Recognized by WHO as a valuable workforce in any health system, CHWs improve coverage and delivery of primary and preventative health services in rural and remote areas. Hailing from their communities, CHWs offer a trusting, one-on-one relationship with their clients. There is now broad awareness that achieving UHC cannot be attained especially in resource-constrained environments without the essential services provided by CHWs who form the foundation of PHC.
In Kenya, community health services are recognized as the first entry point into the health system. There is surmountable evidence of the contribution of CHWs in improving maternal and child health indicators in recent years and their contribution to effective response during the Covid-19 pandemic. Moreover, research has shown that there is a 1:9.4 return on investment when countries invest in Community Health.
Despite the life-saving work they do, there exists a lack of accurate and updated data regarding their size and distribution. This lack of information about CHWs impedes policy development and strategic planning for elements like remuneration, supervision, equipping and monitoring and evaluation. WHO recommends that countries establish health workforce registries to track supply, training, distribution flows, demand, capacity and remuneration.
Since its inception in 2019, the CHU4UHC platform has led advocacy efforts to have a skilled, qualified, enumerated and remunerated community health workforce in Kenya. To achieve this, it is critical to have accurate and timely community health workforce information. A CHWML is a single authoritative source of data that identifies, locates, effectively describes, contacts and enumerates CHWs in a country. The demographic information contained in the registry includes age, sex, level of education, marital status, disability information, training status of the CHVs remuneration and incentives.
Process
A review of the existing community health policy and guidelines as well as a situational analysis was done to identify the gaps and guide the development of the community health registry. Different stakeholders were engaged ensuring that they all understood the importance of the registry. They collaboratively planned, mobilized resources and developed tools for data collection regarding the Data Protection Act 2019.
The findings indicated the need to review the existing gaps and enablers which informed the development and implementation. This was followed by the identification of the existing platforms to be used to host the registry.
The standardized data collected was developed, pretested, digitized and customized in the KHIS tracker which hosts the current registry. The different stakeholders involved validated the data at all levels.
Training
A cascade training approach was employed from the national to the enumerators who were the Community Health Assistants throughout the country. All 47 counties’ health management teams were trained on the use of the tool and the same cascaded to the sub-county (Sub County Community Health Focal Persons and health records officers). At the community level (Community Health Assistants) were trained by the sub-county teams to conduct the actual registration of all CHVs in the country. The training entailed navigation of the tool in the KHIS tracker and understanding the variables.
Data Collection and Analysis
Data was collected through face-to-face interviews using an electronic questionnaire appended in the KHIS tracker. The Community Health Assistants interviewed all the Community Health Volunteers (CHVs) within their Community Health Units. This information was keyed in KHIS Tracker under event capture. To access this information from the tracker one requires credentials from the Health Records Information Officer (HRIO). This is a continuous process as more CHUs are established. Data collected was cleaned and analysed using Microsoft Excel and presented in tables, maps and charts.
Scalability of the registry
A CHWML is a precursor to system strengthening. An effective CHWML is critical for strategic decision-making for community health services by the government. The availability of quality and accurate data can be used in the following ways:
- Planning community health systems strengthening programs such as eCHIS, service packages, etc.
- Identify training needs for CHWs.
- To establish a career progression mechanism for CHAs and CHPs.
Recently the government of Kenya committed to remunerating, digitising and providing kits for all 100,000 CHWs across the country using data available from the CHWML list developed. Further, the registry can serve as a tool to identify and evaluate available human resources for pandemic preparedness purposes
Sustainability
Once finalized, the Ministry of Health will be tasked with maintenance and updating of the registry yearly putting into consideration the high attrition rates for CHWs.