“During refresher trainings, when I go there, it takes me 3 hours because I copy from one book to another.”
Married with two school-aged children Has one year of training in a health-related field Not originally from the community, but communicates effectively with the CHWs Salaried MOH employee Has a personal mobile phone that ranges from a feature phone to a smart phone, used for communication Has an email account primarily accessed via mobile phone
Ann wakes up early in the morning to prepare her son for school and husband for work. She takes her son to school which is on her way to health center where she is based.
She needs to be at the health center by 9 am so she takes a bus for part of the journey and a motorbike for the rest of the journey. The health center is located about 10 km from her home.
She attends to her public health officer’s duties based at the health center. She is primarily in charge of the community and market sanitation, so she facilitates the small scale traders who run business at the nearby market to get health check-ups that are mandatory before she issues them a certified health certificate that allows them to run food related businesses in the market.
In the course of her day, she collaborates with a wide range of stakeholders in order to perform her chores. She liaises with the clinicians and nurses to identify defaulters of care in order to organize for the follows up through the community health workers. The nurse would give her a list of children who have missed their vaccine appointments, the pregnant women who have missed their antenatal care clinics, the Tuberculosis and HIV/AIDs clinicians also have a list of defaulters of care that should be followed to ensure prompt care. She must liaises with the CHWs to be trace these patients and reintroduce them to care. This is one of her greatest challenge as it is hard to trace the children in the wide facility catchment area. You know it is her responsibility to ensure that the community health workers are creating demand for the health services at the community level and ensuring that the community members access the quality care at the health facilities. She assesses the performance of her CHWs by looking at how many community members they refer to the health facilities for care, and the adherence to care of the patients referred by each CHW. This is no mean easy task as CHWs are not paid and the villages they cover are wide and a very hilly terrain which becomes impossible during the rainy weather. Over half of the CHWs that she trained during the initiation of the CHW program in her area three years have dropped, and the new ones she has replaced need to be trained on the whole package of their role. She would gladly do this but “Oh, when will an non governmental organization come by to support us in this capacity building activity?” She exclaims. Meanwhile she must support the new CHWs by accompanying them at least once a month when they are doing their household visits in the villages.
Since there is an upcoming community based polio and tetanus campaign targeted for under-fives and women of reproductive health, she must select and contact several CHWs from each village that will help them administer these vaccines in their villages and therefore reach the most possible target population.
She must also liaise with the area administrative chief who provide the go ahead of the community based activities to mobilize the community for health education and dialogue days and community health related activities. She and her CHWs lead the community to discuss on various disease preventive and health promotive activities that are tailored to meet health needs/gaps they have observed within the community. They use these regular forums to reinforce important health messages like the importance pregnant women going for ANC and children for immunization. She leads the community health workers and community members during community action days.
She also works hand in hand with the schools heads for deworming and Vitamin A campaign targeted at children, a regular activity which she carries out with the CHWs.
Ann’s 80% of her time is spent interacting with the community and the community health workers. This month’s monthly meeting with the CHWs is early next week. She must make some time to prepare some notes on how to make drinking water safe for use in the community, during a visit in the community, she observed that the community was using unsafe water for drinking and the CHW did not know what to advise her households to make the water safe. The CHEW continues to offer need based training to the CHWs depending on assessment of the knowledge deficits of the CHWs after the initial training. He guides the CHWs, on how to effectively communicate well with the community. She intents to guide the CHWs on the data items to collect as most of them have not been sending all the reports as required. If transport within the community was cheap or easier she would visit the CHWs who did not send reports and or those who send inaccurate data or incomplete reports and walk with them as they collect the data.. As a CHEW, she is charged by the MOH to aggregate data about the community’s state of health that is received from the CHWs on a monthly basis. The primary data items for her reflect the utilization of health services by the community.
Ann has a regular end of month meeting with her community health supervisor who is based in the Sub district hospital that is 150km away from her station early in the morning on Wednesday. She must prepare and present her monthly written reports and give a verbal report of the state of the community and performance of the CHWs under her supervision.
Ann gets back to her home at 6 pm, she picks her son from school where he had been playing since 4pm when the other pupils leave school for home. She prepares supper for her family, and carries out the other family chores. She retires to bed at about 10pm tired but happy to have accomplished her day’s duties.
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