Sustaining the Gains: Mobilizing Community Health Volunteers to Increase Uptake of ANC and Facility Services in Bondo, Kenya

Presenter: Lynn Kanyuuru, Jhpiego

The 2008/9 Kenya Demographic and Health Survey (KDHS) showed that although 92% of pregnant women accessed at least one antenatal clinic (ANC) visit, only 47% completed  four recommended visits. Moreover, 56% of the births took place at home. Against this backdrop, the government identified various interventions including strengthening of the community strategy to advocate for health services.  In October 2010, USIAD’s Maternal and Child Health Integrated Program (MCHIP) supported strengthening of the community platform in Bondo, Kenya. For two years, this platform was utilized to create demand for health services and provide health education to the community. Community Health Volunteers (CHVs) were organized into Community Units (CUs), trained according to the national curricula, supported to identify pregnant women and mobilize them to attend clinics. CHVs were provided a monthly stipend of about 20$ per CHV. Sustainability measures were built into the program including the formation of income generating activities (IGAs).   Cross-sectional health data were compared at three time points: 2010 (the year the project began), 2012 (the year the project ended) and 2014 (a year after the project ended). In 2010, the proportion of women attending one ANC visit was 56%. This increased to 84% in 2012 but reduced to 76% in 2014. The proportion of ANC clients completing 4 ANC visits increased from 25% in 2010 to 51% in 2012 (p-value <0.0001) and 61% in 2014 (p-value <0.0001). Skilled birth attendance increased from 29% in 2010, to 55% in 2012 (p-value <0.0001) and 89% in 2014 (p-value <0.0001). The community strategy was successful in mobilizing communities to access health services and demonstrated sustained gains one year later. Empowering the CUs with IGAs ensured sustainability of interventions beyond the project. Results from this intervention provide a strong foundation for scale up and replication of the best practices in other regions.