Distance learning approach to train health sciences students at the University of Nairobi

Background: The University of Nairobi (UoN) College of Health Sciences (CHS) established Partnership for Innovative Medical Education in Kenya (PRIME-K) programmeme to enhance health outcomes in Kenya through extending the reach ofmedical training outside Nairobi to help health sciences students enhance their handson skills. The institution partnered with 18 hospitals in rural and urban centers as the UoN teaching hospitals referred to as decentralised training sites and appointed medical staff from these sites as adjunct faculty of the University of Nairobi to train health sciences students on hands-on skills. Webcasts  presentations were conducted by undergraduate students from all the schools at the College of Health Sciences during their elective term and clinical rotations at the decentralised training sites to present on the ground health issues.Objective: To describe how the University of Nairobi (UoN) used the distance  learning platform from the Medical Education Partnership Initiative (MEPI) grant to outspread medical education to the underserved communities located in rural and urban surroundings across the country.Design: A cross-sectional studySetting: The University of Nairobi College of Health SciencesSubjects: Health Sciences students of the College of Health Sciences, University of Nairobi and Hospital staff in 18 hospitals in rural and urban centersResults: A total of 670 health sciences students participated in the decentralised learning, a total of 549 health sciences  students participated in webcast presentations over a period of four years from 2012 to 2015, and a total of 48 medical  consultants and specialists from the decentralised training sites were appointed as Adjunct Faculty of the College of Health Sciences – University of Nairobi.Conclusion: Webcast presentations provided information on priority health conditions afflicting the communities at the  decentralised sites which would not be the case in the institution’s teaching hospital. Adjunct faculty at the decentralised training sites provided a platform enabling students to enhance their practical skills in line of  health profession and offered mentorship on coping in rural settings where there is scarcity of medical equipment and disposable materials in the health facilities and lack of constant electric power supply and clean water among other

Community perceptions and attitudes on malaria case management and the role of community health workers

Abstract Background Community Case Management of malaria (CCMm) is one of the new approaches adopted by the World Health Organization for malaria endemic countries to reduce the burden of malaria for vulnerable populations. It is based on the evidence that well-trained and supervised community health workers (CHWs) can provide prompt and adequate treatment to fever cases within 24 h to help reduce morbidity and mortality associated with malaria among under-five children. The perception and attitudes of the community members on the CHWs’ role is of greater importance for acceptance of their services. The aim of the study was to assess community’s perception and attitude towards CCMm and on CHWs who undertake it. Methods This study was conducted in five districts in western Kenya where Community Case Management was being undertaken. This was a qualitative cross-sectional study in which in-depth interviews and focus group discussions were conducted with mothers of under-five children and key stakeholders. Results Overall, there were more positive expressions of perceptions and attitudes of the community members towards the CCMm programme and the role of CHWs. The positive perceptions included among others; recognition and appreciation of services of CHWs, bringing health services to close proximity to the community, avoiding long queues in the health facilities, provision of health education that encourages good health practices, and promotion of positive health-seeking behaviour from within the communities. This programme is not without challenges as some of the negative perceptions expressed by the community members included the fact that some clinicians doubt the capacity of CHWs on dispensing drugs in the community, some CHWs do not keep client’s secrets and mistrust of CHWs due to conflicting information by government. Conclusions It was evident that the community had more positive perceptions and attitudes towards the role of CHWs in CCMm than negative ones. There should however, be deliberate efforts towards sustaining the positive aspects and addressing the negative concerns raised by the community and the health care practitioners

Challenges of achieving sustainable community health services for community case management of malaria

Abstract Background Community Case Management of malaria (CCMm) using Community Health Workers (CHWs) is an approach to improve access to timely and effective malaria case management in malaria endemic countries. So far the programme has been shown to be effective in many communities in sub-Saharan Africa. However, questions remain on the sustainability of this programme due to the high dropout cases of CHWs given their modest remuneration. The aim of the study was to identify challenges of achieving sustainable community health services for CCMm. Methods A community based qualitative study was conducted in five districts in western Kenya where CCMm was being undertaken. In-depth interviews and focus group discussions were conducted with the CHWs, mothers of children under-five years and key informants such as public health officers and clinicians involved in the CCMm. The interviews were audio recorded and conducted in English, Swahili and the local language. Recorded interviews were transcribed. Analysis was conducted using NVivo version 7 software, where transcripts were coded after which themes related to the objectives of the study were identified. Results The community members, the CHWs and stakeholders perceived CCMm as an important approach for reducing the burden of malaria. Key informants perceived lack of basic supplies (RDTs, gloves), drugs, inadequate remuneration of CHWs and lack of basic working equipment as challenges for CCM. CHWs highlighted that lack of drugs and basic supplies such as gloves at the health facilities, inadequate community sensitization by health workers, inadequate stipend to meet basic needs, as challenges of achieving sustainable CCMm. Some clinicians perceived that CHWs should not be given Artemisinin-based combination therapy (ACT) as part of the CCMm since they might misuse them. Conclusion This study shows that for CCMm to be sustainable, concerted efforts from stakeholders are needed to boost the programme. Commodities needed for implementation of the programme need to be readily available and the morale of the CHWs who undertake CCMm needs boosting