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Kenya's Eastern province is made up of districts that are arid and semi-arid characterised by frequent droughts, famine, disease outbreaks like aflatoxicosis, malaria, pellagra (a malnutrition related disease) and diarrhoea.

The busy Nairobi-Mombasa highway transects the districts from north to the south and has influenced the high incidences of sexually transmitted infections (STIs) and HIV. The indigenous people are mainly subsistence farmers who also keep small herds of animals and bees. Health indices are poor with an infant mortality rate of 50.3% and an estimated HIV prevalence of 4.6% among the general population and 4.6% among pregnant women.

AMREF is implementing an integrated intervention to reduce the impact of HIV and AIDS and to improve the quality of life for people living with HIV/AIDS in this region by increasing the capacity of the health system to provide HIV prevention, care, support and treatment; increasing HIV/AIDS awareness and prevention in the communities and strengthening the capacity of the communities to take care of their own health through education and information.

Working in partnership with the goverment through various ministries, other NGOs and the community, AMREF has:

• initiated and supported the implementation of the community strategy in 5 units with a total of 25,000 beneficiaries
• strengthened the capacity of 53 sex workers to prevent HIV infection
• built the capacity of 233 community health workers and volunteers to provide health education, first-line/primary care and referrals
• provided 200 community health workers with a bicycle each to ease their movement while providing services within the communities
• trained 12 community health extension workers
• provided 4 community health extension workers with motorbikes which are fully fuelled and serviced by the project to enable them supervise the community health workers effectively
• built the capacity of 30 community health workers and provided them with home based care kits based on national guidelines
• built the capacity of 50 people living with HIV in community home based care to deliver care to patients at home
• renovation of two health-pit latrines and the installation of plastic water tanks currently benefiting 10,000 beneficiaries
• trained 60 health care workers in integrated management of adolescent and adulthood illnesses
• trained 30 health care workers to provide quality and comprehensive prevention of mother to child transmission (PMTCT) services
• developed the capacity of 30 health care workers to provide and scale up much needed Paediatric HIV services including Anti-Retroviral Therapy services
• developed the capacity of 200 community health workers in growth monitoring and nutrition to detect malnutrition within the community using Mid Upper Arm Circumference (MUAC) tapes
• reduced immunisation defaulters by 95 % through effective health education and defaulter tracing by community health workers
• reduced the stigma associated with HIV through working with people living with HIV in community post-test clubs and community home based care
• noted a reduction in diarrhoea cases by over 98% due to improved pit latrine coverage following health education by community health workers.

Lessons Learnt

• There is a lot of potential and willingness within the communities which if well facilitated, can empower them to improve on most of the social determinants of health.
• The community strategy and its structures can be effective in reversing negative trends witnessed in the health sector, for example improving immunisation coverage up to 100% and the reduction of diarrhoea cases due to knowledge and practice of water treatment techniques.
• With political will, the community strategy can improve the health status of communities through motivation of community health workers. The community has the potential to alleviate food insecurity if provided with water for irrigation.