In partnership with governments, independent researchers and other organizations, Living Goods carries out innovation and research to maximize and optimize the impact of existing CHW programs and, ultimately, strengthen community health policy and practice.
Approximately 1 in 10 newborns develop signs and symptoms of a possible serious bacterial infection (PSBI), such as meningitis, pneumonia and sepsis in the first two months of life. WHO recommendation for management of such infections in young infants aged 0-59 days is in a hospital setting with injectable antibiotics, but evidence shows this is not always possible in resource-limited settings.
Appropriately, WHO developed a guideline with simplified antibiotic regimens for outpatient treatment and guidance on the role of CHWs in identifying sick infants with signs of PSBI and treatment follow up. CHW Jecinta is a lifeline in her community in Amagoro village, Busia County. Although she was trained to manage pneumonia in children aged 2 months to 5 years and refer all sick young infants below 2 months of age to health facilities, she was not familiar with management of PSBI prior to 2021—yet for newborns, timely access to care is key and can be the difference between life and death.
With funding from the Bill & Melinda Gates Foundation, and in partnership with Lwala Community Alliance and Population Council, Living Goods conducted implementation research from November 2020 to August 2022 to actively identify and rapidly refer cases of sick young infants and provide adherence follow up for those on treatment for PSBI as outpatients. Overall, 727 CHWs, 95 community health assistants and 104 facility-based health workers across two counties in Western Kenya—half of whom were in Living Goods’ Busia learning site—were trained on PSBI management.
After receiving specific one day training on the management of PSBI, Jecinta and other CHWs now provide health education to families on how to prevent and recognize danger signs in sick young infants. The endline evaluation showed over 50% increase in the number of infants screened by CHWs, and Living Goods-trained CHWs saved 29 lives over the two-year experiment. There was also an improvement in the two-way referral systems between the community and facilities.
These results confirm the high potential of community-based management of PBSI when hospital-level care is not possible. It proves once again that digitally enabled CHWs who are paid, supervised, and equipped with training and medicines save lives. There is, however, still work to be done in strengthening linkages between CHWs and health facilities, addressing heath workers’ knowledge gaps and improving the supply of commodities.
In 2023, we plan to scale this intervention within Busia, Kisumu, and Isiolo counties. We will disseminate the findings to the government and others in the ecosystem, and advocate for a similar intervention in Uganda as it has proved to be acceptable, accessible, sustainable and reaches underserved communities.