Name of Department: Epidemiology and Public Health

Transcription

1 Name of Department: Epidemiology and Public Health The effect of community health workers on utilization of health services and Improving health outcomes in nine rural communities in Kenya a mixed methods approach Miriam Njoki Karinja PhD student, Swiss Tropical and Public Health Institute Supervisors Prof. Bernhard Ogutu Faculty representative Prof. Marcel Tanner

2 Background Community health worker programs (CHW) have been widely used as an approach to primary health care over the years (Lehmann, 2007). Cochrane reviews have showed evidence of effectiveness of the CHWs in certain key areas - exclusive breastfeeding, increasing immunization uptake and reducing diarrhea, pneumonia, and fever among children) Lewin 2005 Other evaluations have shown CHWs were unable to decrease mortality and services provided being of poor quality(lehmann, 2007). Although CHWs can positively influence health outcomes of the community, significant implementation challenges exist especially when programs are rolled to scale (Arid, 2014) Varied performance of the CHW programs in different context highlights the need for implementation research The Government of Kenya places a huge emphasis on preventative health care and health promotion to improve health care and reduce burden of illness in the community Community health strategy (CHS) for Kenya aims to develop linkages between the households and the peripheral healthcare system and empowering households and communities to take charge of improving their own health Challenges in the Implementation of the CHS by government: lack of resources, lack of community ownership, high attrition rate, lack of incentives and training needs among others. Public private partnerships as an opportunity to fill the CHS implementation gap in Kenya 2

3 Policy context Kenya Community health strategy NHSSP introduced in 2005 Emphasis on delivering improved health services to community Key to the strategy: training local community members to deliver basic healthcare services Establishment of Community Health Units to serve 5000 people Trained Community Health Volunteers - in charge of 20 Households - basic health promotion & disease prevention Community Health Worker Kit provided: Tetracycline, paracetamol, Albendazole. Supervision by Community Health Extension Workers 3

4 Familia Nawiri In March 2012, a Novartis Social Venture called Familia Nawiri was launched in Kenya as a follow up to a very successful Social Venture in India called Arogya Parivar Social ventures are innovative business models that build local, sustainable capabilities for healthcare around the world. These programs address societal problems that impact access to healthcare, including the need for: Education, Infrastructure and distribution Familia Nawiri was initially piloted in 3 counties in Kenya: Kirinyaga, Nakuru and Embu, and now has a presence in 9 counties including: Migori, Siaya, Bomet, Kericho, Meru and Nairobi The program has two arms Social arm: improve health awareness and health seeking behavior through health education meetings (HEMs) Commercial arm: works with Health care providers to increase access to essential medicines 4

5 Familia Nawiri Model 5

6 Familia Nawiri - Novartis Social Venture in Kenya The aim of FN is to improve healthcare for local communities living at the bottom of economic pyramid FN uses trained community health facilitators to deliver community education to organized groups in the community Since its launch, the program has conducted approximately 7370 HEMs Through community education; improve hygiene practices/behavior, understand key aspects prevalent diseases in of the community, improve health seeking behaviour and rational use of medicines 6

7 Ministry of Health / Novartis Pharma Partnership Within the framework of community health strategy for Kenya, FN has partnered with several county governments in Kenya to strengthen community health units (CHUs) in order to increase reach and improve health outcomes at the household level. The overall goal of the partnership is aligned with the goal of the Kenya Community Health Strategy To improve the health status of communities at the household level through strengthening and establishing sustainable community health units. 7

8 Familia Nawiri area of engagement with Community Health Strategy 8

9 Operational Research Research embedded within the engagement between Familia Nawiri and Kenya Community Health Strategy aims to document impact of the program Provide the program staff with ongoing and critical reflection on why the program objectives are met or not met. Provides a platform to build operational research capacity in Kenya 9

10 PhD Research Objectives 1. Assess effectiveness in promoting utilization of health services. 2. Assess effectiveness in improving health outcomes. 3. To assess the quality of care provided by the community health workers 4.To develop heat maps to describe spatial difference in accessing healthcare services in the study communities 5. To use qualitative methods to Explore factors affecting program sustainability and performance of the community health workers To explore the notion of quality of care provided by the community health workers 10

11 Methods and Outcomes Objective 1-4 : Answered quantitatively A quasi-experiment using before- and -after design with comparison group Baseline and 18 months follow up HH survey 14 Intervention sites and 14 comparison sites in 9 counties in rural Kenya (~1000 households for each site) Comparison: CHW program implemented through MoH and Novartis partnership vs CHW program implemented by MoH Main outcomes: ANC visits, skilled birth attendance, Immunization, exclusive breastfeeding and care seeking for acute infections under 5 s (diarrhea and respiratory infections), 11

12 Methods and Outcomes Objective 5 Answered qualitatively Methods applied: Focus group discussions, In-depth interviews and observations Respondents: Households visited by the CHWs, CHW supervisors, Patients referred to HF by the CHWs and CHWs Explore the notion of quality of care provided by CHWs Explore issues impacting on the performance of the CHWs Follow up on other emerging issues from quantitative data 12

13 Study sites Name of County No of Households sampled % Households sampled Bomet Embu Kericho Kirinyaga Meru Migori Nakuru Siaya Nairobi Total

14 Current status/preliminary results Table 2: Visits by Community Health Volunteers Household visits by CHVs in the last one year n(n) % Yes No Total Table 3: Health seeking behaviour Health seeking behaviour among under 5's n(n) % Diarrhoea in the last 2 weeks 430 (3722) 12 Sought treatment for diarrhoea 301 (430) ( 3720) (223) 77 Respiratory tract infection last 2 weeks Sought treatment for Respiratory tract infection 14

15 Conclusion Community health volunteers play a vital role in the health system Health promotion activities can improve health outcomes This study seeks to explore the impact of community health volunteers on improving health outcomes Qualitative studies are required to explore reasons for particular behaviors related to health outcomes 15