Q: Why is community health important in the health structure?
Dr. Kezia K’Oduol, Director of Health, Living Goods Kenya: Community health is an effective way of bringing health services to people where they live and is necessary for improving health indicator trends. Effective community health programs have increased universal health coverage (UHC) and contributed to the reduction of maternal, neonatal and under-five (U5) morbidity and mortality. Furthermore, Community health focuses on addressing health needs at the household level through promotive, protective, preventive, curative, rehabilitative and palliative approaches. The very things we strive for and want to see in our health systems such as equity, community ownership, social accountability, and effective linkages with health facilities are all key principles of community health, making it a critical part of the health structure.
Clara Kakai, Communications Manager at Living Good Kenya: We approach community health with a holistic system strengthening perspective when either implementing programs or advising the government on community health.
Q: What is the Living Goods approach/strategy to community health and why is it essential?
Clara Kakai: We use data-driven performance management, incentive systems, regular in-service training, and supportive supervision to help governments ensure there are digitally empowered, equipped, supervised and compensated community health workers (CHWs) who can deliver high-quality primary health care services. Beyond CHWs, Living Goods is also increasingly involved in efforts to strengthen local health systems, including advocating for increased investments in community health systems and integrating best practices into policies and practice.
Q: Living Goods is known for driving and embracing innovations. What innovations are you scaling up or implementing in the field of reproductive health and family planning currently in East Africa?
Allan Eyapu, Senior Field Operations Manager, Living Goods Uganda: To help women plan and space their pregnancies, the CHWs we support have started providing comprehensive family planning education and contraceptives. This started as a pilot experiment in two districts in Uganda in 2018, but has been so successful we’ve expanded it in many districts across the country and have started piloting it out in our Kenya operations.
Through these efforts, women of reproductive age are counseled and provided with the opportunity to access a broad range of contraceptives, including pills and condoms, and can also be referred for longer-term methods. ‘In 2019, we introduced CHW-led family planning services in Kenya through a quasi-experimental study intended to generate evidence to inform policy on scaling-up community-based distribution of DMPA-SC. The pilot was due to continue through September 2020 but was suspended due to government restrictions in response to the COVID pandemic. We are committed to resuming testing of this approach in Kenya as soon as it is safe to do so’.
Q: How do you leverage technology and CHWs to deliver voluntary family planning services to community members?
Dr. Kezia K’Oduol, Director of Health, Living Goods Kenya: CHWs are equipped with a phone and our Smart Health app, which has carefully designed workflows that standardize client counselling, assessment, and administration protocols for family planning services. This enables CHWs to facilitate health education sessions, register women of reproductive age taking up or switching family planning methods, determine their eligibility for family planning, recommend an appropriate method and provide follow-up services. The mobile app sends alerts and reminders for follow up visits while supporting CHWs adherence to guidelines and protocols as they provide quality voluntary family planning services.
In addition, the application also supports training and provides supervisors real-time performance data for each CHW through analytics dashboards, which support improved monitoring and drive better performance—and ultimately, health impact. All the data generated through these digital health tools is shared with the government and is used to inform decisions for CHW programs at every level.
Allan Eyapu: Of note, one of the key efforts we’ve tested and are now widely rolling out in Uganda is the community-based distribution and administration of the DMPA-SC (Sayana Press) injectable, which provides women with 3-months of protection, putting more power into women’s hands about their reproductive choices. Given the worrisome rise in unplanned pregnancies during COVID-19, due to challenges related to accessing facilities, we are now piloting a test of DMPA-SC self-injection, which would allow women to administer their own refills of this contraceptive method.