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Medic Mobile: Doing More with Less
CHWs: The Cornerstones of Health
Q&A with Jane Katanu Kavita

My name is Jane Katanu Kavita. I work as the Africa Regional Designer at Medic Mobile. I was trained as a nurse at the University of Nairobi.

When did you know you wanted to become a nurse?

I knew that I wanted to be a nurse pretty early. I was 10 years old and my brother hurt his foot. Of course, he was playing without shoes on, so he got a really bad wound on his big toe. I took some warm water, added salt and used a rag to clean it. I was cleaning it so thoroughly and nice, my brother was screaming, and Dad was like, “Oh Jane, you’re going to be the best nurse in the world.” I knew I was going to be! Being a nurse was the best thing, even today, I love the smile that comes on the face of a new mom when she holds her newborn baby. For me, knowing that there’s a baby alive and healthy, and I’ve been able to bring out life, was the most fulfilling part of my work as a nurse.

What is it like working for Medic Mobile?

It brings me so much satisfaction. My favorite part is working with the Community Health Worker (CHW), understanding what she does, how she does it, and translating that to making our work easier, more fulfilling. At the end of it, creating an impact, for not one person, not two, but a multitude of people. It’s simply just fulfilling. There’s nothing that makes me as happy as when I realize that the cases of diarrhea in our community have decreased because community health workers taught people about sanitation. There’s nothing that brightens me up like when I hear a doctor say that the rate of maternal deaths have reduced because the mothers are delivering at the hospital, courtesy of the community health worker.

I’m helping to design systems at Medic Mobile, so I’m looking at the sketches that my colleagues are bringing in of the systems that they want to be developed. I’m asking myself, how does this best fit our needs, does this really meet the needs of the users? That’s a question that I’m finding myself more and more addressing nowadays, because I’m concerned about having a system that actually meets the needs of the user.

What are some big human health challenges throughout the developing world?

In Kenya, what we are struggling with in the healthcare system is that we have more needs than resources. We also struggle to get people to take care of their own health. We’ve been recruiting community health volunteers who actually empower the community to take responsibility for their health. I think we are already a step, or a mile, ahead in doing that.

Area patients sometimes need to travel 100-500 miles to receive healthcare. This is often by public transit or motorbike.

Finally, we still have a problem with getting people to the health facility because of the distance. The economic levels of our people are still not at a level where they would be able to freely access health care, even if it is actually being provided free of charge at a hospital, because most of the time you’re not counting the cost of getting to the hospital itself. Look at the large distances that they have to travel, if somebody is so sick they might need a motorbike, and the motorbike means two days of food for a family. That’s quite a challenge.

What exactly does a community health worker do?

Community health workers, are the cornerstone of health in our community. These are people who live within the community, they’ve grown up in the community, and the community selects them. They say, “We know that you can do this, just go for training, then come and tell us what we should do to improve our health.” These are people who the government seeks to empower with basic knowledge on health, so that they can go out to the community and empower them to take responsibility for their own health. They have the knowledge and ability to send people to the facility where a nurse can improve their health before it is too late. I would say that the community health volunteer is much more important than the nurse, because she is a person who actually makes people access care. She’s a person who makes people responsible for their health.

In Kenya, one community health worker should be responsible for 20 households, with an average of five people per household. In reality, because community volunteers are so few, we find they’re serving more than 100 people. We find they have 30, 40 households, and that translates to over 200 people that they serve. Makueni County is actually a rural community, there’s a difference of about five or more kilometers between one household and another. The community health worker has to walk to each household to collect data and teach the community members. It takes a lot of commitment. It takes a lot of dedication for the volunteer to be able to do this. They are not paid for their work. They are not paid for the hours they spend talking to their community members. They derive their satisfaction through imparting knowledge, through seeing the community members live healthier lives.

What are Medic Mobile’s main goals?

Medic Mobile at Kilala seeks to help mothers access antenatal care services. What we mean by access is we want them to come for their antenatal care services pretty early, so that they can be able to do the four antenatal care visits that are recommended by WHO. We do this using the locally available community health volunteers who identify the community members who are pregnant. They register them using the Medic Mobile app which sends the community health volunteers messages to remind the mothers to go for not only the first antenatal care visit, but for follow up visits until they deliver. We remind mothers to take their children for immunizations. The community health volunteers using Medic Mobile register the children who are under five and receives reminders through the mobile app to tell the mothers to take their children to the health facility.

