Village HopeCore International

Rural communities lack access to quality healthcare and information. Globally policies and leaders are pushing for universal health coverage without a clear roadmap on how to achieve it. Village HopeCore International is committed to providing quality health care and information in rural communities to help achieve universal health coverage. 

For 20 years, HopeCore has empowered the community through the implementation of innovative solutions. HopeCore is strengthening the role of community health workers through knowledge building, skills development, and the provision of digital and analog tools. HopeCore digitally empowers CHWs and provides them with training and educational job aids that strengthen their capacity.

Due to their potential reach and proximity to high-need populations, CHWs contribute to improving community health outcomes and could help attain universal health coverage. HopeCore’s cost-efficient CHW strengthening program would change the lives of children and parents today and affect the health outcomes for the next generation. 

As stated in the challenge, COVID-19 has highlighted the overwhelming lack of readiness when it comes to facing a pandemic globally. Working in rural Kenya for the last 20 years, we were already aware of this problem. In our community, children under five are still disproportionately dying due to diarrheal disease. Quality health information and services are lacking in the community. 

Additionally, COVID-19 has created a sense of fear around health facilities due to possible transmission, therefore, now more than ever, we need to equip last mile health providers with the necessary tools and information in order to prevent the spread of misinformation and disease and empower community members to care for their health and that of their families. 

Rates of childhood immunizations around the world decreased during COVID-19 which could lead to outbreaks of disease and illness in our rural communities. For example, globally, uptake of the measles vaccine initially decreased by 93%. On the other hand, with HopeCore’s CHWs in the field, Vitamin A and deworming adherence for children, 6 mos to 5 years increased. 

HopeCore aims to address the issue of insufficient knowledge and resources in the community by training and equipping community health workers.

HopeCore’s solution equips community health workers with the knowledge, skills, and tools to deliver health information and services to the communities they serve. Our continuous process of in-service training, learning through doing,  financial incentives, field gear supplies, appropriate monitoring, digital empowerment, and regular supportive supervision and evaluation have contributed to increased knowledge and skills in CHWs and better health outcomes in the community. The combination of a high-tech and high-touch approach to CHW training, supervision, and evaluation is what sets HopeCore’s approach apart from the other CHW training programs in existence. Additionally, through digital empowerment, CHWs are equipped with mobile tools that aid in decision making, improve data collection for decision making, and provide ongoing support right at the CHWs’ fingertips. 

CHWs have the potential to advance progress to UHC through regular home visits, delivery of specific preventative, promotive, and curative health services, and regular referrals to area clinics. Through the combination of digital and analog tools and an innovative approach to training and learning by doing, CHWs are able to address more complex health challenges in their community thus leading to better health outcomes. 

HopeCore’s solution currently and in the near future will serve rural communities in Tharaka Nithi County. The solution is cost-effective and replicable so has the potential to serve rural populations across sub-Saharan Africa and beyond. Well-trained and equipped CHWs will provide basic healthcare services and health critical health information. In resource-scarce settings, like where we work, CHWs have the potential to make important contributions toward improving access and utilization of primary healthcare services. 

Our target population is people living in extreme poverty and the rural communities in which they live. Currently, rural communities in Kenya lack access to quality health information and reliable health services as clinics are spread out and often undersupplied. With the compounding effect of COVID-19 leading to distrust of health facilities and the ability to remain healthy after attending a health facility, community members need access to quality health services and information closer to home. 

Not only is the community currently underserved but so are the CHWs. In order to set the CHWs up for success, we need to invest time, money, training, and resources into them and their work. The CHWs are crucial in our mission of improving health in our target communities, they conduct health promotion activities such as health education, tracing of immunization and chronic diseases defaulters, nutritional assessments, and referrals. To enable them to perform these functions more efficiently they require sufficient skills, knowledge, and resources. Traditionally, the CHWs in our area receive one 5-day training certification and then ad-hoc training updates throughout the year depending on what funding has trickled down into the community. HopeCore’s approach builds on the initial training to offer ongoing training, support, bi-directional feedback, and evaluation. Utilizing a campaign-style approach with flip books as job aids, CHWs receive targeted training and learn by doing. The learn by doing approach increases the knowledge retention in the CHWs, improves the education offered to the community, and allows the CHWs to take ownership of their training. 

HopeCore conducted an initial training with 188 CHWs in January 2020. The training was packaged in 7 modules supporting the CHVs administrative and advocacy work, offering basic information on disease prevention and referring clients. It was through observation and feedback during this 5-day training that HopeCore and the CHWs recognized the need for an innovative approach to continued education and training. 

