By Ann Morris, Maverick Collective Member
At 30 years old, Riziki Karisa is already the mother of 10 children; her youngest arrived just last spring. Living in a remote area of Kilifi County in coastal Kenya, she never had the chance to go to school, and her family survives on the income she and her husband earn from gathering wood and selling charcoal.
For years, Karisa asked her husband if she could use contraception, permission she believed she needed based on the cultural norms of her community. With each ask, he said no. That was, until a community health worker visited the couple and offered counseling on their doorstep. Her husband agreed and she received an IUD at a local clinic.
Bringing health information and services directly to consumers is a quiet revolution that is disrupting healthcare systems worldwide. New technology and task shifting to community health workers bring care— previously provided only by medical professionals in brick and mortar facilities—directly to patients, while making it safer and more affordable. Mobile phones and tablets allow community health workers to collect data and bring information and care directly to consumers in even the most remote areas.
THIS IS ONE OF THE MOST EXCITING PUBLIC HEALTH DEVELOPMENTS OF OUR TIME. AND IT’S NOT JUST ONE WE’RE SEEING IN THE GLOBAL SOUTH.
In the U.S., skyrocketing healthcare costs and frustration over lack of access are fueling the community-based trend.
In a low-income neighborhood in east Greensboro, N.C., residents walk down the street to the Mustard Seed Community Health Clinic, receiving treatment for common ailments like high blood pressure, asthma and yeast infections, as well as other basic health services they had trouble accessing before.
For many residents, it’s the only healthcare they receive.
“Many people in the community don’t have cars or gas money,” says Dr. Beth Mulberry, who helped found the Mustard Seed Community Health Clinic in 2016 and serves as its sole physician. “They don’t have a way to get to a doctor. We have patients with hypertension who haven’t received care in years.”
Mustard Seed recruits community health workers from the surrounding neighborhoods, which include large immigrant and refugee populations. They make home visits, hold community meetings and spread the word about the clinic and its services. The clinic’s central location in the neighborhood is critical.
“Primary care makes more sense in a community setting,” Mulberry notes. “You can [only] develop the trust of the community if you are part of the community.”
The revolution is also underway in hundreds of CVS drug stores across the U.S. customers can get treatment for ailments from strep throat to sexually transmitted infections to minor burns at the chain’s new “Minute Clinics.” Mainly staffed by certified family nurse practitioners and physician assistants, the clinics provide services that most Americans have traditionally received at a doctor’s office.
“We’re in the community, we’re seeing those patients, we’re becoming part of their daily lives and routines,” CVS Chief Executive Officer Larry Merlo said in an interview with the Hartford Courant last year after the company’s merger with Aetna aimed to create a new model for healthcare. “We can help them achieve their best health and, at the same time, reduce the cost of healthcare today.”
This trend is unfolding in Kenya, too.
As a thought partner and investor in a three-year pilot project implemented by Population Services Kenya, I’m seeing firsthand the advantages of training community health workers to provide a variety of contraceptive methods, including implants. Providing implants during home visits can be a game-changer, offering protection for up to five years so women can better manage their fertility.
The pilot project advocates for a change in Kenya’s policy, which, similar to policies in most countries, requires that only medical professionals insert implants. This policy dramatically limits access, especially for women in remote areas. The project seeks to demonstrate that community health workers, who are widely available, can safely perform the procedure.
Task shifting is already underway. The Kenyan government recently approved a policy allowing community health workers to administer contraceptive injections that provide protection from pregnancy for three months. This progressive move paves the way for further change.
Kenya has made strides in improving its contraceptive prevalence rate, surpassing its national goal and hitting 62 percent in 2016, but huge areas remain underserved. In Kilifi County, only three in 10 women use modern family planning methods. Teenage pregnancy is higher than average; 22 percent of teens still experience unintended pregnancy.
Improving those numbers will take innovative, community- focused solutions. The good news is that mobile, medical and diagnostic technology can change the way we diagnose, treat and manage health, and allows us to put more basic care and control directly in consumers’ hands. We can bring this care closer to consumers’ front doors to reduce the burden on health systems and improve health outcomes.
What’s needed now is a wave of policy change that allows consumers and health workers to do just that.
Ann Morris is a member of Maverick Collective, a philanthropic and advocacy initiative of Population Services International that is focused on improving the lives of women and girls in the developing world.
Banner photo credit: What Took You So Long?
