After working with doctors and patients in Kenya for more than a decade, Debra Litzelman, MD, has learned a lot about how to provide health services to rural and resource-strapped populations.
Now she is applying that knowledge to help reduce risk factors for infant mortality in Indiana—ranked among the 10 worst states for infant mortality in the country, according to data from the United States Centers for Disease Control and Prevention.
Dr. Litzelman, D. Craig Brater Professor of Global Health Education at Indiana University Center for Global Health and associate director of the IU Center for Health Services and Outcomes Research, has worked to build medical education and workforce development programs in Kenya as part of AMPATH, an IU-led, international consortium of academic health centers that fosters a comprehensive approach to improving the health of Kenyan people.
“My work in Kenya was pivotal in seeing the effectiveness of community health workers doing door-to-door screening,” Dr. Litzelman said. “Find, link, treat, retain– that is the AMPATH model for caring for HIV patients in sub-Saharan Africa. I’ve seen that in action, so I thought, ‘why couldn’t we do that here?’”
In 2015, Dr. Litzelman and her team were awarded a two-year, $500,000 IU Health Values Grand Challenge grant—funded in partnership with the Indiana CTSI—to make that idea a reality.
Dr. Litzelman said the project, titled WeCare Indiana, began in January 2016 at two federally qualified health centers in Marion and Delaware counties, where they have implemented the community health worker concept she had admired in Kenya.
The community health workers, who have no prior medical background, are trained by WeCare Indiana to connect new mothers and mothers-to-be with local health resources to reduce infant mortality risk factors, including obesity, smoking, mental health issues, substance abuse, lack of breastfeeding and unsafe sleeping environments for babies. They are given laptops, iPhones and educational handouts to help them build relationships with community members and enroll them in the program, Dr. Litzelman said.
The program also uses targeted text-messaging campaigns to share information, such as how to breastfeed, smoking cessation tips, and when local food banks are open, to share with patients who screen positive for certain risk factors.
Now in its second year, WeCare Indiana recently received an additional $2.1 million grant from the Indiana State Department of Health to ramp up their efforts in Marion County, where Dr. Litzelman, who is also a research scientist at Regenstrief Institute, and her colleagues have partnered with local firefighters, Emergency Medical Service personnel and police officers to reach more patients. The Direct On-Scene Education (DOSE) program trains these first-responders to look for signs in local homes that babies are not sleeping safely, and it prepares them with knowledge and resources including cribs, sleep sacks and pacifiers that they can give to community members.
“The first-responders can find high-risk patients and help connect them with our community workers,” she said. “We think that’s really important because we don’t know how to connect with people who may never come to our health clinics or hospitals.”
While it’s too soon to show a reduction in the infant mortality rate, Dr. Litzelman said WeCare has already demonstrated improved connectivity to health resources. In its first year, the program and its three community health workers have enrolled more than 200 mothers and 25 fathers.
Dr. Litzelman said she hopes to secure more funding to expand the program in Delaware County and implement new initiatives such as a bicycle food-delivery service for those who screen positive for food insecurity.
“If we could create a whole consortium of these community health workers, this could launch a new organizational way to do this as community-based health services—moving away from the disease model of a health-based system to a community-based wellness approach to maintaining health.”