Abstract
OBJECTIVE: To determine whether a simple monitoring and tracking tool, Mwanzo Mwema Monitoring and Tracking Tool (MMATT), would enable community health volunteers (CHVs) in Kenya to 1) plan their workloads and activities, 2) identify the women, newborns and children most in need of accessing critical maternal, newborn and child health (MNCH) interventions and 3) improve key MNCH indicators.
METHODS: A mixed methods approach was used. Household surveys at baseline (n = 912) and endline (n = 1143) collected data on key MNCH indicators in the four subcounties of Taita Taveta County, Kenya. Eight focus group discussions were held with 40 CHVs to ascertain their perspectives on using the tool.
RESULTS: Qualitative findings revealed that the CHVs found the MMATT to be useful in planning their activities and prioritizing beneficiaries requiring more support to access MNCH services. They also identified potential barriers to care at both the community and health system levels. At endline, previously pregnant women were more likely to have received four or more antenatal care visits, facility delivery, postnatal care within two weeks of delivery and a complete package of care than baseline respondents. Among women with children under 24 months, those at endline were more likely to report early breastfeeding and exclusive breastfeeding for the first six months. These results remained after adjustment for age, subcounty, gravida, mother’s education and asset index.
CONCLUSION: Our results demonstrate that simple tools enable CHVs to identify disparities in service delivery and health outcomes, and to identify barriers to MNCH care. Tools that enhance CHVs’ ability to plan and prioritize the women and children most in need increase CHVs’ potential impact.
Key words: Community health workers, maternal health, child health, Kenya, program evaluation
Mots Clés: agents de santé communautaire, santé maternelle, santé de l’enfant, Kenya, évaluation de programme
Résumé
OBJECTIF : Déterminer si un simple outil de surveillance et de localisation, le Mwanzo Mwema Monitoring and Tracking Tool (MMATT), permettrait aux agents de santé communautaire bénévoles (ASCB) du Kenya: 1) de planifier leur charge de travail et leurs activités, 2) de dresser la liste des femmes, des nouveau-nés et des enfants ayant le plus besoin d’accéder aux interventions de santé maternelle, néonatale et infantile (SMNI) critiques et d’améliorer les principaux indicateurs de SMNI.
MÉTHODE : Nous avons utilisé une approche à méthodes mixtes. Des sondages menés auprès des ménages au début (n = 912) et à la fin (n = 1 143) de l’étude ont permis de recueillir des données sur les principaux indicateurs de SMNI dans quatre subdivisions du comté de Taita-Taveta, au Kenya. Huit discussions thématiques de groupe ont eu lieu avec 40 ASCB pour connaître leurs points de vue sur l’utilisation de l’outil.
RÉSULTATS : Les constatations qualitatives de l’étude ont révélé que les ASCB ont trouvé le MMATT utile pour planifier leurs activités et classer par ordre de priorité les bénéficiaires nécessitant une aide particulière pour accéder aux services de SMNI. Ils ont aussi cerné les obstacles possibles aux soins à l’échelle des communautés et du système de santé. À la fin de l’étude, les femmes qui avaient été enceintes étaient plus susceptibles que les répondantes au début de l’étude d’avoir reçu quatre visites de soins prénatals ou plus, d’avoir accouché en clinique, et d’avoir reçu des soins postnatals moins de deux semaines après l’accouchement et un éventail complet de soins. Chez les femmes ayant des enfants de moins de 24 mois, les répondantes à la fin de l’étude étaient plus susceptibles d’avoir allaité leur enfant de façon précoce et exclusive au cours de ses six premiers mois de vie. Ces résultats se sont maintenus après la prise en compte de l’âge, de la subdivision du comté, du nombre de grossesses, ainsi que du niveau d’instruction et de l’indice des actifs de la mère.
CONCLUSION : Nos résultats démontrent que des outils simples permettent aux ASCB de repérer les disparités dans la prestation de services et les résultats sanitaires et de cerner les obstacles aux soins de SMNI. Les outils qui améliorent la capacité des ASCB de planifier leurs activités et de classer par ordre de priorité les femmes et les enfants ayant le plus besoin de soins accroissent l’impact potentiel des ASCB.
