Adolescent Chamas: Groups Contributing to Improved Outcomes
Chamas for Change is a community-based peer support model employing group microfinance and education programs to improve maternal and women’s healthThe program addresses the inequities that drive maternal and infant mortality in Kenya.
The program’s original focus was on pregnant and parenting mothers. It has expanded it’s offering to parenting adolescents and male partners.
Chama beneficiary Rose talks about how her group has helped her.
Central to this approach is the holistic integration of health, social support, positive parenting, and financial literacy (table banking) to improve health outcomes in a 3-year mentored program. ”Chamas” is the Swahili word for group. Therefore, Chamas for Change translates to “Groups for Change.” The Chamas for Change model is low-cost, community-run, independently sustainable, and culturally acceptable.
Chamas combines best practices from women’s health and microfinance programs to create an integrated service delivery platform that is low-cost, community-run, independently sustainable, and culturally acceptable. This intervention empowers the community and facilitates processes of accountability using Community Health Promoter (CHP)-led women’s Chamas during pregnancy and early childhood. Central to this approach is the holistic integration of health, social, and financial literacy to improve health outcomes in a three-year mentored program.
Year 1 of the program focuses on prenatal and early postpartum health. In years 2 and 3, the program focuses on child health specific topics; long-term methods of family planning; and parenting skills to foster positive relationships with children, reduce harsh punishment and alleviate parental stress. Throughout all three years, women engage in a microfinance component that enables them to sustainably finance health practices, enroll in national health insurance coverage, or meet other family needs. Groups are typically comprised of 10-20 women and led by two county government supported CHPs. Individual sessions are typically 60-90 minutes long and utilize a structured curriculum on health and social topics.
From our evaluations, Chama women are significantly more likely to have positive impacts on key health outcomes. Other than the direct health benefits, Chama women have more support, hold each other accountable and provide solutions amongst themselves and the community at large. Chama women feel more empowered. Currently, there are more than 450 groups with approximately 5,000 women participating across five counties. More than 16,000 members have graduated from the program in the last seven years.
As part of these successes, the Chamas program expanded to have male groups as part of partner support pre- and post-delivery.
Sheilah Onzere is a member of the Community Advisory Board.
The AMPATH team also scaled this up to meet the needs of pregnant and parenting adolescents, 14-19 years. The team noted that this group faced a host of complex and intersecting challenges as most of them dropped off of “adult” Chamas. Using a human-centered design approach, AMPATH adapted the delivery and content of the Chamas program to specifically address the health and social needs of pregnant and parenting adolescents using a community-based health intervention called “Warembo Shujaa”. Pregnant adolescents who are part of the program meet weekly and pledge to attend all the recommended antenatal care visits, deliver in a health facility with a skilled birth attendant, attend postnatal clinics, exclusively breastfeed their children and ensure they get all the childhood immunizations. Additionally, they pledge to enroll back in school.
From the above pilot, AMPATH provided supportive evidence to recommend adoption of this low-cost intervention in local and national strategic health plans to broadly alleviate unmet adolescent needs across Kenya and in similar contexts. The adapted Adolescent Chamas program demonstrated significant uptake and positive maternal, newborn and child health (MNCH) outcomes, psychosocial outcomes and fostered a strong, community-based network among pregnant and parenting adolescents to whom the program was acceptable, appropriate, and feasible.
Hear Sheilah’s story
Sheilah Onzere, a resident of Trans Nzoia County, is one of more than 350 beneficiaries of the Chamas, Warembo Shujaa program. Her strength lies in her resilience in going against all the odds related to the stigma of being pregnant as an adolescent. Sheilah achieved positive maternal, newborn and child health outcomes and was able to re-enroll back to school without compromising exclusive breastfeeding for her baby. So far, she successfully completed her secondary education and looks forward to enrolling in tertiary (post-secondary) education. Currently, she serves as a member of the Community Advisory Board of an ongoing study in TransNzoia titled “Chamas for Change: A gender-responsive and microfinance-based approach to empowering women and building resilience to health emergencies in Kenya.” The study aims to inform how gender and social inequities can be reduced to mitigate the effects of the COVID-19 pandemic and future health emergencies on women's and children’s health and economic well-being. Sheilah represents the community’s voice as an adolescent with the AMPATH Chamas for Change experience and actively advocates for the reduction of teenage pregnancies among her peers in Trans Nzoia County.