Community Health Worker Program – Building on a Strong Foundation

Jenga!

After just one week into my Kurian rotation I found myself deeply engaged in the core logistics needed to hammer out Nuru’s promising Community Health Worker (CHW) program. I had arrived right before the third and final week of government mandated CHW training and was working with David to design supplemental lessons on topics he felt deserved more attention.

During a planning session with Paul, the astute and optimistic Field Officer who would conduct the nutrition segment, David brought a wonderful analogy to both of our attention. Using building materials such as bricks, a candle and corrugated metal, Paul would draw on parallels between fueling the body for vital functions and protection against disease and the act of building a house that would protect its inhabitants. Paul would equate the building blocks of a home, which serves to protect a family to adequate nutrition used to fuel the body and safeguard it against diseases.

Sure enough, Paul’s training was a hit and proved valuable as many CHWs had come across moderate and severe wasting during recent home visits.

Two weeks after viewing this exceptional example of creative training I actually found myself on a construction sight. Sabora, a Nuru Education Field Manager, was building a house for his wife-to-be. He had invited our Education Program Manager, Lindsey Kneuven, and I had the opportunity to tag along.  While I was taking one of my many breaks from using my faulty hammering skills I laughed as I recalled Paul’s lesson. Then it dawned on me that this analogy was relevant to me on a larger scale than my own nutrition. I realized I was picking up where the previous Foundation Teams had left of on development of the CHW structure.

Dumbfounded, I watched four incredibly strong men, a child and Kneuven build a structure from the ground up with only a rebar hammer, a few pangas, a jembay, and wood.  There maybe no surprise that construction, or ‘jenga’ in Kiswahili, is quite contrary in Kenya from what most of us are familiar with at home. There are fewer and different resources, and the process is organic, manual and community oriented.  Likewise, when thinking of the process of building a project – and in our case, the CHW program, we must remember to build a good foundation, be cognoscente of how we are reinforcing the community’s efforts, and focus on what will protect us as we see through our goals.

Luckily for me, David and our Kenyan counterparts have laid the groundwork beautifully. While they have dug several holes where no foundation post would be buried, they’ve reoriented the floor plans and created a sound framework using relationships, community involvement, and initial trainings.  Now it is my job to help fortify the structure with a distinct interior plan while Nelly, the Healthcare Community Development Committee guru ignites the fire that will make certain our CHW unit can improve health at a household level. The details of the decoration remain to be seen, but we are confident that a financial sustainability CHW-based prevention education and disease mitigation system is on the horizon.

Though sad to lose David to Stanford Medical School, I am looking forward to working closely with Janine, the integral constructor from FT 1 & 3, as she researches several of the existing CHW models Stateside. Some of organizations on our radar include Living Goods, BRAC, WorldVision, Partners in Health, and the Clinton Foundation.  Our goal is to put best, relevant practices into play while learning from less effective paths.

We have no doubt our model will go through the elements and face some wolves, but we are confident that with a strong framework and the motivation to keep improving we will weather the storm. I am eager to update you on how our strategy unfolds during the next 8 months. In the meantime, thank you for your continual support and please, please share what knowledge you may have of similar practices, commodity sales in developing countries, and life in Kenya!