IMPORTANCE OF COMMUNITY BASED STRATEGIES IN DELIVERING COMMUNITY BASED MATERNAL AND CHILD HEALTH
Community health strategy is a community based approach through which households’and community take active role in health and health related developmental issue. Its aim is to enhance community access to health care through, providing health care services to all cohorts and socio economic groups at house hold and community level; building the capacity of community health extension worker (CHEW) and community health workers (CHW) to provide community level services in turn strengthening the link between the health facility and the community. These also help to create awareness to the community of their right to health services. This article is aimed at demonstrating the effectiveness of applying community health strategies in delivering community based maternal and newborn health care in Kenya and Sierra Leon. According to Gilbert Wangalwa, child death has decreased globally from 12.5million in 1990 to 8.8 million in 2008, of this figure one third were neonatal death of which has been linked closely to the slow progress in reduction of maternal mortality; approximately 342,900 maternal death each year. In Kenya and Sierra Leone just like other sub Saharan African countries the rate of child and maternal mortality still remains high over the past years.
For instance in Kenya a lone the maternal mortality ratio is estimated to be 488 per 100,000 live birth of this 15% were women aged between 15 to 49years (from 2005 to 2008). Where as in Sierra Leone maternal mortality ratio of 970 of every 100,000 live birth and 1 in every 21 pregnant women run the risk of dying. Sierra Leone is also ranked as the 5th in the world for countries with the highest mortality rates with 140 deaths in every 1000 live births. Some of the factors identified in both countriesleading to this high morbidities and mortalities are; unsafe maternal and new born health practices and this is partly due to inadequate and inequitable distribution of health facilities with severe lack of health equipment. These are also linked directly to the shortage of skilled health staff. With this entire factors making a perplexed puzzle,leads to puerperal infections accounting for the major cause of maternal mortality as issues of poor hygiene and deliveries on unhygienic environment come up. Neonatal demise within the first week of life due to sepsis, birth asphyxia, birth injuries, low birth weight and birth defects It’s globally accepted that the continuous follow up of pregnant mother through out to their pregnancy to postnatal is mandatory to improve maternal and child health so as to cub maternal and child mortality.
Though these is faced with a lot of challenges in Kenya and Sierra Leon for instance as Gilbert Wangalwa explained, expectant mothers went to the health centre on their first visit just to get the antenatal booklet then perceive traditional birth attendants to be effective care givers. In case of any danger sign during pregnancy or to the newborn it’s treated with herbs before seeking appropriate medical advice. With both countries having the same interestsin consideration that is to reduce child mortality rate and increase maternal health so as to realise the millennium developmental goals, some policies and strategies had to be put in place to mitigate the rampant increase of child and maternal mortalities and morbidities, for instance, both countries introduced the free health care for all under five children and Sierra Leone went even further by introducing free heath care to pregnant mothers and breast feeding mothers on April 2010. With these efforts, reports indicated that there has been an increased uptake of these services but health centres were struggling to keep up with the increasing demand.
Due to these the government of Sierra Leone decided to come up with a revised policy that lead to integration of CHWs and CHEW into the formal health system and recognised the CHEW and CHW as the alternate cadre in the delivery of maternal and child health services. In Kenya they did not really integrate the cadre into the formal health system, though through the ministry of public health and sanitation and national health strategic sector plan II saw the need to put emphasis on promoting individual and community health with the objective of strengthening the health services. This was to be accomplished through several strategies and community strategy was one of them. After the two countries implemented the above strategies and policies, research show that indeed community strategies plays an important role in reducing child and maternal health morbidity and mortality, for instance, in Kenya a research done by AMREF (African Medical Research Foundation) in Busia county showed that community health strategies are an effective tool in delivering community based interventions; antenatal visits increased from 39% to 62%, deliveries by skilled attendants 31% to 57%, expectant mothers receiving intermittent preventive treatment 23% to 57%, HIV testing during pregnancy 73% to 90%, exclusive breast feeding 20% to 52%, in Sierra Leon a research by (Frederique, Eilish, Issac, Edward and Alliue) showed that through the CHW programmes the CHW provided an important link between the community and formal health system and these has helped greatly in reducing child and maternal morbidity and mortalities. Despite the community health workers being such a useful tool in the community level in implementing community strategies as an appropriate platform to deliver community based interventions, in both countries research show that there is lack of relevant incentives, loss of motivation, insufficient recognition and community support, poor connectivity to health facilities, lack of supervision and a times high attrition rates are observed when the CHWs are called upon to volunteer.
The government in both countries should look into these and take it with utmost importance as it has been highlighted clearly that, CHW form part of the trunk between the community level and the health system in doing so then the pillar on service delivery and health work force would have been strengthened to greater margins and these well pull use closer in realising our millennium developmental goals 4 and 5. From these and researches done over the past decade it’s eminent that to improve on maternal and child health then there is need to build capacities at individual, family and community level especial in the developing countries like Kenya and Sierra Leon where issues of limited resources play a major role, community interventions through the community health workers are important as decisions to seek and access health care are strongly influenced by socio-cultural environment.
Research done in India and Guatemala showed that the neonatal mortality fell by 25% in two years after CHWs were trained on essential newborn care, and infant mortality fell by 85% when an immediate evident based treatment of infants was initiated at the community level followed by referral to a hospital respectively. Conclusion
With appropriate and sufficient training community health workers can play an important role in strengthening health systems especial with the challenges facing our pillars; service delivery, health work force and leadership and governance. But the governments both Kenya and Sierra Leone should look or come up with policies and strategies to motivate them. In doing so, then any country won’t lug behind in realising the millennium developmental goal 4 and 5.