Communities Health Africa Trust’s back pack strategy reaches hard to serve slum inhabitants.

The Problem

In 2012 Kenya formally recognized that the country’s high population growth could completely derail any progress being made toward reaching its primary goal: To achieve a high quality of life for all Kenyans that is sustainable with available resources.

In short, the country’s high fertility rate and subsequent population growth raise the spectre of declines in gross national product, reduced per capita food consumption, and degraded land quality. Countries that experience rapidly growing populations become increasingly dependent on foreign assistance, experience massive urban crowding, and inadequate health systems. In such societies social unrest can occur when large numbers of young unemployed poor people take to the streets.

While Kenya has made progress in reducing the number of children being born, much work still needs to be done if these problems are to be averted.

CHAT’s Mission

A grassroots organization, Communities Health Africa Trust (CHAT) has since 1999 brought health care to literally thousands of people living in underserviced communities throughout much of northern and central Kenya.

CHAT uses a model of door-to-door delivery for its services, using whatever means it takes to reach those in need. This includes by vehicle, camel caravans, bicycle, and on foot.

While CHAT’s mobile health clinics offer a range of integrated services, including immunization, HIV/AIDS testing, malaria and TB testing, and treatment for general illnesses, infections, and injuries, their primary focus is on the provision of family planning. In short, this means affording women and girls the opportunity to control their own reproductive health through the provision of reproductive health care and contraception.

CHAT is huge success story. For example, in 2016 alone CHAT provided nearly 30,000 people with the contraceptive of their choice and some 12,600 were tested and counselled for HIV/AIDS.

CHAT’s Back Pack Strategy

 The Back Pack Strategy was devised to address the needs of those people living in the slums of communities, people who because of poverty, a lack of government facilities, and social stigma or beliefs do not have access to affordable and holistic family planning services. The communities can range from small villages to larger towns.

It works like this.

Motivated people, often women but not exclusively, from the communities are identified and trained to go door-to-door with their back pack of supplies to discuss health concerns with residents and where appropriate to provide a range of health care services. Because these people are working in their own community, they easily earn the trust of the residents and generally enjoy high rates of success at the provision of the various services.

Initially these individuals, called “community own resource persons” or CORPs, work closely with CHAT’s staff, especially its medical team, to ensure they are providing high quality and appropriate service. They identify individuals and families in their community that need intervention. When CHAT’s team visits the community, the CORP ensures that the residents are seen by the clinical staff. And when CHAT’s clinic is not in the community, the CORP provides continual support.

CORPs are approved by and trained, in part, by the Kenyan Ministry of Health. Their agreement with CHAT stipulates that they must meet a certain standard of quality and service delivery before they are compensated for their work. This is called a “motivation allowance”.

The range of services a CORP provides includes:

  • keeping an eye on pregnant women;
  • monitoring the health of newborns;
  • providing immunizations;
  • testing people for diseases such as TB, malaria, and HIV/AIDS;
  • providing basic curative care (for example, treatment for things like respiratory infections or minor wounds)
  • providing counseling and guidance for those with chronic diseases;
  • facilitating access to existing government services;
  • providing family planning information and contraception

Contraception includes condoms, the “pill”, three to five month injections (for example, Depo-Provera), and three to five year implants.

Note that while the primary goal is to afford women the ability to control their own reproductive health, the other interventions help to build trust and lead to a more inclusive health care model.

Sustainability

CHAT’s long term intention with the back pack strategy is to develop enough resilience, skill, and capacity with the CORPs that they become independent and sustainable and no longer reliant on CHAT for either guidance or funding. CORPs are tasked with creating what are called Village Development Committees (VDC) in places that have no “voice’ or structure to improve the community. In short, they help to have the residents learn to advocate for themselves and to access resources within their own community, including the creation of income generating activities.

In short, a successful back pack program ultimately becomes an “exit” strategy for CHAT when the community develops the capacity to be self-reliant and self-sustainable.