In Kisumu, community health delivers better services for children at lower cost

It’s a quiet mid-morning at Bunde Health Centre, in Kisumu, when Alice Mwajuma brings her two children David, 5, and Dahzur, 2, for a check-up.

The health centre is quiet and cool in the shade of large trees. Blue and white buildings sport graffiti art illustrating health messages, such as the six antenatal care steps for pregnant women to take.

Alice and her sons put on masks and wash their hands at a handwashing station at the entrance of the compound, before joining a short queue. The two boys have recently developed an itchy red rash on their arms, which Alice is concerned is not going away.

After just a ten-minute wait, the boys are weighed and measured by a nurse. They go with Alice into the consultation room to see a doctor. Then, they are taken to another room for a lab test, back to see the doctor for a diagnosis, and finally to the pharmacy to pick up their medication. The whole process takes less than half an hour.

“The doctor told me that David and Dahzur have a fungal infection,” Alice says afterwards. “She gave me some medicine to treat it. I like coming to the health centre because it’s close by and convenient. We were seen very quickly, and it was not expensive. It is much better than travelling to the hospital.”

Primary health care and community health are essential health care made accessible to all families at a cost that they can afford, without incurring catastrophic out of pocket health expenses.

A Ministry of Health investment case has demonstrated that for every US $1 invested in community health, Kenya will reap the equivalent of US $9.4 in economic and social benefits.

“Primary and community health services are cornerstones of universal health care,” Unicef's chief of health Yaron Wolman says. “They help prevent ill health and deliver better care for children at a lower cost, meeting up to 90 percent of a child’s health needs. That’s why Unicef is advocating for an expansion for primary health care and community health services so that all children and families can readily access basic health care at a cost they can afford.”

This is exactly what is happening in Kisumu, where the UN agency has supported the establishment of a primary care network in Nyando Sub-County. “In this area, 60 per cent of child mortality is due to three diseases: malaria, diarrhoea and pneumonia,” Nyando medical officer Dr Johnathan Billis explains.

“All can be dealt with most effectively at the primary and community level. For example, we can prevent malaria by distributing bed nets and teaching communities about their importance and proper use.”

In nearby Oketha village, Community Health Volunteer Faith Achieng pays a visit to Tabitha Achieng and her five children. Faith begins by examining Hazel, three. She checks his temperature with a thermometer and measures his upper-arm circumference to check for malnutrition. As she works, she fills out the information via an online form on her mobile phone, to send to the local health centre.

“I’ve visited this family once a month for five years,” Faith says. “The children have had malaria and diarrhoea several times. I check the hygiene situation of their toilet and make sure that they treat their water before drinking it. There are a lot of mosquitos in this area, so I also check that they have bed nets for all the children. When I visited last month, I found that Hazel had malaria. I gave his mother some medicine and he got better in a few days.”

Thanks to Kisumu County’s focus on primary and community health care, Alice and Tabitha were able to get early treatment for their children, avoiding their conditions becoming much worse and more expensive to treat. However, these services are not yet available to all families in Kenya.

“We are calling for the next government to increase budgets for primary health care and community health,” Unicef's Yaron Wolman says. “We also want them to support community health volunteers with recognition, training and financial incentives. As we have seen in Kisumu, this can substantially improve children’s health.”