Beyond the Paid, Digitized, and Kitted Community Health Promoters: The Journey of Sustainability and Improved Population Health Outcomes Begin

In 2006, Kenya embarked on a transformative journey in healthcare with the launch of the Community Health Strategy. What began as a vision to improve access to essential healthcare services and empower local communities has since evolved into a remarkable story of progress and innovation in community health services.

At the heart of this journey are the dedicated Community Health Workers (CHWs), whose tireless efforts have brought healthcare closer to communities, particularly in rural and underserved areas. These unsung heroes provided basic medical care, health education, maternal and child health services, and vital disease prevention measures, leading to tangible improvements in health outcomes across the nation.

As technology advanced, Kenya embraced digital solutions such as mobile health (mHealth) applications, revolutionizing the delivery of community health programs. CHWs leveraged these tools to collect health data, provide teleconsultations, and disseminate critical health education materials, ensuring that even the most remote communities had access to quality healthcare services. However, these tools were many, collecting different sets of information and also majorly run by partners.

The journey towards universal healthcare was further propelled by strategic partnerships and collaborations with non-profits, international agencies, and the private sector. These partnerships brought in additional resources, expertise, and innovative approaches, strengthening Kenya’s community health services and fostering a culture of collaboration and shared responsibility in healthcare delivery. One such collaboration is the CHU4UHC platform which has grown leaps and bounds since it was formed in 2020.

Fast forward to the present day, and Kenya’s progress in community health services continues to inspire. Ongoing efforts focus on expanding access to essential healthcare services, enhancing the quality of care, integrating cutting-edge technologies, and empowering communities to actively participate in healthcare decision-making processes.

The story of Kenya’s journey towards universal healthcare is not just one of milestones and achievements but also a testament to the resilience, dedication, and collective spirit of healthcare workers, policymakers, partners, and communities working together to build a healthier and more equitable society for all.

Beyond the Professionalized Community Health Promoters

The CHPs have been equipped, salaried, and digitized- but is that all? No! There is still a lot of work to be done to ensure the full potential of community health services is achieved. We have to support some potential bottlenecks to the delivery of population health outcomes, functionality, and sustainability of community health in Kenya:

• Upskilling of Community Health Promoters: With attrition that has come with our community health workers over the year due to irregular or no stipend payment, some of the capacity-built CHPs have already left the service. The new community health promoters need to be trained and mentored to deliver quality services. Moreover, with the kitting and expansion of the scope of service, competency-based training should be sustained for population health outcomes. One last thing is to ensure the young CHPs also get a career path through a well-thought-out career progression policy co-created with the Ministry of Education, Ministry of Labor, Ministry of Health, Partners and Community Health Promoters themselves.
• Supervision and mentorship: Kenya still has a gap in the number of Community Health Officers who supervise, train, and mentor the CHPs. CHPs have to be routinely mentored, trained, and supervised. This necessitates the availing of enough competent supervisors for community health services.
• Quality of Community Health Services: The provision of quality community health services can not be over-emphasized. Even though CHPs only offer screening, first aid, preventive, and promotive services, their services need to be of high quality. The education materials have to be standardized and screening/ first aid services quality assured.
• Linkage to primary health care systems: Community Health Services does not operate in isolation. This means a proper and effective linkage between community and PHC facilities has to be created and supported by all. Furthermore, community health services support PHC services by task-shifting services reducing the patient numbers in the PHC facilities. Noteworthy, is the contribution of Community Health Services in social accountability for primary health services.

Conclusion

With support from the Johnson & Johnson Foundation, The ELMA Foundation, and together with the government, and other stakeholders, we are proud to have led the way in this important work to eliminate barriers that stifle CHWs’ ability to deliver care and that undermine health systems.