Medic Mobile has been in Kilala for 10 months now (this interview was conducted in 2016). You just need to talk to the clinical officer to know that the number of mothers they are seeing for antenatal care visits have doubled. The facility has gone from six deliveries a month to more than nineteen deliveries in a month, which they’ve associated with the community health workers using Medic Mobile to refer the mothers to come for delivery at the health facility. We did an assessment three months ago and I was surprised to find that out of all the children who had come there, each mother had received a reminder from a community health worker who is using Medic Mobile.

Why is it a good thing that more women are receiving antenatal care and giving birth in the health facility?

Antenatal care visits actually improve the health of the mother, help the nurse and the doctor to closely monitor her and ensure that she has a healthy baby. The mother, at the end of the day, is as healthy as the baby. Deliveries at the hospital are known to be the best source of a healthy baby. Mothers won’t die because we know that delivery itself is a complicated natural event. You can monitor the level of hemorrhage and prevent it. You can also ensure that the baby doesn’t suffer from neonatal asphyxia. That is one of the problems that occurs when children are born at home. Also, the environment in the hospital ensures that the mother and baby are not prone to infection.

WHO has actually said that over 80 percent of maternal deaths would be prevented if mothers delivered in the hospital and attend four antenatal visits. That’s what we are aiming at. We know that at the end of the day we have a healthy mother who will go back to the community and build it up. We know that the child is healthy which means a healthy, happy community that is economically empowered towards sustainability.

How scalable is Medic Mobile’s technology?

Medic Mobile has the capacity to influence millions of lives. Just one community health volunteer already influences more than 200 people. If you scale this up, say there’s a million community health volunteers in Kenya, that translates to 200 million community members. I have no doubt of the power of Medic Mobile to transform the health of communities of the world in all developing countries.

Medic Mobile uses an approach we call ‘human centered design’ in the development of these tools and systems. This involves actually understanding the users of the system. Medic Mobile’s head office is in San Francisco, but our tools are not tailored for San Francisco. Our tools are tailored for the users in underserved communities. So what we do at Medic Mobile, is we reach out. We go out to the users, and we try to understand them. Medic Mobile tools are inspired by the users, the users being the community health workers.

How does an idea from a community health worker become technology through Medic Mobile?

When Medic Mobile interacts with the community health volunteers, we try to understand what is important to them. When we are developing a Medic Mobile system, our intention is to ensure that at the end of it, the community health worker who wants that system is able to use it.

That process involves the system designers, people who simply go and understand the health care workers. They translate this into what you call a sketch or a visual presentation of how the system should work and what purposes it should meet. Then, design is translated into system requirements both through the help of system designers and software engineers. These are the people who code. These are the people who tell us this is possible with technology, or this is not possible with technology. Eventually it’s brought back to the project managers who say whether this system will be able to meet the needs of the users.

I have always known that we Kenyans are the ones with the solutions to our problems. Being able to come up with technology as a tool for the problems that we face, we can confidently say that in the coming few years we’ll have the answers to our problems. Just like we do in Medic Mobile, there is no way you can be able to solve a problem that you don’t know. You need to know the problem, you need to feel it, you need to understand it to be able to come up with a solution. Kenyans know their problems, and we are able to come up with solutions.

How is Medic Mobile different from other NGOs?

When I was growing up, there was a clinic next to my home. One day I went there after college and I found a nice incubator that was really dusty. I tried to find out why it was not being used. Well, I didn’t need to look far; we didn’t have electricity in this facility. That explains why most NGOs are criticized when trying to come up with solutions for problems that they perceive. For me, I understood that the donor of this really nice incubator did not know that we needed electricity first to be able to make this incubator to work. If only they had asked the nurse she would have just said, “Please, if you’re bringing an incubator bring a solar panel!” That would have solved the problem.

What we do at Medic Mobile is we try to understand the situation as it is and come up with a tool that would use or maximize what is available. The use of Medic Mobile in Kenya, for example, by the Ministry of Health is one of the easiest things to do, because we use available community health workers who are actually trained. When we develop a system with the community health workers, they already know that they have the resources.