The K-MET approach of Training, Equipping and Support Provision (TESS)

THE K-MET APPROACH

Since the ICPD conference in Cairo in 1994, the move towards fully integrated reproductive health (RH) services has been widespread, with many organizations offering comprehensive clinical services. However, K-MET offers a different approach, a 5-step intervention process that is upstream and innovative. The model consists of these five, progressive steps:

The focus on addressing systemic gaps in service, sustainability, education and training combine to make the K-MET model an important tool in improving RH services while simultaneously strengthening the human resources capacity of Kenya. The following framework briefly describes the 5 steps, using examples from each of the K-MET’s main projects to illustrate the process. While the projects that K-MET has implemented in Kenya respond to specifically local health needs, the 5-step process is highly adaptable and can be used to address a wide range of RH health needs in a variety of community settings. Among other K-MET programs, Home based care, Nutrition and care of the OVCs is the most recent intervention due to the identified need in the community served.

STEP 1: IDENTIFICATION OF SYSTEMIC GAPS IN RH SERVICES

The foundation of all of K-MET’s work is the desire to respond to fundamental deficiencies in reproductive health care delivery systems. Thus, the very first step in any project undertaken by K-MET is a careful analysis of unmet needs in a targeted community. But K-MET does not just look at a specific community in isolation. Rather, the approach is more long term, identifying areas that existing health services have been systematically overlooked throughout the region.

In 2003, the Home Based Care and Nutrition projects grew out of the recognition of a major gap in reproductive health services. With the specter of HIV/AIDS taking a growing toll on local communities,

K-MET identified the need to address the overburdening of local hospitals with HIV/AIDS patients as well as lack of access to good medical care in underserved and hard to reach areas. Many patients in the semi –urban/slum communities surrounding Kisumu, unaware of their HIV status, were unable to reach treatment centers, and were unable to afford treatment for the recurring opportunistic infections. At the same time, the local district and provincial hospitals were overrun with patients who needed basic psycho-social, nursing, medical or palliative care which could be provided in the community.

During the implementation of the Home Based Care project, it was noted that patients were unable to tolerate TB, Malaria and ARV treatment regimens due to lack of adequate food. Many patients abandoned/discontinued their medication and died as a result of poor food security and malnutrition. This is an area where malnutrition is still rampant among adults and children due to the scourge.

STEP 2: IDENTIFICATION OF AVAILABLE LOCAL RESOURCES

The second step in the K-MET model is to identify and seek out all available resources for facing the challenges identified in Step 1. This step often requires the members of K-MET to “think outside of the box”, or to look in unexpected, non-traditional places for human and material resources. It is precisely this willingness to think creatively that has made many of K-MET’s projects successful.

K-MET used the Network providers and community based service providers (CBSPs) to identify local resources available to address the challenges faced by People Living with HIV/AIDS (PLWHA). Using the increasingly popular approach of home-based care, K-MET has trained a large number of CBSPs to identify potential clients in their community, encourage VCT, diagnose and treat common opportunistic infections, refer appropriately, offer supportive counseling and promote and provide supplemental nutrition for clients on ARV or TB treatment with the Network. This approach recognizes and utilizes the valuable human resources within the community and helps build a stronger and more cohesive community involvement the process of caring for PLWHAs and OVCs.

The NutriCare program, an outgrowth of the HBC program to address the food security and malnutrition, is another excellent example of K-MET’s commitment to using locally available resources to solve problems in underserved communities. One of the main challenges identified during the implementation of the HBC program was food security among infected and/or affected households. Led by a staff nutritionist, K-MET conducted a community survey to identify the available cereals and legumes in the area. The survey results showed that there is lots of rich food staff tat can be used to address this gap. Using the available resources K-MET developed supplementary flour that can be made into a highly nutritious porridge or Ugali. The flour itself is processed using only locally available cereals, legumes and fruits, which is ground, packaged and marketed by the K-MET staff. The emphasis on using local products ensures that the flour is both palatable and affordable for clients. The HBC workers distribute the Nutriflour as a tool to encourage their clients to complete their treatment regimens and/or supplement the diets of their families. In addition to the Nutriflour is designed to help HIV/AIDS patients with their medication regimens (K-MET Extra), K-MET has also developed a formula for supplementary feeding of children (K-MET NENE) specially in the PMTCT programs/weaning formula. And one for healthy individuals who want to supplement their existing diet is called K-MET Afya, also used to feed the orphans and the vulnerable children recruited in the program. K-MET has set up a Nutricare centre where the clients come for review and monitoring by the project Nurse and the Nutritionist. The team also goes out reach to give health talk in the community, schools and supports centres in the surrounding health facilities.

