The Tujengane project trains community health volunteers in Kenya to become healthy entrepreneurs. As such they provide reliable HIV and SRHR information. At the same time, they act as mobile pharmacies by providing basic medicines and supporting products, such as soap, condoms, and washable sanitary pads. It enables them to make a living while the community profits from health services close by.
Initiated in four sub-counties of Homa Bay, the activities are currently replicated in three more regions. The scale up introduced HIV self-tests in the entrepreneurs’ basket, with the aim to research the acceptability and cost effectiveness in a community setting. Tujengane is a Kiswahili word meaning ‘Let’s support one another’. It’s a collaboration of Healthy Entrepreneurs, Women Fighting AIDS in Kenya (WOFAK) and Aidsfonds.
Tujengane assesses the potential of the Healthy Entrepreneurs last-mile delivery model in Western Kenya. Through an expanding network of entrepreneurs, the project aims to increase HIV testing and prevention, use of modern contraceptives, health knowledge and the availability of health commodities, and reduce stigma. This contributes to a sustainable long-term solution that supports in creating healthy and well-informed communities as well as a livelihood for the entrepreneurs.
Community health volunteers and their community members
In Kenya, more than 1,6 million people are living with HIV, which represents 5.4% of the total population. Homa Bay, Kisumu and Siaya are among the highest HIV prevalent counties of the country.
Poor health systems and low access to information and services contribute to high risk of HIV, early marriages, unplanned pregnancies and gender-based violence. Low levels of employment opportunities in the region result from gender inequality, poverty, high school drop-out rates, poor education in general and low number of formal jobs. This leads to high levels of transactional sex and low negotiation power of girls and young women to demand safe sex.
Long distances to testing facilities, lack of privacy, and fear of stigma and discrimination are key barriers to HIV testing. Self-testing can play an essential role in addressing these barriers by providing a discreet, convenient and confidential way to test for HIV.
In 2018, a total of 292 were trained to become a community health entrepreneur in four out of eight sub-counties in Homa Bay: Suba, Ndhiwa, Mbita and Rangwe. In 2019 an additional 572 new health entrepreneurs were trained and active in three counties of Kenya: Homa Bay, Kisumu and Siaya. In 2020 COVID restrictions interrupted the training schedule. Still, in 2021 another 320 entrepreneurs have been trained, with which the total number targeted for at the start of the project has been met.
An estimated 1,200,000 people have been reached by the entrepreneurs with health services and products in the past two years. During the same period, a total of 326,100 products were purchased by the entrepreneurs, in their turn to be sold to community members. Throughout the project they distributed 96,864 (free) male condoms.
The current focus is on improving the performance and sales of the entrepreneurs through offering refresher trainings. The training curriculum has improved and is now seen as more clear and compact than in 2018/2019. Introduction of an experienced community health entrepreneur in the training curriculum has turned out to be very motivating for potential entrepreneurs.
Lessons from the HIV self-testing pilot
In 2019, the HIV self-testing kit was introduced as a commodity in the product basket of the community health entrepreneurs. 548 entrepreneurs have been trained to provide self-tests. That year, market research showed that distribution of HIV self-tests via health entrepreneurs has potential, however:
- they need to be carefully trained on different aspects of pre- and post-counselling
- Post-counselling aspects should be addressed by them before selling the test
- Communication materials in the local language for post-counselling and linkage to care services should be distributed alongside the self-test
- There should be an option for clients to not perform the test together with the health entrepreneur and not to have to share the results.
Aidsfonds, WOFAK and Healthy Entrepreneurs have explored several ways to facilitate follow-up and monitoring of the HIV self-test. The health entrepreneurs are trained to give pre- and post-counselling. After every HIV self-test sale that is done, the health entrepreneurs receive some airtime to call the client for follow-up and refer if needed.
Electronic devices proven to be effective
The healthy entrepreneurs make use of an off-line tablet with information on prevention of mother to child transmission, HIV-testing and treatment, and stigma for sharing information in one-to-one situations, household and community settings. The different communication tools on the tablet such as videos in local language, interactive apps, text, images and questionnaires have proven to be a very effective way of learning and data collection.
Want to know more?
Are you interested in the Tujengane project and would you like have more information or do you want to share your ideas and thoughts? Feel free to reach out to Nienke Westerhof, senior project officer youth projects at Aidsfonds.