Achuman Emoni stretches her hands, illustrating the vast distance she has travelled to reach the health facility today. She comes from beyond the rugged Teremkus Hills, a journey that takes hours on foot. The sun is relentless in Turkana, but she braves the heat because today is the only day this month she will receive specialized antenatal care.
At four months pregnant, this is only Achuman’s second antenatal visit. She knows now, more than ever, how important these check-ups are.
“This is my third pregnancy,” she says softly, adjusting the layers of brown beads around her neck. “A year and a half ago, I lost my baby at six months. I was doing a lot of heavy work including building, fetching water, cooking. That is our way in my community; women carry the hardest burdens. When I miscarried, I was devastated. At the time, I didn’t understand how crucial these visits were.”
Figure 1: Achuman Emon during the interview with Amref Health Africa at Teremkus Dispensary for the MDT outreach.
“The beauty about today is that first I did not need to travel for an added 30 Kilometers to get our urine tested. Normally, we can only get tested at the sub-county hospital. During the last pregnancy, I did not have any money so I did not go. Secondly, I got to see the baby before it was born. It felt so nice seeing the life I am carrying” she proceeded in Aturkana.
Today, at the Teremkus Dispensary, Achuman undergoes antenatal profiling, urinalysis, nutrition assessment, and critical screenings for non-communicable diseases as part of Multi-Disciplinary Team (MDT) outreach. The sonographer, Samuel Ejikon, studies the screen carefully before turning to her with concern.
“Your placenta is lying abnormally,” he tells her gently. “We need to monitor this closely. If it worsens, you will be referred to the sub-county hospital.”
The news unsettles Achuman, but she is also relieved. If she had stayed home, unaware of this complication, things could have turned out much worse.
As she steps out, she joins a group of women seated under the shade of an acacia tree. Their colourful beads glisten in the sun, laughter and conversation filling the air. Some braid each other’s hair, others cradle their growing bellies. They are here because of one person—Ekitela Nakior, their Community Health Promoter (CHP).
The Backbone of Community Health
Ekitela has been doing this work since 2006, when she started as a Community Health Worker. Over nearly two decades, she has seen the evolution of Kenya’s community health program.
“I feel empowered now,” she says, scrolling through her smartphone. “I started with no tools, no training and no salary. Now, I have a phone with the eCHIS app, which stores data on all pregnant women in my area. I get updates from the facility in advance, so I mobilize expectant mothers and educate them on why these visits matter.”
Figure 3: Ekitela Akior checking updating Achuman’s details on the eCHIS app,
But the job is not without its challenges.
“Households are far apart. Sometimes, I take a motorbike to reach them, but when I can’t afford it, I see fewer families than I would like. And my phone, once it runs out of charge, I have to go all the way to Lokichoggio town just to power it. That means days lost. We were trained to input data in real-time, but how can I do that if my phone is dead? If we had power banks, we wouldn’t have to stop our work.”
Despite these hurdles, Ekitela remains committed. Today alone, four of the women at the clinic came for MDT services because of her.
Strengthening Healthcare Through the PCN Model
The roving clinic Achuman and the other women attend is part of a broader effort to bring healthcare closer to hard-to-reach communities. In Turkana, where distances are vast and the terrain unforgiving, the Primary Care Network (PCN) model bridges the gap.
The multidisciplinary team (MDT) visiting today includes a medical officer, clinical officer, a lab technician and a sonographer and they were joined by the nursing officer, Community Health Assistant (CHA), Community Health Promoters (CHPs) and the Public Health Officer (PHO) from the facility. They travel from the sub-county hospital and the neighbouring Turkana West to dispensaries, ensuring that even the most remote villages receive quality care.
Immaculate Akiru, the nurse in charge, has seen the impact first hand.
“Today, we have seen 31 women, 12 of whom are here for their first ANC visit,” she says, flipping through the maternity register. “The free MCH booklets and mosquito nets are a great incentive, but beyond that, we are seeing improvements in maternal health indicators. These clinics help us identify high-risk pregnancies early, preventing complications for both mothers and babies.”
Samuel, the sonographer, nods in agreement.
“We do eight mandatory tests during ANC profiling. These screenings help detect anaemia, infections like hepatitis B and HIV, and even foetal anomalies. Many mothers don’t remember their last menstrual period, so ultrasounds are crucial in determining gestational age.”
Still, challenges persist.
“Sometimes, we lack essential commodities like lab reagents,” Samuel admits. “And with only one sonographer sourced from Lodwar, we are stretched thin.”
Reaching the Last Mile
As the clinic winds down, Achuman watches as Immaculate hands her a referral note. If her condition worsens, she will need specialized care. But today, she feels hopeful.
“If I had stayed home, I wouldn’t have known that I am a high-risk mother. Now, I have a chance,” she says, pressing the paper to her chest.
Her journey, like that of many mothers here, is a testament to the power of primary health care. The integration of CHPs, the MDT, and the PCN model is changing lives one visit, one diagnosis, one mother at a time in Lokichoggio subcounty.
The Transcend project funded by Royal Danish Embassy has made significant strides in improving maternal health by reaching an estimated 5,484 pregnant mothers through various interventions including outreaches, Multidisciplinary Team (MDT) clinics, community action days, and community dialogue sessions. To support these efforts, the project works with 441 Community Health Promoters (CHPs) across Lokichoggio and Turkana West ensuring strong community engagement.
Through MDT outreaches, 344 high-risk pregnancies were closely monitored, contributing to better maternal and new born health outcomes in the county. These interventions align with the organization’s mission to transform communities through Primary Health Care (PHC), with a special focus on women’s health, ensuring equitable access and the provision of quality services for those in underserved areas.
Nyambura Gitonga, Communications and Advocacy Assistant; Family and Reproductive Health, Amref Health Africa