Village ‘doctors’ saving young lives in Turkana amid Covid-19

It's daybreak at Lobang’a village in Lopur, Turkana West. John Epeta, 57, begins his walking ritual from house to house, on a mission to save lives and improve the health and well-being of women and children.

Although he does not have formal education, Epeta is fondly referred to as ‘the village doctor’.

He is an accomplished Community Health Volunteer (CHV), transforming health services delivery in this marginalised, sun-scorched, hard-to-reach region.

“It is my responsibility to give services to my people,” Epeta says. “I serve my people with the knowledge and skills I have acquired, which helps me to save the lives of our children in the community.”

In the past few years, various programmes have been piloted to empower semi-illiterate community health workers to deliver health and nutrition services at household level. 

The programmes are by the Ministry of Health, Turkana's Health and Sanitation department and development partners.

In July 2020, Health CS Mutahi Kagwe launched the Kenya Community Health Policy 2020–30. Its goal is to empower individuals, families and communities to attain the highest possible standard of health by focusing on strengthening community health services.

Turkana passed the Community Health Services Act 2018. Among other issues, it outlines the recruitment and remuneration of community-level healthcare workers and the package of health and nutrition services they can offer.

Through this initiative, currently, almost 2,000 CHVs have been deployed to nearly every village in the county to offer the services. To sustain their work, the CHVs receive a regular stipend, equipment, supplies and mentorship from the county government.

BRINGING SERVICES CLOSER

The Turkana government is using CHVs to implement simplified protocols for identifying and treating preventable diseases at household level. 

This is in partnership with the United States Agency for International Development (USAid) through various agencies. These include Unicef, Save the Children International (SCI), Nawiri and the International Rescue Committee (IRC).

Titled Integrated Community Case Management (ICCM), the programme involves equipping the CHVs with basic and technical modular training.

They are also given supplies and equipment used to manage childhood ailments, such as malaria, diarrhoea, pneumonia and malnutrition. These diseases account for the highest number of hospitalisations and deaths among young children in Turkana.

As a beneficiary of this innovative approach, Epeta is now able to offer these services at the doorstep of clients in the village he covers.

He says after completing training on ICCM, they were given tools of work and drugs.

“Despite the fact that I didn't go to school because of poverty, I am a doctor in my village,” Epeta said.

“I am saving the lives of young children in the village. Locals see me as a second God. It’s the hardest task to walk from house to house to offer health services without even considering the issue of payment.”

The tools and drugs he is given include: thermometer, colour-coded beads for detecting pneumonia, oral rehydration salts and zinc sulphate for managing diarrhoea.

Others are Mid-Upper Arm Circumference (MUAC) tape for detecting wasted (too thin for height) children.

“We are also given drugs for treating malaria, including Coartem, thus boosting the health services we offer to the community,” Epeta said.

On a typical day, Epeta visits five to 10 households, sharing messages of prevention, screening and treating these diseases, while referring the serious cases of child illnesses to the nearest health facilities.

He also monitors pregnant and lactating mothers to ensure they demand for and utilise available health services.

FIGHTING MALNUTRITION

Like Epeta, Dalmas Lomeju is a community health volunteer at Nabwelpus village in Turkana Central.

He attends to 87 households in his village. However, when the pandemic struck, Lomeju had to minimise his number of visits.

To minimise contact with his clients, he had to train caregivers on how to use a simplified colour Mid-Upper Arm Circumference tape, also called Family or Mother MUAC, for detecting and monitoring malnutrition among young children by mothers or caregivers themselves.

Mothers can now monitor their own children at home and refer those found to be malnourished to a CHV or healthcare facility for treatment as necessary.

Margret Atabo, a resident of Nabwelpus and a mother of six, says through the help of a CHV, she has mastered the use of MUAC to timely avert the negative impacts of malnutrition among her children.

“When I measure the arm of my child and it shows green, it means my child is well nourished, while yellow means the child is moderately malnourished and red shows the child is severely malnourished,” she said.

The communication materials used to educate locals on various health services were translated into their dialect. Local communities were able to embrace the use of MUAC. They seek assistance when there is an emergency.

“The Covid-19 pandemic caused us fear against taking children to health facilities. But with the help of our CHV, we are able to get health services at the doorstep,” Margaret said.

They have also been educated about feeding young children, the importance of exclusive breastfeeding for the first six months, and gradual introduction of appropriate foods alongside breast milk up to two years of age and beyond.

VALUE OF COLLABORATION

Turkana Central subcounty medical officer Joel Lochor said the county and partners have managed to sustain delivery of health services to children under the age of five years even during the pandemic.

“Since the concept of ICCM was introduced, many local and international stakeholders have come to document and learn about the great work we are doing in Turkana county,” he said.

“Before this programme was introduced, we were recording a high number of infant and maternal deaths due to preventable and treatable diseases.”

Lochor hailed USAid partners for being instrumental in implementing and supporting the department of health in actualising the concept of ICCM.

He said they have trained many health workers, extension workers and community health volunteers.

They have also harmonised the process of identification, treatment, referral of severe cases and accountability of commodities and equipment used.

USAid's Lominito Lomoru said they rolled out training and upskilling of 82 health workers and 328 CHVs in Turkana Central and Turkana West subcounties.

He is the health system strengthening adviser for USAid Nawiri programme.

“The training has led to an increase in the pool of community health volunteers previously trained by government, Unicef and other partners in Turkana county using ICCM tools designed to the local context,” Lomoru said.

He said the pandemic and severe acute malnutrition underscore the urgent need to build health resilience.

He said these outbreaks pose a threat to families and local communities thus are national security and public health concerns.

Health resilience requires public health services, such as community mobilisation and disease surveillance, he said.

It needs water, sanitation and hygiene services as well as private sector collaboration. At its root, Lomoru said, health resilience is based on good governance and sufficient financing.

USAid strengthens health resilience by promoting care continuity through an integrated network, including the public sector, the private sector, faith-based organisations, civil society, local and international non-governmental organisations (NGOs), and communities.

He said health resilience increases when the entire health sector, together with its partners, operate in a coordinated and collaborative manner to optimise resources.

They should be shock-responsive and adapt as necessary to enable the whole population access to quality health services when and where they are needed, Lomoru said.