Home Visitations, Referrals and Linkage by Community Health Volunteers in Supporting Maternal Health Care Services in Dadaab

Abstract

Background: There is an increase in the involvement of CHVs in healthcare in low and middle-income countries and the model is being used in refugee camps to enhance access to Primary Health Care including maternal health services. This is in line with the idea of optimizing health workers roles which targeted to address critical health worker shortage, by shifting downwards certain tasks to health workers with less training, such as from nurses to Community Health Volunteers (CHVs) to increase universal access to maternal healthcare. The public health adopted the community health strategy that employs CHVs in providing health care services for the refugees in Dadaab. The role of CHVs on maternal healthcare in the refugee camp has not been clearly described. Objectives: The main objective of the study was to determine the roles of community health volunteers in home visitations, referrals, and linkage to promote maternal health care services in the Dadaab refugee camp, Kenya. Methodology: This was a descriptive cross-sectional study with both qualitative and quantitative methods conducted at Ifo-1 camp, in the Dadaab Refugee complex. It targeted the CHVs and some Key Informants (KIs) involved in maternal health care services. The sample size for quantitative data was 74 CHVs selected by simple random sampling while for qualitative was 5 KIs selected purposively, making the study population 79. Data was collected using questionnaires and interviews; analyzed descriptively and thematically and presented in form of tables, graphs, charts, and narratives. Ethical consideration involved study approval by the University of Nairobi Kenyatta National Hospital Ethics Research and Ethics Committee; permission from relevant authorities in Dadaab and obtaining informed consent from the participants. Results: The results showed that CHVs played a significant role in promoting maternal health care through home visitation and referrals. All the CHVs provided home visit services. Majority conducted more than two visits for Antenatal Care 66 (89%) and after delivery to deliver maternal health services. All the respondents conducted referral and follow-up services where 58(78%) identified pregnant mothers for referral; 51(67%) traced defaulters. There was, however, a weaker link after discharge from antenatal care clinics and no framework for implementing home visits and referrals or community maternal healthcare. Conclusion: The CHVs are playing a significant role in promoting the uptake of maternal health services in the Dadaab refugee camp through home visitations and referrals and linkage between the health system and the refugee community. Recommendations: There is a need to establish a framework for implementing community-based maternal health to guide and support, supervise CHVs, and strengthen monitoring of maternal health services in the community. Further, there should be more involvement of the CHVs by the antenatal care (ANC) clinic after discharging antenatal mothers from the clinic to continue with care and follow-up