It’s early morning at Mwala Clinic in Kenya’s Eastern Province, and everywhere you look women and babies are crowded onto wobbly wooden benches. Mothers coddle and soothe infants, rearranging colorful blankets and knit caps, while toddlers lean against their mums’ bright cotton skirts. Many of these women have traveled dozens of miles to bring their children for vaccinations, and they expect to spend much of the day waiting in this packed room.
Whatever the reason for their visit, the mothers’ presence in this cramped space underscores the importance of a client-centered, integrated approach to health. This is an opportunity to provide the most comprehensive package of health services possible: education on nutrition, breastfeeding and weaning; HIV counseling and testing; family planning services; cervical cancer screening; and so much more.
The two harried nurses do their best to serve the growing throng until a big, white, four-wheel drive truck pulls up, dragging a mysterious boxy trailer behind. A team from Kitui District Hospital arrives with their health clinic on wheels—a one-stop shop of holistic care that affords privacy for patients and a cadre of medical specialists to attend to their individual health concerns.
The “health wagon” is yet another innovative initiative in community health outreach under the AIDS, Population and Health Integrated Assistance II Program Eastern (A2E), which is funded by the U.S. Agency for International Development (USAID) and managed by Jhpiego in collaboration with five partners and the government of Kenya. This innovation was designed to attract and retain as many clients as possible by meeting a range of their health needs in a single visit.
No Missed Opportunities
“Because it’s so difficult in Eastern to get to clinics, when patients do come, they expect everything to be done,” explains Dr. Leonard Okoko, the District Medical Services Officer based in Kitui District. “When we refer them to other, even farther, facilities for basic things like family planning, they just don’t go—and they end up having a baby every year.”
To solve the problem, the government-led outreach team targets isolated clinics serving large populations in areas where immunizations and use of family planning services are weak, he says. A nutritionist, gynecologists, nurses, a pharmacist, a district public health officer and A2E team members plan the event weeks in advance and begin preparing the equipment and mobile pharmacy. They work with local chiefs and community health workers to spread the word about the date of the outreach and the services that will be offered there.
When the team arrives at the facility they set up stations to manage client flow and delegate tasks to the team members. They may use clinic rooms, tents, churches, mosques, schools and other facilities nearby. The cadre of experts offers everything from nutrition counseling, to HIV counseling and testing, family planning and solutions for a variety of health concerns.
The team approach worked well to integrate certain services with immunization, such as TB screening and treatment and antiretroviral treatment, but there was still a gap.
“Family planning was still a problem,” says Okoko. “These are populations that need long-term methods—IUCDs and implants. It’s just not practical for them to be dragging to the clinic every three months for short-term methods. You can only do so much with curtains and tents—these are intimate procedures, and you have to create privacy.”
But how to do it effectively and practically? The answer came when Dr. Kenneth Chebet, the A2E Project Director, spotted a customized insulated truck one day, and noticed who had made it. The company was then hired to manufacture the health wagon.
Dr. Ruth Jahonga, an obstetrician on the A2E team, said the wagon has transformed her work. “First, we have enough space to pack all of the equipment that we need. Second, because the equipment stays in the wagon, we can control inventory and secure our materials much more effectively.”
But the best part, she says, is how it has changed things for the clients. “At first they are very curious, but when they step into the wagon, they just smile. It’s clean and cool and peaceful. I see them relax, and they can share their problems without worrying the whole community will hear them. They can be honest about their sexual activities, and then we can provide appropriate care and counseling,” says Jahonga. “When they get out they are so happy, and they go and tell their friends who are waiting that it’s so nice—they look forward to going into that wagon!”
The only problem with the wagon is that there’s only one.
“I wish there were five of these for Eastern,” says Okoko. “If we could have many of them going every day, it would make a real difference. We could take them everywhere—not just to facilities. With the caravans, we could create a clinic anywhere. . . . ”