April 11, 2017

The Success of Operation Karibu Depends on Community Health Workers

Written by Lynne J. Davidson, PhD; Executive Director, 2020 MicroClinic Initiative, Inc.

2020 MicroClinic Initiative is a non-profit organization working in rural Kenya to increase access to, and utilization of, quality maternal and newborn health services in order to improve health outcomes and, ultimately, save lives. Pregnant women who enroll in 2020 MicroClinic’s signature program, Operation Karibu (OpK), receive a package of baby clothes if they attend prenatal training and deliver their babies in the health care facility (rather than at home, where they are too likely to find themselves in a medically complicated situation). Prenatal training includes at least one session playing the organization’s own maternal health card game, Learning Pamoja, which teaches mothers critical, life-saving information about pregnancy, childbirth, and infant care. OpK also offers mothers access to emergency transportation when in labor.

The benefits of OpK are clear. Participants are attracted to the program because of the baby clothing incentive, but they stay with the program because OpK encourages the formation of a bond between a community’s most vulnerable members – young, pregnant women – and the health care providers who are there to guide them through pregnancy, childbirth, and newborn care. This bond is critical to the success of OpK. In a community that values traditional birth practices (from which trained medical professionals are generally excluded), participation in a program like OpK requires trust. The mom must trust that the effort that it takes to attend prenatal visits and classes is outweighed by the benefits of learning about the signs of pre-eclampsia, the necessity of vaccines, or the dangers of post-natal infection. The mom must trust that the program will deliver on its promise to provide that critical ride in the case of an emergency, and the mom must trust that if something goes wrong during childbirth, the nurse will, in fact, be there to address the problem.

It is no surprise that community health workers (CHWs) are critical to this trust. CHWs are all volunteers who are devoted to the health and well-being of the people in their communities. They are the face of the local health care facility, they are the counsellors who go door-to-door explaining program details, and they are the catalyst to participation. Without these tireless volunteers, most women would be unaware of OpK, and those who had heard of it would not necessarily be able to articulate the benefits of the program or trust that those benefits would apply to them personally. The familiar face of a CHW at the door of a pregnant woman’s home can make the difference between a program that fails to deliver on its promises to the community due to lack of participation, and a program that changes attitudes and saves lives.

Nearly 95 percent of OpK participants interviewed say that they are extremely likely to recommend OpK to other mothers, and 88 percent of staff in OpK-participating facilities say that they are extremely likely to recommend OpK to other facilities. Skilled deliveries have tripled, and in communities where as many as one in 100 women die from pregnancy- or childbirth-related complications, no OpK mothers have died to date, five years into the program. CHWs are absolutely fundamental to this success.