My recent visit to an AMREF project in Kenya
AMREF USA Executive Director, Lisa Meadowcroft visits the APHIAplus Project in Kenya
“Our health equals our responsibility.” This is what Ann Mwihia told me is the motto of her fellow Community Health Workers in Gilgil, a town in Nakuru, part of Kenya’s Rift Valley. I was visiting the United States Agency for International Development (USAID) funded APHIAplus Nuru ya Bonde Project (Swahili for “Light of the Valley”) to see this integrated health program that aims to support the Kenyan Ministry of Health in effectively coordinating all health services in the Rift Valley province.
My day began at 5:45 in the morning. We wanted to get an early start to avoid the horrendous morning traffic in and out of Nairobi, which is as bad as any I’ve ever experienced in the U.S. The roads were pretty good by Kenyan standards, but it still took us about three hours to reach Nakuru.
Once there, I was incredibly impressed with the program – the people I met offered a truly heartfelt commitment to improving their community’s health and lives. I really believe that there will be a strong impact on empowering and educating the community to understand they have the right to greater access of quality health services.
One of the barriers to people accessing quality health services in Kenya, and across Africa, is that there are too few health workers, and the ones who are employed are working in health centers in the city centers, far from where communities live. These health workers are very often overworked, don’t receive much supervision or support from superiors, and don’t have the right equipment or a steady supply of drugs to distribute to their patients. The stresses and strains are burdening to both the staff and the patients. I have heard from women and men in several African countries that they rarely go to health centers for many reasons: because of the distance, that many times they don’t feel respected by health workers, that the quality of health services are poor and they too often think of health centers as places people go to die.
Luckily, these are exactly the kinds of barriers that the program, which began in 2011, is trying to ameliorate. APHIAplus is implemented by a consortium of six strategic partners with a key objective to improve health services at health facilities as well as to enable communities to play a bigger role in identifying and solving health problems themselves.
This is where AMREF and Ann Mwihia (see photo below with AMREF USA Executive Director, Lisa Meadowcroft) come in. AMREF’s role in the program is to train, equip and supervise a wide range of health workers, including Community Health Workers (CHWs), like Ann, who are the strong advocates for health – and are effective first providers of health services in their community. CHWs live among the community members, much closer than a health center which can be six to eight miles away. They are volunteers (though they may receive small stipends and tools like bicycles to reach other households) who are trained to recognize basic signs and symptoms of illnesses, as well as when to refer the person to a health facility for treatment.
What is most important about the APHIAplus program is that it inherently makes the CHWs part of the formal health care system in Kenya. The program strengthens the links between community structures (level 1) and higher level health facilities (levels 2, 3 and 4), where there are nurses and/or other formally trained health service providers.
Now, let me tell you more about Ann Mwihia. Her smile and confidence belie the struggles she encounters every day. Ann is a subsistence farmer – but she says her passion is as a CHW advocating with her fellow Gilgil community members to prevent illness rather than just treat it. When I asked her why she is so committed, she answered: because of the challenges she faces in her own life. She’s the mother of three children and she’s also taking care of two children who lost both their parents to HIV/AIDS. One of the children is herself HIV positive, and Ann ensures the girl takes her medication.
Several times each week, Ann visits members in her community and talks with them about family planning, preventing HIV, malaria and TB, and water catchment. She encourages women to practice pre-natal care and to deliver their babies at health facilities, which she says is a challenge, because of the traditional beliefs and low education levels among women. Ann is most proud of the work she’s doing around women’s empowerment as a CHW. She discusses how rape is not acceptable and encourages women to seek emergency treatment and be counseled for STIs, and most importantly - to report the rapist to the authorities. Best of all, Ann told me with glee how she is convincing her community not to practice female genital mutilation – and when two families recently did, they were taken to court!
Ann Mwihia and her fellow CHWs also collect health data (i.e. number of children vaccinated, number of children born at health facilities; number of women attending prenatal care; number of families with malaria bed nets) and every month the data is given to the Ministry of Health. To engage and serve as a link to the community, the data is publically displayed on a chalkboard at the health facility.
Along with Ann, I met some truly inspiring people while visiting this project. One of these people was Peter Kiuna, a man who once had TB and was so moved by his CHW’s unwavering support that today he is a Community Health Committee supervisor! I already can see a real impact from the APHIAplus project – and left Gilgil truly proud of AMREF’s role.