Footnotes
Acknowledgements: This project was funded by the Muskoka Initiative Partnership Program, Government of Canada’s Department of Foreign Affairs, Trade and Development (now Global Affairs Canada), the Canadian Food Grains Bank and World Renew. Dr. Shajy Isac provided invaluable support in developing the monitoring tool.
Conflict of Interest: None to declare.
References
- 1.Kenya National Bureau of StatisticsICF Macro. Kenya 2014 Demographic and Health Survey. Calverton, MD: KNBS and ICF Macro; 2015. [Google Scholar]
- 2.Bhutta ZA, Ali S, Cousens S, Ali TM, Haider BA, Rizvi A, et al. Interventions to address maternal, newborn, and child survival: What difference can integrated primary health care strategies make? Lancet. 2008;372(9642):972–89. doi: 10.1016/S0140-6736(08)61407-5. [DOI] [PubMed] [Google Scholar]
- 3.The Partnership for Maternal, NewbornChild Health. A Global Review of the Key Interventions Related to Reproductive, Maternal, Newborn and Child Health (RMNCH) Geneva, Switzerland: The Partnership for Maternal, Newborn and Child Health; 2011. [Google Scholar]
- 4.Liu A, Sullivan S, Khan M, Sachs S, Singh P. Community health workers in global health: Scale and scalability. Mt Sinai J Med. 2011;78(3):419–35. doi: 10.1002/msj.20260. [DOI] [PubMed] [Google Scholar]
- 5.Ministry of Health. Taking the Kenya Essential Package for Health to the Community: A Strategy for the Delivery of Level One Services. Nairobi, Kenya: Health Sector Reform Secretariat, Ministry of Health; 2006. [Google Scholar]
- 6.LeFevre AE, Mpembeni R, Chitama D, George AS, Mohan D, Urassa DP, et al. Profile, knowledge, and work patterns of a cadre of maternal, newborn, and child health CHWs focusing on preventive and promotive services in Morogoro Region, Tanzania. Hum Resour Health. 2015;13:98. doi: 10.1186/s12960-015-0086-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Otieno CF, Kaseje D, Ochieng’ BM, Githae MN. Reliability of community health worker collected data for planning and policy in a peri-urban area of Kisumu, Kenya. J Community Health. 2012;37(1):48–53. doi: 10.1007/s10900-011-9414-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Otieno-Odawa CF, Kaseje DO. Validity and reliability of data collected by community health workers in rural and peri-urban contexts in Kenya. BMC Health Serv Res. 2014;14(Suppl1):S5. doi: 10.1186/1472-6963-14-S1-S5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Rugene N. Daily Nation. 2015. County gets new maternity units. [Google Scholar]
- 10.Birgwa P. Effectiveness of community health workers (CHWS) in the provision of basic preventive and curative maternal, newborn and child health (MNCH) interventions: A systematic review. Health Policy Dev. 2009;7(3):162–72. [Google Scholar]
- 11.Haq Z, Iqbal Z, Rahman A. Job stress among community health workers: A multi-method study from Pakistan. Int J Ment Health. 2008;2(1):15. doi: 10.1186/1752-4458-2-15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Bhattacharyya K, Winch P, LeBan K, Tien M. Community Health Worker Incentives and Disincentives: How They Affect Motivation, Retention and Sustainability. Arlington, VA: BASICS/USAID; 2001. [Google Scholar]
- 13.Victora CG, Barros AJD, Axelson H, Bhutta ZA, Chopra M, Fracna GV, et al. How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: An analysis of national surveys. Lancet. 2012;380(9848):1149–56. doi: 10.1016/S0140-6736(12)61427-5. [DOI] [PubMed] [Google Scholar]
- 14.WHOUNICEF. Countdown to 2015 Maternal, Newborn & Child Survival: Building a Future for Women and Children. Washington, DC: WHO and UNICEF; 2012. [Google Scholar]