Furthermore, through monthly feedback meetings, HopeCore gains a better understanding of the needs of the CHWs and is able to incorporate new features into the program. We also equip the CHWs with smartphones to help them key in their data which can not be lost for our monitoring and evaluation. The CHWs can access health information on their smartphones as well. Through the monthly feedback meetings, we can make changes to the application loaded onto their smartphone to ensure that we are collecting the right data and helping the CHWs work more efficiently in their communities. 

The CHWs also use the monthly feedback meetings and digital application to share information about the community with HopeCore. The CHWs can inform HopeCore of disease outbreaks, myths circulating in the community, or general challenges the community is facing. HopeCore, the CHWs, and the Government (Ministry of Health and/or Ministry of Education) can then work together to respond to the challenges in the community.

HopeCore’s solution addresses the first and third dimensions of the challenge. We are employing an innovative approach to training CHWs and equipping them with digital and analog tools. Through increased attention and support, CHWs are educating their communities. The educated communities that have embedded, informed CHWs are able to prevent the spread of misinformation. HopeCore and the CHWs are empowering and inspiring individuals to protect themselves and their communities from existing and future health challenges. For example, communities with HopeCore CHWs have higher rates of immunizations and more handwashing stations than those without HopeCore CHWs.

To understand the practices, motivations, and experiences of CHWs in Mwimbi and Muthambi Sub-Counties, we explored their current role in formal and informal behavior change initiatives and examined their capacity to deliver behavior change interventions. We conducted a pilot study among 49 CHWs in 2018. This study involved a broad investigation into the barriers and facilitators facing CHWs as well as targeted research focusing on CHW capacity building to change behaviors in the households and communities where they work. We then expanded to serving 200 CHWs. These 200 CHWs have been using the data collection tools and closely working with us for two years. 

Within the context of COVID-19, the County government asked us to absorb 600 additional CHWs. The year 2020 served as a one-year field test of our solution. The solution seeks to expand to the rest of Tharaka Nithi County and is poised for growth and sustainability.

HopeCore's approach to equipping community health workers and stopping the spread of misinformation in the community is innovative because it is both high tech and high touch. We build relationships with the CHWs through ongoing supportive supervision and feedback meetings. We have accomplished the development of a robust feedback loop that could be replicated across sub-Saharan Africa. 

Our approach to training is also innovative. Rather than training CHWs once and expecting them to retain and share broad health information. We use a campaign-style approach with specific job aids for each campaign. Through repetition, and learning-by-doing, two proven learning strategies, the CHWs are better equipped with quality health information and knowledge. Additionally, the information they are sharing with the community is quality and standardized. The supportive supervision offered also helps to act as a quality assurance mechanism. 

The mobile application we have developed through CommCare allows us to report to the Ministry of Health the necessary information for the KHIS while at the same time can be quickly changed or adapted to a local context. With feedback from the CHWs on diseases or symptoms they're seeing in the community, we can rapidly deploy questions to CHWs that can provide an early warning on disease outbreaks. The app also includes ongoing, supportive, health information. 

While some programs focus on high-tech solutions and others attend to the relationships, we are innovative because we have combined these two proven approaches to create a solution that is innovative, cost-efficient, scalable, and replicable. 

Current: 

• number of CHWs: 800 
• number of direct beneficiaries: 272,473

One Year: 

• number of CHWs: 1200
• number of direct beneficiaries: 393,177

Five Years: 

• number of CHWs: 3000
• number of direct beneficiaries: 1 million

We measure our progress using the community referral forms, MOH514, health facilities registers, KHIS, feedback, and success stories we get from the CHWs. This helps us to evaluate the progress in terms of reduction in diarrhea cases among under-five children, increased health-seeking behavior, improved hygiene in the community, and community having confidence in the health care services provided.

Community access to quality health care services and information is the key indicator we are using to measure the progress.

Examples of some of our measurable indicators: 

• Number of CHWs trained
• Number of household visits
• % of homes with functioning handwashing stations
• % of children under five up-to-date with immunizations

1 Medical Director - full-time volunteer and Board Member - based in the US

1 expatriate technical consultant - based globally

6 full-time staff who spend a portion of their time on this project 

5 full-time staff serving 100% on CHW project 

800 CHWs

Our team is extremely well-positioned to deliver this solution. 

Our Founder, Kajira Mugambi, is from Chogoria, Tharaka Nithi, Kenya. He personally witnessed the effects of health insecurity with family members dying during his childhood due to preventable illnesses. He was able to access quality education in the United States and became a lawyer before returning to his birth village to start Village HopeCore International. His vision and leadership guide the activities of the organization. He currently lives in Chogoria.

Faith Kainyu, the CHW program coordinator is from Chogoria, Kenya. She has worked with HopeCore for 7 years, lives in the community, speaks the local language, and ensures that the CHW's voices are heard at the organizational level. She is featured in the pitch video.

