It had just clocked 11 am when I arrived at the chief’s camp area for my scheduled meeting with Alice Wanini. It was a bright Wednesday morning in Mukuru Kwa Reuben. Alice arrived moments later dressed in her full work gear in a company of two other Community Health Volunteers (CHVs). We exchange greetings and she introduces me to Jackline Kerubo and Berita Kioko. The women had just come from their usual household visits at Bins village.

Alice has experienced a lot as a front-line community health volunteer-but nothing like this.

“It is different now. We had to adjust” she tells me when I inquire about work. As one of the 119 community health volunteers in Nairobi’s Mukuru Kwa Reuben, Alice has been setting out into the village daily, sharing vital information about Covid-19 with Mukuru residents. At the heart of one of Nairobi's largest slums, Alice walks around Bins zone in Kwa Reuben area, where she is attached, demonstrating hand-washing and explaining to the residents other protective measures that they should adhere to.

Since the confirmation of the first Covid-19 case in Kenya earlier in March, the country has had to adapt to a new kind of ‘normal’. Suddenly, weddings, graduations, conferences, events have had to take a ‘back seat’ until further notice as the countries’ health care workers took the lead in the fight against the pandemic. Need to rapidly put in place preventive, diagnostic and management services for Covid-19 has become a top priority and as the country continues to combat the pandemic, creating these reliable community health structures will ensure the country withstands the effects of the pandemic.

Currently, 388 community health volunteers are serving within the wards of Mukuru Kwa Reuben, Mukuru Kwa Njenga and Viwandani areas. They include individuals who work to supplement the greater health care system. Their contribution is vital, particularly in underserved communities. Alice, Jackline and Berita are among the 388 CHVs who have been trained to provide the most essential lifesaving interventions such as emergency front-line care within the communities and in the wake of Covid-19, the health workers have had to take on new tasks aiming to maintain the community’s overall well-being.

The CHVs are working to provide crucial Covid-19 information to keep communities safe. Through door-to-door awareness and working closely with a popular community radio station, Reuben FM, the health care volunteers ensure clear and accurate lifesaving messages trickles down to the grassroots.

“There are challenges though,” she adds, as she goes on to explain the factors that forbear their efforts.

“Not all residents realize the disease is here” she continues. Some claim the virus could only affect the rich and not those living within the community. Therefore the need to constantly stamp out the misinformation is critical to keep infections low and avoid overwhelming the health care system.

Alice goes on to also explain the challenges she has encountered in her line of work while encouraging social distancing amongst residents. This practice is considered a critically important preventive measure however in settlements such as Mukuru, space is a luxury- and social distancing is nearly impossible, both within the households and on the narrow streets around them. She tells of an incident that recently transpired where a water boozer supplying free water in the community, brought hundreds of residents scrambling for access to free water. In an area notably known for its erratic water supply, the free supply of water to support regular hand washing and other household usage foresaw residents crowd at the water supply area each aiming to get their water cans full with little care to prioritize social distancing.

Additionally, protecting the CHVs from contracting the virus is paramount to ensure the continuity of care for general and covid-19 health-related needs. However, shortages of personal and protective equipment (PPEs) pose a great threat to volunteers such as Alice who are tasked with providing emergency front-line care. As the Nation continues to put in place measures geared towards limiting the spread of the virus, the need to upgrade the existing community health structures from bottom-up remains critical in a bid to boost emergency response capacities especially in settlements such as Mukuru.

Addressing the Gaps

The outbreak of Covid-19 pandemic all over the world has interrupted the political, social, economic, religious and financial structures of states all around the globe. Countries such as Kenya are now racing to slow the spread of the virus and eventually reduce its impact on the society in general.

“Currently, we are unable to render our services as we normally did” Stella a CHV from Viwandani shares on how the pandemic has taken a toll on their main duty to serve. Before the health volunteers were focused on Individual care but now they have to think about public health in the context of an outbreak. The virus which has threatened to heavily affect the marginalized and vulnerable communities alike has prompted support actors to equally prioritize the vulnerable in their joint mission to combat the spread of the virus.

Jackline Kerubo admits to having met individuals who are disabled and the elderly during her regular household visits and emphasizes the need to focus on these groups of people particularly now as the numbers of the infected continue to escalate. It is in its quest to address such emerging gaps that federation reached out to the vulnerable families within Mukuru and Huruma and distributed food to 200 vulnerable families. This marks one of the various actions undertaken to protect communities and further ease the burdens for community health workers who dutifully attend to them.

Additionally, in its effort to safeguard communities from contracting and rapidly spreading the virus, the government donated free hand sanitizers which were supplied to the CHVs for distribution within the households. The supply sought to feed into the high need however, Alice explains the demand for such essentials continues to grow day by day. Concerns over shortage of sanitizers, hand washing stations and protective equipment raise the urgent need of availing such basic infrastructure to ensure the CHVs can continue serving effectively within their zones.

So far, through Muugano’s covid-19 response strategy, the federation has managed to reach out to communities in Nairobi, Nakuru and Kisumu where it has supplied essentials such as PPEs, IEC materials, washing stations and now with plans underway to provide PPEs to CHVs, the federation hopes to ensure the frontline health workers are well equipped with the much needed vital protective supplies to enable them proceeded with their daily duties.

These and numerous other interventions introduced will aid in scaling up preventive measures aimed at reducing the spread of the virus and eventually support general community health workers who are at the forefront of the covid-19 fight.