One of the biggest challenges we’ve had with our CHWs is teaching them how to do an effective home visit. A myriad of things can, and do, make our CHW’s home visits ineffective, or at least not as effective as they should be:
- Lecturing
- Facing away from the household member
- No eye contact
- Talking negatively about the household’s health behaviors
- Skipping around topics in a confusing order
- Giving misinformation
- Missing important information
- Speaking in a condescending or accusatory way
- Lack of empathy
- Not talking at all
This list could go on and on and on. Thankfully, none of our CHWs are doing all of these, but many are doing one or two during some of their home visits. The entire healthcare team is working very hard to improve the quality of each and every CHW’s home visits. We’re doing this through group role plays and discussions, regular coaching from the field officers, and spot-checks and coaching from the field managers. We’re also working to integrate home visit strategies into the disease-specific trainings at our monthly CHW meetings.
Having a set topic of the month to discuss has helped improve the CHW’s confidence when entering a household. The monthly topic gives the CHW a purpose and structure for their visit. The families have learned to expect the CHWs to come prepared to discuss something new and share new information with them. Armed with a checklist of not-to-be-missed disease-specific information, the CHWs are prepped on the important messages and key behaviors that households should learn about each topic. For example, the key behaviors for safe motherhood are:
1) Attend 4 ANC visits during pregnancy
2) Deliver babies at the clinic
3) Sleep under an insecticide-treated mosquito net
4) Eat a healthy, adequate diet during pregnancy
5) Know the danger signs
These behaviors are stressed to the CHWs during their monthly training and reinforced by their field officers throughout the month. We hope that this repetition will ensure that the information is passed down to each household by the CHWs.
Speaking of monthly topics, the team recently discussed our initial topic selection and decided to narrow our focus to six topics – malaria, diarrhea, safe motherhood, nutrition, pneumonia, and neonatal health/immunization. Having only six topics allows us to focus on each topic twice a year, giving the households the necessary repetition to build lasting knowledge and change behaviors. These six topics were selected because we think they’ll have the greatest effect on reaching our goal of reducing the mortality of children under five.
This past month we also launched a referral system so that the CHWs have a formal way of referring a patient to the clinic. The referral system also gives us a way to track how many patients go to the clinic because they are referred by Nuru CHWs, know if the CHWs are referring appropriately, and understand if there is a problem with people being referred but not visiting the clinic. The CHWs will pilot the system over the next couple of months, and we will make adjustments where necessary.
The healthcare program is moving forward at full steam. If everything continues to go as planned, by the end of the year we will have developed a data plan to determine the impact of the healthcare program, collected baseline data from all of the communities where we are currently working, conducted focus groups to hone our key messages and make sure they are relevant for the community, improved the quality of the CHW home visits even more, developed a full CHW training curriculum, and made plans to start recruiting for our next CHW unit. We have a busy six months ahead of us but I know the team is up for the challenge.