Finding What Works: Working in the Context to Improve Maternal and Child Health in Rural Kenya

Problem Statement

Mothers and children in rural Kenya have a disproportionate mortality rate when compared to the rest of the Kenyan population. This mortality can largely be prevented with care and services available within Kenya. A community based approach must be used to bring the established interventions to the mothers and children in need. The AMPATH model uses community health workers (CHWs) to bridge the current gap between the health system and the community. This strategy can prove successful, but current misalignments between existing realities (shortcomings of the CHW program) and goals for AMPATH currently prevent the CHW program from bringing healthcare to mothers and children.

AMPATH has chosen CHWs to be the cornerstone of the health system at the community level. As such, there is enormous pressure to bring the CHW system to scale in rural Kenya. To do so AMPATH has decided to achieve sustainability in scale by not paying CHWs. CHWs are expected to evaluate every expecting mother and child under the age of five in their community routinely, yet they are expected to do so without pay. A lack of financial compensation currently prevents CHWs from fulfilling the expected workload.

The primary function of CHWs is to link women and children to the healthcare system. The CHWs’ ability to do so depends on their knowledge and ability to make and follow-up on referrals to local clinics. Inadequate training threatens the ability of CHWs to get care to women and children. Furthermore, CHWs currently lack an adequate system to check on whether referred women and children make it to the clinic. AMPATH has not yet addressed these three issues.

To build a community health system around CHWs, AMPATH must first address three issues: the existing gaps in compensation, knowledge and follow-up.