By Allison Kozicharow; Edited by Elizabeth Fine
Introduction
WiRED International is continually expanding our Community Health Worker (CHW) programs in low-resource regions. In 2020 we trained our pilot CHW team in Kisumu, Kenya just prior to the onset of the COVID-19 pandemic. Over the years we expanded our reach by training CHW teams in other countries and recently developed a milestone Android app — all the while enlarging our library of 400+ health education module courses to include emerging diseases and health issues.
Every month WiRED receives firsthand accounts from CHWs in Kisumu, which our local managers record and track. We often use these compelling CHW stories in our website postings. Now, however, we just instituted a new reporting process that will measure CHW clinical services and referrals. These “outcomes” will help us understand the direct interventions and level of care that CHWs provide.
Home Visits, Referrals and Follow-Up
CHWs host group sessions on health topics of concern and interest to their community and they also work with people individually. Both activities often lead to home visits that reduce pain and discomfort, to help with minor ailments, to manage proper use of prescribed medications and to provide over-the-counter medications that patients don’t have and can’t afford.
Home visits further provide CHWs with an opportunity to observe conditions that might contribute to the health issues of the patient (e.g., sanitation, food storage and preparation, availability of clean water, family problems). CHWs can then address these conditions to eliminate or reduce health threats. In addition, CHWs can monitor other family members and neighbors for similar signs and symptoms that might suggest a systemic problem such as contagious infectious disease or environmental conditions within the home and the wider community.
CHWs are especially trained to recognize conditions that require higher-level care. Depending on the severity of the ailment, they can suggest that the community member visit a clinic in the near future to address the condition, or in more pressing cases, they can take the person immediately to a clinic.
Here are several examples of CHW contributions to people in their communities.
Outcome Example #1
During a CHW community education session on sexually transmitted infections (STIs), a young boy who was suffering from an STI approached the CHW and said he was experiencing the same symptoms that the CHW was teaching about. The CHW escorted him to Kisumu County Hospital where he was tested and put on antibiotics. The CHW has been doing frequent follow-ups to find out his progress. He is improving and the parents were also involved to strengthen adherence to the medication regime.
Outcome Example #2
Another CHW made two referrals to the community dispensary after observing that two men were showing symptoms of malaria and were not registered with the Social Health Authority. At the clinic they tested positive for malaria and were given drugs. The CHW followed up and found out that the men were responding very well and they thanked her for assisting them.
Outcome Example #3
A CHW escorted six women to a sub-county hospital for family planning initiations. These women had just delivered babies and knew little about family planning. They felt empowered by the CHW and agreed to access family planning services.
Conclusion
The CHW outcome reports provide us with insight into how they contribute to community health, demonstrating their value to the well-being of people in healthcare deserts, where doctors are scarce and regular care is unaffordable. Further, the reports offer a reliable and cost-effective strategy to bring a significant level of care to communities otherwise left out of the healthcare system.
What Our CHWs in Kisumu Do
Our initial team of some 20 CHWs have been providing health services for five years now and have helped sustain their communities through the worst of the pandemic and to this day in the midst of recent medicine supply stoppages such as antiviral medications.
They contribute to community health by:
- Teaching large numbers of people about illness awareness, prevention and treatment
- Offering home care to ease pain and discomfort
- Providing clinical services where they treat common ailments
- Making referrals to higher level care
- Taking WiRED-required continuing education annually to better prepare them to keep their skills and knowledge sharp.
February CHW Deployment Report
During the month of February 2025, 20 CHWs in Kisumu, Kenya, reached a total of 8,503 people with health services. Working 24 hours per week, each of the CHWs met with at least 28 patients a week, and the largest number seen in a week by a single CHW was 267, most of them in health training classes.
Top health topics of concerns for the month of February in order of prevalence:
- Hygiene
- HIV/AIDS
- Malaria
- Cholera
- Tuberculosis
