Nuru Healthcare is in the design and development phase or the CHW (Community Health Worker) model. Here is a brief overview of what is in the works:
After recognizing that our community’s greatest health needs would best be met at the community level, rather than from an infrastructure or clinical approach, Nuru began researching best practices for community health programs. Information was compiled about existing organizations and recommendations made based on these findings, field knowledge and Nuru’s philosophy.
In June 2010 Nuru Kenya launched its pilot CHW Unit, now operating with 43 trained CHWs. While functioning on the basis of the Kenyan Ministry of Health’s Community Strategy Nuru found that inadequate MOH mandated skill training, coupled with lack of governmental support, hindered CHW performance. It is now our goal to equip Nuru Units with ample training, field tools, and guidance in Kenya and future locations.
Clearly defined and enforced CHW roles and responsibilities create a solid base for a successful program. For Nuru, these roles include prevention education, disease assessment, clinical referrals, community meetings, homevisits, program monitoring and evaluation, and commodity sales. Initial CHW selection will be community led with an opt-out policy to guarantee CHWs are respected by the community and have a vested interest in the position. An intensive and comprehensive training will follow the selection process.
Adopting a participatory-based training approach and deciding on an appropriate behavior change theory for which to base our trainings will facilitate the development of skills necessary for effective CHW activities, and foster community-based problem identification and solving. The initial training will provide a comprehensive overview of disease specific information relevant to our jurisdiction, and will be followed by supplemental and refresher trainings based on a topic-specific approach over the span of a year. CHWs will also undergo leadership, home visit strategy, conflict resolution and M&E trainings as part of their base education. Nuru will develop manuals and reference materials for trainers and CHWs. A cell phone based support structure will be researched as a supplementary resource for future use.
Armed with official identification and uniforms to ensure recognition and acceptance, CHWs will be expected to visit fifty households per month where they will train community members on preventive health behaviors, symptoms of diseases, and advise on treatment options. Visits will be conduced under a case management protocol. To complement the educational component of home visits, CHWs will provide first aid and sell health and hygiene products that will assist in disease prevention and low level mitigation. Other innovations may include a bike/boda-boda ambulance service and a boda-based marketing system.
With the goal of increasing access to products in an otherwise unreached area, Nuru Healthcare Commodity Sales will include items such as long-lasting insecticide treated nets (LLITNs), safe water systems (SWS) such as WaterGuard and Pur, soap, nutrition supplements, first aid products such as fungal creams and bandages, and eventually common drugs for treatment.
It is known that a strong relationship with a local Health Center is important for a CHW program for the following reasons: Collaboration on drugs supplies and storage, cooperation for referrals and case management, and for knowledge sharing. We intend to work closely with clinicians when possible and develop a memorandum of understanding to outline our relationship.
The Nuru Research Team is currently working with members of the Healthcare Program to develop logic models to inform interventions and related monitoring and evaluation. The outcome metrics determined by these logic models will result in a detailed plan for data collection methods and indicators related to all healthcare program metrics.
Program sustainability requires that financial and human resource needs be met.
CHW motivation is imperative for low attrition rates. Though CHWs will be considered part-time employees, they will not receive a salary. Rather, they are eligible for commission on non-drug commodity sales and will receive non-monetary incentives including sample products and community respect. Commodity income will also assist in program overhead, and be supplemented by local grants. Nuru will conduct additional research on small business loans for salesmen and women, and micro-insurance options to augment financial needs.
We are looking forward to iterating on these recommendations and following up with our plan for approaching these next steps. As always, your thoughts are welcome
