Online Program

Feasibility of using community health volunteers to provide treatment services to sick children in Bondo, Kenya

Tuesday, November 3, 2015

Dyness Kasungami, MBChB, MPH, John Snow Inc., District of Columbia, DC
Mark Kabue, Dr. PH, 1776 Massachusetts, Suite 300, Jhpiego, District of Columbia, DC
Makeba Shiroya Wandabwa, MMed, MPH, Ring Road, 14 Riverside, Nairobi, Kenya
Savitha Subramanian, Dr. PH, Innovations for Maternal, Newborn & Child Health, JSI Research & Training Institute, Inc., Arlington, VA
Daniel Otieno, MBChB, MPH, JSI, Nairobi, Kenya
Charles Waka, BSc., Jhpiego, Nairobi, Kenya
introduction: Improving health indicators for children under-five is challenging. In Bondo sub-county (Kenya), an integrated community case management (iCCM) study is underway to test whether community health volunteers (CHVs) can manage cases of fever, cough/fast breathing and diarrhea building on the existing community health platform.

methods: The study is for 18 months and is quasi-experimental with intervention and comparison groups of four community units each.  Fifty-eight intervention group CHVs were trained on iCCM and health promotion, provided with iCCM commodities and a monthly stipend of $23. Comparison group CHVs were trained in health promotion and receive a monthly stipend of $23, but no iCCM commodities. CHVs take the lead in identifying and treating sick children. They report to the ‘barraza’, a community dialogue forum. A midline survey was performed in July 2014 and included review of program data, key informant interviews, and CHV clinical case observations.

results:  introduction of iCCM resulted in an increase in iCCM cases managed from 2,367 in Jan-Jun 2013 to 4,868 in Jan-Jun 2014. CHVs managed 56% of cases. There was marked improvement from baseline to midline in CHVs’ ability to “look” (3% vs. 74%) and to recognize illness danger signs (77% vs. 98%), p<0.05, respectively. Key informants reported increased access to iCCM services and increased community trust of the CHVs. 

conclusion: CHVs can effectively provide iCCM services in hard-to-reach areas, and contribute to reducing childhood mortality in Bondo, Kenya. Leadership by CHVs is key to building community trust and increased utilization of iCCM services.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Discuss a promising approach to equipping community health volunteers to deliver treatment for sick children in a hard to reach agrarian community Identify success factors for a community health volunteer led treatment program.

Keyword(s): Community Health Workers and Promoters, Case Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a public health physician trained in Zambia and obtained my master of public health degree from Tulane university. I have been involved in the reported study from design, in implementation and monitoring progress to date.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.