SICILY KARIUKI: Human touch in community health

Health CS Sicily Kariuki when she appeared before senators to discuss the matters regarding Medical Equipment Services and Universal Health Care in the country. November 27, 2018. Photo/Jack Owuor
Health CS Sicily Kariuki when she appeared before senators to discuss the matters regarding Medical Equipment Services and Universal Health Care in the country. November 27, 2018. Photo/Jack Owuor

The goals of Universal Health Coverage (UHC) are shaping the global health agenda, emphasising that all people, irrespective of socioeconomic status, should have access to health services without incurring financial hardship.

UHC is one of the President's Big Four agenda. On December 13 he launched the pilot programme in four counties—Kisumu, Nyeri, Isiolo and Machakos. The government targets to realise 100 per cent universal health coverage by 2022, a vision that will be realised by policy and administrative realignments in key health sector institutions.

The community health sub-sector has been strengthened and integrated into the health strategic planning and financed to increase access, and improve quality and affordability of services.

The importance of Community Health Services has been restated in the Kenya Health Policy Framework of 2013-2030 as well as in the Kenya Health Strategic and Investment Plan of 2013-2017. The Community Health strategy was revised in 2014 to respond to the needs of the devolved governments.

Currently the ministry is working with the county governments to develop a Community Health Policy to guide the implementation of community health services.

The main aim of Community Health Strategy is to empower individuals, households and communities to demand services from all providers and to know and progressively realise their rights to equitable, high-quality healthcare as provided for in the Constitution.

To-date Kenya has established 5,309 community health units, which is 55 per cent of total population coverage with a workforce of 97,335 personnel. There are grand plans to establish 4,261 more community health units and recruit a workforce of community health volunteers (CHVs)

Known by a wide range of titles—outreach workers, community health representatives, patient navigators, peer educators, health advocates—community health workers are trusted members of the communities in which they live, sharing common racial and ethnic backgrounds, cultures, languages, and life experiences with the people they serve.

CHVs have been called the “world’s most promising health workforce resource” in terms of enabling health systems in resource-constrained settings. Most often, community health volunteers are relied upon to deliver a range of health services directly to communities and link households with the formal health system.

In Kenya, strategic partners such as Living Goods, PharmAccess, Red Cross, Amref Kenya are collaborating with the government to initiate programmes to help CHVs play a significant role in health are delivery and thus a key stakeholder in attainment of UHC. The national and county government’s plan is to empower them with a stipend and a CHV kit that contains basic medical equipment, stationery for data collection, and basic preventive and curative drugs.

Since the implementation of Community Health Services began in 2008, there has been an improvement in immunisation, antenatal care and reduction of childhood diseases. Cases of non-communicable diseases such as diabetes and hypertension have reduced as a result of intensive screenings and awareness creation.

CHVs have played a critical role in the following three areas: Securing access to healthcare; coordinating timely access to primary care, behavioural health, and preventive services; and helping individuals manage chronic conditions. These may include case identification and recruitment, health education, human service referrals, home visits, client case management that includes follow-up, counselling and other services.

Expanding coverage of key interventions and achieving documented reductions in maternal, neonatal, and child mortality will require approaches that engage the community as partners, empower women and communities, and reach a high proportion of households with health education that encourages healthy behaviours and appropriate use of improved health facilities such as the managed equipment services in counties, free maternity services, and Beyond Zero mobile clinics, among others.

They have the potential to provide health information, encourage healthy practices, and be an accessible point of entry into the national health system for rural and low-income populations. Mobile applications provide an opportunity to address monitoring and supervision challenges by strengthening CHV programs and making them more efficient.

In the words of Daniel Taylor "a community, a family, is a group of people who share common stories. The health of any community depends directly on the health of the stories the community embraces." It’s the community-partnership approach that helped to reduce Ebola spread in targeted West African communities. The success of preventing Ebola spread in Liberia is attributed to community led engagement to identify, isolate and treat cases.

In Malawi, many improvements in the survival chances of children can be attributed in part to the health promotion work of more than 10,000 health surveillance assistants who are deployed in rural areas. These trained, salaried outreach workers deliver preventive healthcare such as oral immunisations, treat common killers like diarrhoea, pneumonia and malaria, and care for mothers and babies before and after birth.

To achieve UHC and the health SDG targets, long-term community health planning is essential—and along with helping counties identify solutions to meet health goals, it provides an opportunity to evaluate progress and make improvements.