Community Health Volunteers ensure continuity of services amid Covid-19 disruptions
Donning a blue half coat, Dishon Indimuli walks through a winding alley clustered with iron sheets houses in Kiambiu informal settlements, Nairobi County. He occasionally stops to exchange pleasantries with residents as he makes stops in several households. For most residents in this settlement, Indimuli is more than a neighbor but also a guide on issues concerning health. He is a community health volunteer one of the essential occupations that have kept health services going despite the disruptions caused by the Covid-19 pandemic.
Before the Covid-19 pandemic broke out in Kenya in March this year, Indimuli had worked voluntarily for over 13 years acting as a crucial link between the community and health systems. Every day, he would make at least one home visit providing services including checking on expectant women and children under five and referring them to health facilities for antenatal care and immunization. His work also involved following up with people with diseases such as HIV, TB and malaria and ensuring that they were adhering to treatment as well as distributing family planning commodities.
Across households in this informal settlement, where there is limited access to health services, the role of community health volunteers has been critical. “Residents identify us with this blue half coat. They stop us wherever to inquire about various health issues that they may have,” says Indimuli. Despite bearing 25% of the global disease burden, Africa has only 3% of the global health workforce according to Lancet. Lack of health services are more pronounced in remote and marginalized communities like the one Indimuli serves.
Amid the pandemic, CHVs have continued to provide crucial health services at the community level especially at a time when health systems are burdened by the rising cases of Covid-19. There are over 100 CHVs in Kiambiu each in charge of 100 households. The CHVs who report to the government have been responsible for ensuring that they are offering health education to save lives.
“When the Covid-19 outbreak broke out, most people kept away from health facilities for fear that they would contract the virus. Our work has been to mobilise the community to go to health facilities for routine health services,” says Martha Mwanza, a community health volunteer. As part of her work, Martha identifies people with different health needs within the community and refers them to nearby public health facilities without having to queue.
With only protective masks and sanitizers, CHVs have continued making home visits during the pandemic. “We have however reduced visits from 30 to 5 per month to minimize the risk of exposure,” says Martha.
During the Covid-19 pandemic, CHVs have played a key role in creating awareness as well as contact tracing. After undergoing a training by Red Cross, the CHVs have been educating the community on hand washing and proper way to wear face masks. Rosemary Kisyula, a community health volunteer notes that there are lots of myths among the community about Covid-19.
“ Some believe that the disease is a government project while others still think that it only affects the whites and people who fly,” she says . The efforts of CHVs are helping equip the community with the right information about the disease. The health volunteers are also sensitizing the community on the need to social distance, a measure many cannot adhere to due to congestion. Similarly, CHVs have boosted contact tracing efforts by reporting any person with Covid-19 symptoms to health authorities, helping reduce community transmissions.
The work of CHVs has ensured that health services such as immunization, antenatal care and family planning do not stall even as the focus of health system has shifted to dealing with the pandemic. Residents of Kiambiu place high expectations on these health workers. But CHVs can only do so much with little resources.
These health workers are not paid, a factor that affects their morale. “Community members think that we are paid and so when we make home visits they expect us to offer more than just health services but also offer food donations yet we are also struggling,” says Indimuli. CHVs also receive emergency calls from members of the community late into the night with the curfew and insecurity making it difficult for them to respond promptly. Additionally, the interactions they make with minimal protective gear puts them at risk of contracting the virus and other diseases.
Indimuli and his colleagues hope that the government may recognize their efforts in bolstering health systems in marginalized communities and offer them a stipend to help cater for some of their expenses. “A stipend would ease the pressures of having to work other jobs to put food on the table and help us sorely focus on improving health in the community,” notes Martha.