Kenya faces severe shortages of skilled health workers, particularly in remote and poor communities. As a consequence, one strategy that is gaining currency is delegating tasks to the least-educated level of workers able to complete them effectively. Over the years, this has meant that community health workers (CHWs) who receive some basic training from the Kenyan government and/or healthcare organizations have helped to fill critical gaps in medical coverage.
CHWs provide health services as diverse as making home visits to the ill, screening for tuberculosis, counseling on HIV/AIDS, and teaching families safe sanitation practices. Traditional birth attendants (TBAs), women who may have no formal training and often learn their trade from their own mothers or grandmothers, also play a key role in Kenya’s healthcare ecosystem, especially among low-income families. While currently under government pressure to stop delivering babies in their homes due to the medical risks, TBAs typically provide prenatal care to pregnant women, assist with labor and delivery, and follow up with mothers and their babies after childbirth. In light of the vital services proided by these frontline health workers in Kenya, the Internews Center for Innovation & Learning commissioned this study to explore the potential for CHWs and TBAs to use an interactive mobile platform to improve the dissemination of health information in their communities. As envisioned, this “e-health” project would rely on mobile phone texting, and implemented in partnership with one or more community radio stations and other local organizations.
Internews’ Kenya office and the research team jointly determined two initial research sites to capture data from two kinds of marginalized communities: the Nairobi slum of Korogocho, and the small town of Matungu in Mumias District in rural western Kenya. Researchers gathered quantitative and qualitative data on the roles of CHWs and TBAs through focus group discussions, questionnaires and one-on-one interviews.
The study found that community health workers fall into four typical profiles. At one end of the continuum, there is the highly structured role of CHWs who are elected to their position by their communities; these CHWs work within Community Units that fall under the Kenyan Ministry of Health and receive training from the government. At the other end, there are self-selected CHWs who work on a single health project for a non-governmental or community-based organization on an ad-hoc basis. These CHWs receive minimal training.
Traditional birth attendants also fall into a range of profiles. In Korogocho, for instance, these women fulfill the historical role of midwives who oversee labor and delivery in their own homes. While government policy discourages this practice, Kenyan women traditionally give birth at home, and hospital births remain out of reach for many poor women given the obstacles of cost, transportation, and limited hours of operation. In Matungu, under a Ministry of Health initiative, TBAs are making the transition to a new role as “Safe Delivery Advocates” (SDAs) who encourage pregnant women to get care at health facilities that are better equipped to deal with medical complications.
Study researchers learned that community health workers in Korogocho and Matungu already use mobile phones for their work fairly extensively, although most use them primarily for simple voice calls, not for texting or other features. Traditional birth attendants, who tend to be older and less literate, use mobile phones to a somewhat lesser extent, and very few use their phones for texting. At least one community-based organization, Pambazuko Mashinani in Korogocho, was found to be using mobile technology in its health programs, including bulk mobile phone texting.