A community health worker in Komo voicing her opinion during the Community Dialogue Day.
This example was contributed by Cara Smith through a World Health Organization (WHO) Health Promotion Internship (summer 2012).
Often hospitals are just a place that people visit when they are sick, but the Kenyan Ministry of Public Health and Sanitation decided to change that. The Ministry wanted individuals to know that the hospitals belong to the people, and that all people have a right to health. In 2007, the Ministry began the Community Health Strategy, a new program to empower communities to take responsibility for their own health. This program organizes service delivery into 6 levels: national and other high-level hospitals, provincial hospitals, district hospitals, health centers, dispensaries (coordinated by nurses and Community Health Extension Workers), and Community Health Workers, a system that gives individuals access to health information and services in their own communities.
BECOME ENGAGED AS A COMMUNITY LEADER.
Community Health Workers are elected by their communities. They must meet certain criteria, such as being able to read and write, speak English, and be at least 18 years old. Usually they are nominated by the Baraza, the village chief, because they are already invested, influential members of the community who care about its health.
ASSESS YOUR OWN COMPETENCE IN CORE TASK OF LEADERSHIP, AND PLAN FOR IMPROVEMENT.
The Ministry of Public Health and Development realized that there was not a strong link between the hospitals and the people. There was not a way to understand the issues and conditions that were contributing to disease and poor health.
ASSESS YOUR GROUP'S COMPETENCE IN CORE TASK OF LEADERSHIP AND PLAN FOR IMPROVEMENT.
The members of local communities and villages were not always aware of the services provided by the hospitals and clinics, including many of the free and subsidized preventative services that were available. There were also health issues on which some individuals were not educated, such as how proper hand washing and latrine use could prevent typhoid, cholera, polio and other diseases.
Volunteers Cara Smith and Ithar Hassaballa at a Community Dialogue Day
ENVISION THE LEADERSHIP OF THE GROUP.
To make health information and services easier for individuals to access, the Ministry envisioned Community Health Workers (CHW). Each CHW is an elected member of the local community or village and represents a unit of about 100 households. To be elected, individuals must be able to read, write, and meet a few other basic requirements decided on by the community. They are responsible for learning about the health problems community members in their Community Health Unit are experiencing and communicating those problems to the Community Health Extension Worker (CHEW), each of whom supervises 50 Community Health Workers. They also pass information in the other direction, educating community members on various health and sanitation issues. The CHWs also assess and monitor several health indicators in order to track the progress of the community members’ health.
SET LEADESHIP DEVELOPMENT GOALS FOR THE GROUP AND ITS MEMBERS.
The major strength of CHWs is that they are members of the community, and therefore other individuals in the community can comfortably talk to them about sensitive issues. Most CHWs do not have broad health knowledge on their own, but the health centers and higher levels of service delivery can provide them with this knowledge. It is easier for the health clinics to educate one CHW for each community than it is to educate every individual in every community. After some time, Community Health Workers have increased their knowledge about health and how to help the community. They can write proposals to ask for funding and other resources demanded by the community. CHWs are also registered a bank account with the Department of Social Services to use if they receive funding from these proposals.
SELECT METHODS FOR DEVELOPING LEADERSHIP. INDICATE HOW YOU (YOUR GROUP) WILL:
When an individual becomes a Community Health Worker, he or she is trained on how to do each of the assigned tasks. Each Community Health Worker is in contact with the Community Health Extension Worker who is assigned as their supervisor, and therefore any questions or issues they have can be brought to that person. They have meetings with their CHEW every month and give reports on their community unit at this time. They are also supervised and guided by the Community Health Committee, a group that represents the community. The Community Health Committee meets quarterly with the Community Health Worker to tell the CHW what health services and activities the community needs.
RECRUIT NEW PEOPLE TO LEAD. INDICATED HOW YOU (YOUR GROUP) WILL:
If a CHW needs to step down from his role, the community elects a replacement.
ENHANCE COLLABORATION WITHIN AND ACROSS GROUP. CONSIDER HOW YOUR(YOUR GROUP) WILL:
CHWs serve as models of healthy living for their communities. They help connect people to necessary tools and services. Without being forceful, they make sure the right people receive important health information. For example, many households in Komo do not have latrines or recognize their importance. At a recent Community Dialogue meeting, the community members decided to hold an extra meeting the next week specifically on sanitation. The members present decided that they would invite their neighbors, especially those without toilets, to the meeting for a discussion on the benefits of latrines.
PROMOTE LEADERSHIP AS SERVICE.
Community Health Workers work voluntarily. They understand that the training they receive is worthless if they do not use it to help the community.
PROMOTE ADAPTATION TO NEW SITUATIONS.
Community Health Workers are often recognized for their service to the community. They are empowered to communicate with the Community Health Extension Workers and those at higher levels about the needs of the community and their needs as CHWs.
INDICATE HOW YOU WILL BUILD A GREAT GROUP GROUP WITH STRONG LEADERSHIP.
Community Health Workers receive periodic training to insure that they have the continued support that they need.
- APHIA Plus Kamili
- Kenya’s Ministry of Public Health & Sanitation (Miss Ruth)
- The community of Thika West (Komo)
- WHO office in Nairobi, Kenya