- 15.Mbonye AK, Bygbjerg CI, Magnussen P. A community-based delivery system of intermittent preventive treatment of malaria in pregnancy and its effect on use of essential maternity care at health units in Uganda. Trans R Soc Trop Med Hyg. 2007;101(1):1088–95. doi: 10.1016/j.trstmh.2007.06.017. [DOI] [PubMed] [Google Scholar]
- 16.Lewin SA, Dick J, Pond P, Zwarenstein M, Aja G, van Wyk B, et al. Lay health workers in primary and community health care. Cochrane Database Syst Rev 2005;(1):CD004015. PMID: 15674924. doi: 10.1002/14651858.CD004015.pub2. [DOI] [PubMed]
- 17.Bhutta ZA, Chopra M, Axelson H, Berman P, Boerma T, Bryce J, et al. Countdown to 2015 decade report (2000–10): Taking stock of maternal, newborn, and child survival. Lancet. 2010;375(9730):2032–44. doi: 10.1016/S0140-6736(10)60678-2. [DOI] [PubMed] [Google Scholar]
- 18.Lassi ZS, Salam RA, Das JK, Bhutta ZA. Essential interventions for maternal, newborn and child health: Background and methodology. Reprod Health. 2014;11(Suppl1):S4. doi: 10.1186/1742-4755-11-S1-S1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Lauer JA, Betrán AP, Barros AJD, de Onis M. Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: A global ecological risk assessment. Public Health Nutr. 2006;9(6):673–85. doi: 10.1079/PHN2005891. [DOI] [PubMed] [Google Scholar]
- 20.Countdown Coverage Writing Group on behalf of the Countdown to 2015 Core Group. Countdown to 2015 for maternal, newborn, and child survival: The 2008 report on tracking coverage of interventions. Lancet. 2008;371(9620):1247–58. doi: 10.1016/S0140-6736(08)60559-0. [DOI] [PubMed] [Google Scholar]
- 21.Warren C, Mwangi A, Oweya E, Kamunya R, Koskei N. Safeguarding maternal and newborn health: Improving the quality of postnatal care in Kenya. Int J Qual Health Care. 2010;22(1):24–30. doi: 10.1093/intqhc/mzp050. [DOI] [PubMed] [Google Scholar]
- 22.Watt C, Abuja T, Warren CE, Obare F, Kanya L, Bellows B. Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya’s safe motherhood voucher scheme. PLoS ONE. 2015;10(4):e122828. doi: 10.1371/journal.pone.0122828. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE. Lancet. 2007. Continuum of care for maternal, newborn, and child health: From slogan to service delivery; pp. 1358–69. [DOI] [PubMed] [Google Scholar]
- 24.Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H, et al. Sub-Saharan Africa’s mothers, newborns, and children: Where and why do they die? PLoS Med. 2010;7(6):e1000294. doi: 10.1371/journal.pmed.1000294. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.WHO. Maternal Mortality. 2015. [Google Scholar]
- 26.WHO. WHO Technical Consultation on Postpartum and Postnatal Care. 2008. [PubMed] [Google Scholar]
- 27.Lawn JE, Cousens S, Zupan J. Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: When? where? why? Lancet. 2005;365(9462):891–900. doi: 10.1016/S0140-6736(05)71048-5. [DOI] [PubMed] [Google Scholar]
- 28.Crockett M, Avery L, Blanchard J. Program science — A framework for improving global maternal, newborn, and child health. JAMA Pediatr. 2015;169(4):305–06. doi: 10.1001/jamapediatrics.2015.9. [DOI] [PubMed] [Google Scholar]
- 29.Mpembeni RN, Bhatnagar A, LeFevre A, Chitama D, Urassa DP, Kilewo C, et al. Motivation and satisfaction among community health workers in Morogoro Region, Tanzania: Nuanced needs and varied ambitions. Hum Resour Health. 2015;13:44. doi: 10.1186/s12960-015-0035-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Tulenko K, Mogedal S, Afzal MM, Frymus D, Oshin A, Pate M, et al. Community health workers for universal health care coverage: From fragmentation to synergy. Bull World Health Organ. 2013;91:847–52. doi: 10.2471/BLT.13.118745. [DOI] [PMC free article] [PubMed] [Google Scholar]