How male involvement was achieved through Quality Improvement in community health

By Julius Agunda (Community Health Extension Worker, Kitui County) and Lynda Keeru, (LVCT Health, Nairobi)

It is a busy sunny morning at Kaliku dispensary, in Kitui County. Seated among the more than a dozen mothers and their children waiting to be served at the Maternal and Child Health (MCH) clinic is Mr. Nguli Mwengi, a 51 year old man who is carrying his nine month old baby on his lap. He sits patiently waiting for his child’s turn to be given her measles vaccination, as he has done for the past few months.

Three months ago, when Doris, a Community Health Volunteer (CHV) from Kavutei Kawala unit in Kitui first visited Mr. Nguli’s home, the situation was grievous. His then six month old daughter had never been to a child health clinic and neither had his three year old daughter. His wife had been discharged from a psychiatric hospital two years prior and was living in dire conditions in a dirty makeshift structure from where she developed scabies for which she had not received treatment.

Doris admits that although husbands play a vital role in decision making within the home, the role of rearing children has always been regarded as a woman’s responsibility.  “It took me a week of daily visits to the household to convince Mr. Nguli to take his children to the clinic. We had attended a seminar on maternal and child health, so I explained to him the importance of taking his children for immunization and growth monitoring. I also sensitized him on the dangers of not doing so,” explained Doris.  She is quick to add that if men are involved and supported as equal partners by providing them with correct information to inform their decisions, they can support healthy behavior and health care seeking behavior for their families. Fortunately, through the CHV’s intervention and Mr. Nguli’s cooperation, he has been taking his children to the clinic every month for growth monitoring. His youngest child’s immunization schedule is also up to date. His wife Taabu also attends clinic where she receives treatment and has also been started on family planning.

Nguli’s story is among the many successes of Kavutei Kawala’s Work Improvement Team (WIT) in Kitui East Sub County in Kitui County which is made up of two Community Health Extension Workers (CHEWs), three CHVs and two community members. After undergoing training on quality improvement under the USAID SQALE project, the team sought to ensure that maternal and child health indicators were improved within the Kavutei Kawala community units, in Kitui County, which was characterized by unskilled child deliveries and low immunization coverage prior to the training. Training of CHVs was identified as a priority action by the WIT and subsequently the delivery of the program was supported by LVCT Health.

 “It was not easy at first as we had not understood our role as members of the community work improvement teams (WITs) but we gradually learned that our role is to ensure that CHVs provide quality community health services at the household level which in the long run translates into healthy families in our community,” acknowledges Susan, one of the Work Improvement Team members. The team meets on a monthly basis to discuss and identify issues hindering the delivery of quality community health services after which the issues are prioritized and dealt with in that order. After the meetings, all the CHVs are updated and given the go ahead to implement the decisions in their communities. Doris notes that the USAID SQALE, implemented by LVCT Health, has been very beneficial to them as a community.  It has also been demonstrated by the Kavutei Kawala community unit, that engaging men is vital in achieving quality improvement in community health.

Long live Quality Improvement!!