A Health worker’s experience in delivering quality health services to Key Populations in MOH facilities
A normal day in the life of Nancy Wainaina involves a lot of talking, walking, smiling and interacting with her clients. “Every day is different. Everyday means new people, different challenges and different solutions. Mine is a calling. I was called to service and I enjoy serving people, especially members of the Key Populations (KP). These populations include; Female Sex Workers (FSW) Men who have Sex with Men (MSM and People who Inject Drugs (PWID). I love and enjoy counselling so much.” These are the first words Nancy uttered to me as she settled into her seat for the interview. “Seeing a smile my clients faces, and hearing the confession of restored hope from them is what motivates me to get out of bed every morning. My days are usually unpredictable, however, on each day, I know that somehow, I will make a difference in someone’s life.”
Nancy is a HIV Testing and Counselling officer. She is also a trained psychologist based at Mbale Rural Health Training Centre in Vihiga County. With funding from Elton John’s AIDS Foundation (EJAF), Nancy was one of those selected to be trained by LVCT Health in Kisumu on delivery of KP-friendly services in 2015. Key populations are most vulnerable to contracting HIV. Stigma and discrimination are widely recognized as factors that undermine efforts to prevent the spread of HIV and pose barriers to accessing care and treatment services, particularly for these populations. As we delve deeper into the interview, Nancy mentions with a broad smile that when she is not attending to KPs, she will be found taking care of her 4 children, a job that comes naturally to her. She is determined to give her children the best even with the gap left by her husband who died 10 years ago.
At the Mbale rural health training centre, her main role is to provide HIV testing and counselling services to both the general and Key Populations. She points out that she works on week days and weekends, day or night, whenever the need arises. This is necessitated by some of her clients’ schedules and lifestyles which can be very sporadic. “My job does not allow me to work strictly 8am-5pm schedule.
“In the course of my journey as a HTS counsellor, I have made some interesting and valuable observations; for one, during moonlight activities KPs are open and free and show up to receive the services as couples whilst during the day, they shy off and come as individuals when there are very few people at the health centre.” “Moonlight’ is a creative strategy used in reaching KPs with services where service providers carry out an outreach at night to target sex workers at their hotspots and provide services to them. Another strategy is In-reaches, which is when peer educators set aside a day to mobilise their peers (female sex workers, people who inject drugs, and or men who have sex with men) to go to the facility to receive services.
“The peer educators have been very instrumental in my work. I first provided services to this key population in 2016 despite having been based at this clinic since 2010. The first group was introduced to me by Joshua Shiveka from LVCT Health (Key Populations’ Program Officer). The group had attended a health talk at the Comprehensive Care Clinic here in Mbale. From then on, they would come to the clinic in the company of peer educators which made them more settled and confident. We are now doing very well as many now come voluntarily for HIV counselling and testing every 3 months, “a joyous Nancy narrated.
Nancy however pointed out that this progress has not been without challenges. She mentioned that one of the biggest challenges is the lack of private rooms where the KPs can be served privately and fast enough in the public health facilities, citing that they are a sensitive population that’s very wary of stigma and discrimination. “The turn up at the clinic even during in-reaches is low for this reason. Even a tent would work, all we need is just a private space for this population,” she reiterates. The lack of crucial commodities like female condoms from time to time is also a persistent challenge that needs to be addressed.
“The key to success in providing services to this population lies in being non-judgmental. I encourage my clients to be free and honest with me and the only way to achieve this openness is for counsellors to be empathetic. I have created an environment of trust and openness allowing my clients to call me during odd hours if the need arises”.
As we stood up from our chairs and took a walk around the health center, I asked Nancy if she had any recommendations as to how these key population could be given better health services by all stakeholders. She firmly said as she closed her note book, “I would decriminalize KP work so that all service providers realize that we are not doing this population any favors by providing health services to them; instead it is our obligation. This would give these people confidence to seek health services which is their right as enshrined in the Kenyan constitution.”
By, Lynda Keeru.