A Study of Volunteer Community Health Workers Promoting Maternal Health Services in Rural Kenya: A Christian Viewpoint

  • Bradly Alexander Kimbrough Baylor University
  • Lisa Baker Baylor University
Keywords: HIV, Community health, Community health worker, Lay health worker, Volunteer health worker, Maternal health, Antenatal care, Health systems strengthening, Labor and delivery, Kenya, Nyanza, Christian health systemss development

Abstract

Introduction:  Despite the call for community-based health care interventions in the developing world, there is little research examining the effectiveness of paid versus volunteer community health worker (CHW) programs to increase women’s use of maternal health services.  From a Christian perspective, the CHW model is, at its root, discipleship: a credible person leads a neighbor to a source of help and health.  This effective model can be expanded to address the health of the whole person, both spiritual and physical. This study of a government health center program in rural Kenya addresses these issues.

Methods:  The current study analyzed the change in maternal health services after a government program, starting with 30 volunteer CHWs, had been in place for nine months.  The intervention was designed and carried out by the authors in collaboration with Sigoti District Health Center in the western Kenyan province of Nyanza.

Results: The proportion of facility-based deliveries (FBDs) showed a statistically significant increase (p=0.003), from an average of 38 deliveries before the intervention to 60 afterwards.  The proportion of health center deliveries of HIV-positive women also significantly increased (p=0.04) from an average of 6.5 to 14 FBDs. Compared to another program in rural Lesotho with paid CHWs, the Sigoti intervention led to a similar increase in FBDs. Despite their successes, the community-based strategies were time-intensive for both programs, with one CHW adding between 1.12 and 1.7 FBDs per year.

Discussion:  This study demonstrates that a CHW program can be successful, even when using volunteers.  Using solely a metric of time and/or money, the CHW model produces value at a high cost.  However, the concerns of cost-effectiveness and CHW attrition, as well as the success of the CHW model, can be meaningfully addressed from a Christian perspective.  Using the outcome measure of changed lives, volunteer CHWs could be motivated by a Christian call to discipleship.  CHWs may be trained and supported to contribute to the health of the whole person.  Future research will test these assumptions with a CHW program operating from a Christian health center to be built soon in the study area.

Author Biographies

Bradly Alexander Kimbrough, Baylor University
University Scholars Major / Undergraduate Student
Lisa Baker, Baylor University
Clinical Professor in the Honors Program at Baylor University. MD/PhD

References

Bhutta ZA, Ali S, Cousens S, Ali TM, Haider BA, Rizvi A, et al. Alma-Ata: Rebirth and Revision 6 Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make? Lancet. 2008 Sep 13; 372(9642): 972–89. http://dx.doi.org/10.1016/S0140-6736(08)61407-5

Boateng D, Kwapong GD, Agyei-Baffour P. Knowledge, perception about antiretroviral therapy (ART) and prevention of mother-to-child-transmission (PMTCT) and adherence to ART among HIV positive women in the Ashanti Region, Ghana: a cross-sectional study. BMC Women’s Health. 2013;13:2. http://dx.doi.org/10.1186/1472-6874-13-2

Kim MH, Ahmed S, Preidis GA, Abrams EJ, Hosseinipour MC, Giordano TP, et al. Low rates of mother-to-child HIV transmission in a routine programmatic setting in Lilongwe, Malawi. PLoS ONE. 2013;8(5):e64979. http://dx.doi.org/10.1586/14787210.3.6.971

http://dx.doi.org/10.1371/journal.pone.0064979

McIntyre J. Prevention of mother-to-child transmission of HIV: treatment options. Expert Rev Anti Infect Ther. 2005 Dec;3(6):971–80. http://dx.doi.org/10.1586/14787210.3.6.971

Walker DG, Jan S. How do we determine whether community health workers are cost-effective? Some core methodological issues. J Community Health. 2005 Jun;30(3):221–9.

Prinja S, Mazumder S, Taneja S, Bahuguna P, Bhandari N, Mohan P, et al. Cost of dDelivering cChild hHealth cCare tThrough cCommunity lLevel hHealth wWorkers: hHow mMuch eExtra dDoes IMNCI Program cCost? J Trop Pediatr. 2013 Jul 19;fmt057. http://dx.doi.org/10.1093/tropej/fmt057

Prinja S, Jeet G, Verma R, Kumar D, Bahuguna P, Kaur M, et al. Economic analysis of delivering primary health care services through community health workers in 3 North Indian states. PLoS ONE. 2014;9(3):e91781. http://dx.doi.org/10.1371/journal.pone.0091781

Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;(3): CD004015. http://dx.doi.org/10.1002/14651858.CD004015.pub3

Wang’ombe JK. Economic evaluation in primary health care: the case of Western Kenya community based health care project. Soc Sci Med. 1984;18(5):375–85. http://dx.doi.org/10.1016/0277-9536(84)90055-8

Floyd K, Skeva J, Nyirenda T, Gausi F, Salaniponi F. Cost and cost-effectiveness of increased community and primary care facility involvement in tuberculosis care in Lilongwe District, Malawi. Int J Tuberc Lung Dis. 2003 Sep;7(9 Suppl 1):S29–37.

Islam MA, Wakai S, Ishikawa N, Chowdhury AMR, Vaughan JP. Cost-effectiveness of community health workers in tuberculosis control in Bangladesh. Bull World Health Organ. 2002;80(6):445–50.

