Community Health Workers have been shown to be an integral part of successful health care delivery in resource-poor settings around the world. The CHW program is integral to bridging the patient/provider divide in Kibera. Clinicians are usually outsiders to the community, and, try as they might, they cannot truly understand the grinding poverty of their patients. Therefore, CHWs are necessarily residents of the community, who not only acutely understand the needs of the population, but are also familiar faces for patients in a setting that so often seems intimidating and foreign. Our CHWs have been trained using modules adapted from Partners In Health, a leading global health organization, in conjunction with the Kenyan Ministry of Health’s CHW curriculum. They use this training to both provide follow-up care to patients, and to more generally lead health talks and educational outreach in the community.
As trusted community members, CHWs go to the homes of patients to continue health care outside the clinic walls. By actually visiting homes, CHWs not only ensure that patients have finished medication and are physically improving, they see the conditions in which patients live, conditions that all too often ensure that the biomedical treatment of the disease will not lead to full recovery. In the home, CHWs can demonstrate necessary health processes, like proper food storage, adequate procedures to boil water or wash hands. Furthermore, they can understand the barriers to care that exist for specific patients, and report back to the clinical officers based on their observations. The clinicians are then able to cater treatments to the needs of patients. Special cases in the primary care program necessitate CHW follow-up, but every mother in the maternal health program is paired with a CHW who escorts the mother through the process, providing emotional and tangible support as necessary.
This is especially important because childbirth is one of the most pressing issues we face in Kibera. Traditional birth attendants still have an enormous presence in Kibera. Especially in a community where the HIV rate is so high, these procedures, usually done in one-room homes, can be fatal for both the mothers and the unborn children. Furthermore, when the mother is HIV positive, home births almost guarantee vertical transmission to the child. One of the most important roles of the CHW is to help convince each and every one of our mothers to give birth in our partner clinic.
An equally important component of the CHWs’ work is the educational outreach they perform throughout the community. They do “door-to-door awareness,” targeting individual households and family members to spread awareness on any number of topics. Through active demonstrations, plays, and other engaging techniques, they reach even those patients that may not make it through our doors immediately. Such active engagement with the community encourages people to take control of their health, and the health of those around them. The population density of Kibera ensures that successful health care is a reproducing cycle: when neighbors, relatives and friends watch a patient visibly improve, all are encouraged that there is hope for them. And, with the JJJ Clinic, there will always be a respected health worker to support them throughout the process.
