In Kenya, Amplio’s affiliate, Centre for Behaviour Change and Communication (CBCC) is using Talking Books to train and support community health volunteers (CHVs) for the USAID-funded project called Afya Timiza. The multi-faceted initiative aims to improve the health of mothers, newborns, children, and adolescents in Samburu and Turkana counties. CBCC is tasked with the social and behavior change (SBC) component.
In partnership with the Ministry of Health, CBCC employs a range of SBC strategies and approaches to improve access to Family Planning, Reproductive, Maternal, Newborn, Child and Adolescent Health (FP/RMNCAH), Nutrition and WASH health information, generate demand for essential services, and ensure sustainable behavior change.
Samburu pastoralist women many barriers to accessing quality health information and services, including remoteness, low literacy, and gender inequalities. Photo: Lisa Zook
Maternal and child mortality and health risks
Kenya has made significant strides toward reducing child deaths, but mothers and newborns still face high risks before, during, and after childbirth. Many preventable and treatable conditions, including AIDS, dehydration from diarrhea, malaria, and pneumonia remain leading causes of child death and illness, because families don’t have access to quality health information and services.
In pastoralist communities, women deliver at home due to a range of factors, including: distance, poor roads, and the difficulty of obtaining transport; lack of education or awareness regarding the risks of delivering at home; and traditional practices and beliefs related to women and birthing.
Samburu and Turkana counties have high maternal and infant mortality rates, which the Afya Timiza project seeks to address.
USAID Afya Timiza Project – Kenya
Turkana and Samburu Counties
USAID, Africa Medical Research Foundation (AMREF), Communities Health Africa Trust, Inter-Religious Council of Kenya, Centre for Behaviour Change and Communication
In 2018, CBCCC used Talking Books to train and support hundreds of community health volunteers for the Afya Timiza project.
mothers accessed skilled delivery services
community health volunteers (CHVs) trained to deliver key messages on maternal and newborn health
community health volunteers (CHVs) trained on family planning literacy
individuals empowered to receive quality and affordable family planning services
This project supports Sustainable Development Goal 3 — ensure healthy lives and promote well-being for all ages.
Curious? Learn about SDG 3
Community health volunteer use Talking Books to share consistent, accurate health messaging in local languages, which has increased community trust and engagement. Photo: Lisa Zook
Empowering CHVs to promote access to health
For the past year and half, CBCC has been using Amplio’s rugged, battery-powered Talking Book audio device to train and support hundreds of community volunteers to more efficiently and effectively share consistent health messaging. They say the Talking Book bridges a gap in rural because it speaks to people in their own language and does not require grid electricity.
In 2018, as part of their Afya Timiza strategy, CBCC conducted a three-arm program to enhance access and utilization of quality maternal, newborn, and child health (MNCH) information and services. To do so, they supplied CHVs with various training and tools.
At intervention sites, CHVs used flipbook material in combination with Talking Books to educate participants, including mother-to-mother and father-to-father support groups. Comparison sites were divided into two categories: facilities with an Afya Timiza presence, where CHVs had flipbooks, but did not deploy Talking Books, and facilities with no Afya Timiza presence.
CBCC found that the Talking Book, called “Digisomo” in Swahili, made an impact.
At intervention sites, CHVs use Talking Books in combination with flipbook material. Photo: Lisa Zook
Generating demand for ANC services
At evaluation, CBCC found that the intervention health facilities, on average, had experienced a 110% increase in the number of pregnant women completing four antenatal care (ANC) visits. In contrast, control sites with an Afya Timiza presence, but no Talking Books, saw only a 7% increase in the number of women who participated in ANC visits. Sites with no Afya Timiza presence had a 6% increase.
Moreover, between 2016 and 2019, three of four intervention health facilities in Samburu County had a statistically significant increase in the number of pregnant women completing four ANC visits and the number of new ANC clients. Similarly, five of six intervention sites in Turkana County saw an increase in the number of pregnant women completing four ANC visits, though only half showed an increase in new ANC clients.
A Samburu woman asks a health question, which is recorded directly onto the Talking Book through a built-in microphone. User feedback provides insight into community issues and concerns. Photo: Lisa Zook
What did we learn?
CBCC drew on community observations, Ministry of Health data, CHV field reports, and Talking Book analytics and user feedback to inform three takeaways:
1. Talking Books provide CHVs with access to knowledge and support regarding MNCH messaging.
Across both counties, CHVs reported that Talking Books enabled them to deliver consistent, accurate MNCH messaging, leading to more community trust and engagement. Both men and women participants perceived the Talking Book as a reliable information source and “cool” technology. (CHVs reported being sent home to fetch their Talking Book if they showed up at household without it.)
CHVs reported that more women were consult them for health advice. As a result, they made more referrals to ANC services. In addition, with the Talking Book, fathers were more engaged.
“The men want to see with their own eyes this gadget that speaks in their language. This makes them come to the group meetings.” — CHV from Swari CU in Samburu
CBCC uses Talking Books to educate and engage fathers about maternal and child health. Photo: CBCC
2. CHVs regularly use Talking Books to deliver effective messaging.
Because Amplio’s technology collects usage data, CBCC can monitor Talking Book deployment, tracking when and where CHVs use Talking Books, which messages are played, and how often. In 2018, CHVs used Talking Books to deliver 17,548 Afya Timiza messages. On average, CHVs played three hours of Talking Books audio content, with messages ranging from 1-3 minutes in length.
3. Improved messaging from CHVs resulted in increased uptake of MNCH services at intervention health facilities.
At evaluation, the intervention health facilities, on average, experienced a 110% increase in the number of pregnant women who completed four antenatal care (ANC) visits. In contrast, at control sites with an Afya Timiza presence, but no Talking Books, there was a 7% increase in the number of women who participated in ANC visits. Facilities with no Afya Timiza presence saw a 6% increase.
Three of four intervention facilities in Samburu County experienced a statistically significant increase in the number of pregnant women completing four ANC visits and the number of new ANC Clients between 2016 and 2018. Similarly, five of six intervention facilities in Turkana County also experienced an increased number of pregnant women completing four ANC visits between 2016 and 2018, though only half showed an increase in new ANC clients.
A young Samburu woman learns about health during an Afya Timiza community meeting. Photo: Lisa Zook
A heroic campaign for behavior change
For Afya Timiza, CBCC created the ‘Ushujaa’/’heroism’ campaign. Messaging is focused on five thematic areas: maternal and neonatal health, child health, nutrition, water, sanitation and hygiene (WASH), and family planning. Program participants, especially fathers, are encouraged to take heroic action by protecting their families through healthy behaviors. To support the campaign, CBCC produced Talking Book audio content in the form of songs, dramas, and interviews.
Watch a video about CBCC’s Talking Book Program in Kenya.
Centre for Behaviour Change and Communication (CBCC) provides comprehensive social and behavior change (SBC) solutions for the public and private sectors in Kenya and beyond. CBCC is an Amplio affiliate. Visit their website.