Promoting Access to Quality Health Education and Services for Semi-Nomadic Pastoralists

Updated: Oct 12



In Kenya, Amplio is partnering with Centre for Behaviour Change and Communication (CBCC), an Amplio affiliate, to train and support community health volunteers (CHVs) for the Afya Timiza project. Funded by USAID, the initiative aims to improve access to quality health education and services for mothers, newborns, children, and adolescents in Samburu and Turkana counties.


In partnership with the Ministry of Health, CBCC employs a range of social and behavior change (SBC) tools and strategies to improve access to health information, generate demand for essential services, and ensure sustainable behavior change.


Maternal and child mortality and health risks


Kenya has made significant strides toward reducing child deaths. However, 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 geographic remoteness, lack of awareness about the risks of delivering at home; and traditional practices and beliefs related to women and birthing. The Afya Timiza project seeks to address high maternal and infant mortality rates.


Community health volunteers participate in a Talking Book training session.


Conducting a three-arm trial with Talking Books


In 2018, CBCC delivered a three-armed trial in Samburu and Turkana counties, by supplying CHVs with social and behavior change training and tools. At intervention sites, CHVs used flipbooks and Amplio Talking Books to share consistent and accurate health messages during community meetings and household visits. Control sites were divided into facilities where CHVs used flipbooks only and facilities with no Afya Timiza presence.

At the evaluation, intervention facilities where CHVs used Talking Books saw a 110% increase in the number of pregnant women completing four antenatal care (ANC) visits. In contrast, ANC participation at control sites with flipbooks increased by only seven percent and controls with no Afya Timiza presence increased by six percent.


On average, intervention facilities with a Talking Book program saw a 41% increase in new ANC clients from project baseline to endline. With the Talking Book as a support tool, CHVs strengthened their knowledge and capacity to deliver quality information. As a result, CHVs said they observed a significantly higher level of trust and engagement from the communities, with more mothers coming to them for healthcare referrals.


“Sometimes I might forget an important point. I may not necessarily remember all of the health messages. But the Talking Book reminds me.” — CHV from Vihiga County


Generating demand for ANC services


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.


Intervention sites saw a significant increase in ANC visits.


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 and accurate MNCH messaging, leading to improved levels of community trust and engagement. Both men and women participants viewed the Talking Book as a reliable source of health information and “cool” technology.


CHVs reported that more women were coming to them for health advice. CHVs made more referrals to ANC services. With the Talking Book, fathers were more engaged. CHVs also reported being sent home to fetch their Talking Book if they showed up for a household visit without the device.


“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


2. CHVs regularly use Talking Books to deliver effective messaging.

Because Amplio’s technology collects usage data from each community or group, we can monitor Talking Book deployment and message engagement, 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 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 the 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 heroic campaign for behavior change


For the Afya Timiza project, CBCC created a "Ushujaa" or "heroism" campaign, building on traditional warrior culture and values. Messaging focused on five key areas: maternal and neonatal health, child health, nutrition, water, sanitation and hygiene (WASH), and family planning. Community members, especially fathers, are encouraged to take heroic action by protecting their families through healthy behaviors. CBCC produced culturally appropriate, local language content in the form of songs, dramas, and interviews.


Watch a video about CBCC’s Talking Book Program in Kenya.


 

Based in Nairobi, the 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