Naomi Nyanchama, Director of Operations, and Echesa Walter, Public Health Program Manager & Community Health Nurses are both Kenyan and have extensive professional community health and leadership experience.

Our Medical Director, a physician, has 30 years of experience consulting in Global Health on all seven continents. He has been actively involved in HopeCore since its inception and has been following health trends and guiding HopeCore's work for over 20 years. 

Personally, I have worked with HopeCore for seven years and lived in Kenya for 12 and Chogoria for 4 years. I have a Master's Degree in Health and Development and Learning Engineering that I am able to utilize to help develop innovative training approaches for diverse populations and monitoring and evaluation tools. 

HopeCore's bylaws state, 

"Human Rights, Diversity, Equity, and Inclusion

HopeCore shall adhere always to the requirements of all laws protecting the Civil Rights of all communities.   HopeCore is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. HopeCore is also committed to compliance with all fair employment practices regarding citizenship and immigration status."

This statement also guides our leadership team. 

We recently underwent a Board review and recognized the lack of women's voices on the Board of Directors and therefore have started recruitment for women to our Board. We also have a Kenyan Board of Directors comprised of individuals from Chogoria to ensure that we have local governance. 70% of our CHWs are women, within HopeCore we have multiple Kenyan tribes represented despite being in a relatively homogenous area. 

This solution's leadership team is primarily composed of women. In line with Solve's core values, we aim to make our solution open source so that anyone can access it regardless of geographic location or financial means. We also focus on human-centered solutions as demonstrated by our robust feedback loop and regular iteration. 

First and foremost, Solve can help amplify our work and solution. Time and time again, when organizations and people visit us they say, "we had no idea you were doing this much!" This statement has made it clear to me that we are not doing a good enough job showcasing our work and getting our message out there. We have created a replicable program that if showcased has the potential to impact millions of lives. 

Furthermore, as we scale, we need help! There are people, mentors, and peer organizations who have done this. We are an organization in adolescence, we know what we're doing works but we need a little help in navigating the roadmap to adulthood. Whether we're looking at our monitoring and evaluation systems or our governance structures, we could use input and mentorship to ensure a strong foundation to build on our sustainable impact. 

When I, and the organization, participated in the GSBI healthymagination accelerator, we met other organizations working in the same space that we have continued to work alongside. We hope to meet more of these organizations through MIT Solve so that we have a strengthened network of like-minded organizations working toward a more equitable and healthy world. 

And finally, as always, we're looking to expand our donor pool. We have found that the most impactful donations come through personal references. We hope that by expanding our network of partners and funders we can have a greater impact on our community and others. 

Human Capital: We are currently undergoing a review of our Board. We would like continued support in this area as we move to a new phase of organizational development, professionalism, and strength. 

Financing: We would like assistance in pitching to investors or angel investors. We would also like to expand our donor pool. Additionally, we could use support in understanding how to develop some type of endowment for the organization. 

Public Relations: As stated previously in the application, we want to amplify our voice. We recently completed a redesign of our website and logo, but we could use help in our global media strategy. 

Monitoring and Evaluation: We need help in better demonstrating our impact. We've collected so much data and can anecdotally talk about impact, but we want help strengthening how we talk about our impact. 

Technology: We use Dimagi's CommCare application. We could use support in reworking this to be more efficient and replicable as we scale. Also, connecting this to some type of impact data visualization is another project we've been working on and would appreciate support in. 

We are working to develop online courses that will help us to spread our approach and train organizations on our approach and help them to implement it. MIT Open Learning or the Learning Engineers at MIT could be helpful in this process. We would appreciate their support in setting up an online community health worker academy for individuals and organizations. 

Anyone at MIT or Solve Members who have experience with CommCare could help us to advance how we are currently using it to make it more efficient. 

Anyone at MIT or Solve Members who have global health experience could help us to evaluate or solution to demonstrate the impact we have had and hopefully we could use those results to train other organizations on how to have the same impact. 

Over 70% of our CHWs are women and this has offered them a source of income, developed their skills in health, and ensured they are engaged in public forums. The CHWs are seen as leaders in their communities and are included in health decision-making with 70% of them being women. We are improving inclusion in community decisions. The CHW approach to offer KEPH tier 1 services has enabled vulnerable community members to access affordable health care. The CHW approach also helps to put family planning in the hands of rural women; family planning empowers women to plan their families and engage in work.

While we do not currently work within the context of supply chain issues, we do equip last mile providers and community health workers with technology that would allow them to contribute to this cause. With the proper support, we could train CHWs on how to report on availability and stock-outs. Because we are already working with 800 CHWs in the County our involvement in a project like this would help streamline the training and support of the CHWs. Rather than the CHWs in the County having 3 phones from all of the different organizations they work with, we could help leverage our existing relationships with CHWs and local facilities to set up a replicable system of reporting on essential medicines.