Feasibility of using community health volunteers to provide treatment services to sick children in Bondo, Kenya

introduction: Improving health indicators for children under-five is challenging. In Bondo sub-county (Kenya), an integrated community case management (iCCM) study is underway to test whether community health volunteers (CHVs) can manage cases of fever, cough/fast breathing and diarrhea building on the existing community health platform.

methods: The study is for 18 months and is quasi-experimental with intervention and comparison groups of four community units each.  Fifty-eight intervention group CHVs were trained on iCCM and health promotion, provided with iCCM commodities and a monthly stipend of $23. Comparison group CHVs were trained in health promotion and receive a monthly stipend of $23, but no iCCM commodities. CHVs take the lead in identifying and treating sick children. They report to the ‘barraza’, a community dialogue forum. A midline survey was performed in July 2014 and included review of program data, key informant interviews, and CHV clinical case observations.

results:  introduction of iCCM resulted in an increase in iCCM cases managed from 2,367 in Jan-Jun 2013 to 4,868 in Jan-Jun 2014. CHVs managed 56% of cases. There was marked improvement from baseline to midline in CHVs’ ability to “look” (3% vs. 74%) and to recognize illness danger signs (77% vs. 98%), p<0.05, respectively. Key informants reported increased access to iCCM services and increased community trust of the CHVs. 

conclusion: CHVs can effectively provide iCCM services in hard-to-reach areas, and contribute to reducing childhood mortality in Bondo, Kenya. Leadership by CHVs is key to building community trust and increased utilization of iCCM services.