Telemedicine in a time of COVID-19: Kenyan CHW Salome Uses Modified m-Health Tools to Deliver Lifesaving Care to Families

Before the COVID-19 pandemic emerged in Kenya, Salome Osebe, a government community health worker (CHW), was a frequent and welcome visitor to homes in her neighborhood in Kenya’s Kakamega County. Armed with a bag kitted with essential medicines, simple tools like thermometers, health materials and a smartphone, Salome was volunteering her time going door-to-door providing health information and assessing and treating young children for common illnesses. COVID-19 changed everything.

“We used to freely visit clients in their homes but with COVID-19, people were no longer encouraged to move around and there was a lot of fear especially at the beginning. I also did not have protective equipment like masks initially and it was difficult to make in-person visits out of concern for my own and my clients’ safety,” Salome explains.

The inability of community health workers like Salome to safely continue providing essential health services threatened to compromise the health of thousands of Kenyans who rely on CHWs as their first point of contact with the healthcare system. It also meant that health facilities were likely to experience additional strain as they prepared to deal with a pandemic. Fortunately for the nearly 100 families Salome serves, she was able to resume services quickly and safely through an innovative approach. Telemedicine.

Using her smartphone supplied by Living Goods in partnership with the county government, Salome was able to continue doing most of her work remotely which involved screening clients for COVID-19, conducting assessments for sick children, prescribing treatments, referring complicated cases, providing family planning counselling and following up on children’s immunization status. This was made possible by funding from the Foreign Commonwealth & Development Office (FCDO)) and others funders that enabled Living Goods to make quick adjustments to the Smart Health app loaded on CHW smartphones. The modifications to the app included creation of new workflows to facilitate approximately 3,000 CHWs like Salome to work using government-approved ‘no-touch’ and ‘low-touch’ protocols that enabled fully remote or safer in-person visits.

These CHW services are especially critical to clients like Gladys Kemunto. Like many families, hers lost their sources of income due to the disruptions caused by the COVID-19 pandemic. With less disposable income and the fact that they had to travel long distances to health facilities, many families were at risk of lacking access to much-needed care. While telemedicine has had its challenges, local health champions like Salome helped to address this vulnerability by continuing to provide services at client’s doorsteps.

 “When my baby and I had a cold, I was afraid and reluctant to go to the nearest hospital which is about 15 kilometers away,” says Gladys Kemunto, one of Salome’s clients.  “Salome checked on us over the phone, asked us questions to determine whether we may have been exposed to COVID-19 and then assessed the child and told me what to do. It was helpful because it saved us from needlessly exposing ourselves or spending money by going to the hospital.”

“Although it lacks the personal touch and does not allow us to verify things like a child’s breathing or temperature , serving clients over the phone ensures I can still reach my furthest clients even in the midst of a pandemic” shares Salome. “When I opt to work remotely, I mostly refer issues I can’t resolve to the health facility and sometimes clients can come to my house to collect medicines after I assess their sick children over the phone.”

Although Salome regularly makes follow ups over the phone, she now has the protective equipment, training, and digital tools that also make in-person visits possible. Working with new protocols that ensure she screens herself and her clients for COVID-19 before commencing contact and educating families on maintaining COVID-19 prevention habits, Salome continues to make sure that young children and pregnant mothers in her area remain healthy during the pandemic and beyond.

The contributions of CHWs like Salome have been significant. While goverment data showed declines in the number of people who sought facility-based care for common childhood diseases in 2020, Living Goods-supported CHWs helped fill this gap resulting in an 84% increase in the number of treatments and referrals CHWs provided to under 5 children per month from 2019 to 2020.

“Whenever my baby falls sick, Salome has been on hand to support and during the pandemic she has been providing medicines to us for free,” says Edna, a mother of three. “We are happy mothers because we know Salome has our backs in normal times and in times of crisis, she adds.

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