Kenyan Community Health Worker Model Inspires Other Programs

More than one thousand trained AMPATH community health workers provide care and education throughout their own communities in western Kenya. This method of delivering services has been integral to the success of AMPATH’s HIV care and control program and has expanded to address economic empowerment, chronic disease care, maternal-child health and more.

Now this model is being used in Indiana to improve infant mortality rates in Marion (Indianapolis) and Delaware counties. Debra Litzelman, MD, is the principal investigator for the WeCare program, funded by IU Health, Indiana Clinical and Translational Sciences Institute (CTSI), and Indiana State Department of Health, that trains community health workers in techniques to guide and support mothers, fathers and caregivers toward behavior changes that decrease risk factors for infant mortality. These changes include reducing smoking, improving mental health, skipping fewer meals and reducing substance abuse. Results for the first three years in Marion County are promising with improvements in both infant mortality rates and low birth weights.

Graphic provided by WeCare and Regenstrief Institute

Graphic provided by WeCare and Regenstrief Institute

Dr. Litzelman is the D. Craig Brater Professor of Global Health Education at the IU School of Medicine, Director of Education for the IU Center for Global Health and Associate Director for Health Services Research at the Regenstrief Institute. Dr. Litzelman has been involved in AMPATH’s Kenya partnership for nearly two decades. She spent a sabbatical at Moi University and Moi Teaching and Referral Hospital in Kenya working to improve the medical education system, as well as the exchange of medical personnel, students and information between Kenya and AMPATH’s North American partners. Her extensive research has focused on medical education and she played an instrumental role in the initial conceptualization and formation of the IU Center for Global Health. As a member of IU CTSI’s Global Health Innovations Exchange Unit and the associated Global Health Research Executive Committee, she advocates for reciprocal innovation, or taking lessons learned in one place or to address one problem and applying them in other areas of for other problems.

“In both Kenya and Indiana, community health workers are lay workers who come from the community they serve. They have grown up in the community and they know the nuances of what it is like to live in the community,” said Dr. Litzelman. “Community health workers are well-trained to connect people with resources and be health coaches without the perceived barriers that might be present within the health care system or with others in positions of authority,” she continued.

Dr. Litzelman said that 15 percent of mothers in WeCare were self-reporting concerns about or use of illicit drugs which presented an opportunity to expand the use of community health workers in a new way. This extension, called Care Plus is now supporting women this substance use disorder and new mothers with babies suffering from neonatal abstinence syndrome (NAS) due to drug use during pregnancy. The program at IU Health Methodist Hospital is one of 16 pilot projects selected to receive nearly $1 million during the first phase of Indiana University’s “Responding to the Addictions Crisis” Grand Challenges initiative. The Richard M. Fairbanks Foundation provided an additional grant of more than $840,000 to focus on mother-baby dyads who have experienced NAS.

Earlier this month, The Regenstrief Institute launched a new podcast entitled “The Problem.” The inaugural season will contemplate the opioid crisis from many angles. Episode 3 called “Boots on the Ground” highlights the way the WeCare and Care Plus programs are modeled after Kenyan community health workers. The episode features Dr. Litzelman and a local community health worker and is accessible online or through most podcast platforms.

“Developing a network of community health workers who can meet patients where they are has been crucial to AMPATH’s population health work in Kenya,” said Dr. Litzelman. “Creating a similar system that is helping mothers and babies in Indiana shows us again that we can always learn from each other which is the essence of reciprocal innovation,” she concluded.

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