Erik Michielsen (Narrator): Kilifi District is located in the Coast Province of Kenya, covering an area of nearly 4000 square kilometers.
Formed in 2006, Kilifi Kids is an all-volunteer organization of Kenyan and American professionals working to improve public health and education for thousands of children.
In July 2010, Kilifi Kids volunteers traveled to Kilifi to meet with local team members, public health leaders, educators, and communities.
Team Kilifi Kids’ intent was to improve public health services by advancing its mobile health project. Kilifi’s team of Kenyan and American volunteers worked to structure a three-phase mobile health or mHealth program to improve public health care. Key to the trip was interviewing Kenyans working to improve public health resources across Kilifi communities.
In Kilifi District, the majority of the population is between the ages of 0-19. Primary health care service provisioning to young mothers and children is critical and many districts have very low health service utilization rates given long distances to clinics and hospitals.
Dr. Charles Mbogo (Kilifi Rotarian): We try to target from the household level, where you have young children under five. You see the mothers here, most of the mothers here are young and are not educated as such.
Julius Jilo (Kilifi District Education Officer): Go to any school, a school where over 90% of the children do not have shoes on them, 100% of children live in households with poor sanitation.
Ronald Mbunya (Kilifi District Nutrition Officer): One of the causes of malnutrition is the poor cultural practices. For us to be able to change that, we need to have ambassadors who will carry that message to the community.
Erik Michielsen (Narrator): Kilifi District is in the process of implementing the second National Health Sector Strategic Plan (NHSSP II). As part of the plan, the Kenya Essential Plan for Health (KEPH) includes a strong focus on a community-based approach to health care and relies on the use of Community Health Workers – or CHWs - to manage community activities, health education, and health promotion, disease prevention, and basic curative care.
Steven Malingi (Community Health Worker): These are Community Health Workers. We work hand in hand with nurses and the public health department from here to educate the entire community because the staff from the facility cannot go to outreach all the time.
Erik Michielsen (Narrator): One of the major strategic objectives of NHSSP II is to promote effective linkages between the community based system and the formal health care system.
Dr. Benjamin Tsofa (Ministry of Health Official): One of the most important things is adequate health services or health care system. A child born in Kilifi like any other child should have access to immunization services to prevent them from infectious diseases, should have access to adequate nutrition so they can grow and develop well, and be able to get some basic education or primary level education. Now that is not guaranteed to every child given they are born in Kilifi.
Erik Michielsen (Narrator): With a population close to 500,000 people, Kilifi District requires close to 500 trained CHWs and 20 CHEWS, Community Health Extension Workers that supervise the CHWs.
Daudi Barisa (Community Health Extension Worker): We have Community Health Workers. Initially they were trained in general primary health care activities. During March 2009, there were areas supposed to train them, to give them necessary skills and knowledge that is in primary health care and community strategy approach.
Erik Michielsen (Narrator): Kilifi Kids is focused on addressing Kilifi District primary care in three phases.
Phase one is currently in process, providing mobile phones to each of the Government of Kenya or GOK dispensaries so they may digitally complete and submit weekly reports.
Phase two is in its planning stage and involves providing commodity kits. These phones will be used for information sharing as well as digital referrals and patient follow up. Community Health Workers, or CHWs, will complete a digital referral form.
The form will be sent to the CHEW who will use the information to track whether referred patients follow through to receive care.
Jonathan Mativo (Mobile Health Project Manager): We want to see whether we can enhance or help the government have the reporting systems coming from the health facilities that are actually based at the community level.
Erik Michielsen (Narrator): Phase three increases the scope of work to include NHSSP II goals of district-wide household registration. Kilifi Kids will provide CHWs with digitized registration forms to more easily collect, report, and update household data over time. Phase III will digitize the reports to facilitate improved aggregation, analysis, and sharing of reports in and across facilities.
CHWs will use cell phones to collect and transmit this data monthly as well as weekly. This will also allow CHWs to flag any concern areas, such as a household with high morbidity or high instance rates of reportable diseases. Previously, all of this data collection was paper based.
Dr. Benjamin Tsofa: The mobile health project has taken place because of two main reasons. One, in a very immediate and direct way, it ensures direct and immediate linkage between communities and the health system. Especially for the health service provision that is extremely important because timeliness in terms of making health decision, appropriate health decision, when someone is in need of that health service is very important.
Mobile health will ensure there is timeliness in decision-making, whether it is making appropriate diagnosis, giving appropriate instruction, or giving appropriate treatment. This will really help.
More importantly, the other way I look at it is mobile health will open up other avenues of technological development within the community which will, in a very great way, open up other opportunities for community development, generally, even beyond health.
BBC reporter Elizabeth Mearns (@lmearns on twitter) traveled to Kilifi, Kenya to hear from the team about the mobile health, or mhealth, project launch.
Kilifi Kids is a 501c3 charity, affiliated w/Rotary International, raising $1M to improve delivery of health services and fight child malnutrition using cell phones in Kilifi, Kenya. Please friend us on Vimeo and learn more about us at kilifikids.org.