STEP 3: EDUCATION AND TRAINING OF APPROPRIATE WORKFORCE

Once the problem and the resources have been identified, the third step in the K-MET framework involves educating and training the appropriate workforce for the planned intervention. This step forms the heart of the model as it empowers community members while simultaneously improving the human resources capacity of entire communities. Based on a pyramidal model, K-MET’s training touches every level of society, from Community Based Service Providers to highly trained medical specialists in the K-MET pyramidal model. This systematic approach allows K-MET’s projects to have far-reaching and lasting effects within and between communities.

Currently over 750 community health service providers throughout Kenya have been trained by K-MET to provide home-based care to those in need, including those infected with HIV/AIDS, malnourished individual. CBSPs are trained in a variety of areas, including identifying the sick members of the community, Counselling, Nursing care, referring individuals to local clinics for HIV/AIDS testing or care when needed, providing health education in their respective communities, and distributing and administering NutriCare to those in need. CBSPs are also instrumental in conveying to K-MET the needs and challenges of the community and orphans, which enables the organization to tailor their outreach programs accordingly. They are also trained on youth issues to enable then deal with OVC in their communities.

CBSPs attend yearly refresher courses that ensure these volunteers are equipped with the latest health information and tools. This forum also allows the volunteers to share their challenges and accomplishes with other CBSP, which enables them to talk about and improve their own work in the field.

STEP 4: DEVELOPMENT OF COMMUNITY AND PROFESSIONAL NETWORKS

In order to sustain the momentum gained during initial training interventions, K-MET is dedicated to building community and professional networks among its members. for effective Linkage, networking and collaboration.

While these networks can be useful for professional purposes, they are also an important tool for building a sense of community and collective purpose among reproductive health workers.

K-MET holds an annual Providers’ Network meeting involving all members and stakeholders. Any individual who has participated in K-MET training is invited to participate in this annual gathering, which is rotated in the regions to allow good attendance and commitment. Beyond the opportunity to liaise and collaborate with each other, the Annual meeting provides the forum for the development of any Provider Network. Having trained both public and private providers, K-MET often acts as a liaison between government employees and private providers, creating links between otherwise uncommunicative groups.

K-MET believes in the importance of collaboration with existing health and community organizations within individual communities. Community based service providers often work intricately with local hospitals, churches, schools, and other organizations that are also dedicated to improving the health status in their communities.

STEP 5: ENSURING PROJECT SUSTAINABILITY

As with any non-profit organization, K-MET spends considerable time and energy on raising funds to continue its projects. Unfortunately, funding for reproductive health programs is especially vulnerable to changes in the political climate, domestically as well as internationally. This precarious situation has forced K-MET to take the issue of sustainability very seriously, and while “Ensuring Project Sustainability” is the last step, it is perhaps the most crucial and starts from planning as well.. Building a creative sustainability plan into every project is therefore an essential part of the K-MET framework

In 2004, K-MET introduced Revolving Loan facilities (Microfinance) for Private Network Providers as one of its Sustainability strategy. The loans are being made available to the providers to enable them to make small improvements to their clinics and services as part of quality control. Loans have been used for a variety of activities such as purchasing beds for patients, drugs, lab equipment, painting or renovation.

In addition to the Revolving Loan program, K-MET has also recently introduced series cost-sharing programs to ensure that portions of K-MET’s programs are self-sustaining. In all these trainings, the participants cater for their transport, accommodation and 50% of the tuition.

Loans are also made available to CBSPs as incentives for them to continue their essential work as volunteers in their villages and help to alleviate poverty within their communities. These loans are typically used to expand and improve the quality of services offered and improve their living standards and the Orphans and the Vulnerable Children left behind. A number of the CBSPs have started some small businesses and food security projects including poultry, pig rearing and fish ponds. The community has been actively involved in the care of OVCs especially during the feeding days when they mobilize resource and assemble in one venue to feed the OVCs on selected days when K-MET team joins them to offer the Technical assistance /education on how to prepare nutritious food and offer the nutria-flour supplements.

The K-MET project has therefore been an incubator of innovative models and best practices in community health and community development that are sustainable and replicable.