When he’s not coordinating community health volunteers, John Maina spins clay into flower and cooking pots.
Maina is the community health committee chairman for Soweto East, a village inside Nairobi’s sprawling Kibera slum, thought to be Africa’s largest. But pottery is his main profession. Maina mostly sells his products outside of Kibera, where people have money to buy them.
Maina spoke to Devex of the challenges he and his volunteers face, as well as the victories that keep them motivated, during a visit to one of Soweto East’s community health centers — which cofunctions as a computer center and as a church.
Maina is one of nine elected leaders who manage the village’s community health volunteers, a collection of roughly 400 Kibera residents who take time away from their day jobs to visit ramshackle homes within their jurisdiction and administer health education and basic treatments to the families who live there. Maina oversees 120 others.
As committee chairman, he hears concerns from four zones that fall under his administration. Patients who are bed-ridden and cannot visit a clinic, transportation problems — Maina’s job is to help orchestrate responses to challenges that stress his volunteers’ abilities or resources. He lobbies for the materials and assistance they need or devises other practical solutions.
One of the issues that comes up is security. Community health volunteers — men and women, young and old — are often asked to visit households after dark, which can threaten their safety in poorly lit neighborhoods where opportunistic thieves present persistent security concerns.
“Fortunately, I’m [also] the chairman of the security committee,” Maina told Devex.
Maina, like all the volunteers he helps coordinate, lives in the same community he seeks to help. In addition to his committee roles, Maina is an elder of the chief. The chief, Maina said, has also been trained as a community health volunteer. That means that when Maina takes his volunteers’ concerns to the chief, he understands them.
Kibera and other Nairobi slums are independent ecosystems within the larger world of the Kenyan capital city’s relentless expansion, and the systems that have emerged within them to manage health, environmental, economic, and security challenges speak to the ingenuity, self-sufficiency and motivation of their residents to make much use of limited material resources.
For Maina, the biggest limitation is transport. Ambulances either don’t exist in sufficient numbers or can’t make the trip through Kibera’s winding, rutted, trash-clogged alleyways. When a patient’s condition requires further intervention, community health volunteers carry them a kilometer to the local clinic — longer “because of the twists” — on stretchers, at night, if necessary.
Amref Health Africa trained 400 community health volunteers in Kibera in 2009. The volunteers provide tuberculosis testing, house visits for education, water treatment, referrals to clinics and hospitals and are able to identify high-risk patients in advance. They also work to ensure the community health clinics stay clean so they don’t end up contributing to disease transmission.
Kenya’s community health strategy guides their work. It was devised in conjunction with the creation of the Millennium Development Goals, as a step towards achieving those goals related to health.
Since Maina works for no salary, he finds his motivation elsewhere — in the recognition he gets from his team.
“They know I can assist,” he said. “Their respect motivates me.”
The volunteers’ work has taken on special importance, as Kenya’s health services continue to transition toward more localized administration and provision of care and treatment. A process of “devolution” has seen authority shift from central ministries to counties, and in some cases, has caused significant disruption in staffing and supplies.
Last year Kenya saw a number of strikes and significant resignations among public sector medical professionals complaining about low salaries and poor working conditions under the new organizational structure.
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