How To Lose Trust and Anger People

As mentioned last week we are hard at work to develop the structure of the Community Health Worker (CHW) program—all which hinges on one very important factor: community members allowing our health workers into their homes. The purpose of the visits is to collect information to inform future services, share health knowledge, assess current health problems, and eventually sell and distribute commodities that will prevent and mitigate the most common diseases in the area. So far this has proven to be a challenge.  We have received extensive feedback from the CHWs and their respective supervising Field Officers about community members not allowing them into their compounds. When the service we are trying to package is for the direct benefit of the community members it begs the question, why would these households refuse what is currently free and potentially lifesaving?

A few of possible reasons that were brought to our attention are:

  • Households believe that the CHWs are using them to make mone
  • Survey fatigue due to the extensive questioning the Ministry of Health requires CHWs to conduc
  • Households are unaware that CHWs will be providing services and therefore, don’t believe the CHWs have anything (knowledge or otherwise) to provide them with.

In an effort to address these issues in a creative and effective manner we called the last joint (Foundation Teams) FT4 and FT5 conclave to anti-brainstorm. Though I had heard the term ‘anti-brainstorm’ before David proposed the strategy, I had some serious doubts. We would be asking our teams what our CHWs could do that would ensure their failure. I felt I was generally familiar with what infuriates people and causes them to lose faith in a service, and thought our time would be better spent exploring out-of-the box ideas about how to ensure their success, earn the trust of the community, and insert our health messages wherever possible. Not so!

We did open the meeting with a quick-fire collection of trust-gaining ideas, but the most valuable part of the exercise was breaking down what attitudes, actions and lack thereof contribute to loss of credibility of and confidence in our CHWs. So, what is the best way for our CHWs to lose trust and anger people specific to life in Kuria? Here is a representative sample of our conclusions:

– Not fully greeting the head of household
– Not introducing oneself and the purpose of the visit
– Asking too many questions
– Wasting people’s time
– Pulling farmers off their shambas (farms)
– Using technical language
– Not being knowledgeable about topics discussed
– Being a bad health role model
– Being rude and passing judgment on their homes and lifestyles
– Visiting too often
– Making disrespectful comments or facial expressions
– Make the family feel health problems are their fault or that they are stupid
– Gossiping about what is discussed in the visit
– Making promises and not delivering

After reviewing the chaotic whiteboard I realized the value of exploring the inverse. No matter how creative or useful the services provided are, if we don’t understand exactly what upsets the community and change our approach we will never be successful.

So what now? As per the recommendation of our Field Managers the first of our supplemental CHW training will be on home visits style.  While it will outline the process of what to do (introducing oneself, making a connection with the person with whom they are speaking, how to ask questions and give advice in a respectful manner, and how to following up as needed), a large part will be based on what doesn’t work using specific examples. We will have our own anti-brainstorm in this training which I suspect will incite a few ah-hah moments about their own behaviors, and we include the popular activity of role plays to demonstrate productive and counterproductive visits.

After this training we hope the CHWs can paint a clearer picture of their role and goals for the community while developing a good foundation of trust and respect as they continue to go door-to-door enhancing access to health care. I will let you know what happens!