Focus on Community Health Systems, a promising beginning.

By Thomas Onyango – Country Director Living Goods – Kenya

Community Health Workers (CHWs) serve as the key drivers of primary healthcare, which studies have identified as critical pillars to attaining Universal Health Coverage (UHC). They extend primary health care to the last mile supporting every mother to give birth safely and working to ensure no child dies from easily preventable diseases.

A randomized control trial conducted in Uganda in 2017 showed that well-supported CHWs can reduce child mortality by approximately 27 percent. Regrettably, for years, there has been little or no focus and investment in CHWs even as their services proved essential and impactful to the people who know their worth – the community.

A recent survey by the Africa Centre for Disease Control and Prevention (Africa CDC) revealed significant disparities in the financing and sustainability of National Community Health Programs. Among the 42 member states surveyed, only 21 percent had an investment plan for CHWs, and a mere 26 percent had allocated a budget for stipend payments. Furthermore, an alarming 71 percent of the countries still relied on paper-based data collection systems.

A year ago, during his inaugural Madaraka Day speech, the President pledged to collaborate with county governments to integrate CHWs into the mainstream and establish them as the cornerstone of Kenya’s healthcare system.

The goal is to equip 100,000 CHWs and their supervisors with smart phones, provide essential resources such as training and medical supplies through an expanded kit. The CHWs will also receive enhanced compensation with county governments contributing Kshs. 2,500 monthly while the national government contributing a similar amount.

Community health promoters (CHPs) at the recent flag-off of the kits and stipend for the Community Health Promoter Program.

It is exciting to see all stakeholders acknowledge that to drive and deliver high impact community health programs, CHWs must be digitally empowered, equipped, supervised, and compensated. This trajectory is aligned with the community health guidelines set forth by the World Health Organization, affirming that we’re moving in the right direction.

While this vision is commendable, there is still more work to be done to bridge the gap between the tremendous potential of CHWs to enhance and save lives and the persistent challenges they encounter.

The accelerated momentum by the Ministry of Health, in collaboration with county governments and health partners to digitize all CHWs is admirable. Following the successful pilot of the digitization exercise in Kisumu County where approximately 3,000 CHWs and 119 community health assistants are actively using digital tools to deliver health services, the national government is working towards a countrywide rollout with an official launch during the Mashujaa Day celebrations.

This is indeed a bold move for Kenya as digitization can significantly enhance the quality of care for millions of individuals – especially those most vulnerable like women and children – residing in hard-to-reach communities. It has the potential to increase operational efficiency, support decision making processes and enhance management effectiveness. This journey is hinged upon critical foundational elements for digitization including a comprehensive analysis of the digital landscape, strategy development and costing as well as the implementation plans. Kenya therefore joins her counterparts in Ethiopia, Tanzania and Uganda who have jumped onto this opportunity that will accelerate access to quality, equitable and affordable healthcare.

A lot of good progress has been realized so far. The work does come with some challenges including connectivity issues, platform readiness, system functionality and upgrades. The Ministry of Health and partners can tap into the lessons learnt from the pilot to inform sustainable scale.

As a country, we must maintain the current momentum. Nevertheless, a lot of work is required from all actors in the ecosystem to progressively improve and bring this dream to reality. When National and County Governments recently reflected on the 10 years of devolution, they agreed to strengthen collaboration between public and non-state actors in health for resource optimization and improved service delivery. This is the right time to invest strongly at the community level. We cannot get anywhere without a strong primary health care system starting at the community level. It is time to rewrite history.

This article was first published in The Star Newspaper on September 18th, 2023. On September 25th, 2023, Kenya’s President William Ruto, backed by the County Governments, flagged off 100,000 community health promoter (CHP) kits to all the 47 Counties and launched the revamped Community Health Promoter Program. 

For more: A Paradigm Shift in the Community Health Ecosystem in Kenya | Living Goods

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