When a child shows malaria-like symptoms at night in Mukuru Kwa Njenga, a mother is likely to first inform a community health worker (CHW) or a community health volunteer before going to the nearest health facility. When a mother in Kawangware wants to improve their child’s diet, they are likely to turn to a community health volunteer. And when Government wants to immunise every child across the country against diseases, it is community health workers they turn to because they know every household.
Whenever a health crisis hits communities, community health workers and volunteers are on the frontlines in Kenya’s hardest-to-reach communities. As Covid-19 spreads across Kenya and Africa in general, these brave, down-to-earth and hard-working men and women will remain the people communities rely on to remain healthy.
As the frontline of the healthcare system, CHWs could play a pivotal role in reducing the devastating impact of Covid-19. In the face of the crisis brought about by movement restrictions, lockdowns, and social distancing, community health workers and volunteers are finding ways to promote Government directives and to insist on respiratory and basic hygiene among communities.
Even as we laud clinicians on the front lines, including doctors and other cadres of health professionals, it is important to fully recognise the efforts of community health workers who are tirelessly working in the background of the community to keep us healthy.
CHWs have been delivering primary health services in hard-to-reach regions for decades. They take care of the most vulnerable patients by providing basic health services. Members of the communities they serve, know they have gone through basic healthcare training. They serve millions of families, and often act as volunteers or receive only a small compensation.
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They do this despite the challenges they face in their discharge of duties including lack of personal protective equipment, an excessive workload, often indirectly linked to an increased population size served by each CHW and their own fear of contracting the virus.
Kenya’s Community Health Services Bill 2020, which is currently in Parliament, would not have come at a better time. The CHS Bill seeks to entrench community health workers into the health system for ease of planning and resource allocation and investment by the state. The Bill also seeks to protect CHW and promote regular community health service delivery in times of a pandemic such as in the Covid-19 emergency response. We must also laud the Government for quickly developing protocols for CHWs in recognition of the role they play in contact tracing in the Covid-19 response.
CHWs are expected to follow up anyone who has touched the patient’s body fluids (blood, vomit, saliva, urine, faeces);. They also follow up those who have had direct physical contact with the body of the patient (alive/dead); or have touched or cleaned the linens or clothes of the patient. They trace those who have slept or eaten in the same household as the patient or babies who have been breastfed by the patient.
For them to perform these tasks, the CHWs are expected to have access to personal protective equipment (PPE), including face masks, gloves, face shields, goggles; and gowns, respiratory support supplies and equipment; alcohol-based hand sanitisers; transport for on-spot response teams and a community-based ambulance for referrals. All these requirements are not supplied in proportionate quantities to their needs and use.
As countries set up and implement national responses to the pandemic, stopping and flattening the Covid-19 curve hinges on preventive measures and calling communities to action. The extraordinary war that is Covid-19 can only be won at the community level because only communities end pandemics. While Governments provide health services and clinical care, stopping the spread of Coronavirus, will be led by the community.
-The writer is CEO Kenya Medical Training College (KMTC)