Tujengane

Tujengane

Project

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.

Project details

Time frame
01 January 2018 - 31 December 2021
Budget
€ 609,926
Active in
Kenya

Objectives

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.

Proud health entrepreneur with his bicycle
Proud health entrepreneur with his bicycle

Community groups

Community health volunteers and their community members

Group of health volunteers
Group of trained health entrepreneurs

Background

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.

Results 2018-2021

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 295 entrepreneurs have been trained, with which the total number targeted for at the start of the project has been met.

An estimated 1,800,000 people have been reached by the entrepreneurs with health services and products in the past three years. During the same period, a total of 432,350 products were purchased by the entrepreneurs, in their turn to be sold to community members. Throughout the project they distributed 108,800 (free) male condoms.

Based on orders done by community the health entrepreneurs, we have seen an average increase of income of $4.95 per month. 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.

Training settings
Training of health entrepreneurs
Training settings
Training of health entrepreneurs

Who are the health volunteers who became entrepreneurs?

In 2021, a survey was conducted among the community health volunteers who enrolled to become health entrepreneurs under Tujengane project. Among others, striking data reveal that respondents earn, on average, almost five times less than the Kenyan minimum wage and live well below the World Bank extreme poverty line.

Two hands holding a notebook and pen
A survey was conducted among 205 health volunteers
Two hands holding a notebook and pen
A survey was conducted among 205 health volunteers

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. Unfortunately, due to the unavailability of HIV self tests, it was decided to put the self test programme on hold. We all really wish to pick it up again when possible, with affordable tests and confidential referral methods.

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.

Matabel: "I decided to give it a try"

When the effects of COVID-19 were ravaging the country, the life of community health volunteer Matabel seemed to have hit the rock bottom. An unexpected call changed everything. Four months down the line, her future plans are to enroll in college so as to get a certificate that will allow her to get a license to open a pharmacy.

Matabel with her product box
Matabel carrying her product box
Matabel with her product box
Matabel carrying her product box

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.

Partners

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