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Canadian Journal of Public Health

, Volume 108, Issue 4, pp 427–434 | Cite as

Enhancing the capacity and effectiveness of community health volunteers to improve maternal, newborn and child health: Experience from Kenya

  • Lisa S. Avery
  • Elsabé du Plessis
  • Souradet Y. Shaw
  • Deepa Sankaran
  • Peter Njoroge
  • Ruth Kayima
  • Naomi Makau
  • James Munga
  • Maureen Kadzo
  • James Blanchard
  • Maryanne Crockett
Mixed Research
  • 1 Downloads

Abstract

OBJECTIVE: To determine whether a simple monitoring and tracking tool, Mwanzo Mwema Monitoring and Tracking Tool (MMATT), would enable community health volunteers (CHVs) in Kenya to 1) plan their workloads and activities, 2) identify the women, newborns and children most in need of accessing critical maternal, newborn and child health (MNCH) interventions and 3) improve key MNCH indicators.

METHODS: A mixed methods approach was used. Household surveys at baseline (n = 912) and endline (n = 1143) collected data on key MNCH indicators in the four subcounties of Taita Taveta County, Kenya. Eight focus group discussions were held with 40 CHVs to ascertain their perspectives on using the tool.

RESULTS: Qualitative findings revealed that the CHVs found the MMATT to be useful in planning their activities and prioritizing beneficiaries requiring more support to access MNCH services. They also identified potential barriers to care at both the community and health system levels. At endline, previously pregnant women were more likely to have received four or more antenatal care visits, facility delivery, postnatal care within two weeks of delivery and a complete package of care than baseline respondents. Among women with children under 24 months, those at endline were more likely to report early breastfeeding and exclusive breastfeeding for the first six months. These results remained after adjustment for age, subcounty, gravida, mother’s education and asset index.

CONCLUSION: Our results demonstrate that simple tools enable CHVs to identify disparities in service delivery and health outcomes, and to identify barriers to MNCH care. Tools that enhance CHVs’ ability to plan and prioritize the women and children most in need increase CHVs’ potential impact.

Key words

Community health workers maternal health child health Kenya program evaluation 

Mots Clés

agents de santé communautaire santé maternelle santé de l’enfant Kenya évaluation de programme 

Résumé

OBJECTIF : Déterminer si un simple outil de surveillance et de localisation, le Mwanzo Mwema Monitoring and Tracking Tool (MMATT), permettrait aux agents de santé communautaire bénévoles (ASCB) du Kenya: 1) de planifier leur charge de travail et leurs activités, 2) de dresser la liste des femmes, des nouveau-nés et des enfants ayant le plus besoin d’accéder aux interventions de santé maternelle, néonatale et infantile (SMNI) critiques et d’améliorer les principaux indicateurs de SMNI.

MÉTHODE : Nous avons utilisé une approche à méthodes mixtes. Des sondages menés auprès des ménages au début (n = 912) et à la fin (n = 1 143) de l’étude ont permis de recueillir des données sur les principaux indicateurs de SMNI dans quatre subdivisions du comté de Taita-Taveta, au Kenya. Huit discussions thématiques de groupe ont eu lieu avec 40 ASCB pour connaître leurs points de vue sur l’utilisation de l’outil.

RÉSULTATS : Les constatations qualitatives de l’étude ont révélé que les ASCB ont trouvé le MMATT utile pour planifier leurs activités et classer par ordre de priorité les bénéficiaires nécessitant une aide particulière pour accéder aux services de SMNI. Ils ont aussi cerné les obstacles possibles aux soins à l’échelle des communautés et du système de santé. À la fin de l’étude, les femmes qui avaient été enceintes étaient plus susceptibles que les répondantes au début de l’étude d’avoir reçu quatre visites de soins prénatals ou plus, d’avoir accouché en clinique, et d’avoir reçu des soins postnatals moins de deux semaines après l’accouchement et un éventail complet de soins. Chez les femmes ayant des enfants de moins de 24 mois, les répondantes à la fin de l’étude étaient plus susceptibles d’avoir allaité leur enfant de façon précoce et exclusive au cours de ses six premiers mois de vie. Ces résultats se sont maintenus après la prise en compte de l’âge, de la subdivision du comté, du nombre de grossesses, ainsi que du niveau d’instruction et de l’indice des actifs de la mère.

CONCLUSION : Nos résultats démontrent que des outils simples permettent aux ASCB de repérer les disparités dans la prestation de services et les résultats sanitaires et de cerner les obstacles aux soins de SMNI. Les outils qui améliorent la capacité des ASCB de planifier leurs activités et de classer par ordre de priorité les femmes et les enfants ayant le plus besoin de soins accroissent l’impact potentiel des ASCB.

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Copyright information

© The Canadian Public Health Association 2017

Authors and Affiliations

  • Lisa S. Avery
    • 1
    • 2
    • 3
  • Elsabé du Plessis
    • 1
  • Souradet Y. Shaw
    • 1
  • Deepa Sankaran
    • 1
  • Peter Njoroge
    • 4
  • Ruth Kayima
    • 5
  • Naomi Makau
    • 5
  • James Munga
    • 6
  • Maureen Kadzo
    • 6
  • James Blanchard
    • 1
  • Maryanne Crockett
    • 1
    • 3
    • 7
  1. 1.Centre for Global Public Health, Department of Community Health SciencesUniversity of ManitobaWinnipegCanada
  2. 2.Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of ManitobaWinnipegCanada
  3. 3.Department of Medical Microbiology and Infectious DiseasesUniversity of ManitobaWinnipegCanada
  4. 4.School of Public HealthUniversity of NairobiNairobiCanada
  5. 5.World Renew KenyaNairobiCanada
  6. 6.Anglican Development Services PwaniMombasaCanada
  7. 7.Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada

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