Nganda B, Wang’ombe J, Floyd K, Kangangi J. Cost and cost-effectiveness of increased community and primary care facility involvement in tuberculosis care in Machakos District, Kenya. Int J Tuberc Lung Dis. 2003 Sep;7(9 Suppl 1):S14–20.

Okello D, Floyd K, Adatu F, Odeke R, Gargioni G. Cost and cost-effectiveness of community-based care for tuberculosis patients in rural Uganda. Int J Tuberc Lung Dis. 2003 Sep;7(9 Suppl 1):S72–79.

Sinanovic E, Floyd K, Dudley L, Azevedo V, Grant R, Maher D. Cost and cost-effectiveness of community-based care for tuberculosis in Cape Town, South Africa. Int J Tuberc Lung Dis. 2003 Sep;7(9 Suppl 1):S56–62.

Wilkinson D, Floyd K, Gilks CF. Costs and cost-effectiveness of alternative tuberculosis management strategies in South Africa--implications for policy. S Afr Med J. 1997 Apr;87(4):451–5.

San Sebastián M, Goicolea I, Avilés J, Narváez M. Improving immunization coverage in rural areas of Ecuador: a cost-effectiveness analysis. Trop Doct. 2001 Jan;31(1):21–4.

Invitation to tender for the development of a ‘‘Cost-effectiveness study on community health workers.’’. World Health Organization; 2013. Available from: http://www.who.int/workforcealliance/media/news/2013/GHWA_ITT_CHW_CEA_5Mar2013.pdf

Medhanyie A, Spigt M, Kifle Y, Schaay N, Sanders D, Blanco R, et al. The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study. BMC Health Services Research. 2012 Oct 8;12(1):352. http://dx.doi.org/10.1186/1472-6963-12-352

http://dx.doi.org/10.1186/1472-6963-12-352

Satti H, Motsamai S, Chetane P, Marumo L, Barry DJ, Riley J, et al. Comprehensive aApproach to iImproving mMaternal hHealth and aAchieving MDG 5: rReport from the mMountains of Lesotho. PLoS One. 2012 Aug 27; 7(8). http://dx.doi.org/10.1371/journal.pone.0042700

Jan S, Conaty S, Hecker R, Bartlett M, Delaney S, Capon T. An holistic economic evaluation of an Aboriginal community-controlled midwifery programme in Western Sydney. J Health Serv Res Policy. 2004 Jan;9(1):14–21.

Jan S. A holistic approach to the economic evaluation of health programs using institutionalist methodology. Soc Sci Med. 1998 Nov;47(10):1565–72. http://dx.doi.org/10.1016/S0277-9536(98)00228-7

Jan S, Pronyk P, Kim J. Accounting for institutional change in health economic evaluation: a program to tackle HIV/AIDS and gender violence in Southern Africa. Soc Sci Med. 2008 Feb;66(4):922–32. http://dx.doi.org/10.1016/j.socscimed.2007.11.010

The World Factbook: Country comparison: pPeople living with HIV/AIDS [Internet]. Washington, DC: Central Intelligence Agency; [updated 2012; cited 2014 Mar 10]. Available from https://www.cia.gov/library/publications/the-world-factbook/rankorder/2156rank.htmlKenya

Kenya National Bureau of Statistics, ICF Macro (2010). Kenya dDemographic and hHealth sSurvey 2008-2009. Calverton, United States: ICF Macro. Available from:

http://dhsprogram.com/publications/publication-FR229-DHS-Final-Reports.cfm

http://dhsprogram.com/publications/publication-FR229-DHS-Final-Reports.cfm

Chou D, Inoue M, Mathers C, Oestergaard M, Say L, Mills S, et al. Suzuki E, Wilmot J. Trends in mMaternal mMortality: 1990 to 2008. World Health Organization, United Nations Children’s Fund, United Nations Population Fund, The World Bank; 2010. Available from: http://www.unfpa.org/webdav/site/global/shared/documents/publications/2010/trends_matmortality90-08.pdf

Maternal mortality ratio (modeled estimate, per 100,000 live births) [Internet]. Washington, DC: The World Bank; [updated 2014 Apr 2; cited 2014 Apr 3]. Available from: http://data.worldbank.org/indicator/SH.STA.MMRT

Cotter K, Hawken M, Temmerman M. Low uUse of sSkilled aAttendants’ dDelivery sServices in rRural Kenya. J Health Popul Nutr. 2006 Dec; 24(4): 467–71.

Reduction of maternal mortality. A joint World Health Organization, United Nations Children’s Fund, United Nations Population Fund, and World Bank statement; 1999. Available from: https://extranet.who.int/iris/restricted/bitstream/10665/42191/1/9241561955_eng.pdf

Community health workers: What do we know about them? World Health Organization; 2007. Available from: http://www.who.int/hrh/documents/community_health_workers.pdf

Ministry of Health and Social Welfare (Lesotho), ICF Macro (2010) Lesotho Demographic and Health Survey 2009. Calverton, United States: ICF Macro. Available from: http://dhsprogram.com/publications/publication-FR241-DHS-Final-Reports.cfm

What is CHE? [Internet]. Community Health Evangelism; [cited 2014 Oct 3]. Available from http://chenetwork.org/whatische.php

Published
2014-11-06