In the town of Njoro in Nakuru County, Kenya, WASH First-trained community health volunteers are visiting households like Mary Wanjiru’s to strengthen COVID-19 and safety protocol and measures county-wide. These efforts are part of a COVID-19 concerted response led by the local government, with support from the Government of the Netherlands, SNV and Kenya-based civil society organisations. Today, households like Mary’s now have handwashing stations in front of their homes, with visual instructions on how to wash hands properly.
‘Wash your hands for at least 20 seconds with soap and water.’ According to the World Health Organisation (WHO), ’frequent and proper hand hygiene is one of the most important measures that can be used to prevent COVID-19 infection and spread.’
In Nakuru, door-to-door campaigns are proven to be effective methods in reaching rural households with behaviour change messages. As many societies, there are groups who have traditionally been excluded from public life, e.g., elderly people, people with disabilities, and low-income households. Exclusion is manifested in many ways, including for example, their absence and/or limited participation in town hall meetings. COVID-19 has done nothing but to exacerbate the already limited movement of traditionally excluded groups, and their opportunities to access public services. By visiting the homes of people (and with their consent), the partnership continued to make sure that messages reached all household members at a time when town hall meetings and gatherings were discouraged.
Proper handwashing at home with visual instructions on facility
Community health volunteers in BCC and COVID-19 training
Incentivising community volunteerism
There is no better way to gain the confidence and trust of behaviour change ‘target’ groups than engaging the help of individuals who share in their realities. Trust is key. Applying the first two components of the five-part behavioural change methodology of SNV , a group of ten community health volunteers were trained on the subject of COVID-19 prior to the door-to-door visits. The training activity was organised jointly with the Department of Health and the civil society organisations network, and facilitated by the Sub-County’s Public Health Officer.
The trainees are community health volunteers who typically have a wide network, and hail from the very villages they operate in and serve. They are well-acquainted with the social and financial struggles of many households. They themselves have their own families to look after, but they believe that it is important to look after each other and maintain a sense of community. Based on the experience of the volunteers trained by the project, they emphasised that they ‘needed more time to reach all households.’
Learning how to care
Beyond the standard prescription of washing hands properly, maintaining physical distance, and wearing a face mask effectively in public places, volunteers tackle COVID-19 misinformation and disinformation. In rural contexts where incomes are often low, access to healthcare is limited, and knowledge about COVID-19 is relatively lower, the household becomes the first line of defence for members who fall ill. During door-to-door campaigns, volunteers share tips on how to care for members with mild COVID-19 symptoms. The volunteers also engage in conversations that address growing stigma against household members who fall ill.
Through trainings, sensitisation, frequent visits and encouragement by MoH [Ministry of Health] staff, community health volunteers work lead to proper homebased care and isolation, and minimises stigma and discrimination. In cases where space is inadequate due to poor living conditions, having a better understanding of how COVID-19 spreads have encouraged households to search for alternative rooms to safeguard their loved ones from contracting the disease. – Community Health Strategy Focal Person, Njoro sub-county
Sustaining improved hygiene behaviours
Mary is grateful for the lessons imparted to her by community health workers through the door-to-door campaign. Whilst she did validate the importance of these visits, she also expressed a concern over the need to sustain improved hygiene behaviours.
‘People’s awareness about COVID-19 will definitely increase because of these visits. People around here do know about COVID-19 and its dangers, but because most of the cases are in the capital Nairobi, some have grown very relaxed about it.’
For the WASH and health sectors, although the urgency of COVID-19 is likely to reduce, human beings will always be faced with the risks of disease spread. It goes without saying that improved hygiene behaviours must evolve into a way of life.
Contributors: Bendy Kipchoge, Robbert Neijenhuis and Reinilde Eppinga
 This blog reports on implementation of two of the five behavioural change components being implemented by SNV’s WASH First team. These include, (1) training of healthcare workers including community health volunteers; county education staff, teaching and non-teaching staff; chiefs and sub-chiefs; and civil society network members; (2) sensitisation campaigns through door-to-door household visits, schools, markets, transport hubs and other public places; (3) mass-media awareness campaigns, using local radio networks and social media; (4) improve access to commodities such as soap and disinfection equipment; and (5) improve access to WASH services and facilities, e.g., handwashing stations and toilets.