training], I sit down with both husband and wife to discuss about family planning. I tell them that family planning is not stopping childbearing but planning and having children accordingly. If they agree, then I refer the wife to Mla Leo health center for counseling and service. [On average] I refer four clients per week for family planning; out of which 90% are taking long-term methods. Most of the time, I accompany the clients to facilities for services. I regularly visit the clients at their households to get feedback on their method of choice and sexual health. With my training, I am able to serve 38 households. I knew this training would be of help to do more.”
By collaborating with the local government and empowering implementers such as CHVs at the city level, the know-how related to implementing high-impact family planning interventions is now embedded within the health system, which ensures improved access to quality reproductive health services. The bar chart below shows significant improvement in completed referrals because of the training received by CHVs and their engagement with potential clients in their communities.
Veronica now coaches her peers on commodity distribution, reporting and the referral process. Due to her efforts in coaching other CHVs, she has been recognized by the county leadership as an exemplar CHV.
The work of a CHV, however, is not without challenges, including the lack of a salary or payment for their efforts – which is a significant barrier in ensuring their continued efforts. As a result, TCI has advocated with the county leadership, including members of the country assembly, to budget for monthly stipends for CHVs. Athman, the Mombasa County Community Focal Person, explains the various approaches the county is exploring to better financially support CHVs:
For purposes of sustainability, the county has enrolled over 1,200 CHVs into a medical insurance scheme (NHIF) as a way to motivate them as volunteers. They go out of their way to ensure women and girls are getting FP services. The county is concerned about the plights of CHVs and to secure their stipends, we are working on CHV Stipend Bill to be presented into the County Assembly for adaptation into law. This will see the CHVs earning about Ksh 2,000 per month.”